Surgeon General’s Warning: Medical school may kill your child.

Cheryl lost her son Sean to suicide in medical school. Just a few months ago. Her only child. Cheryl didn’t know that medical students were at high risk of suicide—until her son was dead. Nobody warned her.

Sean Petro Medical Student Suicide

Rhonda lost her daughter Kaitlyn to suicide in medical school. Unable to recuperate from the pain of her daughter’s suicide, Rhonda died by suicide one year later. Rhonda didn’t know that medical students were at high risk of suicide—until her daughter was dead. Nobody warned her.

Kaitlyn Elkins Medical Student Suicide

Michele lost her only son Kevin to suicide in medical school last year. Just 3 weeks before he was to graduate. Instead of celebrating her son’s graduation, she attended his funeral. Michele didn’t know that medical students were at high risk of suicide—until her son was dead. Nobody warned her.

Kevin Dietl Medical Student Suicide

I was severely depressed in medical school. I lost both classmates I dated in med school to suicide. Suicide is an occupational hazard for medical students and physicians. Recently, I started a support group for parents who lost their children to suicide during medical training. They all wonder why nobody warned them of the hazards of a medical education. If someone had warned them maybe they could have saved their children’s life.

Cigarettes, cigars, chewing tobacco all come with a Surgeon General’s Warning. Why not medical school? If medical school came with a Surgeon General’s Warning, what would it be? I posed this question to medical professionals. Here’s what they told me.

“I’m an oncologist and this is a package of cigarettes and these cause cancer and you can read that right on the side of the box. It says Surgeon General’s Warning: Smoking causes lung cancer and there are a few other diseases that it causes and they are listed here. And I have a warning for people who may want to go into medicine. This would be my Surgeon General’s Warning to those people: Surgeon General’s Warning: Medical training and the practice of medicine can result in the loss of moral behaviors and expectations. This condition is termed demoralization and can be fatal.” ~ Dawn Lemanne, M.D.

“Medical school may cause poor self care, suicidal ideation, and will complicate pregnancy.” ~ Stephanie Waggel, M.D.

“Medical school could kill your child. [It’s] demands are severely underestimated. Ensure that your child has the ability to do this. Do not ideally assume they are smart and talented and send them off. They may die. Many have.” ~ Andrew Chang, medical student

“Protect your child as they enter this dangerous minefield. 1) Remind them that you love them unconditionally. (No one will be telling them that for many years). 2) Always tell them it’s okay to cry. 3) Call me anytime you want. 4) Venting is vital. 5) You are beautiful.” ~ Annmarie Ray, M.D.

“Medical school attendance may lead to any of the following: isolation, sleep deprivation, demoralization, stress, anxiety, obesity, alcoholism, drug use, abuse, bullying, emotional detachment, poor relationships, divorce, bankruptcy, sexual harassment, disillusionment, compassion fatigue, self-neglect, unethical behavior, mental fog, chronic conditions, preterm labor, suicide . . .” ~ Maili Velez-Dalla Tor, M.D.

“It will separate you from the people you love, prevent proper bodily functions such as bowel and bladder, cause extreme guilt that you are not doing everything right, and lead to loss of life.” ~ Wendy Schilling, M.D.

“Hypertension, diabetes . . .” ~ Lisa Splitstoesser, M.D.

“Extreme fatigue, denigration of self-worth, trauma, chronic illness, and suck the joy and passion right out of you.” ~ Ana Maria Sierra, Ph.D.

“[these health conditions are] Due to the blatant disregard for your own mental and physical wellbeing. It [the abuse] is perpetrated by your supervisors and administrators while you hold the weight of the world on your shoulders.” ~ Sangita Pillai, M.D.

“Surgeon General’s Warning: Residency may cause a psychotic break in previously healthy people.” ~ Kayla Luhrs, M.D.

“Is likely to cause loss of compassion, libido, health, wellness, sleep, close relationships, and overall joie de vivre. Apply at your own risk.” ~ David Kwon, D.O.

