What I’ve learned from 547 doctor suicides

Doctor-Suicide-Altar-Heart

Five years ago today I was at a memorial. Another suicide. Our third doctor in 18 months.

Everyone kept whispering, “Why?”

I was determined to find out.

So I started counting dead doctors. I left the service with a list of 10. Now I have 547.

Immediately, I began writing and speaking about suicide. So many distressed doctors (and med students) wrote and phoned me. Soon I was running a de facto international suicide hotline from my home. To date, I’ve spoken to thousands of suicidal doctors; published a book of their suicide letters (free audiobook); attended more funerals; interviewed surviving physicians, families, and friends. I’ve spent nearly every waking moment over the past five years on a personal quest for the truth of “Why.” Here are 34 things I’ve discovered:

Doctor Suicide Altar2

High doctor suicide rates have been reported since 1858. Yet more than 150 years later the root causes of these suicides remain unaddressed.

Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.

Most doctors have lost a colleague to suicide. Some have lost up to eight during their career—with no opportunity to grieve.

We lose way more men than women. For every woman who dies by suicide in medicine, we lose seven men.

Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India doctors are found hanging from ceiling fans.

Male anesthesiologists are at highest risk. Most die by overdose. Many are found dead in hospital call rooms.

Lots of doctors die in hospitals. Doctors jump from hospital windows or rooftops. They shoot or stab themselves in hospital parking lots. They’re found hanging in hospital chapels. Physicians often choose to die where they’ve been wounded.

“Happy” doctors die by suicide. Many doctors who die by suicide are the happiest most well-adjusted people on the outside. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head. Doctors are masters of disguise. Even fun-loving happy docs who crack jokes and make patients smile all day may be suffering in silence. We are all at risk.

Doctors’ family members are at high risk of suicide. By the same method. Cardiothoracic surgeon Thomas Gahagan died by hanging himself leaving behind seven children ages three to fifteen. Two died by hanging themselves as adults. Another physician died using the same gun his son used to kill himself. Kaitlyn Elkins, a star third-year medical student, chose suicide by helium inhalation. One year later her mother Rhonda died by the same method. At Rhonda’s funeral, I asked her husband if he thought his wife and daughter would still be alive had Kaitlyn not pursued medicine. He replied, “Yes. Medical school has killed half my family.”

Doctors have personal problems—like everyone else. We get divorced, have custody battles, infidelity, disabled children, deaths in our families. Working 100+ hours per week immersed in our patients’ pain, we’ve got no time to deal with our own pain. (Spending so much time at work actually leads to divorce and completely dysfunctional personal lives).

Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment.

Malpractice suits kill doctors. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court on TV, and in newspapers (that live online forever). We continue to suffer the agony of harming someone else—unintentionally—for the rest of our lives.

Doctors who do illegal things kill themselves. Medicare fraud, sex with a patient, DUIs may lead to loss of medical license, prison time, and suicide.

Academic distress kills medical students’ dreams. Failing boards exams and being unmatched into a specialty of choice has led to suicides.

Doctors without residencies may die by suicide. Dr. Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out the flawed system that undermined his career prior to his suicide.

Assembly-line medicine kills doctors. Brilliant, compassionate people can’t care for complex patients in 10-minute slots. When punished or fired for “inefficiency” or “low productivity” doctors may choose suicide. Pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients. Many doctors cite inhumane working conditions in their suicide notes.

Bullying, hazing, and sleep deprivation increase suicide risk. Medical training is rampant with human rights violations illegal in all other industries.

Sleep deprivation is a (deadly) torture technique. Physicians have suffered hallucinations, life-threatening seizures, depression, and suicide solely related to sleep deprivation. Resident physicians are now “capped” at 28-hour shifts and 80-hour weeks. If they “violate” work hours (by caring for patients) they are forced to lie on their time cards or be written up as “inefficient” and sent to a psychiatrist for stimulant medications. Some doctors kill themselves for fear of harming a patient from extreme sleep deprivation.

Blaming doctors increases suicides. Words like “burnout” and “resilience” are often employed by medical institutions as psychological warfare to blame and shame doctors while deflecting attention from inhumane working conditions. When doctors are punished for occupationally induced mental health conditions (while underlying human rights violations are not addressed), they become even more hopeless and desperate.

Sweet, sensitive souls are at highest risk. Some of the most caring, compassionate, and intelligent doctors choose suicide rather than continuing to work in such callous, uncaring and ruthlessly greedy medical corporations.

Doctors can’t get confidential mental health care. So they drive out of town, pay cash, and use fake names to hide from state medical boards, hospitals, and insurance plans that ask doctors about their mental health care and may then exclude them from state licensure, hospital privileges, and health plan participation. (Even if confidential care were available, physicians have little time to access care when working 80-100+ hours per week).

Doctors have trouble caring for doctors. Doctors treat physician patients differently by downplaying psychiatric issues to protect physicians from medical board mental health investigations. Untreated mental health conditions may lead to suicide.

Medical board investigations increase suicide risk. One doctor hanged himself from a tree outside the Florida medical board office after being denied his license. He was told to “come back in a year and we will reinstate your license.” Meanwhile he lost everything and was living in a halfway house.

Physician Health Programs (PHPs) may increase suicide risk. Forcing doctors with occupationally induced mental health issues into these 12-step programs with witnessed random urine drug screens (when they’ve never had a drug problem!) is humiliating and unethical. So doctors hide their mental health conditions for fear of being punished by PHPs.  [Note: PHPs have helped some doctors with substance abuse especially]

Substance abuse is a late-stage effect of lack of mental health care. Since doctors may lose their license for seeking mental health care or get locked into PHPs; they self-medicate with alcohol, illicit drugs, or self-prescribe psychotropic medications.

Doctors develop on-the-job PTSD. Especially true in emergency medicine. Then one day they “snap” like this guy.

Cultural taboos reinforce secrecy. Suicide is a sin in many religions. Islam and Christian families have asked that I hide the suicides of family members. Indian families often claim a suicide is a homicide or an accident, even when it’s obviously self-inflicted.

