Physician Suicide Etiquette: What to do when your doctor dies suddenly

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Edited version of article reprinted by the Washington Post July 14, 2014

An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.

What are patients to do?

When they call for appointments, patients are told they can’t see their doctor. Ever. The standard line: “Sorry, your doctor died suddenly.”

In most towns news spreads fast no matter how veiled the euphemisms. Trust me, when a physician under 50 is found dead, it’s suicide until proven otherwise.

The fact is nearly 1,000,000 Americans will lose their physicians to suicide this year.

So what’s the proper response? Deliver flowers to the clinic? Send a card to surviving family? As far as I know, physician suicide etiquette has never been discussed—anywhere.

Etiquette is defined as the customary code of polite behavior in society or among members of a particular profession or group. The customary way to deal with suicide is to ignore it. Physician suicide is rarely uttered aloud—even at the memorial service. We cry. We go home. And doctors keep dying.

I’ve been a doctor for 20 years. I’ve never lost a patient to suicide. I’ve lost only friends, colleagues, lovers–all male physicians. In the U. S. we lose over 400 physicians per year to suicide—the equivalent of an entire medical school gone!

What can we do? Let’s break the taboo.

Physician suicide is a triple taboo. Americans fear death. And suicide. Physician suicide—even worse. Yes, the people who are here to help us are dying by their own hands. And nobody is accurately tracking data. This is not popular dinner conversation. But it should be.

I’m a family physician born into a family of physicians. Raised in a morgue, I spent my childhood, peeking in on autopsies alongside Dad. I don’t fear death and I’m comfortable with suicide. So comfortable I spent six weeks as a suicidal physician myself. Even I was in denial—clueless about all the other physician suicides. Until our local pediatrician shot himself in the head. He was our town’s third physician suicide in over a year. At his memorial, people kept asking why. Then it hit me: Both men I dated in med school are dead. Brilliant physicians. Both died—by “accidental overdose.” Doctors don’t accidentally overdose. We dose drugs for a living.

Why are so many healers harming themselves?  And when would be a good time to discuss this? During afternoon apéritifs? Discussing a decapitated doctor doesn’t pair well with any wine.

During a recent conference, I asked a room full of physicians two questions: “How many doctors have lost a colleague to suicide?” All hands shot up. “How many have considered suicide?” Except for one woman, all hands remained up, including mine. We take an oath to preserve life at all costs while secretly plotting our own deaths. Why?

I cover physician suicide in my TEDx talk. And Dr. Daniela Drake correctly identifies many of the reasons doctors suffer in her article gone viral, How Being a Doctor Became the Most Miserable Profession.

In his rebuttal to Drake, Sorry, being a doctor is still a great gig, Pediatrician Aaron Carroll calls the misery BS. He claims doctors are well-respected, well-remunerated, and they complain far more than they should. He predicts people will soon ignore doctors’ “cries of wolf.” To cry wolf is to complain about something when nothing is wrong, yet doctors suffer from depression, PTSD, and the highest suicide rate of any profession. Physician suicide etiquette rule #1: Never ignore doctors’ cries for help.

Bob Doherty of the American College of Physicians also downplays physician misery. His response is classic: when doctors complain, quickly shift conversations from misery to money—their astronomical salaries. But when a doctor is distressed how is an income graph by specialty helpful? It’s not.

I run an informal physician suicide hotline. Never once have I reminded doctors of their salary potential while they’re crying. Think doctors are cry babies? Read these physician suicide letters before dismissing doctors as well-paid whiners. Physician suicide etiquette rule #2: Avoid blaming and shaming.

After losing so many colleagues in town, I sought professional advice from our county’s medical society CEO, Candice Barr. She explains:

“The usual response is to create a committee, research the issue, gather best practices, decide to have a conference, wordsmith the title of the conference, spend a lot of money on a site, food, honorariums, fly in experts, and have ‘a conference.’ When nobody registers for the conference, beg, cajole and even mandate that they attend. Some people attend and hear statistics about how pervasive the ‘problem’ is and how physicians need to have more balance in their lives and take better care of themselves. Everybody calls it good, goes home, and the suicides continue. Or, the people who say they care about physicians do something else.”

