I still remember exactly where I was when suicide first touched my life. It was 2 am two days before Christmas when I received the call from my mom. I can’t explain why, but I knew immediately. And ever since questions now flood my mind: Why do people end their life? Why do doctors kill themselves? How many doctors die by suicide each year?
It had been a normal day at first.
My aunt, a perioperative nurse who was more like a sister to me than an aunt, asked my uncle to buy her some creamer since they were running low that morning. She went to church that day, taught a Sunday school class, and went missing thereafter.
My family, including my wife and two kids, were supposed to come stay with her during that Christmas holiday just a few days later so that my aunt and my extended family could meet my newborn son.
We knew it was going to likely be my grandfather’s last Christmas. We did not know it would also be my Aunt’s last Christmas. In fact, she had already had her last Christmas the year prior.
The Details Come Out
As the details came out, I started to realize that I had been in the dark for a long time about the struggles my aunt experienced on a daily basis. Mental illness can create a stigma that prevents people from asking for help.
She had previous bouts of depression and, apparently, serious battles with prescription drug abuse.
On the day that she ended her life, she went to her job where everyone was off for the day (it was a Sunday). She found some midazolam and fentanyl. She got high, walked around the empty hospital, and died by suicide in her office with the very drugs I use to take care of people every day by administering herself a general anesthetic dose of propofol and succinylcholine (a paralytic medication).
To say that losing my aunt in this way devastated my family and me would be an unacceptable understatement.
Not many days have passed where I haven’t wondered what would have happened if I had called or texted her and told her I loved her? What would have happened if I asked how she was doing more often? Would things be different if she had told me she struggled with these things? What if I hadn’t been too busy to show that I cared?
My First Physician Suicide
Two years later, I received news that a woman I worked with in Student Government while in medical school also died by suicide.
She was in residency, just like me at the time.
This hit close to home, too, particularly after experiencing my Aunt’s death.
I began wondering what I could do to help prevent this pain for those I am around on a daily basis?
Do Doctors die by Suicide?
In a 2017 study published in Academic Medicine, suicide was the leading cause of death among male resident physicians and the second leading cause of death among all residents. This was only led by malignant processes.
In fact, in that same time span (2000-2014) 66 residents abruptly ended their life. Rates for depression in resident physicians range from 21% to 43% with one study finding that 21% of interns experienced suicidal ideation.
The fact is that this has always been a serious issue.
Unfortunately, this is not an issue that is experienced in residency alone as the rates of depression and suicide in practicing physicians occurs at a more frequent rate than in the general population.
How Many Doctors Die by Suicide Each Year?
It is estimated that every year
400 physicians take their own lives
That’s a doctor a day.
Some believe the increased rate of suicide in attending physicians is attributed to the fact that, while physicians struggle with all of the same mental illnesses as other people, because of their presumed success in the eyes of others they may have a harder time asking for help.
Mental illness affects us all. We either struggle with it personally or have family, friends, or loved ones that do. It is important that this topic not go on ignored or undisclosed.
Why Do Doctors Kill Themselves?
Do you remember the first time you had a family member get diagnosed with a terminal illness, such as breast cancer? Maybe heart failure from an MI (heart attack)? What was your immediate reaction to that person?
I know what mine was: Sympathy.
Who wouldn’t feel bad for them? I wanted them to get better. To heal. Most of all, I wanted them to feel loved. Unfortunately, that reaction is not universal to all medical disorders.
We, as a society, often fail to remember that the brain is an organ just like the heart, lungs, or kidneys. Like those other vital organs, the brain can also become diseased. Mental illness is, in fact, a disease. One that can be treated.
However, it has to first be diagnosed, not judged.
Why do doctors kill themselves? Often because they don’t want to be seen as weak for needing help. Others because of stigma.
In fact, one study showed:
Only 1/3 of medical students experiencing burnout seek help often because of self and public stigma associated with seeking help.
