How many more physicians will we lose to suicide?

[HuckleB]

http://www.kevinmd.com/blog/2016/03/many-physicians-will-lose-suicide.html

"Almost two years ago I went to the funeral of a medical school classmate. A little more than three weeks before he had jumped from a parking garage after finishing his clinic. He had a loving wife and three young children. He had the respect of his colleagues and the love of his patients. There was nothing out of the ordinary in his financial or personal life. It didn’t make sense, but it rarely does. Something broke inside the mind of someone I have always known to be a happy, easygoing person.

I don’t know why he committed suicide. It seemed to be related to a recent period of intense, severe depression. I don’t know if the pressures of being a physician were a factor, but I do know that physicians have one of the highest, if not the highest suicide rate of any profession; nearly twice the rate of suicide compared to the general population. It may actually be higher. There is tremendous social and institutional pressure to label a death an accident instead of a suicide when ambiguous. If any cohort of people could make suicide look like an accident or death from natural causes, it would be someone in the medical profession.

Of my medical school class of about one hundred, two have been lost to suicide before my 41st birthday. The first was before we even finished medical school. Why do we lose so many physicians to suicide and how many more will be lost?

There are pressures to being a physician that are unseen by most people not working in the medical field. Rates of burnout and major depression are higher in medical students and physicians, and we tend to not seek treatment. Why would we? There is a stigma to mental health problems. Many people view them as a weakness rather than a serious and very real disease. We would never view one of our patients this way, but sometimes we do treat our peers and ourselves this way. Physicians are often afraid to seek help because of fear of losing their medical license, hospital privileges or malpractice insurance. The inconsistency of treatments prescribed by medical boards and physician ‘help’ programs discourages those who need help the most to seek it. If you know a colleague who has gone through this process you know exactly what I mean. Some of these programs cause more economic stress, guilt, shame and depression than they cure. They are a blunt instrument.

..."

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In case any of us didn't remember, health care workers are under extreme pressure every day. We should remember this as we work to improve the systems we've created.

[artyteacher]

1. maybe... they're..

Probably taking their down poisonous perscriptions.

[AxionExcel]

2. might well be...prescription drugs lead lots of people into darkness

http://rxisk.org/rxisk-asks-are-prescription-drugs-causing-suicides/

[Orrex]

17. Damn! Pac-Man is a total bastard!

[HuckleB]

22. .

[surrealAmerican]

37. DUzy.

We never did know what was in those "power pills".

[AxionExcel]

53. Not PacMan, but the pharmaceutical drugs

if you do even a thimble-full of science or logic,
and if you can muster at least average intelligence,
you will be able to figure it out.

[AxionExcel]

54. Free clue. Requires reading ability.

Prescribed Psychotropic Drugs Cause Suicide:

http://www.cchrint.org/2015/09/10/psychotropic-drugs-cause-suicide/

[Orrex]

55. wakka wakka wakka

[HuckleB]

60. Go PacMan!!!! GO!

[HuckleB]

4. Wow.

Just wow.

[Orrex]

18. Just like dentists going crazy from amalgam fumes

SCIENCE!

[easttexaslefty]

34. And sometimes they save lives.

Did mine.

[Lint Head]

3. The physician I had as a child committed suicide immediately

after he retired. I can only imagine the things he saw during his practice. Having to see to the health of people who are dying or and in bad health has to be wearing on a person's mind. No matter who they are. But a physician to deal with it daily. Some younger students who desire to be doctors do not realize the totality of what they are getting into. I have heard of many other situations like this. It is disturbing.

[HuckleB]

5. Too few of us understand the daily toll health care workers face.

And we keep asking more of them...

[Dustlawyer]

36. Attorneys are pretty high up there too. My profession has one of the highest, if not the highest

rates of alcoholism. Lots of stress to go around!

[Rex]

6. Had no idea this was an issue.

Wow, what do we do to combat this kind of thing?

[HuckleB]

8. I could make proposals, but it does seem like this should be part of the conversation...

... moving forward, if we want to truly improve health care in the country. We can't keep squeezing more out of the humans doing the work and expect to improve outcomes. Or so I would think.

[Rex]

10. So what is the answer then? More hiring? Robots?

The system is strained, so is the judicial system and so many others. What do we do about overtaxed staples like health and law? I would say more recruiting and better education for the public as to how stressful those jobs are.

