Why doctors commit suicide

Why doctors commit suicide

I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.

I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.

Why?

Here’s what I know:

A physician’s greatest joy is the patient relationship.

Assembly-line medicine undermines the patient-physician relationship.

Most doctors are burned out, overworked, or exhausted.

Many doctors spend little time with their families.

Workaholics are admired in medicine.

Medicine values competition over nurturing.

Many doctors function in survival mode.

Doctors are not supposed to make mistakes.

Caring for sick people can make you sick if you don’t care for yourself.

Medical education often dissociates mind from body and spirit.

Some medical students believe they graduate with PTSD.

Seeing too much pain and not enough joy is unhealthy.

For a physician, a cry for help is weakness.

The reductionist medical model is dehumanizing for patient and physician.

Many doctors are emotionally detached (especially male physicians).

Doctors are obsessive-compulsive perfectionists in an imperfect medical system.

Physicians are the nation’s social safety net with few resources to help patients.

Some doctors feel like indentured slaves.

Death is perceived as failure.

Doctors don’t take very good care of themselves or each other.

Many doctors are in denial about the high rate of physician suicide.

Physicians are often bullied by insurance companies, employers, and patients.

Doctoring is more than a job; it’s a calling, an identity.

Doctors are often socially isolated.

Doctors can’t just be people. They’re doctors 24/7.

Doctors can feel severe psychological pain.

Doctors can feel powerless.

Doctors can feel trapped. Some see no alternatives to their suffering.

Doctors have easy access to lethal drugs and firearms.

Doctors have the same problems as everyone else.

Doctors have marital distress. They get divorced.

Doctors have addiction to drugs and alcohol.

Doctors have economic hardship and unbearable debt.

Doctors have mental illness.

Doctors are human.

Watch the TED talk on physician suicide.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • http://www.waynecaswell.com Wayne Caswell

    It doesn’t help that patients are starting to distrust doctors and their motives, even though it’s not the doc’s fault.

    The immensely profitable medical industrial complex (hospitals, insurers, drug companies, testing companies & equipment providers) spends twice as much on lobbying as the military industrial complex, opposing real health reforms that would reduce their $2.8 trillion in revenue. The industry is also widely seen as viewing patients as paying customers and working to keep them … Paying … by treating symptoms and managing disease, rather than promoting health, wellness and prevention. This is NOT what the docs signed up for, and many see no way out.

    • PamelaWibleMD

      Yep. We have a culture of distrust in America. Please don’t take your frustrations out on your doctor who has likely been victimized, manipulated, and worn down in the process of receiving the training required to HELP you. Your doctor is a human being with feelings, a soul, wounds . . .

      • rbthe4th2

        Not all of them. Their loyalty is to the corporation they work for. The insurance company. Their paycheck.

        • PamelaWibleMD

          Not all of them? Not all of them have a soul, feelings, are human? Really?

          • rbthe4th2

            The way they act, yes, that is true. There are studies showing empathy, sympathy, etc. start to go out the door in the 3rd year of medical school. Witness enough patient stories to say the doctors don’t care, and its pretty obvious where the loyalties lie. Again, as I said not all of them.

          • PamelaWibleMD

            It is not a buoy loyalties. It is about PTSD and wounded healers. Loyalties have nothing to do with this.

  • DoubtfulGuest

    Most patients have no idea this very serious problem even exists. I’d like to know what we can do to help alleviate stress on our doctors. Or at least not make things worse out of ignorance.

    • PamelaWibleMD

      Realize that your doctor may be a “wounded healer” and treat him or her with compassion. Just because you don’t like your (fill-in-the-blank) diagnosis, appointment time, insurance copay, referral process, prior authorization etc . . .DON’T lash out at your doctor. Your doctor is there to help you, not hurt you. Please do not hurt the people who are trying to care for you.

      • Suzi Q 38

        “…..Just because you don’t like your (fill-in-the-blank) diagnosis, appointment time, insurance copay, referral process, prior authorization etc . . .DON’T lash out at your doctor…..”

        Agreed.
        I wish the problems you described were my problems.
        Those are minor, IMHO.

        I am talking about a doctor that flat out doesn’t listen to what is your problem, or refuses to put through the needed referral and as a result, you get worse.

        Of course, there are other reasons, too numerous to list that are far worse than diagnosis, appointment time, insurance, etc.

        • PamelaWibleMD

          Yes. Be clear. Be honest. State your needs with compassion. You are dealing with another person – possibly wounded – who happens to be your doctor.

  • buzzkillersmith

    Google physician suicide psychology today and you will see the although docs have a higher suicide rate, we also have a higher life expectancy than non-docs, contrary to the myth of early-dying doctors.

    Dr. W’s elementary and related mistakes here are:
    1. Using the wrong output. If you want to tell everyone how bad we have it, you need the correct parameter. The correct on is overall death rates.
    I for one would prefer a higher risk of suicide combined with a lower risk of death to a higher risk of death combined with a lower risk of suicide. So would you.
    2. Denominator neglect. Sure docs can have it tough. Most other people have it tougher.

