Physician, Heal Thyself
Bringing physician suicide out of the darkness
Posted Dec 22, 2016
Seeking respite from the all-consuming rigors of the cancer ward, I remember, I took my smartphone out of my pocket. As I aimlessly flicked through innumerable memes and videos posted on Facebook, I paused on one particularly painful post. A medical intern in New York Presbyterian Hospital had jumped from his apartment to his death less than two months into his training. There was enough sadness to go around on the cancer ward, but this hit close to the heart.
The medical profession is one of great privilege. Starting as medical students and continuing as trainees and attendings, physicians are bestowed the wonderful responsibility of taking care of patients. They are also very well respected professionals, have unparalleled job security and are extremely well reimbursed. Yet suicide seems to factor into their lives much more frequently than those of non-physicians, particularly early in their training.
No matter how robust one’s training in medical school might be, few things can prepare one for a single day in the life of an intern. All of a sudden, the level of responsibility skyrockets and the number of critical decisions made multiply exponentially.
It often takes the suicide of someone famous to make people take pause and pay attention. The last time people in general really cared about suicide occurred after Robin Williams’ untimely and tragic death, which brought the conversation about suicide back into the public’s focus. Physicians, however, are at an even higher risk of suicide compared to non-physicians. This risk remains even after accounting for all known confounders, such as age, gender, level of education, mental health, substance use and socioeconomic status amongst others. One estimate suggests that more than a million Americans lose their physicians to suicide every year.
Suicide among doctors is particularly unnerving. Faced with an already burgeoning mental health crisis, the fact that even the supposed bulwarks of society against disease are vulnerable may lead one to question if there is any meaningful way of preventing suicide. Worryingly, psychiatrists are consistently reported to be at most risk for suicide amongst medical specialists.
Younger physicians, those still studying and training, are particularly vulnerable: Suicide is responsible for a quarter of all young physicians dying in the United States. Yet, this is not only an American phenomenon. I remember when I was a medical student back in Pakistan and I returned from clinic to the dorms to see a large crowd gathered around the room of a medical student just in his first year. A loner, not many outside his class knew of him until that day when he was found hanging by a rope in his room. Was he financially challenged? Was he homesick? Had he been dumped by his girlfriend? There were many theories but none fit. Like so many other suicides, though, while we always hope for there to be a narrative or a reason, there was none forthcoming.
The reason why suicide continues to afflict doctors is similar to reasons why it continues unabated amongst non-physicians. Unlike ‘organic’ diseases, mental disease continues to be wrapped in stigma, and a culture of silence surrounds such incidents. Medical schools and hospitals, like other large organizations, frequently take the silent-treatment approach to suicide among students and employees, not wanting to attract (possibly negative) publicity.
Not talking about it has not helped reduce the rate of suicide and mental illness among students and interns, and that culture has to change. The start of internship is perhaps the biggest transition doctors ever have to make – from students to practitioners – and it is also the time of greatest upheaval. Residency programs need to be explicit and upfront about having the ‘talk’: It is okay to be depressed, it is okay to seek help, and there is no such thing as being ‘weak’.
During my last year of residency, I got an unexpected invitation from my program director to meet her in her office. My first instinct, of course, was that I had done something wrong. I was pretty nervous because I had no idea what it could be. However, she had learned about a particularly stressful situation I had been going through. It was an extremely personal matter that I hadn’t even shared with my family. She offered me her full support, and on a small yellow sticky note wrote the name of a psychiatrist whom the residents could see for free. When I walked out of her room, even though I never made that appointment, just having that note in my pocket seemed to take half my worries away.
Before we arm medical students with unparalleled knowledge and immense skill and send them off to stamp out disease, perhaps it is time to revisit the biblical proverb, “Physician, heal thyself.”