Transcription:
Raising Awareness About Physician Suicide

Intro: Another informational resource from UK HealthCare, this is UK HealthCast, featuring conversations with our physicians and other healthcare providers.

Caitlin Whyte: Welcome to UK HealthCast from the University of Kentucky HealthCare. I'm your host, Caitlin Whyte. Today. we are discussing the widespread issue of physician suicide and how to combat it.

Joining us is Dr. Christopher Doty, an emergency physician with UK Health. Now doctor, physician suicide isn't often top of mind when we think of our doctors, but just how prevalent is this issue?

Christopher Doty, M.D., MAAEM, FACEP: Well, I think that's part of the problem, is that we really don't know how common this issue is, and even physicians don't really know how common it is. Embarrassingly, I didn't know how common it was. And I had been in academic medicine for 15 years before I really looked into this.

There was an article by Frank that came out in the year 2000. And she basically was trying to show that this idea of the unhealthy doctor was not true, and that was indeed what she found in her paper.

But interestingly, that data also showed that almost 400 doctors a year were dying by suicide. Now, the thing is, is that data only looked at 28 states and it didn't look at some of the most populous states as well. So this number that floats around and was quoted in the New York Times a couple of years ago is vastly sort of underestimated. So it's 400 doctors a year.

Now, when I first read that statistic, because I had a colleague die by suicide and I was struggling with how to deal with that. But when I first read that statistic, I said, "Oh, 400 a year. Well, okay. Well, that's, I guess, reasonable." But when I put it in the context of how many medical students must graduate every year to backfill the attrition due to suicide, I mean, medical schools range from 100 to 200 physicians graduating per year. So when you think about it, there are somewhere between two to four medical schools that have to exist and graduate a class every year, just to make up for the attrition due to suicide, and to bear in mind that that number is underestimated. So it's even more than that. And when I think of it in that way, it is a catastrophic loss that we have to have that many medical schools just to make up for that much attrition.

Caitlin Whyte: So getting more into it, why is this such a widespread issue? Are there factors inherent to modern medicine that contribute to it.

Christopher Doty, M.D., MAAEM, FACEP: I believe so. There is some literature to show that that the practice of modern medicine may be separating the physician from the patient. We have electronic medical records, which are necessary with today's complex practice environments, and we spend more time on the medical records and less time at the bedside.

Well, some literature has shown that that doctor-patient relationship is one of the things that's helping the resiliency of the physician. It's one of the things the physician looks to to see that he or she is having impact and to drive satisfaction in their career. One of the other things that's happening is we have a culture within medicine and, you know, and it's not healthy. The culture is don't be weak. The culture is don't ask for help. There has been some science, some literature that has looked at this and physicians are very unlikely to disclose that they are feeling inadequate or depressed or suicidal. And the more depressed they are, the less likely they are to disclose, and the less likely they are to seek help. So we've created a culture where you can't ask for help, or at least it's not normal to do that. And the more you need help, the less likely you are to get it, which is terrifying because people are suffering in silence, afraid to ask for help.

Caitlin Whyte: Now, you touched on this earlier, talking about how people in both the medical community and outside it aren't educated enough about this subject. So how can we get educated? And are we prepared to deal with it as a community?

Christopher Doty, M.D., MAAEM, FACEP: Well, I'm not sure if we are prepared to deal with it. I think within medicine, we don't talk about this. And presently, over the past couple of years, wellness has gotten more and more traction. But in a lot of ways, it's almost like victim-shaming. So we have senior physicians, organized groups, national medicine organizations, which are saying, "Well, you know, you need to do yoga and you need to work on your personal resiliency," and this and that. "Here's some granola bars," and granola bars are nice, but we're not going to be able to granola bar ourself out of this problem. Part of the issue is that there are cultural and institutional drivers, and that's really where most of the bang for our buck is going to be.

