Physician Suicide Letters

Physician Suicide

I asked why physicians were dying by suicide. Here’s what they told me:

“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth it?” I wish I could change back but I realize that I will never be the same again and it isn’t in a good way. We had two suicides and one murder—skull crushed with a bat—and one serving life in prison for murder during a delusional episode after not sleeping for almost a month. Yes I went to a hard-core school (old school kind of place). PTSD isn’t benign; it truly affects you to the core—it changes your brain.”  ~ Doctor in Philadelphia

“I’m in my first year of practice outside of residency and I can’t begin to tell you how often I think of death. Not because I hate my life—I have a wonderful husband and family. But the pressures of daily life as a doctor are overwhelming. I work constantly! Even on my days off, I’m working. When I take a day off, I pay for it later by double the amount of work waiting for me. I have patients yelling at me when all I wanted to do was help. They try to fool me and manipulate me. Insurance companies deny my patients help, leaving me with no resources to help. My boss is a douche—unethical and dangerous. I want to build a relationship and do what’s right for my patients—but the company pushes me to see more and more patients in less and less time. I cry at work, I cry myself to sleep sometimes. I don’t feel depressed, and I know my life has value, but sometimes the thought of suicide is just to escape the pressure of the profession. It’s not like I can realistically give up the job, my calling. I’m neck deep in debt and will never be able to pay it back if I leave the profession.” ~ Michelle

“I didn’t realize that so many others in the field suffered as I do. I have tried to get help many times but it’s hard because I don’t think that anyone takes me seriously and I don’t think I can be completely honest with anyone without major repercussions. I don’t have any friends to socialize with and all my relationships have failed. I come from a background where I was the first to get a higher education so they think that I should be elated to just have MD behind my name and tell me to suck it up. I don’t want to possibly lose my license because honestly I love taking care of patients and sometimes that is the only time I get a few moments of happiness. But things have just been so bad for me that I have resorted to just doing locums [fill-in work] so I can isolate myself because sometimes I can’t stop the tears. I have tried a few times and the last time probably would have worked but at the time I was lying there looking at the dog I had then who was curled beside me nudging me to get up. Somehow I drove to the ER although severely hypotensive where I was hospitalized and they chalked it up to the fact that I had not really been eating or drinking for weeks. I no longer have that fur companion so I find myself alone and thinking about an escape a lot.” ~ Dee

“My 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).” ~ Anonymous 

“I am a third-year medical student. I have done very well in both my coursework and national boards. I have publications, research. On paper, I am successful. Yet I find myself thinking about killing myself frequently. Walking into traffic, jumping through the window, just dying in the course of a normal day. Miserable thoughts. I went to the school psychologist to be fixed; I was referred to the school psychiatrist, who looked just as broken as I felt. He offered me antidepressants, if I ‘wanted to take them.’ It doesn’t make sense. I never felt this way before medical school. I loved, I thought, I reflected. I enjoyed being creative, yet now I’m chained by procedure, bureaucracy, and paperwork. There are no creative solutions to problems, there is no effective effort to improve the system except from big top-down initiatives of whatever hierarchy you’re subject to. It’s maddening. I used to watch the stars and smile. I volunteered. I ate well and exercised. I enjoyed playing with children. Now I’m finding a sort of perverse pleasure in patients’ pain; I recognize this as sadistic. I’m shocked. I’m revolted at how far my soul has degraded. It’s insane. I’m chronically sleep deprived. I can’t think or learn when I don’t sleep. I can’t smile without ulterior motive. I’ve confided in my family, who don’t understand the demands or the situation and have told me that ‘it’s my decision to feel sad.’ The [professors] don’t teach; half of them treat us as annoyances. Learning and healing both got lost somewhere. The good teachers leave or are ground down. I’m full of hate and sadness. I’m not sure why I’m still here, but I am. I feel like an echo of myself.” ~ John

“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 3 am, 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 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 traumatized in medical school and it continues to happen, but we get accustomed to it, to the point of becoming an abused class.” ~ Christian

For every doctor who dies by suicide, friends, family, and patients are left to wonder why. “I am still in a state of shock hearing that my brilliant, loving, compassionate, successful, well-respected, honest, hard-working physician committed suicide this past week. Pressure from the changing medical community/insurance/had forced him to close his 30-year practice and he went home and shot himself in the head. The letters keep coming in of how many people loved him, were healed by him, and admire him. What a tragic end to a successful career. Everyone is asking why. He was the best of the best, surgeon and specialist, nice home, nice family and now he is gone. Totally tragic.” ~ Diana

These letters have now been published in a book: Physician Suicide Letters—Answered. Many are recited in this TEDMED talk:

If you are moved by these letters, please watch and share the TEDMED talk above and my other TEDx talk on physician suicide. Read more letters here. Thank you for caring. Pamela 

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65 comments on “Physician Suicide Letters
  1. Mary Ann Lowrance says:

    Pamela,

    How very sad. I’ve always wondered how ‘they’ could do it (doctors and nurses) … work with the sick and dying in the beginning … but putting it all together it is a wonder there aren’t more suicides. It gives me a whole new perspective on the medical community. Thank you for sharing.

    Mary Ann

  2. I would never minimize any individual’s comment or discussion that they were thinking about suicide or even considering it or had attempted it in the past. I understand how doctors reach this conclusion but I don’t think it’s exclusive to the medical profession only. Any of us that work or have worked in an environment that kept or keeps asking more and more of us and we’ve lost site of any possible reward that we once thought was possible (rather it be helping someone, making our planet a better place to live, correcting bad legislation, or any other thankless passion) possibly end up feeling the same hopeless, exhausted and forever bottomless pit of going in a circle. Our society has managed to forget that 80 hour work weeks are not the norm. A slogan I once felt I had to live by went something like this, “If I didn’t show up and put in a minimum of 20 hours on my days off, then I didn’t need to show up on Monday.” Who said government workers are slugs? Adding to that, being a full time caregiver, I often thought of ways I could maximize my life insurance so that my husband would be cared for as long as he lived.