    Numbers and data trump heart-tugging stories. Or at least they should.

    • DoubtfulGuest

      Just like statistics don’t matter to a patient who turns out to have a bad disease, an individual doctor struggling with suicidal thoughts isn’t going to care what numbers say about his/her life expectancy, right? Some doctors do have it really tough and they’re not allowed to say so. What better place to start to change that than a medical blog? Suffering is not a zero sum game…presumably those doctors spend a lot of time and energy helping people who are worse off in some ways (e.g. financially).

      Now, I would like to get a better sense of numbers. But how reliable is the data, when there’s so much shame about suicide (i.e. the true cause of death may be hidden)?

      From Psychology Today: “Suicide and depression are already stigmatized within the general population, but this stigma is even stronger if you’re a doctor, a person who is expected to be physically and mentally healthy.”

      And: “Therapists who treat physicians may assume that their patients know how to take care of themselves, being that they’re doctors, so the therapy tends to be more hands-off and less helpful.”

      I think this issue deserves attention.

      • buzzkillersmith

        Paragraph 1: Agreed.

        Paragraph 2: Hidden suicide has no effect on the most important outcome, the overall death rate of docs. The overall death rate takes into account of all causes of death and so includes suicide, hidden or not, within it.

        Paragraphs 3 and 4: Agreed.

        Lat sentence: Agreed.

        • DoubtfulGuest

          Paragraph 2: Agreed.

          Since we agree on the rest about suicide, I guess I don’t understand your point?

          http://www.theonion.com/articles/world-death-rate-holding-steady-at-100-percent,1670/

          • buzzkillersmith

            It’s in my first comment. Easy to understand, really.

          • DoubtfulGuest

            Does it seem like physician suicide is discussed in this post in a way that would backfire? Your previous point is well taken. I’m just not sure where the line is between putting an issue in perspective with numbers, and making people think it’s no big deal. I’m more concerned about the latter, since there seems to be a pattern of folks shutting doctors down when they say they have any problems. What’s a better way to handle this, do you think?

          • buzzkillersmith

            Glad you asked.

            I do think physician suicide is a big deal, as is suicide in non-physicians. Suicide comes with a tremendous amount of collateral damage, as you well know. Having a family member or friend who commits suicide is a life-changing experience. It can scar people for life.

            Here are my beefs with Dr. W.’s post:

            1. The problem is not put into perspective. The vast majority of docs do not kill themselves. Also, there is no discussion of how nasty the lives of many other people in this country are. People who work at McD’s or Walmart or call centers or even corporations. All in all, we docs have it pretty damn good.

            I won’t even mention how people are doing in many parts of this blighted world but will confine my comments to moderate circumstances.

            Now, I have complained and shall complain at this blog. But remember that most of these complaints, as is true with most of the complaints of other physicians and NPs here, are focused on how our problems spill over to you all.

            2. As I have said, overall death rates are more important than how people die. You know this. Everyone knows this. And the death rate for doctors is less than that of the general population.

            3. Dr. W., in this post and other posts, goes for the gut and not the brain. I simply do not like that. She’s a doctor and should know better. This is a medical blog, a blog for people trained in and interested in and believing in the idea that an analytic approach to taking care of sick people is superior to an impressionistic approach. I believe that in my bones.

            It is also a blog for people who are interested in how and what we think.

            Feeling people’s pain did not cure cholera. It did not cure pneumonia in 3 year-olds. I go to the old graveyard in this eastern Washington town from time to time and see the angels on the tombstones of the babies to remind me why I do this. Many will disagree, but I believe that we have done more for humanity than the priests have.

            4. A better way to handle this: Tell people that doctors have a high rate of suicide compared with persons of the same socio-economic and educational status. That will get you a yawn. Tell people that this is mainly caused by the dysfunctional system in which they work and is a canary-in the-coal-mine phenomenon. That will make some half-listen. Tell people that improving our system will help them directly. Now we’re getting somewhere.

            In truth, people don’t care that much about docs or firemen or Iraq veterans killing themselves. You know this. They care about their own day-to-day problems. As well they should.

          • DoubtfulGuest

            Right on, Sir. I can’t argue with that. I was a bit slow on the uptake about the overall death rate, because I view the suicide problem as a culmination of a great deal of suffering, not so much as a cause of death. I get it now. I know doctors often get blown off by friends and family if they try to talk about anything that bothers them, so I don’t mind the focus on that here. There’s no shortage of detractors wherever they go… they’re in no danger of hogging the airspace.

