Why am I passionate about changing the culture of medicine?
Because approximately 1 physician commits suicide a day in the US. ONE PHYSICIAN A DAY. That's between 300-400 per year, leaving their friends, their families, their patients grieving the loss.
Physicians are more likely to successfully commit suicide compared to the general public. Medical trainees are more likely to suffer from depression and have thoughts of death. In a 2013 study by Gold et al (see reference below) regarding physician suicide, it was noted that "job problems" contribute more to physician suicide than the death of friends or family.
As a physician, we dedicate our lives to caring for others, yet we still must try and care for ourselves. We cannot speak freely about our days at work due to privacy laws, cannot unload the burdens of the patient who died, the one struggling with chronic medical problems and bills that cannot be paid or the difficult conversations that can strain us. Many physicians, particularly female physicians, carry extra burdens related to managing family life also placing them at increased risk. From training to practice, depression, thoughts of suicide, fatigue, stress and burnout drive the increased rate of suicide. I will not even get into the issues surrounding paperwork, the electronic medical record, lack of control in the workplace and current uncertainty of how our patients will get healthcare in the coming years.
And when a physician commits suicide? When was the last time you heard it reported widely? Almost never. It remains taboo. It is not bravely and publicly addressed with an outcry of anger for yet another catastrophic loss. It is often kept quiet - there is stigma surrounding suicide, no matter who you are.
That stigma is one of the reasons physicians do not seek care. Perhaps some will self-medicate with alcohol. Some will not even recognize the signs or symptoms until it is too late. Others, historically, seeking mental health services formally has resulted in the potential risk of losing a medical license. A physician in the US will spend over 10 years after high school in training before being able to practice. Debt incurred can be profound(my monthly student loan payments have rivaled my rent/mortgage payments) and unable to be paid if attempts to change career paths are undertaken. Pursing medical training, however, places you at increased risk of depression and suicide, yet if you ask for help, there is a threat of losing you career.
This is unacceptable. Anonymous and employee services are available at many institutions now, but are they enough? Can we counsel our way out of a professional landscape that drives such a multifaceted and profound burden on physicians, and ultimately, on our patients?
Even more unsettling, some physicians believe that as doctors we should be able to avoid becoming depressed/burned out/over-stressed. Depression and mental illness are not weaknesses, they are medical conditions. Should we tell our patients to avoid developing cancer? That could also take their life. Of course not. We work to prevent disease and treat it should a disease arise. With the profession of medicine, we must do both. Strive for prevention and whole-heartedly support treatment.
For the sake of ourselves, for our patients, we must navigate the current difficult arena that is medicine. We must support each other and strive to change the culture of a career that drives such devastating rates of suicide. This starts with each of us. Managing ourselves, our careers, our health and then helping lead our colleagues, our institutions, our profession to a better place.
Yes, I want to change the culture. Why? Because I want physicians to love medicine again. But even more important, I want wake up tomorrow and know that I did not let another day pass as an observer while my colleagues die.
- Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry. 2013 Feb 28;35(1):45-9.
- Hampton T. Experts address risk of physician suicide. JAMA. 2005 Sep 14;294(10):1189-91.
- Khan R, Lin JS, Mata DA. Addressing depression and suicide among physician trainees. JAMA psychiatry. 2015 Aug 1;72(8):848-.
- Wible P. When doctors commit suicide, it’s often hushed up. Washington Post. 2014.
- Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA psychiatry. 2015 May 1;72(5):411-2.
- Eva Schernhammer MD D. Taking their own lives-the high rate of physician suicide. The New England journal of medicine. 2005 Jun 16;352(24):2473.