    • Pamela Wible MD says:

      Agree. Human service professions (police, fire, medical) should have mandatory weekly mental health services. Thereby no stigma. All are asked to participate.

      • Lori Bemis says:

        I agree with you Dr.Wible. Mandatory mental health service’s for Doctor’s and Nurses, Firefighter’s and all human service provider’s is a great idea. The first thing I thought after reading all these story’s, is, one more thing they, you, would have to worry about doing with an already overloaded mind and body! I’m just a person who works hard. I’ve had mental health issues with the loss of my husband and mom within 3 months of each other and I did find it hard to make it to those appointments, I felt stressed just thinking about it. I went week after week and I am doing better. It’s a matter of knowing it will help and you can talk to someone who won’t judge you. You are a person just like the rest of us. Please seek help, it really will help.

      • Dr. Wible, great work! I was recently approached by someone inspired by your work who is now helping physicians make transformation in their lives. She was intrigued by my practice in Galveston, Texas which is very similar to yours (IslandDirectCare.com). I too am inspired by your work but have to disagree with the notion to mandate any particular services. An act of kindness can not be forced, and we will not reach salvation through legislation. In many ways, it is myriad senseless rules and regulations that have made the situation for physicians and their patients so difficult. I work hard every day to care for my body, mind, and spirit to serve as a leader. The last thing that I need is another unfunded mandate but rather peer encouragement to be the change I want to see. Thank you again for creating these necessary dialogues.
        Chap Caughron, MD

        • Pamela Wible MD says:

          Hi Chap! Wow! I’ll check out your practice in Galveston. That’s great! I am definitely not thinking of mandating any particular services, but I do think docs should have free mental health care during training. Keep up the great work and together we can finally get back to caring for people. 🙂

          • Kim says:

            Hi understand all update letters that was shared. I’m getting ready to get ready to commit suicide myself. I suffer from pain tremendously and I can’t take it anymore. My poor father has to see his own son in so much pain and you can’t do anything about it that is the worst feeling her son could ever KL feel. I have been going doctors for the last two years. I now haven’t taken hydromorphone for the last 2 years and my pain has gotten worse. I take 8 milligram every 6 hours. My doctors I feel scared to give me anything higher or anything to take my pain away. I hate leaving my family – but I can go on with this pain any longer I hope doctors seeing this video bro change the way they treat people and painkillers when they truly honestly meet them. My name is Kim and is from my heart don’t let this happen to any other people don’t be scared to reach out and let your heart do what is right even if that means going out on I’m the lamp.

          • Pamela Wible MD says:

            Please reach out for help. Suicide is the worst possible solution. There are doctors striving to be caring and loving with patients despite the systemic abuse they suffer. We have the same oppressors. Physicians and patients should never be adversaries. We are on the same team.

        • Ryan Kealy says:

          Chap! What a small world the internet is! (Chap and I were assigned to the same cadaver the first day of medical school) I miss all you guys. I was linked this by my friend and colleague because she and I are pretending to be 3 physicians and it’s incredibly grueling and soul-crushing and there’s always someone complaining about how we aren’t fast enough into the ED or we aren’t getting our dictations cranked out fast enough. Meanwhile I sleep sometimes 90 minutes in a 24hr period, day after day and I may eat here and there and sometimes I don’t. Work /life balance? Please.

  3. Mary Fortier says:

    Thank you so much for addressing this important issue. I just lost my best friend of over 45 years – a doctor practicing in rural Wyoming – who died by suicide three days before Christmas 2013. As someone who would have done anything for her – I wonder how difficult it would have been for her as a doctor to not only seek – but actually receive appropriate treatment. In other words – what are the industry obstacles such as self-disclosure, licensing, etc. and other variables – which make it perhaps more difficult for those in the medical field? Even if her husband, myself and her family had “intervened” as some point to get her the help she needed – I’m not sure what this would have done to her career. Perhaps a helpline should be set up specifically for doctors – with legal support to help them navigate their way through getting the help they need while not losing face in their profession.

    • Pamela Wible MD says:

      Why are healers harming themselves? We have a sick medical system. Industry obstacles are many. Fear of losing one’s license tops the list. Who can doctors speak to? Who will understand? We obviously need 24/7 helplines staffed by doctors or those trained in physician psychology. Our local medical society now has 24-hour care available with a certain number of free sessions with skilled therapists who keep confidential paper records. I have been running an informal helpline for years. I never advertised this, but med students and physicians have been contacting me for help. Why? I am not scared to write and talk about doc suicide. I do this voluntarily and unpaid between patients. I was suicidal once and had nobody who understood my pain. Very isolating. I am trying to give to other physicians what I never could seem to find when I needed help.

      More importantly: What can be done to prevent physician despair that leads to suicide? We must first treat these young humanitarians with the utmost respect and give them a humane medical education. If we expect them to care for others, we must care for them in their training and support them in their careers. No hazing and bullying as part of medical education would be a good starting place. How about adequate sleep? Simple things like sleep really help. How about time to eat? Do you realize doctors do not receive mandatory breaks at work (like nurses and medical assistants) and can literally be worked to death? 40, 50 patients a day!

      We need mandatory free mental health services for all health care workers. Doctors are in a profession steeped in pain and suffering. Of course, we are impacted by what we see and hear every day. We are human. We need public awareness. We are human. We suffer. Reach out to doctors. They tend to be the last to ask for help. People tend to “play the smallest violins” for fallen physicians. Please share this blog widely.

      • Mary Fortier says:

        You’re doing wonderful work and I will pass your blog on – please know it has great healing powers! I just watched your TedTalk and went to the website to find an ideal medicine clinic here in Baltimore. Luckily, as an auto-immune sufferer, I have a wonderful primary doctor; (I’ve had to “fire” a few over the years). I will reach out to her and let her know how much I appreciate her in my life.

        If you ever decide to take your talk on the road and end up in Baltimore, let me know what I can do to help!

