Face a Medical Practice Tragedy: Suicide

According to the American Foundation for Suicide Prevention, physicians die by suicide more frequently than others of their gender and age in both the general population and other professional occupations. Death by suicide is about 70% more likely among male physicians in the United States than among other professionals and 250% to 400% higher among female physicians. Unlike other groups in which men die by suicide about 4 times more frequently than women, physicians' suicide rate is very similar for both men and women.

Why? Let's start with genetic loading. Physicians, not uncommonly, come from families with histories of mood disorders and substance abuse. In fact, for some individuals this is partly why they have chosen to become doctors. Studies of medical students and residents reveal that one quarter to one third have suffered clinical depression in training. Physicians have rates of depression and substance abuse that are equivalent to or higher than rates in the general population. The two most common illnesses that precipitate suicide in physicians are unrecognized, untreated, self-treated, or undertreated depression and substance abuse.

With this as the bedrock and given that all suicides involve a complex confluence of factors, the following is a list of what is known to push susceptible doctors to that desperate final act:

• Overwork.Work that is not pleasurable coupled with a sense of lessened satisfaction and increasing entrapment.
• Loss of stature. This can occur in the medical workplace and can be the result of complaints about performance, demotion, or being fired.
• Perfectionism and self-blame. Many physicians cannot accept their human vulnerability to the slings and arrows that befall everyone.
• Stigma. This encapsulates a terrible inner sense of shame, failure, and inferiority for being ill and needing professional help.
• Recurrence. The return of a mood disorder or relapse into alcohol or other drugs that is severe and increasingly treatment resistant.
• Self-neglect. Many physicians do not have a primary care physician in their life to assist with prevention and early intervention.
• Chronic medical illness. Some physicians have an inability to cope with progressive deterioration and loss.
• Divorce or a relationship breakup. This can increase the possibility of suicide, especially when it’s nasty and there is a sense of futility and powerlessness over custody of the children and access and division of financial assets.
• Lawsuit. This is especially dangerous if the doctor is isolated and not receiving counseling for the inevitable stress that follows a lawsuit.
• Medical license investigation. This is threatening not only to the physician’s livelihood but to their integrity as a physician.
• Limited accessibility to treatment resources. Although every state has a physician health program, not all ill doctors trust that their story will remain confidential, and they will not make that telephone call.
• Ready access to lethal drugs at work and through self-prescribing. Physicians know how to kill themselves, and most suicidal doctors are determined that they will not fail.

But there is some good news. Medical students are being taught about the importance of self-care. This is reinforced throughout their residency training. Average work weeks are shorter in total number of hours, including more rest and time off after being on call. Trainees are being encouraged to obtain disability insurance early. Physician health programs are promoting how they can help, and they are broadening their menu of services to ill doctors and their families. Medical licensing boards are more sophisticated and sensitive in their disciplinary work and how this impacts the physicians who come before them. Stigma is slowly diminishing as physicians who have suffered illness speak openly to their colleagues and urge them to get help early.

To quote former US Surgeon General Dr. David Satcher, who put it so simply but with great eloquence, "Suicide prevention is everyone's business." All of us in medicine can help by taking better care of ourselves—and each other.

Additional Resources

Although you should always seek out the help of a trained professional whenever you or someone you care about is suffering from thoughts of suicide, the following resources may help you better understand the anatomy of suicide.

• The American Foundation for Suicide Prevention. Physician Depression and Suicide Prevention Project. Web site: www.afsp.org.
• Center et al. Confronting depression and suicide in physicians. A consensus statement. JAMA. 2003; 289:3161-3166.
• Myers MF, Fine C. Suicide in physicians: toward prevention. Medscape General Medicine. 2003;5:4.
• Myers MF. Physicians Living With Depression. Videotape. American Psychiatric Publishing, Inc, Washington, DC, 1996.
• Myers MF. When Physicians Die by Suicide: Reflections of Those They Leave Behind. Videotape. Media Services. St. Paul’s Hospital, Vancouver, Canada, 1998.

Michael F. Myers, a clinical professor in the Department of Psychiatry at the University of British Columbia in Vancouver, Canada, is a specialist in physician health and the author (with Carla Fine) of the newly published book, Touched by Suicide: Hope and Healing After Loss (Gotham/Penguin; 2006). He is the past president of the Canadian Psychiatric Association and welcomes questions or comments at myers@telus.net.