As physicians, we always seem to be “surprised and shocked” when one of our colleagues dies by suicide. But it doesn’t have to be that way. We should think of physician suicide as a public health issue and evaluate our “case finding” and our intervention efforts.
Are either of these things working?
Using such findings can help us train our colleagues and ourselves in suicide prevention around problematic characteristics, events, and actions. Let’s start by identifying some common factors including incidents of moral injury in physicians who die by suicide.
Moral Injury and Physician Suicide
Pamela Wible MD, in her study of now 1363 (as of October 2019) physicians in practice and training who have died by suicide, summarizes some events that she sees as leading to physician suicide:
- Medical mistakes.
- Public shaming in malpractice suits.
- Cover up of suicides by other doctors, families, medical institutions, and religious institutions.
- Specific highest risk specialties – anesthesiology, surgical specialties, emergency medicine.
- State Medical Boards through questions denying physicians’ rights to “confidential care” push doctors into pretending, denying, and lying about having sought mental health care and support or lead physicians to avoid needed care so they don’t need to lie.
What if physicians had a support system in place after experiencing one of these events? If we know that there is a higher rate of physician suicide after these types of events, let’s design a system to help physicians when something like this occurs.
Designing a Physician Support System
The Physician Foundation (physiciansfoundation.org) describes what they call “Vital Signs” that should lead to concern and conversation with a suffering colleague.
These signs are broken down by the acronym HEART:
- Health – seeing a colleague increasing use of medications, alcohol, or illicit drugs or talking about wanting to die
- Emotions – hopelessness, having lost purpose, or extreme mood swings
- Attitude – inappropriate outbursts of anger, sadness, or negativity about their professional or personal life
- Relationships – talking about being a burden to others or isolating themselves
- Temperament – anxious, agitated, reckless behaviors, or suffering unbearable pain
Careful gathering of detailed data in the method of forensic pathology of our friends and colleagues who have died by suicide might yield specific opportunities for us to reach out in time to others in need.
Maureen O’Hagan has written about the creative and successful work of Kimberly Repp Ph.D. in reversing the rate of death by suicide in Washington County, Oregon through programs and prevention training based on following detailed data.
Perhaps there is learning available in data about physicians’ deaths by suicide that can be leveraged to successfully diagnose and prevent those physician deaths!
Then at least we can start asking the question to those at higher risk – how can I help?
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About the Author – Peggy Naas, MD
Peggy Naas, MD, FAAOS, MBA is a retired orthopaedic surgeon and consultant in new models of payment and care delivery, patient safety, and high reliability. She began her healthcare career as a registered nurse in oncology and emergency department nursing.
She also held management, executive, and governance positions in medical group and hospital system leadership.
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