            In some previous post about depression as a disease vs. attitude problem, at least one person brought up a physician colleague lost to suicide, who’d done extensive work in developing countries and definitely had a perspective on other folks’ suffering. I see what you mean, though. I can’t recall the word for it, but there’s this phenomenon that people take in emotionally charged media about an issue that demands compassion and social activism, and they have this brief motivation to do something. But it doesn’t go anywhere because they get immediately distracted by the next article that goes for their gut. Then the next one, and the next one, ad infinitum. The suicide problem needs to be addressed in whatever way will get results in the foreseeable future. I care about my doctors, but I looked for information about the health care mess because I was PO-ed at how dysfunctional it was for me. I suspect that other people will also feel empathy. But you’re right, we start with our own lives as a reference point and it can be a pretty big adjustment from there.

          • PamelaWibleMD

            There are so many levels of suffering. Not sure how we can quantify who deserves the most compassion or attention for their suffering. A WalMart worker may be so much happier (and less fearful of a lawsuit) than a doctor. And maybe under less financial distress. Who the heck knows. But when large numbers of people who are supposed to help us are offing themselves, we’ve got a problem.

          • DoubtfulGuest

            True. I don’t have a problem with your post. I had asked for another one on physician suicide and I found the list to be helpful in understanding the problem. I get concerned about the backlash from folks who don’t understand, and how it could affect doctors who are considering suicide, to read the nasty comments. Especially since people can appear mean-spirited on the internet when they’re mostly not. Many folks respond well to emotion and have learned a lot from your posts. Others get very defensive. I can see that it would help to balance things out with a calm, scientific approach that appeals to people’s selfish (as in pragmatic) side.

          • PamelaWibleMD

            I getcha.

          • querywoman

            Show me a happy Walmart worker and I’ll sell you some ocean front property in Arizona.

          • DoubtfulGuest

            Yeah, that might be a stretch…but Dr. W. has a point that happiness/well-being aren’t tied to income. Most people have all kinds of stuff stressing them out that we can’t really understand or judge until we walk in their shoes.

          • rbthe4th2

            I dont know if I could get 6 weeks vacation and a 7 figure paycheck, I could get cooled out real fast.

          • DoubtfulGuest

            LOL, I’d say the same thing, but it’s complicated:

            http://www.pnas.org/content/107/52/22463.short

            (over how long of a time? is an important aspect of it)

            Your income/vacation fantasy doesn’t apply to most doctors, either….

            …But sign ME up, please. ;)

          • rbthe4th2

            Um the doctors’ wife was the one who told the other half. They just got a 2nd vacation home, getting ready to put another kid in college. Have 4 of them. He won’t be retiring in the next 5 years either.

          • PamelaWibleMD

            What? Really?

          • rbthe4th2

            With risk managers protecting the 1%, yes. The docs I’ve seen – go check out the patient advocate groups – and see how much address is on missed/delayed diagnosis and getting that fixed. How much of getting rid of paternalism is welcomed. How many lawsuits are won by plaintiffs (1%). When the other half finds out from a docs wife (stay at home), with 4 kids, gets a second vacation home, well seems the 1% is able to get a break that the rest of us don’t. Higher stress, better paycheck, more opportunities. Go over to England and other areas and see docs salaries. The ratio of PCP to specialties is 70-30, while in America its 30-70.

          • PamelaWibleMD

            Most of my family in Texas works at WalMart. I got a really happy cousin there.

          • querywoman

            Walmart is my favorite love-to-hate entity. My church participates in job condition pickets at Walmart. I sat outside with them, lazy me, once with a picket sign.

          • PamelaWibleMD

            To get the attention of people, we need to be concise (144 characters or less these days). Why should people care? If your doctor kills himself you won’t have a doctor. People care about that. I was not writing a comprehensive analytical or scientific peer-reviewed piece. I was just getting to the guts of the matter. And I was presenting a compiled list of the reasons that doctors have told me they had for being suicidal. I get a lot of phone calls and emails from depressed & suicidal doctors. I was a suicidal doctor once. I lost both men I dated in med school to suicide. 3 doctors in my town died by suicide in over a year. People care about this. It is not being discussed in a way that people can hear and more importantly –> feel. I tried a new approach here. A list of heartfelt reasons doctors die by suicide. I think it is as relevant as any other approach – and it work better for some in this format.

    • PamelaWibleMD

      So let’s track the data. Who do you think should be tracking these suicides? These deaths are whispered among staff in the corners of clinics and hospitals. One doc in town lost 7 colleagues to suicide. We lost 3 docs in 18 months and both men I dated in med school are dead by suicide. The numbers are irrefutable. Nobody wants to track doc suicides. Why do you suspect?

      • buzzkillersmith

        Huh? I’m not sure how your response has much to do with my comment.

        Fact: physicians have a higher suicide rate than the general public.

        Fact: physicians have a lower death rate than the general public.

        True, true, and unrelated.

        • PamelaWibleMD

          Ooops. Agree.

        • PamelaWibleMD

          But who do you think should be tracking the data?