A couple of years ago, prompted by this loss within our own department, I began a resiliency workshop for medical students that were coming through the medical school where I work, UK. And the medical students said to me, each and every time they came through and they were third year students, they said nobody's ever talked to us about this before. And it was a workshop on resiliency. And again, the victim-shaming thing that I mentioned before, but you know, what factors can we influence as physicians to improve resiliency within ourself? And they said, "Nobody ever talked to us about this before. Nobody ever mentioned, you know, physician suicide and depression and burnout."

Embarrassingly, I mean, I've spent my entire career now at over 20 years, educating physicians, most of those being in graduate medical education, at the residency level, but also, you know, many, many students over that time as well. And I've taught about everything within my specialty, within emergency medicine, but I didn't spend a lot of time on resiliency and physician wellness. So to answer your question, we have not spent time talking about it. And part of the issue is, is that to really improve wellness and resiliency, it takes time and treasure. And those are things that sometimes are hard to get with, you know, the ultracompetitive world that medicine lives in right now. It's a tight market.

Caitlin Whyte: I can only imagine how COVID-19 is making this issue worse. Can you tell us more about that intersection?

Christopher Doty, M.D., MAAEM, FACEP: Yeah. I mean, it's been devastational to healthcare workers. And obviously, I come at this from a physician standpoint, but I think you could say the same thing about nurses and respiratory techs and other staff that are working with patients at the bedside. And there are a ton of ancillary services that help everything work in a hospital. But COVID has done a couple of things. One, it has atomized people, right? We are physically, socially and emotionally distant from other people. And that's on purpose. I mean, that's what the science has told us to do, that distancing is a good thing. So we don't meet as often in groups, whether that be in the clinical area or outside of it. So just myself, I mean, I have a wife and kids and I go home and I spend time with them, but I don't really go out with my friends much anymore. Well, in the summer, you know, we can go out to a park or we can hang out at somebody's house outside. But in the winter, you can't do that. And that's not just physicians, that's everybody. It's put a crimp in everybody's sort of social lives and therefore decompression.

And one of the things that's really tearing healthcare workers apart right now is really the moral injury that's happening. We see patients that come in, they're terribly ill and we immediately separate them from their family. Not because we're trying to be mean, but because we have to quarantine and do infection control, mitigate the risk to other patients and their family. So when you're sick with COVID, you know, it's a lonely place to be. You're in the room. We try to minimize the number of times that we go into that room on purpose so that, you know, we can protect our staff. And then the last thing that I think the general public is not thinking about is that healthcare workers are doing all that they can to protect themselves and their families and their coworkers. And quite frankly, not everyone in the public is. And that burns out healthcare workers when they feel like they're doing the best that they can and exposing themselves and potentially their family, and we don't feel like, you know, the public is doing everything that they can do by getting vaccinated and wearing masks and social distancing.

Caitlin Whyte: Now, talk to me more about the power of light. How can something as common as light help us?

Christopher Doty, M.D., MAAEM, FACEP: Well, when we talked a little bit about this before, you know, I said light disinfects, and I mean that in a sort of a metaphorical term. And what I mean is, is that bringing our weaknesses, bringing our inadequacies, and talking about them, disclosing that we're feeling down or depressed, or we need help, just the verbal, you know, speaking it out is tremendously helpful for people. So bringing these things to the light, so to speak, and shining a light on the issue of physician burnout, the issue of physician suicide, disclosing that you're having challenges is tremendously helpful.

One of the reasons that we don't disclose, going back to our cultural issue, is that we're scared of being kicked out of the tribe. We're scared that we're going to be perceived as weak or as one of the others instead of us. And I would argue that we need to really weaponize that tribalism. And what I mean by that is, is that having an adequacies, feeling down, feeling depressed every once in a while, feeling like you're a little cooked and you need to vent or talk about it, that sort of makes you one of the tribe. That's normal. It's not abnormal, right? So if we were to be able to change the narrative about what our practice is truly like, I think people would be more willing to talk about it, more willing to disclose that they're having challenges, and it would be normal to disclose and then to be on the other side of that, you know, to be the person who's hearing that and it not be odd that somebody says they're struggling.

