Physician suicide: We need safe spaces to talk about it [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“Suicide is a path, whether fast or slow, that a person chooses to take because of their own reasons. We certainly can never predict suicide or truly understand it. But with that said, every time it happens, it is a tragic loss of life that time can and will never heal.

We must do more to support our physicians in training, residents, and established clinicians. Like how we sit at the bedside with patients and listen to their stories, someone needs to listen to what doctors have to say.

This is an epidemic that we must address right now. We must shine a light on the underpinnings of stress, dissatisfaction, grief, guilt, and pain. And we must drag out of the shadows a broken healthcare system that burdens many of our physicians.

It starts with making it OK to talk about suicide and to foster an environment where it is safe for medical students and physicians to share their stories privately and publicly. We absolutely must create safe spaces for conversations to be had at all levels of medical education.”

Ton La, Jr. is a medical student and can be reached on LinkedIn.

He shares his story and discusses his KevinMD article, “Physician suicide: We need safe spaces to talk about it.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Here in the show, we have Ton La Jr. He’s a medical student and recent law school graduate, and he wrote the KevinMD article “Physician suicide: We need safe spaces to talk about it.” Ton, welcome to the show.

Ton La: All right, Dr. Pho, great. Thanks for having me.

Kevin Pho: We’ll get into the article a little bit, but first off, can you share your story and your journey to where you are today?

Ton La: Definitely. So I’m based in Houston, Texas, hot Houston, and I’m a fourth-year medical student at Baylor College of Medicine. I recently graduated last December from University of Houston Law Center, and I’m applying for physical medicine rehab residency this fall, with hopes of staying in town.

I love writing. I’ve written for KevinMD for a few years now. I just like to advocate for issues rarely talked about in open settings, such as physician suicide, mental health, the opioid crisis, COVID-19 especially, and just the everyday experiences a medical student has. Before medical school, I wish I had heard these stories, because they give you more insight into what the experience is like. Hopefully, just sharing my experience helps other incoming medical students and current med students.

Kevin Pho: So I don’t talk to very many medical students who are also law school graduates. Can you tell me a little bit about that journey into law school and why you decided to take that path?

Ton La: Yeah, sure. So I initially got interested in the law around the time Obamacare, the ACA, came around. It was about sophomore year of college, and I thought, “Why not?” I took my MCAT and did pretty well. I had some time to explore the space, and I did pretty OK. I got accepted to the University of Houston Law Center. They had a combined program with my medical school, and they took me in with open arms. It was an incredible experience, and I have so many great classmates to thank for the journey I’ve taken.

I’ve taken so many different health law courses, including disability in the law, genetics, bioethics, the health care industry, Medicare and Medicaid law, and HIPAA. So I’m really grateful for the experience, because now I hope down the road to perhaps teach what I know, especially in the health law realm, to future medical students as a professor, and possibly teach residents too.

I think there is a lot of intersection between the two. You think both of them are different, but both fields aim to help people. Medicine is, of course, through diagnosis, management, and acute and long-term care. But on the law side, you actually help people with their acute problems too. Sometimes they have something they need to take care of, whether that’s finances or a lawsuit that’s pending, or they just want legal advice for their own personal lives to make their lives better. So hopefully I get to help people in both ways down the road.

Kevin Pho: Wonderful, and best wishes on your continuing medical education journey.

Ton La: Thank you.

Kevin Pho: So let’s talk about that KevinMD article that you wrote. It’s titled “Physician suicide: We need safe spaces to talk about it.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Ton La: Oh, definitely. So I was part of the American Medical Student Association, and about two to three years ago, there was the annual conference, where medical students from all across the country, premed students, and family members come to explore what it’s like to be a medical student and the steps afterward. There was this documentary called Do No Harm, and we were actually the very first showing of it. It’s all about the increasing rate of physician and med student suicides across the nation, something that’s rarely talked about. Sometimes it’s published in the media, but then, as news goes, once it’s out there, it fizzles away, and there isn’t sustained conversation about it.

After watching the documentary, it was a very profound experience. I remember afterward, probably 50 or 60 med students got in line at each microphone just to say thanks to the producers and to talk about their experiences. One by one, every student talked about medical school and how tough it is: from having a family member diagnosed with cancer and having to balance your life with that, to finding feelings of anxiety and depression, with other students even sharing their own attempts at suicide. It was very, very eye-opening, and it was very, very provocative.

After a few students shared their stories, I decided to walk up to the line and share mine. I would say it was definitely one of the hardest things for me to do. Personally, I like to keep those things to myself. But when I walked into line and waited, I thought to myself, “Should I do this? I’m still a medical student. What if someone in the audience is from my med school? What if they hear me sharing my honest feelings?” But I told myself this is something I’ve kept in for so long, and I really felt compelled to share.

So after I walked to the mic, grabbed it, and started talking, I felt like my soul opened up. I talked about just how tough it was. Not just the information overload, which is not something I’m necessarily complaining about; it’s more so having so much information given to you and, at times, not having the support that you would expect from your peers. And just overall, for me personally, it was a very tough time. I’ve had family members diagnosed with pretty severe conditions, I was thinking about finances as well, and not passing, or maybe I’ll just say it, all right, failing a few exams: shelf exams, school exams. Sometimes people ask me, “Do you really want to do medicine?” It hurt me a lot, especially to know that I didn’t have the support that I would have liked.

