Double Suicide ~ Med Student & Her Mom

[touchpause13]

I see no problem with you having an opinion on the matter but your first statement here does not make sense logically. I said A does not equal B. You said it does because sometimes people with B, do A. While it may be true (I don't know if the prevalence for suicide is higher in rape victims, I'll take your word for it), that people who have had B (rape) happen to them often do A (suicide), that is not the same as equating the degree of accountability in them. At some point we have to make people accountable to a degree for their actions. She had a disease (depression/suicidality) which for whatever social/professional/financial stressors she was unable to treat effectively. While it is unfortunate and tragic and I wish it upon no one, it is not the same as being raped/killed/abused. There is a difference in accountability/control in the two situations.

How is it not the same thing as being killed? You are dead because you had a disease. Would you be making this same argument if she died of breast cancer? You can't just treat your own depression (I mean you can try, but it's not going to work) just like you can't treat your own type 1 diabetes. You can't just think positive thoughts and your body will magically start producing insulin. I hate this idea that depression is somehow on a different level than other chronic diseases and that people with it have more control over their situation. It's bull. They didn't ask to have a mental disorder, they didn't do anything to get it, and sometimes if they don't get proper treatment it kills them. End of story.

---

Members don't see this ad.

 

[jw3600]

How is it not the same thing as being killed? You are dead because you had a disease. Would you be making this same argument if she died of breast cancer? You can't just treat your own depression (I mean you can try, but it's not going to work) just like you can't treat your own type 1 diabetes. You can't just think positive thoughts and your body will magically start producing insulin. I hate this idea that depression is somehow on a different level than other chronic diseases and that people with it have more control over their situation. It's bull. They didn't ask to have a mental disorder, they didn't do anything to get it, and sometimes if they don't get proper treatment it kills them. End of story.

I can just see this discussion not going well. People who use phrases like "end of story" are usually a nightmare to converse with. While cancer sucks and it is unfortunate, I do not necessarily equate it with being a "victim." It is my personal opinion that at some point you have to draw an arbitrary line in the sand for practical issues. Someone who had type I DM and did not seek treatment and therefore died had some degree of accountability in their demise. Same as with someone with depression. A woman walking home from work who was raped and killed had very little control over the situation.

 

[touchpause13]

I can just see this discussion not going well. People who use phrases like "end of story" are usually a nightmare to converse with. While cancer sucks and it is unfortunate, I do not necessarily equate it with being a "victim." It is my personal opinion that at some point you have to draw an arbitrary line in the sand for practical issues. Someone who had type I DM and did not seek treatment and therefore died had some degree of accountability in their demise. Same as with someone with depression. A woman walking home from work who was raped and killed had very little control over the situation.

I'm not sure where you are getting the idea that someone who killed themselves did nothing to get treatment. Suicide isn't typically a first option for someone who has depression, it's more of a last resort. The thing is, sometimes people do seek treatment, do try and get help and it just doesn't work. It may take several times to find a med that works, or maybe they don't find any med that works. Maybe they had a really horrific experience from a physician or psychologist. It's not like getting help = getting better. It's a lot messier than that. I think you are oversimplifying the situation and putting blame in the wrong place.

 

[drdisney]

I'm not sure where you are getting the idea that someone who killed themselves did nothing to get treatment. Suicide isn't typically a first option for someone who has depression, it's more of a last resort. The thing is, sometimes people do seek treatment, do try and get help and it just doesn't work. It may take several times to find a med that works, or maybe they don't find any med that works. Maybe they had a really horrific experience from a physician or psychologist. It's not like getting help = getting better. It's a lot messier than that. I think you are oversimplifying the situation and putting blame in the wrong place.

Also, depression as a disease affects your brain in a way that makes it difficult for you to seek help. Often depressed people find the idea of even picking up a phone to call and make an appointment overwhelming. And then on top of that, we're talking about medical students, who can be socially isolated (so there's no one to force them to pick up the phone) or scared of seeking treatment based on the idea that it might damage their careers. Using the word "victim" doesn't strike me as wholly inappropriate.

 

[Dral]

they didn't do anything to get it.

I respectfully disagree with that. Just like a diabetic may have eaten poorly, the heart attack victim didn't exercise, the copd pt continued to smoke...the depression pt may have done things (or not done things), that may have exacerbated or unmasked their disease...I'm sure it's not all that and there is an underlying propensity for the disease in many...but I don't think we can conclude that "they didn't do anything to get it". I think we just don't know enough about the disease yet to say that with certainty.

I agree with the big picture of what you say. Regardless of how they got it, it should be treated. We don't not treat diabetes, chf, copd, or anything else regardless of how the person got it, depression is no different.

 

[DermViser]

I respectfully disagree with that. Just like a diabetic may have eaten poorly, the heart attack victim didn't exercise, the copd pt continued to smoke...the depression pt may have done things (or not done things), that may have exacerbated or unmasked their disease...I'm sure it's not all that and there is an underlying propensity for the disease in many...but I don't think we can conclude that "they didn't do anything to get it". I think we just don't know enough about the disease yet to say that with certainty.

I agree with the big picture of what you say. Regardless of how they got it, it should be treated. We don't not treat diabetes, chf, copd, or anything else regardless of how the person got it, depression is no different.

I think it's more a predisposition with risk factors (many of which can be found in that person's history) and that is fully unmasked by the medical education environment, sprinkled with a little sleep deprivation, abuse, and mistreatment.

 

[operaman]

I keep thinking about this topic and what we can do as a field to address it. Obviously we'd all like to see some actual research so we can tailor solutions to the actual underlying issues, but that is going to take some time.

What worries me is that medical schools have a special talent for taking great ideas and sucking all the life and passion out of them until all that's left is a mandatory lecture with a sign-in sheet and a list of objectives. I think everyone knows this problem will take a lot more than that.

So, a few thoughts:

1) I like @PamelaWibleMD 's peer-mentoring approach as one part of it. I wonder whether a match(dot)com or eharmony sort of algorithm is the answer. Maybe they've gotten better in the last decade, but ten+ years ago when I was using it, they managed to set me up with some pretty bad matches! Joking aside, it wouldn't be that hard to set this up although I wouldn't use a computer algorithm; I would use peer and faculty nominations. I can think of the people in my own class who would be wonderful at this and I'm sure faculty know some too. The risk in any peer mentoring setup is that if you put a potentially suicidal person with a craptastic mentor, they may feel even more isolated and alone. So, selection is absolutely critical. As a I think about, maybe something like the Gold Humanism Society would be a good vessel for this sort of thing since they already pull in people who are theoretically the kind of folks we'd like to see mentoring underclassman. Just a thought.