Caitlin Whyte: So what steps can be taken right now to help combat this issue? And what larger measures should be looked into in order to find solutions long-term?

Christopher Doty, M.D., MAAEM, FACEP: Well, I think that one of the things that physicians and academic healthcare can do right now, not even academic healthcare, healthcare organizations, is to focus on this and talk about it, to try to provide real-time resources for people to use, to have counseling that is confidential. So if I'm feeling particularly down or depressed, that there's a place that I can go and I can talk to somebody and it's not likely to get back to my coworkers, my residents, my boss, or somewhere else in the healthcare system. So saying, "Well, you know, the department of psychiatry is happy to talk to you," well, that's not always a safe space. So creating places for people to go that are confidential and what I'll call off-book or off-insurance is helpful. I don't want a mental health diagnosis on my chart at the place where I work. And I think a lot of people feel that way.

So that's something we can do today. We can begin to normalize the conversation around the everyday stresses of our practice. And that's not something for the administrators or the academic medical centers to do. That's something that we have to do as providers, as nurses, as doctors, as advanced practice providers or residents, medical students, respiratory techs. We need to be able to talk to each other and count on each other.

There are some personal resiliency practices that can be done. And the literature, you know, shows there's several that can help. And I sort of made fun of the granola bar issue before. And I think the granola bars are nice. I mean, it's nice that people come by and, you know, pay you attention for a second, bring a granola bar or have healthy snacks. And that's great. I don't mean to belittle that, but we need to go deeper than that for sure. And that's just what we do.

And long-term, there need to be cultural changes. We need to realize as academic medical centers that physician wellness, provider wellness, affects the bottom line and it affects patient safety. Academic medical centers are always interested in those two things. You know, no money, no mission. They need to have a margin. So provider wellness helps the margin. Happy doctors are more productive doctors. And the other thing is happy doctors are better doctors. They make fewer mistakes. There's literature showing that physician wellness is directly related to the quality of care that's provided and patient safety.

So if we can have academic medical centers sort of show that they're interested in this, as an example, the University of Kentucky is presently beginning a national search for essentially a chief wellness officer. And it will be at the associate dean level. And somebody will come in that can look at what's going on at the institution and try to develop programmatic responses.

Caitlin Whyte: Well, doctor, we've covered a lot of good information here. Is there anything else you want to add as we wrap up?

Christopher Doty, M.D., MAAEM, FACEP: Yeah, I think that the biggest thing is that if you're struggling, you are not alone. It is normal. What we do is hard, but it matters. And there are places to reach out for help. September 17th, just next week is National Physician Suicide Awareness Day where we begin to think about this and not begin to hopefully focus on thinking about it, but it can be every day. We can help each other or we can ask for help every day. And there are resources within your medical center today that can help you deal with this. And if not, there is a National Physician Helpline that is staffed by volunteer physicians. It's available 17 hours a day. And those people are willing to talk to you, it's obviously confidential, about the challenges you're facing on any given day. And just so it's easy to find, the National Physician Support line is 1-888-409-0141, and that's seven days a week from 8:00 AM until 1:00 AM and that's Eastern time. And also there's a website that you can also get in touch with people and that's physiciansupportline.com.

Caitlin Whyte: And that completes another episode of UK HealthCast with the University of Kentucky HealthCare. Visit our website to request appointments and learn about what services we offer. Find a doctor and more at ukhealthcare.uky.edu. And again, that number for the support line one more time is 1-888-409-0141, 1-888-409-0141. You can also find support online at physiciansupportline.com. Please remember to subscribe, rate and review this podcast and all of the other University of Kentucky HealthCare podcasts. I'm Caitlin Whyte. Thanks for listening.