So afterward, I started crying. I don’t like doing that, but it was just a natural reaction. I felt like I finally got to tell my story. A lot of students came up to me afterward, and they said, “Thank you for sharing it. It’s something we experienced too.”

And then that opened up the overall conversation. There were families of suicide survivors in the audience. One of them was Dr. Boyce Fish, a dear friend of mine. Dr. Pamela Wible wrote an article with him, with the story centered around him, but he was anonymous back then. Recently, I was talking with him about how I wanted to put my story, our story, out there about what happened that night, and he said, “Go ahead, put my name out there, if it helps with the conversation.” So I did. I spoke with him and his lovely wife, Mrs. Fish, and I also spoke with Rachel Dawson, who’s the wife of Dr. Dawson, who was a resident. He took his own life and the lives of his two kids, and she shared her story. There were other families, too, that stayed into the late hours of the night, and we all just talked about experiences and what needs to be done in medical education, from the medical school level to residency, fellowship, and even as an attending physician.

Because if you read Dr. Fish’s story on KevinMD, he was an ER attending physician. What spiraled him into his suicide attempt was a young girl who had influenza. He thought everything was OK with her, so she was discharged, but she came back with respiratory failure, and she ended up passing away. That cut deep for Boyce.

So overall, what I wanted to get through with the article is that suicide, even now, and I think for a very long time, is a stigmatized topic. It’s hard to talk about, because if you want to talk about it, you can say your condolences, “I’m sorry this happened,” but how can we be productive through this conversation? And more so, can we keep this conversation going? It shouldn’t take more suicides happening for this conversation to keep going. That’s not right. That’s not the correct way, or even the fair way, to go about it. I think this is something that affects medical students, hundreds, thousands, across the country, even internationally.

My sense is that although we can never really truly understand what drives a person to attempt suicide, or understand the underlying factors, I’m a firm believer that if you don’t have the support in medical school, it sort of puts in the seeds for chronic stress, fatigue, exhaustion, feelings of inadequacy, even depression, going into residency. And if you’re not fortunate enough to go to a residency program that supports mental health and truly advocates for its trainees, it’s dangerous. You can go on to fellowship, if you choose to go that route, and then you become an attending. At that point, you have to think to yourself, once you have full autonomy to care for patients, “Who’s caring for you?” Because it might have been years, maybe a decade plus, of not having the support that you needed, and now your patients’ lives are in your hands, literally.

So I hope my piece contributes to the conversation, especially as a med student putting at least part of my story out there, so that other students feel comfortable at least sharing, either in public or private spaces, with their deans, their family members, and friends. This is a serious issue, and it shouldn’t take more suicides happening for the conversation to keep going, because it’s just not the right thing to do.

Kevin Pho: So you said that you weren’t comfortable sharing your story until this documentary. Now, what are some specific things that need to be put in place during medical education so more medical students can share their stories before it’s too late?

Ton La: Oh, that’s great. It’s something I’ve thought about recently too. There is something called story slams. I think several medical schools have put this into place. It’s where you can anonymously submit a pitch of your story, and then, in an open forum where you’re with other medical students, residents, and attendings, each person goes up to the mic and just talks. It’s a safe space where you can openly and freely put your feelings, thoughts, and ideas out there, so others can hear what you have to say. I think there’s not enough of that. For me personally, I love to write, because that’s one of my ways to express how I’m feeling and my opinions on things. But it’s important for schools to realize that there need to be more avenues for students to express how they’re feeling.

Story slams are one idea. Another idea I thought of is learning communities. I think this was definitely explored at different medical schools. There was actually a study recently, I think it was at the Saint Louis University School of Medicine. It was a longitudinal study, and they wanted to combat the rates of depression and anxiety reported by their medical students. I believe it may have been a six- to 10-year study, where they made many changes. They cut the curriculum hours. They instituted learning communities, where you have physicians being mentors to a small group of students, and also just having that time with deans to talk about issues you’re having with family, personal life, and school. They also had multiple checkpoints during the preclinical and clinical years to just check in with students and see: “How are you doing? Is there something you would like to talk about? Anything that’s on your mind?”

Remarkably, the rates of depression and anxiety dropped significantly. I believe depression dropped around 80 percent throughout the study for first-year students, and then anxiety dropped about 75 percent. So it works. It’s just a matter of schools knowing right off the bat that once you’re a medical student, you will encounter feelings of self-doubt. If you don’t pass something, you have to have the stress of, “OK, I have one more chance to pass the exam, or I might not advance in my medical school career.” Just those things.

I’m hoping more and more schools, and I believe it’s happening, I’m just hoping that one day the majority of schools in the U.S. have those safe spaces for students to vent, or, one easy way to put it, to just say what they feel and get the help they need, in terms of therapy or just talking. Because I’m a firm believer, too, that talk is one of the best forms of therapy. Sometimes, as med students, we don’t talk enough, because we like to hold things in. We basically feel like we can take care of things ourselves. But when things become too much from external factors, like school, family, finances, personal life, and feelings of not being fulfilled, especially with the rigors of med school, just having those support systems in place, I think, will help med students across the country.

