Standing on the edge of his hotel balcony, a doctor describes the rolling hills. He tells me, “It’s a beautiful place to die.” Ten minutes later, he agrees not to injure himself—for now.
I’m not running a physician suicide hotline. But doctors keep calling me.
It’s midnight and I’m speaking to a psychiatry intern. Bullied by residents and her attending, she cries, “I’ve lost my self-confidence. I’m depressed. On psych meds now. But I don’t feel better.”
Then a fourth-year medical student shares a similar story. “I was normal before med school. Now I’m so afraid. I can’t go on,” she sobs.
I counsel each woman for nearly an hour: “You are not defective, the system is defective. We enter medicine with our mental health on par with or better than our peers. Depression and suicide are occupational hazards of our profession.” Thankfully neither are actively suicidal. Both women just needed to talk—to cry—and to hear the truth.
The truth is doctors are suffering. Surrounded by sickness and death, we watch families wail, shriek, cry while we stand silently—sacred witness to their sorrow—until we’re called to the next room for a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. And when do we grieve? Never.
Doctors are not allowed to grieve.
Today a physician tells me she’s been cited for unprofessional conduct. Why? She was seen crying. Her boss told her, “Unless you are dying, crying is unprofessional behavior and not to be tolerated.”
Then a retired doc tears up as she tells me about a miscarriage she witnessed 30 years ago. She thanks me. Why? She hasn’t been able to cry in 5 years.
Doctors are not allowed to cry.
So what do we do with our sadness? We injure ourselves—and each other.
When I speak to victims of physician bullying, I explain, “Your instructors are suffering from unprocessed grief—probably victims of bullying themselves. Medicine is an apprenticeship profession. Trained by wounded doctors, they’re now wounding you. Your bright eyes, your enthusiasm, your idealism remind them of their loss. Rather than feel their own grief, they lash out at you.”
Individual psychiatric therapy can’t solve institutional trauma. Collective wounds demand collective healing. Doctors are not defective. Our profession is.
And hiding our pain ain’t working. Recently the janitor at a medical conference asked, “What’s with all the grim faces and sad eyes?” To the average person, medical conventions look like funerals. Maybe that’s because doctors are dying by suicide at twice the rate of their patients.
Both men I dated in med school died by suicide. Brilliant physicians. One overdosed at a medical conference. The other overdosed after work. In just over a year, we lost 3 physicians in my town to suicide. Gunshot wounds mostly. One local doc lost 7 colleagues to suicide—so far.
Too often physicians turn to alcohol, drugs, firearms. But why don’t doctors seek professional help? Some do.
Some doctors drive hundreds of miles out of town for therapy. They pay cash for visits with no paper trail. They use fake names. Physicians who seek mental health care know they may face board investigation and license restriction—and those with licensing issues have even higher rates of suicide.
If we want real health care, we must first do no harm to our healers. Imagine if we allowed doctors to grieve.
I once attended an African grief ritual. Villagers wail around a fire for 3 days in a highly emotive ceremony. Attendance is mandatory. Why? Those who don’t grieve become the village troublemakers next year.
Physician bullies are medicine’s troublemakers. And they need our help—and compassion. Not threats. Not license restrictions. Not public shaming. They need psychological support. And so do the rest of us.
Anna, a retired surgeon, still carries the wounds from her medical school professor:
I was happy, secure, and mostly unafraid until the age of thirty. Until med school. I do not know what happened precisely, but I do recall in vivid detail that on the first (orientation) day of med school the MD who was our anatomy professor, and therefore largely controlled our lives for the next many months, stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers and said these words: ‘If you decide to commit suicide, do it right so you do not become just a burden to society.’ He then described in anatomical detail how to commit suicide.
Anna’s experience is not unique. Physicians-in-training are given explicit instructions from their instructors in proper techniques for overdosing on lethal medications too.
Through the many years of training and through what would appear to the observer a successful career in a surgical subspecialty and now into retirement, I have carried the anxiety, and the depression, and the fear. . . . I still remember how to successfully commit suicide because someone who had power over me at a vulnerable time described the details. And we wonder why . . .
Pamela Wible, M.D., was once a suicidal physician. An expert in medical student and physician suicide prevention, She hosts physician retreats to help her colleagues heal from grief and reclaim their careers. Photo by GeVe.