2) Along the same lines, setting up 1-on-1 or 1-on-2 faculty mentoring relationships from early on would help. Again, selection is absolutely critical and participation among faculty should be voluntary and should consist of people with a history of great teaching and great mentorship. We all know the types of attendings we've had who would be awesome at this, and we all can think of a few who would do more harm than good. Many schools have mentored patient encounter/physical diagnosis time already built it, so you could easily add a sort of brief mentoring and counseling component too. Have faculty engage their students privately about how they are doing, inquire about support systems, etc. This could be a good way to identify at-risk students. Faculty could give names to student affairs of people they are worried about so the school can reach out.

3) Mandatory counseling 1x per semester per student. Well, mandatory insofar as you have to show up and be there for 15 minutes or so minimum. We mandate screening for other diseases, for flu shots; mental health is something we need to screen for as well. My inner libertarian is somewhat uncomfortable with this one, but the mandate is simply to show up, not to talk. The a--holes can show up, joke around, and leave when their time is up; seems like the a--holes aren't usually the ones suiciding anyhow. Getting the at-risk people in the room is a big first step.

4) Random drug testing where every student is tested at least 1x per year. Perhaps we could even add CDT and GGT labs. Substance use and abuse is a big risk factor here and one we should be addressing early. I think the key is writing policy such that students are provided treatment and any positive findings kept off their record and completely confidential. The whole point here is to help students, not hurt them.

Well those are my current thoughts. While I have a number of problems with even my own ideas, we just can't keep doing nothing. We're smart, highly accomplished people. We can do better.

 

[DermViser]

I keep thinking about this topic and what we can do as a field to address it. Obviously we'd all like to see some actual research so we can tailor solutions to the actual underlying issues, but that is going to take some time.

What worries me is that medical schools have a special talent for taking great ideas and sucking all the life and passion out of them until all that's left is a mandatory lecture with a sign-in sheet and a list of objectives. I think everyone knows this problem will take a lot more than that.

So, a few thoughts:

1) I like @PamelaWibleMD 's peer-mentoring approach as one part of it. I wonder whether a match(dot)com or eharmony sort of algorithm is the answer. Maybe they've gotten better in the last decade, but ten+ years ago when I was using it, they managed to set me up with some pretty bad matches! Joking aside, it wouldn't be that hard to set this up although I wouldn't use a computer algorithm; I would use peer and faculty nominations. I can think of the people in my own class who would be wonderful at this and I'm sure faculty know some too. The risk in any peer mentoring setup is that if you put a potentially suicidal person with a craptastic mentor, they may feel even more isolated and alone. So, selection is absolutely critical. As a I think about, maybe something like the Gold Humanism Society would be a good vessel for this sort of thing since they already pull in people who are theoretically the kind of folks we'd like to see mentoring underclassman. Just a thought.

2) Along the same lines, setting up 1-on-1 or 1-on-2 faculty mentoring relationships from early on would help. Again, selection is absolutely critical and participation among faculty should be voluntary and should consist of people with a history of great teaching and great mentorship. We all know the types of attendings we've had who would be awesome at this, and we all can think of a few who would do more harm than good. Many schools have mentored patient encounter/physical diagnosis time already built it, so you could easily add a sort of brief mentoring and counseling component too. Have faculty engage their students privately about how they are doing, inquire about support systems, etc. This could be a good way to identify at-risk students. Faculty could give names to student affairs of people they are worried about so the school can reach out.

3) Mandatory counseling 1x per semester per student. Well, mandatory insofar as you have to show up and be there for 15 minutes or so minimum. We mandate screening for other diseases, for flu shots; mental health is something we need to screen for as well. My inner libertarian is somewhat uncomfortable with this one, but the mandate is simply to show up, not to talk. The a--holes can show up, joke around, and leave when their time is up; seems like the a--holes aren't usually the ones suiciding anyhow. Getting the at-risk people in the room is a big first step.

4) Random drug testing where every student is tested at least 1x per year. Perhaps we could even add CDT and GGT labs. Substance use and abuse is a big risk factor here and one we should be addressing early. I think the key is writing policy such that students are provided treatment and any positive findings kept off their record and completely confidential. The whole point here is to help students, not hurt them.

Well those are my current thoughts. While I have a number of problems with even my own ideas, we just can't keep doing nothing. We're smart, highly accomplished people. We can do better.

The same way all GME orientations have a sleep hygiene lecture (as if faculty give a **** about your sleep and well-being). The main problem is that it's all lip service. Medical schools can do as much hand-holding and kumbahyah that they want but med students see whose side the med school is on when **** hits the fan. And guess what? It's not on the side of medical students. It's why schools like Vanderbilt pat themselves on the back for creating "wellness" programs while not changing the culture -- bc a med school can't. It can't lose faculty. The only one's I've seen successfully pull it off is UCSF.

 

[operaman]

The same way all GME orientations have a sleep hygiene lecture (as if faculty give a **** about your sleep and well-being). The main problem is that it's all lip service. Medical schools can do as much hand-holding and kumbahyah that they want but med students see whose side the med school is on when **** hits the fan. And guess what? It's not on the side of medical students. It's why schools like Vanderbilt pat themselves on the back for creating "wellness" programs while not changing the culture -- bc a med school can't. It can't lose faculty. The only one's I've seen successfully pull it off is UCSF.

Exactly. It can't be an institutional solution; it needs to be a personal one. That's why I think the components of any successful program would have to include one-on-one relationships between GOOD faculty members and students. Ditto for peers. The whole idea is to detect at risk students early while simultaneously providing some kind of support structure for people who may not have it. The institution can guide and facilitate, but the action has to happen at the level of individuals.

I wonder if part of the problem is that the people in academia just don't think it's a problem. My spidey sense tells me that people who despise the AMC culture are the first ones to haul arse into private practice and never look back. Those who stay are probably people like me who have really enjoyed medical school and love the academic center atmosphere. From conversations with friends and from threads here, it's clear that my med school experience is very far removed from what many are going through. As such, it's hard for me to understand what in the culture needs to change since I've never had a bad experience with it. Maybe many of the powers that be had similar experiences. Regardless, we can all see that clearly some people are having trouble and we need to reach out and help them as best we can.