        Thank you for doing such important work! Mary

  4. iva ioneskov says:

    I am not familiar with us medical system, but seems it is not something I would suppport my son to go into..he is on the verge taking Mcat, Seems like high stress in med school and high stress job…
    Thank you Dr Pamela for the courage to talk what general population do not know much..

    • Patricia says:

      Your son could take an MPH along with an M.D. That way he would get a fuller education as to what affects health in populations and hopefully allow him to feel better prepared to go into the world and give him many different options to practice.

  5. iva ioneskov says:

    And may be if population knows and is aware doctors are actually HUMANS not just a fat paycheque or cash cow for some hungry law firm jumping out of john Grisham book. Those law firms may be twisting and manipulating unaware clients minds. People just do not know and are trigger happy to sue the Big Bad Doctor. This could be fuelled by the lawyers sweet talk .Once patients step in the law office for advice they turn into law clients. The care of the doctor is forgotten. No wonder malpractice insurance is so high as I heard.. As Dr Wieble mentions so many middle men. so many interests.. People should be educated of what an average primary care doctor goes thru a daily basis.. People don’t know and what they don’t know they dont care. I have 2 adult children few good friends we share live stories, and listening to their problems can give me a headache or worry for a week, How about 30 people a DAY sharing their problems, worries plus physical pain?

    I am a regular person, a patient from time to time, not a doctor, but for the first time I looked from a different anglle. I wil spread the word. It is not fair what we expect from another human being . to be a compassionate listener, empathy filled psychologist, firm decision maker about our utmost important health issues and MIRACLE WORKER at the same time…. prefererbly NOW, or may be 5 minutes ago….No wonder North American doctors are so stressed.. and reach for the unthinkable… I was reading how North America needs primary care physicians, med students are hesitiant to go this direction, now I can see why….. We have to save our doctors and CARE about them the way they care about US.

    • Pamela Wible MD says:

      Thank you all for caring. Thank you Iva.

      Charts and graphs of the grim (underreported) statistics do not tell the story.

      These letters do.

      Thank you for sharing.

    • Patricia says:

      you said: empathy filled psychologist, firm decision maker about our utmost important health issues and MIRACLE WORKER.
      I don’t agree; doctors should NOT see themselves as miracle workers. They are practitioners of modern science. When they see themselves in this light (of ‘miracle worker’ and ‘god’ and ‘saving lives’) they remove themselves from the general population which increases their isolation and in some, self-aggrandizement, and in general, stress and depression. Doctors need to take responsibility and change the system they belong to. Doctors should view themselves as part of a team which includes the client, not as the top of the pyramid. This is damaging to patient and doctor health. The US does not have good health outcomes and medical harm is a leading cause of death and disability in the US. And it’s not because the ‘poor’ doctors are not appreciated.

  6. Jerimy says:

    As a mental health professional and provider, I completely agree that offering services to physicians (and all health care personnel) is not only warranted, but essential. I speak and educate various groups on a variety of health topics, including suicide. It breaks my heart to hear the stories and see the faces of my fellow professionals who are suffering due to the lack of resources and stigma. At the same time, listening to all of you and watching Dr. Wible’s very powerful video has inspired me. I cannot change the world, but I can begin to change my corner of existence. I want to offer a program to area healthcare providers to talk about this subject and want an integral part of this program to include linking folks with area healthcare providers. I even thought of a name, “House Calls.” Thank you for the idea. I needed a positive push to direct this energy to something worthwhile.

    • Pamela Wible MD says:

      Yay! Thank you Jerimy!

    • Patricia says:

      I hope you include the general public as well, making it a dialogue. Doctors seem to suffer from isolationism and need to know that they are not separate from the communities in which they practice.

    • barbara says:

      I am a healthcare provider and recently experienced ptsd for a period from 2008 and feel very recently recovery. I’ve essentially ended my practice to be in a gentle healing quiet practice. I reached out for support for my mental health and found a responsive physician until I ran out of money to pay for the therapy counseling. In 2010. I tried to maintain my practice while more traumatic life events continued. I did self care with nourishment, acupuncture and lights. Though, the number of time that I called various therapists for help…because of ptsd and distressing losses, sadly not one ever returned my phonecalls. 🙁 I meditated and prayed. And since dialing down all pressures of maintaining the “business” of providing services according to rules (insurance, reflecting the medical models, overhead of running office, being in a hostile business environment) to the unknown future ; my mind and heart are no longer shaking. I have not found any support in the medical community. Still not even a phonecall from those I reached out to when I most needed it. I’m attempting to gently kindly provide healing help for others and assist this ptsd recovery process for all these wounded healers; creating a safe model outside of the corporate medical model which is traumatic essentially. Thankyou for bringing this to light.

      • Pamela Wible MD says:

        As harsh as this sounds, it is hard to get care and compassion from people who have had (let’s face it) their souls murdered in their training. Reductionist medicine fragments us and disconnects us from our own spirits. And from our hearts. And then patients wonder why they can not “connect” with us. It’s not because we are “rich and greedy.” We are wounded healers.

  7. Mary DeForest says:

    I grew up with a family doctor that probably would have committed suicide if he didn’t have the nicest wife in the world. He always had high blood pressure, complained the patients and the Los Angeles Medical Society was trying to kill him.

    He was a veternarian that was a good Samaritan. He saved the life of a motorcycle cop on the U of P Philly campus. The judge ordered him to become a doctor, and he always had a free ride there, as she sued the university too. He’d come back rejuvenated. If he took a vacation the cop’s wife had lawyers on his door step. I don’t know why he talked to me, but he did. Can you imagine being sued for medical malpractice before you even become a medical student?

  8. Patricia says:

    Hi Pamela,
    I have been wondering about this because I heard you mention it in your TEDx talk.I think I might have a hypothesis. Doctors as Gods…is it possible that this sort of title given to doctors (implicitly) create a situation where they become isolated and further their own isolation by creating or reinforcing barriers between themselves and their clients? I think it’s very obvious that the process of ‘becoming a doctor’ is a major contributor to this; but I think if we go a step before that into this idea that doctors are the all-knowing healers it places an undue burden on them, and it’s not one that I see them challenging very often.

