Physician suicide etiquette: What to do when your doctor dies suddenly

Physician suicide etiquette: What to do when your doctor dies suddenly

An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.

What are patients to do?

When they call for appointments, patients are told they can’t see their doctor. Ever. The standard line: “Sorry, your doctor died suddenly.”

In most towns news spreads fast no matter how veiled the euphemisms. Trust me, when a physician under 50 is found dead, it’s suicide until proven otherwise.

The fact is nearly 1,000,000 Americans will lose their physicians to suicide this year.

So what’s the proper response? Deliver flowers to the clinic? Send a card to surviving family? As far as I know, physician suicide etiquette has never been discussed — anywhere.

Etiquette is defined as the customary code of polite behavior in society or among members of a particular profession or group. The customary way to deal with suicide is to ignore it. Physician suicide is rarely uttered aloud — even at the memorial service. We cry. We go home. And doctors keep dying.

I’ve been a doctor for 20 years. I’ve never lost a patient to suicide. I’ve lost only friends, colleagues, lovers — all male physicians. In the U. S. we lose over 400 physicians per year to suicide — the equivalent of an entire medical school gone!

What can we do? Let’s break the taboo.

Physician suicide is a triple taboo. Americans fear death. And suicide. Physician suicide — even worse. Yes, the people who are here to help us are dying by their own hands. And nobody is accurately tracking data. This is not popular dinner conversation. But it should be.

I’m a family physician born into a family of physicians. Raised in a morgue, I spent my childhood, peeking in on autopsies alongside Dad. I don’t fear death and I’m comfortable with suicide. So comfortable I spent six weeks as a suicidal physician myself. Even I was in denial — clueless about all the other physician suicides. Until our local pediatrician shot himself in the head. He was our town’s third physician suicide in over a year. At his memorial, people kept asking why. Then it hit me: Both men I dated in med school are dead. Brilliant physicians. Both died — by “accidental overdose.” Doctors don’t accidentally overdose. We dose drugs for a living.

Why are so many healers harming themselves?  And when would be a good time to discuss this? During afternoon apéritifs? Discussing a decapitated doctor doesn’t pair well with any wine.

During a recent conference, I asked a room full of physicians two questions: “How many doctors have lost a colleague to suicide?” All hands shot up. “How many have considered suicide?” Except for one woman, all hands remained up, including mine. We take an oath to preserve life at all costs while secretly plotting our own deaths. Why?

I cover physician suicide in my TEDx talk. And Dr. Daniela Drake correctly identifies many of the reasons doctors suffer in her article gone viral, “How Being a Doctor Became the Most Miserable Profession.”

In his rebuttal to Drake, “Sorry, being a doctor is still a great gig,” pediatrician Aaron Carroll calls the misery BS. He claims doctors are well-respected, well-remunerated, and they complain far more than they should. He predicts people will soon ignore doctors’ “cries of wolf.” To cry wolf is to complain about something when nothing is wrong, yet doctors suffer from depression, PTSD, and the highest suicide rate of any profession. Physician suicide etiquette rule #1: Never ignore doctors’ cries for help.

Bob Doherty of the American College of Physicians also downplays physician misery. His response is classic: When doctors complain, quickly shift conversations from misery to money — their astronomical salaries. But when a doctor is distressed how is an income graph by specialty helpful? It’s not.

I run an informal physician suicide hotline. Never once have I reminded doctors of their salary potential while they’re crying. Think doctors are cry babies? Read these physician suicide letters before dismissing doctors as well-paid whiners. Physician suicide etiquette rule #2: Avoid blaming and shaming.

After losing so many colleagues in town, I sought professional advice from our county’s medical society CEO, Candice Barr. She explains:

The usual response is to create a committee, research the issue, gather best practices, decide to have a conference, wordsmith the title of the conference, spend a lot of money on a site, food, honorariums, fly in experts, and have ‘a conference.’ When nobody registers for the conference, beg, cajole and even mandate that they attend. Some people attend and hear statistics about how pervasive the ‘problem’ is and how physicians need to have more balance in their lives and take better care of themselves. Everybody calls it good, goes home, and the suicides continue. Or, the people who say they care about physicians do something else.

So what works?

Our medical society established a Physician Wellness Program. The first in the nation to create a comprehensive program with free 24/7 access to psychologists skilled in physician mental health. Since April 2012, physicians have been able to access services without fear of breach of privacy; loss of privileges; or notification of licensing and credentialing bureaus. That works.

The key is to “do something meaningful, anything, keep people talking about it,” says Candice Barr. “The worst thing to do is nothing and go on to the next patient.”

What’s most important is for doctors to know they are not alone. Doctors need permission to cry, to open up, to be emotional. There is a way out of the pain. And it’s not death. Physician suicide etiquette rule #3: Compassion and empathy work wonders. More than once a doctor has disclosed that a kind gesture by a patient has made life worth living again. So give you doctor a card, a flower, a hug. The life you save may save you.

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. Watch her TEDx talk, How to Get Naked with Your Doctor

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  • Kristy Sokoloski

    Dr. Pamela,

    I am always glad you bring this topic up because so many people don’t understand why there’s such an issue with doctors dying. And when it is tried to be discussed then the people begin to push it right back under the table. Too many expect doctors to give and give, and give to them but yet when doctors try to cry out for help they are ignored. Yep, just like what that one Pediatrician said. With regard to your statement that doctors need to be able to have a good cry, allowed to be emotional, and open up it tells me that I am doing something right when as I have the chance to do so ask my doctors how they are doing. That way they have that opportunity to do the things you mention that they should. And it’s only fair that I ask them how they are from time to time because they are still human just like me even though they are doctors and because of the fact that they have done so much for me. When I meet their family members (which happens from time to time) I try to thank them for allowing me to share their loved one with them.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Thank you for caring Kristy. Isn’t that what health care is all about anyway?

      • Kristy Sokoloski

        Dr. Pamela, yes, you are correct that’s exactly what health care is all about any way. We have a lot of work to do to try and educate the public. And it’s going to be a major uphill battle. Keep going with what you are doing, and keep up the good work.

  • http://www.amerechristian.com/ Ron Smith

    Hi, Pamela.

    Thanks for the post. For perspective, this is my 31st year in Pediatrics practice

    I think that the world in general equates well-being directly with money. And I think physicians specifically are viewed by the public as individuals who are nearly bullet-proof, too. After all, they are supposed to be smart and should be able to solve all of life’s difficulties, especially their own.

    I think that the level of invasion into a physician’s life by everyone is a factor. If you google me, you’ll find perhaps hundreds of sites that ‘rate’ me. If you contact the Georgia state board’s web site, you can even find out most everything that you couldn’t find out so easily on anyone else.

    https://www.gaphysicianprofile.org/profile.ShowProfileAction.action?lic_nbr=045338

    The intrusiveness is unprotective and demeaning. The analogy here is that if a physician has any black marks, especially a reported mental illness, then they may as well be near-miss road-kill for which nothing is left to put them down and stop the misery.

    The public perception is that because doctors make ‘a lot of money’ then they deserve to see everything about them. Privacy for physicians is not allowed.

    We are pressured from all sides. Insurers want all of our information for credentialing. Practice boards are constantly increasing the requirements for board certification. Local governments are increasingly intrusive to protect the consumers.

    When I started practicing, medicine was appreciated. Now we are nothing more than another commodity bought and sold like everything else. Why does it surprise anyone that the numbers of physicians jumping off the train are increasing?

