A reader writes:
While I think this is important question, I also find the suicide rates not at all surprising. In fact, it is about as surprising to me as the data about soldiers taking their own lives in record numbers (that is to say, not surprising in the least).
During the middle of my residency in surgery, which was before work hour restrictions, I would go months at time without seeing the sun. I would typically work 80-100 hours a week, take in-house call every second or third night, and deal with all manner of death, dying, stress, and trauma. I was single and had little time to date, much less start a family. Showing fatigue, stating you needed a break, or any other sign that you were suffering resulted in you being labeled weak or whiny.
I could look forward to 2-3 more years of the same before my residency was complete. After that, I could look forward to an average salary which seemed to be shrinking by the year unless I tacked on 1-2 more years of fellowship training. Furthermore, I could read in the paper everyday that physicians were losing respect and were perceived as a major source of our country’s health care woes.
I went to work everyday and suffered through nurses with clipboards asking why patient X and Y hadn’t been discharged yet, administrators telling us we had to use instrument A instead of instrument B because A was cheaper (even though B was better or safer), operating rooms that were understaffed (“your case will have to wait until 7 pm to get done because it’s after 2 pm and we’ll have to start paying nurses overtime if we start your case now.”), and patient’s family members who weren’t there at all for the first 10 days of a patient’s hospitalization but are now demanding to see the doctor at 8 pm at night.
So after one snowy February day, after treating a mother whose baby had been decapitated in a car accident and all other manner of horrors, as I was driving home I thought, “wouldn’t it be nice to drive up into the Cascades (my residency was in the Pacific Northwest), get out of my car, walk into the woods for about 30 minutes, find a nice tree, and sit down in the snow and drink a bottle of whiskey until I became numb and fell asleep? I would never wake up.”
The good news is, I didn’t. And I’m one of those older doctors now who has no interest in or thoughts of suicide. I make a good salary, and while I still work hard and treat all manner of horrible things that happen to people, I usually make them better. I have a lovely wife and two beautiful children.
But when I read this question, I think that, like our soldiers (I was one of those too, by the way), most people have no earthly idea about what many physicians experience in training and in practice every day, and how much stress, sleep deprivation, administrative nonsense, medico-legal threats, and continual erosion of autonomy we deal with. It adds up. Throw in a sudden lawsuit, marriage break-up, or other major stress and you have the potential for a physician imploding.
We have definitely tried to make things better for doctors in training, and that needed to happen. We haven’t made things better for new physicians out of training; if anything, things have gotten worse with all the upheaval in the health care system. We are constantly asked to deliver more with less. Patients are more demanding, not less. We have a incredibly skewed perspective on end of life care, a topic which has been previously covered at length in this blog. The future is uncertain for private practitioners. There are multiple factors in play, and what leads a troubled physician to take his own life is different for each one.
For many more stories on suicide, read our long discussion thread here. Update from a reader:
One of Carroll’s readers had a great line:
Most people have to choose between doing God’s work and being in the 1%. Only doctors get to do both.