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 2.27–5.7 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.
- 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.
- Scherdenhammer ES, C. G. (2004). “Suicide Rates Among Physicians: a quantitative and gender assessment (meta-analysis).” Am J Psychiatry 161(12): 2295-2302.