(Listen in above to a rerecorded keynote—due to a fire alarm during event—or read transcript of Dr. Wible’s presentation below)
Michael Phillips MD: Good morning everybody. I want to introduce the lectureship and remind everybody who Gil was. Gil was originally from Philadelphia and then moved to Oregon where he joined The Gastroenterology Clinic, which at the time was the only GI-specialty clinic in Oregon. He became one of the preeminent gastroenterologists well-loved by patients and staff alike and known for his outstanding humor, his clinical skills, and patients who absolutely adored him. I continue to take care of patients that he took care of 20 to 25 years ago and they still think of him as their gastroenterologist. I’m just kind of standing in. That’s the kind of guy Gil was. Gil really dedicated himself to education. He was Outstanding Teacher of the Year twice—a testimony to who he was. He died unexpectedly at the age of 50 [on a ski trip, not a suicide]. In response to his untimely passing, we established this lectureship 20 years ago. We’re here today to commemorate him and to continue to use his legacy to help facilitate our practice and humanity in taking care of patients.
It’s really with a great pleasure that I get to introduce our speaker today, Dr. Pamela Wible. Pamela is family physician born into a family of physicians. Her parents actually warned her not to become a physician. Shortly into her first year of medical school, she experienced the adverse effects of medical education on her own mental health. It wasn’t until 2012 after losing three colleague physicians to suicide that she began to investigate the mental health crisis among medical students and fellow physicians.
For the past six years, Dr. Wible has reported on doctor suicides and human rights violations in medicine. Her articles have been picked up by major media including The Washington Post and Time Magazine. She’s the author of the bestselling book, Physician Suicide Letters—Answered (free copies available today). Dr. Wible has two TED Talks on doctor suicide. She’s been interviewed on primetime investigative television and featured in a new award-winning film Do No Harm that’s currently being screening at hospitals and medical conferences internationally.
In between treating patients as a solo family physician in Eugene, Oregon, Dr. Pamela Wible continues to run a free doctor suicide hotline that’s been in operation since 2012. Today, she’ll share the results of her investigation into more than 1100 physician suicides and reveal simple truths and solutions to prevent the loss of our healers. Please welcome Dr. Pamela Wible. Thank you.
Pamela Wible, MD: Thank you all so much for being here. I want to thank Providence for hosting this event and taking on this topic of doctor suicide. Though I never met Gil in Oregon, our paths did sort of cross in Philadelphia. Turns out my dad and Gil attended the same high school where Gil was actually the vice president of his graduating class.
There he is. Teacher of the Year at Providence as a young guy before he had the mustache. Gil knew from early on that he was headed for a career in medicine. He declared that right away at Central High.
Unlike Gil, my father assured his classmates as the president of his class that his future occupation would be in the motion pictures.
Like a good Jewish boy he relented to parental pressure and became a doctor. Both Gil and my dad did some of their training at Hahnemann in Philadelphia. Both pursued internal medicine. How odd is it that I’m invited to do this lectureship and my father and Gil have such parallel paths in medicine.
Unlike Gil who died at the height of his career, my father practiced medicine for 62 years and retired at 87. He died four years ago this morning at 91. My dad ignited my interest in medicine. Here I am following him around in the hospital. With physician parents I grew up in the hospital hallways back when they didn’t care if your kids crawled through the morgue with you. I don’t see many physicians’ toddlers wandering the hospital hallways today. Too bad. I had so much fun playing with the paraffin in the pathology department and looking at this huge glass jar with all the bullets and foreign bodies he found in patients (that I thankfully inherited after he died).
Dad’s a pathologist. I think the human drama of running a small neighborhood internal medicine practice was a little bit too much for him, so he chose a more predictable patient population in the morgue. My mom is a psychiatrist so I tagged along as a child at the state hospital. So I spent my time with mom hanging out with the seriously mentally ill and with my dad I got to hang out with dead people. Neither of my parents needed stethoscopes so I inherited all their equipment from med school too. I developed this love for medicine and a fearlessness about mental illness and death because of the unusual experiences I had with my parents—amazing for a blossoming young doctor, but for my siblings morgue visits were horrifying and traumatic.
Unlike my father, I’m much more of a rebel. Since I was warned not to pursue medicine, here I am graduating from medical school and becoming a solo family physician (who still doing house calls and practices medicine the old-fashioned way—which is kind of a rebellious thing to do in 2018!).
I was living the happily-ever-after life of an old-fashioned family doc in the sweet town of Eugene, Oregon until October 28th, 2012 at 3:00 p.m. when my entire life got turned upside-down. I found myself sitting in the second row of a memorial service for our third physician suicide in our small, idyllic little town full of farmer’s markets, organic food, and friendly hippies. Sitting at this memorial service, I started to count on my fingers the number of doctors that I had personally lost to suicide in my life and/or who died under suspicious circumstances that I thought maybe were suicides covered up with the classic euphemisms.
Within a few minutes, I had counted 10. Startling for me in my early 40s—the prime of my career. So I did what I needed to do to get a handle on this epidemic—I gave up knitting and mosaic mural artwork and began tracking doctor suicides as a hobby. I became completely obsessed with why so many doctors were dying by suicide. Two of the doctors on that list of 10 were men that I dated in medical school who died by suicide (not while I was dating them I want to make that clear) but later on when they were married. They died at 39 and 44 leaving wives and young children behind.