    For me, the medicine side was old a long time ago. The biggest thrill I get is not from finding that rare medical condition, but it is getting to know the young families whose lives I am a part.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • http://www.idealmedicalcare.org PamelaWibleMD

      But doesn’t it seem strange that people would have such a lack of empathy for its healers?

      • http://www.amerechristian.com/ Ron Smith

        The new Physician image is that doctors in general are all about money, even called money-grubbers, or are quacks. It wasn’t like that three decades ago.

        That is not the case, of course, when you ask people about their specific doctor. In that personal vein, the physician image is much more positive and people are often very appreciative. Their doctor is ‘the best ever.’

        We are a casualty of a post-modern and entitlement society.

        Warmest regards, Pam.

        Ron

        • http://www.thepatientdoc.com The Patient Doc

          I think part of the reason patients think we are all about money, is because sometimes that all they hear us talk about. Media is saying something negative and untrue about us, the we are going on Facebook and other medias posting and sharing articles about the reality of physicians salaries and take home pays, and debt. We even go an compare it with other peoples salaries. We post these things to create awareness, spread the truth, seek empathy, but it is being misunderstood by the public and out patients. It comes off as we only care about money and that we believe we deserve more and are suffering more than anyone else. It becomes isolating to the people we are trying to reach. I think we need to find a way to express ourselves without alienating out target audience.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Spot on. These public salary discussions are not creating more empathy for doctors. Even though with all the calculations (including debt, on-call hours, etc) we end up making less than a UPS worker.

          • JR

            I’ve tried to make this point before and it falls on deaf ears – thank you for stating it so clearly.

          • http://www.thepatientdoc.com The Patient Doc

            How would you suggest doctors defend themselves about the negative image the media portrays of us? What would make our message more relatable and less intimidating. It seems we fight with each other a lot, when we should be working together to improve healthcare. How to we get patients to understand we are on the same side?

          • JR

            I personally relate to individual stories. I know that those are much harder to relate, because of privacy issues – the risk of exposure can hurt someone’s career. I also know those don’t sway everyone and that physicians are taught to discount the personal stories as “anecdotes” – but stories are powerful.

          • http://www.idealmedicalcare.org PamelaWibleMD

            We need to go directly to patients and state our case and BE the doctors we and they always wanted. I lead town halls and take it to the community. Other docs go door-to-door. Since we have no major political voice and we own no media outlets we can only take this to our patients. That works.

            Worse thing to do is suffer in silence and hope things will somehow improve on their own.

          • Suzi Q 38

            I would have to agree.

            If it were only about the money, I would have to say that no one likes to be undervalued in any way, even monetarily.
            Money pays the bills. Reality.
            Whether we are talking about office or household bills, it is fairly important.

            When I see that physicians are complaining about making $150K or more, I think yes, they have cause to complain….especially when the specialists are pulling in $400K. That is a huge discrepancy. How HC is going to even out this huge “divide” is the big question, if it cares at all.

            I can tell you one thing, though. The physician GP “powers” must be vocal and there may possibly be a strike of sorts about many things. Namely, the money.

            I just have a feeling though, it is not just about the money…there are a myriad of other concerns that are troubling here.

            My point is that as a group, they are not the only ones who have suffered monetarily and otherwise. Just read the news. Look at the outlook for new college grads, many of whom will not be able to land a job.

            In that vein, the general public has a point about physicians complaining about salary.

            At times, some physicians sound self serving and selfish, unable to empathize with the fact that their patients may be unemployed and are on the verge of losing their homes, so how can they pay you more, on top of what they are already paying for their insurance….if they can still afford it?

            Of course, some doctors do a good job of pointing out patients who have iphones, good jewelry, nice clothes and drive better cars. These patients are not all of us.

            We could point out doctors who have the same and live even a higher lifestyle while complaining about their pay.

            I have had doctors who used every opportunity during the vulnerable time I was ill to exploit my PPO insurance as a unlimited credit card of sorts.
            When I questioned this, I was met with hostility. Being acutely sick leaves the patient with few choices but to pay.

            Anecdotally, it is all relative.

        • http://www.idealmedicalcare.org PamelaWibleMD

          What created that money-grubbing quack image? Media? It came from somewhere since most people have a positive personal experience with their own doc. Something created the negative image. Who? And why?

      • ninguem

        “Physician — One upon whom we set our hopes when ill and our dogs when well.”

        ……………………….Ambrose Bierce

    • SteveCaley

      Sadly, I agree with you, Ron. There is a great movement in the direction of dehumanizing and alienating our society, and, like polluting our air and water, we have the means to render our entire society unlivable.

      People are more than an accretion of incidental facts. Being a good doctor means that you believe in other humans as existentially worthwhile, existentially SOMEONE. However, the traits of being a good doctor are increasingly similar to the traits of becoming a victim in the rather predatory community we are becoming.

      Social vivisection of the Newsworthy is the habit of the entertainment media. We have become very tolerant of viciousness in our culture. People are victims of violent crimes anonymously – simply because they can be, they were in the wrong place in the wrong time.

      Our culture has a serious conduct disorder. Doctors, like ministers and a few other professions, are there for the engagement of humanity. Members of our society are passive and mute, receiving other’s judgments and opinions, but seem not to understand this or care. Healthcare is merely one aspect of the syndrome.

      Why Are So Many Pastors Committing Suicide? asks CharismaNews
      There is no lack of statistics about pastors and depression, burnout, health, low pay, spirituality, relationships and longevity—and none of them are good. According to the Schaeffer Institute, 70 percent of pastors constantly fight depression, and 71 percent are burned out. Meanwhile, 72 percent of pastors say they only study the Bible when they are preparing for sermons; 80 percent believe pastoral ministry has negatively affected their families; and 70 percent say they don’t have a close friend.The Schaeffer Institute also reports that 80 percent of seminary and Bible school graduates will leave the ministry within five years.
      The Black Coat is in the same turmoil as the White.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Wow. Had no idea. So the go-to person, the helper of the sick and wounded, the one who listens and witnesses the trauma is others’ lives is not immune to suffering and suicide.

        • SteveCaley

          We physicians should reach out to our brothers and sisters in ministry, perhaps – we are both seeing this evil scythe cut through some of our best and brightest ones. I note that nursing and pastoral care have a five-and-out timeline. And in this sort of world, only the arrogant and insensitive are selected for; the kind and vulnerable fall like the wheat in harvest.

        • JR

          In some ways, priests/pastors/etc have a similiar problem to doctors: once they start their career, they tend to be expected to keep that same career for the rest of their lives.

          Imagine that you are a preacher and… you no longer believe in God. They exist. There is actually a small organization to support them. http://www.clergyproject.org/

  • http://www.idealmedicalcare.org PamelaWibleMD

    Do you think mainstream media would be interested to know that nearly 1,000,000 Americans will lose their doctors to suicide? I’ve been told by docs in the know that most major media outlets prefer doctor-bashing.

    Why?

    • Yael

      I suspect a large part has to do with the pedestal that doctors are traditionally put on. No one wants to admit that their doctors could be fallible or even human. The thought that someone who you trust to care for you could be struggling themselves is not something that most people are able to cope with.

      But since as physicians we’re all on pedestals, it’s so much easier to criticize us for every little thing.

      Mass media outlets prey on this mentality. Stories about doctors doing wrong because of their arrogance or perceived sense of infallibility sell. Stories about doctors being human and failing because of their humanity? No one wants to hear about that.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Sad.