 

[DermViser]

Exactly. It can't be an institutional solution; it needs to be a personal one. That's why I think the components of any successful program would have to include one-on-one relationships between GOOD faculty members and students. Ditto for peers. The whole idea is to detect at risk students early while simultaneously providing some kind of support structure for people who may not have it. The institution can guide and facilitate, but the action has to happen at the level of individuals.

I wonder if part of the problem is that the people in academia just don't think it's a problem. My spidey sense tells me that people who despise the AMC culture are the first ones to haul arse into private practice and never look back. Those who stay are probably people like me who have really enjoyed medical school and love the academic center atmosphere. From conversations with friends and from threads here, it's clear that my med school experience is very far removed from what many are going through. As such, it's hard for me to understand what in the culture needs to change since I've never had a bad experience with it. Maybe many of the powers that be had similar experiences. Regardless, we can all see that clearly some people are having trouble and we need to reach out and help them as best we can.

There's a huge culture difference between an academic medical center and a private practice. In an academic medical center there is a lot of politics, a lot of beauracracy, a lot of titles (Dean, Associate Dean, Assistant Dean, Program Director, yada yada) and people who get off on that for their self-esteem and power, etc. It can be very, very toxic and each academic medical center has it's own culture which then pervades into the medical school student culture. This can be very hard to pick up as a medical student with no experience. Many of the people at AMCs would never last in private practice, when you have to have good people skills to bring home the bacon.

AMCs can hold onto very toxic personalities and even create that personality in residents. That being said the culture at UCSF is going to be very different than the culture at MGH or BU. Just ask any medical student who has come under the wrath of an attending who has been there for decades and is known as "that guy", but that the faculty and med school can do nothing about and get rid of. The ones who are most burned by AMCs are definitely the first to haul ass to private practice and never look back and I don't blame them. Medicine has become a field where the farther away you are from the actual inpatient hospital ward, the better you are. Why do you think that is?

 

[PL198]

I keep thinking about this topic and what we can do as a field to address it. Obviously we'd all like to see some actual research so we can tailor solutions to the actual underlying issues, but that is going to take some time.

What worries me is that medical schools have a special talent for taking great ideas and sucking all the life and passion out of them until all that's left is a mandatory lecture with a sign-in sheet and a list of objectives. I think everyone knows this problem will take a lot more than that.

So, a few thoughts:

1) I like @PamelaWibleMD 's peer-mentoring approach as one part of it. I wonder whether a match(dot)com or eharmony sort of algorithm is the answer. Maybe they've gotten better in the last decade, but ten+ years ago when I was using it, they managed to set me up with some pretty bad matches! Joking aside, it wouldn't be that hard to set this up although I wouldn't use a computer algorithm; I would use peer and faculty nominations. I can think of the people in my own class who would be wonderful at this and I'm sure faculty know some too. The risk in any peer mentoring setup is that if you put a potentially suicidal person with a craptastic mentor, they may feel even more isolated and alone. So, selection is absolutely critical. As a I think about, maybe something like the Gold Humanism Society would be a good vessel for this sort of thing since they already pull in people who are theoretically the kind of folks we'd like to see mentoring underclassman. Just a thought.

2) Along the same lines, setting up 1-on-1 or 1-on-2 faculty mentoring relationships from early on would help. Again, selection is absolutely critical and participation among faculty should be voluntary and should consist of people with a history of great teaching and great mentorship. We all know the types of attendings we've had who would be awesome at this, and we all can think of a few who would do more harm than good. Many schools have mentored patient encounter/physical diagnosis time already built it, so you could easily add a sort of brief mentoring and counseling component too. Have faculty engage their students privately about how they are doing, inquire about support systems, etc. This could be a good way to identify at-risk students. Faculty could give names to student affairs of people they are worried about so the school can reach out.

3) Mandatory counseling 1x per semester per student. Well, mandatory insofar as you have to show up and be there for 15 minutes or so minimum. We mandate screening for other diseases, for flu shots; mental health is something we need to screen for as well. My inner libertarian is somewhat uncomfortable with this one, but the mandate is simply to show up, not to talk. The a--holes can show up, joke around, and leave when their time is up; seems like the a--holes aren't usually the ones suiciding anyhow. Getting the at-risk people in the room is a big first step.

4) Random drug testing where every student is tested at least 1x per year. Perhaps we could even add CDT and GGT labs. Substance use and abuse is a big risk factor here and one we should be addressing early. I think the key is writing policy such that students are provided treatment and any positive findings kept off their record and completely confidential. The whole point here is to help students, not hurt them.

Well those are my current thoughts. While I have a number of problems with even my own ideas, we just can't keep doing nothing. We're smart, highly accomplished people. We can do better.

I'm glad you've decided that anyone is an @sshole if they don't want counseling. Genius stuff, really. Random drug testing? Yeah, so we can't drug test people that get government aid and don't have to give it back, but the people that have to give it back? Yeah we should totally totally drug test them. Peer counseling? Yeah all my peers that are busy trying to 1 up each other in the administrations eyes about being diverse, but then write racial profanity on their facebook, they're totally gonna be a great counselor!

Jesus christ. You're disillusioned with medical school and you haven't even left it. Do they keep an IV line in you 24/7 to pipe in their BS?

 

[DermViser]

I'm glad you've decided that anyone is an @sshole if they don't want counseling. Genius stuff, really. Random drug testing? Yeah, so we can't drug test people that get government aid and don't have to give it back, but the people that have to give it back? Yeah we should totally totally drug test them. Peer counseling? Yeah all my peers that are busy trying to 1 up each other in the administrations eyes about being diverse, but then write racial profanity on their facebook, they're totally gonna be a great counselor!

Jesus christ. You're disillusioned with medical school and you haven't even left it. Do they keep an IV line in you 24/7 to pipe in their BS?

Where did he say people who don't seek counseling are @shholes? He's talking about the people who make a joke of it and so would be ones to piss around while in counseling. You know people in your class like that. Heck they're in every medical school class. I do agree with you on peer counseling. Those are the last people who should be evaluating squat. The problem is in residency, you're evaluated by your peers as well as the attending.

 

[PL198]

Where did he say people who don't seek counseling are @shholes? He's talking about the people who make a joke of it and so would be ones to piss around while in counseling. You know people in your class like that. Heck they're in every medical school class. I do agree with you on peer counseling. Those are the last people who should be evaluating squat. The problem is in residency, you're evaluated by your peers as well as the attending.

"The a--holes can show up, joke around, and leave when their time is up; seems like the a--holes aren't usually the ones suiciding anyhow. Getting the at-risk people in the room is a big first step. "

Those are the only two populations mentioned.

