Preventing Physicians From Dying by Suicide: We All Have a Role to Play

“Bronx doctor jumps to his death from hospital roof” screamed the title of the piece in a New York City newspaper last August. My gut tightened, and the familiar refrain of “Oh no” leapt from my throat. I’m transported back to the Thanksgiving weekend of 1962. That is exactly how I, a medical student, responded when my landlady told me that my roommate, Bill, also a medical student, had killed himself the day before. Since that dark time, I’ve lost many physician colleagues and patients to suicide, and I have borne witness to, and counseled, scores of heartbroken and grieving medical families. There is much work to be done—but it takes a village. And that is why, on World Suicide Prevention Day on September 10, 2017, I made a commitment to reduce the number of doctors who take their own lives.

Three to four hundred doctors die by suicide each year in the United States. That’s a doctor a day. The American Foundation for Suicide Prevention’s benchmark is to reduce the number of Americans who kill themselves (44,193 deaths in 2015) by 20 percent by the year 2025. I shout out that this is not only doable, but we can do better than that.

Why focus on doctors? First, it’s not generally known that physicians are at an elevated risk of suicide. Second, a significant number of physicians are dying of treatable psychiatric illnesses, mainly depression, PTSD, bipolar disorder, and substance use disorders. About 10 to 15 percent (or higher) of physicians who kill themselves have received no treatment whatsoever. Their confused and panicked families watch helplessly as their loved one descends from wellness to illness to self-destruction, oblivious to their pleas to seek medical and psychological help. Third, even when ailing doctors do come to us for assistance, they fight becoming a “patient” and far too often fall through the cracks and do not receive state-of-the-art care for their psychiatric illnesses. Many do not realize how sick they really are and may harm themselves. And troublingly, sometimes we don’t either. Treatment becomes a dance of deception.

Stigma attached to mental illness is rampant in the house of medicine. I argue that it is even higher than in the general public—and that is shamefully high. Make no mistake, stigma kills. Medical training and its everyday practice are demanding and rigorous. Physicians have to be on top of their game—smart, able to think clearly, decisive, energetic, in good spirits, and empathic. All or most of these qualities are affected by psychiatric illnesses, and this is very scary for doctors to experience. But instead of going to their doctor to get help, even if they have one, most physicians try to fight it, carry on, and prevail. What comes next though is worse; they feel “less than,” “pathetic,” inadequate, deeply ashamed, and chillingly alone. More often than not, they remain tight-lipped. Any progressive, nonjudgmental beliefs they once embraced about mental illness go flying out the window. They are filled with self-loathing that they no longer belong in the hallowed halls of medicine and feel they are either a weight on or embarrassment to the profession. Armed with medical knowledge about sure-fire ways of dying, it is not a stretch to imagine what comes next.

But, there is good news and lots of hope. The American Association of Medical Colleges is building well-being initiatives and early recognition of students in distress into our medical schools. Almost all have on-site counseling services to keep our students well—and safe. The Accreditation Council for Graduate Medical Education is demanding and incorporating health education curricula into promotional standards, including many recommendations for 24-hour availability of crisis and acute suicidal intervention. Both Drs. Carol Bernstein and Matthew Goldman have written eloquent pieces about these initiatives in recent issues of Psychiatric News (September 15 and October 6, 2017, respectively). This past July, the National Academy of Medicine hosted the first meeting of the Action Collaborative on Clinician Well-Being and Resilience. It is responding to the epidemic of burnout in today’s doctors and setting research parameters and implementation goals to restore the nation’s physician workforce to one of happiness and career satisfaction as well as fighting suicide among physicians.

The AMA and many specialty groups—chief among them, APA—have established well-being committees and informative programs to educate their members. Thanks to our president, Dr. Anita Everett, APA has established a work group on physician wellness chaired by Dr. Richard Summers, and reports on its work, along with a special series of articles on physician burnout and wellness, are being published in Psychiatric News. APA has also posted a toolkit to help psychiatrists assess their well-being and make them more aware of steps they can take to safeguard it; the toolkit also addresses individual and system-level challenges that contribute to professional burnout. The reach extends well beyond our members to include expert training in treating physicians living with serious and life-threatening psychiatric conditions.

On the front lines, doctors have access to a menu of print and digital articles that tell them what to watch for in terms of their own health and functioning. This includes toolkits of how to reach out to each other. It is part of the ethos in medicine that we must be our brother’s (and sister’s) keeper. Medical meetings offer programs for families of physicians, again to provide them with education. In the fight against stigma, more and more doctors are going public with their personal stories of depression, bipolar illness, alcoholism, and drug addiction. These are human-interest narratives, and their accounts are a gift to physician readers. They make it easier for other doctors to bite the bullet and go for help themselves.

But it doesn’t stop here. I am also appealing to the general public to ask for their help. Riding to work on the subway every day, I read the banner “Want to help keep New York safe? Show your support for the ‘If you see something, say something’ movement.” I am urging patients to speak up and reach out to their doctors if they see something amiss. My research on physician suicide has shown that patients who have been with the same doctor over time do recognize if their doctor seems down, preoccupied, rushed, forgetful, or less compassionate. But not knowing their place, they remain silent. They are filled with remorse and regret upon hearing that their beloved doctor has died by his or her own hand.

Dr. Shelly Waldman-Goodwin, the widow of 35-year-old anesthesiologist Dr. Gabriel Goodwin, whose untimely death prompted this piece, is quoted as saying “My husband was a good soul suffering from severe depression.” I thank her for speaking to the press and for being courageous and honest, for naming what is almost always kept in the shadows. She lends respect to her husband’s painful suffering and gives him an honorable death—sadly, not granted to all who die by suicide. My heart goes out to her and their three young children—and to the mental health professionals involved in Dr. Goodwin’s care. ■