Taboo Topic in Medicine Gets Closer Look: Doctor Suicides

Physicians work in a high-stress environment, and are often trained to hide their emotions. These factors, along with the patient trauma they face, can hide signals of suicidal thoughts and prevent doctors from revealing them. But attitudes are changing, and more doctors and medical students are seeking help, health experts say.

In the early morning hours of May 9, Dr. Gordon Troy Birk stabbed himself in the thigh in an attempt to end his life.

A friend discovered the bleeding orthopedic surgeon in his apartment in Hot Springs and called an ambulance. The 52-year-old was rushed to National Park Medical Center, where he had practiced for 11 years, and recovered from the suicide attempt.

Birk approached Arkansas Business with his story to help other physicians who might be considering suicide, and he exemplifies a rarely spoken issue: Doctors do try to kill themselves, and sometimes succeed.

It’s difficult to say for certain how many physicians commit suicide or attempt to take their lives, but the number is believed to be at least 400 annually across the country, said Dr. P. Bradley Hall, president of the Federation of State Physician Health Programs of Wilmington, Massachusetts.

The numbers are a terrible, Hall said. “Any loss of a life as a result of a suicide is indeed a travesty, and that would apply to physicians too.”

But the medical profession is starting to recognize the problem of depression in its industry, said Dr. Pamela Wible, a family practice physician in Eugene, Oregon, who has written and spoken about physician suicides.

“Finally, I have been relentless about drawing attention to these suicides,” Wible said in an email to Arkansas Business. “High doctor suicide rates have been reported since 1858. Yet, more than 150 years later, the root causes of these suicides remain unaddressed.”

The University of Arkansas for Medical Sciences has long offered mental health services for its faculty, students and residents, said Dr. Erick Messias, associate dean for faculty affairs in UAMS’ College of Medicine. Also any UAMS employee has access to the wellness assistance program.

The number of medical students using the mental health programs has more than doubled in recent years, he said. One reason for the increase, Messias said, is the stigma associated with mental illness has declined.

“We have a whole generation that’s growing up seeing their friends going to the nurse to get their attention-deficit medication,” he said. “Depression is not as much stigmatized as it used to be, which is a good thing.”

Still, the stigma endures. After his suicide attempt, Birk said he found it was difficult for his friends to speak to him.

“People don’t know how to talk to you,” Birk said. “They’re scared to talk to you. … It’s like if they touch you, they might get the disease.”

Under Pressure
Birk said that doctors are pressured to be perfect, and “of course, none of us are perfect.”

In addition, doctors are trained to hide their emotions.

“I think we internalize too much,” said Birk, who graduated from the University of Utah School of Medicine in 1994. “And if you don’t find good ways for outlets, then you end up in situations like mine.”

Years ago, doctors might have stayed silent and just plowed through the depression, and “then get home and drink yourself to sleep,” UAMS’ Messias said.

Birk said that “a very large portion of my attempt was related to work and stress … and not handling it appropriately on my part.” He said that the attempt was not tied to patient care.

“The point where you try to kill yourself is obviously not a very good answer to problems,” said Birk, who now practices at Jefferson Regional Medical Center in Pine Bluff.

Birk said he isn’t depressed, nor has he ever been treated for depression. “But I certainly had an episode where I got to that point,” he said. “If you asked me 10 years ago if that would happen to me, I would have laughed.”

UAMS’ Messias said evidence shows that stress levels for doctors have been rising over the last few years.

“And one of the most tragic consequences of that is this high number of physician suicide attempts or completed suicides,” he said.

A factor that can trigger suicide is regular exposure to trauma, death and human suffering. “So there is something about health care that is very hard on people that are working in health care day in and day out,” Messias said.

The death of a patient can also hurt the doctor, said Wible, the Oregon doctor.

“Even when there’s no medical error, doctors may never forgive themselves for losing a patient,” she said. “Suicide is the ultimate self-punishment. In several cases, the death of a patient seemed to be the key factor in pushing them over the edge.”

Employers Can Help
Wible said the employer of any doctor who has attempted suicide should offer confidential counseling. The doctor should be treated “similar to how one would expect to treat a doctor (or any employee) who had a pneumonia or another physical health condition,” she said. “Don’t further stigmatize the person who is already suffering and in pain.”

UAMS’ Messias said the mental health programs that UAMS offers its employees, students and residents is free and confidential. “Their records don’t even go into the general medical record system … to make sure they feel they’re treated in a very, very confidential manner,” he said.

Spotting a depressed doctor in the workplace, though, is difficult.

“Physicians tend to be very good at hiding that type of pain,” Messias said.

And the depression won’t surface at work, he said. “In the workplace, people have put on their best face and they get literally down to business,” he said.

Doctors who appear to be happy and well-adjusted also die by suicide, Wible said. “Doctors are masters of disguise,” she said in a column she wrote for The Washington Post in January. “Even fun-loving docs who crack jokes and make patients smile all day may be suffering in silence.”

Signs of Depression

Signs of a depressed employee, in any workplace setting, could include starting to show up late to work, loss of efficiency or productivity, inappropriate dress or deteriorating hygiene, according to Dr. Erick Messias, associate dean for faculty affairs at the University of Arkansas for Medical Sciences College of Medicine

A change in attitude from positive to negative can also be a sign that an employee is depressed, he said.

While a colleague shouldn’t take the place of a mental health professional, Messias said a trusted co-worker can guide depressed employee to the right professional care.

“In the mental health system, there are tools to identify and help get people out of the crises and prevent new episodes from occuring,” Messias said.