Whether you like her or not, Meghan is speaking openly about suicide. For that, I am thankful.
In her interview with Oprah, The Duchess of Sussex shared her suicidal thoughts—and how she was obstructed from mental health care, told to “tough it out” and keep smiling. The Duchess needed a doctor. Yet doctors are reported to have the highest suicide rate of any profession as we’ve also been obstructed from mental health care, told to “suck it up” and keep smiling. That’s why “happy” doctors die by suicide. We’re seen as privileged with no rights to complain. So we hide our pain for fear of being stripped of our titles.
A physician friend witnessed 13 patients die in one day, then dealt with a physician trainee’s suicide attempt before begging for help. Superiors told her to drive out of town, pay cash, and use a pseudonym.
Most patients seek health care without jeopardizing their careers, yet doctors must report anxiety, PTSD, even postpartum depression and release medical records in applications for state medical licensing and hospital privileges year after year. Lie and you lose your license.
After surviving my own brush with suicide, I began a hotline to help suicidal doctors. A decade later, I’m still shocked by what I hear. A few recent real-life scenarios:
To ensure confidential mental health care, physicians:
- Use fake names or pseudonyms
- Pay cash or crypto (not insurance)
- Drive 300 hundred miles out of town
- Snailmail scripts to Canadian pharmacies
- Pay cash for drugs at multiple out-of-state pharmacies
- Self-medicate with in-office drugs
- Get drugs shipped from psychiatrist mom
- Obtain psychiatric prescriptions by endocrinologist spouse, radiologist friend, orthopaedic surgeon colleague
- Have non-physician family members feign mental illness to get psych drugs they divert to doctor
- See psychiatrists who only use paper charts with fake names or initials locked in fingerprint safes
- Choose psychiatrists who keep sparse or no medical records
- Travel internationally to get psychiatric care and meds
- Visit Jamaica to seek care from a psilocybin shaman
- See unlicensed healers who keep no documentation
- Use physician business retreats for mental health care
- Call suicide helpline anonymously for weekly check-ins
- Meet psychiatrists at secret entrance to office (or in hotel, alley, or parking lot)
- Share psych drugs with each other as medical trainees
- Rely on spouse or pastor for mental health care
Clandestine care makes mental illness non-discoverable. Physicians fear psychiatrists who may be mandated reporters to physician health programs (PHPs) and state boards. Both may publish their conditions on board websites and the National Practitioner Data Bank.
While compiling this ludicrous list, I got an email from a Texas psychiatrist who just opened his practice devoted to serving physicians. When I called to congratulate him, he seemed unaware that the Texas Medical Board (TMB) can subpoena his patients’ medical records without consent.
So maybe we’re back to the Jamaican shaman.
The bigger question: Why obstruct mental health care for a Duchess or a Doctor?
Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Human Rights Violations in Medicine: A-to-Z Action Guide, Physician Suicide Letters — Answered, and Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.
Image credit: Pamela Wible
