Doctors are attempting suicide in high numbers, and are much more likely than the general population to complete it. Experts discuss the coverup of doctor suicides, the reasons behind depression in doctors, and why doctors who are depressed are less likely than normal to get help.
Dr. Pamela Wible, founder, Ideal Medical Care movement and author Physician Suicide Letters, Answered
Dr. Louise Andrew, founder, MD Mentor
Links for more information:
Reed Pence: Doctors are facing an epidemic, one that most Americans are unaware of… And that physicians have been reluctant to either acknowledge or confront. Many doctors are depressed–experts say about 12 to 18 percent of them, a figure that’s actually similar to the rest of us. But depressed doctors often don’t get help, and it results in a suicide rate that’s between two and five times higher than the general public.
Dr. Pamela Wible: Actually we’ve known that physicians have a high suicide rate since 1858 when it was first reported in England. Now 158 years later we actually have done very little to address this.
Pence: That’s Dr. Pamela Wible, a physician in Eugene, Oregon, founder of the Ideal Medical Care Movement, and author of the book, Physician Suicide Letters Answered.
Wible: It’s been estimated that we have over 400 physicians per year that we lose by suicide in the United States and that’s considered an underestimate by researchers who are involved in this data collection. Then as far as medical students, maybe 200 plus over the last two years, again it’s hard to know because we’re not collecting the data, but if you look at those hard numbers, like 400 physicians per year, that’s the equivalent of losing an entire medical school of medical students every year.
Pence: Wible says nearly a million patients a year lose their doctors to suicide… And millions more are being treated by doctors who may be teetering on the edge, seriously depressed. But she says rather than addressing it… Medicine seems to be intent on covering it up. If a doctor commits suicide, you may never know the truth, according to Dr. Louise Andrew, a physician-attorney and founder of MD Mentor, which consults on physician wellness issues.
Dr. Louise Andrew: There is no really secure way to know for sure how many deaths of physicians are due to suicide, and the reason is of course that other physicians are the ones who sign death certificates and certify the cause of death. And it’s strongly suspected that because, as in all populations, physicians have a certain degree of shame around the subject of physician suicide, that it’s very possible that when a colleague dies in a way that looks suspicious but can’t be proven, that perhaps the diagnosis code for the cause of death would be made to appear accidental rather than intentional.
Wible: So, like, say a motor vehicle accident after work is labeled as an accident and not a suicide even though it’s one driver in the car running into a tree and could’ve been a suicide. Also people jumping from bridges, sometimes they call that an accidental fall, you know, out of a hospital window, it’s just unbelievable. Accidental gunshots wounds. Both the men I dated in medical school died by suicide and their families contend that those were accidental overdoses which is absolutely ridiculous because physicians dose drugs for a living and so it would be very unusual to have a physician die by an accidental overdose.
Pence: In fact, Andrew says doctors’s knowledge of drugs and access to them mean their suicide attempts are much more likely to be completed than average. But Wible says covering up the problem isn’t just a medical conspiracy. Society is complicit, too.
Wible: Doctors are supposed to be the people we go to for safe keeping of our health and I think it’s really hard for people to view doctors as being fallible and having the same flaws and pain and suffering as everyone else and so there’s a little bit of resistance to wanting to look at this. Culturally, you know, we have this reputation as physicians to uphold the white picket fence and the big car and big house and nobody wants to hear that you’ve died by suicide or had any pain or personal problems, you know, so I think there’s resistance sometimes on the part of patients to see their physicians as human and then there’s resistance majorly on the part of medical institutions that certainly don’t want to be blamed as the “suicide school” or the “suicide hospital” where everyone jumps from the rooftops. And so, you’ve got a lot of resistance to telling the truth.
Pence: Medical school is where it starts. According to Andrew, suicide has been known for a decade or more as the number two cause of death for medical students, and she says it may actually be number one, given how suicides are often reclassified. Wible says many students become depressed as a result of the brutal methods of teaching.
Wible: The biggest issue is our medical training is full of bullying, abuse and hazing. It’s very militaristic, like maybe how boot camp was 50 years ago or something. I mean, it’s just an intense situation with sleep deprivation and name calling, and if you’ve never been through medical school you wouldn’t know this, but you feel like you come out on the other end with PTSD. And this is just by the way you’re treated by your peers and your instructors, not to mention the fact that you’re surrounded by suffering and human death all day long, you know, I mean it’s vicarious trauma just by watching you know, a three-year-old die. That’s hard to do of itself, you don’t need somebody next to you saying “Well that was stupid, why did you do that, are you an idiot” and not be able to sleep for like three days because you’re on call for 36 hours. It’s a barbaric way to train people to be physicians and it’s totally unnecessary.
Pence: Then when medical school is over, there’s residency with its 80 to 100 hour weeks. A study published last month in the journal Academic Medicine shows that 35 percent of medical residents have clinically significant symptoms of depression. Finally it’s on to their own practices. By then it’s clear, being a doctor isn’t what most of them expected.
