Today I woke up to another email regarding the suicide of a young resident physician:
“Hi Dr. Wible, an intern resident at our pediatrics program died by suicide this past weekend. I am profoundly angered and disturbed by many aspects of the institutional reaction to this tragedy. I find it alarming that members of administration, so soon after her death, are making comments that focus solely on her pre existing health conditions and not the circumstances/surrounding environment that may have contributed. What I DO know is true is that many who have graduated or are in the program currently will agree that it is not difficult to understand how/why this could happen here, and it must change.The private hospitalist group that unofficially controls the program and its admin is dysfunctional and has bullied and abused residents for years. Their involvement is a conflict of interest. The “confidentiality” of spaces like psychiatry absolutely cannot be trusted. Then take into account this horrific tragedy comes on the heels of increasingly poor ACGME scores, constant work hour violations, poor morale, and a highly toxic work culture that silences residents. The deceased is survived by her husband who was also just starting his journey as a pediatrics resident in the program and their young son. We will not do the memory of this amazing young woman justice by ignoring what everyone knows, that these issues already existed and have harmed others here. This is an unacceptable status quo deserving of further investigation.”
This comes on the heels of similar letters I’ve received like this one:
“I’m submitting the name of my classmate to your suicide registry, please. He was in his final year of medical school. He self-administered a lethal dose of anesthetic in his residence room. The two of us had ‘jokingly’ spoken about using this method to kill ourselves since our second year of medical school. Then, in my first year of internship, I found myself almost doing the same thing in a hospital call room. This despite being a ‘happy newlywed’ just starting my life. I was then harassed by hospital seniors and administrators, who forced me to undergo a psychiatric evaluation. When I decided to take the psychiatrist’s advice and take time to heal. They did not keep the matter confidential, I decided to resign. I have still not returned to practice.
My friend was a talented musician and an incredible human. He openly spoke about his depression and wanted to reduce the stigma. He died at the beginning of our academic year. The campus was in mourning. Yet the faculty of medicine did not send out an email of condolences of any kind. Classmates were forbidden from leaving their clinical duties on the day that the news broke. There was no debriefing session organized for the students. The campus of over 1000 undergraduate students remains served by a single part-time clinical psychologist. The memorial was organized by students, and faculty did not attend.”
This January I found myself leading a eulogy, candlelight vigil, and 10-hour memorial for a physician who died by suicide—a pioneering woman in medicine who deserves to be celebrated (read her eulogy here). She stepped off the roof of a 33rd story building that houses hundreds of residents. She was on the ground in her white coat covered in a tarp for hours surrounded by yellow crime scene tape. Yet the crime leading to her suicide has still not been investigated. Residents did not even know who was under the tarp as they walked alongside it to get into their apartment after work. They had to text each other to find out who was missing and by process of elimination on their own! The medical institution did not even share her identity publicly until after I led her eulogy. I was threatened that if any media attended the memorial they would be arrested. Residents told me they had been threatened to stay quiet about the suicide or they’d risk breach of contract and termination.
These suicides are happening at our finest academic medical centers across the United States and the world. Brand-name schools. Many now under legal investigation in wrongful death lawsuits.
Now Duke anesthesia is under legal investigation for censoring doctor suicides and silencing survivors.
After the suicide of a second-year female anesthesiology resident, doctors complained about the “insensitive response” and “stubborn refusal” to support those with mental health disabilities and the widespread discrimination against many female anesthesiologists in the department,” according to a federal lawsuit.
Yet the official stance of the department chair was that they held no liability in the Resident’s suicide. Many faculty, visibly upset, felt the focus should instead be helping staff experiencing depression and grief after the sudden death of their colleague.
Attendings were not permitted to meet with residents to offer support and they were prohibited from organizing a candlelight vigil to mourn the resident who had died.
The fact is these suicides are being actively covered up by medical institutions that blame the victims for having “mental health issues” while never addressing the chronic human rights violations inflicted upon these physicians and medical students who are often forced to work 28-hour shifts on no sleep with lack of access to food, water and bathroom breaks. They experience sexual harassment, racism, vicarious trauma without on-the-job support in our health care facilities. They are bullied, hazed, mistreated in ways that are illegal in any other industry.
I now know of 14 doctors who have died by suicide in my own town. Three within just over one year. So in 2012, I started keeping a list of doctor suicides in my diary. I began with 10. As of today I have 1,009 on my registry organized by name, age, specialty, suicide method, date, and circumstances leading up to their suicides.
High rates of doctor suicide have been reported since 1858, yet 160 years later the root cause of these suicides remains unaddressed. Medical institutions are not real excited about launching an investigation into why so many doctors are jumping from their hospitals or overdosing in their call rooms. Meanwhile one million Americans lose their doctors to suicide—each year. Given physician suicide is a true public health crisis, urgent action is required from our medical institutions. Hiding these suicides from public views only increases the number of suicides. The widespread suffering and hopelessness among our doctors must be addressed head on.
1) Every medical student and doctor suicide must have a full investigation.
2) Victims must not be blamed for “mental illness” (especially when subjected to chronic human rights violations—dangerous working condition known to cause mental health conditions).
3) Victims’ names must be released and services offered (vigils, counseling, memorials, time off to attend funeral, ongoing non-punitive confidential therapy for survivors).
4) Counseling must be 100% confidential. Program directors and staff should never have access to resident mental health files as they do now (commonplace and a violation of HIPPA!).
5) Medical institutions must take accountability for unsafe working conditions linked to these suicides.
Doctor suicide is a public health emergency that requires national investigation and daily tracking of suicides by CDC and other agencies. Legal teams are now confronting dangerous hospital working conditions that violate ADA, civil rights, HIPPA, labor laws, and the United Nation Declaration of Human Rights. Our medical organizations have been ineffective at ending unsafe working condition and many are profiting from human rights abuse of physicians and medical students (cheap labor).
We must start using proper terminology to describe this epidemic. Our doctor suicide crisis is rooted in human rights violations.