[HuckleB]

11. It will have to be comprehensive.

At some point, we have to realize as a country, as a planet, that sleep deprivation isn't good for anyone: Physicians, nurses, truck drivers, shift workers, EMTs... Obviously, we're not going to magically produce enough physicians so they can do their jobs correctly and maintain mental health. NPs and PAs could help ease the burden, but, to date, they're just being pushed into places where there are no physicians to do the job. Of course, we can connect a lot of this, regardless of profession, back to college debt, too. Certainly, the residency schedules, though improved, are not healthy for physicians or patients.

[Rex]

14. Sleep use to be my greatest foe. I wonder if most working Americans suffer from sleep deprivation?

I still suffer from bouts of insomnia, had no idea growing up it would be a 'net gain' toward the workforce! No telling how many months and years I've cut off my lifespan by not getting a well nights rest. Top that off with debt and stress and it is a wonder anyone can maintain sanity for any length of time that has to work 50, 60 sometimes 80 hours a week.

Part of it has to be the ignorance of how stressful working things like double shifts all week and the untold wear and tear on the body deprived of rest can be long term. I know we don't think about it when we are young. At one time I lived off of 5 hours of sleep a night, was more interested in spending the money I made then my health. Ahhh...to be in my 20s again.

I would do things differently, as would everyone I suppose.

[HuckleB]

19. Yeah, I went back to grad school at 33.

I don't think I slept much as an undergrad, and I worked jobs where graveyard shifts and double shifts were the norm, but at 33, my body was not going along with that, any more. I developed one heck of a coffee habit to get through.

It's funny, though, my dad was a construction worker turned contractor, and I saw the physical toll it took on his body by his early 40s. He realized it, too, and while he had me work my butt off for him on job sites in my teens, he pushed me to make sure I went to college. He didn't want me to go through what he had. While I recognized his physical decline, and took that to heart, I didn't transfer that knowledge to other ways of abusing my body.

We are still trying to figure out how to incorporate electric light and screens into our lives, as well. There are so many factors that reek havoc on our sleep patterns in this era.

[YoungDemCA]

7. As the son of a physician, this hits particularly close to home for me

I know my dad experiences burnout. He's a primary care doc, popular among patients; but what means is that he has a lot of patients, and all of the responsibilities, pressures, and demands that come with that.

Thank you for this important thread.

[LisaM]

9. I know it's an issue. A doctor committed suicide in our parking garage at my apartment last year.

She was just flat out overstressed from her job. I think a lot of them feel that they can't do their jobs because the administrative burden is too high (among other things), I think they get pressured by pharmaceutical companies, their workloads are too large. They can't actually spend time seeing patients and getting to know them. I know when my FIL had a heart attack, the actual head doctor "saw" his patients remotely and never met them at all.

As so-called "productivity" rates rise, job burnout becomes a huge deal. In the case of the woman doctor who committed suicide in her car in our parking garage - I looked into her story, because it was so sad. She was talented, youngish, well-liked, but she couldn't cope with all the pressure. She didn't live at our apartment complex, so of course it was also a stress for us at first because we thought there'd been a murder and no one wanted to go into the parking garage. But it was nearly as awful to know someone chose to end her life there.

[HuckleB]

12. Most physicians are good at blowing off pharma reps.

The workload and the lack of time with patients is difficult, however.

And, pharma costs play another role, as physicians spend time trying to get prior authorizations for approval of medications, often even generic meds, and often these "prior auths" are for meds the patients have taken for years. The system stinks. Private insurance companies have created the most bizarre, comprehensive bureaucracy in history.

[Mojorabbit]

13. My physician husband took his life 2 years ago.nt

[HuckleB]

20. My sincere condolences.

Peace be with you, Mojorabbit.

[progressoid]

23. So sorry for your loss Majorabbit.

[reflection]

62. I am so sorry to hear that. n/t

[steve2470]

64. my condolences Mojorabbit

[greymattermom]

15. my daughter's physician quit

to become a high school teacher. My cousin, who is in his mid 60s, works every day all year. He feels like he can't do anything else, and he practices primary care in Western Kentucky.

[Hiraeth]

16. I work in a medical profession. Most, if not all, my colleagues, co-workers, associates are on

some type of medication for either/any/all: anxiety, stress, insomnia, OCD, depression.

