Physician Suicide 101: Secrets, Lies, and Solutions

Pamela L. Wible, MD

November 13, 2014

Solutions

Solutions come from individuals or institutions inside or outside of medicine.

Nonmedical individuals. This is the general population of nonphysicians. Except for Greg's parents, who were aware of the occupational hazards of medicine, these families had no idea their children were at high risk for suicide until the police called to tell them their children were dead. Compelled to act, Vincent's mom starts a foundation that sponsors an annual lecture on mental health for residents at Vincent's school. Kaitlyn's mom writes her heart out online in a blog and on social media sites. She supports struggling medical students online. Ultimately, she publishes a book examining suicides in the exceptionally gifted like her daughter. She asks all 171 medical schools in the United States if they would like a copy; 30 received a copy. Should we rely on grieving mothers—suffering in isolation, as were their children—to solve this?

Nonmedical institutions. Institutions like the media could instantly stop the secrecy and alert the public about the high risk for suicide in medical students and physicians. Sending your child to medical school or a surgery residency is not like sending your kid to law school or to cashier at Walmart. It's more like sending your kid to Iraq or Afghanistan, and it requires a completely different level of vigilance.

I spent two hours on the phone with Kaitlyn's dad recently. A sweet, sweet man. Not the kind of guy who would ever blame anyone else for his problems. I asked, "If Kaitlyn worked at Walmart, would she and your wife still be alive?" He says, "Yes. Medical school has cost me half my family."

Medical individuals. That is me and you questioning these deaths and Greg's mom seeking audits of state PHPs for fraud and abuse.

Medical institutions. Kaitlyn's school started a fund in her name for donations to their wellness center so that presumably Kaitlyn's classmates could seek the help that she didn't. Vincent's yearly lectures continue. But what else can we do?

How Should We Handle Physician Suicide?

Let's compare how we handle physician suicide with, say...umm...human rabies. Since the 1900s, annual human rabies deaths in the United States have gone from 100 to just 2 per year. How did we do this? Not by grieving mothers launching "rabies awareness campaigns." Not by donations to a wellness program. Not by a yearly lecture series. And not by miscoding rabies deaths as the flu!

Here’s how we did it: Medical institutions took this on methodically using science—primary, secondary, and tertiary prevention strategies.

We spend over $300 million annually to prevent human rabies. The cost per human life saved ranges from $10,000 to $100 million. What do we spend on medical student and physician suicide prevention?

Since eradicating the terrestrial canine rabies variant in the United States, 90% of the two deaths per year are transmitted from wildlife—mostly bats, then raccoons. If we can deliver over 6 million oral rabies vaccine baits yearly to raccoons (and I'm talking about guys dropping these from low-flying planes over the Appalachian Mountains and dudes running through dark urban alleys), we've got to be able to do something for med students. Right? We're way easier to find than raccoons. We're already in the hospital!

Right now, we are actively tracking rabies in raccoons, bats, skunks, foxes, cats, dogs, cattle—even mongooses in Puerto Rico, but we're not tracking the numbers of suicides in medical students and doctors. Do you ever get the feeling you might be less important than a Puerto Rican mongoose?

Here's what scares Kaitlyn's dad. Now I want to preface this with something else I learned about Kaitlyn's mom, who also suffered from depression. I asked Kaitlyn's dad when his wife developed depression. Get ready for this. He told me it was after she completed nursing school in her 30s when she worked in a nursing home with a high census in which she was witnessing unsafe conditions for patients—and staff. She was normal before nursing school. Okay. Normal. Like medical students who start med school with their mental health on par with their peers. Then something happens during medical training to doctors—and nurses.

This is what really scares Kaitlyn's dad. He tells me, "I got one child left. She's in nursing school. I hope she'll beat the odds. I can't handle another." This man has a real risk of losing more people in his family than we lose in a year to rabies! What are we doing? For him? For medical students? For us?

Here is what we should be doing.

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