Doctor Suicides: A Growing Epidemic

In September 2014, two doctors in the second month of two different medical residency programs flung themselves to their deaths from high rise buildings in New York. These two tragic cases were 1 in 200 of the 400 cases of doctor suicide in the United States last year.

One can never know what drove these promising young physicians to suicide, but just a few months earlier they probably had celebrated their graduations from medical school with their families and friends. They probably had entered their post-graduate training programs with enthusiasm for full-time work in healing patients. And they probably had tremendous debt after financing their educations, many doctors borrowing hundreds of thousands of dollars to get through medical school, worked at least 80 hours a week, and possibly more, and suffered tremendous emotional trauma at learning the limitations of their profession's ability to help people in medical need.

Young Doctors Especially Vulnerable To Depression

A 2009 study found that 9.4% of fourth-year medical students, nearly one in ten, had experienced thoughts about or desire to commit suicide in the two weeks preceding the survey. Male doctors commit suicide at twice the rate of the general population, and female doctors commit suicide three times more often than male doctors.  Over the course of their careers, about one doctor out of every 50 ends his or her own life.

Medical school and residency (formerly known as internship), especially in the United States, are traditionally times of tremendous stress. Medical students take the equivalent of 24 to 36 semester hours per semester, twice the academic load they endured as undergraduates. Medical school courses require labs and work in clinic, not just preparation from notes and lectures.

Before 2003, American medical residents typically worked 24 hours on, 24 hours off, grabbing sleep when they could in break rooms occupied by the entire staff. Doctors in training were expected to stay with a patient from admission into the emergency room until resolution in the hospital, no matter what toll the experience took on their health or their personal lives.

Economics of The Practice Of Medicine Not What They Used To Be

In the 1960's and 1970's, in the US, doctors were the highest paid of all professions. Many doctors became truly rich. In the twenty-first century, however, more and more patients are insured by health maintenance organizations (HMO's), which strictly limit what doctors are paid for their services. A specialist who has 25 years of experience after 8 years of residency and 8 years of college and medical school who has to maintain a staff of 20 with their offices and equipment might receive as little as $100 for an hour-long consultation. Medicare and Medicaid can take months, or even years, to pay service providers.

See Also: What Doctors Don't Know About Nutrition

In many states, doctors are exposed to malpractice liability, and have to pay onerous fees for malpractice insurance coverage. Patients read about their conditions on the Internet, and expect doctors to know more, while often failing to appreciate the doctor's hard-earned clinical judgment. And doctors go into debt not just hundreds of thousands but sometimes millions of dollars setting up their practices in parts of the US.

What's Being Done About Doctor Suicides?

The system for training doctors in the United States is not as harsh as it once was. Since 2003, American medical residents are no longer required to work more than 80 hours per week. This is the equivalent of 12 hours a day, but it allows some time for sleep, family life, socializing, exercise, and all the things doctors themselves need to do to maintain good health. In the European Union, medical residents are limited to 52 hours in their work week.

Medical students in the United States take on four patients until they graduate, but as soon as the title "M.D." is added to their names, they immediately have to start seeing 10 patients a day. The new doctors often suffer severe fatigue, and make serious mistakes, which are usually immediately caught by their supervisors. The command structure of the hospital is hierarchical, with authority centralized like stones in a pyramid, and new doctors are at the bottom of the pile.

Most medical residents have access to confidential counseling services, although these may be on site.  Teaching hospitals have tried everything from therapy dogs to trips to the beach to enhance their residents' mental health, but the nothing in the system helps with the American expectation of "equanimity."

Originally taught in medical schools by its Latin name "aequinimitas," equanimity refers to the expecation most Americans have that their doctors should be mindful, in control, unmoved by emotion, unflappable. The term means "imperturbality," and reflects a very deep demand that doctors remain outwardly calm at all times. The originator of this concept,  the celebrated physician Sir William Osler of Christ College Oxford and Johns Hopkins medical schools in the early twentieth century, explained that doctors should develop "presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril. In full development, it has the nature of a divine gift, a blessing to the possessor, a comfort to all who come in contact with him." The problem is, doctors by no means always feel that way.

See Also: Doctors Hit By High Fees For "Virtual Credit Cards," Why You Should Care

What can you as a patient do to get the best medical care from a new doctor, a resident, or a medical student? Here are some suggestions:

• Know that the resident taking care of you sometimes may be "faking it 'til he or she makes it." Be polite, and be patient, but do not tolerate pronouncements from students or residents who have not yet taken time at least to read your chart and who have never examined you. In the long run, it's kinder to demand good treatment than it is to tolerate slipshod treatment.
• Realize that older residents like to boss around younger residents. Don't rely too much on a young resident's assessment of how long you will have to stay in the hospital or whether you will have to be admitted at all.
• Don't be afraid to ask your doctor about your treatment if you don't understand it. Ask foreign-born residents to speak slowly, or to spell words they cannot pronounce.
• Don't consent to procedures that don't make sense to you. If you are well enough to object, you are well enough to give informed consent.
• But finally, be kind. Your doctor is probably more acutely aware of his or her limitations than you are. Don't be impatient, don't be dishonest, and let your doctor give you the best possible medical care.