The thing that confuses me most about this thread is .. how come we never post stuff like...
Resident gets dismissed, dies from car accident? dies from asthma exacerbation, dies from heart attack. Crap like that happens all the time to doctors and yet no one here seems to get so sassed about it. So is it something unique about suicide? If you say it's because it's directly attributable to residency, I can tell you that the stress of residency hasn't helped my cardiovascular health one bit... I dunno what's so additionally tragic about suicide versus a disastrous stroke or cancer or whatever that it merits a huge thread...
Though I want everyone to feel good and live well, I have to admit that Em Doc Bob makes some valid points in this case.
The only thing I'm going to touch here:
Yes, I think that the factors that play into poor lifestyle choices made by physicians can be attributed to the individual, family, culture, society, but also a certain something from training, other factors notwithstanding.
Those are the very ills I would speak to. I think that the physician who, before training, or in its absence, is able to live in a healthful manner re: diet, exercise, etc, and finds that training becomes a major barrier, due to time, other contraints, or even just the psychological toll, well, to me it seems that there occupation becomes a major factor.
If the current health professions atmosphere is the major contributer to earlier physician morbidity & mortality aside from suicide, than those MIs & strokes, etc, are tragic and much as we want for patients, intervention & prevention would be the thing.
The upset about suicide versus these other causes of death, in my mind, has to do with more proximate vs more downstream effects. We can be prone to reacting to tragedy much as patients do.
I think we can all agree, that the current training atmosphere is an occupational hazard. I'm not board certified in occupational health but...
Regardless of the health issues we seek to prevent in health professionals, from suicide to a stroke 20 years from now, is that there are certain things that are healthy and can mitigate risk factors for a huge number of conditions from MI to MDD to suicide.
For almost every factor that I went to list here, most of them are meaningless or inaccessible in practice without adequate time off to pursue, a lack of fear or experience of negative consequences for seeking help whether it's dental mental or physical, and a general change in the work environment, culture, and I believe, the economic realities.
Maslow's hierarchy. Sleep, food, shelter, reliable membership, the list goes on.
I would argue that what the 3 years of training one might do in residency and what it does to one's CV fitness does less harm to QALYs than suicide. The good news as well with the processes in CV health, is that after training, often physicians can still earn a reasonable living to support a family, pay loans, and preserve some time for the pursuit of health, at least relative to training. Of course this doesn't account for or change the stress of the work itself post-GME. For CV health, there are a number of interventions available that, while not totally reversing harm, can greatly improve health and mitigate risk factors even after a period of relative CV health neglect.
You can argue the difficulties in achieving optimal CV health is a form of self harm or a coping strategy. It could also be neither and is just the reality of the occupation, which is, of course, unfortunate.
However, I think while we empathize with the physician that is hurting and is not able to pursue CV health, we recognize that this suffering is different.
This suffering has not reached a point that is immediately fatal, and can no longer be modifed through intervention.
I don't like seeing my classmates put on weight in residency and develop other problems. However, it seems to me that if they are not mentally ill, they seem to have some insight into their own health and how their career and lifestyle choices factor into their current health state. They are still mentally capable of saving themselves from harm, even if they choose not to.
I am absolutely floored that some seem to develop a mental illness they otherwise would not have had. That an otherwise healthy mind develops an illness. Even more freaky to me, that they would lose so much insight, that they are not able to recognize the progression of their illness.
I've done some reading, "Feeling Good" handbook I believe, that suggested some factors re: completed suicide that should be considered.
One, is the presence of suffering. However, as mentioned, that's not enough. Many suffer and are not depressed, and many suffer and are depressed, yet they cope.
He suggested that one key issue is loss of insight. While the depressed person can think rationally when it comes to, say, lasix dosing, there does emerge irrational thoughts & feelings, characteristic of the disease, and sadly, are about the dz. We can say disease, and label irrational here. (I'll skip examples of this in MDD. The beliefs can be more or less fixed than in other MH dx that impair fxn to lesser or greater degrees.)
The last crucial ingredient, the author argues, is a loss of hope that the suffering can change or that the sufferer can successfully cope.
He argues that many people suffering immensely with and without mental illness, are often able to cope because they retain insight as well as hope that things can be better or that they have the inner resources to tolerate the suffering (as seen in, say, cancer pain that gets worse).
So yes, to my mind there is something very tragic to an otherwise physically healthy person being burdened with enough stress to develop a mental illness that then impairs their ability to cope, as well as their ability to recognize just how poorly they are coping.
That they don't seek help for fear (rational or not, often not baseless actually). That they lose so much insight, that they see their suffering as hopeless.
Because they believe that the prospect of EITHER quitting or continuing in their training, is too painful, that n
either will relieve a suffering that is so great they have both lost the actual ability to cope as well as losing the belief that they could ever cope.
People expressed in this thread just how irrational it all is. "They could have sought help," "they could have quit," "how could their suffering be so great? I didn't suffer like that when I was ____." "Couldn't they see solutions besides suicide?"
This just shows that we are not understanding the disease. If someone goes to war, and comes back with a mental illness under the strain, we get it. Or we could put someone in isolation tanks, and they hallucinate. Basically, science has shown we can **** with people's brains through environment.
We even understand with a lot of illnesses that some people with the same exact exposures or risk factors, some will have differing presentations of illness compared to one another.
We sorta get sometimes, that we can do things people can't control to their brains, and that they will have experiences or illness that they cannot control. That some of those will cause them to be irrational, and most dangerously, not even be able to recognize it as such.
Newsflash, depression can do this.
Newsflash, we can do this to a resident.
The fact that all have the exposure, some get the disease, and most of those don't lose so much insight, lose so much coping ability, experience so much suffering, and feel so hopeless, as to seek what would be an otherwise rational solution to delusional beliefs, I don't think makes it something to dismiss.
If we can imagine a better way to handle MI risk, asbestos exposure for firefighters, liver transplantation, I don't see why we wouldn't imagine how to make the practice of medicine healthier for all.
What's healthy for CV health, is also healthy for mental health.
It's not an either/or.
The issue isn't, can we change the practice of medicine to where every special snowflake makes it unscathed & intact, can we prevent every suicide, can we remove every risk factor? Of course not.
But, do we think that improvement in factors for major killers of physicians, is possible? Is there room for improvement?
Do we recognize, that while it may not be our responsibility, or an attainable goal, to recognize when physicians have developed mental illness and lost insight, that it is still something to aspire to, much as we approach catheter-associated UTI, which we recognize efforts can never make zero, yet for which the goal I see set to zero, as we apply reasonable interventions.
I can tell you right now every medical board has made it their goal to identify when physicians have become impaired or lost insight because of mental health, in the interest of protecting the public, foremost.
Do we really, really, think the way we treat residents, attendings, patients, is not only totally reasonable, but cannot, should not, be improved?
I'm guessing no. We know residents are treated like **** and it could be better. The proof happens outside this country every day. The fact it is the way it is here and that most make it is not an excuse for the status quo, not even a little bit.
TLDR
We need to improve physician health overall and in multiple ways. Many strategies could improve CV & mental health. Not all suicides are due to depression but I believe all represent suffering, loss of hope, and usually loss of insight. All physician deaths are tragic, and where reasonable effective intervention can be made, should be. I think there is room for improvement, and it should be made.