Because I am so vocal and such a prolific writer on doctor suicides, I ended up well-known among my peers for my investigation into doctor suicide and soon people began telling me about more and more doctor suicides. Five years later, I ended up with 547 cases submitted to me by physician colleagues and family members. I never went looking for these suicides. They were submitted from people calling me saying, “Hey, I want you to know my neighbor shot himself in the head a year ago. I was in my backyard. I heard the shot, I saw the police come. The family’s not really talking about it, but here’s the backstory and I want you to know what really happened to this cardiologist.”
So I end up with this list—an informal suicide registry where I’m tracking by name, specialty, date, method, and location of suicide, plus any extenuating circumstances. Now I have a very deep understanding of why my peers chose to die. And cases keep coming to me almost daily. Now I have 1103 doctor suicides that I’ve personally investigated by talking to family members, friends, the last boyfriend, and medical school classmates.
With so much content, I’m discovering themes. Here is my blog where I began to share results of my investigations. Full disclosure: Personally I’m so obsessed with this topic because I was a suicidal physician myself in 2004. I thought I was the only one. I had no indication that other doctors were suffering. I felt like the oddball, the sensitive one. Maybe I was too idealistic. I just had no idea physician suicide was such an epidemic.
Professionally, I feel called to be a healer. As a scientist and physician, it is my obligation to research why my peers are dying. So I started blogging about suicide and my blog (that nobody really read up until then) suddenly on December 12, 2012 when I published Why Physicians Commit Suicide ended up with 80 comments right away and now 231 comments. So the public response kind of egged me on to continue talking and writing about it.
Then my blogs started to get picked up by The Washington Post, like this one, What I’ve learned from my tally of 757 doctor suicides. That was how many cases I had on my registry as of January 13th this year. Here’s a screenshot of the top of my blog a month ago back when I had just over 1000 cases and reported on my latest data at my keynote at this orthopedic surgery conference. I was the only female physician speaker during this four-day orthopedic surgery symposium. I consider that a huge accomplishment. All the orthopedists only got 10 minutes to deliver their content and they gave me an hour on doctor suicide! There’s an indication that we’re making progress as a profession addressing doctor suicide.
So here’s a wall in my house covered with physicians and medical students who have died by suicide. Again, I’m taking this very personally and I’m in touch with many of their family members.
Now a bit about the scope of the doctor suicide crisis. We’ve known about the high rates of doctor suicide since 1858 when first reported in the UK. Now, 160 years later, the root causes of these suicides remain unaddressed. That’s because we don’t really understand the root causes of a taboo topic—hidden for more than a century. Because as a culture we’re scared to say suicide out loud in and we’re definitely scared to say doctor suicide out loud.
Doctor suicide is a triple taboo. Death is not a topic anyone wants to discuss over dinner. Suicide is death suddenly in your face. Now doctor suicide—the people that are supposed to be helping us are dying by suicide too. This strikes terror in the hearts of patients and makes doctors feel vulnerable. It’s just a scary topic for most people so I’m taking this on because lives on the line that can be saved today by the way we behave with each other and our willingness to tell the truth about physician suicide.
Physician suicide is a public health crisis. More than one million Americans lose their doctors to suicide each year—just in the United States. Researchers say we lose 400 physicians per year to suicide (they believe this is an underestimate), yet 400 is the size of an entire medical school. The average medical school has 126 students in each class, and so that’s an entire medical school equivalent of physicians per year. Due to all the secrecy and underreporting—even death certificates that are completed as accidents when they are self-inflicted—doctor suicides are often well hidden. A physician in family medicine has a patient panel of 2,300 patients. The average emergency medicine doctor probably sees even more per year. Simple math on 400+ times 2,300+ and you’ve got a million patients who’ve lost their doctors to suicide (and that’s not including student doctors).
Here’s some raw data on more than 1100 cases I’ve received. Of 1103 suicides. 969 are physicians and 134 are medical students on the registry and 920 of these happened in the U.S. while 183 are international. People are contacting me from all around the world. Last week I was on a Skype call with a doctor form Israel telling me about the head of the department who died by suicide, as usual “happiest” guy and totally unexpected. When looking at raw registry numbers per specialty (and not accounting for size of specialty), surgeons are in the lead, then anesthesiologists, family medicine, internal medicine, emergency medicine, psych, ob/gyn, pediatrics, and radiology. However when evaluating these numbers based on active physicians per specialty we can see the real impact of suicide per specialty below:
These are numbers based on active physicians in the largest specialties. Now we start to see some really interesting trends. Anesthesiologists are really off the charts. Of the largest specialties, general internal medicine has the lowest number of suicides according to my 1100+ cases. Anesthesiologists actually have 2.3 times the rate of suicide of all surgeons (general surgeons plus all surgical subspecialties). Anesthesiologists have 5.5 times the rate of suicide of general internal medicine doctors.
Medical students with preexisting mental health conditions deserve informed consent about mental health risks per specialty. I have premed students calling me who’ve had previous suicide attempts or panic attacks that are poorly controlled right now and they want to go to medical school. They deserve to know this information just for their own sanity and survival.
To fill in the gaps of this underreported epidemic, I’ll review 13 reasons why doctors die by suicide through case studies by introducing you to 13 our best and brightest colleagues who have died by suicide.
First, a quick recap on the language of suicide. Because this is such a taboo topic, people have been afraid to even say suicide aloud. By the way, at that memorial service that I went to they never said suicide out loud. Everyone knew that he shot himself in the middle of the day at Mount Pisgah in Eugene, so it wasn’t hidden. He’d had a public death in a public park, but nobody at the memorial service said suicide out loud. In the bathrooms and milling around, everyone kept whispering, “Why?” Everyone wants to know why and nobody will say suicide out loud. Imagine if we we were afraid to say diabetes out loud but we had to sneak into the bathroom to whisper about our diabetic patients. How far we would be with treating diabetics? Imagine if patients had to sneak out of town and pay cash and use paper charts to keep diabetes off the EMR. Insane. Right?
