Why don’t we speak openly about doctor suicides?

depressed young doctor adj

Just over a week ago, I read an obituary in a medical publication about a young talented and clearly lovely junior doctor (not pictured above). Her life and achievements were celebrated, but naught to mention was made of the cause of her untimely death. Some colleagues and I surmised it was suicide, but then we wondered why it was it was not mentioned in the obituary?  At the time it felt as though there was an embargo on talking about doctor suicide, and we wondered why. There is a shame about discussing it in public, and if this is the case then how can we possibly learn about the things that lead to suicide in our colleagues? We discuss medical cases openly so that we might learn, but why not of our colleagues who reach a point of no return? Subsequently it has been confirmed in the media that the death was indeed a suicide, but it was not mentioned in the medical publication.

It is well known that doctors do have a higher rate of suicide than the general public. These results have been reported as being up to 5.7 times higher than the general public, with female doctors being at the greatest risk, with rates between 2.275.7 times higher than the general public. 

These results are quite staggering, but to speak truthfully, the fact that we have suicide at all in the profession is indicative of a deep dis-ease in our profession.

It concerns me to question:

How is it that can we have people who are caring and sensitive by nature, who choose to do medicine to care for people, ending up so despairing of life and caring so little for themselves that they take their own life?

And worse, that their colleagues and medical friends do not notice their decline to that point and are often completely surprised to hear of the death of a colleague in such a fashion.

How can this possibly occur in a system about health ‘care’?

These suicide statistics have been known for some time yet until now, no true action has been undertaken.

The NSW Health Minister has now instructed his staff that they have 1 month to find a solution to the doctor suicide crisis. It is great to see urgency brought to this matter, but is 1 month really enough and will it really get to the root of the cause?

I consider that what we are looking at here are long ingrained issues here, where for so long suicide has been accepted as a ‘sad yet inevitable’, ‘occupational hazard’. I was taught the statistics as though it was an inevitability that could not be altered. But is this really the case, and is this the way we would or ought to approach other health issues?

We care about the health of ‘the population’ in medicine yet we do not appear to be taking the same care and attention to the health of ourselves as part of the population!

Doctor suicide occurs within the context of the health care system and culture. It would be wise to consider the matter on both a personal level and within the whole.

Increasingly the culture of medicine is being revealed to be replete with bullying and harassment. Far from caring for health care professionals, the culture of medicine is that of judgement, critique, condemnation, blaming and shaming. There is no true care and attention brought to the health and well-being of doctors and we are not trained in any suitable way how to deal with the emotional demands of the job, let alone all of the other cultural factors that are at play, nor are we taught how to look after our own health and well-being. Medicine is not a culture of peer support, but rather of peer competition, and peer judgement. Any sign of human vulnerability and feelings are seen as a sign of failure, that someone is unable to and unsuitable to do the job. Medicine teaches you to be a ‘doctor’ and not who you are as a human being. You are taught to ‘toughen up’. You learn that only the tough survive. There is stigma for those with mental health issues. Thus people become isolated, hiding what they are going through. There are definitely some cultural factors that need addressing.

I have heard it said more than once that medicine is more stressful than being in the army or in a war zone and that there is more compassion for your well-being when you are a soldier. These are very telling remarks and reveal that there is much to be addressed in terms of the need for true care for doctors in health care. In such a harsh environment, does it really surprise us that people do not survive? In fact, does it surprise us that anyone survives?!

And, in a health care profession, ought we not all be thriving, not just surviving?

Doctor suicide is the end of a long line of health issues for doctors, who are well known to have worse mental health than the general population on a number of counts. Things to further consider are:

  • For every doctor who commits suicide successfully, how many have tried and failed?
  • How many are depressed but undiagnosed?
  • How many are daily considering suicide but not talking about it or lack the conviction to follow through on their harming thoughts?
  • How many suffer from psychological distress and anxiety?
  • How many have relationship issues?
  • How many struggle with their own health?
  • How many take care of their own health?

And how many are burnt out struggling at work barely making it through the day? According to statistics 40-55% of the profession are burnt out with all of the personal health issues issues that entails such as higher rates of cardiovascular disease, anxiety, depression, diabetes, musculoskeletal disorders and suicidal thoughts.

How can a health care profession as ancient as Medicine reach such a deep state of despair and misery where the staff are in many ways more ill than the people that they are caring for? If even only a few in the profession are struggling that is still significant.

Doctor suicide exists in a longstanding culture that is well established to be uncaring and at times frankly abusive towards its own professionals, an environment that fosters and celebrates a lack of personal care, and it is having a far and wide reaching effect on the health of the profession including and beyond the ultimate tragedy of suicide. Suicide is a tragedy but the day to day ill health of the medical profession is also a serious issue that needs to be recognised.

We need to consider the bigger entire picture when it comes to doctor suicide and doctor health in general and if we truly care, to be willing to do whatever it takes to address the whole culture and system including the educational, medico-legal and regulatory aspects, that contributes to this endemic issue. There are both personal and systemic factors to be addressed if we are serious about the issue of the health and well-being of the profession.

We cannot make needed changes until we are willing to examine an issue in absolute thoroughness.

Lets focus on this issue of suicide, and the health and well-being of the profession. Lets be open about it. Lets investigate it thoroughly and lets make a true study of it.