Media offers incomplete coverage of suspicious deaths. Articles about doctors found dead in hospital call rooms claim “no foul play.” No follow-up stories.

Medical schools and hospitals lie (or omit the truth) to cover up suicides—even when media and family report cause of death. Medical student Ari Frosch stood in front of a train, yet his school reported he died at home with his family. Though the family of psychiatrist Christine Petrich shared that she bought a gun and killed herself (after just getting her hair done and planning a surprise trip to Lego Land and Disney for her kids) on their GoFundMe page, her employer wrote she “passed away.” Shouldn’t the department of psychiatry take a more active interest in physician suicide?

Euphemisms cover up doctor suicides. Suicide is omitted from obituaries, funerals, clinics, hospitals, and medical schools. Instead we hear “passed away unexpectedly in her sleep” and “he went to be with the Lord.”

Secrets will not save us. We’re unlikely to make a medical breakthrough on a hidden medical condition.

Doctors choose suicide to end their pain (not because they want to die). Suicide is preventable. We can help doctors who are suffering if we stop with all the secrecy and punishment.

I’ve been shunned for speaking about doctor suicide. After being invited by the AMA to deliver my TEDMED talk, I was disinvited shortly before the event because they were “uncomfortable” with physician suicide.

Ignoring doctor suicides leads to more doctor suicides. Thankfully, an Emmy-winning filmmaker is completing a documentary on physician suicide this month. To honor a doctor or medical student who has died by suicide in the film, submit their name and specialty here.

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75 comments on “What I’ve learned from 547 doctor suicides
  1. Connie says:

    I worked 216 hours in the last 2 weeks. Slept 17 hours in the last 1 week. I’m exhausted. No hope for change anytime soon.

    • Pamela Wible MD says:

      Wait until you see the film and patients FINALLY understand the dangers of sleep deprivation and human rights violations in medicine that trickle down onto everyone. Did you see the film trailer? http://donoharmfilm.com

      • Connie says:

        Very sad. There are no regulations limiting the hours attending physicians can work. Without collaborative agreements between hospitals and private practices for covering call we are creating dangerous/abusive situations. The problem is hospitals are often not willing to work with private physicians leaving no options as we can not abandon our patients ethically or by law. It’s a lose-lose.

        • Pamela Wible MD says:

          We have the resourcefulness and native intelligence to solve this if we stop hiding the truth in the shadows. We all deserve to know the truth of the working conditions in hospitals and clinics.

        • Allan Kelly says:

          Connie,
          Perhaps you are in training. But if you have finished your training there is a better way. Certainly Pamela can give you ideas. I am also working on a project to change the equation for idealistic doctors trying to work for their patients, families, and communities. Colleagues like Pamela and I can help.

  2. Gordon says:

    Doctors are human. A fact many do not understand including doctors. We all need good support systems especially at home. We need God in our lives too.

  3. Anne Stohrer says:

    It is the toxic work and cultural environment, not the lack of resilience or strength of the individual. Tell it, Dr. Wible!

    • Pamela Wible MD says:

      From my blog Burnout is a smokescreen for human rights abuse:

      “Burnout” is a smokescreen for rampant human rights violations in medicine. Am I losing anyone here? Let me break it down.

      “Burnout” is a complete mental and physical collapse from overwork. Psychiatrists define it as a job-related dysphoria in an individual without major psychopathy. Which means—your job sucks. You’re normal

      Smokescreen is an artificial cloud of smoke that hides the perpetrator’s true intentions. This cloud of smoke may take the form of a statement or word used to obscure the truth so victims don’t understand what the heck is really going on. For example, apply the victim-blaming term “burnout” to deflect attention from oppressors who are guilty of human rights violations.

      Human rights violation is the violation of a basic right to which all humans are entitled, including the right to life, liberty, equality, a fair trial, freedom from slavery and torture, and freedom of thought and expression. Common human rights violations in medicine include: 1) Sleep deprivation (24+hour shifts, 80+hour work weeks) as described by this physician whistleblower who was forced to work 168-hour shifts. 2) Not being allowed to eat, poop, pee when one needs to 3) Bullying and hazing 4) Being terminated, harassed, or threatened rather than receiving accommodations under the ADA for mental or physical health issues as described by this physician whistleblower who nearly died when her hospital obstructed her medical care.

      Physician whistleblower is a physician who reveals health care’s human rights violations to the public. If you’re a physician with a whistleblower story, contact me. Doctors must stop being complicit with abuse or they will become the perpetrators (see below). Physician whistleblowers protect themselves, other health professionals, and patients from continued abuse. Silence and secrets protect the perpetrators.

      Victim is a person harmed, injured, or subjected to oppression or mistreatment (may include being sacrificed or killed due to an action/inaction). Those who don’t know they are victims are at high risk of becoming perpetrators.

      Perpetrator is an individual (acting alone or within a system such as a medical school, residency or hospital) who harms, injures, or subjects another to oppression or mistreatment (may include sacrificing or killing someone else due to perpetrator’s action/inaction).

      Burnout is a smokescreen for rampant human rights violations in medicine. One way to end a cycle of abuse is to stop blaming the victims. Tell the truth: it’s not burnout, it’s abuse.

      • Stephen Rodrigues, MD says:

        “rampant human rights violations in medicine” is an understatement!!

        Every citizen in the United States, physicians, and patients have been tricked, betrayed, deceived, confused, miseducated, and paid not to care or think for themselves. Especially to figure out what happened to THE MOST ethical, moral, and honorable profession., A Physician.

        [remainder edited by moderator as off topic]

  4. Joanne says:

    Dear Pamela, I didn’t know that the AMA put their heads in the sand. Aren’t they there FOR their members? You know you are doing very important work, don’t you? So, keep going, keep talking about it, because it is REAL, AUTHENTIC, and for the sake of every doctor and their families is a story that MUST be told!

  5. Fantastic post, Pamela. Thank you.

  6. Trudy Martinez says:

    Thank you, Pamela Wible for your tireless efforts to shine a light on the important subject!