My plea here is let’s destigmatize suicide so we can actually discuss this crisis factually with data—and without such terror and shame. We can actually solve this problem. Because we don’t often know how to talk about suicide I’d like to encourage correct terminology.
“Committed” suicide is actually a very antiquated, stigmatizing way to discuss suicide because it makes it sound like a crime (like committed burglary or rape). Really suicide is a medical condition in which people are dying prematurely and should be discussed like every other medical condition—died by diabetes, died by heart failure, died by or of suicide. I know it’s hard because it’s like a knee-jerk reaction to say “committed” suicide. Even newscasters are still saying “committed” suicide, but I’ve been schooled on this through a psychiatrist who is the parent of a 29-year-old internal medicine physician who died by suicide. She was one of the first who commented on my blog Why Physicians Commit Suicide and she wanted me to know the title of my blog was stigmatizing. I didn’t know any better. I was just starting to discuss this myself and it was a great teachable moment for me, and so I’d like to pass that on to you.
Next, the idea of a “failed” suicide. How weird is it that when a physician attempts suicide and actually survives that should never be framed as a failure? Call that an attempted suicide in which we now have salvaged the person’s life by the grace of God. “Successful” suicide. To die as a 29-year-old internal medicine resident is not success. That’s a completed suicide which shouldn’t have happened in the first place. To prevent the next 29-year-old internal medicine resident from dying by suicide, I would ask you all to please destigmatize the suicide conversation.
Now I’ll share 13 case studies and 13 reasons why we’ve lost some very beautiful and brilliant people to suicide. I could talk about each of these amazing people for hours. Due to time constraints I’ll give just a thumbnail sketch of each case (some have been discussed in far greater detail in my other articles and keynotes).
First meet Dr. Ben Shaffer. Ben’s sister just sent this newspaper clipping to me. Ben was voted Most Likely to Succeed in high school. That has a new meaning for her now. He was also voted Most School Spirit in junior high. You can see this guy is awesome, charismatic, loving. He was the top DC sports surgeon at the time of his death. They called him Dr. Smiles. Nobody had any idea he was suffering. Such a smiley guy cracking jokes up and down the hospital hallways.
Why is he now suddenly dead by suicide? What you didn’t see from his smile is his chronic lifelong anxiety. Plus he had marital and work distress, which I think we all have. That’s not unique to Ben. As a physician when you throw yourself into your professional life at the level at which demands are made on us, you will have personal life atrophy. I don’t think there’s a doctor in here who hasn’t had a strained marriage or relationship related to the commitment that we have to our profession. Plus he had work distress. Not unique to him. Reimbursement was going down and that puts stress on you when you’re in a private practice as an orthopedic surgeon. On top of that, he’d just had back surgery. He was dragging his foot and expected to have a complete recovery, but the whole process of having chronic anxiety added to his recent stresses and on top of that his long-term psychiatrist retired and passed him on to a new doctor who changed his medication regimen resulting in worsened insomnia and anxiety.
Ben knew he needed to be hospitalized. Instead he hanged himself on a bookcase at home rather than seek inpatient care. He died from shame and stigma. He was more concerned about his colleagues knowing that he would be on an inpatient psych ward. He did not want other professional team members to know. As a very high-profile guy in DC he was scared that everyone in town would know that he had mental health problems. And so, he chose to die instead. Unbelievable.
What I’m listing here is that final event among a cascade of events that happens over time. Notice how preventable these suicides are. On interviewing physicians who have survived suicide attempts (all male) I asked, “How long did it take between when you decided you would take your life and when you pulled the trigger, took the pills?” They said, “Three to five minutes.” So we have just a few minutes to intervene if we wait until the time of their suicide and perform some heroic salvage via 911 and chest compressions. It’s very hard to heroically insert yourself within those last three to five minutes of someone’s life. Meanwhile, there are thousands of missed opportunities over decades leading to those last few minutes of life. Let’s not waste one more early intervention opportunity. Please.
Here we have Kaitlyn Elkins, a third-year medical student. Perfect child. Everyone dreams of having a child like this. She doesn’t curse or drink or do drugs, and is home on time for dinner, straight-A student. Valedictorian. Brilliant, gifted, artistic. A deep existential thinker. She grew up in rural North Carolina, probably had the highest IQ for 100 miles around. Being a gifted person can be a lonely experience because you feel different from everyone else. You feel sort of more responsible than everyone else. You’re the president. You’re the valedictorian. You don’t really have a peer support group because nobody is like you. Life can be lonely.
Why did Kaitlyn end up dying by suicide as a third-year medical student near the top of her class? I believe she was hoping when she got to med school she could finally be with her tribe of like-minded, high IQ, deep existential thinkers. We are brothers and sisters in medicine. We are a family. We have a whole heck of a lot on common. Yet medical education is delivered in such a way that pits students against each other in a fear-driven atmosphere that is competitive, not collaborative, to the point where the first day of medical school they’ll welcome students with a threat: “Look around the room. Half of you won’t be here next year.”