 

[DermViser]

"The a--holes can show up, joke around, and leave when their time is up; seems like the a--holes aren't usually the ones suiciding anyhow. Getting the at-risk people in the room is a big first step. "

Those are the only two populations mentioned.

Yes, but to get the at-risk, you have to screen the prior group as well.

 

[jw3600]

lol im glad this thread turned into a debate. typical SDN

Isn't this thread intended to be about the prevalence of depression and suicide in the medical profession and ways to identify and treat it? Inherent in those tasks is the need for discussion about the optimal way of doing that.

 

[touchpause13]

Isn't this thread intended to be about the prevalence of depression and suicide in the medical profession and ways to identify and treat it? Inherent in those tasks is the need for discussion about the optimal way of doing that.

Don't pay him any mind, he's just a troll

 

[PamelaWibleMD]

So I spent 2 hours on the phone tonight with Kaitlyn's dad who is holding it together pretty well considering his daughter and wife have died by suicide. I ran through my entire talk (Physician Suicide 101: Secrets, Lies & Solutions) with him. I will be presenting this at the American Academy of Family Physicians Scientific Assembly in DC next month. I like to fact check everything a few times and make sure I'm representing people's stories accurately.

Then I asked Kaitlyn’s dad straight out: “If your daughter worked at WalMart, would she and your wife still be alive?”

He says, “Yes. Medical school has cost me half my family.”

Here are some solutions we discussed that he (and other parents of suicided medical students) feel would have saved their children.

1) Matched Peer Mentorship Program: Match Day should be in the first week of medical school. Kaitlyn always had a few close friends, but none in med school because "people just went their own way," she said. Obviously the study schedule is not conducive for developing intimate connections. In Kaitlyn's case she would have done well with a matched peer one year ahead of her. Someone with similar social, religious, political views who she would have felt comfortable letting in. She is a very private person. She would have also done well to have a well-matched physician in the specialty she was interested in (anesthesiology). VERY important to have close friends IN TOWN in your school. You know, a support system.

2) Teach NVC (Non-Violent Communication) in medical school—especially (mandatory) for ALL faculty who are the primary perpetrators of public humiliation & fear-based teaching. This is 2014. There's no excuse for bullying, hazing, ridicule of med students & young doctors . . . NVC is easy to learn in one afternoon. http://www.cnvc.org

3) Institute Balint Groups on all rotations (especially high stress rotations - OB, surgery). These are clinical case presentations by med students (MS3, MS4) and residents in which the goal is not discussion of differential and plan, but enhancement of the relationship between doctor/MS & patient. It is facilitated by a counselor or another physician and 5-10 MS, docs attend. Group meets weekly to monthly. Proactive way to release trauma and process feelings around medical cases. Learn more: http://americanbalintsociety.org/content.aspx?page_id=22&club_id=445043&module_id=123029

4) Annual physical exams with mental health & substance abuse screening. (Kaitlyn had lost a lot of weight preceding her death, was running 12 miles every morning at 5 am before school, on a strict diet, etc. . . did anyone notice this??? )

5) 24/7 suicide & help hotline dedicated to medical students. Every school teaches their own med students how to care for one another and they rotate through this hotline and get experience actually caring for each other. We learn how to do blood pressures and other exams on one another. We should learn how to take care of our classmates with the goal that no family of a classmate gets a phone call from police telling them that their child was found dead. Look after one another like family.

6) Transitional stress support - We know that certain times during med school are particularly stressful. Build support into the program.

7) Debriefing post trauma.

8) Medical error & malpractice support.

9) Non-blaming, non-shaming mental health, substance abuse treatment specifically for med students & docs.

10) We need a new specialty: the doctor's doctor. Doctors who specialize is treating doctors. We are a sneaky groups who utilizes health care at 30% the rate of the general population. We need physicians who know how to handle smart, perfectionist, sneaky people like us who rarely ask for help. Docs with compassion and sensitivity who can see through our BS.

I have a lot more and I do not have time to write everything. This is part of an hourlong talk. I am including it here so the motivated ones among you can start acting on these and implementing them. Let's try to stay positive and focus on things we can all do. The important thing is to keep talking and act. We can not keep watching our comrades die by suicide. Every case should be discussed in an M & M Conference with a full psychological autopsy.

Pamela

 

[deleted480308]

So I spent 2 hours on the phone tonight with Kaitlyn's dad who is holding it together pretty well considering his daughter and wife have died by suicide. I ran through my entire talk (Physician Suicide 101: Secrets, Lies & Solutions) with him. I will be presenting this at the American Academy of Family Physicians Scientific Assembly in DC next month. I like to fact check everything a few times and make sure I'm representing people's stories accurately.

Then I asked Kaitlyn’s dad straight out: “If your daughter worked at WalMart, would she and your wife still be alive?”

He says, “Yes. Medical school has cost me half my family.”

Here are some solutions we discussed that he (and other parents of suicided medical students) feel would have saved their children.

1) Matched Peer Mentorship Program: Match Day should be in the first week of medical school. Kaitlyn always had a few close friends, but none in med school because "people just went their own way," she said. Obviously the study schedule is not conducive for developing intimate connections. In Kaitlyn's case she would have done well with a matched peer one year ahead of her. Someone with similar social, religious, political views who she would have felt comfortable letting in. She is a very private person. She would have also done well to have a well-matched physician in the specialty she was interested in (anesthesiology). VERY important to have close friends IN TOWN in your school. You know, a support system.

2) Teach NVC (Non-Violent Communication) in medical school—especially (mandatory) for ALL faculty who are the primary perpetrators of public humiliation & fear-based teaching. This is 2014. There's no excuse for bullying, hazing, ridicule of med students & young doctors . . . NVC is easy to learn in one afternoon. http://www.cnvc.org

3) Institute Balint Groups on all rotations (especially high stress rotations - OB, surgery). These are clinical case presentations by med students (MS3, MS4) and residents in which the goal is not discussion of differential and plan, but enhancement of the relationship between doctor/MS & patient. It is facilitated by a counselor or another physician and 5-10 MS, docs attend. Group meets weekly to monthly. Proactive way to release trauma and process feelings around medical cases. Learn more: http://americanbalintsociety.org/content.aspx?page_id=22&club_id=445043&module_id=123029

4) Annual physical exams with mental health & substance abuse screening. (Kaitlyn had lost a lot of weight preceding her death, was running 12 miles every morning at 5 am before school, on a strict diet, etc. . . did anyone notice this??? )

5) 24/7 suicide & help hotline dedicated to medical students. Every school teaches their own med students how to care for one another and they rotate through this hotline and get experience actually caring for each other. We learn how to do blood pressures and other exams on one another. We should learn how to take care of our classmates with the goal that no family of a classmate gets a phone call from police telling them that their child was found dead. Look after one another like family.