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Hello Pamela: Your articles are always powerful & thought provoking. As part of my work in patient satisfaction, I interview patients. People often talk about physicians empathizing with patients. However, it is also important that patients empathize with physicians. When talking to patients, I always emphasize they need to think about what it is like to be in a physician’s shoes. This translates into — be pleasant with doctors. Being mean and hostile will get you no where. Empathy is a two-way street. Keep up the great work! Eddie

    • Suzi Q 38

      I can appreciate your thoughts:

      “……This translates into — be pleasant with doctors. Being mean and hostile will get you no where. Empathy is a two-way street….”

      I started off being pleasant and appreciative.
      I got nothing.
      Once I figured out what was going on, I got mean, demanding, and hostile.
      This got me better care.

      Through a nurse navigator, thankfully.

      If being nice isn’t working, voice your concerns with the hospital’s nurse navigators, who will co ordinate everything and then call and deal with the errant doctors for you.

      It is sad to have to do it that way, but sometimes necessary.

      Yes, this might get your doctor ticked off, but who is more important?

      My nurse navigators thought that my care at their facility was not good and ” a perfect storm.”

      • PamelaWibleMD

        Be vocal. And compassionate. It’s a great combo.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        Hello. Thank you for your note. I am both a healthcare professional & patient. I know how healthcare people think. Keep in mind, being nice doesn’t mean being a pushover. When I am in the patient role or advocating for a family member, I am very polite, but also very assertive. Healthcare people listen to scientific data (myself included), so I always present information that validates my concerns — this factual evidence goes a long way! Good luck to you, Eddie

      • Becky

        What is a nurse navigator? What issues did they help you with?

        • Suzi Q 38

          A nurse navigator can be a nurse that prefers to assist patients who have problems dealing with the doctors or system at that hospital.
          I finally found one by asking around at the hospital.
          She wrote a letter of concern on my behalf to one doctor, who had previously refused to request a referral when I needed it. Although I did not like the results of the test, it made me feel validated that I knew something was very wrong. My doctors at first thought that I was making it all up and I was a menopausal wreck.

          The day I was scheduled to get a lumbar puncture, I went to that clinic area, and the receptionist had no record of my appointment,
          yet, I was holding the appointment card in my hand as proof that i was correct.

          I told them I had asked for nerve tests on my legs for months, and my neurologist did not think it was necessary. I told her why I needed them.
          She coordinated the test, and it proved that I was right. I had nerve damage and subsequent weakness in my legs.

          Basically, they agreed that my care there had been a “perfect storm” and wanted to know what they could do to help, which was a big help.

          Also they keep the doctor on notice as far as lack of treatment is concerned.

          It is another pair of eyes and a person to assist you if you are having any difficulties with your condition or the physicians.

          They try to get you what you need and ameliorate a difficult situation.

        • PamelaWibleMD

          Help you figure out how to maneuvers through the ever-more-complex health care system.

    • PamelaWibleMD

      Thanks Eddie. Medical care can be production-driven or relationship-driven.

      Two questions to ask ourselves before we see our doctors:

      What kind of care do we want?

      How should we behave to get that kind of care?

  • CouldSleepAMillionYears

    Doctors kill themselves, if not because of their own stuff, which we can’t focus on here, then because of one big factor. You mentioned it, but it got somewhat buried in the list.

    Doctors are smart, motivated, dedicated and for the most part caring people. They are at the pinnacle of the medical system.They have the knowledge and they bear 100% of the responsibility and the blame.

    Yet they’re treated by the system like criminals-in-waiting, like dirt, like nothing. Every time a nurse manager waves you imperiously into her office to ‘have a talk’, you die a little.

    Every time credentialing YELLS AT YOU IN ALL CAPS with their absurd demands to PROVE YOU’RE NOT A CRIMINAL by DOING THIS BACKGROUND CHECK for this hospital where you worked at several times before, and to PEE IN A CUP, and do it again, and again, and again, and again – you die, a little. Because the ALMIGHTY GOD of credentialing trumps all common sense.

    Ever time your opinion is dismissed, discarded, frowned upon by those with lesser knowledge, you die, a little.

    If you’re bullied outright, as I have been, then you die a whole lot, all at once. And you exist in a semi-dead state for years. No one ever, ever apologized to me. You’re mauled till within an inch of your life, the attackers go on with their lives, and you never will. You miss out on everything, everything in life.

    And if you have no way out, no other way to pay the bills, no one to support you, no future and no hope, you will eventually…do the math.

    The abuse and bullying from all sides is intolerable, especially when you’re a good and kind and smart person who wanted to help people. THEY are REALLY all out to get you. No sane person can work in the medical system and NOT be depressed.

    • PamelaWibleMD

      To be fully “in the system” would be depressing. I was suicidal and had quite medicine back in 2004 due to the dysfunctional system that seemed to engulf my entire life. Planned to get job at a coffee shop down the street. . .until . . .I cut out the middlemen (DISINTERMEDIATION) and put the patients in charge of designing their own ideal conic. Ah . . . now I can finally be a doctor!