  7. Loretta Madden-Holman says:

    I’m glad to see your article come to fruition. God bless all of them. I think it’s about time physicians learn to stand up for themselves…they NEED TO…they are beaten into the ground by lawyers, insurance companies, angry patients, and politicians. You have got to get organized or it’s going to get worse. Just this week it was announced that the opioid crisis in this country was due to over-prescribing! Well, when “PAIN” is made the 5th vital sign and it’s being driven by Medicare/Medicaid and then reimbursement is fueled by patient satisfaction and PRESS-GANEY scores, why is anyone surprised!?

    • Pamela Wible MD says:

      Part of the problem is:

      1) Doctors don’t understand that they have been victimized (or are unwilling to accept the extend of their victimization).

      2) Most doctors seem to fall for the psychological warfare embedded in words like “burnout” and “resilience” and “work-life” balance which deflects attention from the perpetrators of these human rights abuses and make doctors feel defective for not being able to keep up with the inhumane requirements of their job.

      3) Divide-and-conquer and intimidation tactics have worked well thus far to keep doctors pitted against each other instead of truly standing up for their own rights and the rights of their colleagues.

      We have been wounded by medicine and resist grasping the extent of the wounds.

      Suicide becomes one way to end the pain.

      I can truly say this mass-wounding of our healers is one of the sickest things I have witnessed in my lifetime. Tragic beyond belief.

      • Jonathon Tomlinson says:

        How much do you think that many of us who choose a career in medicine are wounded to begin with? David Zigmond gives a rare analysis of the paradox of the wounded physician http://www.marco-learningsystems.com/pages/david-zigmond/physician-heal-thyself-3.htm

        In my experience of working with stressed GPs and trainee GPs, many of them have had to deny their emotional needs from a very early age, were made to feel that they were never good enough, that failure wasn’t an option and their goal in life was to attend to other people’s needs. We (doctors) are rarely encouraged to think about how experiences of care and being cared for led us to choose a medical career, or to reflect on our shame at being seen to be emotionally needy or vulnerable in the eyes of our peers.
        None of this is to deny that the cultures in which we work are not toxic, but it does help to explain that on the whole, it’s doctors who have built these cultures

        • Pamela Wible MD says:

          Yes. That savior complex stats early for many. We hope to heal others to in some way also heal ourselves. Many of us are driven to choose the profession based on personal suffering, witnessed abuse of others, traumatic events with family members (parent or sibling dying young of cancer). We need an educational environment that does not further torment those who choose the healing arts. We need (obviously) emotional support to do the amazing work we are capable of in medicine.

      • Diane says:

        Dr Wible, I cannot describe how meaningful your work is. Thank you for exploring such delicate subject

        • Pamela Wible MD says:

          Labor of love for my beautiful profession and so many true healers who were not able to give their fullest gifts of healing to the world. Many have been so tragically shunned in the deaths. Certainly a civilized society should honor and nurture its healers from a young age and celebrate them even after their deaths. I for one am unwilling to forget them. Thank you for caring so deeply Diane.

      • Can't say says:

        I’m a Child, Adolescent and Adult Psychiatrist who is currently not providing clinical care in part related to some of the wear and tear that my chosen profession has added to my life. Luckily, I found other work that utilizes my skills. I’m not sure if I will return to clinical care. I have mixed feelings about this for lots of reasons, but especially because there aren’t enough us out there.
        In my practice, I treated many depressed/suicidal MD’s including residents and fellows and it was very difficult, upsetting and rewarding. It is always tragic when someone chooses to end their life and even more tragic for those families with several members have made that choice
        However your statement “I can truly say this mass-wounding of our healers is one of the sickest things I have witnessed in my lifetime. Tragic beyond belief.” is where you lost me. Child abuse/neglect that never ends despite having multiple systems involved for years. Domestic violence victims that aren’t believed/protected and eventually killed by their perpetrators no matter what they do or who they ask for help. A huge majority of runaways after 48 hours being tricked or kidnapped into sex slave trade.
        And this is just in our very privileged country.
        No, I have not personally witnessed all of these atrocities, just like I haven’t witnessed the horrors in Syria.
        It’s just hard for me to get behind that sentiment despite losing colleagues/patients to suicide and applauding you for taking on this serious crisis.

        • Pamela Wible MD says:

          “I can truly say this mass-wounding of our healers is one of the sickest things I have witnessed in my lifetime. Tragic beyond belief.” I think this statement comes from personally witnessing some of the most caring, compassionate, loving people of my life succumb to suicide over and over again at the hands of a “health care” system. I am not saying this is worse than other terrible crimes against humanity but it IS the worst thing I have personally witnessed in my life so far. I’m a very emotional person as you probably have figured out and it is hard for me to contain my absolute horror at what I have personally seen in (mostly men) doctors who I’ve loved go down one after the other. . . often for short-term greed (as declared in their suicide notes). It really is unbelievable.

  8. Christine B Myers, MD says:

    I remember the first day of medical school, August 1991: introductory lecturers warned all of us doctors had an especially high risk of suicide and to guard against it.

    The only time my entire life I became suicidal was during my residency in the mid-1990s. We were asked to track our work hours, record them, and turn them in. I, at least, was working 90-110 hour weeks, so the idea of adding another task to my plate was laughable, even though I realized had I done so, it might have meant an objective measure to effect change. I couldn’t have done it if I tried! I was far more focused on practicing how to sleep like a dolphin, where half my brain rested while the other still functioned! I somehow learned to take quick naps while standing upright during rounds or while taking a history from a patient or in the middle of dictating an intake history or discharge summary.

    I was told, at the time, a first-year Internal Med resident had committed suicide by hanging himself in a call room during his first month of rotations. I also was told one of my former medical school classmates killed herself near the end of her anesthesia residency by hooking herself up to IV propofol in an empty patient room.

    • Pamela Wible MD says:

      Welcome-to-medicine lectures are very scary. Here’s one I share in chapter 1 of Physician Suicide Letters—Answered:

      Dear Pamela,

      Thank you so much for the truths you speak for so many. Many times in my years of medicine I have said to trusted friends and to several therapists, “Something happened to me in med school.”