    I hear doctors describe their duties as: saving lives. I don’t want to take away from what good medical professionals do; but in the case with myself and my son, *I* saved his life and my concerns were ignored by his pediatrician (and I am not exaggerating because he had diabetes type 1 that went un-diagnosed by the doctor after repeated visits).

    I subscribe to medpage.com and often, doctors are whining and complaining about the changing face of healthcare and they are also often dismissive of non-medical opinions (how could a non-doctor know about ANYthing a doctor has to face in his/her daily life). I feel so astonished because I know what it’s like to work hard and be vulnerable to health conditions that I must see a doctor for and then get no solution, plus a subtle feeling of the problem being ‘in my head.’

    There is a bad power dynamic that exists between doctors and the general public. Trust has eroded greatly, yet doctors are still taught that they are “life savers” and given the idea that they are above the common fray of the rest of humanity. I know that sounds dramatic but I think it’s true. Doctors also protect each other when there are issues of malpractice. This is so damaging to any type of connection between the public and the profession. Don’t you think? If you look to the whole field of cosmetic procedures where doctors use their position in society to conduct questionable procedures for big bucks and then walk away from bad outcomes, it shows how bad things have gotten.

    The problem is, it’s hard to get the public to feel sympathetic to their plight of mental illness (which is how I would describe a condition that leads one to suicide). I think doctors need to address this, and do it from a non-doctor position.

    Health care is changing for everyone. The way it’s done at least in the US, has to change, and that includes outdated attitudes and high-horses that doctors seem to have. I don’t mean that to deny that doctors don’t go into medicine to help people but I also think they need to see their place within a holistic approach of helping people.
    I feel bad for anyone who is stressed and feels suicidal. But I would like to point out that the uneducated, day laborer faces much more stress in life. And probably works harder.

    I don’t know what the answer is, except perhaps holistic physician training that includes a lot of knowledge of other fields, and make that training less expensive so that physicians don’t expect to get huge salaries in the future (out of relationship to their actual performance). But I do know there is a huge problem.

  9. I thought readers might be interested in my e-book Intravenous Hope, Stat! We Need to Help Stressed or Suicidal Doctors, Nurses, Psychologists, Therapists and Their Relatives. I may have already posted on this, if so, please forgive an 81 year-old retired shrink for repeating himself.
    And keep writing on all those crucial topics!
    Warm regards,
    Bill Taylor

    • SteveofCaley says:

      Thanks, Bill. The health of a society is its ability to heal ITSELF. Societies and civilizations exist for the mutual betterment; those which exist for mutual exploitation, explode.
      Mental health is not something one can put in a box, or put a ICD code on to describe. It is the robustness of health in the individual, not the presence of disease.
      Suicide, in my opinion, is what humans do when their individual future human existence is intolerable. Doctors, more than most other persons, are themselves examined, rated, prodded, poked, tested, and otherwise treated impersonally by employers, licensers, etc.
      No, our society is not “pro-life” and being “pro-life” to me is not an opinion on the legality of abortion. If we were, as a group, pro-life, then suffering and suicide would be intolerable.

      • Pamela Wible MD says:

        And all we wanted to do was help people. And we lose our lives in the process . . .piece by piece. . . and eventually it is intolerable.

  10. Julie Greene says:

    Hi, I cannot help but add to this. I am not a doctor. I am a writer. I am now over half a century old, and my economic place in society has become lower as the decades have gone by. With each step downward that I’ve taken, the doctors have closed their ears tighter and have closed themselves off to me more. It became assembly-line medicine. I was hardly noticed after a while, brushed aside as if I were rubbish, or shall I say “trash.” Worthless. As a writer, I was able to clearly record and observe precisely what was happening. Today, I cleaned my desk and found old documents. I found a letter I’d written to my health plan stating that I’d gone to them pleading for help and had stated precisely what I needed and had been refused. The last two sentences of one letter state, “I think you folks need to think twice. Get some people who know what they are doing.”

    I don’t feel sorry for doctors at all. Do I get to do a TED talk? People listen if you’ve got MD after your name. MD’s can see to it that I am forcibly taken from my home against my will. MD’s can have someone’s kids stolen from them or have a person declared insane for no reason. The day someone starts listening to me, I think I’ll move up in the world. Till then, no money, no power, no voice, no authority, no credibility, no “likes,” no prestige, no rights. Not only that, the police will back anything anyone with MD after their name says, in or out of court. Take away their power, please! So many people fear their own doctors!

    • SteveofCaley says:

      Julie, thanks. Have you read “Darkness Visible” by William Styron? Writers provide an essential element of a true civilization – to see and put into human voice what they see. All aspects of humanity are devalued – we are sliding into a depersonalized, demoralized society.

      One cardinal myth of a “machine society” is the assignment of personal moral failure to the results of an impersonal machine. Adolf Hitler was convinced something was wrong with the world – and then hit upon the Jews as the problem. Once that problem could be eliminated, there would be prosperity.

      “Get some people who know what they are doing.” Yes. A machine society thrives on moral hazard – the detachment of actions from consequences.

      “Till then, no money, no power, no voice, no authority, no credibility, no “likes,” no prestige, no rights. Take away their power, please! So many people fear their own doctors!” Don’t worry – that is on the way, and very soon. That may well be a kinder, gentler form of the Final Solution for healthcare.

  11. Diana Mortensen says:

    Reading all of these comments today took my thoughts back to a year ago when I found out my doctor had just committed suicide. Recently I made an appointment with one of his associates for my yearly exam and am hoping that perhaps she will be able to shed some light and help me understand. Yes, even a year later I am still saddened by the shortsighted actions that lead to his death. My only conclusion is that perhaps he truly loved his exceptionally well run clinic, reputation, patients, and work so much that at age 65 the concept of trying to ‘sell’ himself after his clinic was forced to close was totally inconceivable. I wish he could have realized that his gift and skills could have worked absolute miracles in millions of places on this earth. We have been living abroad for 2 years….the field is open and there is so much need. There are so many other options where he could have found total joy and happiness doing what he loved to do.

