September 17th was National Physician Suicide Awareness Day. An estimated 400 physicians commit suicide per year, which accounts for more that one per calendar day. It is assumedly-safe to say that this number is dramatically higher if we include APPs, nurses, other medical staff and students in medical training. In the State of Well-Being 2019 report from the Mayo Clinic, physicians were found to be at a 2x higher risk of suicidal ideation than other professions.

Burnout levels, pre-pandemic, hovered around 50% of physicians. During the unprecedented stressors upon us since the pandemic started, I’m willing to bet that this number is significantly higher right now. This thought concerns and saddens me, but also makes me appreciate the fact that there is a dedicated day for awareness about suicide by physicians. At the meta-level, if the healers aren’t healthy themselves, how can they give their best to themselves, their colleagues, their loved ones and their patients? The answer is simple: They can’t.

This summer, I read a New York Times article about Dr. Lorna Breen, and I just couldn’t help but cry. I cried because I was sad for Dr. Breen and her loved ones, sad for everyone else that cared deeply for her, sad for the many that she cared for and impacted, and sad for my fellow medical professionals (and myself) still enduring unprecedented levels of personal and professional stress. I also felt sad and unnerved in reading her story because I found many of the details eerily-relatable.

Many of us medical professionals have experienced burnout, and many have also suffered from depression. As the numbers tell us, many suffer from major depression and get to the point of deciding to take their own lives. I am willing to say that I’ve experienced burnout and major depression since working as a PA, and I can empathize with those trapped within the “darkness” of those afflictions that might be considering all possible abortive options, including suicide. Sometimes a permanent solution to what is most likely a temporary problem sounds like the best way out of the hole we find ourselves in. But, as someone who has seen and felt (personally and professionally) the toll of what the act of suicide does, I understand it as acting as a solution only for the victim, and also how it exponentially displaces the emotional toll to others, and makes them lifelong bearers of grief. I compare it to an explosion, wherein there is emotional shrapnel that inflicts collateral damage within a certain radius, and often those wounds are then carried around by those “other” victims forever. 

Physicians, APPs, nurses and other medical staff are, at the most basic level, just everyday people who have decided to make healthcare their profession. Although some of may be considered rather high-functioning and even sometimes appearing unflappable, we still run on the same basic human hardware and are not immune from emotional distress, depression, burnout and even suicidal ideation. Unfortunately, due to a plethora of reasons, including mental-health stigma and the “I’ve got this ” attitude engrained in many of us, medical professionals are also not likely to seek help when we may need it. 

Dr. Breen was an incredibly intelligent and well-respected leader in her organization, who likely had endured countless stressors during her life, including within her training and career, so she was no stranger to overcoming challenges. But, as the article says, at some point she felt that  “I couldn’t do anything “, and the stress of the pandemic became absolutely overwhelming and seemed to break through all of the resilience strategies and traits that got her the acclaim she had. It was tragic in reading of how her spirit was broken by her work as an emergency department physician during the pandemic, and how she reached the point of not wanting to live anymore. 

Could her suicide have been prevented? We can’t know that for sure. But, for every Dr. Breen, there are about 399 other physicians, and countless other medical professionals, who annually take the action of suicide. I’m not sure how many of our comrades can be “saved”, but I do know that it is worth putting in the effort to try. We just have to keep trying. 

Awareness of the epidemic of physician suicide is the first step in suicide prevention. I think discussion, especially proactive solicitation of feelings by employers, colleagues and loved ones, is a vital piece of a solution. A simple and genuine “How are you doing?” can be the invitation we need to take our first step towards healing. This alone, coming from my medical director at a critical time, was the opening I needed to let my suppressed emotions come to the surface, and was the catalyst for my burnout healing process (see my “Pandemic-fried Soul” post). I don’t think I’m alone in sometimes just needing someone to genuinely check in with how we are doing, and I think we all should be trying to do so with our colleagues. Systemically, I don’t think that most healthcare organizations are proactive enough in this solicitation, and I find it challenging to not be cynical about their efforts, but I think it always means more from a fellow clinician or medical professional. At the risk of sounding hyperbolic, I think that a simple and genuine ” How are you? ” can save a life.

Easy access to mental health and other resources is also critical in limiting medical professional suicide. Any barrier, no matter how small, may feel impossible to push through to find the help that some desperately need. Organizations need to have easy-to-find and routinely referenced resources for their employees to get help, should they be suffering from depression, burnout, a combination of both, or especially suicidal ideation. One such reference, which I have personally found helpful, is an Employee Assistance Program (EAP). I have found it easy to get connected to a therapist at no cost, for a limited number of sessions, and I think it serves as an excellent first step for anyone who feels they need help. 

Lastly, let’s eliminate the stigma associated with suicidal ideation, and distinguish that from the actual act of suicide. As someone who has spent a lot of time with suicidal ideation, I have come to see it as a gauge for just how low I am in my downward spiral, and try to eliminate the shame that previously would accompany those feelings.  “I’m a failure “, “I just can’t cut it ” and similar negative thought patterns used to accompany the SI, which would only serve to feed the depression, but I’ve learned to look at the SI more objectively as a signal of my emotional state. By removing the judgments, I’ve allowed myself to think and feel the SI and then recognize that “This is where I am mentally, and that is okay”, and it is time to start to dig out of the hole I find myself in. My hope in sharing this reframing of SI is that, should someone reading it find themselves having SI now or in the future, perhaps they can try to pause, remove the judgments and shame, and just see it is a measure of where you are in your depression. The wonderful news is that there are plenty of tools to employ that can help you start the process of first, stopping the downward spiral, and second, start the process of reversing course.

I, like all medical professionals, including the late Dr. Lorna Breen, are just people at the most basic levels. We are subject to the same emotions, stress and other aspects of the human experience as all others, and we should not assume that the strategies we have used to accomplish what we have, nor the parts of our training that we routinely use to treat others, empower us to heal ourselves. Medical professionals historically make bad patients, because we often fail to truly engage others, thinking we can have a go at it ourselves. The heavy burden of burnout and depression should be one shared by many, not just one individual, when it becomes too much to bear. There will be some, such as myself, who can recognize when they may need some help, but there will also be many who do not recognize this, nor feel able to take action to heal. This is why I encourage my fellow medical professionals to not be afraid to seek help, and also I plead with the rest of you to take the time to ask that stressed-out or depressed colleague, “Hey, how are you?”. That simple question may just be the catalyst to beginning their healing process, and could even be the right words at the right time to save their life. And even though it may not be enough in the end, we still have to try.

***In memory of Dr. Lorna Breen and all of the other physicians and other medical professionals who have taken their lives.***

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) There are no conflicts of interest to report. 3) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #burnout #medicine #physician #physiciansuicide #physiciansuicideawarenessday #depression #APP