      • Payne Hertz

        Doctor shows lionizing physicians on the one hand while showing them to have human frailties like drug addiction that would be treated with contempt in anyone else have been a staple of Western society for decades. I don’t think the media or the public is as hostile to doctors as you imagine. The public almost always tends to side with doctors in malpractice cases, to the point some lawyers won’t take cases in certain conservative areas as they are guaranteed to lose.

        It is difficult to see what role the public has in doctors seeking help for depression, substance abuse or other issues because the public is usually unaware their doctors are suffering from these problems. The stigma, if any, comes from the medical system itself.

        • Yael

          Yes and no. When the husband of our residency director killed himself (he was the head of the department of psychiatry), mainstream media at the time demonized him for “taking the coward’s way out”. There were articles that attacked “depressed docs” saying that they had to “man up or get out”. They released “studies” that showed how many doctors had depression and asked the public “would you trust them with your health?”. It was very dirty and very painful for everyone concerned.

          As for siding with doctors in malpractice cases, I think you and I must read very different newspapers. NoI have yet to find an article where the public is sympathetic to the doctor. Even when the doctor is found non-negligent, there are comments that say “well, of course, he could afford the better lawyer” etc etc.

          What the public can do is soften their attacks on physicians, so that those who have enough insight into their illness can seek help without fear of repercussions, before their disease harms either themselves or their patients.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Absolutely agree. Denial runs strong. I was attacked in the local paper when I first started talking about doc suicide. Docs claiming that there was no real problem despite all the local dead docs. The usual “dcd are healthier than the general population” and other lines that discount our very real and unique suffering. (Note” not downplaying anyone else’s non-physician suffering here)

            I have also received letters from surviving spouses wanting me to back off on the topic. But I’m honoring my dead colleagues by getting to the bottom of this. These are not isolated deaths that can be swept under the carpet. No. I do not plan to stop discussing this topic. Not at all.

          • DoubtfulGuest

            Did the spouses explain their feelings? Is it a privacy issue? If so, I could see that. Otherwise I’d tend to agree with you on this.

          • DoubtfulGuest

            Juries tend to side with the doctor, don’t they? But I agree with you on general attacks by the media and the public. This is really awful.

  • Markus

    My father, not a physician, was a suicide. He had many of the risk factors, i.e. male, older, white, that are recognized. He was depressed and self-medicated with alcohol. He was not emotionally open and would not have cried in public under any circumstances. He scorned counseling for emotional problems.
    I suspect that many physician suicides are found in similar people. Tough, macho guys who are high achievers but not emotionally accessible. Warning sign: alcohol is a poor antidepressant. Depressed men can be very successful in work; good income does not immunize against depression.
    Our friends and family recognized that he suffered from an illness and were very supportive to my sister and me. In some cultures there is a stigma to suicide, but I think it is often the result of an illness, depression, treated with the exactly wrong drug, alcohol.

  • http://blog.stevenreidbordmd.com/ Steven Reidbord MD

    Thanks for writing about this. How sad that physician demoralization is ignored and argued away even up to the point of suicide. I don’t know about “etiquette” for bereaved patients, but I do know the sudden abandonment by a caretaker is upsetting for many. By nature we tend to idealize caretakers and consider them bulletproof — this is very comforting for young children, which we all once were. As a vestige of these early feelings toward parents, it’s easy to forget, or to actively and angrily deny, that doctors (and teachers, police officers, clergy, etc.) are people too.

    Although it’s directed toward suddenly losing a therapist not a physician, I wrote a short piece in 2009 that seems relevant. Interesting commentary too:
    http://blog.stevenreidbordmd.com/?p=151

    • http://www.idealmedicalcare.org PamelaWibleMD

      Excellent piece Steven. Always good to look at things through the lens of the patient. As a doctor who has had 6 jobs in 10 years (before becoming happily self employed for the last 9), I wrote more than my fair share of goodbye letters to patients. Some of these people were heartbroken. I never realized how emotionally distraught a patient could be upon losing a doctor. Even after a brief yearlong relationship.

  • buzzkillerjsmith

    I have been a doc for 25 years and have never know a doctor who has killed himself. Not one. I have never contemplated suicide. Not once. I have never once even been sad for more than a few days.

    Gentle readers, Dr. Wible’s experiences are way, way, off the bell curve. Pam, you’re overdoing here big time.

    Gentle readers, physician have, on average, higher life expectancies than most people. Sure, we suffer, the regular folks suffer more.

    • http://www.idealmedicalcare.org PamelaWibleMD

      We DO have higher life expectancies and better health overall, but more suicide than the average person and than other professions.

      There is a physician in my town who lost 7 colleagues to suicide in her career.

      I lost both men I dated in med school. One was in cali and the other in South Carolina.

      We’ve lost so many docs in my town that even the medical society that tracks the physician suicides does not have a comprehensive list. And this is a great town to be a doctor (high reimbursement, low malpractice, wholesome family kinda place).

      I think there are a lot more suicides than anyone wants to believe.

      Many docs suffer far more than “regular folks” but they do so in silence. Until the gun shot wound.

      • buzzkillerjsmith

        Higher life expectancies. I rest my case.

        Outcomes, Dr. W., outcomes. You must have learned that in med school. At some level you simply must understand this. You’re too smart not to understand this.

        Admit it. Admit it at this blog. Right now. Or at least when you read this.

        Details multiply, structure abides.

        • JR

          I just ponder if the reason people with PTSD are dealt with so badly in the ER, in the hospital, or in other medical settings is because doctors deny the PTSD that they see in either themselves or the people they work with.

          • buzzkillerjsmith

            Probably not. Docs compartmentalize. Lots of pts with emotional problems are treated poorly in docs’ offices. Of course lots of pts with any type of problems are treated poorly.

          • DoubtfulGuest

            To me, denial = non-stop compartmentalizing. I think that’s what JR is talking about? Yep, yep, it happens in-office as well, it sure does.

          • JR

            While I agree it’s hard for those with emotional problems to find a safe place to get care… When you make a comment like that… it just seems like a comment with no hope.

          • buzzkillerjsmith

            Now you’re getting it! That is the ueberpoint of many of my posts. There is no hope. There is no hope! Or at least very little. Oddly, that does not bother me that much.

            My favorite book is Blood Meridian by Cormac McCarthy. Here is what Shane Schimpf says about it: ” Blood Meridian is a profoundly nihilistic novel entirely devoid of optimism or hope.”

            Most people probably shouldn’t read it.

          • JR

            Isn’t having no hope what leads people to be suicidal?

            And that books sounds completely like something I’d hate.

          • buzzkillerjsmith

            That’s is where you are wrong. Lack of hope does not lead to that. Bad experiences lead to that. And most likely genetic influences as well.

            Perhaps what I call lack of hope is what you call misery. To me those are two different things. Lack of hope, to me, means not having unreasonable expectations about the future.

            Getting back to my comment about how pts are treated badly. I just mean that they will most likely continue to be treated this way –unless the structure of the health care system is changed, of course.

          • Suzi Q 38

            “………Getting back to my comment about how pts are treated badly. I just mean that they will most likely continue to be treated this way –unless the structure of the health care system is changed, of course.”

            Sure, buzz, you may be right about that observation.
            Understand though, is that there are some of us that will not go away quietly. If there is out and out purposeful attitude and or negligence, patients as well as the powers that be at whatever clinic or hospital physicians work at will figure it out.
            What will they figure out?
            That maybe this physician or patient is not working out.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Agree with Suzi Q

          • http://www.idealmedicalcare.org PamelaWibleMD

            And who can change the structure of health care in a democracy? Who really has the power to change things? I think doctors have more power than they realize. We can create ideal clinic that work for us and our patients.