    I am grateful that you are being bold enough to raise awareness about this issue. I think that EVERYONE needs a confidential shrink once in a while. Especially those who are in high profile pressure positions -especially the medical community where people have to wear the badge of “super human” everyday. How sad that we have created a stigma in our country labeling those who seek counselling or professional help as flawed, unbalanced or incompetent. I believe those who are willing to look at their issues and work them through are the more intelligent sector who create a better life for themselves. Everyone needs someone from time to time who will hear their frustrations and their heart. Everyone needs someone to help them see where and how to improve the quality of life and living. No one should have to walk the path of life alone–especially because of their occupation or fear of being censured. No human being should feel so alone, pressured and despondent that the only option is suicide. This is exceptionally true for brilliant doctors who, generally motivated by a desire to serve and help other human beings, have sacrificed so much of their lives becoming experts in their field.

    May you be blessed for bringing this issue to light and providing this forum for expression. ~ Diana

  12. Anonymous says:

    I suspect that you would be hard-pressed to find one of us that isn’t at least sometimes suicidal. We’re just not allowed to admit it as it would end our careers.

    • Lori Bemis says:

      This is truly a sad statement. If you don’t admit it, you can’t deal with it. Why not seek help and lead a happier, healthier life? My first visit to seek help with my, mental breakdown, there was a poster that says, “which mask are you hiding behind”? I broke down and started crying. I hated that poster & cried every time I went for my therapy. In time, I stopped hating that poster & remember thinking, “I’m no longer hiding behind that mask”! I saw my specialist today and made a point of telling him how much I appreciate him and the work he does. He was at a loss for words. If we appreciate our health care providers, we NEED to tell them! Just a thought from an average everyday person who has a soul (a lost soul, sometimes) but a loving soul.

  13. a.patient rural nys says:

    I have thought about the issues of ptsd for some point in time. My thought is that there is probably a percentage of people that have ptsd issues would terminate their lives. I would think the number would be higher than the average population.
    My question are those numbers on the increase ? possibly due to what I think is a realionship in the use of medications that can have uncontrolled urges thoughts of suicide. My thinking might be that while a number of those unfortunate souls, might had the control, even when depressed, until treatment brings in these documented evidence in their side effect disclosers.
    If many dr.s are suffering, I would think many may be receiving pharmaceuticals for treatments , antidepressants….
    Then I wonder how this could effect dr. patient realsonships. Maybe the fact your dr. is taking a drug that has an ability for uncontrolable urges for example, this should be disclosed some how for patient safety. I understand drs are human. I have empathy. I would also like to know I am safe. This is gonna be or new normal. I think sigma with depression is attached yes. Do the patients attach the sigma? dr judge patients daily In my real world experience, drs judge people quickly, more often than they want to know us. we are all human. we need to work as a team. things will be better. I am sorry people suffer.

    • Pamela Wible MD says:

      I do not have the answers to all your questions. I do think PTSD is on the increase (and increasingly diagnosed). We all would benefit from a humane work environment. Unfortunately, many (soldiers, doctors, police) are exposed to tragedy and death daily. Are we safe with police, doctors, soldiers on anti-depressants? Are we safe with police, doctors, soldiers with PTSD? Lots of good questions.

      • Lori Bemis says:

        Agree, are we safe? We almost have to decide that ourselves, wouldn’t we? So many things to think about, sadness that this is happening to the professionals we put so much trust in. But, how does one help? I don’t know the answer to that. If I did, I would love to save the world, truly I would.

  14. Guest says:

    As a physician who spent a year in residency avoiding walking next to busy streets, parking on the bottom of the garage, and refusing to have any medications in my house because I knew that I could, at any moment, use them as a means to escape, I thank you for this article.
    I recognize that it’s hard for many non-physicians to ‘feel bad’ for doctors – we are seen as privileged. Many of us are egotistical. All of us are fallible. And, like everyone else, all of us are capable of plummeting to the depths of hell quickly and of feeling like there is no escape.
    What I don’t think many non-physicians understand is some of the unique circumstances we face. Even other non-physician medical providers don’t typically have the same experience.
    Most people have to work their hardest to be at the top in high school to get into a good college, then in college to do well on the MCAT and get into a good medical school. Then in medical school to do well on shelf and board exams to get into the residency we want. Even then, there’s no guarantee of that residency. We could work very hard for 4 years towards one specific goal and then be required to pursue a different specialty.
    Once we’re in residency, what feels like indentured servitude begins. We can’t really choose where we go, we can list the places we’d be willing to go, and a computer decides for us. We can’t negotiate our contracts. We are frequently seen and treated by patients, other medical personnel, and (worst) our attending physicians as unwelcomed intruders. Attending physicians who feel that it’s their right to treat residents like scum exist, and if you are unlucky enough to have one choose you as his/her pet destruction project, you have just bought into 3-7 years of abject torture from someone who can literally end your entire career in a moment.
    After residency, physicians work hard for their patients. We bring them home with us, figuratively speaking, every night. We work endless hours and sacrifice our families to help someone else’s family member. Sometimes we’re rewarded with the knowledge that we did our very best for someone, sometimes we find people who are grateful for our help. All too often, and more frequently these days, we find people who declare us slaves to PHARMA or the government. They declare that they know more than any doctor because they’ve read something on the internet, they rant on about how doctors only want to make money and don’t care about patients, and they respond to articles about the problem of physician suicide with comments like “I don’t feel sorry for doctors at all.”
    This doctor is working hard to pay off student debt that amounts to a very nice house. I really do love my patients and I do my best for them. I feel better most days, but I would never recommend medical school to another human being because one simply never comes out the same. Articles like this help us realize we’re not alone, even if non-physician members of society are likely to think we get what we deserve.

    • Pamela Wible MD says:

      Thank you. That made me cry. Cleansing tears. The pain is still leaking out after all these years. . .

