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When doctors commit suicide, it’s often hushed up. Washington
Post article
An obstetrician is found dead in his bathtub; gunshot wound to the head.
An anesthesiologist dies of an overdose in a hospital closet. A family doctor
is hit by a train. An internist at a medical conference jumps from his hotel
balcony to his death. All true stories.
What are patients to do?
When they call for appointments, patients are told they can’t see their
doctor. Ever. The standard line: “We are sorry, but your doctor died suddenly.”
In most towns, news spreads fast no matter how veiled the euphemisms.
About 400 doctors commit suicide each year, according to studies, though
researchers have suggested that is probably an underestimation. Given that a
typical doctor has about 2,300
patients, under
hi
s
or her care, that means more than a million Americans will lose a physician to
suicide this year.
So what’s the proper response if your doctor died by suicide? Would you
deliver flowers to the clinic? Send a card to surviving family? What’s the
proper etiquette for dealing with this issue?
Physician suicide is rarely mentioned — even at the memorial service. We
cry and go home, and the suicides continue.
I’ve been a doctor for 20 years. At 46, I’ve never lost a patient to
suicide. But I’ve lost friends, colleagues, lovers — all male physicians. Four hundred physicians
per year are lost to suicide, according to a Medscape report,which
pointed out that “perhaps in part because of their greater knowledge of and
better access to lethal means, physicians have a far higher suicide completion
rate than the general public.”
What can we do? To start, let’s break the taboos that have kept this
topic hidden.
Physician suicide is a triple taboo. Americans fear death. And suicide.
Your doctor’s committing suicide? Even worse. The people trained to help us are
dying by their own hands. Unfortunately, nobody is accurately tracking data or
really analyzing why doctors may be depressed enough to kill themselves.
I’m a family physician born into a family of physicians. I was practically
raised in a morgue, peeking in on autopsies alongside Dad, a hospital
pathologist. I don’t fear death, and I’m comfortable discussing the issue of
suicide. In fact, I spent six weeks as a suicidal physician myself. Like many
doctors, at one point I felt trapped in an assembly-line clinic, forced to rush
through 45 patients a day, which led to my own despair and suicidal thoughts.
Then I opened my own clinic, designed by my patients. I’ve never been happier.
Despite my own trouble, I was clueless about the issue of physician
suicides until one beautiful fall day in Eugene, Ore., when a local
pediatrician shot himself in the head. He was our town’s third physician
suicide in just under a year and a half. At his memorial, people kept asking
why. Then it hit me: Two men I dated in med school are dead. Both died by
“accidental overdose.” Doctors don’t accidentally overdose. We dose drugs for a
living.
Why are so many healers harming themselves?
During a recent conference, I asked a roomful of physicians two questions:
“How many doctors have lost a colleague to suicide?” All hands shot up. “How
many have considered suicide?” Except for one woman, all hands remained up,
including mine. We take an oath to preserve life at all costs while sometimes
secretly plotting our own deaths. Why?
In a TEDx talk I
gave to help break the silence on physician suicide, I pointed out why so many
doctors and medical students are burning out: We see far too much pain; to ask
for help is considered a weakness; to visit a psychiatrist can be professional
suicide, meaning that we risk loss of license and hospital privileges, not to
mention wariness from patients if our emotional distress becomes known.
Internist Daniela Drake recently addressed this topic in her
article-gone-viral “How
being a doctor became the most miserable profession.” She identified
underfunded government mandates, bullying by employers and the endless
insurance hoops we have to jump through as a few of the reasons. “Simply put,
being a [primary-care] doctor has become a miserable and humiliating
undertaking,” she wrote. “It’s hard for anyone outside the profession to
understand just how rotten the job has become.”
In a rebuttal article, “Sorry, being a doctor is still a great
gig,” pediatrician Aaron Carroll disputed the misery claim: Doctors are well
respected, well remunerated, he writes, and they complain far more than they
should. He predicts people will soon ignore doctors’ “cries of wolf.” But to
cry wolf is to complain about something when nothing is wrong. Yet studies have
found that doctors suffer from depression,
post-traumatic stress disorder and thehighest suicide rate of any
profession.
So what should we do?
Etiquette rule No. 1: Never ignore doctors’ cries for help.
Bob Dohery, a senior vice president of the American College of
Physicians,downplayed
physician misery in a blog post on the ACP Web site this spring.
His suggestion was classic: When doctors complain, quickly shift conversations
from misery to money: their astronomical salaries. But when a doctor is
distressed, how is an income graph by specialty helpful?
I run an informal physician suicide hotline. Never once have I reminded
doctors of their salary potential while they’re crying. Think doctors are
crybabies? Read some of their
stories before dismissing doctors as well-paid whiners.
Physician suicide etiquette rule No. 2: Avoid blaming and shaming.
After losing so many colleagues in my town, I sought professional advice
from Candice Barr, the chief executive of our county’s medical society. Here is
her take:
“The usual response is to create a committee, research the issue, gather
best practices, decide to have a conference, wordsmith the title of the
conference, spend a lot of money on a site, food, honorariums, fly in experts,
and have ‘a conference.’ When nobody registers for the conference, beg, cajole
and even mandate that they attend. Some people attend and hear statistics about
how pervasive the ‘problem’ is and how physicians need to have more balance in
their lives and take better care of themselves. Everybody calls it good, goes
home, and the suicides continue. Or, the people who say they care about
physicians do something else.”
So what works?
Our Lane County Medical Society established a physician wellness programwith
free 24/7 access to psychologists skilled in physician mental health. Since
April 2012, physicians have been able to access services without fear of breach
of privacy, loss of privileges or notification of licensing and credentialing
bureaus. With 131 physician calls and no suicides in nearly two years, Barr
says, the “program is working.” Even doctors from outside the town are coming
for support.
It’s important to “do something meaningful, anything, keep people talking
about it,” Barr says. “The worst thing to do is nothing and go on to the next
patient.”
What’s most important is for depressed doctors and those thinking about
suicide to know they are not alone. Doctors need permission to cry, to open up,
to be emotional. There is a way out of the pain. And it’s not death.
Which brings me to physician suicide etiquette rule No. 3: Compassion
and empathy work wonders. More than once, a doctor has disclosed that a kind
gesture by a patient has made life worth living again. So give your doctor a
card, a flower, a hug. The life you save may one day save you.
Wible is an author and board-certified family physician in Eugene, Ore.
