Physician Suicide 101: Secrets, Lies, and Solutions

Pamela L. Wible, MD

November 13, 2014

Psychological Autopsy #2: Greg

Figure 5. Greg, age 3 years.

This is Greg at age 3. Outgoing, curious, and clever. He always got along great with adults. At 5, he goes on this family trip to visit his great aunt—a nun at a convent. A French professor, she asks Greg to give her a word he would like to hear in French. He says, "Guacamole."

Figure 6a. Greg as a child, with his mom; Figure 6b. Greg at medical school graduation.

Greg graduating from med school. A pianist, painter, poet, a real Renaissance man much beloved by his patients. Greg sent this email to his parents, both physicians, 1 year before he died:

Subject: Piece of My Mind
Read this if you have time. It resonated with me especially well this morning. I like these two paragraphs[2]:
"I love practicing medicine. Unequivocally. Yet it sometimes seems as much a burden as a privilege. We begin our careers in the anatomy room, a ghoulish lab in which many 'civilians' would faint. We cut our teeth in bloody operating rooms and intensive care units from which few people leave intact. We spend our lives bearing witness to the sufferings and diseases of troubled souls. We are well paid, intellectually stimulated, and, if we are lucky, trusted and maybe even loved by our patients. Yet on certain days, when our patients do not do well, the trade-off seems untenable.
How are we to protect ourselves from the emotional hazards of the practice of medicine? How are we to stand with our patients through the very worst while avoiding depression, significant stress reactions, and even substance abuse or addiction?"
Love, Greg

Greg was the only one in his family who struggled with anxiety, depression, and alcohol. After an outpatient program his third year of med school, he was sober until his second year of residency. A brilliant clinician, never impaired at work, but a Physicians Health Program (PHP) mandated a 90-day treatment facility 300 miles away, where Greg felt marginalized, belittled, and was 3 months behind in completing residency. He felt that if he were a banker or lawyer he wouldn't have this forced upon him. He hid his depression and substance abuse and carried a lot of shame. Just 24 hours before his death (he had relapsed), he met with his psychiatrist, who arranged admission at a local rehab facility. Greg notified the PHP who held the keys to his license. They disagreed with his psychiatrist's safety plan. Greg felt humiliated and cornered, and killed himself.

His mom wrote this letter to the editor of The New York Times in response to a physician suicide article last month. You may recall the article about the two young doctors—interns who jumped to their deaths in late August from their Manhattan hospitals.[3]

Greg's mother writes:

An unacknowledged predicament for physicians who identify their struggle with substance abuse and/or depression is that they are often placed under the supervision of their State Medical Board's Physicians Health Program. My son, Greg, was being monitored by such a program. He took his own life at age 29, one week before he was to enter an esteemed oncology fellowship. His final phone calls were to the PHP notifying them of his use of alcohol while on vacation, a disclosure he had previously described as a 'career killer.'
These programs, which often offer no psychiatric oversight, serve as both treating and policing agencies, a serious conflict of interest. Threatened loss of licensure deters vulnerable physicians from seeking help and may even trigger a suicidal crisis. Medical Boards have the duty to safeguard the public, but the assumption that mental illness equals medical incompetence is an archaic notion. Medical Boards must stop participating in the stigmatization of mental illness. We cannot afford to lose another physician to shame.

I read 12 pages of online condolences. This anonymous entry stands out: "Thank you for being nice to even the unpopular kids in high school. May your soul rest in eternal peace."

Greg looked out for the underdogs, but what happens when doctors are considered underdogs? Who looks out for us? Do we get the care we need? Greg didn't. Greg transected his bilateral radial and dorsalis pedis arteries with a scalpel in the bathtub, candles lit, music playing, some wine, vodka, surrounded by family photos. Here's the note he left.

Figure 7. Greg's suicide note.

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