    • SteveofCaley says:

      Bro, I can sing that song – ” Attending physicians who feel that it’s their right to treat residents like scum exist, and if you are unlucky enough to have one choose you as his/her pet destruction project, you have just bought into 3-7 years of abject torture from someone who can literally end your entire career in a moment.”
      Psychopaths gravitate to positions where they can control others, and my residency director was a psychopath. I believe that he would have danced with joy if he could get me to suicide – he was that sick.
      I made it through because I have a genetic inheritance of “F- you!” running through my family. That’s the only thing I can think of that kept me breathing.
      This pervert would OPENLY solicit married female residents to put out. There are sick F-s in the world, and some in medicine too – and they cause immeasurable damage.

  15. K says:

    This is my little story of “rebirth”. I got burned out many times in the past, starting in medical school, so many times that I had lost my count. I had always took it, now knowing any better then, as something simply attached to medical carrier by the nature of it. When in medical school and then residency, I accepted the expectations for functioning in high stress environment without sleep, food or rest for 36 hour stretches (sometimes even no bathroom trip for 24 hours once :)), and successfully pushed my body trough all of this. There were times however, when those 36 hour periods of constant workload were actually affecting my ability to think straight. By the time after 30 hours was the worst- my head was in the fog, my speech was literally slowed down, sometimes I got dizzy for few moments. I was perfectly healthy, none of this was caused by any underlying health problem. I remember thinking that maybe I am just too weak mentally? Not having enough of self discipline? I am the ambitious, rely on yourself first type of person, and my first response to this was to push myself even more. It felt like hell, this constant near faint like exhaustion, but I would do anything then to be a physician. My need to be a healer is a personal type of need, ingrained in my very nature; this is who I was literally born to be. I was ready to die, literally, before ever giving up.

    But nothing I did, no degree of pushing myself further made this exhausted state to go away, I actually got worse. I remember sitting at the kitchen table and trying to read a newspaper one day during my early time of residency training; I realized then I am not able to grasp the meaning of words I was reading, even multiple attempts were not helping. I could not focus enough on words to read them and then remember. If felt like very early onset of Alzheimer disease. I did not even knew what burnout is in reality, I was only familiar with the general meaning of the word, not with the specific physical symptoms. I was exhausted, had difficulty falling asleep, did not feel rested even if I slept, had difficulty concentrating, my short term memory seemed to be impaired. I was also starting to feel depressed and irritable with mood swings. I was afraid that I was going crazy! Worse, I was emotionally drained and finding it harder to express emotions, I was going “flat”. My cheerfulness and joy of life were gone. I did my own investigation into this, and it lead to realization that I am in fact burned out to cinders. The problem is, I could not take time off from my training tor recover, I simply pushed myself to continue, thinking this is what a physician is suppose to do. My symptoms waxed and waned, but I pushed myself trough it, graduated on time, and started my first job in family practice. I endured all of this because I wanted to heal, to take somebody’s pain away, and be a physician who is a blessing to patients.

    Next 8 years I worked in family practice office, seeing 30 patients a day, being on call every 4 days when overnight phone calls do not allow me to sleep; I work next day until 5 pm without any real rest. My day started at 8 am, my lunch time did not exist; there was always a patient to see, a phone call to make or labs to look trough; so I ate “in between” patients when typing on keyboard. I had to see all my patients and still handle paperwork, labs, referrals also “in between” patients. I had barely 10-15 minutes allowed in my schedule per patient. I could no longer be the physician I wanted to be; I did not have enough time for compassion, listening and detailed workout of presenting problem; instead I was participating in constant brain numbing race every day to battle my unreasonable workload. I had handled my own share of difficult, unpleasant personalities, and hard to figure out diseases for which, when I got those squared away , few wanted to give me a credit for. To top this off, I was loaded with paperwork filling pages of approvals for insurance, medications and commode refills, nursing home forms, disability papers, the list can go on here. At the same time my employer was pushing me to see even more patients, when trying to pay me less. But even this did not brake me, only burned me out, and so I pushed myself trough again.
    One time, I had a patient yelling loudly in a hallway: “how long I am suppose to wait here?” when I was running late. I was trying to force some food down my throat then because I found myself in a middle of hypoglycemic episode since I skipped lunch. I was really close to fainting, my hands were shaking and I was very nauseous. Trying to eat in a hurry when feeling like this is not easy… But again, I am push yourself first type of person, so I did, went to see the patient and apologized for being late. I had fleeting thoughts sometimes that working like this is nuts; but I simply did not have time to ponder on it.
    It took the birth of my third son for me to finally change things. I knew deep inside that I would not be able to handle 3 small children and full time family practice work and the combined sleep deprivation caused by overnight calls and my newborn baby. I simply got TIRED. Everybody has a breaking point and I had reached mine then. I experienced despair then like never before. I felt guilty for… loosing the “race” and not being able to push myself trough fatigue again. I was done for good this time.

    Then out of a sudden I saw the craziness of the entire situation here. I feel like a failure? For surviving 15 years battling unreasonable working conditions? For not being superhuman and succumbing into exhaustion after…15 years of life like this? That my body has the same physiology just as everybody else and it needs sleep, rest and food or it will break down? I also knew I cannot just quit medicine, it is simply who I am.
    Instead I quit family practice, worked part time for a year, and later switched to full time urgent care. I am still busy and actively treating patients, but my hours are defined and I can sleep at night because there is no call requirement. Paperwork is minimal to non existent. I have time for exercise and cooking my own meals, I feel human again. My cheerfulness came back and I can give it back to my patients now, I can be a blessing again. I also no longer think that I have early Alzheimer disease :).

    It is unfortunate that so many physicians face unreasonable workloads and expectations. I was lucky to wake up and find a solution without being forced to quit medicine altogether. If I did , a part of me would die anyhow. I wish the general public could see better what doctors are going trough; their situation is probably applicable to many other high stress occupations, like police force, or firefighters. Throwing demands at doctors to reform their own occupation, stop wining and get their act together will not work, but simply inflict more damage. It is like telling a depressed person to simply …stop being depressed! Thank you for taking time to read this piece.