Informed consent is required in medicine. Everyone deserves to be informed of not only the health risks of using tobacco; they also must be informed of the health hazards inherent in the medical profession. Do you agree?

___

Pamela Wible, M.D., reports on human rights violations in medicine. She is the author of Physician Suicide Letters—Answered. Her TEDMED talk “Why doctors kill themselves” addresses the hidden medical culture of bullying, hazing, and abuse that endangers physicians—and patients. She hosts biannual retreats for medical students and physicians to help them heal from the trauma of medical training. Depressed Struggling?  Contact Dr. Wible for help. Video by GeVe.

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35 comments on “Surgeon General’s Warning: Medical school may kill your child.
  1. BK Milburn says:

    Dear Pamela —

    Keep up the good work of getting the word out that ABUSE, that is unresolved, such as the horrendous conditions physicians are often required to work in, is the Root Cause of the large majority of suicides. We used to have labor laws, that at least protected the “Working Class” of the USA, and those have been diminished and the pool size of “Working Class” shrunk.

    When companies are able to label an employee as “Exempt Status”, which most, if not all physicians can be, the potential for an abusive Employer-Employee relationship exists. As a consulting engineer, which tend towards being the techno-geek-equivalent of physicians, some of us apparently took one of the employers to court, and it was clearly stated that if the consulting firm charged for the employee’s time, the employee must be paid for the hours they work.

    This obviously creates the “Golden Handcuff” issue of good employees getting worked into the ground. I even had one of my clients laughingly saw that he did not care if I was being overworked, because when I broke, he would toss me aside and get another consultant to replace me.

    Those replacements had subsequently shorter terms of engagement and word got out that my former position was best avoided. Direct employees may have it even worse.

    Some companies try to get them “young and dumb (gullible is a better word)”, use up those twenty years where a person can “burn the candle at both ends”, then toss them aside. The person often is bitter because they did not realize that THEY would be one of THOSE people.

    Being abused sometimes, because I was/am an intelligent (and modest) female engineer, was actually a blessing. I knew that I could only survive ten more years of the abuse and retired early.

    Then I found that the “Healthcare Industry” and Academia could be far more vicious than Engineering/Construction, where the Laws of Physics keep us firmly based in reality. Engineering/Construction people may bicker and fight sometimes, but frequently dozens to millions of lives could be on the line, if or when we are in error.

    So this Veteran’s Day, let us all please remember that people gave tremendous amounts of themselves, including their very life, so that we can ALL pursue Life, Liberty and Happiness, using the values of Honesty and Hardwork, while caring for the less fortunate. These people that take advantage of others, including the seditious element that resorts to “Clicky System” torture to steal from others, like they do, need to be stopped. Intelligent and wise people may then, again, be willing to become Physicians.

    • Shikha Baishya says:

      As someone looking to go into the medical profession, this really made me rethink my choices and I am really thankful to have come across this. I think that everyone should be made aware of the dangers of anything they are about to enter.

      • Pamela Wible MD says:

        Informed consent should be mandatory upon entering any profession. Clear risks and benefits reviewed in detail. Here’s something else that premedical students are rarely aware of until the have amassed huge student loans—the may not be able to even use their medical degree: http://www.idealmedicalcare.org/blog/im-a-doctor-im-on-medicaid-i-work-as-a-waitress/

      • celia padron says:

        if you have a passion for medicine you should go for it, nothing like doing what you like the most. it is important to know the risk and act upon it if you feel the pressure. most med schools offer free psych visits where you can vent. with a good family and friend circle you can also overcome those feelings. i am a physician, felt a little presure during residency for the many hours on call, that has changed since i graduated. the more aware they get the more changes for better they will do. go with your dreams!!!

  2. So much work to be done to heal in the world of medicine. I am so grateful for the efforts to change how we relate to each other in the intense crucible that is medicine. Perhaps Compassion/Self Care 101 need to be a required part of medical curriculum, and not just for physicians.

