I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide. I’ve lost only colleagues, friends, lovers–ALL male physicians–to suicide. Why?
Here’s what I know:
A physician’s greatest joy is the patient relationship.
Assembly-line medicine undermines the patient-physician relationship.
Most doctors are burned out, overworked, or exhausted.
Many doctors spend little time with their families.
Workaholics are admired in medicine.
Medicine values competition over nurturing.
Many doctors function in survival mode.
Doctors are not supposed to make mistakes.
Caring for sick people can make you sick if you don’t care for yourself.
Medical education often dissociates mind from body and spirit.
Some medical students believe they graduate with PTSD.
Seeing too much pain and not enough joy is unhealthy.
For a physician, a cry for help is weakness.
The reductionist medical model is dehumanizing for patient and physician.
Many doctors are emotionally detached (especially male physicians).
Doctors are obsessive-compulsive perfectionists in an imperfect medical system.
Physicians are the nation’s social safety net with few resources to help patients.
Some doctors feel like indentured slaves.
Death is perceived as failure.
Doctors don’t take very good care of themselves or each other.
Many doctors are in denial about the high rate of physician suicide.
Physicians are often bullied by insurance companies, employers, and patients.
Doctoring is more than a job; it’s a calling, an identity.
Doctors are often socially isolated.
Doctors can’t just be people. They’re doctors 24/7.
Doctors can feel severe psychological pain.
Doctors can feel powerless.
Doctors can feel trapped. Some see no alternatives to their suffering.
Doctors have easy access to lethal drugs and firearms.
Doctors have the same problems as everyone else.
Doctors have marital distress. They get divorced.
Doctors have addiction to drugs and alcohol.
Doctors have economic hardship and unbearable debt.
Doctors have mental illness.
Doctors are human.
As a third-year medical student, I can extrapolate all of the above statements and feel their truth in my gut. The economic hardship part rings particularly true at this point, but I trust/hope that will pass. At this point, I often feel trapped, like I can’t be myself, like we are constantly being watched. Upholding the utmost level of professionalism is drilled into us from day 1.
I see it already: the day-to-day minutiae, the email fatigue, the endless requests for you to DO something OR ELSE, all of it. Not being free to take care of yourself, developing a warped sense of what “time off” really means (not much), feeling guilty when you advocate for a meaningful quality of life. When it all builds up, I go see patients, and all this B.S. I’m complaining about melts away, for that time. Therein lies the key!
Yes. We need less “to do”and more time to be. Just be. I also get centered and recharge around patients. It is the system that beats one down.
Definitely MUST read the comments here: http://blog.oregonlive.com/health-care/2012/12/why_physicians_commit_suicide.html
Oh and please cut & paste your comment above on The Oregonian blog. Time for a candid discourse on this topic!
Extremely powerful. Fortunately I have not lost any colleague that I know personally but there was one physician suicide that I know of in our community about 2 years ago. The practice manager was a patient of mine and it really rocked her world.
But as we say in medicine death is only one extreme negative endpoint. Doctors and patients are suffering every day.
Keep up your important work.
DFD
Thanks John! Will continue “to ask the difficult questions.” This was the recommendation from the widow of a physician lost to suicide in our town.
Powerful.truths. Saw myself there more times that id care to count.I ve been a physician for almost 25 years now,lived in the US but was put off by the coldness,the machinery feel of it all.In my third world native country is a different deal bt then you have a whole different set of irksome problems:unchecked mediocridity,inadequate resources,damn impotence!!Back in my Internal Medicine Resident(just the first year,enough was enough for me)I became so frustrated I abandoned the carrer for more than three years.Now I live in a rural area and am planning a holistic practice.lets just exchange input.
Thanks Carlos for your honesty. Please let me know if I can be of any help in planning your practice. Physicians should nurture one another and collectively we will demonstrate what a health care system can be. I’m here if you need me.
A dear friend & surgeon committed suicide last spring. We’re still struggling to understand why, and can’t help but wonder if we could have done or said something differently to prevent it. It’s an important issue.
Yes, such an important issue and many people are unaware or in denial about the high numbers of doctors committing suicide. Unfortunately, there is no agency tracking all the data in any effective way. That’s part of the problem. Claiming this as a public health issue is the first step in healing. Please let me know if I can be of any further assistance. I’m here.
