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August 30, 2017

The Mystery of Doctor Suicide: Signs and Stressors for Family and Colleagues

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Michael F. Myers, MD

SUNY Downstate Medical Center, Brooklyn, New York​

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Shock, surprise, disbelief, and horror are all nouns—and there are many more—that capture the initial reaction to the news that a physician has died by suicide. Mystery follows. “But why?” “This doesn’t make any sense—I just saw her last Friday, and she seemed fine.” “I knew he was pretty upset about the divorce, but this upset? I had no idea he was that grim.” “But she just passed her boards—this is crazy—are you sure it wasn’t an accident?” “Sure, he was on medical leave; I know he went away to a treatment center for cocaine, but he’s been clean for 2 months. He was going to come back part-time in a few weeks. This is so sad.”

In researching my bookWhy Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared, I interviewed approximately 100 people, mostly family members (but also colleagues, training directors, friends, and others) who had lost a physician loved one to suicide. What follows are some highlights, the “on the ground” observations of these intimate others. What they have to say does not explain everything, nor does it ease the pain and sorrow, but their narratives do help to solve the mystery:

  • Physicians tend to minimize the magnitude of their symptoms of anxiety, depression, drug and alcohol use, faulty thinking, and changed behavior both at home and at work. This tendency is not necessarily deliberate or intentional. The culture of medicine does not embrace what they perceive as “weakness” or “being less than.” Unlike their worried loved ones, many ill doctors are blind to the changes in themselves.
  • Physicians may dread seeking mental health care. A lot of this reluctance is due to stigma, shame, and fear of consequences to their reputation, job security, hospital privileges, medical licensure, malpractice insurance, disability insurance, and life insurance. Many of the folks that I interviewed pleaded with the physician they cared about to get help. Their exhortations often fell on deaf ears. If their loved one did seek help, not uncommonly he/she dropped out after a few visits, including stopping life-saving antidepressant medication.
  • Several families felt that their loved one’s physician colleagues were complicit bystanders or that they enabled the problem. They gave examples of colleagues not reaching out in a compassionate way, not trying to help with the workload, or making excuses for or covering up absences from work. Some wrote prescriptions for medications without encouraging their office partner to get a proper primary care physician. In other words, the message to colleagues is, “Just be a supportive friend, do not try to be their doctor—and don’t let them seduce you into that role.”
  • In situations in which their deceased loved one did see a psychiatrist and/or psychologist, the family members often felt excluded in 2 ways by the treating mental health professionals. Not only did the family members wish to impart what they were noting about their loved one at home, including their fears and confusions, but they also wanted to receive information and feedback about what their husband or wife or son or daughter was struggling with and how they might help (and not hinder) at home. They feel that family members of doctors (and even non-psychiatrist doctors who are being treated themselves) need more information about common diagnoses—depression, anxiety, posttraumatic stress disorder, substance use disorders—in physicians. They feel that this would go a long way toward overcoming stigma (ie, “you’re ill, not bad or weak”) and getting a formal diagnosis and treatment.

The refrain from almost everyone I interviewed was, “If I can save one other doctor or medical student from taking his or her own life by telling my story, then I believe my husband (or mother, son, friend) will not have died in vain.” They are fiercely committed to talking about this difficult subject, to bringing it out of the dark shadows of the world of medicine, and to unraveling the mystery of physician suicide.

Financial disclosure:Dr Myers has no relevant personal financial relationships to report other than as author of Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared.

Category: Suicide
Link to this post: https://www.psychiatrist.com/blog/the-mystery-of-doctor-suicide-signs-and-stressors-for-family-and-colleagues/
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7 thoughts on “The Mystery of Doctor Suicide: Signs and Stressors for Family and Colleagues”

