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.

On Your Graduation

For my endocrine fellows who graduate today.

I was pleasantly surprised to receive a book from you yesterday. A parting gift as you graduate today. From the Eyes of A Healer, an anthology of medical anecdotes. I saw what you wrote on the back of the front cover. Consider this my response.

Last night, as I sat in the car on my way home, tired but strangely content to finally have some cash in my pocket (I had been away from clinic for a week) – I thought of giving you a thousand peso bill as my graduation gift. I wondered if I still had some crispy ones, like what grandparents give out on Christmas.

It is not an original idea. Because someone had done the same for me, more than a decade ago. Though I don’t remember now how much cash that was.

Everyone loves graduations. I’m sure someone will tell you that today is the beginning and not the ending. How many graduations have you had as you pursued a career in medicine? Too many perhaps, but this is probably your last. Now, you will start an endocrine practice. You’ll be on your own, finally.

The one thousand peso bill. For me it evokes that ad which asks, Saan aabot ang 20 pesos mo? What is it for? My small contribution to the days ahead when you will no longer receive a fellow’s stipend.

Enough to buy a few cups of coffee as you sit waiting for patients in an empty clinic. They will come, eventually. And someday, you might wish you had time to drink coffee when the line at your clinic is long. No worries. A grateful patient will buy you coffee, and more.

Enough to buy load if you needed to call me to ask something. Once I had to call her to ask, How do I give endocrine clearance for gynecomastia? Sure, I knew the endocrine workup. But I also knew it was expensive. The guy just wanted to be a waiter in the Middle East. Surely, gynecomastia was the least of his worries.

Enough to pay for a few minutes of surfing online. You might need it to go on Pubmed to search for answers to an all important clinical question, for your very first confined patient. Enough to make phone calls to the nurses station hourly, to adjust an insulin drip.

So what will you do with this one thousand peso bill? It’s all up to you. Graduation is about possibilities. Someday soon, I’d like to hear how you spent it and how you’re doing. Good luck!