You put this so well – I just sent the link to your post to Sen. Sanders, for their health care hearing this month.
Wonderful Jennifer Michelle. Thank you. This is an underreported public health topic. Physician suicide is the triple taboo. Three issues so difficult for Americans to discuss: death, suicide, and healers harming themselves.
I am not a Physician but I know many as there are close family members Number One reason why Doctors commit suicide is
Doctors think them self as a Super Man and they consider every other physician as competitor this ego makes them not seek any kind of help, also isolates them and make vulernable for other sharks to in the tank (lawyers, insurance companies) to take advantage of them.
Doctors needs to collectively address this situation before anything they need to admit and understand they are humans they don’t think of themselves, after working 48 hours shift they think they can do this allover again after a brief nap
So true! And a repeat 48 hour shift after a brief nap. Love that line. The stories I could tell on this topic!!!!
Thank you for this article. I am in my final year of medical school and have had several classmates attempt suicide over the course of my degree. I love medicine and I love people, that’s why I chose this profession. Sometimes when awake studying at 3am, or watching an autopsy, or witnessing highly emotional scenes at the hospital, I feel incredibly alone. Sort of like I’m not a part of humanity! It deeply saddens me that classmates and colleagues feel they are unable to seek help for their problems, and I hope there is more research in this in the future.
Julie ~ I’d love to talk to you. You are not alone in your feelings. I am dedicating myself to helping other medical students and doctors be the healers they always wanted to be. There is no need to continue training physicians in a manner that isolates us from one another and leaves us feeling disconnected with our hearts and souls. Call me anytime. 541-345-2437 . . .
Thanks so much for calling attention to this very real, and very serious issue. I am a physician (psychiatrist, fortunately) as is my husband. Our 29 y.o. Physician son died of suicide (now the more PC term that physicians should be aware of) in June of last year. We struggle everyday to understand the “why” of this. As you point out, the causes and contributing factors are many. He struggled with depression and alcoholism and was being monitored by the Missouri physicians effectiveness program. When he relapsed 1 week before he was to begin his oncology fellowship at a high-powered academic institution, he notified the board, then got drunk and took his own life (with a scalpel). No one at the hospital claimed to have any awareness of his struggles, worse yet, they cleansed the death notice we provided them of unsavory details. They clearly see his death as an injury to their institution. They have offered little in the way of condolence to us. This matter must be brought into the light of day. The lack of data about the number of suicide deaths is appalling. The monitoring people from the Medical Board ( who were the last to speak with him that day) have provided us with scant information. They told us that they did not plan any sort of internal case review. He was seeing a psychiatrist, but they never sought collaboration with him. They thought he was a “model patient”. So this is what oversight by the Medical Board provides to impaired physicians. Well, I could go on…..and probably will…but want to hear more from others. How can we take action? I cannot bear the thought of young doctors as dedicated and talented as my son dying in such a tragic manner. Your list certainly resonates with Greg’s struggle to come to grips with allowing himself to be human and vulnerable in such a highly competitive environment and to deal with the shame he felt about his very human vulnerabilities.
Thank you SO MUCH for being open and honest about the tragic loss of your son. I believe the Medical Boards should be tracking these deaths. We should certainly be able to have correct data and statistics on the loss of our own colleagues. The level of denial is disturbing. We can not allow our healers to suffer in isolation. The first step would be that we collectively recognize this as a real problem among physicians.
I thank you for the website and the many comments by people. I qualified in the UK and things here appear to be the same. I have several colleagues who have committed suicide over the years, and I feel lucky to have survived myself, for all the reasons you describe. I am particularly taken by the PTSD image. Yes indeed I was traumatised in medical school and it continues to happen, but we get accustomed to it, to the point of becoming an abused class.
Thank you for sharing your thoughts Christian. So sad that medical students and physicians have become accustomed to so much abuse in what should be a healing profession for all, patient and physician. Let us bring this issue to light so that we may heal together.
Suicide is becoming an epidemic in our society. Every suicide is a tragedy that leaves a wake of grief and unbearable guilt. Unfortunately, family, friends and loved ones are left to suffer the rest of their lives due to the “what ifs and whys”. I have been touched by suicide more times than I can count, most of them young people between 15-25.