The old saying is “Doctors: The 3 Ds are Drink, Drugs, Depression”
In a system with high med-school fees we clearly need:-
“Doctors: The 4-Ds. Debt, Drink, Drug, Depression”
Previously I thought it was only patients that had the 4-Ds.
In Nursing we call it horizontal violence. As an NP who has studied integrative medicine and holistic healing for 30+ years, I am sad to see our system hurting providers as well as patients. It seems that all of the issues of our time will ultimately have to unite us. We can’t keep spending money on useless education, disease care which is creating the unhealthiest population on the planet and offering treatment that harms not heals.
SLEEP RIGHT is the answer and the solution to this tragic issue. Discussing the issue endlessly, is not the answer, neither alleviates the solution. Medication intake, for the purpose to alleviate and solve this tragedy, will never help. “Sleepless in the O.R.”is the Mother of the self destructiveness that we are witness to.
For the “How” and Where”, please contact via IT:Information Technology. and IP
Intellectual property. Happy days, are here again.
The seeds are grown from a culture of elitism that comes from the way medicine functions in the USA.it is all about the money.doctors are judged in large part by their “success” the most important indicator being how affluent they are.They are indoctrinated into the system by Schools,drug companies,research institutes,hospitals,etc. Other countries,virtually the entire world beyond this pathetic country I am unfortunately living in,have free or relatively low cost health care.our country fights against such an insane idea because the insurance companies would cease to exist if our system changed.it is done elsewhere brilliantly.Only in this cesspool of avarice do we suffer.patients and doctors.Nurses and paramedics.Healthcare workers in general.because we perpetuate a divisive hurtful system.God has left us to our own greedy devices.
The seeds are grown from a culture of elitism that comes from the way medicine functions in the USA.it is all about the money.doctors are judged in large part by their “success” the most important indicator being how affluent they are.They are indoctrinated into the system by Schools,drug companies,research institutes,hospitals,etc. Other countries,virtually the entire world beyond this pathetic country I am unfortunately living in,have free or relatively low cost health care.our country fights against such an insane idea because the insurance companies would cease to exist if our system changed.it is done elsewhere brilliantly.Only in this cesspool of avarice do we suffer.patients and doctors.Nurses and paramedics.Healthcare workers in general.because we perpetuate a divisive hurtful system.God has left us to our own greedy devices.wow,the system here will not allow me to post this comment.why am I not amazed?
Hi Pamela, thanks for the great article. Its great to see things like this being spoken about and shared.
More context about why a physician instructs how to successfully suicide to a group of student docs would be helpful. Citing your suicide stats would be especially appreciated. Thank you!
For a more in-depth analysis of the topic, please refer to: https://www.idealmedicalcare.org/blog/physician-suicide-101-secrets-lies-solutions/
when i show this to my non-medical friends, they are astonished and disbelieving. the level of bullying in my institution is amazing, including a faculty member seriously suggesting that a resident’s mistake was so heinous he should off himself. my medical colleagues think your suggestions are impossible bc support = $$$ and in our institution money is a deal breaker. we have a patient wellness program with financial/insurance premium incentives, but as far as i know no physician wellness program with incentives. i will watch what happens with you with interest, keep doing it.
Thanks for this article I left the med profession in 89 because of the bullying. I worked at a Children’s Hospital and a young boy passed that I had come very close to and because I cried with the parents I was told I was weak and better get thicker skin. My mother was a OB nurse for 30 yrs and I can remember her stories and her tears when she came home. I have been bullied in the last 2 yrs by several Dr’s & PA’s but I’m fortunate to know I can move forward and find the right Dr for me. But I worry about people who don’t know they have a VOICE & a CHOICE they just have to speak up.
Ironically I left the med prof and became an Insurance Agent so I know how the system works and how sad it is for everyone both the med prof’s & patients. And because I’m from a small town where Dr made house calls & knew you by your first name & we always brought flowers, baked goods and cards to our appt’s I still do this now & you should see the smiles & looks I get from the nurse’s, receptionist & Dr’s because they have become numb and no one shows appreciation any more. So as a patient it is our responsibility to speak up and do something & also understand the med prof not everyone is only in it for a dollar. We need to support & show appreciation to the med prof’s who are in it for the healing & helping of the patient.
Take them some flowers, a card, fruit basket or goody basket on your next appt and watch the smiles!!
