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#DocsTalkSuicide

Ending the Silence

Simons, Sandra Scott MD

Emergency Medicine News: July 2019 - Volume 41 - Issue 7 - p 9
doi: 10.1097/01.EEM.0000574800.53334.09
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Nobody wants to talk about physician unwellness. We physicians experience mental illness just like the general population, yet we feel like we're the only ones because we don't discuss it. Silence puts us in an illusionary world where it seems other physicians are coping better than we are, and we are alone with our pitfalls and embarrassing mental health struggles.

The reality is 400 physicians each year in this country are feeling isolated, depressed, and trapped enough to die by suicide. (Am J Prev Med. 2000;19[3]:155; http://bit.ly/2w3Y93x.) Silence kills.

National Physician Suicide Awareness (NPSA) day shines a light on the unspoken crisis every September. Last year, the American Academy of Emergency Medicine sparked vital dialogue with a simple question: “How have you been affected by physician suicide?”

Doctors were asked to share their stories on social media using the hashtag #DocsTalkSuicide. The response painted a sobering picture of the insidious reach of physician suicide. I can think of no greater rallying cry than these powerful narratives.

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It Starts in Med School

“I can think of at least four dear people who died by suicide before and after medical school graduation,” said Jenny Bencardino, MD. “My first encounter with suicide happened soon after I started medical school. An MS2 jumped to his death at our university hospital. A close friend from my grad class did the same from a balcony. A much-admired psychiatry attending died by a self-inflicted gunshot. Recently, a very well-liked and enthusiastic MS4 who did research in our department took her life at her hospital dorm.”

Heather Finlay-Morreale, MD, wrote an essay about the suicide of med school classmates: “He chose carbon monoxide to end his life. We had studied carbon monoxide poisoning earlier that year. It is heartbreaking to realize that the knowledge we gain to save lives can also be used to end life.”(Pharos Alpha Omega Alpha Honor Med Soc. 2008;71[1]:4.)

“One in every year of med school,” tweeted John Aquino, MD.

“Two medical students,” said Katherine Reyburn, a fourth-year med student. “One didn't match and then went down a spiral. Another just didn't show up to his rotation.”

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It Plagues Residency

“I worked with a resident physician who was struggling and eventually took her own life,” tweeted Robert Lam, MD, the chair of the AAEM wellness committee.

“I personally witnessed another resident physician unsuccessfully attempt suicide,” wrote Danielle DonDiego, DO. “Another resident I didn't know well completed suicide during my residency. All the info I studied in books didn't prepare me for this. It doesn't seem real until it's real.”

One physician who wanted to remain anonymous told me that she was suicidal in residency and felt medical training experiences were a big part of why. “It was during my peds ED rotation—in winter. Lots of darkness. Circadian rhythm disruption. Death of an infant in a horrible manner. Perfect storm,” she said.

“I insisted I was fine until my second year of residency when I seriously considered driving my car off the road and ending it all,” said Ellie Wallace, MD. “You are not alone. It's OK not to be OK.”

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Continuing Past Residency

“I have lost six colleagues to suicide in the past 25 years. Two in the past two years. One three weeks ago,” wrote Cheryl Mack, MD.

Rebekah Bernard, MD, said, “We created our physician wellness program to provide free and confidential counseling to suffering doctors because of the suicide of several of our medical society members.”

William Lynes, MD, said, “One jumbo jet filled with MDs, or three medical school graduating classes—those are visuals of the 400 physicians lost per year to suicide. Coming out with this info has helped to heal me. Too many of my colleagues are suffering in silence.”

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No One Saw It Coming

Shock at the silent suffering they didn't recognize is a commonly expressed sentiment among family, friends, and colleagues. “The best PCP I ever had committed suicide three years ago. No one knew he was struggling,” wrote Hilary Robbins.

So often colleagues thought victims were fine. “I've known eight colleagues [who died] by suicide. High-functioning individuals even in the depths of despair put patients and colleagues before self,” tweeted Melanie Jones, MD.

Hillary McNamara, DNP, said, “Recently, one of our hospitalist physicians [died by] suicide. I saw him two days prior, he seemed completely fine to me, though the nurses said he was increasingly irritable and rude with them and was ultimately reported. He was disciplined just one day prior to [completing] suicide.”

Ryley Weatherford wrote about a friend who died by suicide during his second year of residency. “Marley was the most boisterous and fun person in the group. Top of her class, first-choice residency. Her suicide came VERY suddenly. She never withdrew from us or her job. ... People sometimes really don't see it coming.”

Josh Fessel, MD, messaged me about the loss of a treasured mentor and friend. “I sought his counsel when I made a major career change, and he was both very honest and very supportive,” he wrote. “And not long after that, we learned that he'd taken his own life. I had absolutely no idea anything was wrong.”

Sylvie Rimmer, MD, shared the story of an OB/GYN who took his own life in the OB call room. “We watched him come through the ED early one day and thought little to nothing of it. He seemed a little withdrawn, but it was 5 a.m. so no one questioned it. About two hours later, the now daytime doc was called to a code on OB. It was him.”

Tragic.

We need prevention and intervention before more of our colleagues reach this level of distress. The first step is to acknowledge the problem. Awareness leads to change, so talk more about physician suicide and mental health in general to destigmatize mental illness. NPSA day is Sept. 17, but we should be encouraging awareness every day. The more we share, the less isolated we are. As someone who has struggled with depression, this subject is near and dear to my heart. I'd like to see more #DocsTalkSuicide because it matters, we matter. End the silence.

Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter @ERGoddessMD, and read her past columns athttp://bit.ly/EMN-ERGoddess.

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