Suicide and the Young Physician

[El]

Graduating from medical school and starting residency training should be one of the most exciting times in a physician’s career. Instead, for two newly-minted New York City doctors, who ended their lives within a week of each other this summer, this period marked a morbid end. They represent a tragic and rarely discussed phenomenon in the medical profession: Doctors commit suicide at a rate more than twice the national average. Every year approximately 400 physicians take their own lives. That is roughly one per day, or the equivalent of two entire graduating medical classes each year.

As a recent graduate of an internal-medicine residency, I know that physician depression and suicide are not routinely discussed in medical school or training. Significant time is given in medical education on how to recognize depression and suicidal thoughts in patients, but never once did I hear of my own increased risk of suicide.

One might expect that older physicians, after years in an emotionally and often physically taxing profession, bear the burden of an increased suicide risk. But it is really a phenomenon of young physicians. Suicide accounts for 26 percent of deaths among physicians aged 25 to 39, as compared to 11 percent of deaths in the same age group in the general population.
How can it be that physicians, whose lives are spent providing care, are not seeking their own necessary care?

It does not take long for physical and mental exhaustion to overtake a young doctor. A 2006 study at the University of Pennsylvania demonstrated that over the course of the first post-graduate year of training, commonly known as “intern” year, rates of burnout–a triad of symptoms comprised of emotional exhaustion, depersonalization, and a sense of decreased personal accomplishment–soared from 4.3 to 55.3 percent. Not surprisingly, increased rates of burnout were associated with increased rates of moderate depression, affecting nearly one-third of interns by the end of the year.

Physician training can be an extremely stressful undertaking, from managing crushing education debt while receiving a minimal salary, to an 80-hour workweek, to having to keep up with the frenetic pace of evolving medical knowledge, all while being responsible for life-and-death decisions. However, none of these reasons–individually or combined–can fully explain why doctors have significantly higher rates of suicide. The complex issue is made only more complex by silence among medical professionals.

One recent study found that only half of depressed interns obtained mental health services. How can it be that physicians, whose lives are spent providing care, are not seeking their own necessary care? Responses for avoiding help include lack of time, lack of confidentiality, a desire to manage their mental health independently, and professional stigma. Nearly half of the interns in the study believed their colleagues would have less confidence in them as medical providers if they sought psychiatric treatment. Threat of judgment from other physicians serves as one of the largest roadblocks to seeking psychiatric care. And yet, there is not one doctor I know who would ever want a colleague to suffer. How can the medical community begin to rectify this self-destructive paradox? As physicians, we believe that initiating a dialogue with our patients is the best way to enact healthy behavior changes. The profession would do well to adopt this same technique to best care for our own.

[Pyraxis]

When is it EVER going to occur to society that having doctors work 80+ hour weeks and 24 hour shifts is not good for anybody?! 

[Icequeen]

When is it EVER going to occur to society that having doctors work 80+ hour weeks and 24 hour shifts is not good for anybody?! 

Unfortunately probably never.
My neighbor is an RN and pulls a lot of those 24 hr shifts mostly due to call offs...I don't know how she even drives home some nights she's so worn out...and people are amazed when mistakes happen.

[Pyraxis]

It just seems utterly illogical. Other industries have had quality of life initiatives, why would one of the most important professions still be worked like factory slaves.

[El]

It just seems utterly illogical. Other industries have had quality of life initiatives, why would one of the most important professions still be worked like factory slaves.

Because the original standards were set by a guy who was using a lot of cocaine?

['andersom']

When I was doing theology, and got in a non functional episode, people that used to be friends suddenly became all professional towards me. Was horrible. I cut back some friendships because of that. I did not need them to be my therapists or my referrals to therapists. I needed them as friends. It was as if they had given up on me as a person, and saw me as a case.
Can imagine something similar happening when a doctor confides to a colleague that things are not going well.
On the one hand, it is good that there is a professional approach. On the other hand, if you know the professional drill by heart, it may not work for you. A professional treating a colleague or a doctor will need creativity on top of professionality to be able to reach out to his patient.

That there is no space in the curriculum at university about work related stress and depression for doctors is astonishing. It is bound to happen. There will be stress, there will be overload, there will be threats by patients, there will be fuck-ups that could have gone better if only...

That at least they did include a bit in my studies.

[Icequeen]

Where do they go for care if they even choose to?  One of their co-workers or staff?...doubtful.

A two hour drive to the city?...when do they find the time or the energy? Dr's around here are usually swamped at whatever practice they've affiliated themselves with and are pulling morning or evening shifts making rounds at one or two of the local hospitals.