So, how to do we help those that are afraid to help themselves? Most importantly, we have to be aware of those around us.
Have you noticed your co-resident or co-student feeling down? Do they look burned out? Have they lost interest? Started drinking too much? Maybe they look tired all the time or overwhelmed? Easily jaded?
Some of the above are clues to a potential depression diagnosis. The first step in helping is asking the person, “Are you all right? It seems like something may be wrong?“
I’ve never known anyone to get mad at this question. In fact, they usually appreciate it because it means you are paying attention and that you care.
There is Hope!
If you or someone you know is experiencing burnout, depression, or suicidal ideation please seek help! One of the most important aspects of this is that people realize that you are NOT alone in dealing with their struggles. There are people who care and want to help. Help that will not affect your career trajectory or cause disciplinary action.
One of the most helpful resources for medical students and residents experiencing depression can be found at the AFSP (American Foundation for Suicide Prevention). They also have a helpful video (below) that really does shed light on the issue. Take the three minutes to watch it.
Additionally, some medical schools (Some examples: Saint Louis, UC San Diego HEAR program) have also started to develop curriculum specifically focused on the mental health, well being, and wellness of their residents.
Why Do Doctors Kill Themselves? Be A Part of the Solution.
Be present with those that surround you. Check in on them. Then aim to learn more and be a part of the solution.
If you are struggling, please ask for help. The weak thing to do isn’t asking, it is avoiding getting the help. Your life is more important than anything else. There are many people who want to help you.
Do you or a loved one struggle with depression or burnout? Has suicide directly affected your life? Are you paying attention to those around you?
Thanks for posting this, there is such a stigma with mental health, especially in the high end of professional ranks. Remember how Tony Soprano was worried he would be knocked off if anyone found out.
My wife’s profession (Veterinarian) is even worse than physicians for suicide rates, they’re programmed to take care of unresolvable patients that way. Professionals can need help too
Thanks for commenting! It is a conversation we as a community have to take part in.
That surprised me about veternarians! And absolutely agree that professionals need help, too. It’s important that we encourage others to seek help and to make sure they know it’s okay to do so!
Thanks for this column.
I have been educating physicians and the public about physician suicide for several decades, starting with my Medscape article (http://bit.ly/MDSuicide) which is frequently updated with everything I’ve learned and is intended for everyone. I maintain a website http://www.Black-Bile.com dedicated to further openness and learning.
On Sept 12, 2018, during Suicide awareness month, I will be presenting a free CME webinar sponsored by NorCal on the topic of prevention. Everyone is welcome, registration is required at http://bit.ly/MDSuicidePrevention.
Also, Sept 17 has been designated as National Physician Suicide Awareness Day. Everyone needs to get involved to help to end this deadly epidemic.
I have heard about the high suicidal rate among physicians. You would think that with such a lucrative career. It wouldn’t happen. I am about halfway through updating the story I wrote about my brother.
Yeah, it goes to show that money doesn’t matter as much as you’d think.
The things that I have seen happen with my own eyes are beyond disturbing. It’s easy to see how that’ll have a downstream effect someday if I don’t keep the right perspective and seek help if/when I need it.
Money does not matter one bit. If you are overworked, under-appreciated it does not matter how much you get paid.
This post probably saved someone. Thanks for all you do about Burnout and Suicide.
Thanks, Badger. If that is ever true than this entire operation has been more than worth it.
Thanks for your encouragement
I am so sorry about your aunt. The pain of suicide is incredibly devastating.
I just saw a disturbing documentary about suicides among physicians. It was at the Cleveland International Film Festival and the film is called Do No Harm. It had such an impact on me & I actually want to write a post about it. Additionally, I am thinking about getting input from some of the docs in the PF world. Would you be willing?
Physician suicide is a problem, unfortunately. I know about the film, but haven’t had a chance to see it yet.