Thanks so much Dr. Pamela Wible for changing lives !!!!
Thanks Ruby for sharing your blessed and exemplary vulnerability, clarity, love, and kindness. This is precisely the kind of visionary thinking we need to foster healing on a global scale.
The bullying may have changed over the years, but the pain has always been an issue. I graduated in 1972 one of 5 women in 150 member class. While I identified the dull eyes as men who did not like women in the profession, I think the issues raised in your article may have played a part. I have been in the same location for all my post training professional life and would like to add these thoughts and throw in the idea that someone might like to join me here.
My father died at age 44 of emphasema and he kept a great sense of humor through it all. We were able to marvel that he could float with heels out of the water without moving his arms.
Really appreciate your article which has broadened my view of what others are dealing with. I graduated in ’72 as one of 5 women in class of 150. We got the “you are the cream of the crop” talk by the Dean of the medical school.
My father died when I was a junior in premed at age 44 of emphysema. I once was in the back seat of the car as we left his pulmonologist appt. for which we had driven four hours to the university I later attended when I heard my mother say in frustration, “It is just as important for me to talk to the doctor as it is for you.” And my father sympathetically responding, “Well it happened so fast I did not get much insight from the visit either” Father was brave and observant and involved with his 5 “kids” even though on oxygen at night he continued to work and play at his hobby (crashing his model airplanes) and impress us with his ability to float with his feet out of the water without moving his arms. I held his hand when he took his last breath (and felt guilty for months till finally telling my mother who was at the foot of the bed and hearing her say she was glad to have me do the honors as she had been holding his hand for over a week).
I was a senior in premed when he died and at his death bed I considered telling him I had been accepted into med school but decided this was not the time to start lying to him.
I learned to protect myself during this time. I learned to grieve. I understood irritability of my mother when my Dad lost control of his urine on the airplane runway. I saw my dads doctor respond to dads last breath by stabbing his heart with a needle in an attempt to bring him back and stood by that doctor in front of the casket as he said with tears in his eyes “I just lost my best friend” and I responded “I’m glad you know it” When dad went fishing in Canada with Dr. M I never got to go as it was not a good place for a young lady amongst all those men. He also didn’t want me to have to work while in college. When he died I got a part time library job and loved it–it made me feel human and alive in the moment.
Working solo with various coverage arrangements over 40 years doing unattached call in ED every 5th day initially and following up on patients that did follow up (no financial restrictions) adjusting as best as I could to coding, osha, hipaa clia ,managed care, rising medical liability costs, EMRs and hospitalist system Ideal Medical Practice and Buprenorphine treatment for Opioid addiction limit 100 by Federal ruling I am happy to say I did not act on my own plan for a successful suicide and so are my patients including the lady whose home I visited yesterday who told me she loved me and was so sorry to have to “bother” me to come out as she had been home for 9 days with no nurse visits and she needed face to face evaluation before they could and next ambulance transport was 4 days away. Oh and she did not know where her medication was but thinks it was left at the rehab center where she received care after a MVA causing multiple fractures ribs ant. And post and femur fx requiring pin. Then the follow-up hospitalization for Pneumonia listed all meds admit and discharge obviously from a list as patient ad granddaughter both denied her having meds. And no she did not want any opioids.
My maternal uncle graduated from the same medical school I did 25 years earlier and he and I had occasion to shake our heads in wonderment over the long hours and hard work we had done.
And Dad didn’t want me to have to work while in college or be in an environment inappropriate for a young lady.
Unprocessed grief…….That makes so much sense. I never understood the bullying in medicine until now.
Yes. This is EXACTLY what is happening. –> https://www.idealmedicalcare.org/blog/assisted-physician-suicide-are-doctors-killing-doctors/ Unprocessed grief fuels medical bullying. We need to have support for our grief. Our work with the sick and suffering is no cakewalk. We need unlimited therapy, debriefing, onsite counseling, NOT punishment and licensure threats.
Just got this note from a female doc: “Although I will say that an anatomy professor did in fact inform us that we would commit suicide at a higher than average rate and informed us from the lectern on how to accomplish it successfully. Considered following the instructions on 3 occasions. Once as an M3, once as an intern, and most recently 8 years ago when a 4 year old I had in the hospital died.”