Challenging to bond with each other under such threats. This woman ended up dying by loneliness, which is totally preventable. We can prevent this by changing the atmosphere. We could welcome first years into the family. The dean could pass out her cell phone number and say, “Hey, I’m here for you. You’re the cream of the crop. We won’t let you fail.“ Orientation could be a time for people to make lifelong friendships. We could start nurturing our gifted students instead of terrorizing them to learn—a horrific strategy for everyone and especially for gifted, sensitive people. Public humiliation and terror as a teaching tool is catastrophic for our mental health.
I became very close with Kaitlyn’s mom, who died by suicide a year later completely heartbroken that she lost her daughter. I ended up at her funeral. I have to tell you standing at a funeral where you see one headstone with that beautiful, blonde-haired, 23-year-old woman and then the pile of dirt and the casket of her mother who I’ve had a million phone conversations that I never met in person until I was next to her dead body with my hand on her casket—this is a scene out of a nightmare.
Her husband who’s the sweetest man, not a vengeful bone in his body, not an angry person, a very sweet kind guy, I hung out with the whole family for the afternoon after this memorial service, this devastated family in rural North Carolina. I asked him, “Do you think if your daughter worked at Walmart or went into real estate or did something else, do you think your family, your wife and your daughter would still be alive?” Sweet guy says, “Yes. Medical school has killed half my family.”
This is Dr. Kevin Dietl, a kind, loving, genuine, hardworking student doctor. He put in his best effort through medical school. Why did he die? He ended up depressed. He minimized it. His mother noticed and Kevin reassured her, “Mom, everyone in my class is depressed.” Probably true. So he normalized his depression as just what happens to all medical students. He feared losing his career. He didn’t want to seek treatment in town and didn’t want it on his record. He was three weeks away from graduating medical school. They gave him his degree posthumously. Three weeks away from graduation when he died from untreated depression by firearm. Nobody should be dying from untreated depression—especially when surrounded by such a high density of doctors all day long. Doctors saw that he was suffering and they just let him continue on his rotations (even though he was picking at his skin and having obvious signs of serious depression leading to a psychotic break).
Family members are startled when they find out about this epidemic after losing a child to suicide in medical training. They are under the assumption that sending your child to medical school will be one of the safest places for a student. In case of a medical emergency, these students are surrounded by doctors and hospitals. Paradoxically, it is just the opposite. Medical training and practice (though surrounded by medical professionals who could presumably help you) is a high-risk career for near-fatal and fatal mental health crises such as suicide. Like sending your child to Afghanistan, to an active war zone. Interestingly, a medical student who was in the military reported to me that she felt safer in Afghanistan during active sniper fire than she did in medical school.
Meet Julian Matthew Richardson who had a love of live, made everyone laugh, was a real people person. Why did he die by suicide? I’m very close to his mother now who texts me multiple times a day with all sorts of pictures. She’s a reverend—a real spiritual, beautiful approach to life. Well, she revealed he had a very traumatic childhood. A lot of people who go into medicine have survived childhood trauma and for whatever reason, they’re attracted to emergency medicine often where they’re re-triggered every day at work through every case. Without mental health support, this could undermine your sanity. Julian felt very broken, like emotionally, spiritually, and physically fatigued just from medical training and what he was witnessing, He took a leave of absence and suicided the next month. He died from total exhaustion, according to his mother. I do believe this was absolute total emotional, spiritual, physical exhaustion and in part exacerbated by preexisting issues before medical school but medical training just opening theses wounds every day. One of the last things he said was, “Mom, they really don’t care about these patients.” He just felt like people weren’t getting their needs met. What he was witnessing was just too much for him. Julian was obviously not getting his needs met either.
Sean Petro, a third-year medical student. Caring, generous, smart, sensitive guy. Creative, artistic. Must be challenging to be creative and artistic when you’re on a military scholarship in medical school. He’s not somebody who I think would thrive in the military; however, he signed on to the Navy to cover his student debt. He had hidden despair and depression I think earlier in life because his father died when he was a teenager. He then became the man of the family. He was an only child.
You know how painful it is to be on the phone with his mother who lost her only child to suicide in medical school and didn’t see it coming the day after Mother’s Day? Depressing beyond words to lose your only child who had so much promise. His mom believes he had some disillusionment with medicine and he had just returned from Navy training exhausted. Plus he had the usual stressors of medical school, but then you are having to fly across country for additional military training. It probably doesn’t make you feel very creative and artistic or nurtured. He probably could have used a supportive and loving male mentor in medicine himself. He died of by exhaustion and sleep deprivation due to endless demands made on him without adequate support in his training. He saw no way out and hanged himself in a closet.
Dr. Vincent Uybaretta. He’s a compassionate, sensitive, gregarious guy. You can tell. This is his high school prom picture. He’s also a compulsive perfectionist. Here he is right before his suicide. Look at his eyes. Look at the difference in his eyes between when he finished high school and his graduation from medical school. Why did he die? He was a surgery intern. Exhausted. The way surgeons sometimes treat each other in training is really sad. Pimping and public humiliation and calling colleagues idiots and throwing scalpels. He had extreme sleep deprivation, lost a lot of weight, was depressed, was disillusioned and he died by bullying and died specifically by hanging in his closet (like Sean), Again, totally preventable.
Dr. Steven Ortiz. I absolutely love this dude. He grew up in Eugene where I live. Here’s a picture of him on Sheldon High School’s baseball team. I’m very close to his mom now, so we’ve talked about Steve endlessly on the phone. He died last year. He’s a thoughtful, kind, family man. An orthopedic surgeon. I just want to share with you he’s the type of guy that when a patient fell ill, he came home from vacation early to care for her. I’ve never done that and I consider myself pretty altruistic. I don’t know about you, but I’ve never come home early from a vacation to take care of a patient. This is the kind of guy Steve is.