  1. Physician suicide is fast becoming a major issue. Apart from the possible causes enumerated, increasing occupational pressure may be an important contributor. It is often said, ‘physicians are bad patients’. This is true to the core. Physicians delay in consulting, and when they do consult, the compliance is not satisfactory in majority of cases. I have seen family members to be a little complacent about their physician relative’s health status.
    Thanks.
  2. Thank you for your comments. Yes, occupational pressure is an important contributor and is the bedrock of most doctors living with burnout. The sense of powerlessness can become overwhelming especially if coupled with other co-morbid conditions like major depression, anxiety disorders, substance use disorder and other illnesses that heighten a physician’s risk of suicide. What is hopeful is that most major national medical associations in the US are examining this and coming up with preventive and intervention strategies for today’s doctors.
    I too have noted that some families can be complacent about their physician loved one’s health issues. In fact, they may also be neglecting their own health care needs. But I see this as an opportunity for us in the mental health field to educate both doctors and their families to take all health issues seriously. The risk of worsening morbidity and mortality is too great.
  3. The phenomenon of physician suicide has been investigated and one of the most significant factors not listed in this review is the professional impact of a licensed physician seeking mental health services and the stigma of mental illness than can lead to termination, professional isolation and devastating loss of income and resources. The reality is that anxiety, depression and PTSD go undiagnosed in physicians who do not seek care and may not recognize the pathology of their symptoms because they are so high functioning. Physician scarcity in underserved areas where stress levels are highest means doctors feel a mandate to work…even when physically and or mentally ill. Until this is recognized as a top contributor to physician suicide we will make no medical progress in recognizing and treating it! I personally was impacted by a doctor who lost his license after being convicted of medicare fraud. He was found at his desk slumped in a chair surrounded by bills and invoices…dead.
  4. Thanks for commenting. I completely agree with what you’ve added to the discussion. Your personal loss of a colleague highlights the pernicious effects of stigma. To my knowledge, the Federation of State Medical Boards is working to create a universal template for all states to follow that allows only questions related to current and potentially impairing conditions both for new licensing applicants and renewals. Unfortunately, many hospital and other medical institution credentialing applications are draconian and in violation of the ADA. This sends shivers down the spine of many doctors and tragically hinders them from seeking essential mental health care when needed. We all have to fight this.
  5. I think that there are many contributors to this issue, many of which have been mentioned here by Dr. Myers and the commentators. If people are overwhelmed and feel they are forced into a corner from which there is no way out that is acceptable for them, they may consider suicide. Acceptable for them is key: some solutions seem obvious to outsiders, but the person is not able to consider them for reasons of shame, pride, etc. Stigma research shows that most people feel more compassion and identification with suicidal people (and other Dx) when the issue is framed as a reaction to overwhelming and accumulating events and circumstances than when it is framed as a brain disorder which is incurable and lifelong, only to be treated with drugs and talk/other therapy, when the person is seen as a loose canon or loaded gun. Physicians have massive debt from their long training, and this is also related to being overwhelmed and dispairing. The issues of substance abuse is very important here, and we know about OD epidemic with opioids and other (benzo, alcohol, etc.). I do not know the typical means physicians use for suicide, but it may be related to this general societal issue as well. There are also many problems when physicians are forced into treatment where the care is very bad and aftermath is demeaning, etc. Discrimination unfortunately is found in physicians and health professionals, too. Also the suicide rate in the general population in the US has increased dramatically: 25% or more over a relatively short time, a couple of decades. Sorry, do not have any citations right now but easily found. We are definitely doing something wrong.
  6. A simple method of uncovering suicide thoughts and plans is to require all medical practices to administer. The PHQ 9 every visit to every patient physician and to ask about the answer to question 9 which is the suicide question and has good predictability data for suicide. As soon as these questionnaires become as common as a new vital sign, we should begin to reduce the need MBeach f physician suicides. Since people usually visit a physician in the month before they kill themselves, we should have ample opportunity to help them
  7. The last two posts are very important in terms of broadening the sphere of influences that prey on individuals who become suicidal. I appreciate the emphasis on stigma – both external (discrimination, judgment by others) and internal (shame, self-castigating thinking) but we have to fight this with urgency. When physicians go public with their stories of recovering from substance use and/or other types of psychiatric illnesses they are chipping away at stigma in the house of medicine and making a courageous gift to their colleagues. They make easier for other struggling docs who read their stories to go for Rx. I wholeheartedly agree with routine use of PHQ 9 administered (easily) at regular and annual checkups. A few will not answer honestly but many will. It is incumbent upon the treating or evaluation health professional to respond to a positive 9th question with sensitivity and commitment to further evaluation and treatment. MM

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