Given the long association of suicide with the medical profession there is clearly something amiss and thus something that can potentially be rectified. Let us not take a shallow look at the situation to provide a quick and superficial solution that will give us short term relief. Lets aim to truly address the situation in full and get to the roots of the matter. Lives depend on it.

  1. Lindeman S, L. E., Hakko H, (1996). “A Systematic Review on Gender-Specific Suicide Mortality in Medical Doctors.” British Journal of Psychiatry 168(3): 274-279.
  2. Scherdenhammer ES, C. G. (2004). “Suicide Rates Among Physicians: a quantitative and gender assessment (meta-analysis).” Am J Psychiatry 161(12): 2295-2302.
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11 thoughts on “Why don’t we speak openly about doctor suicides?

  1. Well said Maxine. If we are so intelligent, and we are so highly trained to care for the lives of others, why are some of us unable to even keep ourselves alive? And why are most of the rest of us struggling, living lives of “quiet desperation”? Something is seriously wrong with the culture of medicine, and it cannot be fixed with a bandaid…short term solutions aimed at providing relief, allowing us to keep living the way we were living that made us sick in the first place, are what got us into this mess. It is time we looked more deeply at what is truly going on, and allowed ourselves to see the rot that has set in, that we may be inspired to make true change, for the wellbeing of everyone.

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  2. I recall reading an article only just recently on the young doctor who suicided. It was singing her praises as a person, as it should someone who is young a talented, part of best and brightest. But like you Maxine something didn’t feel right about the article and something was missing. For me it was how would someone who essentially had the world at their feet end their own life so prematurely, especially considering that they were learning about health, illness and the body. They were learning a trade to serve the community, which is very honourable. You are correct in saying that we need to start talking about this much more, get it out into the open, stop hiding it. Not to try and fix anything, just talk and build connections, drop the competitive facade.

    Liked by 2 people

    • Yes its true. If there are people killing themselves then there is something wrong in health care. We need to have very real discussion about what is happening. One of the common things I am hearing is that nobody suspected what was going on. We are trained in the health care profession to observe people and thus to know if there is something wrong. Are we hiding behind our professional facades with one another? and if so, why? How can we miss the signs of distress? Do we accept distress as ‘normal’ in Medicine?

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  3. There is so much weight on the ‘health care’ systems as the vast majority of people are not taking responsibility for their own health at all. No one else can take responsibility for our choices or take away the record of these choices from the body – so perhaps doctors have an unrealistic picture of trying to take this responsibility on for people, which ultimately leads to their unfortunate demise.

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  4. A thousand lines to quote here – each a gem from living experience. Thank you DrMaxine for this article. It is needed. Yes let’s take a thorough look and get right to the roots of the matter – the systems – the culture – the lot.

    Liked by 2 people

  5. Wow,

    Are you in fact asking of us to look to treating the root cause of suicide, rather than “medicate” it with solutions that at best bury it somewhat for a time, only to see it explode with greater force at a later date?

    I like that idea Dr Maxine.

    And so simple (that could be a problem:).

    Liked by 1 person

  6. Everyone is a human being first and foremost – our professions are a service to humanity regardless of perceived ‘authority or stature’ in society. Why do we give the outward appearance so much more value than the inner well-being of a person? Clearly this concept doesn’t support anyone and the truth is lived in unnecessary pain, suffering and death. And we are ok with this?

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  7. There is something seriously out of line occuring here – and the fact that these figures tend to be hidden from our view, suggests to me that we know exactly what is going on. If we foster a system, that churns out Doctors who are abused and burnt out, how in the world can they effectively care for anyone else? As you show Maxine, its uncomfortable for any profession to see such a reality, but surely it is time to stop and accept that 1+1 does not equal 3.

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  8. Wonderful points Joseph and Maxine. Maxine I particularly liked that you challenged the old views that the suicide of doctors is not preventable. I attended an AMA session 2 years ago in the wake of multiple junior doctor suicides. The psychiatrist running it said ‘not all suicides are preventable’. Whilst I understand what she meant, I felt very angry at this justification. I believe having lost a friend ‘to medicine’ and as a doctor myself, that we can absolutely prevent suicide in medicine. 1) fix the rostering of junior doctors AMA with an external body regulating these 2) investigate, review and fine the hospitals via an external body for breeches in safety of hours (for fatigue and bourn out reasons) just like CASA for pilots does and bullying (do not ever rely on internal investigations). Junior doctors can not and wont report bullying or poor hours because there is an oversupply of doctors and they can not get a job if they do. 3) stop justifying it as unpreventable and that ‘they must have had a problem underlying’ or ‘they carried the expectations of patients health on their shoulders (as someone above clearly not in medicine posted). The problem and common denominator is medicine, not the individuals, stop blaming the individual. It’s time to take a good hard look at medicine, from the outside not the inside.

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    • Its very true Tess about what you say about not reporting bullying. It is well known that if you report bullying, you are the one who is harassed and ‘managed out’, particularly if the person harassing you is a senior doctor. I know medical students that won’t report serious sexual harassment and inappropriate behaviour because they are afraid it will permanently damage their careers and I remember operating under such assumptions as a medical student also. You very much learn not to ‘rock the boat’ and in that, unwanted, inappropriate and anti social behaviours get protected and endorsed in the system, affecting more people.

      I also agree that suicide is not an inevitability and there is much that we can all do here to foster more caring and meaningful supportive relationships with each other in medicine. Thanks for your comments. It definitely is very timely that we look at the systems of health care and medicine as a whole!

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