I didn’t ponder this issue much — until it hit my own family.
Some of those trained to heal us are hurting the most — here, Dr. Rick Boulay shares a very personal story about depression and suicide among doctors.
When calamitous world events like a pandemic, earthquakes, or wars saturate our thoughts, we often fail to see the daily tragedies occurring right in front of us. I’m a board-certified Gynecologic Oncologist, practicing for over 30 years, and though I’ve been profoundly satisfied with my career, there have been many days where I’ve wondered if that was worth the tremendous sacrifice so many of my colleagues make. My first experience with physician suicide was during my last year of medical school — and it wouldn’t be my last.
That year, our entire medical-school class attended a funeral for one of our own who’d taken their own life just months prior to graduation. Aside from commencement, this was the only time our class met as whole — bewildered, in disbelief, and heartbroken — paying respects to one fallen in pursuit of a career in healing. We struggled, unsuccessfully, to come up with an answer, any answer, that could explain why this tragedy occurred.
The suicide rate for physicians is twice as high as the general population, meaning that over the ensuing 30 years or so of my practice, an estimated 12,000 physicians died by their own hand. In fact, one American physician dies by suicide every day. And despite what I’d experienced, I wasn’t paying close enough attention to this issue until the problem came home with me: On July 25, 2021, my daughter, a second-year general surgery resident, attempted suicide.
Throughout her life, the sun didn’t set each day without a new reason for me to be proud of my kid. From early childhood on, she was clever and curious, thoughtful and perceptive. She had an infectious giggle that caused teachers to lose command of the class as the students fell into hysterics. Her dedication and work ethic resulted in so many awards that she needed a wheelbarrow to get them home from one high school ceremony.
In her teens, though, the tide of her personality started to shift. She was diagnosed with depression at age 20, but admits her symptoms started far earlier. In her third year of college, she lost several friends and family members to illness and returned to her last year of college reeling, only to hear about two other classmate suicides in the first week of school. One night, we received an ominous phone call from my daughter late one night reporting that she “didn’t feel safe with herself.” Her mother drove six hours to pick her up, and my daughter spent the remainder of that semester getting help for her depression.
She returned the next semester to complete school, and with treatment, my daughter led a productive life. She gave her high school valedictorian speech on the quote, “Be kind, for you never know what burdens others carry.” Then she graduated from college, Phi Beta Kappa, with a publication in a scientific journal. She completed medical school and matched into a competitive general surgery program. She successfully managed her depression with medication and counseling.
However, upon graduation from medical school, things drastically changed. Her work schedule, which sometimes required more than 90 hours per week in the hospital, precluded any form of counseling or self-care.
Then the pandemic hit, and the stress of caring for critically ill people deepened. An already-difficult job became saturated in hopelessness and toxicity, caring for what seemed like all of the 1.2 million Americans who died of COVID. Each unsuccessful intervention, each intubation, every arterial and venous line placed — everything seemed to worsen the suffering, and death came anyway. Through her protective equipment, she could barely see, let alone touch her patients. Despite warning signs of suicidal behavior and an inpatient admission for depression, her training program allowed little room for mental health care. When her daily dose of antidepressants proved ineffective at alleviating the chasm of emptiness and pain of her depression, she sought refuge in fistfuls, and welcomed death as an old friend. Yet fortunately, for perhaps the first time in her life, she failed at something.
After a five-day stay in the intensive care unit, her boss reached out to me. He’d tried telephoning her, but was unsuccessful. When he heard the news, he didn’t ask how she or the family was doing: He asked when she’d be back at work.
I reached out to her institution and even national organizations that oversee medical training programs to secure a medical leave of absence, but I found no help. Only one of her 30 physician friends reached out to see how she was. The medical community abandoned her.
Despite studies documenting higher than normal resiliency, or the ability to bounce back after difficult times among medical students, resident physician depression scores skyrocket during training. Forty-three percent of training physicians report significant depressive symptoms.
Physicians are also less likely to formally manage their symptoms of depression than the general population. Though they’re trained at understanding the human body and psyche, they fail to identify symptoms of depression within themselves and their colleagues. There are other impenetrable barriers to treatment, too: a lack of free time, the desire for anonymity, and the licensure requirements of documentation of any mental-health condition. Another powerful factor? Stoicism and the normalization of stress are baked into physician culture, almost forbidding us taking time to care for ourselves.
This isn’t a new problem, and physician suicide can be curbed. We can assist physicians in identifying depressive symptoms in themselves and colleagues, through education. We can change the way that licensure works, eliminating the need for doctors to report inactive medical and psychological illnesses. And physician culture can be improved, by implementing wellness models that are designed to reduce burnout.
Firefighters race into burning buildings to rescue comrades, and soldiers brave enemy fire to return the wounded from the battlefield. Yet physicians, trained healers, stand idly by while body bags of dead colleagues stack up around us. It’s time that physicians began looking after our own.
Rick Boulay MD practices Gynecologic Oncology at the St. Luke’s University Health Network in Bethlehem, PA. His writings, written at the intersection of medicine and society are published in numerous medical journals and lay press; follow him on Twitter @journeycancer.
