Medical Student and Physician Depression and Suicide

I’m disturbed by all suicides. This is such a problem in our society now. Something is so very, very wrong. But what I want to write about tonight is the alarming rate of medical student, resident, and physician suicide that seems like an epidemic now.

I know medical school is stressful. It has been since whenever it originated. I know you have to be very intelligent, driven and more often than not, they are perfectionists. You have to have a great drive, intelligence and accomplishments to even come close to being accepted by a medical school. Of course they have to be, look at what they will be doing. But something is not going so right in medical schools when many doctors depression starts there.

I feel I know some of the reasons for physician suicide. Being a doctor is not what it once was. They often don’t have respect, are subject to high malpractice rates, are always under the threat of being sued, they feel they have to hide any depression therefore they don’t seek help, having to see too many patients, insurance calling the shots on many things. And I don’t see anything getting any better at all with our so called healthcare reform. As a matter of fact, I see it worsening.

I know I do a lot of writing about medical student and physician depression and suicide, but it’s because it hits me right into my heart because my daughter was a medical student when she took her life. While I don’t pretend to even know whether the stress of med school had anything to do with it, I can’t help but wonder if things could have been easier for her to seek help without threat of losing everything she put into it.

I wanted to post a couple of articles of physician suicide that have happened within weeks of each other. Then I want to post a blog post from Pamela Wible MD who is trying to move mountains in helping with this problem. She has her own practice that is MD and patient friendly and has started doing things differently than what has been traditionally done. She has retreats for doctors who are burned out and depressed. She holds seminars on how to form a better practice so an MD can feel human again instead of feeling like a machine. She’s been on multiple TV programs, TED talks, and newspapers online, and has her own blog and much more. I know there is more to come from her. Much more.

My daughter Kaitlyn’s picture is on her wall beside her desk….all the way in Oregon. Thank you Pamela for all you do.

http://gothamist.com/2014/08/23/medical_intern_dead_after_jumping_o.php

http://gothamist.com/2014/08/19/doctor_jumps_to_death_from_top_of_n.php

Here is Dr. Wible’s blog post:

Physician Suicide Letters

I asked why physicians were dying by suicide. Here’s what they told me:

“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth it?” I wish I could change back but I realize that I will never be the same again and it isn’t in a good way. We had two suicides and one murder—skull crushed with a bat—and one serving life in prison for murder during a delusional episode after not sleeping for almost a month. Yes I went to a hard-core school (old school kind of place). PTSD isn’t benign; it truly affects you to the core—it changes your brain.” ~ Doctor in Philadelphia

“I’m in my first year of practice outside of residency and I can’t begin to tell you how often I think of death. Not because I hate my life—I have a wonderful husband and family. But the pressures of daily life as a doctor are overwhelming. I work constantly! Even on my days off, I’m working. When I take a day off, I pay for it later by double the amount of work waiting for me. I have patients yelling at me when all I wanted to do was help. They try to fool me and manipulate me. Insurance companies deny my patients help, leaving me with no resources to help. My boss is a douche—unethical and dangerous. I want to build a relationship and do what’s right for my patients—but the company pushes me to see more and more patients in less and less time. I cry at work, I cry myself to sleep sometimes. I don’t feel depressed, and I know my life has value, but sometimes the thought of suicide is just to escape the pressure of the profession. It’s not like I can realistically give up the job, my calling. I’m neck deep in debt and will never be able to pay it back if I leave the profession.” ~ Michelle

