Physician Suicide 101: Secrets, Lies, and Solutions

Pamela L. Wible, MD

November 13, 2014

Physician Suicide Prevention

Primary prevention. Actions that prevent healthy medical students or physicians from developing a condition that would lead to suicide.

Secondary prevention. Early diagnosis, referral, and rapid initiation of therapy after illness onset or suicide risk factors develop in asymptomatic medical students or physicians.

Tertiary prevention. Rehabilitation of suicidal medical students or physicians and return to maximal function with minimal risk for recurrence.

Primary Prevention Strategies

Let's start with a holistic and humane medical education that destigmatizes mental illness.

The goal: help medical students be the self-actualized doctors described in their personal statements for which they were accepted into medical school in the first place. We know how to grow happy and healthy people. This is not some sort of secret. Follow Maslow's Hierarchy of Needs. Begin by meeting physiologic needs with adequate sleep, time to eat, and bathroom breaks. Simple. Basic. You know?

Meet safety needs with a safe workplace without bullying or abuse. Social needs can be met by allowing students to feel part of a community with time for intimate friendships. And finally, self-esteem needs. Medical students should feel honored and respected for their contributions and level of mastery in medicine. Not belittled. Not shamed. Not pimped. Not hazed. This is 2014.

Meet social needs with matched mentorship programs. Use technology to match first-year medical students with second years—and physicians within their specialty of interest. Match Day should be the first week of medical school. Don't wait until the fourth year for Match Day. These people need friends. Now. We should not allow medical students like Kaitlyn to die from extreme loneliness.

Meet safety and self-esteem needs using nonviolent communication (NVC), which is based on the premise that every behavior is an attempt to meet a need. We can try to change others' behaviors by using shame and blame, or we can listen and educate compassionately. If you had heard a doctor raise his voice at Vincent, would you have passed by unsure of what to say? Meet the conflict with confidence using NVC using a simple four-sentence sequence—a stated observation, feeling, need, and request.

Observation: I heard you speaking loudly to Vincent.
Feeling: I feel concerned because...
Need: I need everyone to be respected in this hospital.
Request: Would you be willing to lower your volume and speak with more consideration for Vincent's feelings?

Meet social and self-esteem needs with Balint groups: small-group clinical case presentations that focus on the patient-physician relationship and enhance our ability to care for patients. Balint groups are usually led by a doctor with some experience in facilitating these groups and/or a psychologist/counselor. These groups are easy to start. If you want some training, I'd recommend the American Balint Society.

If Vincent could have attended a Balint group, he might have shared: "This week I saw a 30-year-old male who presented with injuries after jumping from a 3-story window after raping a young girl. I was tachycardic and I had trouble maintaining eye contact . . ."

Vincent would have had the chance to share feelings and get feedback in a safe environment. Offer Balint groups at lunchtime and meet physiologic needs too because students do need to eat! Give them a sandwich or something to share.


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