TRIGGER WARNING. This blog post talks about physician suicide and a physician suicide register (database). This may be triggering for some people. If you are at risk of self-harm, please note that Physicians Anonymous is not an emergency service. Please call 911 or your local emergency service.
Nearly 300 doctors a year die by suicide. That’s a million patients losing their doctors every year. Beyond the horrific numbers are the human stories.
In this article, we reference a number of writings remembering the human beings — physicians, bright, dedicated, loved and loving, yet still human — who died by suicide. Specifically, we seek to learn from the work of others including those who have built records of our lost colleagues so that we never forget them, and start to do things differently for physician mental health.
Dr Pamela Wible MD, for too long a lone voice in the wilderness talking about physician suicide, has painstakingly built a registry of every physician suicide. Dr Wible, a family physician and incredible person, is a leader in the field of physician wellbeing.
Her lessons were described in a hard-hitting op ed in the Washington Post. Here are the highlights:
Dr Wible’s conclusions:
“Healers, after all, also need healing.”
As a doctor who has lost a family member, two physician friends, and too many patients to suicide, this is difficult to write about. Even more so because I have been there myself – suicidal ideation with intent after my rock bottom – but thank God, I didn’t go through with it because of my love for my kids.
There is so much to say on the topic, but let me be brief. I don’t believe that suicide is driven by a desire to die. I conclude that suicide is seen as the only option to relieve the emotional pain. If I had my chance over again to those who have died, I would try and tell them that things will get better, that this too shall pass, that there are other pathways through. But within the distorted thinking of mental illness, sometimes ending it all seems like the only ‘sensible’ option.
Doctors who die by suicide often have untreated or undertreated depression or other mental illnesses, a fact that underscores the need for easy access to fear-free early diagnosis and treatment. According to physician suicide researcher Dr Deepika Tanwar, MD, of the psychiatric program at Harlem Hospital Center in New York, “It’s very surprising that the suicide rate among physicians is higher than among those in the military, which is considered a very stressful occupation”.
According to Dr Beth Brodsky PhD, the occupational stress starts in medical school and continues in residency with the high demands, competitiveness, long hours, and lack of sleep. This may contribute to substance abuse, another risk factor for suicide. This high stress is exacerbated by dwindling healthcare resources and residency positions. When medical students graduate and enter the profession, they face different but equally challenging stressors. As more women enter the medical profession, they are becoming increasingly vulnerable to the fallout from work stressors. As a result, their rate of suicide is also increasing, Brodsky says.
Brodsky is among the experts advocating for better ways of addressing these problems, which may start with simple changes. People do not “commit” suicide but “die by suicide,” she says. She notes that suicide is an “illness and not a crime.”
Openly discussing suicide as an illness helps to “bring it out of the darkness” and shed the stigma shadowing this awful issue.
Hence the need for all of us to speak out and write about physician suicide.
The main barriers to getting help? Fear and stigma, according to the research – and my experience of working with physicians.
Physicians are expected — by the public and themselves — to be immune to stress and mental health challenges, despite being human and subject to abnormal and sustained occupational stress. Like other humans, we can experience mental illness just as we can experience physical illness.
For physicians, there is a notable stigma associated with seeking help for mental health and admitting we’re not okay. We are trained to be tough, resilient, superhuman, make no mistakes. We also have a tendency to be high achievers and perfectionists.
And then there is the ingrained culture of quiet stoicism, handed down over the medical generations. Our professors, attendings, and mentors may set the standard of, ‘you’re tough, you don’t cry, you don’t break down, you don’t ask for help, you just do it,’. This culture makes it crucial for healthcare leaders to focus on physician suicide awareness and address mental health openly and with compassion.
To work around the fear barrier that stops so many physicians from seeking help, we have developed a safe space for physicians to get together and share with other doctors in confidence. Where we will not be judged by our sisters and brothers, but listened to with empathy and understanding. We have all been there.
Call this place of sanctuary Corrigan’s Secret Door, if you will.
If you would like to find out more, feel free to access our physician-only forums or completely anonymous peer-support groups.
Doctors supporting doctors is our way.
If you think that a friend or loved one might be suicidal, you need to take action. Call 911 or your local emergency services.
The AMA have a Physician Suicide Prevention resource available here.