It breaks my heart that anyone ever reaches the point where they feel their life doesn’t matter or they feel they have no where to turn. Yet I know everyone who contemplates taking their life has many, many people who lave them and would do anything to help them. As a society, we need to teach our children it’s okay to ask for help!
My desire is to start a program, go into middle schools and high schools providing tools and messages of hope and purpose. Please email me if anyone has any insight or resources that could be helpful. We must shine a light and turn the tide on this tragic epidemic that is gripping our nation! My email is margopowell @yahoo.com.
My post was meant to say “many people that LOVE them”.
Pamela, thank you for your important work in this area and your powerful insights.
My purpose for coming to this sight was because a beautiful female acquaintance took her life recently. She was a physician with a promising career and successful practice. She was married to a handsome pyscholgist husband, had everything to live for and yet lacked purpose. Couldn’t make sense of it then and still can’t. My condolences to all that have suffered a loss to suicide!
Hi Margo, Thank you for writing. I am going to start interview people (physicians primarily) who have survived near-suicide. Doctors are the worst at asking for help – especially male doctors. Men don’t even like to ask for directions when they are lost!
Oh my! Where do you live? We must stay in touch. If you hear of any docs who contemplated suicide and then chose not to proceed, I would like to speak with them.
Hi Pamela,
Hadn’t come back to your site since my post. I recently heard of a young intern who recently tried to hang himself in the hospital he was working at here in Honolulu. If I can find his name and contact information for you, I will.
I am diligently working to put my program together for young people. The statistics surrounding those most vulnerable are frightening. The numbers are increasing dramatically:(
Thanks for keeping me informed. I am offering a biannual retreat for physicians to prevent suicide, depression, and burnout. Please let folks know. It is open to anyone in health care, but ESPECIALLY physicians. Physicians rarely ask for help. They need to be lassoed and dragged in. (excuse the metaphor, but it is TRUE!)
I think almost everybody who goes into a healthcare field has a strong sense of purpose . . . then you arrive at the factory floor (medical school/nursing school) and realize that you’re still competing with others and should anything happen to you, somebody will step in to fill the void. Given how dehumanizing healthcare is, (for both patients and care providers), it is not wonder that doctors feel they don’t have a purpose. And of course there is the issue of the biochemical etiology of depression, meaning that depressed people might not “have a reason” to be depressed, yet be very depressed.
I enjoyed your post and these stories need to get out there because our
health care system is SO SICK for reasons the general public has no idea
about!
I’d love to mail you a book if you send me your mailing address.
Also LOVE it if you would come to the next retreat. You should
heal from the abuse that you may still be carrying around. It is
so hard to get the sadness and anger out of ones system after
being SO ABUSED in a health care training program!! I know!
It took me a good ten years to heal from all that sadistic treatment.
Anyway here is info on the retreat in October:
http://www.petgoatsandpapsmears.com/retreats.php
I bet there is a way you could still practice medicine – on your own terms
and consistent with your highest values. It would be my honor to help you do that.
~ Pamela
While I am not a physician, I am a medical caregiver. I have been a nurse over 22 years…now, after all these years I have discovered (with therapy, reading mountains of books, clocking countless hours of research) that there are reasons some of us choose the medical field. For myself, as a wounded child, I believe now I want to help heal and reach the “wounded” in a way that was not there for me as a child…. so after years of medications, 4 in-patient stays, hospital oncology, hospice and now pediatric private duty nursing. I want a sabatical. I want to become a doctor office fish aquarium cleaner-so that the fish/eels AND patients can see each other clearer and learn to judge less, understand more and speak truth in love the way it truly was intended. Right after I get out of my wading pool and finish my celebatory cigar.