Now the pothole story. He’s a spine surgeon. He’s working at a hospital where the hospital parking lot has all these deep potholes that staff were complaining of. I’m sure spine surgery patients don’t like bouncing over them either. Hospital wouldn’t repair the potholes. Previously Steve had a career in construction but then got a full ride through Stanford into medical school. He’s a brilliant guy. He actually came to work early one day with cement, gravel, and was out fixing potholes in the hospital parking lot before doing surgeries in the morning. This is the type of guy he is. His mom says, “He’s got 19 years of medical training and he’s out in the hospital parking lot fixing potholes.”
So why did he die by suicide? He refused to do surgeries when conservative treatment was more effective. I think many people in medicine feel pressure to do procedures to generate revenue to keep large organizations afloat through billing insurance for high-ticket items. I know this doesn’t come as a shock. He felt bullied to do procedures which he felt were unethical and lost as a result 30% of his income and had his career threatened. This was not the first hospital where this happened. This is in Florida where there’s a lot of elderly people who are getting a lot of orthopedic surgeries that he feels could be handled in nonsurgical ways. I think he was just exhausted by the fact that even if he moved to another hospital, he wouldn’t be guaranteed it would be different there. This is part of a larger toxic medical culture adversely impacting us all. He left a letter documenting exactly what he witnessed and naming patient cases. Called his mother the night before. She had no idea any of this was happening until that last phone call.
He tucked in his patients in at 2:00 in the morning to make sure they were safe and properly cared for. Doctor suicide victims are often very ethical workaholics until their last breath. They’re checking on their patients knowing they’re going to die by suicide in an hour. They’re checking critical lab results and completing chart notes in the moments before they die. They’re making sure they give the right orders to the nurses. Leaving thank you notes to staff.
Then Steve heads out to the parking lot by the pothole that he fixed, sits down in his truck and and he shoots himself in the heart. He died as a whistleblower. He didn’t feel like he had support. He tried to share his struggles with peers experiencing the same sort of pressures, but I think they told him to “go with the flow.” He felt very isolated and alone.
Several of these suicides on my registry are related to the toxic medical system and are what I call “statement suicides.” The victims are making a statement about an unethical medical system by way of their suicides. They seem to believe that finally someone will pay attention and do something to stop the abuse and criminal activity that they’ve witnessed.
Dr. James Evan Astin. Bright, caring, compassionate second-year internal medicine resident. Why did he die? He first felt suicidal in medical school. He made that clear in his suicide note. He was disillusioned with for-profit medicine, discontent as a factory worker, which is kind of how I felt when I was suicidal. He wrote in a suicide note, “I just wanted to be a scientist who helped people and that is not at all what I do.” He died due to misery in medicine feeling like he was in the wrong career—a career that had been degraded in such a way that he could no longer actually help patients. He was unwilling to participate any longer and could see no other way out.
Dr. Greg Miday is one of my favorite people on Earth. His mother (a psychiatrist) schooled me on why not to use the “committed suicide” term. I’m very close to his mom. I’m closer to his family than any of these other families in here. In fact, his suicide letter is on the cover of my book and his mother writes on the back of cover, “In medicine we measure everything except the lives lost from medical education and practice.”
Greg is a prodigy, a renaissance man. Unlike many people (like me) who have to study all the time just to pass classes in med school, Greg never really had to study and seemed to have all the free time in the world to devote to others. On his legacy page online I read this, “Thank you for being nice to even the unpopular kids in high school. May your soul rest in eternal peace.”(you know you’ve got an awesome doctor when years after his suicide patients are still thanking him for saving their lives and not calling off their husband’s code so the family could have a few more years with him). He’s totally for the underdog. Since life was so easy for him academically, he spent most of his time helping other students pass their tests and saving patients lives seemingly effortlessly!
So why did Greg die by suicide? He had chronic anxiety. He self-treated with alcohol, was never impaired at work, was excellent as a physician. In fact, work was a coping strategy that allowed him to avoid drinking. He did really well with patients. He shined at work and he would never drink at work. He’d drink on vacation or to feel normal in social situations. He ended up in the PHP because these hospitals will mandate when they find out that you drink excessively (even on your own time). Greg said if he went into banking or real estate, he would have never been turned in anywhere for drinking on his own time. But as a physician drinking too much on weekends he got locked into a PHP. They sent him way out of town to a three-month program. He was off cycle in his training after that. PHPs mandate 12-step programs and monitoring of your random urine tests for up to five years. Physicians are blackmailed to comply by having their license held in the wings. There is often no physician oversight in these programs!
What killed Greg actually is the PHP. They would not allow him to follow his safety plan designed by his personal psychiatrist. He had already done a three-month PHP stint which one point just by the way, he wanted to call his mom and check in with her. His therapist there at the PHP said, “Oh, you want to call your Mommy?” and just belittling this very brilliant prodigy. It doesn’t really work when lower-IQ folks (non-physicians) are managing high-IQ docs using bullying tactics which is what seems to happen at some of these punitive PHPs.
The other thing about the PHP is it’s a one-size-fits-all 12-step program. Many docs have called to tell me, “I got sent to the PHP for depression and they put me on a 12-step program even though I never drank and I’ve never done drugs in my life. Now I have five years of urine screens that I have to do at my own expense. I don’t understand why I’m in this.” Shocking to me that we’re sending people who have occupationally-induced anxiety or depression or PTSD (with no substance use) into 12-step programs. Some of these physicians are atheists and “giving your power up to God” is not a strategy that even works for them. They’re not a “leave it up to God” group. They’re science-based. Again, not how we approach diabetes. In medicine we use science to create treatment plans that will actually be effective.