[ChairmanAgnostic]

51. One source of their situation?

Corporate take over of their practice, the requirement to re-document the Dx, the horrible computer systems they use (check out Epic), and the manditory maximum of 15 minutes per patient, seven of which includes answering computer generated questions, filling out computer screens, and taking a breath, a piss or a bite.

No doctor I know wold allow his/her kids go to Med school. And I deal with MDs every day.

[Hiraeth]

52. yes. We are expected to do our job like a production job. We are expected to be able

to stick round pegs in round holes in so many seconds. Patients are not round pegs and medical staff are not round holes.

what might take 5 minutes with one patient may easily take 15-20 minutes with another.

Our medical system as it stands now is quite broken.

Burn out rate is off the charts. At worst, we are medicated and going through the motions, at best when we do have the rare patient that is alert, oriented and knowledgeable about their history then we can rise above and actually be our best.

[linuxman]

21. It's a difficult proffession to say the very least.

Overworked, under appreciated.

They deserve every dollar they make.

[progressoid]

24. I married into a family of physicians.

The stress level is intense.

[840high]

25. So did I. I'm also

a retired nurse. The stress level IS intense.

[progressoid]

28. And into the next generation...

My nephew will start his residency soon. He'll make a great doctor. He thrives on the intensity, but he also knows the risks and has a down-to-earth family to keep him grounded.

[840high]

30. My brother-in-law was a very

relaxed physician - went into research. My husband very intense - brought every problem home. Our dinner conversation was usually about medicine. My father-in-law (psychiatrist) knew how to leave problems at the office. I wish your nephew the best.

[LiberalArkie]

26. The 2 I had used a pistol to do it. This was like 12 years ago.

[jalan48]

27. It seems we could afford to pay much of the cost of medical school with what we spend on war.

Imagine all these Drs with little debt from schooling. It would be better for all of us.

[HuckleB]

46. We could certainly improve many things with that money!

[Fast Walker 52]

48. there's so much we could afford if to do if we weren't so pre-occupied with our empire

War is a racket and it's literally destroying us. Enough is enough.

[moonbeam23]

29. It's the bullshit from the corporatization of medicine

My brother is a extremely overworked MD as well as being the medical examiner for a large rural county...

My dad was a dentist and all through our childhoods ranted about "socialized medicine" and how evil it would be so he always voted republican...

My brother shared this view up until about 20 some years ago, when the paperwork and the insurance companies started to get really crazy...now he votes green/liberal democrat and CAN'T WAIT for single payer...he thinks it would be the greatest thing in the world for us...he's feeling the Bern...lol

[mrmpa]

32. Great for him........

applauding single payer. I had an ophthalmologist visit earlier this week. The intake nurse stated she had been in the medical field for 29 years and "knows" that single payer will bring about rationed medical care, e.g you could only get one cataract removed and not 2, etc.

As I have no experience in the medical field, other than 59 years as a patient, she said my views don't count. Once I'm done with my cataract surgery, the Doctor will be getting a letter from me about this nurse.

[Fast Walker 52]

50. I know a lot of doctors are upset about new regulations and blame the ACA

a lot of the older docs are particularly upset. The ones just coming into the system will adapt naturally but it's hard for older ones. Regulatory regimes seem to keep expanding, in my field too.

[HuckleB]

56. The ACA hasn't made things any more onerous.

The insurance companies already did that, long ago.

[Fast Walker 52]

57. I agree. But the more wingnut-oriented MDs are only too happen to blame their problems on the ACA.

I've heard serious complaints about the new electronic medical records law though, which is really hard for private docs. Not sure how much of that is from the ACA.

[HuckleB]

58. I work at a small clinic, and we went to E-records three years ago.

It is a pain up front, but it saves both providers and patients a lot of time.

[AngryAmish]

31. This will not get butter.

All doctors are going to become employees of hospitals or large medical practices. Most doctors hate the bs that comes with their jobs and feel hampered by the new evidence based guidelines.

[HuckleB]

33. I don't see docs being hampered by evidence based guidelines.

More and more are advocating for science based guidelines. Unfortunately, the for-profit system makes a lot of money off "integrative" treatments, and docs are stuck.