Everything around here has reverted to the mental health clinic setting, private practices have either merged or left for greener pastures...you can expect at least a 20-30 min wait and are packed in a waiting room with at the least 15 other people. Then it's usually 3 intake appointments before you even see a Dr., unless you are having a crisis and then you are referred to the nearest inpatient facility which is normally full to capacity.

Standard procedure when you're in the waiting room and see anyone you know is to wait and see if they acknowledge you...most don't and will put their head down and go hide in another section of the waiting room...many times you see someone recognize someone, talk to them, and then sit and whisper to their friend about them when they're called in.  If you ever want to know everyone's problems...sit behind two elderly ladies in the waiting room. The most innocent looking ones normally turn out to be the most ruthless, judgmental bitches you've ever seen.

I'd hate to be a Dr. or someone in another high profile position in the community. 

[Pyraxis]

That was exactly why WolFish wasn't talking to therapists back when I first met him. Working as a crisis counsellor, he already knew most of the people in the area as coworkers and peers, and he'd already been screwed over once by somebody breaking confidentiality. It just wasn't a viable option.

Which gets back to the root of the issue. No amount of talk therapy or meds can overcome sheer exhaustion from overwork - though I do know there is a significant drug abuse problem among doctors working crazy shifts. They get what benefits they can from chemicals. Attitudes need to change at a high administrative level.

[El]

That was exactly why WolFish wasn't talking to therapists back when I first met him. Working as a crisis counsellor, he already knew most of the people in the area as coworkers and peers, and he'd already been screwed over once by somebody breaking confidentiality. It just wasn't a viable option.

That was an issue I ran into as well when I was seeking counselling for myself.  Though it's less brutal for therapists, I think, because so many of us have been in therapy/are in therapy; it's not stigmatized, just awkward.

[Yuri Bezmenov]

That was exactly why WolFish wasn't talking to therapists back when I first met him. Working as a crisis counsellor, he already knew most of the people in the area as coworkers and peers, and he'd already been screwed over once by somebody breaking confidentiality. It just wasn't a viable option.

That was an issue I ran into as well when I was seeking counselling for myself.  Though it's less brutal for therapists, I think, because so many of us have been in therapy/are in therapy; it's not stigmatized, just awkward.

I dated a chick in OC who was a shrink at a nearby prison. She took psych meds and had mental issues of her own.

What's with that anyways?? Going to a shrink who has mental issues themselves is a a bit like going to a mechanic with 2 broken down cars in his front yard. 

[Pyraxis]

Cause things don't get cured instantly even if you're seeing a good therapist. If I had diabetes, I wouldn't have a problem going to a doctor who had diabetes too.

[Parts]

With the new electronic record keeping there will be no way to hide any help you get no matter where you go which is even more of an incentive not to go

['andersom']

With the new electronic record keeping there will be no way to hide any help you get no matter where you go which is even more of an incentive not to go

Do you have to comply with that?

They are asking for my permission now. But to me it is unclear how safe it all is. I know that with an older system almost everyone working on health could get access. My brother found out when someone who's wife had malpracticed on him told him he was happy my brother was doing so well five years later. They just had been goning through all his records....

[odeon]

That was exactly why WolFish wasn't talking to therapists back when I first met him. Working as a crisis counsellor, he already knew most of the people in the area as coworkers and peers, and he'd already been screwed over once by somebody breaking confidentiality. It just wasn't a viable option.

That was an issue I ran into as well when I was seeking counselling for myself.  Though it's less brutal for therapists, I think, because so many of us have been in therapy/are in therapy; it's not stigmatized, just awkward.

I dated a chick in OC who was a shrink at a nearby prison. She took psych meds and had mental issues of her own.

What's with that anyways?? Going to a shrink who has mental issues themselves is a a bit like going to a mechanic with 2 broken down cars in his front yard. 

Doctors don't get sick? Are you saying that if the shrink has issues, s/he shouldn't be allowed to work?

[El]

That was exactly why WolFish wasn't talking to therapists back when I first met him. Working as a crisis counsellor, he already knew most of the people in the area as coworkers and peers, and he'd already been screwed over once by somebody breaking confidentiality. It just wasn't a viable option.

That was an issue I ran into as well when I was seeking counselling for myself.  Though it's less brutal for therapists, I think, because so many of us have been in therapy/are in therapy; it's not stigmatized, just awkward.

I dated a chick in OC who was a shrink at a nearby prison. She took psych meds and had mental issues of her own.

What's with that anyways?? Going to a shrink who has mental issues themselves is a a bit like going to a mechanic with 2 broken down cars in his front yard. 

Lol, have you MET any mechanics?  Sounds about right to me.

And, people get into this field for a reason.  Usually, that reason is previous exposure to it.