Last week I lost a friend and colleague to suicide. A talented, compassionate rural physician who worked hard to meet the needs of her community. A physician who loved rural medicine, especially obstetrics and surgery, and sought out opportunities to use her skills to help under-served populations both locally and globally. Yet somehow the illness of depression led to a dark and final place. And I feel responsible, as do all the physicians who worked with her, because we feel we should have been able to help. We should have noticed more. We should have reached out more often. We should have been able to prevent this.
Medicine attracts people who are driven, perfectionistic, self-reliant and proud. Too often our sense of self-worth is defined by our job. Our training encourages an exaggerated sense of responsibility, and intense scrutiny from our licensing bodies and health authorities add an insidious layer of anxiety about the calibre of our work. The societal trend to always seek someone to blame when things do not go well often targets physicians. The media—and social media in particular—implies that the system is rampant with bad medicine and deviant doctors. Yet I doubt anyone is more critical than we are of ourselves when we make a mistake.
Some of the personal guilt we assume is not justified. But some is due to the recognition that we work in a dysfunctional system and have not done as much as we can to change this. Rather than addressing problems, we hide them. We encourage trainees to develop resilience while perpetuating many aspects of a toxic system. Those who do seek help for issues around mental health may find these conditions specifically excluded from their disability insurance, or experience negative consequences on future career options or promotion. We pay lip service to removing the stigma of mental health for our patients, but are far less compassionate with our peers. We are competitive by nature—too often we strive to make ourselves look better by making someone else look incompetent. Criticism is delivered in a humiliating rather than a constructive way. But my success does not have to equal someone else’s failure, and vice versa.
The problem of physician suicide has been studied since 1967, when one study demonstrated a suicide rate in women physicians four times higher than that of the general female population. In the U.S., estimates are that 300–400 physicians die by suicide annually. Canadian numbers are less well studied, but we know from the 2007–08 Canadian Physician Health Survey that up to a quarter of physicians in this country experience at least a two-week bout of depression. This is a systemic public health problem.
Our working relationships are full of the usual human emotions and we need to recognize and acknowledge that we are subject to the same conditions as everyone else in the human race. We grieve when patients die, we develop PTSD symptoms when witnessing trauma and abuse. I know doctors who ignored physical symptoms that would have triggered urgent investigation in a patient, to the point of actually dying from the disease they denied could possibly happen to them. Deep down many physicians still perceive mental illness as weakness rather than disease. Well, guess what? We are just as vulnerable as everyone else, and perhaps, due to the stresses and nature of our work, even more so than the general public.
Dr. Pamela Wible, a U.S. physician working extensively in the field of physician suicide has concluded, “Doctors choose suicide to end their pain (not because they want to die).
“Physician, heal thyself” is terrible advice—we need to look after each other, and not be afraid or ashamed if we need to seek help. Only then can we develop the healthy workplaces we all need and deserve.
Why have I shared this story? As long as we continue not to address the issue of physician suicide and mental health it will remain a shameful secret. Eventually, it will happen to someone you care about it. It is time to examine the system and speak out. We cannot change what was, but we can change what will be. So I say to my friend: May you find peace and joy and all the blessings of whatever comes after. You will live on in the many lives and hearts you touched. You were loved. I wish you did not have to leave us so soon. We will try to do better.
A version of this article first appeared on doctorsofbc.ca