6) Transitional stress support - We know that certain times during med school are particularly stressful. Build support into the program.

7) Debriefing post trauma.

8) Medical error & malpractice support.

9) Non-blaming, non-shaming mental health, substance abuse treatment specifically for med students & docs.

10) We need a new specialty: the doctor's doctor. Doctors who specialize is treating doctors. We are a sneaky groups who utilizes health care at 30% the rate of the general population. We need physicians who know how to handle smart, perfectionist, sneaky people like us who rarely ask for help. Docs with compassion and sensitivity who can see through our BS.

I have a lot more and I do not have time to write everything. This is part of an hourlong talk. I am including it here so the motivated ones among you can start acting on these and implementing them. Let's try to stay positive and focus on things we can all do. The important thing is to keep talking and act. We can not keep watching our comrades die by suicide. Every case should be discussed in an M & M Conference with a full psychological autopsy.

Pamela

I get the goal of this, but logistically there isn't time/room in my life two more regular meetings with two more groups/people

 

[Dral]

So I spent 2 hours on the phone tonight with Kaitlyn's dad who is holding it together pretty well considering his daughter and wife have died by suicide. I ran through my entire talk (Physician Suicide 101: Secrets, Lies & Solutions) with him. I will be presenting this at the American Academy of Family Physicians Scientific Assembly in DC next month. I like to fact check everything a few times and make sure I'm representing people's stories accurately.

Then I asked Kaitlyn’s dad straight out: “If your daughter worked at WalMart, would she and your wife still be alive?”

He says, “Yes. Medical school has cost me half my family.”

Here are some solutions we discussed that he (and other parents of suicided medical students) feel would have saved their children.

1) Matched Peer Mentorship Program: Match Day should be in the first week of medical school. Kaitlyn always had a few close friends, but none in med school because "people just went their own way," she said. Obviously the study schedule is not conducive for developing intimate connections. In Kaitlyn's case she would have done well with a matched peer one year ahead of her. Someone with similar social, religious, political views who she would have felt comfortable letting in. She is a very private person. She would have also done well to have a well-matched physician in the specialty she was interested in (anesthesiology). VERY important to have close friends IN TOWN in your school. You know, a support system.

2) Teach NVC (Non-Violent Communication) in medical school—especially (mandatory) for ALL faculty who are the primary perpetrators of public humiliation & fear-based teaching. This is 2014. There's no excuse for bullying, hazing, ridicule of med students & young doctors . . . NVC is easy to learn in one afternoon. http://www.cnvc.org

3) Institute Balint Groups on all rotations (especially high stress rotations - OB, surgery). These are clinical case presentations by med students (MS3, MS4) and residents in which the goal is not discussion of differential and plan, but enhancement of the relationship between doctor/MS & patient. It is facilitated by a counselor or another physician and 5-10 MS, docs attend. Group meets weekly to monthly. Proactive way to release trauma and process feelings around medical cases. Learn more: http://americanbalintsociety.org/content.aspx?page_id=22&club_id=445043&module_id=123029

4) Annual physical exams with mental health & substance abuse screening. (Kaitlyn had lost a lot of weight preceding her death, was running 12 miles every morning at 5 am before school, on a strict diet, etc. . . did anyone notice this??? )

5) 24/7 suicide & help hotline dedicated to medical students. Every school teaches their own med students how to care for one another and they rotate through this hotline and get experience actually caring for each other. We learn how to do blood pressures and other exams on one another. We should learn how to take care of our classmates with the goal that no family of a classmate gets a phone call from police telling them that their child was found dead. Look after one another like family.

6) Transitional stress support - We know that certain times during med school are particularly stressful. Build support into the program.

7) Debriefing post trauma.

8) Medical error & malpractice support.

9) Non-blaming, non-shaming mental health, substance abuse treatment specifically for med students & docs.

10) We need a new specialty: the doctor's doctor. Doctors who specialize is treating doctors. We are a sneaky groups who utilizes health care at 30% the rate of the general population. We need physicians who know how to handle smart, perfectionist, sneaky people like us who rarely ask for help. Docs with compassion and sensitivity who can see through our BS.

I have a lot more and I do not have time to write everything. This is part of an hourlong talk. I am including it here so the motivated ones among you can start acting on these and implementing them. Let's try to stay positive and focus on things we can all do. The important thing is to keep talking and act. We can not keep watching our comrades die by suicide. Every case should be discussed in an M & M Conference with a full psychological autopsy.

Pamela

I like most of those, but I have some things to think about: In terms of yearly screenings: some say if at least one life is saved, it's worth it. Others would disagree. All those screenings cost money, unless someone at every school volunteers their free time. Why do we not screen all patients with chest x-ray for cancer? The cost to benefit ratio is not there. Can we prove that the cost to benefit ratio is there for your proposed yearly physical/screening for every person in medical school? Is there someone who walks this earth who is even qualified to make that determination?

Non-blaming, non-shaming. That is a start, but we have to remember...Not everyone in medical school is set to take care of patients. While non-shaming should be part of it, what happens when someone's mental illness is so severe that they cannot or should not be taking care of patients? If someone with mental illness is determined by someone else through a screening and subsequent treatment that they are unfit to care for pts, what happens? That's a decision that can ruin a career and possibly a life that it was intending to save. What's the solution in that case? I don't know....just something to think about.

 

[ToldYouSo]

Non-blaming, non-shaming. That is a start, but we have to remember...Not everyone in medical school is set to take care of patients. While non-shaming should be part of it, what happens when someone's mental illness is so severe that they cannot or should not be taking care of patients? If someone with mental illness is determined by someone else through a screening and subsequent treatment that they are unfit to care for pts, what happens? That's a decision that can ruin a career and possibly a life that it was intending to save. What's the solution in that case? I don't know....just something to think about.

I agree with this. There is still a stigma associated with mental health and all it takes is 1 student being deemed "unfit" and dismissed to remove any incentive to seeing a therapist. Maybe instead of school mandated meetings, they could require that a student meets with an outside confidential psych/counselor etc. and simply submit proof (not sure how they could this confidentially) that they have seen someone.