It’s a slow process, for sure, but I think once more schools publish what they’re doing in journals such as Academic Medicine, on PubMed, other schools can see what they’re doing and probably model off of what’s successful. I think we can definitely take positive steps forward in reducing the rates of med student suicide.

And one other thing I wanted to point out is that the literature on med student suicide is lacking, which is not surprising, because when it happens, you’ll hear about it, but schools themselves don’t want to put it out there, because, understandably to me, it might discourage people from applying to the school. But it’s also important to know that if you don’t acknowledge that it happened, it affects the current cohort of students, knowing that the administration is not being forthright about what happened. So I think it’s about transparency: schools emphasizing it’s OK to be vulnerable, and having vulnerability actually be part of the curriculum. Writing, talking, all those ways are ways to tackle med student suicide, and even beyond that, physician suicide.

Kevin Pho: We’re talking to Ton La Jr. He’s a medical student and recent law school graduate, and he wrote the KevinMD article “Physician suicide: We need safe spaces to talk about it.” Ton, there have been some changes in medical education that help address medical school burnout. For instance, USMLE Step 1 is now pass/fail, and more and more clinical rotations are now pass/fail, perhaps trying to take that pressure of grades off medical students. Now, do those factors help, or does more need to be done?

Ton La: It definitely helps. I believe the Saint Louis University School of Medicine, as part of that, transitioned to pass/fail. It definitely helps, because it takes the pressure off getting a B, a C, what have you. But I think something that’s unknown to premed students is that even if you are in a pass/fail system, you still are ranked. So if you’re gearing up for those really competitive residencies, like surgery, radiology, dermatology, and plastic surgery, you’re still ranked, and that’s based on your preclinical grades. Although it’s pass/fail, the school internally ranks you; they just never release it to you. So when you enter that MS3 or MS4 year and you find out you didn’t make AOA or get other honors, it’s because you were ranked from the beginning. It just wasn’t told to you. So I think that’s another thing where there’s not enough transparency. Pass/fail is great, but it’s sort of a bandage: “OK, I’m not being compared with my peers at the moment.” But actually, you are. So definitely more needs to be done.

As far as Step 1 being pass/fail, I think that’s great. It’s a tough exam, for sure. But because Step 1 is pass/fail, especially with this transition, with students applying with their Step 1 and deciding whether to take the score or not, more emphasis is actually now placed on Step 2. I’ve actually spoken with a lot of doctors and current students about this, and they feel even more pressured to do even better on Step 2. Right now, we’re sort of in a flux: How will residency programs take that? Will they consider school prestige more in their rankings of students, or even in offering interviews? How much emphasis will they put on Step 2?

So I think when it comes to board exams, there’s always going to be stress, even if you make it pass/fail. And even recently, they took off Step 2 CS; that’s no longer in play, which is great. That takes a lot of stress off. But I think board exams are here to stay. There’s a reason we have them. If you want to gear up for certain specialties, it’s a way to know where you’re at and to work toward the goal of the score. I think that’s healthy. It’s OK.

But I think more needs to be done from the medical schools themselves: support from the get-go, from orientation. Deans need to be open to having those tough conversations with students, not pushing students aside, and just having safe spaces, like I said before. So I think there’s a lot more room to go for schools to give that support to students, but I believe we’re definitely in the right direction. My med school, for example, is phenomenal. We have learning communities, we have a peer resource network, and we have individual specialty mentors for each student, depending on what you want to go into. So I would say my med school is a great example of a model for mental health support for students. It’s just a matter of whether other schools can do that for their own students too.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Ton La: Yeah, so I know it’s a very wide-ranging audience. I think I have probably two take-home points. One is that physician suicide, and also suicide among med students, is unfortunately going to continue to happen. It’s unfortunately become a norm, just to put it plainly.

But with that said, I think regardless of whether you’re in med school or not, if you know anyone in medicine, or even just health care in general, suicide doesn’t just affect us. It affects EMTs, RTs, anyone who’s treated COVID-19 patients. It’s a serious situation. So if you know anyone, reach out to them. You don’t need to have a reason for it. Just reach out to them. Just ask, “Can you meet up for lunch or breakfast, have a phone call, a Zoom call, what have you?” Just reach out and truly, truly put yourself there for that person you’re reaching out to.

I think this is truly a grassroots movement, honestly: everyone from the entire society understanding that this is a thing that’s going to continue happening, and it’s up to us to support the people who care for us. Because if we don’t do enough for them and this keeps happening, hundreds to thousands of medical trainees and physicians will keep dying by suicide every year. It’s just not something that sits right with me, and I don’t think it sits right with anyone. We need more than just writing articles, like what I’m doing. We need to have a productive conversation moving forward, and for med schools and residency programs, and even afterward, to show that support to those who invest their own time into learning medicine and treating patients.

Kevin Pho: Thank you so much for sharing your insight and time, and thanks again for being on the show.

Ton La: Thanks, Dr. Pho. I appreciate it.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes