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Why aren’t we talking more about physician suicides?

Why aren’t we talking more about physician suicides?

Picture of Monya De
Photo: Joe Raedle/Getty Images

I had just finished telling a physician colleague that I was volunteering on the team of a documentary about physician suicide. I told her that at least 400 U.S. doctors die every year in this way, that many of them are shockingly young, and the epidemic knows no international boundaries.

“Well, maybe there just needs to be some kind of screening,” she said brightly, referring to identifying potentially suicidal people before they even enter medical school.

And that’s exactly the problem. Her words might hold water, were the rate of suicides among doctors not higher than in the population as a whole. That’s what research from several countries has told us — essentially, that the same person is less likely to die by suicide if he becomes an accountant instead of a doctor.

Think about that: A medical career is a risk factor for suicide.

Try screening someone now for potential suicidal behavior seven years from now — after medical school, internship, and residency. It is impossible. Premedical students are on top of the world. They have aced the MCAT. They have done all the right research and taken all the right courses. They are going to be doctors, and their brains are filled with happy chemicals.

Fast-forward to medical school, and four years of endless humiliations in front of one’s peers, of slaving away trying to impress the right people, then facing the prospect of not getting into one’s intended specialty or severe doubt about medicine as a profession — all through the haze of constantly studying instead of sleeping after an 18-hour workday. There is nowhere to turn. 

There is no way to know the exact thoughts going through medical student Kathryn Stascavage’s head before she jumped out of her Manhattan dorm-room window. Horrifyingly, the dean of students at Mount Sinai School of Medicine, where Stascavage was a student, said, “Immediately, the students could relate to it.” There is something very wrong with schooling that causes students to say, “Suicide, well, yeah, I get it, totally.”

A staggering number of students and physicians report feelings of depression, suicidal ideation (thinking about suicide), and drug or alcohol abuse. It is the system, not the students.

The pressure never relents. If one makes it through medical school, residency offers new ways to stretch a young doctor’s body and mind to the point of breaking. Suddenly, there loom  angry family members, violent patients, and “code blues” in the middle of the night that require calm, decisive thinking. Praise is rare; the doctor can never be fast enough, smart enough, or humble enough. As Dr. Danielle Ofri points out in Slate, “You must document extensively but not keep patients waiting.”

Thanks to low federal government allotments of money for new residents and an outdated tradition, hospitals keep residents awake and working for 80 hours a week or more instead of allowing for human-compatible sleep schedules. That doesn’t include time spent commuting or studying for interim exams or board exams. Depression and anxiety set in, and the residents are liable to hear from their friends, “If you ask for help, it goes on your permanent record and no one will hire you.” Either the young doctor suffers in silence, or far worse, ends it all.

The American Medical Association has recommended that medical schools offer independent counseling for medical students and residents and time off for maintaining one’s health. That time off is important. Too many say, “When would I see a therapist? I’m on call again today.” The full resources of medicine and health care should be at the disposal of medical trainees, not held above their heads like a faraway carrot on a stick. Instead, the message med students hear: “Take perfect care of your patients — but don’t you dare take time off for your own care.”

The fallout goes beyond physician burnout and suffering. This is a public health emergency .We already know resident doctors make more errors when they are exhausted and depressed — errors that can cost patient lives.

While practicing physicians have the choice to stay or leave their jobs, too many of those jobs are made unbearable by administrative hassles, alienating medical record systems, and the daily pressure to see patients as fast as possible. The too-common refrain is: “I hate my job.” Job-related stress and frustrations further elevate the risk of suicide among doctors, according to research studies on the topic.

For things to truly change, training programs and schools will need to heed the AMA’s recommendations and undergo a cultural revolution. We need to do away with the abusive personalities that beat the life and spirit out of future doctors and cultivate those doctors that lead by example, not bullying.

Hospitals will need to take cues from the airline industry, where putting rested people at the controls is a priority and automation helps reduce the amount of cognitive fatigue. Health systems that employ doctors need to go beyond lunchtime talks on burnout and actually look at what they could do to reduce the burdens on the doctors that lead them to feelings of powerlessness and depression.  

Physicians have been asking for this for a long time, and those that have not been heard are either quitting or dying. It’s about time that patients and providers demand that hospital administrators make doctoring a noble and desirable profession again — and certainly not a death sentence.

[Photo: Joe Raedle/Getty Images]

Comments

Picture of <span class="username">Guest (not verified)</span>

Several additional factors should be considered in any study of physician suicide.

First, it is important to be put in context. Is it higher than known suicides rates and ratios within the general population? Documented cases of suicide in the United States now runs approximately 50,000 per year. That does not include other unknown methods, such as those classified as "auto accidents," "suicide by cop" and other means of death.

Secondly, its prevalence is important when compared to that of other healthcare professionals. Dentists are reportedly higher, even without many of the factors cited by Ms. De (above).

Thirdly, method, means and opportunity are important considerations. Physicians and other healthcare professionals have regular, legal, access to drugs. So do pharmacists, veterinarians, dentists and nurses. Are physician suicides by drugs higher than those of other healthcare professionals?

Finally, it is important to consider the impact of expanding, legal,, access to elective medical aid in dying. Society's understanding of "suicide" may be changing, as legal access to medical aid in dying is expanding, both domestically and internationally.

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