COMMENTARY

A Med Student's Response to Physician Suicide

Emily Kahoud

Disclosures

August 08, 2019

With the constant bombardment of news describing how the physician workforce is more prone to completed—not just attempted—suicide, medical students may wonder what kind of a field we have gotten ourselves into. We wonder whether physician suicide is being dramatized, much like the negative experiences of medical school and post-ed training in general. Is the rise in depression, burnout, and suicide headlines possibly furthering a vicious cycle of self-fulfilling prophecy? Is the practice of medicine in such a crisis state that we are all vulnerable?

I'm still early on in training. What I can describe are not the burdens experienced by physicians but the dialogue among physicians whom I've shadowed during preceptorship—the stories of physicians, former colleagues, who reached a point of no return and suddenly disappeared from their practices without a word.

I have heard physicians describe how they convinced their own children not to pursue this "now tainted" profession due to the "hell" of dealing with insurance. Most of us have had at least one physician tell us that we are choosing a destination toward disgruntled disaster, that we should save ourselves the investment of money, time, and energy and pursue a happier career path. Few consider the effect that all of this talk has on medical students in the earliest stages of their careers.

Inside the Bubble

In a recent piece published in the Journal of Patient Safety and Risk Management, Elisabeth Poorman, MD, MPH, speaks of how certain perceived standards affect students. She explains, "Beginning in medical school, we cover up our vulnerabilities, donning our white coats as if they possessed some talismanic charm to overcome our weaknesses."

Living up to such a standard in the face of exhaustion, demoralization, depression, or brutality may lead medical students, residents, and physicians alike toward the depths of darkness, ensnared by an unapologetic profession that fails to accept responsibility for its perpetuation of mental illness. As Poorman states, we need to speak about these "occupational hazards of practicing medicine" and be vocal against the "high demands but little control over one's environment, bullying, and long work hours" known as the "hidden curriculum."

Except, instead of an increasing sense of control over various factors, energy and enthusiasm appear to decrease for students over time. Many embark on their medical journey with a "can do" attitude, but by the end of first year, they say their summer goodbyes with an "if I return" jest. Many have confessed to me that they had never experienced anxiety—not even on the MCAT—but now they're drowning in it. Many have questioned to me in private whether they've perhaps made the single greatest mistake of their lives.

I don't find the decline in morale throughout the medical school years and beyond to be surprising, considering the steady stream of "it only gets worse" propaganda with which we're bombarded at every turn.

Second-years tell first-years, "Just wait till you're doing all this plus cramming for the boards."

The overall messaging is disastrous, even for the most optimistic and ebullient among us: If you think you're stressed and tired now, just wait...

Third-years tell second-years, "You think it's bad now? I haven't slept for 36 hours and have a shelf exam in 2 days."

Residents tout the glories of sleepless days and nights during intern year.

The overall messaging is disastrous, even for the most optimistic and ebullient among us: If you think you're stressed and tired now, just wait... The loss of perspective is tremendous in the medical school bubble.

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