            What’s health care without doctors?

          • Patient Kit

            It may surprise you that I love Cormac McCarthy. He is such a terrific writer. I haven’t read Blood Meridian yet but it’s on my reading list. I loved The Road and No Country for Old Men. And I’m kind of a relentless optimist by nature. We humans can be so contradictory. ;-)

          • http://www.idealmedicalcare.org PamelaWibleMD

            Good one. Yes, if we can’t look at ourselves clearly in the mirror we may be in a state of denial. I think that is the source of doctor-on-doctor bullying. A “strong, invincible” doc attacks a “weaker, vulnerable” one to run away from his own vulnerability.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Hey Buzzkiller ~ You said I didn’t get it and wrote a 10 point list which I responded to, but by the time I responded you had deleted your post. Why? Here’s my response to you:

      I like your list (please repost it)

      1. Looking at our lives from outer space we are all so insignificant. But what about the doc I dated in med school who died at 39 of an overdose and left his 3 and 6 year old daughters behind? His life mattered to those young girls. And to the patients in his town.

      2. Yes. Our lives were a one in a gazillion chance sperm to egg dance. So if we are here we are way ahead of the game. So we should all be grateful and not be depressed? I wish it were that easy.

      3. Yes. We’d all be happier if we could connect around a campfire and expand our world view.

      4. Railing against suffering? What about developing empathy for suffering? Many docs need validation that they are not the only ones teetering on the edge. We are social animals. We need each other.

      5. I find sport metaphors as annoying as war metaphors and a distraction to the topic at hand.

      6. I like loons.

      7. Aging and ailing is interesting. And?

      8. Will try. (Though you deleted your post so I can no longer reference the books you asked me to read)

      9. But not all docs can break out of victim mode and wander around western Montana with their newfound tatted friends. Sounds like fun though.

      10. You wrote “Don’t hang out with vegans in Seattle. Boooooring.” I was vegan in Seattle in 1999. Most vegans I know are at least as interesting as the tatted campground crowd.

      So. Buzzkiller ~ What is wrong with calling attention to a real issue that impacts so many doctors?

      And why did you delete your original message as this will make no sense at all to others reading my reply later.

      • buzzkillerjsmith

        I sure as heck did not delete my post. I don’t even know how to do that. Nor do I know how to re-post it. Kevin?

        We seem to disagree about all this. I suspect you and I would disagree about almost everything in this world. When I read your stuff, I shake my head and wonder about the wonderful invention of folly in all its forms. Perhaps you do the same when you read my comments.

        But I am right.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Actually I think we would get along well in person. There is almost nobody that I don’t get along with. I welcome conflict and a good discussion on almost any topic.

          Hmmm . . . maybe Kevin will repost your top 10 list on why I and other physicians just don’t “get it.” Ah . . . I did manage to save a copy on my desktop, but don’t want to break any moderator rules or disrespect you by reposting. That’s between you and Kevin.

          • buzzkillerjsmith

            You wouldn’t bother me if you reposted it. Please do.

            You might get along with almost everyone, but I get along with almost no one, especially those who try to get along with me.

          • Dr. Cap

            Buzz, I believe there is a DSM V for that… ;)

          • DoubtfulGuest

            Oh no, it’s just part of his charm.

          • buzzkillerjsmith

            You made me chuckle. For that I salute you!

    • Arby

      Well, most of what you suffer under, I suffer under merely by being your patient. I don’t want a stress-out, demoralized physician even if his suffering is less than mine.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Unfortunately the abuse and trauma we suffer does trickle down to staff and patients. This IS a public health issue. Medical students and doctors require free, confidential mental health services to deal with work-related PTSD.

        Anyone disagree?

        • Yael

          Free, confidential and without fear of repercussion of accessing this service (ie, being reported to the medical board)

          • http://www.idealmedicalcare.org PamelaWibleMD

            Absolutely.

    • guest

      Interesting. When I was a med student we lost one of our junior residents to suicide. He had a wife and 2 kids. Then, in training we lost a resident and had our vice chair discovered in an OR after an overdose. Finally, private practice. I’ve been with my large group for 8 years. We’ve lost 3 physicians to suicide. I am an anesthesiologist so I am in a specialty that has a higher risk of suicide.

      • buzzkillerjsmith

        Maybe I’ve been lucky with all this. Hard to say. I did not know there was a higher risk among anesthesia docs. Do you have ideas about why that might be?

        • querywoman

          Yeah, I know how the luck feels. I had never lost a friend to a tragedy like an automotive accident or suicide till I was about 40.
          Then, a person who had trained me in food stamp land had been caught stealing food stamps and eventually killed herself.
          No one knew why she stole.
          Not all suicides can be stopped.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Access to drugs that put you to sleep – permanently.

        • guest

          Like Pamela says, access. Though I feel like there’s more to it than that. Is there something that draws higher risk people to the field? I wonder if any other anesthesiologists who post here can share their insight.

    • Yael

      During residency, the husband of our residency director, a highly regarded psychiatrist and director of the psychiatry department, threw himself off the 8th floor of the parkade and landed in front of the hospital. A final year medical student, who was contemplating going into psychiatry himself, found him first. I was working in the emergency room that afternoon when he was brought in. I will never forget that day.

      I’ve been in practice for 6 years now. In that time, I have lost 3 other colleagues to suicide and have contemplated it myself. I don’t think the numbers Pamela quotes are as skewed as you might think. They’re just very well hidden.

      • buzzkillerjsmith

        Harrowing tales. Maybe I’ve been lucky.

        If you feel comfortable doing so, would you share what made you contemplate suicide?

        • Yael

          I’ve shared my story on one of Pamela’s other posts here on KMD. The one on physician suicide letters. I’d rather not relive the experience.

          • buzzkillerjsmith

            I read your comments from the previous post.

            Yael, if you think medicine is going to get much better in the next decade, you are sorely mistaken. My advice: Find a niche (Botox or whatever) or just pull the plug on medicine.

          • http://www.idealmedicalcare.org PamelaWibleMD

            That’s a bad attitude buzzkillerjsmith. Be optimistic. How will anything ever get better if people just get cynical and give up dude?

  • DeceasedMD1

    Hi Pam
    I always get the idea that the public thinks CEO’s are the ones with power and money. I think the idea of the rich doc is less pervasive now?

    But I think our field is becoming more and more oppressive from all directions. That phrase don’t shoot the messenger comes to mind. I think whether a physician is alive or even those sadly deceased– this article screams out that HC is trouble. Those in primary care fields in general are being demoralized and dehumanized. Add insult to injury, the average person has no clue that is happening. When one is feeling oppressed and no one knows their pain exists, this is a recipe for disaster. At worst suicide and at best–well it still ain’t pretty.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yep. DeceasedMD1 ~ Agree. Canaries in the coal mine. KevinMD is one of the few larger scale media outlets for the physician voice.

  • Suzi Q 38

    I have not known a physician who killed him/herself.
    I am concerned about it, but I will admit that it has not happened to anyone around here.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Thank you for the very human way you handled that. Emotions are hard to contain and need to be expressed. If not, they can lead to disease. We all have quite a bit to learn from one another–doctors and patients.

      • DoubtfulGuest

        It would be better for her doctor to give Suzi Q 38 a real apology.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Apologies are always accepted and part of healing. to everyone is easily able and willing to say that they are sorry.