      I was happy, secure, and mostly unafraid until med school. I recall in vivid detail the first orientation day. Our anatomy professor stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers and said these words: “If you decide to commit suicide, do it right so you do not become a burden to society.” He then described in anatomical detail how to commit suicide.
      I have often wondered how many auditoriums full of new students heard those words from him. I am sure someone stood in front of us and told us what a wonderful and rewarding profession we had chosen. I do not rememember those words. But I do remember how to successfully commit suicide—with a gun.

      One month later, on the eve of our first monthly round of six exams in one day, I had my first full-blown panic attack. I had no idea what was happening. I thought I was losing my mind. I took a leave of absence and made up excuses. I returned untreated with maladaptive compulsive behavior, completed med school, survived the public “pimp sessions,” and all the rest.[Pimping is a “teaching” technique in which a student is grilled with rapid-fire questions (often about obscure medical minutiae). These much-feared public interrogation sessions can be so malicious that the student may be left crying—in front of peers, staff, and patients.]

      No one ever suggested that the process was brutal, or the responsibility frightening, and no one offered us help. I have maintained contact with only one colleague from med school, so I do not know how the others fared.

      Through the many years of training, and through what would appear to the observer a successful career in a surgical subspecialty and now into retirement, I have carried the anxiety, and the depression, and the fear. Perhaps entirely unrelated to those first days in med school, but still something happened to me, and probably to many of us, that changed us forever. I still remember how to successfully commit suicide, because someone who had power over me at a vulnerable time described the details. And we wonder why . . .

      ~ Anna

      Download free audiobook here. Its like a 3-hour doctor suicide hotline call with me.

  9. Pamela Wible MD says:

    Regarding the issue of “happy doctors” dying I wish to quote from the 1858 book I referenced in the beginning of this blog:

    “Carlini, a French actor of reputation, consulted a physician to whom he was unknown, on account of the attacks of profound melancholy to which he was subject. The doctor, among other things, recommended the diversion of the Italian comedy; “for,” said he, “your distemper must be rooted indeed, if the acting of the lively Carlini does not remove it.” “Alas!” ejaculated the miserable patient, “I am the very Carlini whom you recommend me to see; and, while I am capable of filling Paris with mirth and laughter, I am myself the dejected victim of melancholy and chagrin!”

    Recalling the suicide of Robin Williams and many wounded healers every time I read this.

    From: Bucknill JC, Tuke DH. A Manual of Psychological Medicine. London, England: John Churchill; 1858

  10. Pamela Wible MD says:

    My first attempt at writing this same blog 5 years ago. Very interesting list of 35 reasons doctors die by suicide (written by a novice Pamela)

  11. Marcus Fidel, MD says:

    “Physician Health Programs (PHPs) increase suicide risk. Forcing doctors with occupationally induced mental health issues into these 12-step programs with witnessed random urine drug screens (when they’ve never had a drug problem!) is humiliating and unethical. So doctors hide their mental health conditions for fear of being punished by PHPs.”

    Do you have evidence of this?

    I think that there is a correlation between the two but not a causal relationship.

    Since these doctors are already mentality ill, their risk for suicide is already increased.

    My suicide risk went down when my PHP intervened. They found me proper treatment. So my personal experience refutes your claim. PHPs help impaired physicians not hurt them!!!!

    • Pamela Wible MD says:

      Thanks for sharing Marcus. Calling you now. I will return to a first draft of this entry where I had “may” inserted in there and will add an addendum indicating that there is wide variation from state to state.

      Physician Health Programs (PHPs) may increase suicide risk. Forcing doctors with occupationally induced mental health issues into these 12-step programs with witnessed random urine drug screens (when they’ve never had a drug problem!) is humiliating and unethical. So doctors hide their mental health conditions for fear of being punished by PHPs. [Note: PHPs have helped some doctors with substance abuse especially]

    • Pamela Wible MD says:

      An example of how PHPs have not been helpful (I have a section in Physician Suicide Letters—Answered devoted to PHPs):

      Dear Pamela,

      I’m amazed at the punitive terms I’ve had to face in recovering professionally from a depressive episode for which I was hospitalized last year. One of my requirements is to be urine tested for substance abuse, despite multiple demeaning assessments that have rendered the clear verdict that I don’t have a substance use problem. I’ve had to attend costly treatments for “professionals” in which I am the only female in a group of male physicians who have had sex with their patients or have become assaultive with staff. Any efforts on my part to point out that I don’t quite “fit” are taken as further evidence of my pathology. I’m a single parent as well, so that each of these “treatments” I’m required to attend takes me away from my two children for extended periods of time. throughout all of this, nobody has told me how common my feelings are—that a large number of doctors feel depressed and suicidal at times. Rather, I’ve been told that my actions are unheard of for someone in mental health and may preclude me from ever providing therapy again since “we tell patients to never give up hope, but you did.” Hopefully, in the near future this won’t be a taboo subject, and there will be places for those like me to seek responsible and con dential care.

      Sincerely,
      Amy

      • Yes, a key problem of PHPs according to my clients is that PHPs often have only round holes, such as twelve step programs, “preferred” physician assessment and rehabilitation centers that invariably diagnose significant illness and prescribe prolonged –cash only–inpatient stays and drug testing schemes, into which they try to stick “square clients” such as yourself to maximize their apparent efficiency and profits. Then, when the squared edges start to shear off, they label the victim a “denier” of sameness or accuse them of “substantive noncompliance”, or in the case of substance use “Level 1 relapse: behavior without chemical use that is suggestive of impending relapse”…terms the PHPs have cleverly had written into FSMB policy, to extend their ability to report such substantive “noncompliance” to medical boards and use the physician’s license to hold him/her hostage to their preferred methods. There are plenty of reports of this, and some will be explored in “Do No Harm”.
        Marcus, so glad that the system worked for you. Perhaps you are “round”. Please do not assume that your experience is perfectly typical.