I understand everything that you stated about how much it takes to be a doctor and how much you do to heal a very sick world.However,we as patients hurt as well…Here is my story. I have been suicidal ever since a doctor that I trusted and had a great doctor patient relationship with. We both agreed on a very minimal surgical procedure and the cost was basically average for the sinus procedure. But he took it upon himself to bypass that and it cost over 90.000 and left me miserable 24 hours a day with Empty Nose Syndrome. I know I will kill myself while the doctor will be at his grill on the 4th of July. I’m sure he needed the money for his huge practice.I would rather die than sue him,because I’ve read that doctors kill themselves when they are sued,and I’m already dead
I suggest you write a letter to the doctor and that you seek help from your family physician, therapist, or counselor.
i am so sorry that doctors commit suicide but my doctor ruined my life for profit and my target day for suicide is mothers day. He will be playing golf that day.
I would hope that you will seek out support from the skilled professionals mentioned above.
Don’t forget about bullying by police for illegal search of your patients files and regulatory authorities who often treat colleagues in a very poor fashion during their investigations, hiring experts who create most dishonest reports. I am a coroner and would be most interested in helping any physicians suffering from stress and depression.
Yes! So true. Here’s an example of the bullying:
http://www.youtube.com/watch?v=3v4Sq7oDCgo
I traveled across country to attend medical school in the northeast, and became precipitously depressed before 3rd year, and was hospitalized. Everything was so depressing, the trees looked barren bones in winter, I would use a public webcam setup back home to see what home looked like, I was that homesick. I visualized the day I would be able to leave this city. My psychiatrist worked at the school and did not like me, and specialized in ER care, not outpatient, and even I had to stop going to her because she stared at me in a kinda of angry way, and just asked about symptoms, quick 3 min. visits. So, yes, schools and hospitals hate it when one of their own has mental health issues.
I had significant trouble on one rotation where the attending took great pleasure in bullying the students, and I saw real pathology among fellow students who felt like they couldn’t “take it” anymore, and complained of “PTSD”. I am not currently practicing medicine (for reasons quite possibly stemming from the fact that I never could find adequate mental health care). But I am surprised nobody at the school asked me what they could have done better (maybe they concluded that I Darwined myself out of medicine!). I would have said:
1. Vitamin D. Seriously, up north there is less sunlight, and students/doctors complain about not getting to see the sun (could there be a physiological reason for the desire to get some fresh air?). They might want to consider giving all students/residents/attendings Vitamin D, considering high suicide rates, and/or consider blue light therapy for seasonal depression. Even in areas with a lot of sunny days, doctors/students are keep indoors for large stretches.
2. Poor nutrition. I eat much, much healthier now. It is important to make fruits and vegetables 1/2 of the foot on the plate. Have you seen what they serve in hospital cafeterias? Corned beef and junk like bacon and scrambled eggs for breakfast. Berries pack a lot of antioxidants, and for me, they help relieve stress. High quality food would include things like 2 cups of frozen blueberries blended with a banana, not what is served in hospitals today.
3. Malignant workplaces. Some hospitals/clinics have a great group of professionals to work under, other times there is a culture of belittling and harassing the person underneath you. Sure, if all you’ve known is the abrasive culture then you might well consider getting out, or unfortunately harming yourself. Some people can take a real perverse pleasure in messing with you! I was very naive when I started medical school, believing that fellow students would be helpful, and that attendings were generally interested in teaching. Medicine is competitive, and attendings compete with students even, so you have to constantly make sure you’re not overtly being a brown-noser while you try your best to please the attendings while not “showing off.”
These high maintenance superiors take a lot of physical energy and brain power that could be used to care for patients, and this very depressing! This is why that radiation oncology doctor killed himself . . . his own colleagues didn’t value his time, or the effect it would have on his patients, to drag him through the mud. Poor guy logically concluded that either his colleagues were sadists, or they were correct in appraising his value somewhere around the level of pond scum. Either scenario is depressing enough.
Medicine is so competitive (attendings do hate students who want to go into their specialty) that I have *no* doubts whatsoever that a good chunk of attendings are perfectly fine with 400 physicians suicides a year as only those who are tough like them deserve to be doctors, (not suicides who they view as just being weak people) and more deaths among colleagues means less competition.
4. Lack of sense of team. Doctors fight with doctors, and students are little more than transients who get kicked around, on some rotations. Often the department head is inapproachable, and runs the department like a fiefdom.
