The first time that suicide was a reality in my life was when I was 22. I was having drinks with friends when my mother called. The father of one of my childhood friends had hanged himself in the front foyer of their house. For years I had known that my friend’s father had become increasingly isolated. Having lost touch with her after going to college and then medical school, I vaguely knew that he had been suffering immensely with trigeminal neuralgia. He had sought and tried numerous medical treatments, all of which had failed. He stopped working, stopped going outside, and stopped interacting with his family and friends. In retrospect, he displayed every obvious sign of depression and the fact that he had died by suicide in such a tragic way, is not entirely surprising. But yet, I could not understand why it had happened. I am not alone. Many of us do not understand. But not understanding does not equate with ignoring that mental health issues, specifically suicide, happen and continue to happen at an alarmingly increasing rate.
The annual rate of suicide in the United States as a whole has increased 24% between 1999-2014. Alarmingly, the rate of suicide among physicians is twice that of the general population. In numbers, that means that one physician dies every day by suicide. Physicians have the highest suicide rate among any profession. When separated by gender, the numbers continue to be dismal. The completed suicide rate among male physicians is 1.41 times higher than the general male population. The rate among female physicians is 2.27 times higher than the general female population. With each physician lost, a personal loss is not only felt, but the public health crisis is also compounded. An estimated one million patients a year lose their physician (1,2).
September 17, 2018 marked the first National Physician Suicide Awareness Day. This initiative was supported by a number of EM organizations, including CORD, SAEM, ACEP, AAEM. The day was meant to call on individuals, residency programs, health care organizations and national groups to make a commitment to break down the stigma, increase awareness, open the conversation, decrease the fear of consequences, reach out to colleagues, recognize warning signs and learn to approach our colleagues who may be at risk for suicide.
So what can we do? The first step is awareness. Sharing the facts, knowing what we are dealing with and what the current climate surrounding these issues are is vitally important. It is only from this place of awareness that we can move forward to finding solutions. Ignoring the facts will not make the truth of what is happening go away – it will only work to stigmatize further the many of us who are afflicted. In fact, stigma is a large part of the reason that physicians do not seek treatment. In a 2016 study of female physicians, 50% reported that though they had met criteria for a mood disorder, they did not seek medical treatment because of the fear of stigma in their profession (2).
So how can we change the culture? Something as simple as changing the vocabulary we use can make a huge difference. Dr. Freedenthal and other researchers in the field of suicide prevention have advocated for substituting the phrase “committed suicide” with “died by suicide.” By replacing the word “commit,” the connotation that one has somehow perpetuated a crime by taking one’s life is eliminated (3). As we all know in this political climate, words have power and by not choosing the correct ones as healthcare providers, we are doing a disservice to ourselves and our friends.
What can we do on an institutional level? Wellness programs have been widely instituted within residency and medical school training. All of that is well and good – we all should be eating better, sleeping more and exercising regularly. Learning good sleep hygiene is certainly important for all of us, particularly those of us who are shift workers. However, we also need a trickle down effect from an institutional level. This may be as broad as recognizing the importance of good family leave policies, building social support systems at work and allowing a degree of control and flexibility in scheduling options in work schedules. More specifically, facilitating meaningful work for each physician’s unique perspective may be helpful as well. As Stephen Covey discusses in his book The 7 Habits of Highly Effective People, changing a person’s paradigm can drastically change a person’s outlook on life, both professionally and personally. Identifying each person’s unique skill set and aligning it with their goals at work can fundamentally alter one’s perception of themselves and the world.
There is no simple solution to the ever increasing rate of physician mental health issues. By first starting with the simple awareness and acknowledgement that this a dire health issue for everyone, not just physicians, is the first step. Openly discussing the importance and the need for solutions will hopefully work towards shedding the stigma surrounding this problem. I may not have been able to help my friend when I was 22 but at least I can say that at least now perhaps I can understand a little better.
- Anderson, Pauline. Doctors’ Suicide Rate Highest Of Any Profession. 2018 May 8.https://www.webmd.com/mental-health/news/20180508/doctors-suicide-rate-highest-of-any-profession#1
- Freedenthal, Stacey. Language Matters: Committed Suicide vs. Completed Suicide vs. Died by Suicide. https://www.speakingofsuicide.com/2017/09/21/suicide-language/
Language is important. They way we say things can send clues in what we believe in the subject. We as physicians could make an impact if we would highlight the divisive nature of the phrase “commit suicide”. Suicide is separated from all other deaths. No other death is committed- no one commits cancer or a heart attack or even a fatal car accident death. With those words there is a subtle inference that one has committed a crime against the state or sinned against God. Alternatively, it is an unchangeable fate. There is no going back once one commits to… Read more »
Thank you Dr.Swisher for such a powerful response. Your sentiments are exactly what I was hoping to convey. Words are power and we must learn to yield them well. Thank you as well for all the work that you do in raising awareness!
Thought provoking article. I don’t think those who do not regularly treat chronic pain patients realize how often unrelenting pain ends in suicide (there’s a good reason trigeminal neuralgia is known as the “suicide disease”). The crackdown on opioid prescribing for those who are in chronic pain will undoubtedly increase the frequency of this phenomenon. I couldn’t agree more with the substitution of almost any other phrase for “committing” suicide. That is only slightly worse than the euphemism “died suddenly” which serves to continue to hide the problem. “Completed suicide” is an acceptable alternative. As a coathor of the cited… Read more »