So what works?

Our medical society established a Physician Wellness Program. The first in the nation to create a comprehensive program with free 24/7 access to psychologists skilled in physician mental health. Since April 2012, physicians have been able to access services without fear of breach of privacy; loss of privileges; or notification of licensing and credentialing bureaus. That works.

The key is to “do something meaningful, anything, keep people talking about it,” says Candice Barr. “The worst thing to do is nothing and go on to the next patient.”

What’s most important is for doctors to know they are not alone. Doctors need permission to cry, to open up, to be emotional. There is a way out of the pain. And it’s not death. Physician suicide etiquette rule #3: Compassion and empathy work wonders. More than once a doctor has disclosed that a kind gesture by a patient has made life worth living again. So give your doctor a card, a flower, a hug. The life you save may save you.

Pamela Wible is an author and board certified family physician in Eugene, Oregon.

This blog was reprinted with author’s permission in The Washington Post.

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32 comments on “Physician Suicide Etiquette: What to do when your doctor dies suddenly
  1. Barb Winnick says:

    Pamela,
    What a profound blog. In many years of nursing I have known my share of nurses as well as physicians who have had so much trauma. Unhappy home life,multiple marriages and people who have no experience in caring for people making major decisions dictating how to practice medicine. Top all this off with spending working hours dealing with patients health issues and emotional concerns. Have you ever thought about creating a place that would cater to only to just vent. Maybe a monthly meeting? I know you had the retreat recently,I am sure it was very therapeutic but it would be helpful to do something more frequent.
    About 10 years ago Peacehealth had a service called Ask A Nurse. It was a program where people could call an RN and they could get advice on whether to seek treatment in ER,their doctor or home treatment. We would also help people understand what their doctor’s told them,lab results and medication. This was a 24 hour program. Today once a month our group gets together for dinner . We talk about whats going on in our lives current jobs and a few of us have really opened up to each other feeling very safe. It would be great to set up some sort of safe place for people who spend their lives caring for others.
    Thank-you for sharing this very important topic.

    • Pamela Wible MD says:

      I am starting a teleclass that will offer emotions support and practice management so docs can have the camaraderie they need and develop the courage to open their own ideal clinics or make their current clinics more ideal. Spread the word. Will let you know when registration begins.

  2. Gram says:

    I think every thinking feeling human being has thought of suicide at least by the age of 45. If not they are very, very lucky or something is very wrong. Thank you for helping in a productive way.

  3. Greg Stueve says:

    Thank you for your thoughtful, caring essay. My town has been saddened by the suicide of a physician within the past year. No one talked about it. It just got swept under the rug. Thank you for suggesting ideas for action.