    K

    • Pamela Wible MD says:

      This is my story. And the story of so many doctors. I had no kids and I only lasted 10 years. Then I created an ideal clinic. Saved my life. Thank you for sharing what really goes on behind the exam room door.

  16. r58black says:

    The best way to drive a primate insane, including humans, is to have the primate responsible for things that they cannot control. Doctors are being made into human shields amongst other un-pleasantries.

  17. Geoff says:

    I am glad the door is being opened to discuss the inhumanity that so pervades the medical profession. Having read the comments posted so far, I grieve with you all, doctors, patients, and survivors of those who killed themselves.

    Oddly, I think we are the lucky ones – we KNOW things are wrong and we have entered into the conversation. Truly pitiable are the masses who have “successfully” cauterized their hearts and continue to spread dis-ease through medical schools, insurance companies, hospital administration, and all the rest.

    May we here take solace in knowing we are not alone in our grief and loss and later, go forth to call the injustice and toxicity by their rightful names; perhaps to spread healing among the healers.

  18. Pamela Wible MD says:

    Just got this e-mail:

    Ideal Medical Care Contact Request

    Message:
    In the past three years our OR dept. has lost 2 anesthesiologists, a pharmacist, and 2 nurses, one recently, to self inflicted injuries that resulted in their deaths. What do we do with this?

  19. Kathy says:

    My heart goes out to all of you medical students and MDs who endure this enormous kind of stress. You take on the herculean task of caring for others at a soul-breaking pace, with no time or energy to care for yourselves. I’m not sure, but I’m guessing that this type of stress is much more difficult for MDs in America than for those in Canada, where there is socialized medicine.

    Pamela, you are a unique and precious gem.

    • Pamela Wible MD says:

      Anyone from out of the country want to take a stab at this? No pun intended. I hear things are similar in the UK.

      • Alicia Schreader says:

        Sadly, the situation in Canada is not significantly different here in Canada. I’ve been practicing medicine for almost 24 years and have had essentially the same experiences: overwork, stress, marriage breakdown. We too are like “human shields” expected to buffer the worst effects of a dehumanizing culture.

        My training of 36 hours of on call without proper sleep, bathroom breaks, food intake was essentially the same.

  20. Melody Carr says:

    I wondered if you have seen this amazing video of a neurologist, Dr. John Kitchin, who found a unique way to heal himself, but is no longer practicing medicine, in part because of medical problems. But he also became aware of the stress and craziness of his life.
    “Disillusioned with a life that had become increasingly materialistic, he had abruptly abandoned his career as a neurologist and moved to a studio by the beach.” He took up roller blading and is known to everyone as Slomo: http://vimeo.com/90655826.

    Josh Izenberg, the filmaker, wrote an article in the New York Times about it as well: http://www.nytimes.com/2014/04/01/opinion/slomo.html.

  21. this breaks my heart to read. maybe you don’t know about EFT or TBT – please check them out. EFT is the emotional freedom techniques, using a simple form of tapping with the fingers on the energy lines of the body to relieve stress.

    TBT is used for radical stress – war, loss, accidents, acid in the face, wife-beating and abuse, PTSD, etc. http://TraumaBusterTechnique.com if you’re at all interested.

    Look up Rehana Webster there. Also David Anton Kanosh, who does work with vets, and Joanne harvey, out of Northern California, who works with nurses.

    If doctors and med students knew this simple technology life would improve radically. and isn’t it about time to get the teaching norms changed to support new docs? good grief!

    • Pamela Wible MD says:

      Yes! Angela, I know about EFT. We need medical schools to embrace a nurturing and healing environment for students and offer these healing modalities. Time to evolve. Time to allow our healers to heal – and to be human.

  22. Guest says:

    Thank you for posting this. I am a 4th year medical student who would quit right now if I didn’t have so much student loan debt. It’s nice to know I’m not alone.

    • Laura says:

      I was a medical student and I *did* quit despite the amount of debt I had accumulated. It was the BEST decision I have ever made in terms of taking care of my health. Had I not quit, I would probably be writing sentiments similar to the ones that Dr. Wible presents in this article. Instead, I have found a job that I enjoy, and I have time to pursue my hobbies and spend quality time with my friends and family. I am so thankful to have rediscovered my enthusiasm for life.

      As far as the debt goes, I deal with it one month at a time. I think of it as just “one of the bills,” like that of my cell phone or rent payment. If I had to pay my loans using a check then I would write “The Price of Happiness” on the “For” line. You have never run out of time to take the necessary steps toward making your life one of happiness and fulfillment. It is not too late to make changes or to stand up for yourself and say, “Enough.”

      I want to mention that I had an INCREDIBLE mental health counselor who looked after me and met with me biweekly during my time in medical school. She was my rock, and she helped me find the inner strength to make the informed decision to leave school. THANK YOU to counselors everywhere. You inspire me.

  23. harry guda says:

    what a website…we all suffer….it is terrible…..please don’t suffer alone….speak up…
    talk to someone about how awful it can be….it has changed….I thought I suffered but I really feel sorry for the way doctors are treated now….don’t kill yourselves….don’t turn to drugs and alcohol…..you can find a way out …but you must not be alone in that awful stress black hole….I survived…but it wasn’t pretty….it isn’t pretty out there…I send my love to you all…from a very old tired medical doctor…

  24. Linda says:

    I can relate. Veterinarians are in the same boat. We are looked down upon by other medical professionals and treated like the embarrassing poor cousins. If we are lucky, we make 1/5 what an MD does. Students graduate with debts they will never be able to repay. Owners scream at us for not doing everything for free because we are supposed to love animals. Far too often older practitioners who own practices have become far too jaded, often unethical, and money grubbing that medical care suffers greatly. And other sectors such as humane societies are often run by completely clueless egocentric laypersons — and again, the animals and those who actually care and want to do a good job are the ones to suffer. School is the same as well. Those in charge pick out the favored ones and the rest are tormented mercilessly. The ones who come out on top are the best bullshit artists– not the best practitioners. Complete lack of appreciation and compassion fatigue is rampant among anyone who cares and tries to do a good job. I have recently moved and am not working. The thought of going back out there and trying again- dealing with all the drama and and insanity– panic attack central! PTSD — oh yeah, it is real. And it sucks because I am damn good at what I do and I love the animals. I have known vet students and veterinarians who have committed suicide. Back in school, a classmate’s husband committed suicide and she was right back in class the next day– another classmate’s spouse read about it in the paper which is the only reason we all found out about it. Have I ever though if it? Yes. Attempted it? No. I have no answers. And for now, will remain unemployed.