          • DoubtfulGuest

            So, if he doesn’t want to or feels he can’t, that’s it? Not acceptable. This is really a topic for another post but “doctors being fully human” MUST include full human apologies. It’s better for everyone involved. Someone who can’t or won’t apologize has never fully grown up and will never have healthy normal relationships.

          • DoubtfulGuest

            Because that’s the line that patients usually get when we ask to talk with the doctor or to hear an apology after we’re harmed. We get this from administrators and people in the legal profession:

            “He doesn’t want to talk to you”.

            “Well, he doesn’t have to. He prob’ly just doesn’t want to and he doesn’t have to”.

            Over and over again, the same response in the same apathetic tone. No matter how compassionate our approach. It’s creepy.

            I have no problem with the focus of this thread staying where it belongs, on physician suicide. But I can’t let this “doctors and patients being human with one another” business stand without pointing out what a normal-person thing to do apologizing is. We can’t expect doctors to have all the rights of regular people with regular feelings but allow them to stand apart from the rest of us this way.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Doctors need to be human. Part of being human is apologizing. That would actually not only be therapeutic for the patient—but for the doctor too!

  • B Viner

    Why shouldn’t someone be allowed to end their life or their suffering if they want to? Maybe it’s getting harder to find the joy in life and maybe they are too tired of trying. Any bad outcome is a potential lawsuit. Any money earned is quickly gone due to increased cost of living. Taking medication is seen as being weak and the side effects may not be ideal. Psychiatry is of doubtful efficacy. Our colleagues see us as competition and would exploit any weakness. It is a terrible thing to lose a life, but isn’t it that person’s decision?

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes. It is a person’s decision. We have free will. No problem with that. The problem I have is that these young bright-eyed medical students greatest dream was to help people. They ended up injured by the system that was supposed to help them be healers. Emotionally, spiritually destroyed, isolated, and left to suffer alone, their only perceived way out of the misery is death.

      What kind of health care system does that?

  • DoubtfulGuest

    You know, I do think these articles would be better without that “never lost a patient” line. This series has helped many suffering people, I’ll give it that. What I think would be helpful is to explore further how doctors are discouraged from asking for help, and what happens to them when they do. I’d be interested to learn how the medical societies and certification boards respond, including these so-called “physician help” programs that often turn out to be a cover for some kind of disciplinary action. Or so I’ve heard, elsewhere on this blog.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes there has been a lot written about PHPs and their outcomes. Some may increase doc suicide. Michael Langdon write prolifically on this.

  • Michael Langan

    The elephant in the room is the state PHP programs that were originally funded by medical societies and staffed by volunteer physicians. They have been taken over by the “impaired physicians movement,” and that is not a good thing. The Federation of State Physician Health Programs (FSPHP) is composed of American Society of Addiction Medicine physicians ” board certification not recognized by the ABMS and I the COI are staggering with the drug and alcohol testing industry and for profit assessment and treatment centers.
    No one has done a cochrane or IOM review of them and that needs to be done. They have convinced Regulatory Agencies (boards) not to question diagnosis, consider them the experts in substance abuse, disruptive, aging physicians and to only allow assessments at “PHP -approved”centers and here is the kicker- ALL the approved centers have ASAM physicians as medical directors ( look up like-minded docs) institutional justice is a protective factor in preventing suicide. None exists here- you do the math

    • DoubtfulGuest

      How can the public learn more about this and do something to help? I’m going to read more of what you’ve written on the topic. This is very troubling and I agree these programs need to be held accountable for the damage they cause.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Michael Langan – please share a few links for others to reference if they would like to know more.

    • DeceasedMD1

      Just when i thought it couldn’t get any worse. So let me get this straight. Any physician that is impaired from drugs and Etoh is sent to FSPHP which is a mandatory for profit drug treatment program. There is no choice of where a doc can go for tx? And FSPHP is just trying to profit off of them. Please tell more. Are there that many of us that Corp Med can now profit from our docs with addictions?
      First, Corp Med drives you to drink, but wait… then they also have the ultimate answer in treatment?

      Best treatment plan is get rid of Corpmed. Bartender please make me a strong one…

    • http://www.idealmedicalcare.org PamelaWibleMD

      Michael ~ please share a few links so people can learn more about this. Thank you.

      • Michael Langan

        I do not think I can post links on KevinMD but I would suggest searching “FSPHP” and “medicalwhistleblower .” Also on Facebook “Eliza Blackwell” contains links and commentary. By the way the same individuals are behind the current push to use drug and alcohol testing in all physicians by creating another “moral crusade” and panic. There is absolutely no evidence base to it and the person who introduced the long term alcohol biomarkers ( junk science) is co- author of JAMA article pushing for widespread testing of MDs. Of course this will include these biomarkers.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Physician suicide not good for the health care consumer:

    http://www.youtube.com/watch?v=8VfSvLfUCEQ

    • DoubtfulGuest

      Consumer? Argh…it makes me think of 1) Cookie Monster or 2) this: http://collegelifestyles.org/wp-content/uploads/2012/07/girl-with-shopping-bags.jpg

      • http://www.idealmedicalcare.org PamelaWibleMD

        I know.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Consuming not good for the average consumer either.

    • sarah

      It is not ony physician suicide that is unhealthy for patients……but “burned out” physicians that continue to work as doctors when their heart is no longer in it. There is much research on how “burned out” doc’s lose compassion for their patients, short tempered, make many mistakes, etc.

      I have much empathy for doc’s but they don’t necessarily have empathy for how their being unhappy in their chosen field negatively impacts patients care. This is our lives that we are putting in their hands!

      • http://www.idealmedicalcare.org PamelaWibleMD

        Correct. How many of you have had the experience speaking to a doctor and you feel like nobody is home. You look in the docs eyes and they are glazed over, vacant. Anyone had this experience?

        Yes. This is not good for the doctor or the patient’s health.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Two thoughts:

    1) I was merely reporting my actual experience as a doctor. Not downplaying the suffering of others. Just sharing what I have witnessed with my own eye, heart, and soul among my colleagues.

    2) Regarding Drake article, it would be great to value primary care, I do believe if ethical physicians took the helm we would have a real health care system. When we get back to caring for patients and return to the sacred patient-physician covenant, the malpractice risk plummets and patients actually want to pay for great service. I actually get tips now! Seriously . . . I have my own take on a solution. Thought Drake brought up some good points though.

    • DoubtfulGuest

      Re: #1, I have to agree with PH that it’s just not helpful to make comparisons. People tend to shut down when they hear/read them…they rarely advance the discussion in any constructive way.

      Despite our disagreement on some issues, I’m overall very supportive about this topic and I’m glad you’re giving it the attention it deserves. I do feel there’s a bit of, well, on days I feel grouchy I’d say it’s “subliminal patient bashing” on these posts. On my better days I’d call it “incompletely addressed frustration with patients”.

      These are all issues that could be dealt with in other posts. But for the purposes of this one, please consider focusing on doctors? More “I” and “we” statements? It would be interesting to see if you get a more compassionate response.

  • querywoman

    Suicide is high in all of the helping professions. Perhaps one of the ways to lessen it among doctors is to encourage them to admit it’s okay to be fallible.

    • http://www.idealmedicalcare.org PamelaWibleMD

      without legal repercussions

      • DoubtfulGuest

        Dr. Wible, I sent the doctor who harmed me a signed general release of all claims. Including for any future damages that I might suffer for the long delay in diagnosis. I also offered to do a different form in case the one I signed wasn’t the right one (I just briefly talked with a lawyer on this blog; I don’t have a lawyer). The doctor’s office had given me a copy of my records free of charge so I tried to make that the “valuable consideration” that you supposedly need to make any contract binding.

