August 20th was designated the National Day of Solidarity to Prevent Physician and Medical Student Suicide. There were gatherings at ten cities in the U.S., including at Dupont Circle here in Washington, DC.
The announcement for the event arrived with a shocking statistic: each year about 400 physicians and medical students die by suicide – the highest of any profession, and double the rate of the general population. There were 180 young people in my med school graduating class. That means we lose the equivalent of 2 entire classes of doctors from major medical institutions every year. If this occurred from some rampant infection, it would make headlines. This sad fact is buried in records that no one publicizes. It has been an issue for 150 years.
Presenters at the Dupont Circle event included physicians who have attempted suicide, others whose mental and physical health have been ignored by the same health system that trains us to be healers, as well as others who are working to change the system to be sensitive to the health of physicians as we simultaneously take care of patients.
Why does this happen?? Imagine the combination of a high stress load, in people who are aiming for perfection, in competition with other high achievers, making decisions about life and death, sometimes on a daily basis (depending on the specialty), abiding by ever more time-consuming data collection rituals that do not improve the quality of health delivery. Add in a history of depression and other mental illnesses in some, as there is in the general population. Doctors often try to ignore or suppress symptoms of depression, feeling that they cannot talk to anyone about it because of possible professional repercussions, and often trudge on without seeking care for themselves. And then sometimes it gets out of hand. Unfortunately they have learned enough about life and death to know how to precipitate their own premature death.
This unhealthy system starts in med school and residency and is perpetuated throughout our professional lifetime. If you call in sick in most residency programs, it means that another overworked doctor needs to do even more – never a pleasant situation to return to once you feel better. One recent accommodation in some programs is to have someone on an elective be the ‘extra person’ in case someone calls in sick. One speaker last night is president of the American Medical Students Association and is focusing attention on program development to promote personal health on behalf of students and residents.
Most likely, nothing terrible would happen to patients or staff if a doctor calls out sick, or takes time for their own doctors appointments, but that so rarely happens. Statistics show that your doctor is less likely to have had an annual physical or most of the preventive care that they dutifully recommend for you.
Depending on your doctor’s field, they may have needed to tell the patient before you that they have a new diagnosis of cancer or that the scan they just had shows something unexpected. Imagine Dr. Chitra Rajagopal, the wonderful oncologist in our group, supporting her patients through their treatment, every single day. Or our obstetricians, being up all night delivering babies, and needing to occasionally diagnose cancer in a pregnant young woman. And then the next patient comes in, and the physician needs to switch gears and pretend all is well. We all adapt, but it takes its toll.
The gathering at Dupont Circle, which ended with a trailer for a documentary on physician suicide, Do No Harm, followed by a candle lighting ceremony in memory of those whose lives were lost to suicide, was an eye opener for me and for the other Lady Docs and husbands who attended. We felt very fortunate to have an extensive support system among ourselves. Some of us are also working through the Montgomery County Medical Society to raise awareness among our members of the toll the profession takes on us personally. It’s a wonderful, giving profession and I wouldn’t choose to do anything else. We need to change the culture of medicine so that we feel we have permission to take care of ourselves.
What can you do if you’re not a health professional? If you appreciate your doctor’s care, please let him or her know. That goes a long way! Watch the trailer for the documentary, Do No Harm. It’s the story of an epidemic that has been kept under wraps for too long. I hope it will help open the discussion for all of us who have friends and relatives who are health professionals. Acknowledging the problem and raising awareness is a step in the right direction.