Physician Suicide 101: Secrets, Lies, and Solutions

Pamela L. Wible, MD

November 13, 2014

Editor's Note: This article was adapted from a lecture presented at the 2014 American Academy of Family Physicians Assembly held in Washington, DC, in October. It is being published on Medscape with the permission of the author.

Why Did You Go to Medical School?

I'm a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I'm unhappy with the direction of my profession (and I'm not the only one). Then I get this crazy idea: What if I ask for help? Not from the profession that wounded me. Just from random people on the street. So I hold a town meeting and ask patients to help me—design an ideal medical clinic. I promise to do whatever they want as long as it's basically legal. That's going out on a limb.

I'm a go-out-on-a-limb kind of doctor. In med school I protest the dog labs, and I'm sent to the office of the Dean—who diagnoses me with "Bambi Syndrome." In residency, I'm caught giving patients recipes for kale salad. I'm sent to the office, reprimanded for not getting approval from the patient education committee. I'm 46 and I'm still handing out unapproved kale salad recipes—now I'm taking on physician suicide.

My therapist calls me the "Dr Kevorkian of Medical Taboos." Before my wedding, my dad actually made my husband promise to keep me out of jail. "Always pushing the limits," Mom says, "always going out on a limb." Today I invite you to join me.

Why do we do what we do? To save lives. Why did you go to medical school? Seriously. Why spend your 20s studying while all of your friends are at parties? To make a difference—to save lives. What is your calling? They recruited me for pediatrics, but I kept asking, why? Why this kid's got asthma? Why the parents smoke? Why they live next to an incinerator? I'm a family doc because I can't stop asking why. So why are you reading this? Maybe you lost a colleague to suicide, a friend in med school. Maybe you are struggling now. Maybe (like me) you just want to know why our colleagues die by suicide at twice the rate of their patients. And you want to save lives.

The Facts About Physician Suicide

The fact is that each year we lose over 400 doctors to suicide—that's like an entire medical school gone. I lost both men I dated in med school to suicide. In my town, in just over a year, we lost three doctors to suicide. One doc in town lost seven colleagues to suicide! In what other profession can you lose seven colleagues to suicide?!

This year over 1 million Americans will lose their doctors to suicide. Why? To know why someone has died, we perform an autopsy. With suicides, we perform a psychological autopsy[1]:

An investigation into a person's death by reconstructing what the person thought, felt, and did before death, based on information gathered from personal documents, police reports, medical and coroner's records, and interviews with family and friends.

I'd like to share with you the results of four psychological autopsies.

Psychological Autopsy #1: Vincent

Figure 1. Vincent, age 2 years.

This is Vincent at age 2. He framed this photo to give his parents at his med school graduation. An adored first grandchild, a joyful little prankster who made everyone laugh. His Aunt Edna told me a story: In Catholic grammar school, Vincent has his feet up on the chair in front of him. Sister Agnes comes by and tells him to put his feet down. He replies, "I have to keep my legs up!" She asks why. He says, "I have varicose veins."

Figure 2. Vincent, age 18 years.

Here's Vincent at high school prom. An athlete and artist, compassionate, sensitive, gregarious, yet private. A compulsive perfectionist. Always a good kid. Never any addictions. Just a straightforward, normal, good guy, according to his mom.

Figure 3. Vincent, age 25 years.

Here's Vincent's med school graduation photo. Just 25 years old and 2 months after starting a prestigious surgical residency in New York City, he dies by suicide. Why? Look at his eyes. Notice the difference between his childhood photos and his medical school graduation picture. He looked happy and healthy before med school. What happened during Vincent's medical training? I interviewed several of Vincent's family members to find out.

His mom says he became disappointed, disillusioned. He lived near the hospital but drove an extra 45 minutes home at every chance he had just to sleep in his own bedroom. He lost a lot of weight, and his jokes and laughs were gone. His family was concerned, but they thought it was the adjustment to a demanding profession.

Vincent told stories of how surgeons publicly humiliated interns. How he and his partner fell asleep leaning against walls in the hospital while waiting for their patient's turn for a scan. He spoke of his doubts about saving this one guy who jumped out of a building when caught raping a young girl who was also being treated in an adjacent room. He spoke of the sisters—victims of a car accident—brought to the ER who stunned him for a moment because they looked like his mom and aunt, who often travel together without seat belts. Vincent took a belt and hung himself in his closet. The note he left:

Figure 4. Vincent's suicide note.

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