        Still no progress. I have bent over backwards to be nice to this doctor. Please consider how hurtful your statements about “can’t/won’t apologize” are to patients here. Many of us try to maintain good relationships with doctors and chose not to file suit even though we were badly harmed.

        • http://www.idealmedicalcare.org PamelaWibleMD

          I think it DOES hurt that the physician can’t/won’t apologize. And they should apologize when in the wrong.

          Again my statement was just a fact. Not meant to hurt anyone. Just like the fact that I never lost a patient to suicide, but I have lost many, many colleagues. That is a fact. It is inarguable.

          I do have empathy for patients and patients deserve far better treatment than they are getting which is why I spend the bulk of my time helping doctors open ideal clinics so that all Americans can get ideal health care. It is possible. We actually can do this.

          • DoubtfulGuest

            Okay, okay. It’s just if we state facts about the status quo to people who are already painfully aware of it, it can kind of look like we support or at least accept the status quo.

            On the “never lost a patient” part, I have to agree with PH. Since you changed jobs several times, YOU might not have lost a patient, but chances are at least one of them WAS lost (to themselves and their loved ones) to suicide…just not on your watch. And who’s to say who might have been considering it, suffering in that very same way? But suicidal doctors deserve their own post. It’s a serious problem, comparisons notwithstanding.

  • DoubtfulGuest

    Will do, thanks.

  • DeceasedMD1

    You seem to know a lot more than the rest of us about this. Would love it if you had an article we could read here on KMD and to be able to chat with you (if you have a moment). If you have already done that here I will have to look it up. o/w I don’t this is something most docs even on this board are remotely aware of. It makes sense what you are saying. I have noticed ABIM and wondered but i had no clue how far it was going. So they are treating non addiction medicine as well now such as taking over psychiatric issues and all they have to do is be internists and take a test for ABIM? That’s practicing outside of the scope of their specialty by far if I am understanding you correctly.

    • DoubtfulGuest

      Yes, a guest post if possible, please, Dr. Langan. I took a quick look and didn’t find any previous one. I’d especially be interested to know about the reporting end of this. I’m concerned about patients’ possible role in unwittingly harming our physicians.

      It seems intuitive that a good doctor who needs help would be in good hands with fellow physicians. I’m not talking about egregious violations, just situations in which the patient experiences some harm and wants their doctor to get help as well as apologize. In my situation I wondered briefly if there was substance abuse. The only possible indication I could see was a sudden change in behavior. There were no obvious physical signs. That is part of why I complained to the local medical society. I did not speculate about causes in my complaint. I tried to be kind and constructive, but it’s really a sham process. It was no help to me and probably hurt the doctor.

      The movie “The Parent Trap” is not exactly a wellspring of timeless wisdom, but I’m reminded of a line when the almost step-mom says to Hayley Mills x 2: “Help me? Sure, you’ll help me…right over a cliff!” or something like that. So, yes, all doctors should be aware and the public should get involved in stopping these corrupt practices.

      • DeceasedMD1

        I think I was always aware of problem docs etc but always believed that the Board was doing an adequate job until recently. I can see it is so suboptimal that it is quite unsettling. I remember your trouble quite clearly which also was quite disheartening to hear.
        I am not even sure even under the best circumstances how an organization can force docs to apologize or admit errors etc. as disturbing as that might sound.
        The way they are suppose to operate -as you may know- is simply to judge if they are able to work. If not, possible loss of license but then they can work in another state-or it is possible. Or a probation period where another doc is monitoring their work for a period of time. How well that works-I am skeptical.
        Also even if there are boundary violations of whatever sort, if a pt was not harmed-other than delayed tx or emotionally miserable, they really do nothing. I think you unfortunately know this all too well. But i can tell you if you want to get a message through to this doc, if you feel he is erratic and he did not appropriately treat you, you can report to the board-not a medical society that has no pull. Even if they clear him, he will get the message. Any doc would dread being involved with the board and WOULD THINK twice.

        • DoubtfulGuest

          Thanks, DeceasedMD. Your reassurance last time helped restore my sanity a bit. It’s my understanding that once you make a peep with the board it becomes public record? So you’re assured of the doctor being aware you’re not happy, but it’s the “big guns” with no nuance or discussion no matter what?

          I’ve looked very hard for a “no guns” solution. This doctor’s practice is already struggling at least partly for reasons not his fault (mostly M/M patients with very low reimbursement). I operated for a long time on the assumption that he would apologize if he knew it was safe to do so. But the evidence doesn’t support that.

          I contacted the medical society specifically because they’re a private organization. I thought the doctors would be nice to me AND the doctor I had trouble with. (I’m only repeating this for other folks reading, sorry). When you say the doctor would think twice, is there anything he can do to improve the situation at that point or do you just mean he’d take that sort of thing seriously in the future? Thank you very much. I’m not leaning toward this option but I want to make sure I have my facts straight.

          • DeceasedMD1

            Unless he is found to be incompetent in some fashion, I think it may still be part of public record but all it would really say is someone complained and he was not found to have done any wrong doing.

            And yes what I meant was if he was reported he would think about it twice in the future.

          • DoubtfulGuest

            Okay, thanks. I really have no evidence of a substance problem, as opposed to say, bereavement or something that contributed to his odd change in behavior. I’m always looking for more understanding, that’s all. I don’t want to hurt anyone, or pull a trigger that I can’t un-pull.

  • DoubtfulGuest

    You’re right to be skeptical, PH, and I agree with you to some extent. I still have compassion for them, though, if only because I suspect (nope, no evidence) that the docs who are suffering the most are in general NOT the same ones who are treating chronic pain and psych patients so horribly. I might be wrong. About your last statistic, though, a few people on Dr. Wible’s last post about this said they were punished horribly for voluntarily seeking help. I think in at least one case, we’re talking mental illness with no substance abuse. So, there’s the possibility that those programs are actually pushing folks to suicide. I really need to read Dr. Langan’s stuff and get better informed here.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Good points. Not trying to offend anyone or belittle the experience of others. I appreciate your input. Always good to look at things through anthers’ lens.

    • DoubtfulGuest

      Enough to not put the “never lost a patient” line in the next piece? :)

      • http://www.idealmedicalcare.org PamelaWibleMD

        The comparison does drive home a point. My mom is a retired psychiatrist and I think she only lost 1 or 2 patients in her career to suicide, but knows of more docs who have gone that route. I’m going to interview her on this.

        Can’t promise, but no plans to use that line again in another article. Again. not at all trying to downplay anyone else’s suffering.

        • DoubtfulGuest

          I think part of the problem is you seem to be anticipating (preempting) the argument that other people suffer and commit suicide, not just docs. And you are still getting that argument from lots of people. Just sayin’, I wonder what would happen if you started the discussion in a more open way. It’s hard, though, I’m famous for this in my personal life. I don’t mean to, but when I’m afraid my feelings and experiences won’t be well-received, I stick in something defensive at the beginning. Often a comparison of some sort, or something that anticipates criticism. I bet lots of people here would be interested in your mom’s take on the topic — great idea. But focus on the docs…please?

  • DeceasedMD1

    I really appreciate your response. tHAT IS frightening. I always had some notion that non psychiatrists trained in addiction medicine were not as skilled in the whole field, but never realized they had taken over these programs. My god it’s like the blind leading the blind Eliza. Are they really taking over not just addiction medicine but mental illness as well without the input of a psychiatrist?