    • PamelaWibleMD

      And to you CouldSleepAMillionYears – I am sorry that you were abused in your training and in your job. All you ever wanted to do was help people. It’s an absolute tragedy. But you can recover your passion, dreams . . (my story below) . . .

  • PamelaWibleMD

    Anthony D – I got one word for you: DISINTERMEDIATION.

    It works. I discuss how in the TED talk referenced in the article:

    http://www.youtube.com/watch?v=5cvHgGM-cRI

  • Anthony D

    One other reason is the stigma attached to medical doctors saying that they are greedy and only care about their HUGE bank accounts, instead of the patients well being!

    Plus, you have the media that likes to vilify physicians (like the New York Times), is it any wonder why many distrust these healthcare workers and doctors feel they are pushed against a corner!

    • PamelaWibleMD

      Media does tend to inflame people’s fears. Divide and conquer is unhelpful and certainly does not promote health for patient or doctor.

  • head_and_brain

    If physician comtemplated/attempted suicides, why didn’t they temporaily suspend practicing and get treatments, or even cease practicing medicine all together? I did not have much sympathy or empathy for physcians who knew that their conditions weren’t fit to practice medicine, yet continued to do so risking patients’ safeties.

    • DoubtfulGuest

      The Psychology Today article linked above is pretty enlightening. There are lots of barriers to doctors seeking help. The way they’re socialized in medical school (which stays in their heads forever), likely rejection by colleagues, the real possibility of disciplinary action just for admitting a problem. I Googled physician help programs awhile back, for substance abuse, anxiety and depression. They appear warm, fuzzy, and supportive, but are mostly associated with licensing boards. Doctors can be punished just for contacting them. A real support system for doctors just does not exist, but we need that. Also, there’s a shortage of physicians in many parts of the country. Let’s say a doctor recognizes that s/he has a problem. At what point can they just leave their patients? There’s no mechanism to ensure that those patients are all able to find another doctor, even short-term. If all doctors with anxiety and depression stopped providing care until they became mentally fit by our standards, it would be a disaster.

      • PamelaWibleMD

        Exactly.

    • PamelaWibleMD

      Because . . . . if a doctor seeks treatment there may be repercussions to one’s license. Would you chose to do something that would dismantle your entire career, identity, and life?

      Think about this from the doctor’s perspective please:

      1) You may have up to 500K debt from your training
      2) You have a family to support
      3) You just went to school 30+ years to become a doctor
      4) All you ever wanted to do is help people. You are the helper.
      You are not the one that is supposed to need help.

      PLUS when you are depressed and suicidal you re not exactly thinking clearly.

      Yes. For some it is easier to grab a gun. In America, that is often the easiest way out.

      • querywoman

        If a doctor can’t work for a while, then he or she could do a deferment, forbearance, or an Income Based Repayment plan on the loans.

        • PamelaWibleMD

          It’s so much more complicated than that. But yes, you are correct on loan deferment.

          • querywoman

            I have done all the student loan options, and they are not hard.

  • Rob Burnside

    Another grand slam, Dr. Wibel. Here’s the problem as I see it: you’ve got tremendous responsibility with insufficient autonomy; complex issues with insufficient time for proper solutions; unrealistic expectations with extreme aversion to failure. All this and the cumulative affects of stress and revulsion. Taken together, it’s the perfect prescription for suicide.

    If ever a profession warranted an industry-wide sabbatical program, medicine tops the list. Truck drivers, after all, are limited by law to a certain number of driving hours per day, for their protection and ours as well. Physicians are a regional and national asset, one that should not be squandered in our obsession with the time/money business model.

    • PamelaWibleMD

      What does it say about a civilization when its healers harm themselves?

      • Rob Burnside

        Until the day they are completely replaced by robots, physicians ought to be put on the Endangered Species list, along with police officers, firefighters, and Classical DJs. I’m not kidding. The list should be a lot longer. Orwell wasn’t very far off at all.

        • PamelaWibleMD

          Yep. Reductionist medicine breeds automaton doctors. Sad.

          • Rob Burnside

            And a very good reason to keep the show going. Please don’t go down in flames yourself, however.

    • querywoman

      The overwork is my own most intense criticism of the medical profession.
      It’s strange that a doctor can give me a note to take off work when he or she is hopelessly overworked, even with all of the NPs and PAs sharing the load.

      • DoubtfulGuest

        Funny, I had never thought about that, but you are right!

      • PamelaWibleMD

        Barefoot shoemaker.

  • PamelaWibleMD

    Perfectionists working in an imperfect system.

  • DoubtfulGuest

    Anxiety, depression, and hopeless feeling/suicidal ideation are nothing like being drunk. If we want to stay far away from everyone who has these conditions, we wouldn’t be able to leave our houses or do anything at all. We’re talking about people who are sad, not sleeping enough, have no time to take care of themselves, put up with verbal abuse from a bunch of different people, and on top of that, they can get in trouble if they say anything about it. If you felt this way in your own life, should people assume you’d be a danger to others…or maybe think that you deserve some compassion and help?