    • Pamela Wible MD says:

      Kind of a challenge to teach self care at a work camp. Great idea though. Let’e eradicate the human rights violations in medical training and practice so we can finally deliver health care as whole healthy humans. http://www.idealmedicalcare.org/blog/meditation-is-not-the-treatment-for-human-rights-abuse/

      • BK Milburn says:

        Thanks, Pam, yet again. Other leaders in workplace abuses keep talking up “self-care” and other blame-the-victim strategies. I bought into thinking that would work for some people, then realized there was a lot of “Work as a place to go; not a thing to do” and passive-aggressive types, especially in the more abusive workplaces. Certainly, these classifications have wide ranges of applicability, with People being People, and all.

        Why we do not have a system where people are asked to commit to what they are willing to do, negotiate the pay, then both sides honor the agreement, excepting changes in conditions, is beyond me. We over-complicate things, as a society, then wonder why it does not work right.

        Straight talk, followed by others explaining the “Facts of Life”, if necessary, would go a long way towards re-unifying the People of the USA. Part of that “Straight Talk” is having leaders actually understand the laws and realities of things available for purchase, rent, etc., then seeing if that is workable, so that the necessary upgrades in income, and downgrades in technological over-complications, can be made.

        How many physicians’ families and communities are better off with those physicians in their offices so much, that they spend too little time with their families and out in the community? Granted, people being people, there will be some, but I have not met one yet, personally, that I would classify as that.

        So keep writing and talking! What you are promoting — some more physicians returning to self-employment, especially as a sane way to divorce oneself from abusive work environments, is wise. I did the equivalent as an engineering consultant, starting twenty years ago, but too many clients tried to shift their liabilities onto me, making it foolish for me to continue that path of income generation. I am not seeing Medicine being as capable of shifting an undue amount of liability onto a lone physician, especially in this technologically well-connected world and Law Enforcement more willing to pursue civil law violations as criminal actions.

  3. I am an Hyperemesis Gravidarum and health advocate and this is the first time I heard this ! The word need to be out there ! It makes since why so many doctors at times take it out on the patients , being over work unappreciated and push to your breaking point . The Hippocratic oath is Do no harm , if doctors are being over work and having to work hours long past they should they are not going to be able to work in there right mind .
    This is an eye opening video medical School and the pressures to be perfect in a humen world !
    Keep spreading this , for someone who educates doctors at medical conferences this is such a eye opening video !

  4. Coleen Howard says:

    Everyone should share this important story. ((( <3 )))

  5. Kate Copsey says:

    Wow! What about Law School?

    • Pamela Wible MD says:

      Bullying, hazing, 120+-hour weeks with 28+-hour shifts in law school?

    • Michael says:

      I don’t know any stats specifically about law school, but practicing lawyers commit suicide at a rate significantly higher than the general population yet still quite a bit less frequently than doctors.

  6. Kesha Crichlow says:

    Last year I was shocked to hear that two doctors from the hospital I trained at both committed suicide. The only thing they had in common was their career, place of work, being single and gender. They couldn’t have been anymore different from one another, one black the other white, one a subspecialty surgeon the other a radiologist, one at the beginning of his career and the other in the middle. Their personalities were also drastically different, arrogance vs compassion, aloft vs friendly. But still in the end they both committed suicide, leaving me as well as their family and friends to wonder why. I too have battled moments of stress and depression, along with the sense of isolation because despite having friends you want to be the strong doctor. Despite being married there are somethings your partner won’t understand. This issue must be addressed by every training program and we all need to be trained on recognizing depression within ourselves or our colleagues. Doctor treat thyself begins with talking to someone, anyone. This is a public health emergency, we already have a shortage of physicians due to training limitations and burnout, we have to stop this tragedy. Thanks for opening the discussion.