  4. Cyril Marcus says:

    Unfortunately a big elephant in the room regarding physician suicide is that the state PHPs that were originally funded by medical societies and staffed by volunteer physicians thoughtful and competent have been taken over by a group that is not so kindhearted. PHPs are not regulated, opaque, and without accountability. Look at the recent North Carolina PHP audit done by NC State Auditor to see how they operate by sending doctors to out of state programs. Then look at the FSMB policies on physician impairment and you will find that this group has successfully convinced the FSMB to accept “potential impairment” and “relapse without use” as diagnoses, convinced them to implement a hands off policy from state medical boards in diagnosis of addiction and relapse ( appealing to the logical fallacy that scrutiny undermines professionalism, and convinced the FSMB that physicians assessments and treatment be limited to only those facilities that are “PHP approved.” The medical directors of all the PHP approved facilities can be found at “like-minded docs.” Then check out J Wesley Boyd’s blog and look at the comments. Dr J. Parker at medicalwhistleblower website has been trying to expose this for years and interviewed physicians in the WA PHP and many said that they would kill themselves if sent back for another positive test. Coercion, control, junk science testing with alcohol biomarkers they introduced as Laboratory developed tests to bypass FDA approval, got the regulatory agencies to accept these tests as valid with no evidence base, and tested them on Physicians being monitored without consent. And they are behind creating the moral panic of an epidemic of hidden drug addicted and drunk doctors with easy access and a conspiracy of silence to push for random drug testing of all doctors, they started the disruptive physician panic, and the next target is doctors over 60 as they are associating increased age with increased risk of dementia and are targeting administrative and regulatory agencies to see all of this through there lens. They represent the multibillion dollar drug testing and inpatient rehab industry and are using the PHP blueprint as a “replicable model” and the “new paradigm.” Look it up and you will see the PHP study is a methodologically flawed retrospective non-blinded puff piece with false conclusions and the system is frequent drug and alcohol testing with “swift and certain consequences” for positive tests, mandated 12-step indoctrination, and contingency management. This is what any doctor referred to these programs is subject to and complaining or even questioning can result in reporting you to the board for noncompliance. This keeps most of them scared and silent and obedient to the demands of the PHP. Some are truly addicts but most not as a DUI, one-off, or even sham referral can land you in this web . It is self referral and a closed racket

    • MDKK says:

      Dear Cyril,
      My son, Dr Greg Miday, died by suicide in June 2012 while being ” monitored” by the MO PHP. He was 29 and was about to begin an oncology fellowship at Wash U. He and his psychiatrist met that day and arranged for him to have an inpatient stay at The Harris House, a public recovery center in St Louis. When he called to notify the MPHP of his relapse, they advised him not to go to the Harris House but instead to report to them. He was dead within 18 hours of his contact with them. Clearly he did not see them as “helpers” but rather as a policing agency. He had also had a very bad experience at the agency they had previously referred him to. Their approach seemed to be one of ” blaming and shaming.”
      I hope that you can help me to network with others who have been wronged by these groups. I quickly learned of their lack of accountability. They seem to work well outside the legal parameters that are typical of other mental healthcare agencies. I am a psychiatrist and was appalled to hear that they were not planning any sort of review of my sons case. This would be unheard of in any public mental health facility.
      I fear that involvement with these agencies heightens the risk of physician suicide. I am virtually certain my son would be alive today if he had experienced the MPHP as compassionately concerned for his well being.

      • cyril marcus says:

        Go to the website above on FB. There is a group of people concerned about this but the biggest problem is the apathy and disinterest of others. Their lack of regulation and opacity is by design and they continue to sway regulatory agencies, professional organizations, and legislative bodies by propaganda and misinformation as moral entrepreneurs by purporting to uphold and enforce what they stand for. They have bamboozled them into power. Most doctors do not know that the Federation of State Medical Boards accepted “potentially impairing illness” and “relapse without use” as definitions, the FSMB has given the Federation of State Physician Health Services complete autonomy as the ASAM wrote a public policy statement affirming it. The FSMB also accepted the proposal that any doctor referred to a PHP be assessed at a “PHP-approved” facility with NO EXCEPTIONS. The ASAM also put out a public policy statement advising State Medical Boards to accept the diagnosis of “relapse” in any physician who the PHP deems relapsed (i.e take our word for it, trust us) and to accept the FSPHP as the only experts in addiction. They are eroding protections in drug testing by undermining the MRO protocol. Just take a look at the ASAM White Paper on drug testing. They are going to justify clinical drug testing of “potentially impaired” physicians by claiming forensic testing is not necessary as it involves punishment, therefore if we test specimens clinically and do not give punishment but “treatment” we don’t need the chain of custody and MRO protection. They are currently maintaining and intensifying the moral panic of drug addled doctors to create moral panic to institutionalize random drug testing of ALL physicians. And no one is speaking up. For a variety of reasons we deflect threatening information by mobilizing our intellectual artillery to destroy it. Identity and culture protective cognition is a way of avoiding dissonance and estrangement from valued groups. Individuals subconsciously resist factual information that threatens their defining values. It protects who we are. So when they post another “Is your doctor addicted to hard drugs?” propaganda piece no one speaks out. It is time we expose this. The PHPs FSPHP ASAM and Like-Minded Docs are all the same people. Any doctor who is referred to a PHP is mandated to a fundamentalist faction of AA facilitators who say they are in denial, helpless, and in need of spiritual recovery and must do anything and everything they say or lose their license. They use junk science and unvalidated personality tests to diagnose physicians with “character defects.
        There is no choice. And unless we collectively speak up they will be in charge of any one with any license. Look how out of control the “disruptive physician” myth is. Sure they exist, but not enough to fill the 3 facilities associated with ASAM. And they are going to target “the aging physician” next. Just google FSPHP and “aging physician” and you will see the propaganda and misleading hype about aging physicians, dementia, and medical misfortune. It is all a charade.