If you want to learn more about it, Pamela Wible is a leader in this space on both physician burnout and physician suicide. She has a list of a ton of physicians who have committed suicide, and blogs about it here : http://www.idealmedicalcare.org
Yep, Pamela Weibel was featured in the doc. She is doing great work.
Okay, I will formulate a question that I’d love to get some docs input on and I’ll email you all. Thanks!
TPP: Brave. Touching. Powerful.
I too have been close enough to this dark and lonely place to feel its cold visceral painful isolation and returned to the warmth and light because of more powerful connections of love and support in my life. I too have lost a medical colleague to suicide; the day after I worked with her and did not see her pain or “it coming”.
Thank you for sharing your story and helping others not feel so alone that a moment of profound isolation and despair does not wreck painful lasting havoc and tragedy. Anyone that needs help, please contact those that understand. Help us save you. There are more of us than you think…You are not alone.
Thanks for your thoughtful comment, Bill. I am sorry that you had to go through that, but find it encouraging that there are others out there who want to help solve this problem.
Thanks for being spreading the word on an important topic!
Please stop calling it mental illness. Lack of a bizarre level of super-human resilience in the face of mental and physical abuse is not mental illness. If anything it is PTSD. No person should have to put up with PTSD as part of their job description. Calling it mental illness puts blame on the victim. Please stop. It is insulting.
Hey Jane, we are actually on the same side. This is a pretty grey area without a lot of black and white.
Clinical depression and suicidal ideation are a form of mental illness, though.
Burnout and secondary PTSD caused by the horrific nature of the job is sometimes aptly described as moral injury because it doesn’t have the same victim blaming implications.
I appreciate you trying to spell out the difference, but I don’t think it is as black and white as you are making it.
This article touches me because I have a niece who has made multiple serious suicide attempts. She basically gets anxious and takes whatever medication she can find. She has ended up in ICU on a vent twice. She is now doing ECT which is helping but it destroys her memory. This is so sad. She tells me she has never been happy. She has 2 young children and a caring husband.
That is super sad, Hatton! I am sorry to hear about her struggle. The fight can be very real. I am glad that she has you and other family to love on her.
Sounds like the doctors are in a situation similar to those of us on the ambulances, where a suicide epidemic is raging. The things we both see are the things nightmares are made of. We both get used to seeing death and we both become somewhat desensitized to it (by this, I mean it doesn’t shock us as much as it would the general public. I don’t know about you guys, but some of my friends even joke about suicides). We both get overloaded mentally because it seems the only ones who get it are people like us and then they’re just like “suck it up or GTFO.” Our spouses, try as they may, can’t understand. Substance use is common and complicates things. It’s a recipe for disaster.
I think the problem is healthcare wide, particularly in the emergency/critical care settings.
Stephen, I didn’t know that was happening on the bag of ambulances. Makes complete sense, though.
It is called secondary PTSD and I’ve written about it on several occassions:
Thanks for responding to my above comment. Yes, it is happening out here. It’s quite alarming. I can personally think of some nasty calls where for weeks afterward I was thinking “man, it would be so much easier to just take a vial of Sux and some etomidate and end it all than it would be to carry on and have to do this tomorrow too.” I’ve since gotten help, but knowledge of and access to lethal means is a risk that’s often overlooked.
These are just a couple of examples of articles I’ve seen over the past few months. I’ve seen some that demonstrate that the suicidal ideation and attempt rate are ten times that of the general population. In Canada, paramedics have the highest PTSD rate of any profession and are on par with the military. Don’t have articles right off hand for them, but I do remember reading them (you can probably google them). There’s a saying at my service that “if you haven’t gotten PTSD yet, you haven’t been doing this long enough.”
So we’re right here with you guys.
Thank you for sharing such a vulnerable and powerful post.
The Prudent Plastic Surgeon
Thank you for sharing this post.