    • PHPs vary greatly state to state. I am currently conducting a confidential survey on state PHPs and your input would be very helpful (link below). Although you had a positive personal experience with your state PHP many others have had very negative experiences. Not all of those referred to or being monitored by PHPs are “already mentally ill” and many do not even meet the diagnostic criteria for Substance Use Disorder or psychiatric diagnoses for which they are being monitored ( substantiated by second, third and fourth opinions from experts). Complaints of financial exploitation and “diagnosis rigging” are increasingly coming to light. To assure organizational justice oversight, regulation and some form of accountability is needed.

      http://www.emailmeform.com/builder/form/8eG0Wb4A0PjKw4J

  12. Susan Daly MD says:

    Thank you, Pamela. I actually had no idea of the scope of the problem until I started reading your columns. I’m glad you have such a social media presence so that people in general, but especially other doctors and also residency training program directors can learn from this.

    I’ve mentioned my own issues with you before, but I just thought of something else: Between 1985-1990, there were a fair number of intern and residents committing suicide. The timing co-incided with the emergence of AIDS and the fact that there were no blood draw “teams;” the interns got the job and suffered from the pricks. It was a very scary time. At the hospital where I worked at that time, the head of Medicine requested from the head of Psychiatry that a group be run for trainees. I offered to do it as long as I received supervision in group therapy. One of the important parameters of the group was that it would be for interns only. This was because, as you know, sh** flows downhill and there would be plenty of payback for any interns who complained to residents. I did this group for two years, with two different groups of medical interns. I’m just mentioning this now to you because it could be built into a training schedule as protected time (residents had to cover for interns for that one hour) and it seemed to be a good forum for the group of interns to grow closer. In no way am I suggesting that this is all that’s needed; far from it. But the experience just popped into my head as I was reading your email this evening.

    • Pamela Wible MD says:

      Excellent idea! We absolutely need more group coaching & healing opportunities as medical students, interns, residents, docs. Thank you for sharing this Susan. Much appreciated.

  13. William says:

    https://jamanetwork.com/journals/jama/fullarticle/2658326?utm_

    Please read the article linked above. What I don’t like about the tone of the article is the subdividing that the author uses in classifying the victim…”one of ours”….(meaning Anesthesiologists)….”our family”….(again meaning Anesthesiologists) This mindset needs to change. Anesthesiologists are part of the larger group called Doctors, who are part of a still larger group called Health care workers. You are genuine and I believe sincere in documenting suicide amongst doc’s. However I would wager that if expanded to include ALL health care workers, PA’s, Nurses, etc, etc…..that work in critical care environments, you will find a disproportionate number of suicide’s, divorces, drug abuse and depression. There are multiple factors that contribute to these problems. Physicians are one subset of a much larger group. You identify many of the causative factors in your writings, however there are many more, and to ignore them only serves to leave so many others suffering within the system without a lifeline. I know this is not intentional.

    The oppressive nature of the system as it exists presently is a massive problem. Doc’s are most certainly abused by a heartless, oppressive, cold, dehumanizing culture. That culture permeates everything in health care. It is because the system is sick, that the participants within the system become ill also. I applaud your efforts to bring these problems to the public at large. I just want to make sure that we don’t lose sight of the larger picture. Again, I applaud and commend you for illuminating a problem that has existed for far too long. I hope that your example will encourage others to come forward.

    • Pamela Wible MD says:

      I totally agree with you and I always welcome depressed & suicidal health care workers of all sorts to the retreats I offer. (massage therapists, RNs, veterinarians have all come in the past).

      Also I have a separate list I keep with other health care professionals. For the purposes of the film the focus is on doctor suicides. Lessons learned can apply to all health professionals I’m sure. I do not want anyone excluded.

      ~ Pamela

  14. Sarah Gahagan Kumar says:

    Fantastic article and research Pamela. You are one of the first beacons of hope in my lifetime illuminating the truths of the diseased medical system which cost the life of my brilliant and beloved father, a pioneering surgeon and in turn influenced the suicide deaths of two of my siblings.
    Medical culture and training reform is long overdue and an idea whose time has come.
    Infinite thanks from myself, my family and so many others in this healing journey for us all.

    • Pamela Wible MD says:

      Thank you Sarah for being willing to share the pain that your family has endured since 1967 with no answers—until now. May this documentary shed light on your beloved father and the tragic loss of your siblings. The grief is unbearable. Suicide is preventable. May your family heal and be part of the healing that the medical profession has needed for more than a century. Thank you for opening your wound for the world to see & feel . . .

  15. farah ferrer says:

    I am very proud of Dr Wible for been a female doctor who addresses suicide in physicians the way it is, without fear. Thank you!!

  16. tom fiero says:

    keep up the good fight , Pamela

  17. Melanie Mein says:

    Pamela, firstly you have done and are doing amazing work,I hope you start to get more support from the AMA and others.
    I am really saddened to hear things are so bad in the US. Having trained in the UK in the late 90s conditions were finally improving and have continued to improve with much more acceptable hours. Working now in New Zealand I think there is a more accepted culture of trying to achieve a good work/life balance.
    I really wish you well with your amazing work.

    • Pamela Wible MD says:

      Thanks Melanie! Yes, I do feel support is coming now from our medical organizations. The awareness among physicians of the humna rights violations and the public outcry for change is right around the corner.

    • Dr Nell de Graaf says:

      Hi Pamela and Melanie.
      Great informative needed work you are doing Pamela .
      I also trained as a New Zealand doctor and there used to be a better wwork/life culture but the pressure is really on the younger generation in their residency and training years.
      We have never worked the insane hours like US docs and I dont know how anyone can survive that system.
      I have now been working in Australia in remote rural hospitals where GP generalists get very well paid but have onerous hours and responsibilities.
      Not surprisingly younger docs arent keen to work like that and there is always a shortage of remote area docs,nurses and allied health.
      We are all facing a mental health crisis .
      This is rising in the general population with so many anxious stressed people as patients pushing their stress and demands onto us and we are not supported by the beauracracy or our managers who keep demanding more for less.
      I am now nearly 60 and although I have enjoyed some great times in general practice and met some amazing people I cant recommend it as a career anymore especially if you would like a family and good relationship.