      • Young Doc says:

        MDKK – I was so sorry and shocked to read here about Greg. I never knew him personally, but had interacted with him on the phone (he kindly taught me about returning-page/MD-to-MD telephone etiquette during my first week of internship after I made a big blunder!) (ie – “I know it’s your first week so no worries, but just so you know…”) I was *so* appreciative for the gentle correction (who knows how many more blunders would have followed otherwise!) and never forgot his name.

        I just ran across this article about the Physician Health Programs and felt like I should share it: https://secure.avaaz.org/en/petition/Commonwealth_of_Massachusetts_State_Auditor_Suzanne_M_Bump_Performance_Audit_of_Physicians_Health_Services_Inc/?pv=3

        I don’t know what can be done, but I know from my own personal experience that it is very hard for a physician to find confidential mental-health care. (Doubly-so if you are in the same field yourself!) This really is not acceptable.

        Best wishes to you and your family. I am so very sorry for your loss.

      • Apryl Schmalz says:

        So sorry for your loss, Greg’s story has really touched me, even after losing a few professional acquaintances to suicide. Shamefully, it was easier to avoid the implications than address them. As a provider liaison to my company I have gained invaluable insight into what is a silently growing issue. Dr. Wible thank you for bringing up the uncomfortable and taboo subject, it is why we are losing so many talented and gifted physicians. It has to be stopped. If I may be of any help, please contact me. We should all continue to bring this to the forefront of our minds and be diligent to be that door that opens, offering non judgemental help. My heart breaks for those suffering pain, it’s so evident why and it must be changed. Physicians are people too, so many people/patients want their practitioners to be human and yet when they exhibit human characteristics they are judged and humiliated. It’s change time.

        • Pamela Wible MD says:

          Thanks for writing Apryl! I just got off the phone with a documentary film crew who wants to do a film on physician and medical student suicide so I am excited that the public will finally know what is happening and that we will be able to save the lives of our healers! Can’t come soon enough. Every day we wait we lose more of these caring and compassionate people who are suffering in isolation.

  5. Thank you for this article Pamela. I spend a lot of time advocating for my patients, but I don’t spend any time advocating for myself. I read the kevinmd blogs and going there makes me feel like I have a community, a friend who understands. As much as I love the comfort of feeling there are others like me, it scares me. Some of the docs there have become so bitter, and almost hateful towards patients, and it worries me that with time I will become that way too.It can be isolating being a doctor, when all my friends/family outside of medicine, don’t understand, and consider me to be crazy for complaining about my supposed success in becoming a doctor. I will admit at times I have contemplated suicide, especially considering I have lupus, and that has only made the journey harder. But at the end of the day, I rely on my faith in God to provide. Thank you for not only advocating and raising awareness but also trying to find solutions for us.

  6. SteveofCaley says:

    Creatures without food die of starvation. Creatures without water die of dehydration.
    Humans without hope, without feeling human, without feeling alive, die of suicide.

    We all – not just physicians – have a need to be validated as human beings to some degree or another. Some need a little – some need a lot.

    Nothing makes me feel more alive – or more grateful – than to be part of making a difference in another human’s life. Bringing my abundance and my skill to do the craft.

