Pamela Wible MD’s book, Physician Suicide Letters Answered, is a devastating view of raw pain, the pain of young, energetic, highly committed young people motivated to help and heal. These healers themselves have been plunged into the spiritual, physical, emotional, and intellectual hell of suicidal thought and action. Iatrogenic illness in action (iatrogenic illness being that which is caused by medical practitioners). Unfortunately, and tragically, the iatrogenic illness that Physician Suicide Letters Answered lays bare is that caused by medical school/practice. In addition to dedicated, competent doctors, medical schools are turning out corpses. Unspeakably awful.
Yet, speak we must! The courage of Wible and her co-authors, the words of those who were driven to contemplating or completing suicide and grieving people who cherished them is essential to creating health and well-being in medical education and in the students thereof. A problem unnamed or unspoken cannot be relieved. Wible and her co-authors have taken a first step to ending colossal ill-health in the education process that should be designed and dedicated to robust health within the medical community.
It is no secret that acquiring a prized MD is a pursuit of exceptionally high demands and expectations. Indeed, it is essential that demands, expectations and, more importantly for the health of patients, performance of doctoring skills be exceptionally high. Lives depend on that being so. Harassing, belittling, demeaning, and physically and emotionally violating students in not an avenue to producing healthy humans.
The old corollary about the definition of insanity comes to mind: Insanity being defined as doing the same old thing and expecting different results. Treating vulnerable, young, idealistic students in degrading, humiliating, victimizing ways and expecting healthy practitioners to result is truly insane. And utterly shameful.
A long-time RN, I am no stranger to egregiously unkind and angry behaviors displayed by doctors toward other doctors, toward other health care professional and even toward patients. Indeed, I have been on the receiving end of such behaviors, both as a professional and as a patient.
If we know something is a problem, particularly a problem that is causing others to kill themselves, there is an implied moral imperative to take action to solve the problem. To that end, I am offering the following suggestions:
We, as individuals and as a society, must speak out and categorically demand that all abusive, demeaning attitudes and behaviors stop — immediately. Those behaviors are antithetical to health; therefore, have absolutely zero legitimacy within health care institutions or practitioners.
Medical schools and other institutions must implement healthy physical conditions within them. Hospital food is notoriously unhealthy; donuts, sandwiches made with white bread and coffee are inherently unhealthy. Sleep deprivation is unhealthy. Lacking time for exercise, relaxation, or time with loved ones is unhealthy. Living for years on end in conditions of high stress is unhealthy.
Imposing unhealthy living and working conditions will never result in healthy doctors, whether student or seasoned practitioners. Expecting existing conditions to produce health in anyone, doctor or patient is purely and simply nuts.
Doctors, patients, and the public must prioritize health in health care institutions and practices. Actions as simple as increasing the number of fresh, organic fruits and vegetables in our institutions must be undertaken. It is virtually impossible for hospital staff to access healthy food in the middle of the night.
All of us, no matter how successful and powerful, perhaps especially those who are successful and powerful, must treat everyone with respect and caring. Health care practitioners ought to be at least polite to one another.
It should be understood that all health care professionals by the nature of their work will encounter extraordinarily painful situations and that sometimes those painful situations will be caused by human error. Receiving spiritual/psychological/emotional support and sustenance must be expected/required.
PTSD must be acknowledged and treated. Major efforts must be extended to prevent practitioner PTSD, starting with the conditions of medical education.
Medical students coming from experiences and expectations of being super-successful must be educated/coached in how to successfully cope with the inevitable failures they will encounter/mistakes they will make.
I write this from the perspective of someone who has on more than one occasion experience suicidal thoughts; my own flirtation with suicide arose from unrelenting, unmitigated exponential physical pain. I knew I could not tolerate more that 4 or 5 days of such pain. I had no desire to die, but an overwhelming need to stop the pain. Fortunately, Botox injections saved my life. Please note, those life-saving injections were only available to me because I could write a check to cover the cost. Had I been dependent on my health insurance, I would likely have attempted suicide.
Long ago as a psychiatric nurse, I hypothesized that suicidal ideation was not really aberrant unusual behavior but likely almost inevitable at one time or another in the course of a human life. We need to stop re-victimizing people who are feeling suicidal by making them feel they are hopelessly psychopathological because of those feelings.
One last suggestion stems from my experience as an Appalachian Trail through-hiker. Setting the goal of hiking over two thousand miles in six months meant I would inevitably confront the desire to quit. The contract I made with myself was that I wouldn’t allow myself to quit while I was having a bad day; I could only quit when I was having a good day. The self-imposed structure worked.
More importantly, when I was forced to deal with long-term Lyme and pharmocogenically-induced adrenal insufficiency which robbed me of five plus years of productive happiness, the same strategy kept me going: I could not, would not, quit, i.e., suicide while I was having a bad day.
I would coach/encourage all medical personnel, student or seasoned professional to adopt the same strategy. And to seek out and get the help they need to be restored to enthusiastic, productive, healthy professional lives. It is an inherent responsibility of all of us, no matter what our role is, to extend compassion, caring, and support to one another.
Rita Losee is a nurse.
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