The Physician Philosopher Podcast

TPP #71: Physician Suicide and Moral Injury

This is not for the faint of heart. In this post, we discuss very real topics, including; physician suicide, physician disability, and physician burnout.

Larry Keller

This week, I sat down to chat with Dr. Boyce Fish. For those of you who aren’t unfamiliar with his story, he was like many physicians in medicine. He was working as an ER doctor, wanted to make a big move for his family, and after a series of unfortunate events, had a monumental life crisis.

The Impact of Income on Disability Insurance

After a recent injury, Dr. Boyce had a long road to recovery. While in second place, he collided with another biker during a triathlon race, resulting in a severe fracture.

He went immediately from running, riding, and swimming to nothing for 8 weeks. Slowing down required a lot of mind work. He shared that this was his next challenge – since he had to learn to walk and run again, maybe he could learn better form.

When accidents like this happen, we also learn in other ways. It was about disability insurance and own occupation insurance for Boyce.

The IRS had an inaccurate evaluation of his actual income. His ability to earn money while receiving disability was reduced to a much smaller amount than expected.

It is not uncommon in the coaching space to hear that you should use an S corporation business structure once you hit a certain amount of revenue.

This allows you to pay yourself partly through wages and partly through distributions taxed differently. But if you’re a high-income earning physician and you get disabled, they’re not going to include any of the distributions in your disability calculations.

It’s essential to think about your tax situation and how it would impact you if you were disabled.

Unfortunate Events Turned Fortunate

Dr. Boyce and his family moved to Idaho to be closer to his wife’s family.

In the process of moving, a physician management group informed him that he hadn’t completed his two-year contract even though he worked more than two years’ worth of hours. To avoid owing the sign-on bonus provided, he worked 12-hour shifts six or seven days a week for nearly a month and a half.

He didn’t want to go back to work after this. The experiences and moral injuries started to stack up; a new job, challenging cases, the death of a patient, and patient complaints and negative case reviews.

He had given everything, was in a dark place but thought he’d find his way through. He said, “”I don’t remember doing anything. I just remember this dark, huge, enormous pressure just crushing down on me. And there appeared to be no way out.”

He was done.

He was done hurting his family and dragging them around the country. He was told he was being fired when he had done everything in his power to care for patients.

He headed for the hills, typed out a note to his wife and children, and then turned off his phone.

What ensued next in his experience was unpredictable and yet life-saving.

A sheriff’s officer begins following him. He wasn’t speeding. Before he knew it, there were more officers following him. They almost looked like little ducklings.

Finally, he pulls over, they proceed to ask if he wants to talk. He doesn’t want to talk. He makes that clear, rolls up his window, and carries on.

Further down the road, he is boxed in by the officers, guns are pointed at him, which were two AR fifteens and nine millimetres.

He was provided onsite medical treatment, which was blood pressure taken through a winter jacket and the EMTs asking if he was suicidal, and then he was taken to jail.

Little did they know, he had already done what he needed to do; he had taken pills.

He went into cardiac arrest while in his jail cell; he was transferred to the hospital upon arrival he had little memory and labs that were off the charts.

For Boyce, having loving family members and nonjudgmental support was helpful.

Being transparent with mental health difficulties is profound for others who are scared to share what they’re going through.

In a way, this experience was a series of unfortunate events turned into fortunate events. When he decided to share his story publicly, it went viral.

As physicians, many of us, if not all, experience pressure and shame. We are trained to be Superman when really, that is a fallacy.

Throughout both of our experiences, when we openly share, there are always physicians and medical professionals who can relate.

When Moral Injury, Burnout, and Mental Health Collide

There is a distinction between shame and guilt.

Guilt is, “I did something bad.”

Shame is, “I am bad.”

Both are an internal state of affairs. When you experience guilt, it can deeply move you. Boyce is an example of this.

His guilt has moved him to share his story publicly and turn his own experience into something helping people.

The human experience is messy; we’re all humans, we’re all broken, and at the same time, we’re all lovable, worthy, and enough simultaneously.

Moral injury, burnout, and mental health intersect. If you were imagining a Venn diagram, they’d overlap and meet in the middle.

Moral injury is a systematic phenomenon that happens to physicians, not because of physicians. It can look like seeing, witnessing, or taking part in something, or you’ve done something right and are ostracized for it.

Burnout is an individual phenomenon that happens. Moral injury is often the cause of burnout. One of the results of burnout is no longer having motivation. For example, if you no longer love medicine.

Mental Health meets all of these in the middle. For physicians, it can look like stacking pressures and stressors.

While coaching doesn’t take the place of therapy or medicine, it does help work through individual thought processes. You cannot change the current circumstances. You can change the narrative about the possibilities and what they mean to you internally.

Remember why you first got into medicine. Find your way back to that ideal or find something equally rewarding if needed.

We’re here to help; if you’re looking for support book a free call here.

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