    I have been kissed a few times by patients; interestingly, all of them were men. None of them were even all that good-lucking, and I’m not into other guys. But all of them got better because of something I did, and they knew it, and I knew it. Not embarrassing – but incredibly energizing. That’s like oxygen to a physician.

    So many of us have had the plastic bag over our heads, turning us blue. Spiritual hypoxia is lethal – just add 240 grains of lead, or a few grams of barbiturate, or even plain old 10 stories worth of gravity.

    As for etiquette – if there’s nothing you can do, there’s nothing you can do improperly. If you’re a doctor on not, speak out for humanity. We’ve got nothing else to hang onto.

    God bless you,
    Steve of Caley
    Physician Scientist Deutschschwätzer Corgi Owner Rockstar in God’s Country New Mexico.

  7. Pam,
    Thank you for this post. I want to say to doctors…”Imagine what would happen if you told your patients that you needed them. Imagine telling them that maintaining and promoting your relationship with them is the reason you get out of bed everyday.” Go ahead… It’s only a thought crime.

    What insurance company executive, pharmaceutical rep, government official or malpractice attorney could wedge themselves between us and our patients if we actually told them how much they really matter to us, that we live for the sacred space that opens between us as the exam room door closes. You don’t have to do it…yet. Just imagine it. You may realize that it is the only conversation worth having, in fact the only one you CAN have when you take your eyes off the computer and look into the eyes of your patient. A lot in medicine may be out of our control …. but not the content of our hearts or the direction of our gaze. Our patients need witnesses, not super heroes. So do we. Just think about that… it may save your life.

  8. nobody says:

    i will die because of the insurance companies
    this HMO idea
    taking billions off patient care to “save” millions
    make us go through hopes to provide care
    because of lawyers, the dep. of labor
    my litigious nurses
    because of me

  9. ambs says:

    while I regret the death of any human being, hearing about the death of so many doctors by suicides give me a sense relief. my personal opinion of almost all medical doctors are unfair human being because they live a life of luxury based on a lie. the medical profession pretends to healers of individuals when in reality most of their ideas about healing people are just guesses with a 50/50 chance of success. another thing that brings sadness to my heart about doctors is the life of luxury they live based on medical knowledge; to me it is nothing more than exploiting the a natural part of living, DEATH.
    while sad the doctor kill them self, glad to see someone acknowledge guilt for exploiting people.

  10. Julie Ana says:

    There is a very intriguing book out there called Second Hand Trauma. I believe all helping professions albeit doctor, law enforcement, veterinarians, social workers etc… should consider the authors perspective. The authors distinguish the difference between natural empathy and controlled empathy. Controlled empathy, means we as helping professionals, control our responses to pain, sorrow and traumas that affect the the client while maintaining our professionalism. The authors state that “controlled” empathy actually changes our physiology lending to depression, anxieties and addictions. Then the book goes on to talk about how to cope and heal the inner areas that need attention.

  11. Thank you for another great post Pam!

    In my experience working with hundreds of burned out doctors, I believe there is also an appropriate organizational response to a physician suicide. Here it is…

    Physician suicide should be a “never event”. Regardless of whether the doctor was mentally ill or drug/alcohol addicted at the time of their death, my experience is that physician burnout underlies all suicides until proven otherwise.

    Unfortunately the organization tends to point to the doctor and blame them — rather than do what they ought to – take a good long look in the mirror. Suicide can be a sign of a toxic or abusive workplace. At a bare minimum, colleagues and administration missed a number of signals of this doctors distress that preceded their choice to take their life. Just like any other “never event”, all suicides are potentially avoidable/preventable.

    The Lane County Medical Society burnout prevention program is an excellent resource if people are looking for “best practices”. And this program is external to the healthcare organization. I believe all organizations that provide healthcare have a responsibility to actively prevent burnout for the physicians and staff working in their facilities.