  18. Susie says:

    I work in the Social Work/ Community area and there are a lot of similarities.

  19. Geeta says:

    Very sad. Doctors are under tremendous pressure, professionally and personally.They need more help than anyone else in society.

  20. Jed Diamond says:

    Pamela,

    Your work is a great gift to medical professionals, their families, patients, and communities.

    I went into medicine to help people, but dropped out of medical school in my first year because it medical school seemed inhumane. I had to see a psychiatrist to get out. “You must be crazy to give back a 4 year, full-tuition fellowship at U.C. San Francisco.” But I knew I’d be crazy to stay.

    Too many doctors are in a no win situation, but as you have proven, it doesn’t have to be that way. That you for all you do.

    • Pamela Wible MD says:

      Thanks Jed. I’ve been up for almost 3 days (more sleep deprive than a resident) cold calling families in obituaries about their loved ones so we can have them in the film.

  21. teach them to eliminate what is killing them and not themselves

    he who seeks to save his life will lose it (being submissive and pleasing others)
    he who is willing to lose his life will save it (reclaim your true life and eliminate the untrue life imposed upon you)

    ask yourself why you became a health professional and if the answer is not about caring for people you have a problem because people bring the problems to their doctors

    how about nurse suicide rates?
    they want to help everyone how does that affect them?
    being unable to say no when asked to do things by friends and family they do not want to do is a big problem for nurses

    health professionals don’t teach or live survivor personality behavior

    go to my web site for many helpful articles and my books too. i felt the pain of not being able to cure everyone and sought the answers and helped to heal myself by living the sermon. a perfect world is not creation it is a magic trick with no meaning.

  22. Nora McNamara says:

    A third year psychiatry resident from our children’s hospital (Rainbow babies and Children’s Hospital) killed himself by overdose in 1995 and we were all forbidden from attending that resident’s funeral. Because our pediatric attending (who sucked) told us “This is an occupational hazard of this job. You need to come to work and do your job.” ~ Nora McNamara

  23. Nora McNamara says:

    A third year psychiatry resident from our children’s hospital (Rainbow babies and Children’s Hospital) killed himself by overdose in 1995 and we were all forbidden from attending that resident’s funeral. Because our pediatric attending (who sucked) told us “This is an occupational hazard of this job. You need to come to work and do your job.” ~ Nora McNamara

  24. Kim says:

    I was in medical and was going on for a PA from RN but after two years Quit because I couldn’t handle all the patients alone . They were sick and don’t understand the paperwork involved and red tape just to help their pain . I would be stuck with 30 all alone ! Well fast forward 15 yrs I’m starting to get sick so 4 months ago I’m dx with Lupus which is an entirely different story but what I’m trying to say is I’ve now been on both sides of medical . I see it crumbling . A Dr ,or anyone in medical should never ever be forced into risking their great talents for a corrupted bunch of money hungry imbisals ! I have actually calmed others down while in waiting on my Dr who was called to an emergency at hospital explaining why they are waiting hours . I gave one lady 50.00 gift card ( I didn’t need it) to calm her down because she was in waiting area 3 hrs & I seen the stress and she started cussing the office staff who truly are sometimes clueless and should be trained to explain things and show compassion because patients don’t understand what’s going on and the tons of aggravation a Dr. faces . I had that waiting area in complete calmness by simply explaining & listening to them. I was so sick that day but I knew somebody had to do something because the Drs and other nurses would be blamed and oh God nothing worse than hearing a patient cuss you out and degrade you for stuff out of your control ! I’ve seen Drs go off and stand alone as if they had nobody who cared . Where’s their hug or thank you ? It’s pitiful ! ( I give my dr sports stuff for his favorite team because it’s gave to me , I try small things to return the kindness my dr shows despite sometimes Drs who know my background take for granite I’m to know certain things and I’m left basically saying what blood work I’m needing lol I don’t know everything and it’s something learned everyday ! I can say this …The DEA needs put in their place and you guys shouldn’t have their rules . I say stand together & continue treating your patients your way & as far as opioids , I honestly think that’s a Dr and patient decision , not DEA or pharmacist . That’s adding to the stress DRs face ! There’s got to be a way ALL Drs can do what they love without criticism and dictators . I am in agriculture now and I love it but I loved medical as well . Don’t give up on something your called to do . Its a gift that very few can do! Your a family & maybe some of you can join in and get your own practices together and practice medicine as it was intended . We need you & not for just pain medicine ! We need hope there’s a better tomorrow & numerous other things ! I wish patients could understand what’s going on with you guys as well as them . I apologize for the long reply , I’m just trying to explain things as I see them and let each of you know your needed !so band together and take back what you were trained to do and make time for yourself & family ! We each know life is short!!!

    • Pamela Wible MD says:

      Thank you Kim. We need the equivalent of a WalMart greeter and clinic/hospital peacebuilder at every medical institution. Addressing underlying system dysfunction first would help. Prevention is the mainstay of good medical care & service.

  25. Excellent column, Pamela.
    I take issue with the assertion that residents are ever “sent to psychiatrists for stimulant medications”. This would be unethical behavior on the part of whoever is doing the referring, besides which psychiatrists rarely if ever prescribe “stimulant medications”.

    A resident might possibly be diagnosed with narcolepsy or ADHD, but this would not normally be treated by a psychiatrist, and at any rate, the treating psychiatrist would decide which medications to prescribe if indicated.
    Some reports have noted that a large number of today’s students have long been on ADHD medications. Some even more disturbing reports are emerging that PHPs (even non physician PHP directors such as psychologists) in their zeal to promote strict abstinence programs for all clients regardless of diagnosis, have demanded that students and doctors come OFF their ADHD or narcolepsy or OSA medications so as not to interfere with drug testing for substances of abuse.
    Stopping a legally prescribed medication for a potentially life threatening condition is medically indefensible, unethical and illegal, if it is done by a nonphysician.

