Thursday, October 10, is World Mental Health Day 2019, and the World Health Organization (WHO) announced the focus for this year is suicide prevention. According to the WHO, a life is lost to suicide every 40 seconds—and for every suicide, there are 20 more attempts. The suicide rate in the United States has been increasing for years and is now the 10th leading cause of death with an average of 129 lives taken per day.
Physician Suicide Rate
Though the healthcare industry should be more attentive to mental health awareness and suicide prevention, the unfortunate reality is that doctors are not immune to these challenges—in fact, they are more susceptible to suicidal ideation than the general American population. The statistics tell a hard story:
- While most medical students begin their education in a healthy psychological place, by their fourth year up to 33% are clinically depressed, over 50% report burnout, and up to 12% report suicidal thoughts (ACP Hospitalist)
- The physician suicide rate among males is 1.41 times higher than the general male population, and 2.27 times higher among females (AFSP)
- Suicide is the second leading cause of death in all residents, and the number one cause for male residents specifically (Journal of AAMC)
- Studies estimate that one doctor dies by suicide every day (CNBC)
The ‘Why’ Behind the Numbers
It’s easy to read those numbers and be stunned or saddened, but what’s harder is taking the next step to pinpoint the reasons that clinicians are struggling so acutely with suicide. Everyone has a different mental health journey, handles stress and pain in different ways, and communicates in varying ways about these experiences. But despite the extremely personal nature of suicidal thoughts (and the reasons behind them), SCP Health’s Chief Clinical Operations Officer, Dr. Steve Nichols, has found that generally as physicians get further along in their education and experience, the gap between expectation and reality often grows. The same is true for their clinical colleagues—physician assistants, nurse practitioners, and nursesin general have a higher suicide rate than the general public.
These days, being a doctor extends far beyond just patient care—and the sorrows of work in the medical field are weighing on physicians. Eight common beliefs among many providers include:
- Scale of the industry robs the sense of meaning from the job
- Demand for specialization limits potential
- Concentration of capital squeezes out potential initiative
- Extent of consumer choice forces a commercialization of work that feels intolerable
- Competition and economic realities generate a state of perpetual anxiety
- Requirements of collaboration can be frustrating
- High personal aspirations may create bitterness if they are unrealized
- The notion that the world is meritocratic imposes a crushing burden of responsibility for flaws and failure
The joy of healing is sometimes lost amid the waves of other requirements, expectations, and disappointments. And since physicians are so prone to see their jobs as integral to their identities, triggers like a patient death or a clinical error can quickly metamorphize that loss of joy into depression and suicidal ideation. “I don’t want to be a doctor anymore” can turn into “I don’t want to be alive anymore” in a frighteningly short span of time.
The “Conspiracy of Silence”
One might assume that since clinicians are trained in medicine and health, they would be the most equipped to handle those sorrows and disappointments; of anyone, they should know how to convey what they are feeling, understand why suicide is not the answer, and have easy access to professional help. But that is not always the case. In fact, psychiatrist Michael Myers, MD, found that the stigma attached to mental illness is greater in medicine than in the general public. This means that not only are physicians more at risk for mental health conditions and suicidal ideation, there is also a high likelihood that their struggles will go unaddressed.
In his examination of suicide among physicians, Myers also found that when they do ultimately take their own lives, there is a “conspiracy of silence surrounding their deaths that may aggravate feelings of isolation and shame in their survivors.” They may even throw themselves more heavily into their work to numb that pain, only exacerbating the issue. Vulnerable, exhausted physicians paired with an industry that has traditionally lacked the necessary awareness and support has proven to be a lethal combination.
The ‘How’ Behind Healing
It’s clear that fundamental changes throughout the industry are absolutely imperative. Dr. Nichols urges clinicians to rediscover personal meaning in their work by:
- Learning what work-life balance looks like on an individual level, and not feeling swayed by what peers/colleagues have chosen for themselves
- Looking for joys in the daily tasks, finding the positive moments, and making a habit of behaviors that bring fulfillment, including:
- Taking a deep breath several times a day, perhaps every time before you enter a patient’s room. This “centered breathing” can be thought of as a quick meditation. There are many references for this sort of practice. One book Dr. Nichols recommends is Conscious Breathing by Gay Hendricks
- Going outside for even one minute and focus on something natural in the distance—the sky, the moon, the horizon, a tree, or a plant
- Reading something inspirational—a religious or philosophical quote (one of Dr. Nichols’ favorites is The Daily Stoic by Ryan Holiday and Stephen Hanselman)
- Listening to music—more specifically music that makes you feel good, or challenges your usual styles
- Reading an interesting non-medical book, or watching a movie (when you have enough time). There are hundreds of “best” lists available on the internet for suggestions—check one of them out
- Finding mentors and/or mental health professionals who can be supportive guides throughout difficult circumstances. While talking through your thoughts and emotions can be challenging at first, opening up about personal situations and difficult cases is both comforting and cathartic. You’re not the only one who has felt this way, so don’t be reluctant to seek help and share your experiences.
Though physicians do need to take responsibility for finding their own meaning and protecting their own health, as a medical community we all have a role to play in driving change. There is much more to be done.
Steps to Preventing Physician Suicide
Healthcare leaders, educators, clinicians, nurses, staff, partners, and lawmakers all have a part in:
- Destigmatizing mental health diseases (especially suicide) and treatments
- Starting the conversation, spreading awareness, and providing preventative resources beginning in the first year of medical school
- Aligning action with that education, including radical transformation of unhealthy or unsupportive procedures and programs within hospitals and health systems
- Teaching both healthcare students and current staff (from sanitation workers to surgeons to senior executives) how to identify warning signs of suicide, what to say (and not say), and where to direct those suffering for professional help
- Promoting physician wellness—specifically emphasizing that physician burnout is not a badge of honor—and removing practices that disrupt that balance (e.g. assigning excessive administrative tasks)
- Applauding those physicians, and others in the industry, who get help and who step forward to tell their stories of struggle and healing
- Taking the time to honor and mourn those clinicians who do commit suicide and providing support services for survivors, rather than sweeping it under the rug
- Starting support groups to prioritize and enhance clinician wellness; discussing and dissipating the drivers of physician burnout; and identifying and supporting those at high risk for suicide
Suicide Prevention Resources
- The American Foundation for Suicide Prevention provides toolkits, fact sheets, prevention programs, and other resources for healthcare professionals
- Dr. Steve Nichols recommends the following books to inspire hope and meaning for physicians as well:
- Principles, by Ray Dalio
- The Pleasures and Sorrows of Work, by Alain de Botton
- On the Shortness of Life: Life is Long if You Know How to Use It, by Seneca
If you or someone you know is struggling with suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.