The wall of silence is slowly coming down. The tragic deaths of two newly minted residents in New York City in 2014, both of whom jumped off of buildings within one week of each other, has brought attention from ACEP, the Accreditation Council for Graduate Medical Education (ACGME), the Society for Academic Emergency Medicine (SAEM), the Council of Emergency Medicine Residency Directors (CORD), and other national organizations to this problem. In 2015, ACGME held its first-ever symposium on physician wellness, and ACEP, SAEM, and CORD have also introduced wellness initiatives, including ACEP’s Emergency Medicine Wellness Week.
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ACEP Now: Vol 36 – No 01 – January 2017What will it really take to reduce the rate of physician suicide? Many suggest a three-pronged approach:
- Destigmatize seeking help through education, with a change in culture and policies that makes it easier for physicians to access mental health care when it is needed.
- Inform the medical community of how to recognize the signs of depression and burnout and the knowledge of how to refer colleagues who need help.
- Research to understand and change the factors related to the practice of medicine that create higher rates of burnout and depression in physicians.
These are not easy tasks but are necessary to help avoid the loss of precious physician lives.
As the push continues on a global level, the question remains, is there more that we can do in our own shops to help our colleagues and friends? Keeping with the three-pronged approach, here are some suggestions:
1. Although it is not always possible to know when someone is contemplating suicide, some common warning signs include:
- Talking about their own death or being preoccupied with death/dying
- Obtaining the means to take their own life
- Withdrawing from social contact
- Feeling trapped or hopeless
- Increased use of drugs or alcohol
- Engaging in risky or self-destructive activities
- Giving away belongings or getting affairs in order without a logical reason
- Saying good-bye to people as if they will not see them again
2. If you suspect someone you know may be contemplating suicide, be willing to ask the difficult questions and to listen. You are not responsible for preventing someone from taking their life, but your intervention may help. Examples of questions to ask include:
- How are you coping with what is happening in your life?
- Do you ever feel like giving up?
- Have you thought about harming yourself?
- Have you ever attempted to harm yourself before?
- Do you have access to a means to harm yourself?
3. If someone shares with you that they are contemplating suicide:
- Encourage them to seek help; be aware of local resources including your institution’s well-being committee
- Provide them with the National Suicide Prevention Lifeline at 800-273-8255
- Offer to help them in seeking assistance and support
- Remind them that things will get better
- Encourage them to avoid alcohol and drug use
- Remove dangerous items from the person’s access, if possible
For more information about suicide and suicide prevention, go to www.suicidology.org, www.afsp.org, www.survivorsofsuicide.com, and www.acgme.org, which has developed a new set of resources particularly for physicians in training.
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2 Responses to “Stigma Surrounding Physician Suicides Means Many Go Unreported”
January 24, 2017
Robert OelhafThank you for this timely and reasonable article. The stigma is sadly still a very large problem for the entire House of Medicine.
It would be really nice if someday in the distant future the act of voluntarily seeking help would no longer be mandated for disclosure on forms for employment and hospital privileges. I am fine with keeping involuntary confinement within the realm of mandatory disclosure. Treat that similarly to DUI, as both potentially endanger the public and cast doubt on the judgement of the practitioner to know what is best for themselves and others. But a voluntary hospitalization, pursued by the doctor themselves, is an act of consent to medical care which should be protected under HIPAA. A voluntary psych hospitalization says that the person consenting to care is acting in the interest of themselves and their community and has the capacity to know that this consent to care is the right thing to do. Which is the whole point of this discussion.
Mandatory disclosure, in my opinion, also treads upon the spirit of the Americans with Disabilities act. There have been various takes on this law, but last I heard it is meant to allow employees to work in a reasonable environment and accomplish their work tasks if generally left unmolested and with reasonable customary accommodations. If an employee generally appears to be a fairly close approximation of what was expected in the job description, the employer in my opinion has no preexisting right to scrutinize medical records. This protection should be extended to the psychiatric realm.
Doctors with mental illness have to feel it is less risky to get care than to avoid it for us to ever stop dying at a higher percentage rate than the general population.
I am not an attorney. This is not legal advice. These are my opinions. They are not the opinions of either Schumacher Clinical Partners, TeamHealth, Erx Group or any affiliated organizations or agents.
January 29, 2017
NNI’m sick of this conversation. Very few physicians/medical groups, academic institutions, etc. are taking the lead on addressing this issue because it is distasteful. We know it exists, we don’t like to talk about it. It is a perceived weakness, an Achilles heel if you will, within our medical ranks. If we were serious about addressing it, the first place to begin would be the application process. I agree with the comment which stated that by requesting such information be provided, they are violating HIPPA laws. It would be enough to ask if one possesses a medical or psychiatric condition that would affect their ability to care for patients. If the concern is that the individual will lie, well, they can lie about having seizures as well. What’s to prevent a doctor with that particular diagnosis, who happens to be a surgeon, from having a seizure during a procedure and endangering the patient? Basically, what is the difference?
Two residents kill themselves in New York within a week of each other in 2014 and it causes concern. My residency in Emergency Medicine was in New York. A third year surgical resident was terminated from his position. He was accepted at another residency in anesthesiology. Within a month he was dead by suicide. His death has bothered me ever since. That was 1997-1998. 2015 ACGME holds their first wellness conference? What took so long?
There is, in fact, a physician who is actively speaking on this issue and assisting physicians/medical students and residents in addressing their depression or suicidal thoughts. Giving them tools. Speaking out. Her name is Pamela Wible, M.D. I’ve sent a letter to ACEP requesting this physician be invited to speak at our yearly conference. No response to my letter.
The suggestions made in the article have been suggested thousands of times before. Until they are taken seriously, they are rhetorical. Written fodder.