3 Strategies for Physician Suicide Prevention

Ignoring physician suicide won't make it go away.

"It has to get better," a young man implores his hopelessly out of touch high school counselor. "The way we treat each other and look out for each other. It has to get better somehow."

In the recently released (and controversial) Netflix series 13 Reasons Why, the audience, along with the series' protagonist, a teenager named Clay Jensen, spends thirteen hours questioning how a community could have prevented a suicide.

While 13 Reasons Why focuses on the death of a teenager, Clay's plea has a universally applicable point; in an era of increased social isolation, many people could benefit from an improved system of checking up on the well-being of their friends, colleagues, and neighbors.

While many physicians would deny it, they might benefit more than other groups, says Michael Myers, MD, professor of clinical psychiatry at SUNY Downstate Medical Center in Brooklyn, NY. He specializes in treating physicians, medical students, and their families.

On average, one American physician dies by suicide every day, says Myers. "For male doctors, these numbers are about 1.4 higher than men in general, and for female doctors, it's about 2.3 times the numbers of women in general."

Even more concerning, many physicians do not get help when they need it. Myers estimates that 10 – 15% of physicians who go on to commit suicide never received any treatment.

"The culture of medicine is based on strength and perfectionism. Everyone is expected to be on top of their game," says Myers.

1.Start Talking

The first step in preventing suicide, says Myers, is to talk about it. Especially when something seems amiss or it is known a physician is going through a rough time personally or professionally, Myers suggests reaching out to that individual. "People often worry that they're making worse the situation worse or intruding on privacy," he says.

But the benefits outweigh any risk. "It's possible you might upset them, but you also might save a life."

It's important to let physicians know that in most states and most instances, they cannot lose their licenses for seeking mental health care, says Myers.

"It's a common concern, but in most states and jurisdictions, it's overstated."

Most licensure and renewal applications no longer ask if a physician has ever sought mental health care; most now ask if in the past two years they have suffered from or been treated for any illness that necessitated taking time away from medical practice or studies, says Myers. A weekly therapy session likely wouldn't count.

2.Train Physicians to Know the Signs

Not only HR should have the tools to prevent suicide and address depression—physicians and other members of the hospital community need the tools to be able to evaluate their colleagues, too, says Myers. Signs that a colleague might need help can include:

• Seeming distant or preoccupied. A typically attentive colleague seems to have something on his or her mind
• Changes in personality or appearance. When a usually fastidious doctor starts showing up to the hospital in rumpled scrubs, it's time to start asking questions
• Seeming tired or hopeless for more than a couple days. Everyone gets a bit down occasionally, but sleeplessness or hopelessness for more than a few days is often a symptom something is wrong.
• Self-medication. Whether with illegal substances, prescription substances (whether self-prescribed or prescribed by a colleague), or with alcohol or marijuana, are all cause for concern.

3.Promote Balance
Prevention and awareness will be an uphill battle in many organizations. Starting in medical school, many physicians are trained to be competitive, to work more than is healthy, and to function in survival mode. These habits do not foster a culture of openness or wellness.

"Sometimes, [burnout] feels like a badge of honor. I'm hard-working and I'm miserable," Myers says to describe the prevailing attitude.  The best way to combat this, he says, is through cultural change. Physicians, along with other healthcare workers, need to know that the organization they work for values work-life balance, a message that often starts in HR.

Myers says he thinks it's worth it.

"To not feel well and to just accept that they are not [feeling well] is so hard for doctors," he says.

To function as a community—to get better at looking out for each other and treating each other better is an important first step.