This marks my 90th post, momentous for me when I reflect on all that I have learned with each post. Throughout this time, I have become more acquainted with my passion and purpose that drives me to continue creating and writing. Physician health and wellness is one of my passions, and in turn, one of my purposes is to reach out to my colleagues to improve their well-being and find meaning in their work and life. Recently, I have come across a few shocking truths about physician suicide – a topic that has been relatively in the dark.
The truth about physician suicide:
In an article titled “Recent Suicides Highlight Need to Address Depression in Medical Students and Residents” published this month in the Journal of the American Medical Association, the statistics on physician suicide are staggering. Each year in the United States, 300-400 physicians commit suicide – the rate in male and female physicians is 40% and 130% higher than men and women in general, respectively. This article was prompted after 2 residents in New York City jumped to their deaths from buildings in late August.
Pamela Wible is an innovative Family Physician in Oregan and a true advocate for physician suicide prevention. In a recent talk “Physician Suicide 101: Secrets, Lies & Solutions” that she presented at the American Academy of Family Physicians Scientific Assembly in Washington, DC, and to third-year medical students, she candidly discussed the significant impact physician suicide has had in her life. The 2 men she dated in medical school, and 3 physicians in her town in one year, all took their own lives. In a profound statement she says: “Physician suicide is medicine’s darkest secret and our code of silence is maintained by layers of lies.”
I remember a few years after finishing medical school feeling shocked after hearing one of our energetic, enthusiastic orientation leaders in first year medical school had committed suicide. Another male physician I didn’t personally know in a city I worked in, was suspected of committing suicide after hitting a tree at high speed in the midst of public allegations that he was having an affair with a patient. Again another male physician, elderly, that worked with my husband, was found in his home after hanging himself. Given the shame that is often associated with completed suicide and uncertainty that may surround it, it is easily conceivable that it is much more prevalent in medical professionals than we realize.
Why are physicians at higher risk?
Some of the reasons cited for an increased rate of suicide in physicians include:
- not recognizing mental illness in themselves, nor seeking help because of the stigma surrounding mental illness
- increased expectations from student to resident and practicing physician
- higher levels of burnout which is independently associated with suicidal ideation
- higher rate of completed suicide, knowing lethal methods (as opposed to an increased rate of depression)
What can be done?
As with most things in both medicine and in life, prevention is the key. The following are thoughts and strategies to consider:
- Timothy Brigham at the Accreditation Council for Graduate Medical Education plans to propose a consensus conference in 2015 to discuss suicide prevention in trainees.
- The Healer Education Assessment and Referral (HEAR) program at the University of California – San Diego School of Medicine involves presentations to physicians and trainees to decrease stigma of depression and its treatment and also encourage reaching out to colleagues.
- Balint Groups consist of between 6 and 10 members with 1 or 2 trained leaders. Pamela Wible endorses belonging to these groups. They focus on doctor-patient relationships with peers, improve empathy and improve resilience (both personal and professional). In a commentary by Dr. Michael Roberts that appeared in the Canadian Family Physician, he states “the goal is to improve physicians’ abilities to actively process and deliver relationship-centered care through a deeper understanding of how they are touched by the emotional content of caring for certain patients.”
- Build physician resilience through various elements such as balancing work and family life, prioritization, organization, maintaining perspective and setting boundaries. I am only scratching the surface – this is a huge topic unto itself.
Were you aware of the prevalence of physician suicide?