*Edit: Most students have health insurance through a school sponsored provider; so the insurance company could simply confirm to the school that the meetings were held but provide no other information.

 

[calvnandhobbs68]

I definitely agree there should be an M&M type meeting for every suicide. Without one, people all kind of know what happened but it gets whispered about it in the halls and discussed behind closed doors. Bring it out into the open and discuss the signs we missed but could have picked up on. Discuss the ways we could do better. At the very least, it keeps these from being swept under the rug and forgotten about.

 

[Señor S]

Is there any research on what makes a medical student/resident/physician more or less likely to commit suicide? I remember hearing that the rate for women in medicine was quite a bit higher than the rate for non-medical women, but are there other pre-disposing factors (age, substance abuse, marriage etc)?

The cases in this thread are interesting. All these people seem highly accomplished as med students (certainly much more so than myself), yet they were deeply unhappy. Was all the striving just a way to quell feelings of worthlessness (that seems to be the case for the guy from Penn), or does one ultimately realize how hollow the mindless pursuit of "prestige" really is?

 

[FIREitUP]

I get the goal of this, but logistically there isn't time/room in my life two more regular meetings with two more groups/people

I definitely agree there should be an M&M type meeting for every suicide. Without one, people all kind of know what happened but it gets whispered about it in the halls and discussed behind closed doors. Bring it out into the open and discuss the signs we missed but could have picked up on. Discuss the ways we could do better. At the very least, it keeps these from being swept under the rug and forgotten about.

yes, but i think privacy would be a strong issue if this were to be implemented. either way, i think situations like these are difficult to discuss and potentially harmful to schools so no one actually opens a forum for discussion.

 

[DermViser]

So I spent 2 hours on the phone tonight with Kaitlyn's dad who is holding it together pretty well considering his daughter and wife have died by suicide. I ran through my entire talk (Physician Suicide 101: Secrets, Lies & Solutions) with him. I will be presenting this at the American Academy of Family Physicians Scientific Assembly in DC next month. I like to fact check everything a few times and make sure I'm representing people's stories accurately.

Then I asked Kaitlyn’s dad straight out: “If your daughter worked at WalMart, would she and your wife still be alive?”

He says, “Yes. Medical school has cost me half my family.”

Wow, reading that just broke my heart esp. coming from a father.

 

[Snoopy2006]

I like the debate. These are issues that need to be dealt with and it starts with the exchange and critique of ideas.

Of all the ideas proposed in this thread, I like the idea of mandatory counseling. The time invested is low (spare me the crap about not having 15-30 minutes a semester or year). While the other ideas are great in theory, this proposal seems like it may produce the most results in practice.

Many medical schools already have the peer mentoring system described above. The problem with this is it falls in the hands of the students. All it takes is disinterest from 1 side for the mentor relationship to fail. As a senior mentor during M3 year, my assigned junior student stayed in touch, asked questions, and utilized the resource, but he was in a small minority. Most senior mentors couldn't get their juniors to reach out to them. If a student has already separated him or herself from the rest of his/her class, there's a considerable chance they won't make the effort to establish a deeper relationship with their assigned mentor. The counseling idea - to me - is the most important because it gets people who don't want to reach out for help in the hands of a professional.

@DermViser - What does UCSF do that's unique, and can it be emulated?

 

[DermViser]

I like the debate. These are issues that need to be dealt with and it starts with the exchange and critique of ideas.

Of all the ideas proposed in this thread, I like the idea of mandatory counseling. The time invested is low (spare me the crap about not having 15-30 minutes a semester or year). While the other ideas are great in theory, this proposal seems like it may produce the most results in practice.

Many medical schools already have the peer mentoring system described above. The problem with this is it falls in the hands of the students. All it takes is disinterest from 1 side for the mentor relationship to fail. As a senior mentor during M3 year, my assigned junior student stayed in touch, asked questions, and utilized the resource, but he was in a small minority. Most senior mentors couldn't get their juniors to reach out to them. If a student has already separated him or herself from the rest of his/her class, there's a considerable chance they won't make the effort to establish a deeper relationship with their assigned mentor. The counseling idea - to me - is the most important because it gets people who don't want to reach out for help in the hands of a professional.

@DermViser - What does UCSF do that's unique, and can it be emulated?

UCSF has really tried to bring about a cultural change across the entire institution. Yes, medical students can receive professionalism concern forms from faculty, but faculty can also receive concern forms from students and they're actually taken seriously and there have been faculty who are let go, if those type of things continue. At many places that have adopted findings from UCSF -- they tend to adopt some parts but not other parts, or they definitely take some parts seriously (ones punishing students) but not others (those punishing faculty). A lot of the initial medical "research" in the area of medical "professionlism" has stemmed from UCSF which apparently found that there was a correlation between the Dean's letter to predict future state board medical board disciplinary action: http://www.udel.edu/PT/current/PHYT600/2013/Lecture1handouts/Papadakis, Hodgson, Teherani. Unprofessional Behavior.pdf. So then medical schools across the nation adopt their policies, either in part or as a whole. Many times they cherry pick (and not usually in favor of the med student)

I haven't looked at the methodology of that paper to see how accurate it really is and if it isn't more of this is what we think, let's make a paper supporting that.

 

[FIREitUP]

UCSF has really tried to bring about a cultural change across the entire institution. Yes, medical students can receive professionalism concern forms from faculty, but faculty can also receive concern forms from students and they're actually taken seriously and there have been faculty who are let go, if those type of things continue. At many places that have adopted findings from UCSF -- they tend to adopt some parts but not other parts, or they definitely take some parts seriously (ones punishing students) but not others (those punishing faculty). A lot of the initial medical "research" in the area of medical "professionlism" has stemmed from UCSF which apparently found that there was a correlation between the Dean's letter to predict future state board medical board disciplinary action: http://www.udel.edu/PT/current/PHYT600/2013/Lecture1handouts/Papadakis, Hodgson, Teherani. Unprofessional Behavior.pdf. So then medical schools across the nation adopt their policies, either in part or as a whole. Many times they cherry pick (and not usually in favor of the med student)

I haven't looked at the methodology of that paper to see how accurate it really is and if it isn't more of he this is what we think, let's make a paper supporting that.

"Although only 6% of physicians
are psychiatrists, 28% of physicians disciplined
for sex-related offenses are psychiatrists.
Only 6% of physicians are
obstetricians and gynecologists, yet they
represent 13% of physicians disciplined
for sex-related offenses."