[RobinA]

35. I Have Long Believed

that medical school needs to take a serious look at this. My father is a doctor, graduating from medical school in 1960. I was born in 1958. For years my sister and I used to play with the other doctors' kids of the same age because all the med school friends would socialize at each others houses. Great bunch of guys (to my young eyes) and kids and mothers. The kids got older and people drifted, but they still knew each other. Come the '80's and alcohol set in. One suicide in this small group, several (most) with drinking problems, one falling down drunken drug abuser. These were not people who grew up drinking a six pack a night and graduated to a case, they were high functioners who developed a problem in middle age. Something wrong here in this profession. I look back at those young guys, and yes, they were all guys at the time, and it's just a damn shame.

[HuckleB]

38. +1,000 ... 000

[Odin2005]

39. There are not enough doctors to go around.

I remember reading many years ago that the AMA restricts the number of people who can get accepted to medical school in order to create an artificial shortage of doctors in order to keep salaries high.

[HuckleB]

40. I 'd like to see that link.

[Odin2005]

42. It was something I heard back in '09 or so, I can't remember the source, unfortunately.

[Recursion]

47. The charge was originally by Jeffrey Berlant in "Profession and Monopoly" in 1975

The extent to which the AMA or any other trade organization is actually effective in its goals is always hard to measure, but it's definitely a goal of the association to keep physician salaries high, which means limiting the number of physicians out there. That said residency programs seem to be the real bottleneck right now.

http://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

[redruddyred]

70. so we shouldn't be worrying abt the "physician shortage"?

i wonder if we can convince the AMA to let me actually have a longer than 5 min conversation with my GP for once

[Nevernose]

41. The suicide statistic is true across all Western nations

So the AMA probably can't be blamed.

Also, I'd say the half a million dollars needed for medicsl school is the biggest barrier to the number of new doctors.

[Odin2005]

43. Damn, a good hypothesis slayed by pesky facts.

[JanMichael]

45. can you post the source of equal rates in western countries?

not the overall rate just physicians.

[Nevernose]

61. Ton of links at bottom

http://www.ncbi.nlm.nih.gov/m/pubmed/8833679/

And then down the Google hole from there

[RobinA]

59. This Actually Fits

my own theory that it has a lot to do with trauma. Not the "I survived an airplane crash on my way back from the war" kind of trauma, but the day in, day out level of responsibility and hypervigilance, second guessing yourself, being second guessed, a mistake could kill somebody trauma.

[Fast Walker 52]

49. I work at a medical School and was on the admissions committee for a couple years

Medical school is very demanding. It's actually hard to get enough qualified and well-motivated students, at least in my state.

[JanMichael]

44. is the rate of self destruction the same in other countries?

i gave that a quick search but did not see any comparisons.

[tblue37]

63. Most physicians, especially surgeons, have high stress jobs and access to drugs. nt

[redruddyred]

65. seems like these docs have a p good handle on how well shrinks respect their own patients

knowing several personally of course

[HuckleB]

66. Can you clarify this post?

I'm not sure quite sure what you're saying.

Thanks.

[redruddyred]

67. docs are by and large an arrogant bunch and psychiatrists are no exception

i know this firsthand i'm related to one!

[HuckleB]

68. Some are, some not so much.

I work with 16 of them, and most are very down to earth. Primary care docs, that is. Psychiatrists on the other hand...

[redruddyred]

69. i've noticed that women and esp minority women docs don't tend to have

their heads entirely occluded by their asshole
i think there's one male GP at my practice and he's not utterly despicable either.
this is a very unsual practice however, in that the staff are largely quite likeable. i hand over my copays gladly.

[HuckleB]

71. It's always good to have down-to-earth folks.

I love working at my clinic. The docs talk to everyone as equal humans, from NPs, RNs, to MAs, and billing personnel.

[redruddyred]

72. do you treat me/cfs patients? are you open to them? if so, would you like to namedrop?

i work for several patient orgs and a common refrain is that GP is weak in the difficult of technical skill of listening to his patients. we try to empower patients to either move on or fight back (hopefully move on) but medical care is an expensive endeavor and it's no wonder so many of them give up entirely.

[HuckleB]

73. I'm in pediatrics, so those things don't pop up on the radar, as far as I know.

I don't know how much the Internists see, but I will ask them in the coming weeks. Thanks for triggering that discussion.

[redruddyred]

74. pediatric cases too

usually dx'ed as munchausen's according to british group tymes trust.
sorry i realized my previous post wasn't clear: our "good docs" list is incomplete and we're trying to make it less so.