Mismanaged physician health programs are leading to loss of our physicians like Greg. Misleading title too leads you to suspect it’s a place you could go for “physician health.” Greg died by suicide because the PHP overrode his personal psychiatrist’s treatment plan after a relapse he had on vacation when he had a breakup with a girlfriend. He turned himself into the PHP as part of his monitoring to keep his license. The PHP undermined Greg’s safety plan created by his psychiatrist. Some of these cases feel more like homicides than suicides that require wrongful death lawsuits in my opinion.
Meet Dr. Charles Christopher Martin. He was compassionate and caring, wanted to pursue a career in geriatrics. Why did he die by suicide? Same sort of thing as some previous victims. Disillusionment and despair with medicine. He wanted to do geriatrics and churning elderly patients through seven-minute visits while maximizing billing codes was not the future he wanted for himself. He used alcohol to cope with his professional disillusionment. He would have been a great geriatrician, but not when trained to be a factory worker. His mom claims he died of a broken heart and soul. I happen to concur. He died due to assembly-line medicine. Had I died by suicide, this would have been my slide (minus the alcohol). Assembly-line medicine killed my desire to live back in 20004 so I can totally relate to his situation.
Alexander Reading was Britain’s top trauma and orthopedic surgeon, a pioneer in hip replacements. Perfect career, exemplary record. Why did he die? Extreme guilt following a minor clinical error that did not kill a patient. Really I don’t even think the patient knew they were harmed.
The problem with perfectionists who don’t want to make any errors is they don’t allow themselves to be human. There’s an array of non-malicious errors that can happen when you’re human. For physicians they range from minor to malpractice. Patients may have no idea that there was a mistake or patients may want to sue you. Along that whole continuum, there’s this self-loathing that develops in the perfectioist who made the mistake even if nobody else knows.
I had a doc just tell me the he blames himself for a patient’s death. So he kept the patient’s chart in his bedroom closet for 4 years during residency to remind himself that he is not as smart as he thinks he is. Is that how we should handle these cases? Self-blame and then isolation? Or should we go to therapy and debrief after such incidents? Should we be holding the charts of people that we feel like we’ve somehow injured in training under our pillow at night while we sleep? Not healthy folks. We need debriefing. He died by perfectionism. Analyzing the last thing that pushed these people over the edge, these are all preventable. Perfectionism is treatable so is loneliness and so is depression.
Dr. Lara Barnett was a very good physician. She was an internal medicine resident when she died, sensitive and compassionate with others. Why? She was hypercritical with herself. Any sort of criticism she got, she was fixated on it. Attendings can make offhanded comments that stick with you forever. “Am I an idiot? Should I be a doctor? Do I not understand the renal system?” These sorts of things, they just don’t go away. You get tortured by perfectionism. She died by OCD and depression.
Finally, Neil Grover, a second-year medical student who died 20 years ago. I met with his family recently. What’s so sad is the family still doesn’t understand why he died by suicide decades later. A sweet, gifted man. Brilliant and compassionate. Why did he die? Maybe it was undiagnosed mental illness. Maybe existential despair. At the time he died, he had just ended a relationship with a girlfriend and was reading The House of God. Maybe he was disillusioned with his chosen career. We have no idea. Suicide due to an unknown reason. Many physicians and medical students end up in this category. Why don’t we know? Why are so many people dying by suicide of unknown reasons when they’re surrounded by scientists in top-tier medical centers? Big red flag here that we’re not investigating these deaths. And so the epidemic continues.
As I mentioned earlier when parents send their children off to medical school, they feel their children are in the safest place possible. If they break an ankle or have a medical emergency, they’re surrounded by hundreds of doctors so they’ll get the care they need right away. They have no idea the mental health landmine that they’ve sent their children into. It’s worse than sending them to Afghanistan or Iraq. We have a higher rate of suicide than veterans in the military, but parents and families have had no idea.
So 13 reasons why just to review on these 1103 cases—shame and stigma, loneliness and isolation. Again, this is all preventable. Untreated depression, total exhaustion, sleep deprivation, bullying, whistleblowing, misery in medicine, assembly-line medicine, physician health programs, perfectionism, OCD depression, and unknown reason. I took these 13 and organized them into thematic categories. The next two slides are my two attempts to categorize them.
First is clearly a lack of mental health care. So grouped here is shame and stigma, untreated depression, OCD depression, perfectionism, which is a mental health issue very unique to physicians and some other professions. Physician health program (12-step programs for everyone is just outright dangerous), unknown reason (often undiagnosed mental health issues). Inhumane medical education is another category where you’ve got loneliness, isolation, sleep deprivation, total exhaustion, and bullying for no good educational reason. This does not improve your ability to deliver health care by being terrorized during medical training. That’s not a good teaching strategy. Unethical medical practices. Whistleblowers, misery in medicine, assembly-line medicine. I think a lot of us feel distraught about the practice of medicine. We have the brain power to solve this if we just would talk about it.
Another way of looking at this 13 reasons is from the human rights violation standpoint which would include sleep deprivation. Sleep deprivation is used during war as a torture technique by the military to try to extract information from people. During medical education and residency, for example, we know we’re in a first-world country in a top-tier hospital intellectually. Our body on the other hand is having the same physiologic response it would have as a prisoner of war or in a life-threatening environment—a fight-or-flight survival reaction. Very conflicted and dissociative way to live for 7+ years of medical training.