    My two cents,

    Dike
    Dike Drummond MD
    http://www.TheHappyMD.com

  12. Julie Greene says:

    Pam, your well=written article is clearly sparking up a lively discussion! Just my two cents…The first person who was close to me who committed suicide was not a doctor. She was a talented artist who quite clearly died, yes, from whatever “method” she used, probably pills knowing her, but really, she died because she couldn’t get proper medical care. I had moved away from her area about a year previously because of the poor quality care in that area. I recall that I begged her to move, too, but she was too afraid to leave her home and move one more time.

    Of all those that I know who suicided, in every single case they had indeed tried as hard as they could to get “help.” However, they were either denied care or received substandard care or were misdiagnosed. Or they were abused in care.

    Decades have passed now and it seems that “monitoring” is what they are now doing. This doesn’t help. Who wants a babysitter? Most adults would be insulted, to say the least, to be watched all the time, in whatever form.

    I just think we all need to listen better to each other. That’s more important than “policy” or “protocol” or whatever baloney they call it.

    Julie Greene and her little dog, Puzzle

  13. Karuna says:

    Thank you for stirring the pot and taking the lid off. We need to know. We love our docs and we want them happy and alive.

  14. Cyn says:

    Dr. Wible, are there signs a patient might pick up on. I cannot understand why a doctor or any other professional would fill their life/time with a work that is continually taking. Little time off, practicing in a large health care company with multiple offices, treating all ages and then once a week working in another town doing GI procedures. My doctor is phenomenal. Definitely making the patient feel important during that visit. Has taken time to teach healthy eating, encouraging healthy lifestyles and easily praising for any progress made. Truly a doctor who makes you want to do well if not for yourself, for them. Looking forward to the next visit to let her know how well the month or 3 months have gone. She, in appearance, looks healthy, eats incredibly healthy, does yoga, meditates and is a mother and wife. Why then do I have this concern that all may not be well? Is there something I could ask? How can anyone do and give so much and keep going. After reading your articles/posts, I want to go see her and serve her in some way. I definitely do not want to vent to her any longer. As I have written in another post, she has been a lifeline for me. I do feel she has saved my life. More ways than I could put in a post. I just wanna be sure I don’t miss anything. Maybe I’m just paranoid.
    I’m a nurse but unable to work due to chronic pain and fatigue. My gut instinct is usually pretty good. Can you imagine why someone would specialize in so many areas of medicine? Just very concerned?

    • Pamela Wible MD says:

      Please make your physician a nice card (handmade or other) and express your deepest emotions from a place of compassion and love. You will transform her life in more ways than you know.

      • Beth says:

        You are amazing Pam!
        As one comment suggested, no one looks at doctors as human. Must be that “salary” (maybe she needs more education about physician debt)…
        Our time, our compassion are looked at as someone else’s right! Now we may not even be able to be paid for our time…but only for “outcomes”…which we have little control over…

        I lost my spouse to alcoholism…I was an abused teen…I am a great primary care doctor…But I am emotionally drained. Dangerously so…When my few but intense relationships fail I feel like I have lost the tiny little bit of love and support “for me” and I contemplate suicide often. I resent patients. I resent my children. For sucking the emotional life out of me.
        I feel doomed to always be the caretaker.
        But never be on the receiving end…To never have time to read a book…to truly relax…to have someone smile and spoil me!!
        I’m not sure I could accept it…
        We are trained to be the giver. Not the takers.
        I’ll always be essentially always alone…at the end of the work day.
        Until I die and that will be that…
        My soul feels like it is shriveling up and dying…yet I show up to work and smile…love my patients…hold their hands when they cry…try to help them see that they are “ok”. Everyone thinks I am an awesome Doctor. I am.
        But I’m dying inside…
        I see it…like an hourglass…blood dripping out…none going back in…
        But no one sees me. I am one of those perfect doctor machines.
        I fail to exist except for what I can do for others…
        That is why doctors die…
        They care themselves into emptiness…
        And can’t find their way back…

        • Pamela Wible MD says:

          So true. This is the real life story of so many doctors. This is what motivates me to keep sharing our voices. You need to be heard. Cared for. Revered. And loved. And I’m going to see to it that it happens in your lifetime. There is no way in the world you are going to give yourself into oblivion without receiving the love and care that you deserve for devoting your life to others.