  26. Excellent column, Pamela.
    I take issue with the assertion that residents are ever “sent to psychiatrists for stimulant medications”. This would be unethical behavior on the part of whoever is doing the referring, besides which psychiatrists rarely if ever prescribe “stimulant medications”.

    A resident might possibly be diagnosed with narcolepsy or ADHD, but this would not normally be treated by a psychiatrist, and at any rate, the treating psychiatrist would decide which medications to prescribe if indicated.
    Some reports have noted that a large number of today’s students have long been on ADHD medications. Some even more disturbing reports are emerging that PHPs (even non physician PHP directors such as psychologists) in their zeal to promote strict abstinence programs for all clients regardless of diagnosis, have demanded that students and doctors come OFF their ADHD or narcolepsy or OSA medications so as not to interfere with drug testing for substances of abuse.
    Stopping a legally prescribed medication for a potentially life threatening condition is medically indefensible, unethical and illegal, if it is done by a nonphysician. And if it leads to morbidity or mortality, well, then we are potentially dealing with intentional infliction of emotional distress/suffering/illness or even murder.

    • Pamela Wible MD says:

      The entire topic of prescription use/overuse/abuse among med students/residents needs further investigation. I’m horrified by what I’ve heard from those forced to receive psychiatric care for “inefficiencies” on the medical assembly line.

      “I was told by the psychologist at my med school’s campus assistance program, that 75% of the class of 175 people were on antidepressants,” shares psychiatrist Dr. Jaya V. Nair. “He wasn’t joking. How broken is the system, that doctors have to be pushed into illness in order to be trained to do their job?”

      “During my internship, I found out that at least 75% of my fellow residents were on SSRIs or other antidepressants, just ‘to get through it’ because it was so horrible.” states Dr. Joel Cooper, “Depression, or a constantly depressed state, is more or less the norm in medical school and throughout one’s residency.”

      “When I left my residency, I was alarmed to find out that about 75% of my fellow residents had started antidepressants since their intern year,” says Dr. Jill Fadal.

      More here on this epidemic: http://www.idealmedicalcare.org/blog/75-med-students-antidepressants-stimulants/
      (of course another symptoms of meded gone awry)

  27. Amanda says:

    As a second year resident I stood in a patient room on the top floor of our hospital and wished the window opened so I could jump.

    I promptly realized the severity of these thoughts and sought help. Part of me worries about my “record” of MDD (and OCD) and what it means for my future as a physician.

    The thankfully louder part of me is now very open about my mental illness, treatment and experiences. I want others to know that asking for help is ok. Having depression, anxiety, etc does not make you weak. I hope my openness is a catalyst for change in my medical community.

  28. Chrystal says:

    I very clearly remember one lecture as a medical student about to start my internship. The topic was “you will kill patients, and this is how you’ll do it”…

  29. Anonymous cardiology trainee says:

    Dear Dr Wible, thank you for speaking up for doctors. Your article “What I’ve learned from 547 doctor suicides” summarises so much of what is wrong with the medical profession. I am a cardiology trainee, and the expectations of the system on myself and my colleagues is brutal. It has made all of us into the worst versions of ourselves, and I am ashamed to no longer be able to care as much as I used to. I hope that change towards our work culture will continue to happen, and wish you all the best.

  30. Jo says:

    Thank you so much for bringing this out in the open. I too recently spoke up about suicides occurring in corporate Australia – by the C-Suite of professionals. Again, in a room for 22 people, we have 6 directly affected by a suicide of someone, most a direct report!!!!!! I too became a quasi-suicide hotline.

    Suicide is a public health crises – a GLOBAL public health crises. Thank you

  31. Ann-Marie LeBlanc says:

    Lost a dear friend, and world-acclaimed physician to suicide years ago. He was brilliant, tender hearted and physically blessed as a competing triathlete. He was written about in the book: WALK ON WATER. I’ll never get over it.

    • Pamela Wible MD says:

      Who was this doctor? Do you have an obituary? Are you in touch with family? We can honor him in film if we have family approval.

  32. really impressed that you have contributed so much on this topic, this hidden and stigmatised issue that needs full exploration. Well done.

  33. Pamela Wible MD says:

    HOW PATIENTS CAN HELP DOCTORS NOT KILL THEMSELVES:

    “Hi Dr. Wible, An acquaintance posted one of your articles about physician suicide online. I have multiple chronic illnesses (metabolic syndrome +) and so I see a few doctors. They are all residents, as I live near the University of Michigan. I am lucky as they are wonderful but I am also concerned about them after reading this. Although there is zero chance they would share something like this with me, of course, is there any way for patients to support your efforts to prevent physician suicide? I would be devastated if any of them killed themselves. When I was hospitalized with high blood pressure, I wrote all of them thank you notes, specifically noting their strengths in treating me. I’m sure they all found this somewhat weird, as the caring we receive from doctors is largely a one-way transaction mediated by money in our society. In any case, thank you very much for bringing light to this issue.”

    My answer:

    The thank you cards really help.
    Even if docs don’t show it – they are touched.

    Keep doing that. You can also ask:

    1) How are YOU feeling?

    2) Did you get any sleep last night?
    How long have you been on shift?

    3) If they seem like they are starving
    hand them a power bar (keep little
    snacks with you to share)

    It’s simple things like this
    that make all the difference.

    ~ Pamela

  34. Jamie says:

    Great article! I have a dear friend who lost her physician husband to suicide. Hope his sheds light on things she has thought and felt for years.

  35. Neena Grover says:

    Neil was 2nd. year student at University of Massachusetts Medical School. He was 6 ft 3 in tall, smart, great personality and was known as Demi God among his friends.

    One day before thanksgiving in November 1998, we lost him at the age of 23 years.

    Our younger daughter, Meera Grover, also graduated from University of Massachusetts Medical School in 2004. The school and his classmates have a bench in his memory at the school and a Neil Grover Memorial Scholarship awarded every year.