Human rights violations in medicine include sleep deprivation (and others not on the list of 13 such as sexual harassment, food/water restriction) plus loneliness, isolation, total exhaustion, bullying. Medicine has a bullying culture that is unfortunately widespread. Then of course the other obvious category is lack of mental health care. Untreated depression, shame and stigma, perfectionism, OCD.
Another category I added is lack of curiosity. Really odd that as scientists we’re allowing so many of our colleagues to die by unknown reasons and then just going on with our day after maybe a brief email from the head of the hospital: “Sad to say we’ve ‘suddenly’ lost a colleague.” When we don’t have an M&M conference, we don’t investigate these suicides like we would a patient death, how will we know why doctors are dying?
Four big themes here in conclusion. Doctor suicides are occupationally-induced or exacerbated. They are linked to disillusionment with medical education and career. Suicides are increased among doctors due to lack of mental health care and we have a medical culture that leads to isolation which is very dangerous. All of these people at the end of their lives probably felt like I did when I was suicidal. “I’m the only one that’s a whistleblower. I’m the only one that’s so lonely. I’m the only one with this chronic anxiety.“
Here are six very simple solutions. Humane and safe medical institutions. Hospitals must be safe zones for patients and health care workers. If you see somebody pimping somebody else, please intervene. Honoring and respecting the human rights of each other would go a long way. Stop the widespread bullying of medical professionals. Require on-site accessible mental healthcare so that when people do need something, they feel safe to go access services during working hours.
I had a chaplain call to ask me how he could help with doc suicide prevention. The infrastructure exists. Physicians could call the chaplain and sit in a special room to cry after a stillborn. It’s not just the family that’s freaking out after you deliver the bad news and the dead baby to the family that’s been infertile for 10 years. You’re having a reaction too. You should be able to talk to the chaplain and cry without documentation on an electronic medical record and being sent to the medical board or a PHP 12-step program. It makes no sense that you can’t access something like that inside our hospitals.
Please talk about the doctor suicide crisis and screen the film, Do No Harm. It’s hard to talk about suicide. Obviously. It’s been 160 years that we’ve been having a hard time talking about it. When you show a documentary with a follow-up panel discussion with leaders in your hospital system, I think that’s a really good way to start the conversation and manifest culture change. Host a wellness day for everyone. Even nursing staff suffer from mental health impacts of delivering care to people who are seriously ill. EMTs have their own mental health issues with PTSD. Showing this film would be a great way to unite everyone on staff and increase empathy across departments.
My last plea is to please stop suicide censorship. The reason why doctor suicides have been hidden is that families are overwhelmed, confused, and in sort of a self-blame, regret, pain mode after suddenly losing their star child or husband to suicide. Medical institutions fear risk, copycats, litigation, and blame from this. Religions and cultures don’t help when they suggest everyone’s burning in hell now if they choose suicide and media guidelines censor suicide (while we have headlines about kidnapping, rape, and everything else plastered across the media).
I’ve had my share of emails from the “media guideline police” suggesting I’m sensationalizing and using wrong headlines in my articles. Censoring and not talking about doctor suicide for 160 years hasn’t helped us so I feel compelled to tell the truth. Censorship and secrecy has perpetuated doctor suicides. I’m reporting on doctor suicides from a place of love for my brothers and sisters in medicine (and I’m available for those who need to talk and can refer those suffering to additional resources).
The other media “guideline” that simply does not work so well for doctors is the mandatory listing of the national suicide hotline number. I’ve never met a doctor who has called a generic suicide hotline. Doctors want to talk to other doctors who’ve survived suicide and depression and PTSD. They don’t want to call a suicide hotline and talk to a random college student who has never been to medical school. Someone recently told me he did call the suicide hotline and was on hold for like an hour. That’s obviously not going to work out well either.
As scientists, if we can’t tell the truth, we’re unlikely to solve a medical crisis. If we have untreated PTSD, how can we help veterans with PTSD. We can’t give the care that we’ve never received. Having suffered so much in life, physician suicide victims are dis-remembered in death, left to perpetual isolation. Had I not dug up these cases and put their pictures across the wall in my house, many of these people would be lost to eternity. I just happened to take an interest and talked to their families who were so happy to keep their memories alive. Talking to Greg Miday’s and Sean Petro’s mom keeps their children alive because I’m taking an active interest in them—and now you are too. As scientists, we must investigate the suicides of our brothers and sisters in medicine. We have much to learn from them for the benefit of ourselves and our beloved profession. Thank you for caring.
I’ll repeat questions submitted from audience and answer as many as I can.
Question: Great presentation. I commend you for what you are doing to put the word out. How does the physician suicide rate compare to the general population?
Answer: Doctors die by suicide at two to three times the rate of the general population. We are two to three times more likely to die by suicide than our own patients.
Question: You mentioned physician suicide rates compared to the general population. What about compared to other professions such as law?
Answer: I don’t have the answer compared specifically to other professions. I do know police, firefighters, there are certain professions that have serious mental health impacts just on the job. We should have accessible mental health care for all high-risk professions.
I’d love to have more data (while hoping for fewer suicides). I asked the Oregon Medical Board to start collecting at least the number of doctor suicides in Oregon. They were totally resistant, did not want to do that. I’ve asked them twice. They’re in the perfect position to be able to determine why an active license lapsed or went inactive and the reason why could be suicide or heart attack or moved out of state. They could figure that out.
