High rates of suicide in medicine call for awareness and action

Last December, the world was shocked when a young surgeon in Texas shot and killed his two young children and then himself. His family acknowledged in a painfully honest obituary that after years of battling anxiety, severe depression, and addiction, Christopher Chad Dawson did “the unimaginable.” His widow also wrote, “He fought to get out of the deep, deep hole he was in but was afraid of the repercussion on his career if he were to get professional help.”

That statement strikes at the heart of a long-term and pervasive problem in medicine. High suicide rates among doctors have been reported for more than 150 years. Doctors are consistently among the top occupations with the highest risk of death by suicide, reported Medscape, which calls suicide “the end stage of an eminently treatable disease process.”

What’s being done to address the mental health crisis in medicine? And where can doctors turn for help without fear of repercussion?

Medicine’s tough toll on mental health

Sadly, medical training and some practice environments are rough on mental health. High pressure, long hours, sleep deprivation, and strained family relationships due to these factors all put medical professionals at higher risk for mental health issues and suicide.

Research shows 75% of medical students are on psychiatric medications, and more than 19% of female doctors suffer from depression.

Depression is an epidemic among doctors, according to family physician Pamela Wible, M.D. Dr. Wible, who gave the TEDMED talk, “Why doctors kill themselves,” began compiling a list of doctor suicides in 2012. The tally was up to 699 as of January 2018.

Her research has uncovered that 75 percent of medical students and new doctors are on psychiatric medications. “Depression is at least as common in the medical profession as in the general population,” affecting an estimated 12 percent of males and more than 19 percent of females, reported Medscape. And depression is even more common in medical students and residents, affecting as many as 15 to 30 percent.

Stigma and access to care hurt depressed doctors

Yet many doctors are reluctant to get help, mostly because of the stigma. “Problem is physicians must answer mental health questions (right next to questions on felonies and DUIs) to secure a medical license, hospital privileges, and participate with insurance plans,” Dr. Wible explained on her website. “Check the YES box and be forced to disclose your ‘confidential’ medical history and defend yourself—again and again for your entire career.”

We must allow doctors access to non-punitive mental health care, she wrote on KevinMD.com, citing an example of a fellow physician “who had her state license delayed for six months because the medical board demanded to review her marriage counseling records because she was depressed during a divorce.”

The American Medical Association is taking action to develop policies aimed at studying and destigmatizing mental illness among physicians and medical students.

Access to care is a major problem, as half the counties in the U.S. don’t have a single practicing mental health professional.

Of course, access to mental health care is a major problem, whether you’re a doctor or not. “Two-thirds of primary care physicians report having trouble getting psychiatric services for patients,” according to FierceHealthcare, which also reported that the U.S. has only 40,000 psychiatrists, most located in urban areas. “Half of the counties in the country don’t have a single practicing mental health professional.”

Better understanding the problem

Addressing suicide prevention for medical students and doctors is tricky because of the secrecy, shame, and stigma, but also because we need better data to understand the problem, according to Nathaniel P. Morris, a resident physician in psychiatry at the Stanford University School of Medicine.

For instance, coverage of doctor suicide frequently lumps together medical students, residents, and attending physicians, but these groups are not the same, he wrote in Scientific American. “Medical professionals face unique stressors at different stages of training.”

A new study shows residents may have characteristics that protect against suicide; studying these factors may prevent future tragedies.

Dr. Morris cited a new study that found that the rates of suicide for medical residents—while still a leading cause of death—appeared to be much lower compared with the general population. This suggests “residents may also have characteristics that protect against suicide. Protective factors might include problem-solving skills, social supports, links to mental health resources, reasons for living and financial stability,” he wrote. “Further research into these types of protective factors could help prevent future suicides among doctors.”

The risk to patients and our nation’s health

Of course, that research could take years, and we also need more immediate solutions. Some say the health of our nation is at stake. Every year 1 million patients will lose their doctor to suicide, according to Dr. Wible. That’s in addition to the looming doctor shortage. And that’s not the only impact doctors’ mental health has on patients.

With medical mistakes the third leading cause of death in the U.S., patient safety is a risk when doctors’ mental health is impaired.

“The biggest risk is patient safety…if you have somebody that is not functional either mentally or physically, then you can’t have good quality care,” said emergency medicine physician Kim Perry, D.O., in the upcoming film, “Do No Harm: Exposing the Hippocratic Hoax.” In fact, medical mistakes are the third leading cause of death in the U.S.

“Proposals to combat physician suicide have often focused on mitigating risk factors for suicide like depression and sleeplessness,” noted Dr. Morris. Doctor burnout is certainly a serious issue, with burnout rates among doctors now 51 percent—up from 40 percent in 2013, according to Medscape’s 2017 Physician Lifestyle Report.

Awareness of doctors’ mental health risks and offering wellness programs that provide confidential care are necessary.

Dr. Wible believes we must start by increasing awareness of doctors’ suicide crisis. “Be alert to mental health risks of medical training and practice, including high-risk specialties for suicide,” she wrote, noting that male anesthesiologists are at highest risk of suicide. “We can’t solve a problem nobody knows exists. Talk about it.” Dr. Wible will refer doctors in need to confidential care by phone or Skype 24/7. Contact her here.

Some local medical societies are now offering physician wellness programs that pair doctors with local psychologists to provide strictly confidential care, wrote Rebekah Bernard, M.D., in Medical Economics. These programs “ensure complete confidentiality so that physicians don’t feel anxious about any type of stigma or adverse consequence to seeking help for mental stress.” Check to see if your local medical society offers such a program.

And to read more about maintaining work/life balance in health care, see our blog archives.