Wednesday, August 19, 2015

Suicide and Physicians

This week, it was announced that my colleague and pulmonologist was found to have committed suicide. He disappeared about two months ago and his body was found about a month ago. The medical community in the Fox Valley and Waupaca has lost a wonderful and compassionate physician.

I first knew Jeff as a colleague when I was working as a Family Doctor in Waupaca. I referred complicated pulmonary cases to him as well as getting ICU consults. He was always incredibly professional, but also just a nice guy. After I quit practicing, I went to see him for a sleep study and I was diagnosed with obstructive sleep apnea. I saw Jeff as a pulmonary patient once a year. Again, he was professional and a nice guy. And he always asked about my migraines and about whether or not I was close to being able to come back to practicing medicine.

He hid his depression well, as those of us with depression tend to do. But, 400 physicians every year commit suicide. 400. That's a lot. Too many. According to what I've read, the primary underlying cause is depression or bipolar with substance abuse coming next.

Why so much suicide? I've done a little research and what I've read confirms what I experienced. Even in physician groups that try to do a good job of finding depression in patients, physicians are terrible at taking care of ourselves. Many physicians don't have a primary care physician themselves. Many don't recognize the symptoms of depression to see a physician.

And then, there is the stigma of depression or, even worse, substance abuse. Admitting to substance abuse can affect licensure and future practice. This is devastating to a physician.

There are remarkably few support structures for physicians who are depressed. Apparently, Jeff was known to have a history of depression, so he, at least, was in the mental health system. But, he was in a minority. Most physicians with depression or otherwise at risk for suicide don't seek help and don't have much help available.

Working in medicine can be stressful and overwhelming. I worked in a large medical group that did make some attempts to provide some mental health resources in times of stress. After a case where we lost a baby, both the clinic and the hospital did debriefing sessions to help us process our feelings. At the hospital debriefing, the (humanist) chaplain said, "Well, we know that life has no purpose, but we can still find meaning in it." I left soon after. I was reading the book of Lamentations at home and trying to find meaning through God. I didn't find the chaplain helpful at all. At the clinic debriefing, we were led by an EMT and didn't try to find any religious meaning, but talked through our actions on the day in question. It was much more helpful. So, the current structures to help are iffy, at best.

But, it's not just the bad days that are the problem. Medicine is inherently overwhelming. Physicians are expected to not make mistakes day after day after day. Working in an ICU has the immediate life and death decisions, but even the day to day work of a family physicians has the overhanging dread of making a big mistake. And this is just wearing.

I'm going to miss seeing Jeff once a year for my pulmonary visit. I'm sure his friends, family, and colleagues are devastated by their loss. And what is so sad is that Jeff had an illness that probably could have been treated.

I've written before about depression. Untreated depression leads to suicide. And it leads to suicide more often for physicians than for other people. 

Please, whoever you are, if you are depressed, contemplating suicide, or even just thinking that the world would be better without you, talk to someone. If there's no one around to talk to, call 911. They know who to contact to get you help. 

Depression is a fatal illness. And it hurts more than just the person who has it.

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