Wible: What people are telling me is that they’ve been abused, they’ve been bullied, they had to work seven days on in the hospital without sleep, they’ve been in really unsafe situations, they’ve watched people perform things that they consider unethical on patients for money, lying on the medical record, all sorts of things that these basically idealistic humanitarians who are very bright come into medicine just wanting to help people and then they see just really the dark side of humanity. And they see their dreams getting dashed, they now have $300,000 of student debt and they realize that they’re just going to be an assembly line worker practicing assembly line psychiatry or something like that, just throwing pills at people. It’s very disheartening.
Andrew: Practicing medicine has for many physicians no longer the joy that brought them into the practice and a lot more frustration that they did not expect when they entered the practice, and those two things work together to make the practice less fulfilling and to contribute to the epidemic of physician burnout.
Pence: Depression can be very treatable. But when doctors are depressed, they face numerous hurdles that keep them from seeking help. First, like many of us, they may not see it in themselves. But that carries special consequences.
Andrew: Very often, the very first sign is some kind of a physical complaint. However, when the real issue that’s causing the physical symptom is a depression, it’s often impossible to find the diagnosis and therefore physicians may not recognize that that’s what they’re experiencing and they may also recognize that they’re not really being very good at finding out what’s wrong with themselves which gives them a sensation or a feeling of inadequacy and subsequently depression.
Pence: Andrew says other doctors in the office may not point out depression, either… for similar reasons.
Andrew: If you are a colleague of a physician who seems to be ill, it’s quite often not addressed. You don’t go up to that colleague and say “You don’t look so good today” because it’s kind of an afront to that colleague that that colleague, him or herself, doesn’t already know that there’s something wrong with them.
Pence: And families? They’re not likely to call out their physician spouse, or mom or dad.
Andrew: In physician families, both the spouse and the children have this special sense about the physician family member that they’re put on an elevated level and they are not to be questioned when they do things that may otherwise seem unexplainable, such as for example, working all the time. A person who’s in a family, or a primary family relationship with a physician, recognizes that this is kind of a special relationship and therefore you don’t want to jeopardize that relationship by risking that you might be asking about something that special family member doesn’t want to talk about.
Pence: But even if a doctor knows full well that he or she is in trouble, and would welcome psychological help, the system may keep them from getting it. Doctors need a license to practice medicine. They need insurance and hospital privileges. And they know that a record of mental illness could jeopardize all of those.
Wible: We’re not really allowed to get mental health care without a fear of losing our medical license so that we are suffering in isolation from one another, we’re pretending to have the facade with the starched white coat and the fake smile that everything’s okay and we are not able to ask for help. So, you know, doctors after work are maybe drinking or crying themselves to sleep in their pillows or just kind of getting numb.
Andrew: If a physician should receive a diagnosis of just about any mental condition, they are then almost certainly going to be faced with a dilemma when they go to apply for licensure or employment or insurance of various types.
Pence: Andrew says that for most of us it’s illegal for a prospective employer to ask if we’ve ever been treated for a mental illness. That’s a provision of the Americans with Disabilities Act. But medical licensure boards routinely ask it anyway. And if a physician who has been treated answers truthfully…
Andrew: They are then going to be required to come in and basically prove that their mental health condition, which could have happened 25 years ago, in fact when they were in medical school for example, is not currently causing them to be impaired. So a fear that they’re going to have to face many additional hoops during their licensure quest and then even if they get through those hoops, then when they look for employment, that their employers may be asking the same types of questions and their insurers, such as medical malpractice insurers, without which a physician cannot practice medicine in most states, they may be denied insurance and therefore their career pathway has been terminated by the fact of a mental health diagnosis which they were honest enough to answer on an application form even though the question itself is illegal.
Pence: Andrew says most states have a physician help program allowing them to say “no,” they haven’t had mental health treatment… even if they have. Those help programs typically require doctors to register and be monitored. But Andrew says most doctors are unaware of those programs and sometimes, the hoops they have to jump through are just too much.
Andrew: Some of the physicians who have voluntarily put themselves in these programs for pure mental disorders such as a long past history of depression in remission, or a very stable treated depression which we know that probably 15 percent of the population has, is going to end them being treated as if they had a substance abuse disorder and being in monitoring programs, sometimes starting with 90 day inpatient evaluation, monitoring programs that can last for 5 years of drug treatment and drug monitoring when they’re only infraction, if you will, is if they had a treatable mental health disorder which is now perfectly stable.
Pence: But even if doctors make it past all of those hurdles to seek help… They may not get the same treatment as everyone else. Andrew says doctors aren’t very comfortable treating other doctors. But other physicians and even patients can play a role in healing depression. Andrew says it may not seem like much, but it can make a difference when you tell your doctor, “I hope you’re having a good day and I appreciate what you do.” And despite the magnitude of the problem, Wible is encouraged. She says we’re taking the first step in addressing physician suicides. Finally, we’re starting to talk about it.
You can find out more about all of our guests through links on our website, radiohealthjournal.net.
I’m Reed Pence.