COMMENTARY

Two Powerful Ways to Help End the Physician Suicide Epidemic

Pamela L. Wible, MD

Disclosures

November 06, 2018

Each year, more than 1 million Americans will lose their doctor to suicide. I was almost one of those doctors.

I'm Dr Pamela Wible and I have devoted the past 6 years of my life to ending the physician suicide epidemic.

I have investigated more than 1100 doctor suicides personally and I have attended many funerals, delivered eulogies, and I even operate a physician suicide hotline from my home between patients. As a result of speaking to thousands of suicidal medical students and physicians since 2012, I now have a very clear idea of what leads to these suicides and what we can do about it.

One of the most shocking things that I hear from people, often through an email or phone call—sometimes years later—is them explaining to me that merely because I answered the phone when they called, or because I responded to their email, they consider that I actually saved their life. Could it really be that simple? Just being there for each other, answering the phone, or responding to emails when our colleagues are suffering—it is that simple.

The number-one question that I get from physicians is, "How can I help you?" How can I help prevent doctor suicides in my town? And the answer is simple. There are two very simple things that any physician could do right now today. Number one is, share your personal story. Every one of us has had mental health struggles—probably a diary full of mental health struggles starting in medical school—whether this is test anxiety or panic attacks around failing a board exam. Or during residency—depression related to sleep deprivation, bullying, or pimping. Or even as a practicing physician. You've probably lost a patient you were connected with—a very tragic, unexpected loss, like a stillborn or maybe a maternal death. These things, including malpractice lawsuits, can create PTSD in physicians. Without sharing your personal story, you are containing the grief, pain, and misery of all of the patients that you have cared for and cared about.

The number-one thing that you can do is share your mental health struggles with your colleagues. There are various ways that you can do this. You could write a blog. You could write an op-ed in the local paper, because this mental health conversation, especially around physicians, needs to be normalized so that patients start to see us as human and as somebody who cries when a patient dies. They don't always know that we care that much because of professional distance. I would recommend that you share your story in written or verbal form, one by one with your colleagues. You could open your Grand Rounds presentation with your personal story. Please don't be afraid, because by sharing your personal story, you're opening a door to allow other people to share their personal stories, their suffering that they've experienced in medicine. Until now, that has been contained for most of us.

The other thing that you can do is be a warm line for your colleagues. I know that the whole idea of being a suicide hotline, especially a one-woman or one-man show, can seem rather scary—to talk people off the ledge during active suicidality. Being a warm line is a step down, like the difference between emergency room and urgent care, or just an outpatient visit for a physical. It's just being there as a warm, compassionate, loving person for your colleagues so that they know they can call you if they have minor struggles and that you're available to listen to them. The way that you could start generating these calls and contacts is by—back to number one—writing about your personal mental health struggles. That will allow people to start to see you as a safe person to connect with.

Another thing that I would recommend that is very simple and which anyone can do—even medical students can do this right now—is pick three to five of your peers, your colleagues at clinic or students in your class. One by one, go on date nights with them, whether it's taking them out for tea or coffee, and start by sharing your personal mental health story and your survival story because you're still alive. This will give the other person an opportunity to feel safe enough to share their personal mental health story and struggles in medicine. Again, you will be able to be seen as a safe, nonjudgmental person for other people to contact in your organization. You can do this with only three to five people. If you enjoy this sort of thing, you could become the point person at your organization without even being appointed the chief wellness officer. You could be perceived as the person that people can go to and safely share their struggles.

The reason why it is so important to do this is that doctors have the highest suicide rate of any profession—higher than the military and three times the rate of the general public. We've known about these high suicide rates of physicians since 1858 in the UK, when it was first reported. I am happy to announce that we're on the precipice of a major culture change in medicine 160 years later, and it couldn't come soon enough for me.

I want to share how this works with all of you cynics and pessimists who like to rail against the system. A system is just made up of people. When people change, when people lead, leaders will follow and systems will change. You have a great opportunity now to be one of those people that creates the ripple effect that leads to a system change in the way we deal with mental health and the way we deal with each other as colleagues in medicine. We are brothers and sisters in medicine, and this is a public health crisis.

We are losing 400 physicians per year to suicide in the US. That is the equivalent of losing an entire medical school—all 4 years of students—to suicide every year. That's not even counting the medical students who die by suicide; nobody's really tracking that, which is really odd and very sad. When you look at those numbers, each one of those beautiful people who are dying in the prime of their careers is often the loving humanitarian, very intelligent, and just wanted to serve and help others. We should all be concerned about this.

They are leaving behind children, parents, brothers, sisters, and thousands of patients. Each one of them has a patient panel of probably 2000-3000 patients. I know, as a family physician, that I've worked in practices where I had 3000 patients. The average for family physicians is 2300 patients.

Do the math. You have 400-plus physicians, not even including medical students (by patients' perspective, they consider medical students to be their doctors as well). If you look at the loss of 400-plus doctors and maybe 50-100 medical students a year—we just don't know—that's times 2000-3000 patients in the physician's panel—that's a million Americans who are losing their doctors every year to suicide.

And this is 100%, for the most part, occupationally induced. I truly believe, after reviewing these 1100 cases, that most of these people would be alive if they were real estate agents or baristas at Starbucks. They would be home with their families on the weekends. They would be rolling Easter eggs, doing family activities, and being live human beings.

These are people that we've lost and that patients have lost. It is so shocking to me that healthcare, of all professions—we are a profession that's about healing and saving lives—would allow our own brothers and sisters to die at this rate. To cover this up for 160 years is absolutely unconscionable.

I ask you to join me in stating that physician suicide should be a never-event in our hospitals and clinics. Thank you.

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