 

[@JackShephard]

So I spent 2 hours on the phone tonight with Kaitlyn's dad who is holding it together pretty well considering his daughter and wife have died by suicide. I ran through my entire talk (Physician Suicide 101: Secrets, Lies & Solutions) with him. I will be presenting this at the American Academy of Family Physicians Scientific Assembly in DC next month. I like to fact check everything a few times and make sure I'm representing people's stories accurately.

Then I asked Kaitlyn’s dad straight out: “If your daughter worked at WalMart, would she and your wife still be alive?”

He says, “Yes. Medical school has cost me half my family.”

Here are some solutions we discussed that he (and other parents of suicided medical students) feel would have saved their children.

1) Matched Peer Mentorship Program: Match Day should be in the first week of medical school. Kaitlyn always had a few close friends, but none in med school because "people just went their own way," she said. Obviously the study schedule is not conducive for developing intimate connections. In Kaitlyn's case she would have done well with a matched peer one year ahead of her. Someone with similar social, religious, political views who she would have felt comfortable letting in. She is a very private person. She would have also done well to have a well-matched physician in the specialty she was interested in (anesthesiology). VERY important to have close friends IN TOWN in your school. You know, a support system.

2) Teach NVC (Non-Violent Communication) in medical school—especially (mandatory) for ALL faculty who are the primary perpetrators of public humiliation & fear-based teaching. This is 2014. There's no excuse for bullying, hazing, ridicule of med students & young doctors . . . NVC is easy to learn in one afternoon. http://www.cnvc.org

3) Institute Balint Groups on all rotations (especially high stress rotations - OB, surgery). These are clinical case presentations by med students (MS3, MS4) and residents in which the goal is not discussion of differential and plan, but enhancement of the relationship between doctor/MS & patient. It is facilitated by a counselor or another physician and 5-10 MS, docs attend. Group meets weekly to monthly. Proactive way to release trauma and process feelings around medical cases. Learn more: http://americanbalintsociety.org/content.aspx?page_id=22&club_id=445043&module_id=123029

4) Annual physical exams with mental health & substance abuse screening. (Kaitlyn had lost a lot of weight preceding her death, was running 12 miles every morning at 5 am before school, on a strict diet, etc. . . did anyone notice this??? )

5) 24/7 suicide & help hotline dedicated to medical students. Every school teaches their own med students how to care for one another and they rotate through this hotline and get experience actually caring for each other. We learn how to do blood pressures and other exams on one another. We should learn how to take care of our classmates with the goal that no family of a classmate gets a phone call from police telling them that their child was found dead. Look after one another like family.

6) Transitional stress support - We know that certain times during med school are particularly stressful. Build support into the program.

7) Debriefing post trauma.

8) Medical error & malpractice support.

9) Non-blaming, non-shaming mental health, substance abuse treatment specifically for med students & docs.

10) We need a new specialty: the doctor's doctor. Doctors who specialize is treating doctors. We are a sneaky groups who utilizes health care at 30% the rate of the general population. We need physicians who know how to handle smart, perfectionist, sneaky people like us who rarely ask for help. Docs with compassion and sensitivity who can see through our BS.

I have a lot more and I do not have time to write everything. This is part of an hourlong talk. I am including it here so the motivated ones among you can start acting on these and implementing them. Let's try to stay positive and focus on things we can all do. The important thing is to keep talking and act. We can not keep watching our comrades die by suicide. Every case should be discussed in an M & M Conference with a full psychological autopsy.

Pamela

Great job. This is a great service you are providing for future medical students.

 

[DermViser]

Don't pay him any mind, he's just a troll

He's a troll in high school. He's actually an hSDNer. Be lucky we don't have mSDN for middle school students.

 

[DermViser]

"Although only 6% of physicians are psychiatrists, 28% of physicians disciplined for sex-related offenses are psychiatrists. Only 6% of physicians are obstetricians and gynecologists, yet they represent 13% of physicians disciplined for sex-related offenses."

Sex-related offenses aren't the only way to get disciplined by a medical board. It's also something as benign as not doing enough CME as well.

 

[jw3600]

Sex-related offenses aren't the only way to get disciplined by a medical board. It's also something as benign as not doing enough CME as well.

I think you may have misread. He was quoting statistics from a population of physicians disciplined for sex related offenses, not just disciplined in general.

 

[deleted480308]

The time invested is low (spare me the crap about not having 15-30 minutes a semester or year). While the other ideas are great in theory, this proposal seems like it may produce the most results

15 minutes a semester won't fix anyone. I stand by my opinion that mandatory "help" just becomes another hurdle we have to leap. Another hurdle that we don't have time to deal with if you give it the time it would take to help people.

 

[Rendar5]

15 minutes a semester won't fix anyone. I stand by my opinion that mandatory "help" just becomes another hurdle we have to leap. Another hurdle that we don't have time to deal with if you give it the time it would take to help people.

I did counseling throughout my last year or two of med school, 40 minute long sessions, at least once weekly, to work through personal issues (thankfully nothing as severe as depression). It's not hard to fit in 15 minutes a semseter. I do agree that 15min is not useful for fixing people, but may be useful for identifying those at risk for depression and suicide completions and determining those that may benefit from more involved counseling.

 

[JP2740]

When did substance abuse come into this? Really? You want me to be sober and deal with this **** now. I'm not even joking.

 

[PamelaWibleMD]

I haven't posted much on SDN lately, but feel compelled to respond to this thread. I remember reading about Kaitlyn's death last year when someone posted about it on SDN. I was very moved by it, and for some reason, it felt very close to me. I read her mother's posts, both on SDN and on her blog, and was deeply moved by the profound grief evident in her posts. I remember being shocked by the cold logic with which Kaitlyn had planned her death--the note to her landlord, the extra catfood, and the rent checks, and horrified at what her mother most have gone through. I came back to her blog from time to time, and felt worried by the profound grief, but also felt somehow, perhaps illogically, that if her grief was so evident even to me, she must be getting help for it, and her family must be watching over her closely. She wrote about seeing a therapist too. On Saturday, I saw a link to Dr. Wible's video on "how not to commit suicide in medical school" or something like that on the front page of pre-allo. Reading the accompanying blog post, I saw Dr. Wible mention Kaitlyn's mother Rhonda had written a book recently, and I googled Rhonda Elkins. I saw first a blog post dated Aug 28th, and then was shocked to find a result for her obituary on Aug 29th near the top of the search results. Somehow, following her posts sporadically, I felt really close to Rhonda, and was really shocked, horrified, and saddened by reading of her death. My heart really sank, reading that article. How terribly sad that things ended this way for her and Kaitlyn. What a tragedy for the family. I can't even imagine what the family must be going through.