    • Pamela Wible MD says:

      Thanks for writing Kesha and I am so sorry for your loss—our loss—of these physicians. Until we correctly identify that we are suffering from chronic human rights violations (not burnout), we will continue to lose these beautiful brilliant physicians. I have an entire section of my blog devoted to the “burnout” smokescreen that covers up the real human rights abuses that are rampant in medical training and practice: bullying, hazing, sleep deprivation, lack of access to mental health care (without punishment and potential limitation/loss of career) to name a few. Please see these articles:http://www.idealmedicalcare.org/blog/category/physician-burnout/

  7. Christiana Shoushtari says:

    Im a current medical student & very much appreciate your article! I personally know of many student leaders actively trying to impact change at different levels of policy to promote “wellness” education in our medical training curriculum.

    So, Im not sure how much you are following this topic, but I was curious to know your thoughts on the ACGME’s consideration of lifting the 16hour-limit of resident work hours?

    • Pamela Wible MD says:

      The ACGME lifting he 16-hour work hour limit is absolutely unethical. Sleep deprivation is a torture technique. We can no build a health care system on a foundation of human rights violations. Have you seen this? http://www.citizen.org/hrg2335

      • Mary Zozulin says:

        “A heart has to do what a heart has to do”
        The Practice of Medicine is a all encompacing profession that takes over every aspect of your and your family’s life. If it is what you love go for it but protect yourself also because no one else will. We need the system revamped and better cooperation among doctors to help each other instead distrust each other over money issues. Love your family hard and plan great getaways together. Be proud and be proud of each other and our aspirants which is our future. Take a break if you are unhappy or unsure. It’s ok to do something else because your heart might like that better. Nothing is worth being unhappy all the time. My dog got me through med school and residency and 2 labors. I r/c a pet.

  8. Cristin says:

    Veterinary school is similar, same work load and stresses, even less money. They are 4 times more likely to commit suicide than the general population, and may actually be at more risk than MDs. Please be nice to your medical professionals, of whatever species. They are doing the best they can to solve your problems while dealing with a heavy load of their own.

  9. Mike Abernethy says:

    I guess you could say the same about the military. ( Ive been through both). No doubt it was a stressful time, but at least for me, the 4 years of med school was one of the most amazing intellectual & social periods of my life (to date). At the same time, one of my classmates committed suicide during our third year. How is it that 2 people are exposed to the same environment – one person can flourish and another utterly disintegrate. I wish I had the answer.

    • Pamela Wible MD says:

      Exactly why we need to study these suicides and stop hiding them. Honest and open discussion would help. Taboo topic keeps us all in the dark.

    • BK Milburn says:

      I commend you for your accomplishments and am sorry about the loss of your classmate. Unfortunately, what is the “same environment” can be experienced in vastly different ways. In addition, some of the passive-aggressive types and other trolls, are able to take “digs” targeting one or more people, when the surface of the communications appear calm.

      There is a strong chance that this DID NOT happen to your former classmate, but overwork, lock-step requirements for advancement and other abuses make it more difficult to solve problems or escape the damage caused by those people. There are also sick people among us that ENJOY destroying others’ careers — getting away from them is really the only solution, which many of these sick people will prevent.

      Pamela’s quest for sane workloads makes it much less likely for suicides to occur, because people will then still have resources to develop options, if they find themselves in predicaments.

  10. Jenn says:

    I am currently done with my surgical training…4 years of med school, 5 years of residency and two years of fellowship. My lowest darkest point was medical school. What made it worse was the pride of becoming a doctor and wanting to protect that image. That feeling would be trumped by understanding that I too was human and would not be able to care for others if I was also suffering silently. For this reason I finally sought help from friends and a therapist. There comes a point or points when you question everything over and over…it would have been easier to know others were struggling like me. For this reason 10 years later I feel compelled to encourage med students and their families to be aware of this risk but not hesitate to seek help early. I’ve always wanted to write about that experience as well as the struggles faced quietly after med school…such as a surgical resident struggling as patients we cared for got worse or passed and we were compelled to keep moving while our hearts healed (or continue to grieve and heal) at their own pace.

  11. TedMed says:

    I think this is so exaggerated and wrong that i don’t know where to begin with

    • BK Milburn says:

      Would you please provide more of a basis for your remark? People have many varied experiences. Some places are responsible, responsive and are terrific organizations for one to affiliate oneself.

