Category Archives: HealthXPh

Let’s Talk About Physician Suicide

I’ve two sons. The younger one wants to be an entomologist, while the eldest is still deciding on a career. I’d be perfectly happy if none of them chose to be a physician like myself. I think medical school is too darn long and so damn hard. I certainly survived it and so can they, but at what cost? My maternal instinct is to shield them from the hardships I experienced.

I once asked, are doctors allowed to have a bad day?

We are trained to put patients first. And when lives are at stake, we cannot allow ourselves to have a bad day. Or so we think… until a physician commits suicide.

The damaging culture of medicine is evident when Dr. Michael Myers (author of Why Physicians Die by Suicide) says that physicians look at burnout as a badge of courage.  As a senior internal medicine resident and later as Chief Resident, I’ve seen trainees burn out. He/she may quit suddenly but it is never on a whim. Often it comes slowly, with a gradual painful realization of one’s unworthiness. As Chief Resident, I struggled to find the words to console and uplift. How can you tell a soul so deflated, to continue?

Danielle Ofri writes about Physician Suicide and the Tyranny of Perfection

We’ve been asked for a perfection that is unachievable, yet the system acts as though the expectation is eminently reasonable. It’s no surprise that disillusionment is a prominent feature in the medical landscape today… To feel that you are falling short, every day, saps the spirit of even the most dedicated of physicians. We feel as though we have been set up to fail.

This made me think of grit. My sons are still young. At the school orientation before the opening of classes, the principal exhorted parents to help the teachers develop grit in our sons. This was no doubt inspired by Angela Lee Duckworth’s Ted talk, Grit: the Power of Passion & Perseverance. SkepticalScalpel is of course skeptical if it applies to surgical residency. He writes in Who has Grit? Cutting Resident Attrition Rates

The Guardian story said Duckworth’s father often disparaged her, and she reacted by trying harder to prove him wrong.

In today’s world, can you imagine teaching a resident to persevere by using disparaging remarks? I don’t think so.

I tend to think that the average medical student has more than average grit. So perhaps the question should be, how do we maintain grit? Will harnessing grit prevent physician suicide? But does grit mean not asking for help when it is needed? What happens to physicians when one of their own commits suicide? Do we all just muster grit and move on?

We’re discussing physician suicide at the #HealthXPH tweet chat on June 10, 9 pm Manila time. Join us! Tweet your answers to the following questions.

T1 How can we change the “damaging culture of medicine” with it’s “tyranny of perfection” to prevent physician suicide?

T2. How can we reduce the stigma around doctors receiving mental health care?

T3. Does your training program have an “after a suicide toolkit”? Please describe.

Self-diagnosis: valid or dangerous?

At the recently concluded #hcsmph2017, a question was asked during the Unconference –

Is self-diagnosis online valid?

The question was raised in relation to mental health and answering online questionnaires to see if one is depressed. Another participant had also asked the same question, relating how a friend’s father had died of stroke because of a neglected headache. Apparently, the family members had relied on Google search and delayed going to the doctor. This inspired me to have this topic for the next #HealthXPH tweet chat on 29 April Saturday, 9 pm Manila time. I had previously written about Dr. Google and why self-diagnosis annoys doctors.

T1 As a healthcare professional or patient, how useful are online symptom checkers or screening tools?

A quick PubMed search led me to work by Ameringen VM et al, Internet Screening for Anxiety Disorders: Treatment-Seeking Outcomes in a Three-month Follow-up Study. Psychiatry Res. 2015 Dec 15;230(2):689-94. doi:10.1016/j.psychres.2015.10.031. Epub 2015 Oct 30.

… 51% sought treatment after completing the MACSCREEN. In the 49% who did not seek treatment, fear of medication (57%), discomfort talking to their doctor about anxiety (28%) and the belief that symptoms were not severe enough (28%) were cited as barriers.

It is striking that less than half of those who met criteria for anxiety or mood disorder using the online screening tool sought treatment.

Another study looked at the accuracy of the Boots WebMD symptom checker in the self-diagnosis of ENT Symptoms by Farmer SE et al. Clin Otolaryngol. 2011 Oct;36(5):517-8. doi: 10.1111/j.1749-4486.2011.02375.x. Of 61 patients, the WebMD symptom checker 70% (n=43) included the correct diagnosis but only 16% (n=10) of these included the correct first diagnosis. Hence the authors concluded that the symptom checker provided a large number of differential diagnoses which may be inappropriate. The symptom checker completely missed the correct diagnosis in 30% (n=18).

T2. How can healthcare professionals support patients when they search online for health information?

Lydia Nayer writes in Affinity Magazine

In an ideal world, everyone would have access to proper medical care without the fear of stigma and abuse due to their medical condition.  However, since this is not an ideal world yet, we must accept that many people will self-diagnose and we should respect their diagnosis and support them in seeking treatment.  Instead of worrying that people who self-diagnose are “faking” or  “attention seekers”, we should focus on creating a healthcare system free of bias and accessible to all, no matter their background.

In my Google search on this topic, I ran into another term self-advocacy. Morgan White writes about the difference between self-diagnosis and self-advocacy

Self-advocacy involves educating yourself on your symptoms and behaviors in regards to your health… Living with a disorder does in fact exist outside of the medical context. Disorders do not become real only when diagnosed by a professional. Those without access to a diagnosis still have the disorder, and a self-diagnosis can help them cope. A diagnosis is simply an explanation for why you are who you are. Labeling yourself with a disorder or illness can help you understand your actions and feelings and learn to cope with your disorder. It enables you to find a community of people who understand and support you. Self-diagnosis leads to you making sense of yourself.

Also at the #hcsmph2017 Unconference, a participant who was a librarian stood up and asked if doctors are threatened by Dr. Google. They shouldn’t be! Doctors need to accept that Morgan White has written in the excerpt above, which I repeat here for emphasis – Disorders do not become real only when diagnosed by a professional. I’ve had patients consult me who are unbelievably calm when I tell them the diagnosis – because they already know. They are not in shock but often feel relieved, even if it means that their worst fears have been confirmed.

T3. What advice would you give for those who seek health information online?

I always mention Medline Plus when asked. Their page on Evaluating Health Information is a good place to start. I also recommend looking for the Health on the Net (HON) code seal though many websites do not apply for certification hence limiting its usefulness. Better if their physician can give an internet prescription, a curated list of websites for further reading after a consultation.