    • PamelaWibleMD

      Doctors are really nice people who have been abused.

      • DoubtfulGuest

        Most of you are nice. ;) Probably nearly all of you started that way.

  • PamelaWibleMD

    That we actually can change. No blame. We created this ourselves.

  • PamelaWibleMD

    Drunk cab driver. That’s good one.

  • PamelaWibleMD

    Really? Can you post that blog Karen? I’d like to read those comments.

  • Sharon

    Edward Leigh: I can appreciate your comment. Pam sums it up with: “vocal AND compassionate….a great combo.” I appreciate that you bring up this topic, Pam; though I can’t say I agree that “physicians created this themselves.” At very least, they have had a lot of help!

    And yes….physicians tend to be perfectionists in an imperfect system [that expects them to be perfect].

    crichardsoncae also makes a very good point. I could certainly relate to that line of thinking.

    [RN, Psych.]

    • PamelaWibleMD

      The “physicians created this themselves” referred to the sick dysfunctional system that we have participated in creating. If we keep working under abusive third-party contracts, employers, etc. . . we are participating in perpetuating the sick, dysfunctional system. We create our own destiny.

  • PamelaWibleMD

    The ultimate in physician-assisted suicide.

  • DoubtfulGuest

    Here’s one:

    http://journals.lww.com/academicmedicine/Abstract/2009/09000/The_Devil_is_in_the_Third_Year__A_Longitudinal.12.aspx

    “Fear of making mistakes, a demanding
    curriculum, time pressure, sleep loss,
    and a hostile environment have all been
    described by some students as factors
    that changed their views about
    patient–physician relationships.”

    Thoughts? I don’t feel like this particular post is the best place to talk about our bad experiences with doctors. But would like to understand these issues better. Forgive me for defending rbthe4th2 a bit because I get where he’s coming from. Many doctors do and say things that are…hard to understand, to say the least. I’ve had only good experiences with the students.

  • PamelaWibleMD

    Reasons:

    1) Exhaustion
    2) PTSD
    3) Soul loss

    You can’t give what you no longer have.

    • rbthe4th2

      Then why are so many trying to get into medicine due to your 3 items? Answer: $$$ and the top NY Times article on the what the top 1% of earners majored in (pre med).

      • DoubtfulGuest

        The NYT has had it in for doctors lately, it seems.

        • rbthe4th2

          I can see it if it is an editorial, but this is data. Facts.

          • DoubtfulGuest

            Okay, some doctors are in the 1%, but many are not. Some of the kindest ones, who would NOT do what some of our doctors have done to harm us, are the ones who are suicidal. So, I feel like we should focus on suicidal doctors for this post. They have lots of legitimate reasons for feeling bad, no matter how much they make. And I think they deserve some support. You know I have no shortage of criticisms, I just try to direct them specifically toward the people who deserve them. Or I examine doctors’ assumptions and decision-making processes that could lead them to harm a patient. The ones who are really stressed out, reading all this, don’t need to be reminded how much some of their colleagues make. I don’t think we’d like it if some of our colleagues’ salaries were used against us?

          • rbthe4th2

            Do you have a citation for the “some doctors are in the 1%, but many are not.”. What I’ve posted shows even FP’s can become millionaires. Same for “some of the kindest
            ones, are the ones who are suicidal.”

            We have no way of knowing who is and who isn’t. While the list put up here on suicides is great, I think a focus should be on the medical profession helping not only their “brother/sister in arms” but the patients and doing a lot more, especially socially and peer wise, to help their professional out. Peer pressure, from what I’ve read, is a huge factor. I don’t mean from patients, its from “physician heal thyself” and other internal mechanisms of perfectionists. Everyone has a legitimate reason for feeling suicidal, doctor or not, and actually, many of us have a good idea of what our colleagues make. I do. Would it be used against me? Yes. The reason why is that the higher the pay of the job, the more stress you would likely get with it. That’s one of the justifications for more pay. Its like me being salaried, there is more riding on me than my family members who do a 9-5 hourly job and go home. I get hit up holidays that they’ve not. Part of the reason for higher pay.

          • DoubtfulGuest

            1. http://healthland.time.com/2012/04/27/doctors-salaries-who-earns-the-most-and-the-least/

            http://money.cnn.com/2012/11/20/news/economy/top-1-percent/

            2. For this one, I’ve made educated guesses based on tracking doctors’ comments elsewhere on this blog. The ones who’ve said nicer things and have been more supportive of patients, when we say bad things have happened to us, are also some of the ones who’ve expressed the most…despair…I guess you could call it. You’re right, I have no way of knowing if they’re suicidal. I’m extrapolating from available information.