    After Neil’s death, we started going to a Grief Sessions held in Springfield, MA under Mary Pat McMohan, who had lost her son at the age of 22 years. We became a family of our own. The interaction with other people helped us to become little stronger every day. With so many sad stories at the grief session,I wondered how I could make other parents and sibling aware of this illness.There were all kind of Walks except no formal Walk on Suicide prevention.

    I told my idea to the grief session group. There was a dead silence on this idea. They were all worried that this idea would not work as there was so much Stigma attached to this cause. I did not give up and started pursuing for a location and got many rejections. I did not tell the group about the rejections. There was a myth that if we talked about suicide, it would happen.

    Ultimately, Jewish Community Center in Springfield gave me the place at no cost. I would always be thankful to Michael Paysnick (The Director) for his sensitivity of the cause. He knew Neil. However, he expressed his concern that I would not be sad if not too many people joined me for this Walk. My answer was that even if 10 people walked, we would be bringing awareness, to the community.

    In 2001,with full support from the grief session group, we had about 250 people at the first walk with no TV coverage We had a picture on the third page with a small write up on the third page of the news paper.

    We had named the walk as” The End of Secrecy”

    In 2004, American Foundation for Suicide Prevention made this as formal Community Walk named as ‘Out of the Darkness’. It is now in more than 365 cities.

    Currently , I help the cause by anyone wants me to share the story. At the last Springfield Walk, we had approximately one thousand people.

    Dr. Meera Grover is an Anesthesiologist at Brigham and Women Hospital in Boston.. We have three grandchildren who participate in the Walk. They always ask about Neil..

    Neena grover

  36. Diane says:

    “Male anesthesiologists are at highest risk. Most die by overdose. Many are found dead in hospital call rooms”. Hits VERY close to home for me- the primary reason is the extreme pressure working in anesthesia. I’ve had a schoolmate commit suicide in the call room, have sent another to drug rehab. It is a job that take a high toll. At least for me, between working ICU and then anesthesia- a part of me died with each patient I lost until I was dead inside. Been out for 15 years and am still recovering from it…I suspect one never fully does recover. Between being ICU charge nurse and then anesthetist for 20 years the stress was too much and I had to quit to save both my sanity and life

  37. Anesthesiologist says:

    I know a woman who was a year ahead of me in an anesthesiology residency. I think of her often. I was starting to get to know her better and she was confiding in me some of the problems she was having. She had married an attorney who turned out to be very controlling and abusive. They divorced. She was physically drop dead gorgeous, which she felt got in the way of relationships since men could not see beyond her looks. I barely could, either at first. Even in scrubs, her physical beauty just radiated. But she was also so smart, funny, interesting-and very lonely. She started an IV on herself with the “usual” anesthesia cocktail and ended her life and suffering.
    I had gotten to know her better when we talked as she “kept on eye” on me during my coma from taking 11 grams of barbiturates (and after a week, life support was being removed, papers signed for organ donation, etc)…. and then totally unexpected….very shortly before life support was to be turned off, I started to come out of the coma. In one conversation, she asked me about other methods I had thought about and I did mention the IV route, but did not think I could manage that. And then the following week, she died and we never had the lunch date that we had planned for that next week. Decades later, I think about her and ache for the pain she had. So she will be an unnamed, but remembered person in the film.

  38. Jordan Rinker says:

    Regarding the suicides of the brothers Drs. Gary and Jeff Reiter.

    Pamela

    Thanks for sharing this information. I find it incredibly sad that two brothers with so much love and support for others, who went into the same profession, and attended the same residency program ended their own lives.

    Joe Pace was another good friend from school I’ve lost touch with. I resonate with his feelings and taking time off. During our first summer as med students we were allowed to go off on vacation in the summer for two months (a luxury at the time). Another classmate and I went to Europe riding the trains and backpacking. We ended up on the far side of the island of Corfu in a campground. As we were setting up our tent I heard a voice from another campsite. It turned out to be Joe who was traveling on his own in Europe! One of the few moments-memories I cherish during my schooling along with my friendship with Jeff and Jill (all of us were from California living in the foreign land of Wisconsin).

    I want to add that advocating for proper time off for students and interns, residents, fellows is critical. My residency program in Internal Medicine essentially made us draw straws for which month in our internship we would get vacation. I drew the short straw and had to take the first month of internship as vacation. I came back from “vacation” behind all of my intern classmates with no time off left in the year. As you can imagine I went through a mini crisis after Jeff’s death where I felt that the training and setting for my internship did not support or look like what I wanted to be as a physician. I was barely “allowed” to go to his funeral were it not for my resident. I had been on call the night before and up all night admitting and caring for patients. My resident let me leave in the AM to fly to LA for the funeral (I made only the burial not the service). It all remains a blur to me except for standing alone over his casket in the hole at the end and putting a decal from our favorite band in his grave. I had to return that afternoon and come back to work the next morning. Later that year I went to my program director and told him I want to take the next year off. I spent that year working in the local outpatient clinics and assessing whether I wanted to continue my training. Fortunately I realized that residency training was not representative or indicative of the profession and went back.

    I also took the year “off” between college and medical school to explore myself and the world before the big commitment. It was a year which I still cherish and have friendships for life. I have shared these insights and advocated to our medical students, residents and others that it is okay to take time off for personal and professional development. It should not be seen as a “gap” in your resume as long as your soul, motivations and goals are nourished. Now some thirty years later I find a new chapter in my career as I pursue developing and supporting a lifestyle medicine approach to my practice and our clinic. The vital signs of nutrition, physical activity, social engagement, stress management, and sleep have taken the forefront for treatment and prevention. Physicians and all healthcare providers need to check their own vital signs frequently before they go silent.

    Unfortunately suicide remains a pervasive issue for everyone. It has been in the top ten causes of mortality in the US for several years. I recently had a good friend from college (non-professional) kill himself. As I reached out to others it was amazing (and disheartening) how many of us have known someone (or many) who took their own lives. It is a dialogue and advocacy that must continue for all of us until the underlying causes in society and our environments are addressed in a positive and supportive way.

    Thanks for your work and please feel free to share this information as you see fit.

    With gratitude

    Jordan

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