COMMENTARY

Ending Resident Suicides Starts With More Humane Training

William S. Gould, MD

Disclosures

December 10, 2018

In This Article

Are We Training Doctors to Eventually Leave Medicine?

I begged him not to allow the bullying of academia to do to him what it had to me. He graduated near the top of his medical school class, but was already asking whether he had made a terrible mistake. Other than fewer hours at the hospital (and in the end, not that many less), his residency was no different than mine, and I watched the spark fade as each season passed. He, too, found war zone duty preferable to the indignity of residency, though the man had the wisdom not to speak those words to his program director.

He is now practicing, and as much as he loves seeing patients, the experience has scarred him. He spends a lot of time doing two things: First, he avoids the vicious hospital infighting for which he was so well-schooled during residency; and second, he sadly keeps alert, like so many doctors these days, for opportunities to escape clinical medicine.

Because, institutionally, everything dribbles down from the top, it follows that we must hold deans and hospital CEOs accountable for the product they generate, and for the dismal mental health conditions to which they subject their serfs.

Changing Human Behavior, not Human Nature

The solution, although simple, is not easy. Until boards of directors are forced by litigation to take punitive action against the administrators, senior residents, fellows, and physicians who champion the perilous hours and disrespectful treatment; until we start freely complimenting each other, even residents, and support all other doctors without snide comments in front of colleagues and students, and even patients; until doctors support and take the seconds needed to thank nurses; until clinicians thank housekeeping and phlebotomists, and then teach that respect to the students and house staff who so look up to their teachers; until all of us are forced with the big stick of litigation to redo our daily routines to make the hospital a positive place to spend the rest of our working lives, our profession will continue to see stress-generated mental illness culminating in suicide.

I'm not suggesting it is possible to change human nature. Arrogance and the need to humiliate seem to be hardwired. On the other hand, it is clearly possible to change human behavior. Just as women now understand they have the power to reject eons of humiliation, and just as bullying in junior high school is being addressed and abolished by good principals, so, too, must it be erased from medical education.

Finally, we can agree to psychiatric counseling for damaged students and residents, but as helpful as it may be, in the end it's a Band-Aid. Though it makes the leadership feel better about itself, that it is doing something, it is as ineffective long-term as excising the primary sarcoma long after metastases have overwhelmed the body.

Young doctors will complete their programs utterly exhausted and angry, then drag those sad lessons into teaching hospitals; home to their families; and, worst of all, into the exam room. The product of these programs is not what you're looking for in the doctor who holds lives in his or her hands.

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