In residency, where can the residents find time to seek the help they need. Working 80 hrs a week does not leave much time to get regular help. Mandating downtime for mental health counseling could add stress and take away from training time. I know counseling has become an integral part of my life for the past five years. This is something I talk about mental health with my partner, PGY3 gen surgery resident, regularly and there does not seem to be a viable solution. At least my partner has me but finding a solution for all residents seems difficult.
Believe it or not, it isn’t that tough. It is just like a 401K. Instead of having people “opt-in” to a 401K match, studies have shown higher participation when you must “opt-out” of it.
Residency programs need to get their head out of their ass and provide 3-4 “opt-out” sessions with a counselor as part of their training each year. These sessions should be protected days (maybe a half day of clinic prior to an afternoon appointment) where the expectation and encouragement is to go to these meetings as you are already “signed up”.
This reduces stigma because the program set up the appointment (“not me”) and would improve the chances of residents actually getting some help (and continuing it if helpful for them).
Suicide is not a single homogeneous entity; it is incredibly complex, as varied and diverse as cancer. One of the very first steps to de-stigmatize it is to change the language. A person commits suicide as much as they commit a death by cancer or heart attack. The word commit carries a negative connotation, eg committing a crime or sin. It also, whether intentionally or not, imparts judgmental aspersions upon the sufferer, implying that they had a choice when in fact they had as much choice as someone with cancer. And the fact that this language exists for suicide when it doesn’t for any other disease shows how poorly it is understood. It is better to say the person died by suicide, or died because of bipolar/depression/schizophrenia/etc. Or simply a brain attack. The public perception of suicide is laughably uneducated and simplistic, borne of blissful ignorance, and the mental health profession one sadly is not much better.
Hey Marcher, I appreciate you calling out the poor choice of words. This was one of the first posts I wrote on this site, and – at the time – I was not educated on the language around suicide. I’ve since then learned the negative and unhelpful connotation that “commit” brings to the discussion, which is not (and was not back then) my intention.
I’ve corrected the language to what I now use around this subject, which is also “died by suicide” as you describe in your comment. I appreciate you holding me accountable, and moving this conversation in a better direction.
thank you for this important post. I was a medical student at SLU in St Louis when Dr Stuart Slavin implemented the curriculum changes to decrease anxiety, depression, suicide, etc. It was a dramatic success. We have all seen peers struggle with these issues and it is so sad to see suicide ultimately happen. It needs to stop. Thank you for talking about this on your blog.
Sorry to hear about your aunt, thats a very touching story. I agree with the thesis that many doctors are afraid to ask for help due to the ‘Optics’ that might create with people who look up to them. I can imagine the stress has to be off the charts. Thanks for sharing!
The year was 1977, when a young brilliant Pulmonary/Intensivist invited me to relocate with him to Texas, where we could continue our aggressive interventions with ARDS patients. He and I had worked in Philadelphia when Legionella broke out in the summer of 1976 claiming the lives of many victims.
I was an ambitious Respiratory Therapist, pursuing graduate studies and hell bent on pursuing a career in research. Finally 17 years flew by, I achieved my academic goals, suffered an acrimonious divorce but was now 39 years old embarking upon my research career, which began later than I planned. It was on a brisk November day in 1994, when I called the Department of Pulmonary Medicine, to let my old friend know I was in town and to invite him to lunch. When I called I began to feel uncomfortable, as upon the mention of his name my call continued getting transferred until I finally spoke to a the Departmental Chairman. He indicated my friend had committed suicide in 1987. This explains the missing Christmas cards and no contact, as I had embarked on financial recovery from my divorce. As a researcher I would visit this hospital many times and one day I happened upon an older faculty member, as no one would ever acknowledge having known him. He was a brilliant clinician, who judged himself without mercy. This coupled with a propensity for depression, ended a brilliant career, left behind a widow with 3 children, and ultimately medicine lost one of its greatest. I wish I had been more communicative with him or possibly been around to help him through his situational travails, I wish physicians were required to undergo periodic evaluations to get them through tough times