Tuesday, January 16, 2018

Physician suicide

I was talking to a medical student recently who said he didn't want to do a residency in NYC because "everyone there kills themselves."  I think that's a little dramatic, although I do recall several years ago there was a rash of suicides in residents.

I just read an excellent article on physician suicide.  What's sad is that if a physician really was feeling suicidal, I guarantee there's no way they could seek counseling quickly that wouldn't jeopardize their career and confidentiality--the only effective way would be to threaten suicide, which would take them to the ER and give them a record of suicidal behavior.... a fate many proud physicians would consider worse than death.

I'm going to take a step further and say mental health treatment in this country is really bad.  This is not a jab at mental health professionals, who are probably fine individually.... just saying there aren't enough of them. The system is bad. If someone is feeling depressed or suicidal, they can call their local behavioral health center and maybe get an appointment in a month or two.  Hopefully they're alive by then.

I had a few really down periods during my medical training, so I can speak to all this from experience.  There were no mental health services available.  At one point, when I was having a really hard time, I called some student health hotline, and the person told me that this wasn't the purpose of the line. I asked where I could go, and they said such a service didn't exist at the school. They talked to me a little, but it was clear that they were just doing it to be a good human being, and not because it was their job or something they were trained in. 

So.... I guess the takeaway is don't get depressed because if you do, you're shit out of luck.


  1. I'm thankful that at my institution things are very different. From the first day of medical school, they talked to us about the resources that are available, and that continued all the way through residency. I made use of the counseling services as a medical student and again as a new attending, and it has been very helpful to me. Hopefully more institutions will start offering good mental health supports for physicians, because I think it's something that most of us could benefit from.

  2. At least where I work we are offered resources, but personally I don’t trust that they are confidential anymore that I trust that my gynecologist (whom I work with) won’t divulge my private information to my colleagues. Which has happened.

  3. The stigma surrounding mental health issues in the U.S. is disheartening to say the least. The culture needs to change, but I have no idea how to do that.

  4. My university is building a medical school right now, and I am the director of the psychology clinic on campus. I'd love to hear from you how you would like connections to be made between the medical school and the clinic to best serve medical students to counter those issues - so there is confidential, immediate and continued treatment when helpful and not just in a crisis.

    1. There are multiple barriers to getting help:
      1. Lack of time to actually get to appointments particularly during residency.
      2. Inability to get disability insurance
      3. Required disclosure when you apply for your medical license. If you disclose it can lead to delays or rejection of your application. If you don't disclose and the medical board finds out later, then you are at risk of losing your licence.

      So what is the incentive to seek treatment?

  5. True outside medicine as well. You need help. So, you use the (tiny) mental health benefit your company health plan doles out. Next thing you know, "Human" Resources knows you have "issues," and you are on the chopping block. Now no job and you are still trying to resolve the mental health problem. You manage to get a new job, but there are waiting periods and exclusions.
    Anne, I applaud the desire to help med students, but we outside medicine need help, too!

  6. I had an experience tangentially similar. I was at school in Oklahoma, my wife was at home in South Carolina. She had been grumbling at work about being effectively a single parent and one of her coworkers overheard her. So he showed up at the apartment one Saturday morning. She says they sat out on the front steps of the building and chatted for a bit but nothing happened. After she told me, I was upset because I couldn't do a thing about it. One of my friends advised me to seek counselling from the battalion chaplain. I did. One of the worst mistakes of my military career. I walked into his office being mad that I couldn't be home to keep the scumbags away. I walked out being certain she would be raped by sundown. I never sought counselling (or conversation) from him again.

  7. also, there is a feeling that, for the most part, we have heard it all before... there isn't anything that a counselor can tell me that i haven't heard before or have communicated to a pt myself. i struggle with depression and suicidal ideation and after seeking professional help from numerous counselors found that they all had the exact same tired tropes to share.

  8. It's difficult. I think there's a number of issues regarding mental health in doctors: 1) I think being a doctor already makes us less likely to ask for health related help. I imagine a mechanic would find it difficult to ask another mechanic for help on their car. I think the above comment stands true, physicians know what the recommendations are and have probably tried them already. 2) The very nature of the problem makes it even harder to ask for help. 3) Plus there's the worry that admitting that you're not ok will come round and affect your career in some way
    I think we need to tackle why doctors/physicians burn out in the first place and actively try to work on it from that angle as well helping those that are already suffering

  9. Exactly our son died of the effects of bi polar disease. He was given a few pills which made the depressions worse..:(