Whether you like her or not, Meghan is speaking openly about suicide. For that, I am thankful.
In her interview with Oprah, The Duchess of Sussex shared her suicidal thoughts—and how she was obstructed from mental health care, told to “tough it out” and keep smiling. The Duchess needed a doctor. Yet doctors are reported to have the highest suicide rate of any profession as we’ve also been obstructed from mental health care, told to “suck it up” and keep smiling. That’s why “happy” doctors die by suicide. We’re seen as privileged with no rights to complain. So we hide our pain for fear of being stripped of our titles.
A physician friend witnessed 13 patients die in one day then dealt with a physician trainee’s suicide attempt before begging for help. Superiors told her to drive out of town, pay cash, and use a pseudonym.
Most patients seek health care without jeopardizing their careers, yet doctors must report anxiety, PTSD, even postpartum depression and release medical records in applications for state medical licensing and hospital privileges year after year. Lie and you lose your license.
After surviving my own brush with suicide, I began a hotline to help suicidal doctors. A decade later, I’m still shocked by what I hear. A few recent real-life scenarios . . .
To ensure confidential mental health care, physicians:
Use fake names or pseudonyms
Pay cash or crypto (not insurance)
Drive 300 hundred miles out of town
Snailmail scripts to Canadian pharmacies
Pay cash for drugs at multiple out-of-state pharmacies
Self-medicate with in-office drugs
Get drugs shipped from psychiatrist mom
Obtain psychiatric prescriptions by endocrinologist spouse, radiologist friend, orthopaedic surgeon colleague
Have non-physician family members feign mental illness to get psych drugs they divert to doctor
See psychiatrists who only use paper charts with fake names or initials locked in fingerprint safes
Choose psychiatrists who keep sparse or no medical records
Travel internationally to get psychiatric care and meds
Visit Jamaica to seek care from a psilocybin shaman
See unlicensed healers who keep no documentation
Use physician business retreats for mental health care
Call suicide helpline anonymously for weekly check-ins
Meet psychiatrists at secret entrance to office (or in hotel, alley, or parking lot)
Share psych drugs with each other as medical trainees
Rely on spouse or pastor for mental health care
Clandestine care makes mental illness nondiscoverable. Physicians fear psychiatrists who may be mandated reporters to physician health programs (PHPs) and state boards. Both may publish their conditions on board websites and the National Practitioner Data Bank.
While compiling this ludicrous list, I got an email from a Texas psychiatrist who just opened his practice devoted to serving physicians. When I called to congratulate him, he seemed unaware that the Texas Medical Board (TMB) can subpoenae his patients’ medical records without consent.
So maybe we’re back to the Jamaican shaman.
The bigger question: Why obstruct mental health care for a Duchess or a Doctor?