I had only been an attending for a few years when I had a resident rotate through the ER who seemed the opposite of a gunner. He appeared lazy. He would often sit on a chart. Once, as he was presenting a chest pain case to me, he was so tired he was yawning. My first thought was that he must have been out late last night drinking.
But this wasn’t your average tired resident. Right in the middle of presenting the case he actually fell asleep. I actually had to poke him to wake him up. I decided not to ride his case about it and let it go, but in the back of my mind I was thinking: this guy needs to buck up, splash some water on his face, get it together.
A few weeks later, I was rounding on a patient in the ICU and I saw him again. He was sitting there on the counter, his head against the wall, almost dozing off. I nodded to an intensivist friend of mine and asked if the resident often did this. My friend said yes.
Again, we decided to let it go. We figured he wasn’t cut out to be a doctor. My feeling was that he’d wash out of medicine or get fired. No action needed on my part. A few weeks later he was found to have committed suicide by injecting himself with a cocktail of anesthesia drugs lifted from the hospital.
The Statistics and the Warning Signs
Research presented at the American Psychiatric Association several months ago showed that physicians commit suicide at more than twice the rate of the general population. An estimated 300-400 physicians die by suicide each year within the U.S. That’s roughly one every day.
Suicide is also the second leading cause of death amongst residents, and the leading cause of death amongst male residents. It is believed that, because of physicians’ knowledge of and access to lethal means, there are fewer barriers to suicide for those who are predisposed. Physicians can also have untreated or under-treated mental illness, primarily depression. Other contributors include substance abuse, job disillusionment, burnout, and litigation or disciplinary investigations.
Overcoming Culture and Stigma
For my part, I feel that I ignored obvious red flags for the resident who I briefly oversaw. Ignoring those, or failing to recognize them, remains my biggest regret as a young attending.
I also struggled with overcoming cultural barriers to intervening. The House of Medicine teaches you to compartmentalize. My gut reaction was that this resident was simply weak and wasn’t going to make it. As physicians, we are naturally competitive, and that leads residents to overwork themselves. As residents, we were all sleep-deprived – but the culture was to push through, to do whatever you had to do.
The whole cycle starts in medical school. Our natural competitiveness leads us to harden ourselves against the challenges of our education. We tend to believe that if someone gets left behind, that’s because they don’t have what it takes. Our competitiveness is what’s supposed to get us into the specialty that we want, and after that the residency that we want, and after that to the job that we want. Sometimes, along the way, you push yourself to the brink.
Intervening Can Save a Life
Overcoming these cultural pressures is important if we want to avoid the mistake I made. I ignored obvious warning signs: in the resident’s case, behavioral problems, sleep deprivation, and depressed mood.
At the same time, sometimes it is the relentlessly upbeat people who may also be at risk. Like comedians or actors who project a constant image of competence, we physicians are often performing. When we walk into a patient’s room, we put on a face, we speak from a script. Constantly performing like that takes its toll, but it can also be a convenient mask for ignoring deep-seeded mental health challenges or hiding them from others.
The fact is, suicide can be prevented. Support is available for all who need it. We can all be the one to be there for a colleague. Often simply supporting someone through a dark time long enough for them to recover is enough to prevent someone from taking their own life. Below this article there is also a list of resources that are available to support your colleagues, or if you yourself want to seek help. The resources available from CORD (Council of Emergency Medicine Residency Directors) are especially helpful.
If you are attending ACEP in San Diego, I’ve also highlighted below a newly released documentary, “DO NO HARM,” which shines a light on an international epidemic of depression, burnout and suicide at medical schools and hospitals.
I encourage you to make use of these resources. Let us come together and make a commitment to break down stigma, open conversation, recognize warning signs, decrease fear of consequences and challenge each other to reach out to our colleagues who may be at risk.
- CORD: CORD website for Videos, Podcasts & Curriculum for Physicians & Residents
- Crisis Text Line 1-800-273-8255
- Rather text than talk on the phone? You can contact the Crisis Text Line by texting HOME to 741741 anywhere in the United States 24/7.
- Magellan: Our USACS Magellan Healthcare Employee Assistance Program (EAP)
- This is confidential and free benefit to all providers
- Free CME Webinar: register here.What We’ve Learned About Clinician Suicide and Responsive Measures
- Wednesday, September 12, 2018, 7pm EST
- ACEP Scientific Assembly Wellness Activity on Physician Suicide
- “DO NO HARM” Documentary Screening
- Presented by two-time Emmy Award-winning filmmaker Robyn Symon, this documentary exposes an international epidemic of depression, burnout and suicide at medical schools and hospitals that have been largely covered up – until now.