            What I don’t understand (even though I agree with you about most things) is why physician suicide can’t be discussed here without folks piling on about their income and bad things that (many of) their colleagues do. I feel it’s not appropriate. If someone is in that much pain emotionally, I’d rather understand it and try to help. I know you’ve expressed the same thing to some extent, and I’m no less frustrated with docs than you are. But we have a different take on this particular topic, I guess.

          • rbthe4th2

            Because if you talk to any one on the street, they’ll say that the salary is way high due to being a stressful job & that’s part and parcel of any of the high $$$ jobs (CEO’s and the like included). 6 weeks vacation for the medical people in the local hospital groups is 4 weeks more than we get a year.

            Based on what I’ve gotten, if someone carps on a doc needing help, the doc will blow you out of the water. I’m not the only one. Helping a struggling doctor only bought me problems. Its the docs any way who have and keep a culture where those who have problems will get into trouble if they are helped, that’s where the focus needs to be, is on the medical profession and accepting and helping one of their own in need. Docs should be supporting other docs, not creating an atmosphere that doesn’t support their getting help. It also doesn’t mean taking it out on patients who try and help.

          • DoubtfulGuest

            Yeah, I see what you’re saying. I guess I’m thinking more of individuals who are feeling hopeless, and feeling compassion for them. I don’t like to blame the victim. You’re talking about root causes that affect all suicidal doctors, probably. I recall you were treated very badly by at least one doctor to whom you offered compassion and understanding. Same here. And I don’t know what to do about that. I also get frustrated when doctors talk about problems in their profession and when we press them about what exactly causes those, then they often say “Well, it’s our culture in medical school” or other stuff patients have no control over! :/ Unless the cause of that med school culture is society having unreasonable expectations of doctors. Then we should fix that, for sure. It just bothers me that discussions of doctors’ stress quickly turn into being about everyone else’s stress. We have lots of other blogs to discuss those. This is a medical blog. I totally agree with you that mean doctors are a huge problem. Some of them are really, really mean to patients and it’s the most screwed up thing I’ve ever seen. They are obviously holding us (nice, reasonable patients) responsible for stuff that bad patients have done. I want to make them think, not turn the tables on them.

          • rbthe4th2

            http://aeon.co/magazine/being-human/why-rude-doctors-make-bad-doctors/
            “Yet despite such outcomes, many in medicine actively protect the culture of disrespect because they hold a fundamentally flawed idea: that harshness creates competence. That fear is good for doctors-in-training and, by extension, good for patients. That public shaming holds us to higher standards. Efforts to change the current climate are shot down as medicine going ‘soft’.”
            “Arguments such as these run counter to all the data we have on patient outcomes. Brutality doesn’t make better doctors; it just makes crankier doctors. And shame doesn’t foster improvement; it fosters more mistakes and more near-misses. We know now that clinicians working in a culture of blame and punishment report their errors less often, pointing to fear of repercussion. Meanwhile, when blame is abolished, reporting of all types of errors increases.
            We can no longer deny the facts. Bad cultures lead to bad outcomes. Jerks do not make good medicine. They foster a backwards atmosphere that degrades trust, tarnishes open communication, and promotes cover-ups. We can’t ignore a system that takes loads of formerly ‘nice’ people and churns out jaded, bitter, and gruff ones.”

            The fact is, it starts in medical school. No matter how much complaining there is on a blog, “eating your young” attitudes start the abuse. I have a problem when I hear the complaints, yes not for just my issue, but for the fact that medical “culture” knows this and doesn’t do anything about it. The first step is stop this stuff. Next is to do something about medicine and how it treats its brothers and sisters when they need help, to be able to reach out. Try that and work on missed/delayed diagnoses, I bet you’d help the medical profession a lot. The change though has to come from docs. Not us, docs.

          • DoubtfulGuest

            Nice article. I agree…I still have compassion, though, I am just cautious about how and to whom I show it. There is too much blaming of innocent folks on both sides.

          • annette ciotti

            thank you for your understanding and for being reasonable.

          • DoubtfulGuest

            :-)

        • PamelaWibleMD

          You are not the first to mention that. Media often perpetuates a belief that doctors are rich and self-serving.

      • PamelaWibleMD

        Money is not what motivates the doctors I know.

        • rbthe4th2

          Since primary care is needed badly, then why aren’t docs going into it? Money isn’t there, medical school culture has a theme of promoting specialties over primary care.

          • PamelaWibleMD

            TRUE

      • PamelaWibleMD

        There are easier ways to make money than spending 30 years in school and amassing up to 500K debt.

        • rbthe4th2

          See the above article. More doctors are in the one percent (especially now that there are more doctor/doctor couples), you have a better chance of going into a specialty and making the 1% than you do becoming a CEO of a corporation. Also, you can go military and have it pay for your education, you come out debt free. Where are your figures on that debt? All I’ve seen is the average of $150-200 K at the most. How many articles go on $500K vs. the smaller number?

          Again, if it was easier than why aren’t econ majors getting overloaded with applications for schools, etc.?

