For Meg — with sorrow.
We have failed to address the scale of suicide and mental illness in the medical profession, which is a global issue. Each of us can help prevent doctor suicide with these five strategies both locally and worldwide:
1. We can destigmatize mental illness for doctors and medical students
First, we can change the negative attitudes to mental illness in our profession by accepting that doctors and medical students have the same risk factors as the general population. When our patients have mental illness and alcohol and substance misuse, chronic illness or pain, negative life experiences and relationships, fractured family structures, family of origin histories of violence or suicide, and histories of child abuse — we may experience “triggering” of our own histories.
We often have a perfectionist, self-critical, hypervigilant and task-oriented personality styles that make us great doctors but put us at risk of failing our own impossible expectations. Only by fully understanding our potential vulnerabilities can we be proactive in mitigating them.
However, instead of recognizing our common risk factors, most doctors wear well-developed emotional “masks” due to the damaging stigma of mental illness, and as a consequence, many of us fail to identify signs of distress in our colleagues, particularly when functioning well at work. Unfortunately, unhappiness, stress, and burnout are often regarded as normal in medical workplaces, rather than as warning signs of mental illness.
Disclosure of doctor distress often results in “career suicide,” the unfortunate term whispered in medical workplaces. Our harsh medical culture is intolerant of doctors who are “not coping,” “emotional,” “overly sensitive,” “not up to it” and “not pulling their weight.”
In view of this systemic stigma, if we suspect a colleague is quietly suffering, we need to do more than ask “are you OK?” or send a superficial SMS. Making time to meet one-on-one for an informal coffee to connect and listen is an effective way to offer each other mutual support without our “masks.”
2. We can encourage all doctors and medical students to have their own trusted independent doctor and seek help early
Like other patients, doctors do not always have insight into their own problems. We can get better at the early recognition of the atypical symptoms of mental illness our colleagues may exhibit at work — such as uncharacteristic irritability or anger, difficulty concentrating or making decisions because of excessive worry, lack of empathy, social withdrawal and/or fatigue or low energy due to insomnia. However, we should never become a treating doctor to a colleague at work or a friend because we cannot offer them optimal comprehensive care.
Only about 50 percent of us have our own treating doctor. And if we do, we tend to present late or in crisis, partially self-medicated and with a poor prognosis, rather than for early intervention. We can help encourage all our colleagues in our workplaces to have regular annual preventive health assessments with an independent GP, including routine mental health screening. By building a trusted relationship with a treating doctor, we are more likely to also attend for routine debriefing, optimal early mental health intervention, and postvention after direct or vicarious traumatization, particularly involving suicide.
3. We can provide optimal management of mental health problems in doctors and medical students
In my experience as a GP treating other doctors, I have learned to recognize that doctors may present with a mixed pattern of depressive disorder, anxiety disorder and post-traumatic stress disorder related to acute and chronic exposure to patient misery, violence, abuse, and death, including suicide, which makes diagnosis and treatment challenging. Structured formal mindfulness-based cognitive behavioral therapy has been found to be one of the most effective treatments, but how many doctors actually know what this involves?
As doctor suicide is more common than in the general population, doctors are frequently traumatized by a colleague’s death and then placed at risk of suicide themselves. For patients at risk, doctors are trained to respond: “Many people who are under extreme pressure feel like harming themselves. Have you ever felt this way?” This can be a difficult question to ask a colleague in distress, but it is an essential part of ongoing suicide risk assessment.
4. We can change our medical culture
A medical career has never been more challenging or complex, and doctors, like all health professionals, require support. Although doctors tend to take very little sick leave, many medical workplaces fail to support doctors when they request a lower patient load or time off work because of skeleton medical staff levels, which is a major occupation and safety issue.
To our shame, the families of young doctors who have died by suicide have recently described our medical culture as “soul crushing.” Systemic occupational health and safety issues predisposing doctors to mental health problems include bullying, harassment, discrimination, racism, and escalating patient complaints and medico-legal action. Recommending information about resilience to doctors for these complex issues is as foolish and harmful as trying to fix a displaced compound fracture by covering it with a dressing.
5. We can make our medical organizations work for us
Each of us can engage with our medical organizations to make them work together and present a powerful united voice of advocacy for doctors at a national and global level.
Medical organizations can feature presentations doctors’ mental health prominently in conferences; offer training doctors to care for the special needs of other doctors and medical students; provide resources and education on healthy organisational culture and how to address bullying, harassment and discrimination; and include mental health promotion and information more prominently in newsletters and websites on an ongoing basis.
Most importantly, together, we can all celebrate the great aspects of being a doctor, such as the joy and satisfaction in making a difference to people’s lives, the deep insights into life, working with people from diverse backgrounds and learning about amazing advances in medicine.
None of this is easy, but we can prevent the tragedy of doctor suicide — together.
Leanne Rowe is a physician in Australia and is the co-author of Every Doctor.
Image credit: Shutterstock.com