This article was originally published in the SCPS Newsletter, April 2017.
In the March 17th, 2017 edition of Psychiatric News there is a story that hopefully caught the attention of many of my colleagues. On page 14 is the story of our colleague Greg Miday M.D. who took his own life on June 22, 2012. The article quotes his suicide note,
“My family, I love you.
To others who have been good friends, I love you too.
This is just the end of the line for my particular train.”
This young physician’s tragic end is all too common. It is estimated that between 300 and 400 physicians die by suicide every year. In fact, the answer to the question posed in the title is: suicide is the only cause of death that is more prevalent among physicians than the general population. The risk is higher in female physicians (250% higher than the general population), compared to male physicians (70% higher than the general population). We also know that the increased risk begins as early as Medical School and that this is a worldwide phenomenon.
The largest risk factor, for suicide in physicians, is a history of psychiatric illness. However, we know most physicians who end their lives in suicide have relied on self-treatment and are never formally diagnosed or treated. While a history of a suicide attempt is a major risk factor for future suicide attempts in the general population, that is not the case for physicians. Because physicians’ initial suicide attempts are much more lethal, few physicians have a history of a previous attempt. This is key. If you are evaluating a physician and they have a history of suicide attempt, they are likely to already be deceased.
Some of the largest barriers to obtaining treatment for physicians who are suffering seem to be stigma and fear and systemic barriers such as lack of time due to work obligations. Unfortunately, when physicians do seek help, it is often by a “curbside consult.” Unfortunately, in many cases our colleagues may undermine the quality of care by seeking to avoid a formal diagnosis, documentation and hospitalization for many of the same reasons mentioned above (namely stigma, and fear that their colleagues career might be put in jeopardy).
So what can we do? Much like the general population it is important to limit access to lethal means. Beyond firearms which we often think of, physicians have access to lethal drugs but by virtue of their ability to write prescriptions and also, in many cases, in their office or operating room as part of their practice of medicine. We need to train Psychiatrists on how to better evaluate and treat Physicians. It is vital to understand that the risks and needs of Physicians are different than members of the general population. This evaluation and treatment must be outside of the physicians medical group or health system, so that they get confidential, independent and unbiased treatment.
Maybe most critical is that medical school and residency programs need to start better screening and educating our early career physicians about depression, burnout and other challenges that are inherent to the practice of medicine. If we shift from a focus on a physician’s psychological history to their current symptoms and present fitness of their professional abilities, we will see less stigma, less secrecy and decreased fear of seeking help.
Physician Health is both the academic and clinical focus of my career. I have been fortunate to have been mentored by Karen Miotto M.D. and Greg Skipper M.D., who are two of the leaders in the field of Physician Health. There are unsung heroes I have had the pleasure of meeting from Wellbeing Committees around our State and Physician Health Programs around the country. There are organizations fighting to improve physician health like CPPPH, which is committed to bringing back a quality Physician Health Program to California.
If we look at our colleagues as members of our team, we should speak up and support those who are suffering from mental health conditions, substance abuse and burnout, because they all raise the risk of suicide. When one member of our team is struggling and is unwell, our whole team is not functioning at its highest capacity. Not only does the individual physician suffer, but the quality of care their patients receive and patient satisfaction is also negatively impacted.
I am always available for a confidential consultation regarding a personal concern or one regarding a colleague. Your hospital wellbeing committee is also available as a resource. Hopefully soon we will also have a fully functioning Physician Health Program in California that will be accessible, confidential and highly effective for Physicians across the State.
At APA’s Annual Meeting in San Diego, APA President-elect Anita Everett, M.D., chaired a town hall discussion on the drivers of physician burnout and strategies for promoting wellness. Dr. Everett, M.D., chaired the session, and APA CEO and Medical Director Saul Levin, M.D., M.P.A., and Trustee-at-Large Richard Summers, M.D will participated.
Matthew Goldenberg D.O. has presented data related to Physician Suicide, and other Physician Health related topics, at local and national conferences. For more information education related to Physician Health visit: www.ProfessionalsHealthSolutions.com