  25. Delmar H. Knudson, M.D. says:

    I went to an unusual medical school at a time when 1/2 of the faculty hazed and bullied us; and openly joked about our chances of making it through med school. Over 1/4 of the class ahead of me didn’t make it, and one quarter of my class were flunked out. The Dean had his secretary walk into the lab one day and hand each of those who would be ejected a pink slip informing them of this (in front of all the rest of his/her class). The top student admitted to vomiting before every test. My roommate’s father died; he asked for one day to go home 60 miles to bury his father, and the dean said we’re about to take semester tests, so if you leave school for a day, don’t come back. The entire aura of this medical school has now been changed; but I always thought going through Parris Island in Marine boot camp would be a snap after that. But, I always could rise above that; and one day in talking to a classmate, I said “I may decide to quit, but I swear they’ll never be able to flunk me out.” I had grown up on a farm where my Dad worked us up to 16 hours a day; helping out for many chores from age 8, and driving the tractor at age 9. My family didn’t have much money; I never got any money from my family, nor from anywhere else, except for $500.00 from my grandfather, and $400.00 from a charitable fund. My family was known for their perseverance against any odds that came up. I think I may have been “immunized” by my upbringing from quitting or committing suicide.

  26. HDG says:

    So sad.
    I’m an allied health professional. 26 years ago my Dad (a medic) gave me this advice when I was under huge pressure to commit to medical school
    “You are the most sensitive of my children and the most lateral thinker, you would make a great doctor, but becoming one would either destroy those traits or kill you.”
    I’ve never regretted the decision to not become a doctor, only wished my field earned more occasionally.
    Last night on a bus trip to another city to visit my partner (another down side – good jobs are rare) I sat with a 19 year old struggling with the same dilemma. I’ve given her my e-mail and invited her to contact me if she wants to see what I do in my daily job – and see what my junior colleagues do.
    We need bright talents in the roles that support medicine, and with those perhaps we can ease the burden on our medic friends

  27. DOT says:

    It is very sad to see how much doctors suffer in trying to graduate from med school and how much more when we get into practice,from my little 9 years into practice after med school,few years of about 3 years in my home country and the rest so far outside the country ,the most troubling issue for any doctor is the pressure in which the society and family has placed on us,the best way to insulate oneself is to know that ,we do all have a human limit that should not be exceeded at anytime under no circumstances ,our happiness should come first, and if changing environment will be the key ,grab it .do not be scared to take the risk of saying it is enough.

  28. NewDocOldProblems says:

    I recently finished my residency in a surgical subspecialty… “off-cycle” as they call it. I required extra time due to persistent depression (brought on by sole shattering training environments) through medical school and residency. And now my job hunt is filled with PTSD as I struggle to find a position that doesn’t remind me of what I just left and the terrible direction most medicine and patient care is headed. All that training… I know it’s the right thing to practice, but how does a surgeon ever practice ideal medicine that requires an OR, assistants, and equipment?

    Really struggling to move forward…

    Thank you for the blog, at least I am not crying alone.

  29. Frances says:

    Let’s work as a community to ease the pressure. I wrote a book about my experiences in residency, you can find it on my website, francessouthwick.com. I welcome ideas.

  30. Ekta says:

    I’m convinced all of medical school and medical education can be summed up by the song that plays at the end of each of the Jason Bourne movies depicted by matt damon……..Extreme ways by Moby

    https://www.youtube.com/watch?v=Cyt0ViDtJ_w

    I used to listen to this song when I was at an all time low in my ugrad day but its lyrics, especially verse two:

    Extreme songs that told me
    They helped me down every night
    I didn’t have much to say
    I didn’t get above the light
    I closed my eyes and closed myself
    And closed my world and never opened
    Up to anything
    That could get me along

    I had to close down everything
    I had to close down my mind
    Too many things to cover me
    Too much can make me blind
    I’ve seen so much in so many places
    So many heartaches, so many faces
    So many dirty things
    You couldn’t even believe

    I would stand in line for this
    It’s always good in life for this

    I hear this song echo in my heart and mind when I think of all the abuse in the system, the patient care that is compromised, the egos, the arrogance, the sleep deprivation, the hazing and initiations, the back biting and belittling, the desperation to stomp on anyone just to get ahead, and the projection by those who themselves have been abused worse then the ones they are now abusing, etc, the patients who lack paitentce with us when we try to give equal time to all patients and aren’t done with each patient in 15 min driving their appointment to be later then they anticipated, the deans who refuse to listen to the needs of the med students even when they have not entered med school themselves to get it, the administrators who deny patients care they desperately need in the form of insurance companies who think their MBA qualifies them to tell a physician how to do their job, the pharma companies who try to woo physicians patient care be damned; need I go on???

  31. I’m from.Australia I’m not in the kedical industry but am a patient thats suffer chronic pain from Arthritis, Uvitis, Glaucoma, Osteoporosis & I’m legally blind. I’m terrified of being addicted to the medication so I sleep a lot as to not feel the pain & whwn I sleep I’m not taking the medication. I have always wonderinv how medical staff can do there job but never truly realsied how bad things are until reading the comments. I honestly neverthought about it that much which saddens me. I’m not sure what it’s like here in Australia but I hope everyone can get help & be around to continue their great work. I see you all in a different light now.

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