COMMENTARY

Physician Suicide: Let's Do Something About It

Disclosures

November 13, 2014

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Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

Suicide. I hate everything about that word. I hate even pronouncing it. Have you thought much about it? What do you know about suicide?

Virtually all animals kill, intra- and inter-species. Only Homo sapiens deliberately self-kills. It must have something to do with that forbidden fruit in the Garden of Eden.

All cultures and religions experience suicide; most abhor it and try to prevent it. A few celebrate suicide, especially when it is used as a method of warfare. Many religions hold "life after death" as a basic tenet; believers often say that the deceased has "gone to a better place," while doing anything possible to prevent or delay dying. Some religions believe in sin, and in forgiveness of sin, if sought by the sinner. Such religions hold suicide as unforgivable, because it is so final.

As a clinical toxicologist, I have encountered attempted suicide by drugs innumerable times. As a forensic pathologist in three countries, I have investigated successful suicides innumerable times. In Sweden, suicide was recognized and the manner of death accepted. In England, such was the stigma that the forensic pathologist could not label a death a "suicide" unless there was a suicide note. In Coroner's Court, I would have to call obvious suicides, by New York standards, "death by misadventure."

I have known many people who have killed themselves. As a patient, I had a surgeon who killed himself shortly after operating on me. Physician suicide is a big deal in the United States. As a profession, in American medicine, we lose the equivalent of two or more full graduating classes of physicians each year to death by their own hands.

I belong, or have belonged, to a large number of medical organizations. To my recollection, none have seemed to care enough about physician suicide to try to do anything about it. Why is that?

Many physicians believe that suicide is abnormal and a result of psychopathology (such as depression), and that depression can and should be treated, in large part to prevent suicide. Many others believe that the decision to end one's life can be a thoroughly rational act. I agree with both points of view. But I consider suicide to be deeply sad for everyone, and if it is a physician suicide, a particular waste for society. I consider suicide to be abnormal, a behavioral aberration, even a disease. You, I, we are all at risk.

Take care of your mental health. Be kind and helpful, not mean and spiteful, to your fellow physicians. And that includes medical students, residents, and fellows. You know who the bullying and abusive physicians are. Confront them, in a redemptive manner, but don't let them get away with it.

We all owe a great debt to an outstanding and unusual family physician from Oregon, Dr Pam Wible. She has been forcefully and repeatedly writing and speaking about physician suicide and what can be done about it. Do an Internet search for Dr Pam Wible. Pay close attention. Act on her suggestions. The life you save may be that of your colleague, or even your own.

That's my opinion. I'm Dr George Lundberg, at large for Medscape.

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