5. There is nobody to commiserate with. My parents are doctors, and they can discuss things with each other, I had nobody. If you are a student doing poorly on a rotation, or having problems fitting in, or have a personality conflict with an attending there is nobody to commiserate with:
A. Professors, teachers, attendings will tell you to buck up, and that you are weak.
B. Fellow students who aren’t having said problems will look down on you as everybody is competitive.
C. People outside of medicine won’t get what the big deal is.
6. The future is bleak. I really love a lot about medicine, the teaching, rounding on patients, the community aspect, but for some reason a lot of attendings didn’t go into medicine for these reasons, or forgot why they did it in the first place and trash talk medicine. I got depressed reading dribble online from malcontents, should have realized you probably can find a happy medium. Also, lot of attendings’ sort of teach via intimidation and you only learn tidbits of knowledge, and it is depressing that you don’t get taught more.
7. Too much self-pity. It was depressing all of the self-pity talk among doctors, I remember hearing an orthopaedic surgery resident giving us a lecture, he lived in New York and complained that he was still paying of his tuition loans. Well, yes, you will need to do that. The guy sounded really, really depressed, even though he would in the future be able to pay of his loans, I got depressed just hearing about it. You hear nightmare stories about GP’s going out of business, but in reality they could work for a group practice or do intensivist work. It didn’t make sense, but I kinda bought into all of this self-pity as a student.
8. Lack of control over your life. For me, my mental health breaking point was when I considered the randomness of residency training. My medical school experience overall was hell, some rotations were great, but others were a nightmare. I was homesick, I would have gone with a peds specialty, or general peds/med-peds, and devoted myself to part time international service. But there was one big problem that held me back from doing the best I could (or even caring in the end): I had no choice with regards to residency and could get a malignant place. I could end up in middle of the most malignant residency program on earth, and I would always have the memory of the nightmare rotation experiences. Yes, not rational, but perhaps tinted by depression.
My last piece of advice would be that if you need the services of a psychiatrist, don’t go to one at your own institution! I was asked to sign paperwork so that my psychiatrist could communicate with the school concerning my condition . . . big mistake. Of course, I’m sure patient confidentiality goes out the window when it comes to a student with mental health issues. I was pretty naive.
I appreciate the opportunity to share my experience, but I sadly doubt that anything will be done to address this issue, even though it is a silent epidemic.
Thank you for reaching out and telling your story. These stories need to be told and I am happy to be that portal in which to share them with the world. There is no health care legislation that can help us if we have such sadistic training methods. Enough is enough. This is no way to treat the bright-eyed young students who aspire to be healers. Here’s what I suggest to premedical and medical students:
1) Find physicians who are HAPPY in their chosen field and ask to shadow them. Ask them for advice.
2) NEVER ask cynical and jaded physicians for career advice. They need therapy to heal their own wounds.
3) REMEMBER your personal statement. You are paying 50K/year tuition to be trained to be the physician you described in your personal statement. You are NOT paying 50k/year to be talked out of your personal statement or be told your dreams are “unrealistic.”
It really irks me that the older generation of doctors seems to victimize the younger generation. It is abusive and not at all helpful to anyone. There is a quote about this that I love: “Those who say it can’t be done should not interrupt those who are doing it.” We are far too many sick doctors training the next generation of doctors. And they are teaching them to be depressed, burned out, and perpetual victims. It is so unnecessary.
I’d love to send you my book:http://www.petgoatsandpapsmears.com/
Inside there are inspiring examples of doctors who are loving medicine.
We need to study what works and stop the cycle of abuse and self-pity.
Pamela
The doctors are one of the most vulnerable group of professionals. However, we are trained to be hard skinned from the Day 1 in the medical school. We are all made to believe that if we do not sustain the stress and the brunt, then we are not fit enough to be doctors and we should better be out of the system. We are a ‘heard of sheep’ where we are at the mercy of external forces as well as reasonable and unreasonable demands. In other words we learn to live in a world where ‘survival of the fittest’ is the rule and we are ready to take it all whether we like it or not.
Someone has rightly said that doctors are the worst as far as seeking help is concerned but the poor busy doctor has no time to seek help.
Unfortunately if we do not first heal ourselves we are less able to heal our patients.
If doctors are discouraged, patients learn to be discouraged. If doctors are victims,
patients learn to be victims. Is this health care?