      However, other organizations/people may be, at one or more levels, petty, greedy, lawless, etc., to the point of causing undue harm to others. These writings target those people/organizations that do not know how to operate fairly, and especially if they vehemently fight the learning process. I VOLUNTEERED at one of those organizations, and they are still harassing me and tried numerous times to cause my death. (Yes; Law Enforcement is on the case.)

      So please, let us know your background and why you find speaking out so objectionable.

  12. Mary Zozulin says:

    I find it interesting that resident’s and med student’s hour are limited (I think they should be) but practicing physicians are not limited or monitored or even a concern. I work 24-36 hours straight still with no sleep on my feet. I take call for 3 days straight on weekends and sometimes get 12hre sleep the whole 3 days and that is even interrupted. We think this isnormal and don’t say you are tired because that means you are a wimp or dumping on partners or don’t care about your patients or something ike that. Yeah this is abuse we set up and participate willingly because it has been this way a long time is what I am tols.

  13. Anonymous says:

    When I was PGY1, I went through basic clinical training. We would have 1 in 4 calls in one given month. Call shifts were officially restricted to 24 hours. Most departments would respect this, except internal medicine, and most particularly CCU.
    I was forced to do 30+ hours when I was rotating through GIM and cardiology. The cardiology chief threatened to fail me if I didn’t do 36 to 48 hours. I didn’t do that – only 32 to 34 hours max, and she failed me.
    The week after my cardiology rotation, I had to be admitted to psych because I was psychotic, and my program director realized I lost a lot of weight within 3 months. I went from 55 kg to 36 kg.
    The psychiatrist said I was psychotic because of the sleep deprivation.

  14. caroline ferris says:

    While I know that medical school is stressful as I did it myself… and 2 people in my class died by suicide – 98 did not. Could it be that the personalities of those who die by their own hand be such that other professions for them could have ended the same way? I have watched all the Ted talk and the book – and I agree that much of medicine is somewhat archaic in its methods – and stressful and dehumanizing.. much the same way the military and boot camp is for so many. Could the trick be to treat it simply as a job – like training to be a plumber or a journeyman electrician somehow deconstruct the trouble it all seems to cause? To me it is an interesting way to make a living. Thats about it. If I could not do it anymore I would be a Barista or work planting flowers somewhere. I have zero pride nor personal life invested in it. It is a job. As against the medical code of honor this is: really – it is just a job. You get up, put your pants on and go make a living… like all the other people who have to make a living. This is what I taught my residents for years. They were always appreciative of this fact. Getting people to believe that they somehow had to be superhuman or super smart or whatever to do this job is what gets so many of these young people in trouble. We try we fail or we sometimes succeed. It is how life goes.

    • Pamela Wible MD says:

      Good point. So many docs have dreamed of making a difference in medicine since they were 5 years old. I think it’s hard for some to conceptualize as “just a job” when it seems their soul’s purpose is somehow wrapped up in the profession.

  15. Matt says:

    I’m not a medical student. I’m pursuing a M.S. in Environmental Science. I never realized how much stress is on med students. As a patient I’d rather know that the people treating me have been treated well themselves. If they aren’t treated well, how can they treat me well?

  16. Mark Mecikalski M.D. says:

    At 65 I am almost done with my medical career..saddens me to see what I thought was a bad situation 40 years ago is even worse. I have survived and done well by making career adjustments, but that was because it was possible to be more flexible because you could work with your fellow doctors, who had independent practices…just about everyone was their own boss, from family practitioners to ER groups..now more doctors are employed. Listen: YOU CANNOT SERVE TWO MASTERS. If you are an employed physician you are in a hopeless position of being held by society to be responsible for your patients, yet controlled by your employer. If you plan on taking care of patients, do not become a doctor unless you are committed to work in a situation controlled by doctors that you have an ownership stake in. Otherwise don’t take on the patient care responsibility or don’t become a doctor.

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