When a Doctor Breaks His Hippocratic Oath, by Suicide

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According to one survey, almost a quarter of doctors have "felt suicidal." janbommes / Flickr

In the past 20 years, the suicide rate in the US among those 16 to 64 years of age has risen 40%. Hidden inside that percentage are physician suicides -- the completed ones.

In the past year alone, we, as a country, have lost about one physician a day.

Medical students and doctors battle the same mental health challenges that we do: depression, anxiety, loneliness, and alcohol and drug abuse -- now pile on the rigors of medical school, the pressure of long work hours, and making weighty decisions about their patients’ health. And for good measure, add in the weariness and abject helplessness of fighting an invisible virus for the past year. Those are the ingredients for a toxic mental health cocktail.  

Too often doctors don’t seek help for their psychological struggles for fear that the stigma associated with mental illness will derail or jeopardize their career. Michael F. Myers, MD, understands this. For the last 20 of his 35 years in practice, Dr. Myers  had a singular practice; he only treated medical students and doctors. In an interview with Medical Daily , he said he has reminded his peers in psychiatry and psychology for years that they don’t grasp the precarious shape that some frontline physicians are in.

“[As psychiatrists and psychologists] we have to do a better job to make it easier and safer for our colleagues to come to us for help,” said Dr. Myers, author of the memoir, Becoming a Doctor’s Doctor. “Some of them are dying of treatable illnesses. That really, really troubles me.”

It should trouble all of us. But, said Dr. Myers, we can actually help.

Troubling data 

As the Covid pandemic continues scorching the planet, helping doctors deal with burnout and depression has become more urgent. A February 5 study conducted by the Yale School of Public Health found almost one-quarter of the 1,096 health care workers surveyed showed indications of posttraumatic stress syndrome. The study, published on PLOS One, also found that roughly half of those surveyed could have an alcohol disorder.   

A 2018 literature review of MEDLINE and PubMed found that between 2008 and 2018 “the suicide rate among physicians (28 to 40 per 100,000) was more than double that of the public (12.3 per 100,000). That is roughly one physician suicide a day. 

And  physicians are more efficient than the general public in reaching their goal, as they know drugs and likely have access to what they want. How much more efficient than the general public ? Male physicians, 40% more, and female physicians, even higher.

Troubling surveys

The January 2020 Medscape National Physician Burnout & Suicide Report surveyed 15,000 doctors across 29 specialties and found that, depending on age, 21% to 24% “felt suicidal.” Two percent said they had attempted suicide. The survey was compiled before the pandemic.

Which makes Medscape’s 2021 report all-the-more intriguing. Interviewing 12,000 respondents across 29 specialties, the report revealed that 13% of doctors said they felt suicidal and 1% had attempted suicide.  Those are significantly lower percentages from the preceding year and during the pandemic, a petri dish for burnout and depression. What gives?

“It is possible that the pandemic has given physicians a sense of purpose that many were struggling with prior to Covid-19,” Dr. Myers said. 

Last spring, when New York was the nation’s Covid-19 epicenter, New York State University (SUNY) in Brooklyn ran support groups for doctors. Dr. Myers is professor of clinical psychiatry there. Many of the doctors who attended said they no longer felt 'burned out.” 

“Their very sick Covid patients needed their expertise and advanced training, even though the mortality rates were so high and most of their patients died,” he said. “They felt they were practicing medicine as they were trained to do. So, I wonder if this newfound vitality, that we are all in this together, might have reduced thoughts of suicide in at least this cohort of doctors.” 

In the 2021 Medscape report, doctors in three specialties most closely associated with Covid, critical care (51%), infectious disease (49%), and pulmonologists (48%), said they were either burned out or depressed. Those percentages – infectious disease (45%), critical care (44%), pulmonology (41%) – were up slightly from the previous year.

Digging deeper, the 2021 survey also revealed that between 33% and 37% of doctors said they had talked to a therapist about burnout. But 20% refused to speak with a therapist because they didn’t want to risk disclosure. Of those surveyed, 79% said their burnout or depression began before Covid-19 while 21% said it started after the pandemic. 

A witness to a trend

Decades before those studies, Dr. Myers was witnessing the suicide trend unfold in real time. He saw the toll that medicine’s culture of perfectionism was taking on medical school students and doctors and how reluctant many were to seek professional help. The fear of losing a medical license made many find other ways to deal.

They often leaned on colleagues to prescribe medication off-the-record. Others treated themselves, hoping that whatever was troubling them would go away. Dr. Myers decided to close his general psychiatric practice and become the doctor’s doctor.  

“I wanted to establish an all-physician practice as a safe place to come,” said Dr. Myers. He made clear to patients that he was “going to keep a file” on them because it was a medical practice. 

“But I am going to observe all the rules around confidentiality and your privacy,” he explained. “I am going to make sure that you don’t run into people that you know in the waiting room. My notes are all hand written and my files are all locked up.”

His patients have spanned the medical specialty spectrum. He retired from private practice in 2008 and became the ombudsman at SUNY Downstate Health Sciences, investigating student complaints. He’s noticed a change in medical culture. Gone are the days of doctors cursing out students or surgeons throwing instruments. Many medical schools now offer courses in stress management and professional behavior. Overall, the atmosphere in medical school is “pretty good.” 

When Dr. Myers told friends and colleagues that he was writing a memoir about his years of treating medical students and doctors, they wanted to know why? After all, he already had published a book on Why Physicians Die By Suicide.   

“I said that I really wanted to get the message out there that doctors are human too,” he said.

That message wasn’t just intended for the public to hear. It was for doctors also. The message: Become the patient.

Dr. Myers does.

“If I don’t feel well, I don’t start treating myself,” he said. “I go to my doctor. I put myself in his or her hands.”

Patients can also help their doctors. If she or he seems stressed, fatigued, or frazzled, mention it, nothing heavy handed, just a friendly, hey, doc, are you feeling okay? 

Even better, send a card, or drop an email to say thank you.

“When I had a really bad day, I would close the door for 10 or 15 minutes and pull open the draw and start reading old cards of gratitude my former patients sent me over the years,” Dr. Myers said. “I’ve heard so many doctors who do that. It reminds them that they are good at their job. That’s their humanness coming through. It’s like an e-hug during the pandemic.”

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