Why don’t we speak openly about doctor suicides?
Why don’t we speak openly about doctor suicides?
Just over a week ago, I read an obituary in a medical publication about a young talented and clearly lovely junior doctor. Her life and achievements were celebrated, but no mention was made of the cause of her untimely death. Some colleagues and I surmised it was suicide, but then we wondered why it was it was not mentioned in the obituary. Subsequently, suicide was confirmed, but at the time it felt as though there was an embargo on talking about doctor suicide. There is a shame about discussing it in public, and if this is the case, how can we possibly learn about the things that lead to suicide in our colleagues? We discuss medical cases openly so that we might learn, but why not of our colleagues who reach a point of no return?
It is well known that doctors do have a higher rate of suicide than the general public. These results have been reported as being up to 5.7 times higher than the general public. Female doctors are at the greatest risk with rates 2.27 – 5.7 times higher.
These results are staggering, but the fact that we have suicide at all in the profession is indicative of a deep dis-ease in our profession.
How is it that we can have people who are caring by nature, who choose to do medicine to care for people, but ending up so despairing that they take their own life?
And worse, that their colleagues and medical friends do not notice their decline to that point and are often completely surprised to hear of the death of a colleague in such a fashion?
These suicide statistics have been known for some time, yet until now, no true action has been undertaken.
In response to recent matters, last month the NSW Health Minister Brad Hazzard, instructed his staff that they have one month to come up with a plan for the doctor suicide crisis. It is great to see urgency brought to this matter, but is one month really enough and will it really get to the root of the cause?
What we are looking at here are ingrained issues, where for so long suicide has been accepted as a “sad yet inevitable”, or an “occupational hazard”. I was taught the statistics as though it was an inevitability that could not be altered. But is this really the case, and is this the way we would or ought to approach other health issues?
As doctors, we care about the health of people in medicine, yet we do not appear to be taking the same care and attention to the health of people in our own medical community.
Doctor suicide occurs within the context of the health care system and culture
Increasingly the culture of medicine is being revealed as replete with bullying and harassment. Far from caring for health care professionals, the culture of medicine is that of judgement, critique, condemnation, blaming and shaming. There is no true care and attention brought to the health and well-being of doctors and we are not trained in any suitable way how to deal with the emotional demands of the job, nor are we taught how to look after our own health and well-being.
Medicine is not a culture of peer support, but rather of peer competition and judgement. Any sign of human vulnerability and feelings is seen as a sign of failure. Medicine teaches you to be a “doctor” and not who you are as a human being. You are taught to “toughen up”. You learn that only the tough survive. There is stigma for those with mental health issues. People become isolated, hiding what they are going through. There are definitely some cultural factors that need addressing.
I have heard it said more than once that medicine is more stressful than being in the army or in a war zone, and that there is more compassion for your well-being when you are a soldier. In such a harsh environment, does it really surprise us that people do not survive?
As health care experts, why are doctors ‘surviving’ and not thriving?
Doctor suicide is the end of a long line of health issues for doctors, who are well known to have worse mental health than the general population on a number of counts. For every doctor who actually dies by suicide there are many who make an attempt but survive. Statistics show that 40-55% of the profession are burnt out with all of the personal health issues that entails such as higher rates of cardiovascular disease, anxiety, depression, diabetes, musculoskeletal disorders and suicidal thoughts. 25% of the profession have thought about killing themselves.
Doctor suicide exists in a longstanding culture that is well established to be uncaring and, at times, frankly abusive towards its own professionals. Suicide is an absolute tragedy but the day-to-day ill health of the medical profession is also a serious issue that needs to be recognised.
If we are serious about dealing with doctor suicide, we need to address the entire medical culture and system including the educational, medico-legal and regulatory aspects as well as personal factors at play. We need to be willing to make the needed changes. But we cannot do that until we are completely open about it and willing to examine the issue in absolute fullness.
Given the long association of suicide with the medical profession, there is clearly something amiss and thus something that can potentially be rectified. Let’s not look for short term solutions. Let’s aim to truly address the situation in full and get to the roots of the matter. Lives depend on it.
Dr Maxine Szramka is a Sydney-based rheumatologist and Clinical Senior Lecturer at the University of Wollongong. She blogs regularly at Dr Maxine Speaks.
Doctorportal hosts a dedicated doctors’ health service providing support and information about suicide prevention in the medical community.
For support and information about suicide prevention, call Lifeline on 13 11 14