  15. James says:

    I am a dentist, I feel all the health care fields are under attack. Not many rooting for us, since they think we are all rich. I drive a 23 year old truck..not much. I have practiced the military, in public health, tribal health, a large corporate office, a failed partnership, and for the past several years a solo private practice where I can practice like a true ally to my patients without being rushed. Financially I have been on the ropes for several months and may be shut down by August, losing my building, equipment and possibly my home. Why? I have a heavy Medicaid practice, many have a myriad of health issues and are very loyal. However, the state has not been able process medicaid claims for 9 months due to problems with their “new” processing system. We work almost every day. I have made a modest living with my small practice, but since my funding source has been so low for so long, I may lose it all before they pay. My savings is gone. I feel my best days are behind me, my wife (and clinic manager) is so frustrated. I am very depressed from this as well as some issues from my wartime service, and am so frightened to get help, afraid of the professional consequences of even getting counseling . I try to alleviate suffering every day, but I am in pain as well. Thank you for what you do.

    • April Schmalz says:

      James,
      Can you apply to become federally qualified to help offset the costs of taking on such a large medicaid population? Would love to help if I can. 541-998-4711.

  16. Eliza says:

    Very little can be done unless the willfull ignorance of the medical profession is lifted and the Elaphant in the room recognized and caged. It is an unspoken truth that Physician Health Programs are not what they seem to be. All the propaganda and praise is marketing and disinformation. You never hear anyone caught in the maw of the PHPs praising them. You hear few criticisms also and for good reason-retaliation with impunity. The medical boards have become willing gulls in enforcing a false and irrational authority. The collective subconscious of medicine knows they are to be avoided. And because doctors also know that any concerns related to substance use, depression, anxiety, or anything at all really that reaches the ears of the PHP could be a one-way ticket to a dark place many avoid seeking help. The speculation that doctors are different constitutionally in some stereotypical personality trait is nonsensical fallacy. The inadequacies in treatment for mental health in doctors is not because of any common factor internally inherent in doctors but an external common negative component imposed on doctors. And the first thing to do is to acknowledge what that is. No one dare say its name be it out of ignorance, fear, or misunderstanding. But te issues are clear. The FSPHP is composed of ASAM physicians- a made up specialty with phony board certification. They are an easy target as all their studies are biased and flawed, the conflicts of interest are enormous, and the ethical violations are rampant if you look. They have been treated with kid gloves as benevolent ex-addicts helping others. Given a pass they mean well.,,.no they do not and they deserve to be held to the same critical analysis as the rest of this. We need to demand accountability, transparency, and regulation. Medicine dropped the ball on forsaking vigilance and not requiring oversight and it may be too late..if we do nothing we will all be subject to their control soon. So speak up now.

  17. Robert says:

    I would hope that at least a few of them were smart suicides, i.e. successfully avoiding a more unpleasant impending death.

    We’ve had a several probable (hard to prove) suicides, one absolutely clear case (slashed wrist after a previous attempt), in the family, none of them physicians. Family of course grasps at any explanation of the death as accidental if it’s plausible, because that way nobody can be ashamed of immiserating them or failing to un-immiserate them. But one of them was a pretty good death to avoid a bad one, so only the hosp. staff pretended the self-administered DPH OD was accidental.

  18. Timothy Nguyen says:

    The statistic of 400 doctor deaths a year is extremely inaccurate and is just a figure propagated over and over again by articles and papers. I would avoid using it. It is based on data from the 1970s.

    • Pamela Wible MD says:

      Since physician suicide is so taboo and the data is not properly tracked this figure is the only thing we have to go on. Still, researchers believe this is an underestimate. If physician suicide were an infectious disease it would be on the evening news every night and we’d have a body count.

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