My husband was lost in the shuffle in a big teaching hospital in a large city and died of sepsis. The ER doctor who saw him was a resident who had been on call for many hours, admitted him, but somehow missed the sepsis diagnosis. My husband’s white count had gone from 8,500 when he had blood drawn outpatient to 800 when he went into the ER 24 hours later. He met the criteria for sepsis, but the tired resident never used the sepsis tool. Later, he said he didn’t understand how he missed it. I know how he missed it – I remember very well – he was exhausted. After the ER doctor admitted my husband, the hospital doctor assigned to him also made a mistake, and again my husband received no antibiotics – all the while I was asking for antibiotics for my husband, but I couldn’t make them treat him. The hospital doctor was also a resident and exceptionally tired (it was around 3:30 am when he saw my husband – he also complained about how long he had been on call and said he was just beat). By the time my husband was treated, he was in septic shock. It was too late for him, and he died a gruesome death in the ICU less than 24 hours later. At my insistence and my Medicare and Joint Commission complaints, the hospital investigated and said both of these doctors made mistakes, and they were so very sorry my husband died. They hoped I healed from my grief. My husband was my whole life. If I could trade places with him with him alive and me dead, I would do it in a heartbeat. The emotional pain is so unbearable, it is indescribable – my heart literally skips beats when I think about his care and death – he was bloated beyond belief from the sepsis. I would NEVER EVER be treated at a teaching hospital (we had gone to Cleveland Clinic the prior week and it is just as bad – residents who are exhausted and have too much to climb on the learning curve left to make decisions on patients). I encourage people to never go to a teaching hospital for this reason. Does anyone want to lose their loved one like this? Think about the patients who are now disabled or dead who are husbands and fathers who die because of the medical system’s horrible practice of putting exhausted individuals in charge of their care? What kind of a system does this? Only one that cares little about patient outcomes. Is it money? I would have pulled out my checkbook and written any amount to get a doctor who had some rest and was mentally present for my husband. And it goes beyond residents. Young doctors just out of residency are more beholden to the older doctors in the practices they join than the patients they serve – they need a job and the system is the only game in town. That’s just a reality. The U.S. medical system is horrible. Who gives exhausted physicians the power of life and death over patients? I’m told to move on, but I can’t move on when I saw what happened to the person who I loved more than I love myself. The medical system is such desperate need of reform, and I will add my voice, but the greed for the trillions spent on medical care is overwhelming. Anyone who gets into the medical machine is in danger of getting crushed, physicians included.
BTW – I read your adapted article on Kevin, MD:
“We spend over $300 million annually to prevent human rabies. The cost per human life saved ranges from $10,000 to $100 million. What do we spend on medical student and physician suicide prevention.
Since eradicating the terrestrial canine rabies variant in the U.S., 90 percent of the 2 deaths per year are transmitted from wildlife — mostly bats then raccoons. If we can deliver over 6 million oral rabies vaccine baits yearly to raccoons (and I’m talking about guys dropping these from low-flying planes over the Appalachian Mountains and dudes running through dark urban alleys), we’ve gotta be able to do something for med students. Right? We’re way easier to find than raccoons. We’re already in the hospital!”
My husband was the research scientist who invented the raccoon pox recombinant vaccine of which you speak and the method of distribution and held the patent on it (that would be me now since he died). Yes. You are right. It’s all about the money. Politics and money drive the process.
I was a surgical intern when a patient I had bonded with coded in the ICU. He was a great guy. Former Navy Seal in Vietnam, older stay-at-home dad to a 7 year old. Strangulated hernia went really really bad. I came back from a rare weekend off and heard the Code blue in the ICU, knew my patient had declined and feared the worst. Sure enough, it was him and it was hopeless. Tears started running down my face. The guy had thanked me and said how much he loved Navy doctors 6 or 7 times. Every day he thanked me. I thought about that 7 year old not having his dad anymore, his loving wife, his love of life and fishing and all the things he told me and I was just overwhelmed with grief for this man. One of the attendings looked at me and asked, “Why are you crying?” I answered back, “Why aren’t you? He was a great guy, and we lost him.” The attending turned away in disgust, but I knew he was wrong, that the right thing to do, the caring thing to do, was to show the grief I felt.
And as far as that attending? Well, I switched out of surgery to EM because of that attitude. Too many of our attendings and senior residents were bullies. I didn’t want to spend my professional career surrounded by A$$holes.