Physician Wellness
U Suicide and Crisis Center of North Texas
If you are in crisis, please call the National Suicide
Prevention Lifeline at 1-800-273-TALK (8255)
24/7 Crisis Line (214) 828-1000
Crisis Text Line by texting TALK to 741741.
Recognizing Suicidal behavior:
Who Is Most Likely to Commit Suicide?
June 2019 Dallas Medical Journal 23
nderneath his irresistible smile, Ben hid a
lifetime of anxiety amid his professional
achievements. He had recently been
weaned off anxiolytics and was suffering
from rebound anxiety and insomnia—
sleeping just a few hours per night and
trying to perform surgeries and treat
patients each day. Then his psychiatrist retired and passed him
on to a new one.
Eight days before he died, his psychiatrist prescribed two
new drugs that worsened his insomnia, increased his anxiety,
and led to paranoia. He was told he would need medication for
the rest of his life. Devastated, Ben feared he would never have
a normal life. He told his sister it was “game over.”
Ben admitted he was suicidal with a plan, though he told his
psychiatrist he wouldn’t act on it. Ben knew he should check
himself into a hospital, but was panicked. He was terrified he
would lose his patients, his practice, his marriage, and that
everyone in DC—team owners, players, patients, colleagues—
would find out about his mental illness and he would be
shunned.
The night before he died, Ben requested the remainder of
the week off to rest. His colleagues were supportive, yet he
was ashamed. He slept that night but awoke wiped out on May
20, 2015. After driving his son to school, he came home and
hanged himself on a bookcase. He left no note. He left behind
his wife and two children.
I feel a kinship with Ben, partly because I used to suffer
from chronic anxiety that I hid under academic achievements,
but mostly because I’m a cheerful doctor who was once a
suicidal physician too. In 2004 I thought I was the only suicidal
physician in the world—until 2012 when I found myself at the
memorial for our third physician suicide in my small town.
Despite his very public death, nobody uttered the word suicide
aloud. Yet everyone kept whispering “Why?” I wanted to know
why. So I started counting physician suicides. Within a few
minutes, I counted 10. Five years later I had a list of 547. By
January this year, I had 757 cases on my registry. As of today,
that number is 1,013.
High physician suicide rates have been reported since 1858.1
Yet 160 years later the root causes of these suicides remain
unaddressed. Physician suicide is a global public health crisis.
More than one million Americans lose their doctors each
year to suicide—just in the US.2 Many physicians have lost
several colleagues to suicide. One doctor told me he lost eight
physicians during his career with no chance to grieve.
Of the 1,013 suicides on my list, 888 are physicians and
125 are medical students. The majority (867) are in the US
and 146 are international. Surgeons have the greatest number
of suicides on my registry, then anesthesiologists.3 However,
when accounting for numbers of active physicians per
specialty, anesthesiologists are more than twice as likely to die
by suicide than any other physician. Surgeons are No. 2, then
emergency medicine physicians, obstetrician/gynecologists,
and psychiatrists.4
For every woman who died by suicide on my registry, we
lost four men. Suicide methods vary by specialty, region and
gender. Women prefer overdose. In the US, men use firearms.
Jumping is popular in New York City. In India, doctors are
found hanging from ceiling fans. Male anesthesiologists are at
the highest risk among all physicians. Most anesthesiologists
overdose. Many are found dead inside hospital call rooms.
Physician suicides on my registry were submitted to me
during a six-year period (2012–2018) by families, friends
and colleagues who knew the deceased. After speaking to
thousands of suicidal physicians since 2012 on my informal
doctor suicide hotline and analyzing registry data, I discovered
surprising themes—many unique to physicians.
Public perception maintains that physicians are successful,
intelligent, wealthy, and immune from the problems of the
masses. To patients, it is inconceivable that doctors would
have the highest suicide rate of any profession.5
Even more baffling, “happy” doctors are dying by suicide.
Many doctors who kill themselves appear to be the most
optimistic, upbeat and confident people. Just back from
Disneyland, just bought tickets for a family cruise, just gave a
thumbs up to the team after a successful surgery—and hours
later they shoot themselves in the head.
Doctors are masters of disguise and compartmentalization.
Turns out some of the happiest people—especially those who
spend their days making other people happy—may be masking
their own despair. Reading this excerpt from the 1858 Manual
of Psychological Medicine, I’m reminded of so many brilliant
doctors I’ve lost to suicide:1
Many of our most inspiring and visionary leaders—artists,
actors, even doctors—suffer from mental illness.
Yet students enter medical school with their mental health on
par with or better than their peers. Suicide is an occupational
hazard in medicine. Doctors develop on-the-job PTSD,
Suicide rates are highest in teens, young adults, and the
elderly. White men over the age of 65 have the highest rate of
suicide. Suicide risk also is higher in the following groups:
• Older people who have lost a spouse through death or
divorce
• People who have attempted suicide in the past
• People with a family history of suicide
• People with a friend or co-worker who committed suicide
• People with a history of physical, emotional, or sexual abuse
• People who are unmarried, unskilled, or unemployed
• People with long-term pain or a disabling or terminal illness
• People who are prone to violent or impulsive behavior
• People who have recently been released from a psychiatric
hospitalization (This often is a very frightening period of
transition.)
• People in certain professions, such as police officers and
healthcare providers who work with terminally ill patients
• People with substance abuse problems
Although women are three times as likely to attempt suicide,
men are far more likely to complete the act.
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