“I didn’t realize that so many others in the field suffered as I do. I have tried to get help many times but it’s hard because I don’t think that anyone takes me seriously and I don’t think I can be completely honest with anyone without major repercussions. I don’t have any friends to socialize with and all my relationships have failed. I come from a background where I was the first to get a higher education so they think that I should be elated to just have MD behind my name and tell me to suck it up. I don’t want to possibly lose my license because honestly I love taking care of patients and sometimes that is the only time I get a few moments of happiness. But things have just been so bad for me that I have resorted to just doing locums [fill-in work] so I can isolate myself because sometimes I can’t stop the tears. I have tried a few times and the last time probably would have worked but at the time I was lying there looking at the dog I had then who was curled beside me nudging me to get up. Somehow I drove to the ER although severely hypotensive where I was hospitalized and they chalked it up to the fact that I had not really been eating or drinking for weeks. I no longer have that fur companion so I find myself alone and thinking about an escape a lot.” ~ Dee

“My attending took great pleasure in bullying the students, and I saw real pathology among fellow students who felt like they couldn’t ‘take it’ anymore, and complained of ‘PTSD.’ I am not currently practicing medicine (for reasons quite possibly stemming from the fact that I never could find adequate mental health care).” ~ Anonymous

“I am a third-year medical student. I have done very well in both my coursework and national boards. I have publications, research. On paper, I am successful. Yet I find myself thinking about killing myself frequently. Walking into traffic, jumping through the window, just dying in the course of a normal day. Miserable thoughts. I went to the school psychologist to be fixed; I was referred to the school psychiatrist, who looked just as broken as I felt. He offered me antidepressants, if I ‘wanted to take them.’ It doesn’t make sense. I never felt this way before medical school. I loved, I thought, I reflected. I enjoyed being creative, yet now I’m chained by procedure, bureaucracy, and paperwork. There are no creative solutions to problems, there is no effective effort to improve the system except from big top-down initiatives of whatever hierarchy you’re subject to. It’s maddening. I used to watch the stars and smile. I volunteered. I ate well and exercised. I enjoyed playing with children. Now I’m finding a sort of perverse pleasure in patients’ pain; I recognize this as sadistic. I’m shocked. I’m revolted at how far my soul has degraded. It’s insane. I’m chronically sleep deprived. I can’t think or learn when I don’t sleep. I can’t smile without ulterior motive. I’ve confided in my family, who don’t understand the demands or the situation and have told me that ‘it’s my decision to feel sad.’ The [professors] don’t teach; half of them treat us as annoyances. Learning and healing both got lost somewhere. The good teachers leave or are ground down. I’m full of hate and sadness. I’m not sure why I’m still here, but I am. I feel like an echo of myself.” ~ John

“I am in my final year of medical school and have had several classmates attempt suicide over the course of my degree. I love medicine and I love people, that’s why I chose this profession. Sometimes when awake studying at 3 am, or watching an autopsy, or witnessing highly emotional scenes at the hospital, I feel incredibly alone. Sort of like I’m not a part of humanity! It deeply saddens me that classmates and colleagues feel they are unable to seek help for their problems, and I hope there is more research in this in the future.” ~ Julie

“I thank you for the website and the many comments by people. I qualified in the UK and things here appear to be the same. I have several colleagues who have committed suicide over the years, and I feel lucky to have survived myself, for all the reasons you describe. I am particularly taken by the PTSD image. Yes indeed I was traumatized in medical school and it continues to happen, but we get accustomed to it, to the point of becoming an abused class.” ~ Christian

For every doctor who dies by suicide, friends, family, and patients are left to wonder why.

“I am still in a state of shock hearing that my brilliant, loving, compassionate, successful, well-respected, honest, hard-working physician committed suicide this past week. Pressure from the changing medical community/insurance/had forced him to close his 30-year practice and he went home and shot himself in the head. The letters keep coming in of how many people loved him, were healed by him, and admire him. What a tragic end to a successful career. Everyone is asking why. He was the best of the best, surgeon and specialist, nice home, nice family and now he is gone. Totally tragic.” ~ Diana

If you are moved by these letters, please watch and share my TEDx talk on physician suicide. Read more letters here.

Thank you for caring.

Pamela

Here is the link to Pamela’s blog post so you can read the responses and get an even better idea of how doctors and med students are feeling.

http://www.idealmedicalcare.org/blog/physician-suicide-letters/