        • JM

          AMEN……(from a fellow MD)

  • rbthe4th2

    You can google anything – but here are a few links.

    http://www.medscape.com/viewarticle/510502_4
    http://articles.latimes.com/1993-12-20/news/mn-3935_1_american-medical-student
    https://www.aamc.org/newsroom/reporter/june2012/285314/viewpoint.html
    http://blogs.jpmsonline.com/2013/09/23/fighting-holmes-heart-over-brain-empathy-over-sympathy/
    http://virtualmentor.ama-assn.org/2007/06/medu1-0706.html
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681685/
    A lack of role models, educational experiences, and the development of a sense of being part of a privileged group (elitism) are among the factors that may contribute to a decline in empathy during medical education.

    http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00729.x/abstract
    Malpractice claims, 1% were for the plaintiff.
    http://www.kevinmd.com/blog/2013/06/stop-medical-students-jaded.html

    http://www.fiercehealthcare.com/story/hospital-vip-customer-service-programs-bid-loyal-patients/2012-01-24
    http://www.fiercehealthcare.com/story/hospitals-step-up-ritzy-care-for-the-wealthy/2007-04-16
    http://www.kevinmd.com/blog/2014/02/patients-lost-trust-doctors.html
    http://www.fiercehealthcare.com/story/hospital-amenities-gain-value-over-clinical-care/2010-12-03
    http://www.fiercehealthcare.com/story/hospitals-cater-wealthy-patients-despite-safety-net-mission/2012-01-23
    http://www.nytimes.com/2006/02/22/business/22leonhardt.html?_r=0
    http://www.healthline.com/health-blogs/bipolar-bites/how-doctors-discriminate-against-mentally-ill

    and most of all – http://economix.blogs.nytimes.com/2012/01/18/what-the-top-1-of-earners-majored-in/?_php=true&_type=blogs&_php=true&_type=blogs&_php=true&_type=blogs&_r=2.

    Now when I see items from a non working wife with a surgeon husband who has 4 kids and they can afford a second home, while we are struggling to keep one cottage dollhouse, I’d say that the job pays pretty well enough to take care of the above.

    We all have stress, but we all knew the jobs we were going into. IT has stress jobs also and not all of us get paid the money docs do.

    I suggest googling mortarboards to millionaires, as it indicates that doctors are paid well for their services.

    Randy

    Randy

    • PamelaWibleMD

      Money can’t buy you love of your profession. Many docs have lost their passion. So they compensate for their loss by playing the money game.

      • rbthe4th2

        So which is it? You say that money doesn’t motivate docs you know, but here you say they compensate by playing the money game. Try reviewing or googling info or studies on medical culture, bullying, shaming (or pimping) and depression rates, etc. I’d say the culture is bred into them. Again, if applications to medical schools are such that new schools are getting created to fulfill the demand, the suicide rates, etc. don’t seem to be a factor in any one not going in. Doctors are looking for lifestyle specialties, 9-5 type of jobs, witness that less are doing coverage of the weekends (skeleton staff) and the risk of death is greater. If patient care is the top of the list, you’d expect to find docs working together for coverage, not everyone trying to get out of it.

        • PamelaWibleMD

          At a certain point, when your soul has been killed, you are just in survival mode. We all need to recognize this and get back to being fully human. Most doctors are humanitarian idealists at heart. Then they are wounded trough their training . . . .

  • rbthe4th2

    New medical schools opening … not sure where we’ll get a shortage –
    http://www.nytimes.com/2010/02/15/education/15medschools.html
    https://www.aamc.org/newsroom/newsreleases/358410/20131024.html
    http://management.fortune.cnn.com/2013/04/01/medical-students-residencies/

    Maybe you can help out? I know about residencies but there is still a lot of docs … and can they be foreign trained and then come back here?

    Randy

  • PamelaWibleMD

    It’s not about who deserves more compassion than someone else. The sooner we all start being fully human with one another the better.

  • DoubtfulGuest

    I don’t think R’s job has anything to do with health care? I don’t believe this discussion should focus on how much doctors make, though. I know of some docs who are really having financial trouble, through no fault of their own.

    “…is that the final nail in this doc’s coffin is having to deal with a morale butchering EHR system…”

    Tell us more, please? I have seen one of my doctors get really stressed out over the new EHR at the hospital I go to. One of the IT guys came in to fix something and this doctor was almost crying because nothing in the system made any sense. It was really an eye opener for me. I hate to think of patients getting pissy with this excellent doctor when EHR snafus rear their heads.

  • PamelaWibleMD

    What does this have to do with this physician suicide blog?

  • PamelaWibleMD

    Yes. Anything that erodes the doctor-patient relationship is obviously detrimental to both parties – and may be fatal.

  • PamelaWibleMD

    In response to the many letters I have received from suicidal physicians, I have put together this video:

    http://www.youtube.com/watch?v=sHAj_wEEraQ

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