Now what are we doing for mental health maintenance in high-risk professions? Not much. I know this isn’t really answering your question, but I thought it was a good way to frame our mental health needs so people can understand. Your car is on a maintenance program for its health. Your teeth are on a maintenance program. If you’re over 50, you’re probably getting colonoscopies at intervals. You don’t have to hide, pay cash, and sneak out of town for your colonoscopy. You can just turn around and bend towards this guy and he’ll do it. Why are we not doing the same for our mental health?
Question: Actually, I’ve had this conversation with people in police locally. They do actually have maintenance programs for mental health. They’re actually, when I described the situation in medicine, they said, “Oh wow, we were like this about 20 years ago.”
Answer: So my question to you all is why as medical professionals are we 20 years behind the police in dealing with our own mental health? Shouldn’t physicians lead so we can set the standard for every other profession on this? Shouldn’t the department of psychiatry be the leader on physician mental health and not trailing 20 years behind the police department?
Question: I’m wondering about the gender breakdown. I noticed that most of the stories were male.
Answer: Yeah. Most are male. Of 1103 cases for every female that we lose to suicide in medical school and beyond, we lose four men. It’s skewed towards men. Most practicing physicians are still male, so it’s going to be skewed towards men just because we are still a male-dominated profession. Example, orthopedic surgeons, 92% of them are male. I was the only female speaking at the conference. Obviously, every single one of those 33 cases of orthopedic surgeons featured in my keynote were all male. I don’t have any female orthopedic surgeons who died by suicide. But coming into medical school now, it’s majority female or at least half and half depending on the school so there will be more female cases over time.
Question: What about the relationship between the Oregon Medical Board publications, physician shaming and doctor suicide?
Answer: Every quarter all physicians get a hard copy in their mailbox. I open this thing up and I’m still in disbelief seeing the printed list of all the doctors who are in trouble with the board and details of their cases. Publicly shaming physicians seems to be an invasion of privacy. When published online these details lives on forever. One physician contacted me after a divorce to share that a woman he tried to go on a date with was Googling his name and reading all this stuff from the Oregon Medical Board. How is that going to help you put your life back together? Realtors, pilots aren’t publicly shamed online forever and in front of their peers. I think this is a violation of our civil rights and certainly confidentiality where our private health information is concerned. Apparently doctors and med students aren’t protected by HIPPA.
Question: Thank you very much. This is a really important issue. A couple things. In doing the work and delving as deeply as you have and I’m thinking about a situation that happened last year. A resident died by suicide. There was so much secrecy. It seemed like there was almost immediate censorship. Have you seen a healthier way that organizations for physician suicide have handled this? It seems like it adds a little bit of trauma to everybody else as well not to be able to talk about what happened and what this means and all that. Have you seen a better way of handling suicides?
Answer: So have I seen a better way of handling the what’s called postvention—what to do after a suicide from a medical institution versus censorship, which up to this point is sort of the classic “Let’s cover the tracks and get the blood off the sidewalk and remove the doctor from the website and we’ll pretend like she was never a resident here.” Yeah. Some of these institutions are not only censoring that way, they’re threatening their current house staff by sending social media reminders of never to talk about this or it’s breach of contract and you’ll be fired. It’s not just censorship, it’s active threats against people, many of them J-1 visas who could have their careers destroyed and even be deported.
By not helping the grieving survivors and censoring the suicide that sends another stigmatizing message “I better keep quiet.” People end up with actual PTSD, especially in New York City where a lot of these suicides are very public—stepping off of hospital rooftops. I had a woman call me who was in the middle of a surgical procedure in a patient room and was looking out the window and saw a doctor in a white coat actually actively dying by suicide by stepping off a building. This particular woman started to have flashbacks while doing a procedure. She’s crying because she’s doing the procedure but also witnessing a suicide which she’s hoping is not a friend (but did turn out to be her friend). She’s having flashbacks to three others that she knew that had died by suicide and she just recently graduated medical school less than five years before. Terrible that these people have not received treatment as colleagues afterwards so that they’ve got wounds that are opening and again and again.
Some medical schools are being much more progressive about this. A.T. Still, which is a DO school in Missouri where Kevin Dietl graduated posthumously, his parents are speaking there every year. They planted a tree for him. They have services. They talk about medical student suicide and have quarterly mental health meetings I believe. I’m happy that they’re doing this, however, when we have a public health crisis the CDC should also be involved and we should be tracking body counts (like we would with Ebola or any other crisis). We are making progress. I’m a very optimistic person. A culture change is on the horizon. I’m very glad that you all are here and I’m happy to stay as long as you need me to. I know you have to go back to work. One last question . . .
Question: Do you think gun control would help?
Answer: People in unbearable pain will choose what is most convenient and accessible. Even OTC drugs, car exhaust, a rope, or knife. There’s always something to use for a desperate person who needs to release themselves from pain by ending their life. Overseas doctors aren’t dying by firearms so much. In India, they’re hanging from a ceiling fans by saris. In the very rare physician suicide-homicide cases, gun control would prevent a mass casualty event (though doctors are probably the least likely group to instigate a mass casualty event). Of course, mental health care will ultimately help us help people avoid reaching for knives, ropes, and guns. The brain is ultimately the control panel. Let’s help the brain.
In closing for anyone who is suffering, I’m available. Download my free audiobook here (for more discussion of problems & solutions). I’m happy to speak to you via my website here or come on out to the Oregon coast or mountains for one of our physician retreats (scholarships available for med students & residents). Thank you so much for coming!
Have you lost a doctor or med student to suicide? Submit name confidentially to registry here.