    • Michael Langan

      The ASAM outnumber the ABMS approved specialty of Addiction Psychiatry by 4:1. To make a point I paid the 2200$ and sat for the ABAM “board certification” and without any preparation passed by 150 points. The ASAM is heavily lobbying to get ABAM certification approved by the ABMS

      • DeceasedMD1

        It’s ironic, that part of addressing addictions is putting boundaries on manipulative behavior. But the very specialty that is suppose to be treating addictions, seems to be addicted to power themselves and on their way to a big paycheck, from what you have shared. Truly disheartening! I can see that in general board cert seem to be have less and less meaning anyway.

      • DeceasedMD1

        I agree with your Kennedy quote. Have you thought about writing something brief for this site to submit? I say brief because just the gist of it I think would start a huge discussion. I would do it myself but I don’t feel I would be qualified to moderate or answer questions like you and Eliza could to facilitate a great discussion. Kevin even takes short pieces to just give readers the gist of it. the details can be in teh discussion.

        • http://disruptedphysician.com/ Michael Langan

          I have been waiting for my non “PHP-approved” evaluation to be completed before writing anything at this level. Thankfully this has now been completed by a psychiatrist board certified in both Addiction Psychiatry and Forensic Psychiatry (who someone within the MA BORM referred me to!) and she not only validated and documented fraud but the systemic abuse and bullying I suffered at the hands of the MA PHP. The MA PHP tried to send me to Kansas for a “disruptive physician” evaluation and gave me 7 days. I refused. My non “PHP approved evaluator” states “to a reasonable degree of medical certainty” that the request for this evaluation was “in retaliation” for uncovering the forensic fraud. Had I gone to Kansas I would have been diagnosed “in denial,” cognitively impaired, and unfit to practice medicine. This is a surety. Just look at the public profiles that are out there–they are diagnosing doctors with “character defects.” These disruptive physician facilities use non-validated psychometric testing as well as “polygraphs” in their evaluations (despite the AMAs previous stance that the accuracy of polygraphs approximates chance!) and tailor their data to fit the PHP diagnoses (as Knight and Boyd point out). I am writing a paper specific to the topic of bullying and suicide in physicians, but here is something that might get the conversation started http://disruptedphysician.com

          • DeceasedMD1

            Sorry to hear of what you went through. They can force you to go what sounds like out of state for you for a further evaluation? I can understand you would not want to get into the details of your case. I was thinking just the very basics of how the system works would be a great article without necessarily anyone’s personal details. just even a short summary of the Knight and Boyd article to make others here aware. I hope you get out from under this ASAP.

          • DeceasedMD1

            PS– the disrupted physician article you sent was wry and very well written. I am not sure who wrote it but it would be great if Kevin could post something like this or similar. thanks for posting this Michael.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Probably for the same reasons Yael pointed out above.

  • DoubtfulGuest

    This is terrifying. Even worse than what I’ve been through as a patient, in terms of sheer gas-lighting. I’m going to read all I can about it.

  • DeceasedMD1

    You know Eliza, it’s odd. I was going to ask you that– if any of these docs had a h/o addiction but I thought it might sound crazy to ask. I knew that could be a possibility of course, but my mind could never quite come up with the fact that you say they are the ones making the decisions???
    It’s brilliant on their part. When they relapse, they are covered. They can blame it on the “impaired” physician they are treating. He or she is the addict- not them. Frightening. Even more frightening that no one is doing anything about it from what you say. I tell you that phrase “driving me to drink” comes to mind from listening to this craziness.

  • DeceasedMD1

    That is down right abusive. it is true that addicts deny. Just look at the addicts running the program. Sounds like denial to me.
    Let me get this straight. Are they dealing with non addiction issues as well such as mental illness without addiction, without a psychiatrist involved? Are they allowed to judge the fitness of another physician that is not related to an addiction? What about dual dx? Are they treating mental illness in the context of a dual dx even? If so that is getting even further out there unless they are psychiatrists.

  • DoubtfulGuest

    Once again, I partly agree. Wishy-washy and proud of it. ;) Oh, I have my hostile moments, too, but thanks. I could actually believe there’s some screwed-up formula by which the boards discipline sad doctors while letting the really dangerous ones walk. I tend to believe the ones who show up here saying they were punished for seeking counseling. They’re usually anonymous and clearly under stress when posting.

    I’m biased myself in that I know how much it hurts to be disbelieved when telling the truth. It’s just nice people with emotional problems who aren’t hurting anyone, often don’t have the skills to defend themselves. Other folks are weaselly and manipulative so they prevail in situations that those skills are required. I just want to learn how the system actually works, as a first step.

  • buzzkillerjsmith

    OK, OK. Just as long as you don’t have any neck tattoos.

  • Kaya5255

    What do health consumers do?
    It would be considered courteous to send an expression of condolance/sympathy. A card or perhaps flowers, if it’s a long-standing relationship.
    Then the consumer begins the process of securing a new provider.
    If the provider who commits suicide has a history of impairment and their colleagues knew and did nothing to help, they should be ashamed.
    It has been my experience that turning a blind eye is SOP.
    You do the consumer no favor by pretending all’s well.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes. Time to break through these taboo topics. Let’s be honest.

  • yazter

    What about the link between physician suicide and substance abuse? While it’s not a prerequisite, maybe there is a link of some kind?

    • http://www.idealmedicalcare.org PamelaWibleMD

      Easy access and knowledge on lethal doses is not protective.

    • http://www.fornits.com/phpbb/index.php?topic=37626.0 Elizablackwell15

      Depression and substance abuse are the two biggest risk factors for suicide but neither of these explains the disparity of completed suicides between doctors and the rest of the population. The prevalence of depression in physicians is close to that of the general population and, if one looks critically at the evidence based literature, substance abuse in
      medical professionals approximates that of the general population. Controlled studies using DSM diagnostic
      criteria suggest that physicians have the same rates (8-14%) of substance abuse and dependence as the general population, and slightly lower rates compared to other occupations.Epidemiological surveys reveal the same. Hughes,
      et al. reported lifetime prevalence of drug or alcohol abuse or dependence in physicians at 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.

      Physician suicide has been correlated with personal,
      professional, and financial stresses, Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according
      to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician. Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment. And all of this can be explained by the current state PHP system that is in place.

      The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of
      the stigma attached.”

  • DoubtfulGuest

    Okay, I’ve read the Knight/Boyd paper and am working on the rest. I was disappointed that there seems to be no distinction in these programs between substance abuse and mental health counseling? It makes a big difference in terms of potential for patient harm. I had difficulty with the “coercive” issue, because, well, sometimes even doctors have to do something they don’t want to do, in order to avoid hurting another person (who also matters in the world). But I can see how that could be taken way too far.

    Another issue I found problematic was the different ways doctors can get in trouble during monitoring for potential relapses. For example using an EtOH-based hand sanitizer (which they say is more typical in hospitals than isopropyl alcohol based) can yield a positive test. Then the physician has to go through all the procedures for a suspected relapse, including being reported to the licensing board…for sanitizing their hands. :/ I’d like to learn more about how depression and anxiety themselves are handled by these programs, although I see that these often are underlying factors in substance abuse as well.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thank you for sharing, You are spot on. I have heard many doctors complain about the same. One woman doc inOregon could not get her license without a huge delay. Why? She sought counseling for depression. Why? Because she was in the middle of her divorce. Who isn’t depressed in the middle of a divorce??