I have been on the phone with Kaitlyn's dad. He is holding it together.
A quote from Kaitlyn's Dad:

I spent two hours on the phone with Kaitlyn’s dad the other week. A sweet, sweet man. Not the kind of guy who would ever blame anyone else for his problems. I asked, “If Kaitlyn worked at Walmart, would she and your wife still be alive?” He says, “Yes. Medical school has cost me half my family.”

 

[DermViser]

I have to wonder how much this is the culture of the specific medical school they attended, the specialty they actually entered, and location they do residency at (New York) that plays into this.

 

[PamelaWibleMD]

Definitely worse in the urban East Coast areas I believe. One mean attending who believes in fear-based teaching could ruin your year. Some people have a great time in med school with wonderful support and no bullying or abuse. These are more often students at smaller schools. One D.O. school in Oregon is particularly humane per students I am in touch with there. Location. Location. Location. Brand-name schools not always better for emotional health.

 

[DermViser]

Definitely worse in the urban East Coast areas I believe. One mean attending who believes in fear-based teaching could ruin your year. Some people have a great time in med school with wonderful support and no bullying or abuse. These are more often students at smaller schools. One D.O. school in Oregon is particularly humane per students I am in touch with there. Location. Location. Location. Brand-name schools not always better for emotional health.

Yes, New York esp. since the volume is so high and ancillary staff to do things is very low and those who are unionized don't do much, leaving the resident to get things done. Quite different in mentality I believe in East coast vs. West coast vs. the South.

Yes, big names also not a good assurance for better emotional health for sure.

 

[aklark]

@PamelaWibleMD Thanks for starting this discussion. Are your lectures on this topic available online somewhere?

 

[Winged Scapula]

@PamelaWibleMD Thanks for starting this discussion. Are your lectures on this topic available online somewhere?

Its posted in her profile.

 

[DermViser]

.

 

[PamelaWibleMD]

@PamelaWibleMD Thanks for starting this discussion. Are your lectures on this topic available online somewhere?

You can check my lectures out transcribed in full on my blog.

I will also be starting a speaking tour through US medical schools next year so maybe we can meet up at your school. I plan to meet with faculty and teach students so that we can create a better environment in which to train the next gene ration of doctors.

 

[DermViser]

You can check my lectures out transcribed in full on my blog. Sections to review would be category of medical school here: http://www.idealmedicalcare.org/blog/category/medical-school/ and also the archives on physician & med student suicide here: http://www.idealmedicalcare.org/blog/category/physician-suicide-2/

I will also be starting a speaking tour through US medical schools next year so maybe we can meet up at your school. I plan to meet with faculty and teach students so that we can create a better environment in which to train the next gene ration of doctors.

I'm sure many will require Student Affairs approval for you to talk.

 

[PamelaWibleMD]

It should be medical schools that organize these talks rather than sleep-deprived medical students scurrying around between exams while trying to get me to their schools for events. Medical student mental health should be a top priority for med schools and these programs should be funded and initiated by faculty and administration for their students.

 

[DermViser]

It should be medical schools that organize these talks rather than sleep-deprived medical students scurrying around between exams while trying to get me to their schools for events. Medical student mental health should be a top priority for med schools and these programs should be funded and initiated by faculty and administration for their students.

If only. For many medical schools, students' mental health is their last concern. And no amount of "Wellness" programs covered in the New York Times as window dressing to make it seems like they care will make up for that. The same way simulators now used in Sim Labs won't substitute for seeing actual, real live patients. And after that 6 figure education, MDs still aren't qualified to do jack squat, while NPs and PAs walk straight into practice.

It's definitely a well-engrained culture problem. Meanwhile, med students are now getting lectures on professionalism, when many times it is med school faculty who need it the most.

 

[PamelaWibleMD]

Exactly why I am working on this DermViser.

 

[Kaustikos]

Meanwhile, med students are now getting lectures on professionalism, when many times it is med school faculty who need it the most.

Whaaaaaaa? No, that's not true.



#sarcasm

 

[NontradCA]

Med school is largely sink or swim culture. It reminds me a lot of the military, only less team based. I'm not surprised there are so many bouts of cynicism and depression. The profession holds itself to the highest of expectations and does little to facilitate failure in reaching it. Most students are so caught up in their own survival mode that it's difficult for them to address others. It's ridiculous. Even club and group activities are guided by self interest, 1-up attitudes and neuroticism.

It should be medical students having the self awareness for mental health. It seems, while the faculty is there for support, they can not possibly fully understand what the students are going through. The thing is, no one wants to show weakness, and having group meetings based on a stigmatized weakness would not be of the highest interest of our ilk.

 

[PamelaWibleMD]

The paradigm shift needs to come from all angles. Exhausted medical students do not always have the most resilience and best energy level to orchestrate a revamping of medical education. A family attitude (we are al in this together) would work wonders. )

 

[lisi326]

med student mental health was a topic that I took a fair amount of interest in over the past few years. To that end, a classmate/friend and I helped put two different ideas into motion at our school:

1) mandatory mental health panel ~1/2way through first year (when things really ramp up for us): short lecture about mental health in medicine and the resources available to students (which are actually quite good, except people don't know about them or don't want to use them) followed by a panel of 3rd/4th years students, residents, and attendings who talk about their struggles with mental illnesses and how they've dealt with them --- our student health physician did note an uptick in students coming to her about mental health issues after these. The feedback that we got was quite positive, especially at having an attending be open & honest about his/her issues.

2) death rounds: a voluntary, monthly meeting for 3rd & 4th years students led by 2-4th years, a social worker/chaplain, and a palliative care physician where students talk about cases they've been involved with regarding patient suffering and death. we're just getting this started but again we're getting good feedback. getting med students to talk about emotions feels like pulling teeth sometimes, but everyone wants to know that what they're feeling is both acceptable and normal. again, having an attending talk about how hard her cases hit her at times and how much she's struggled with things is very popular with the students.

...In the end, we're the tired, overwhelmed med students who are organizing these things that perhaps the administration should be doing, but it's totally worth it knowing that it's helping even a few students a year. The key is getting attendings who are willing to take off the stoic mask for a few moments talk openly about how they've struggled and overcame or at least tolerated those struggles --- med students will never accept the negative emotions they're having or seek help for them until those feelings have been validated and normalized by the people in power over them.