    YES! She had to contact her marriage counselor to get her psych records. Yes. Her marriage counselor had since stopped practicing so YES they did make her seek out another therapist to see to make sure she was safe to practice in Oregon.

    What other profession is so scrutinized? And for such normal feelings. If you are NOT depressed going through a divorce you should get checked out. Geez.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Absolutely correct. Over-regulated. Micromanaged and macromanaged (is that a word).

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thanks! Just got word that Al Jazeera America will be filming a special on ideal medical clinics fir AMERICA TONIGHT at my office in a few weeks. That should take the physician suicide discussion to the national stage!

  • DeceasedMD1

    Eliza thank you for your thorough explanation. I gather PHP’s are working with mental illness as well without psychiatry involved just these ASAM docs? I wish someone would write a short article on this. Even what you just wrote published here would help. I dont think anyone on here except a few know about this. thank you so much again. I wish there was more that could be done. If Journal of Addiction Medicine has exposed it, that says it all.

  • DeceasedMD1

    wow that is pretty creepy. I recently read that they are pushing to test all physicians as part of their employment in the NY Times -and i think you mentioned this as well. Anyway, I was appalled. Well now I know where all this hype is coming from. I had no clue about where this came from but it sounded insane and intrusive. Isn’t the fact it was in the Journal for Addictions by well respected authors getting any attention? I don’t think I am going to read medscape anymore.

    • dontdoitagain

      Welcome to the club. As a commercial license holder *I* am drug tested all the time. I prove my innocence over and over and over. It’s a really good deal for the companies who do the testing. They have expensive technicians, labs, offices etc. Of course it’s for the public safety and if I have nothing to hide, then I should be thrilled to (constantly) prove to everybody that I don’t do drugs. I think some of our DC senators own shares in the drug testing companies, so it is in their best interest to have everybody tested. So yes, I take the unpopular view that doctors, nurses et al and police officers of every stripe need to submit to the same level of oversight that a lowly truck driver gets. OR quit harassing me over it. Fair is fair.

      • DeceasedMD1

        LOL. Talk about pissing you off! This is getting ridiculous. sort of treating everyone as a suspected criminal. oh except the real criminals so to speak.
        Perhaps we should test Congress too then? They should be for testing since it will help the economy. Right?sorry for the sarcasm.

        • dontdoitagain

          Are you kidding me? Congress is full of doped up people. Did you get a load of good ole’ Hank, congressman from Georgia, talking about Guam (an island for geography challenged readers) capsizing if we sent more troops there? Oh yeah, test those congressmen/women. If they pass laws that the rest of us have to deal with, then hell to the YES! Drug tests for all.

          On the serious side, I consider that absent any real REASON to suspect people of drug abuse, then drug testing is an invasion of privacy, covered by the 4th amendment to the constitution.

      • http://www.fornits.com/phpbb/index.php?topic=37626.0 Elizablackwell15

        They are not currently comparable in the current system. I suspect you are tested under Federal Drug Testing Guidelines, DOT, or some other system that provides a high level of procedural protection with strict chain-of-custody, custody and control form, MRO review, split specimen with the right to challenge at an independent lab of your choice, an appeal process, etc. Moreover, you are tested for a specific number of substances with FDA approved tests with cutoff levels that have been well thought out. (probably 5-12) And there is no way you are bI doubt you are being tested with long term alcohol biomarkers, hair, nails, etc. So the statement “if I have nothing to hide, then I should be thrilled to (constantly) prove to everybody that I don’t do drugs approaches being completely correct but it is not 100% correct. Human error and false positives are a problem even under the best of circumstances. As an MRO for the MBTA I have thrown out several positive tests (mostly for PCP) after careful interview and analysis. The point is you need procedural safeguards as well as accuracy and honesty.

        Now let’s look at PHPs (Physician Health Programs) populated by the “impaired physicians movement.” They tend to think in black and white and don’t believe in cutoff levels. (“it’s either their or it ain’t” I heard one misguided MRO for a PHP tell a doctor once) and as untrue as this statement is there is no arguing with this type of mentality. Secondly they have introduced tests such as long term alcohol biomarkers such as EtG, PEth, EtS that are not FDA approved. They are laboratory developed tests (LDTs) and there specificity is unknown. The only drug testing systems that use these tests are those where the power differential is very high (prisoner, guard type relationship). The PHP -Doctor relationship exceeds that of the prisoner-guard. They are using long term (*biomarkers (weeks to months), alcohol, “health professionals panels,” etc. etc. Of course they are making a ton of money off this as doctors are tested 1-3x per week and it is self pay. Any positive, innocent, explained, caused by a valid prescription results in being evaluated at an out of state facility.

        So this is comparing apples and oranges.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Appreciate your comprehensive coverage of this underreported issue with immense implications for both physicians and patients. I was unaware of the patient suicides linked to these regulatory abuses. Thank you for shedding light on this. You are welcome to insert links in your future comments.

  • DeceasedMD1

    I wish you would write a brief article just like your post. most of us on here don’t know this. It is deeply troubling.
    I just wondered if mental illness is alos treated by ASAM docs without the input of a psychiatrist. Inn other words, in addition to their corruption in addicion medicine are they starting to practice outside of their supposed scope of practice?

  • DeceasedMD1

    wow is there anything that they don’t do? They seem to be experts on just about everything! Are most of them internists at least? They are good at throwing around names of well known physician specialists that they may think gives them credibility but far from that. At least reading this they seem transparent to me and incompetent at judging personality disorders from infectious disease. THis is ridiculous. I have no clue how they got empowered in this way.-you told me i think but it is just hard to believe anyone would believe them.

  • DeceasedMD1

    one more thing from my last message to add. Is the referral to PHP instigated by the medical Board for physicians having reported problems?
    Is a PHP a forced mandatory referral or voluntary for unsuspecting physicians seeking help themselves.

  • DeceasedMD1

    1800 how’s my medicine? LOL. Unreal.
    So if you are reported even anonymously, is it mandatory for the physician to go to the PHP? I thought the board could only mandate treatment?

  • DeceasedMD1

    You are very perceptive. This term “moral entreprenuer” –the idea seems to repeat itself throughout history. What this sounds like to me is sort of similar to religious zealots that act overtly upon some “moral” code, when underneath their motivations are very aggressive and persecutory towards others. In essence what they cannot accept about themselves they project that ‘evil” onto others. So makes sense that all the disrupted screwed up addict docs are running the PHP’s and are likely getting high as we speak.

    So in essence if an MD is reported, the PHP is more powerful than the medical board. You are mandated to be interviewed by them and they can then mandate any treatment they see fit? Have I got that right? It is so shocking I am speechless. how can they actually enforce an interview? They can’t take away your license if you don’t come since they are not the medical board. Correct?

  • DeceasedMD1

    PS i assume if you are in a state without the “blessed” PHP they can’t touch you but that is only something like 3 states?

  • Dylan Mann

    I am in my last year of med school and my good friend from college, just after finishing Radiology residency, just committed suicide. He was about to do a fellowship and had already tentatively been offered a lucrative faculty position at his residency program that he was very excited about. He was future oriented, but he also had Bipolar Disorder. It’s incredible that he was able to achieve as much as he did, while basically keeping that a secret from almost everyone who knew him. He didn’t want to die, but he had a break from reality and caused his own death in the process; to me, it’s as if he died in a car accident or fell off a bridge, b/c I really think this was beyond his control. He was getting treatment for his problem, but he was always going to be at risk for this, no matter what. I’m proud of him for what he accomplished in life and I’m glad to have known him. What happened to him is tragic.

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