I just received this email:
“I’m a male anesthesiologist. I have been battling suicidal ideation for seven years and eight months. I vividly remember the day I was admitted. A colleague came into my locked office and saw me sitting at the desk with induction meds and an IV. My career was over and nearly my life. I know seven colleagues that have committed suicide, all male anesthesiologists.”
I have several male anesthesiologists who have written me over the years about losing up to 8 – 10 colleagues (including CNRAs) to suicide. Mostly male suicide victims. What’s unique about men in anesthesiology that puts them at high risk?
1) Anesthesiologists have access to painless lethal medications—that’s #1.
2) Men are less likely to ask for help. And physicians—especially proceduralists—are the fix-it guys.
3) Anesthesiologists may develop addictions to handle the stress of their job. Alcohol, Rx diversion, illicit relationships.
4) Anesthesiologists have the highest rate of suicide completion of any specialty. Nearly twice as many as the next highest specialty (surgeons).
5) As compared to family medicine (and more relational specialties), anesthesiologists are less relational and their procedural focus is on medication. Meaning they have a closer relationship with the drugs they dose than the patients they care for.
6) If anesthesiologists are having a bad day, they may dream of switching places with their patients so they can escape.
7) Frustrated by endless bureaucracy, board certification, insurance credentialing, hospital privileges, OR drama, stressed surgeons, anesthesiologists can’t just leave large medical institutions and launch cash-based clinics with autonomy.
8) All physicians fear having to answer mental health questions on med board applications, hospital privilege renewals, and to participate with insurance plans. Male docs may be likely to be in therapy due to cultural stigma.
9) Anesthesiologists have high exposure to vicarious trauma with patients who are suffering and sometimes dying during surgery.
10) Male anesthesiologists are less likely to cry and emote than their female peers. Women physicians may call a friend, cry on the phone, go visit a female relative, talk with their girlfriend.
11) Anesthesiologists are underappreciated by patients who are more likely to give thank-you cards and gifts to their surgeons and primary care doctors.
12) Medical education teaches all of us to internalize our stress and then punishes us when we ask for mental health help or have unexpected outbursts.
13) Men are more likely to lose their temper and choose an impulsive reactive way to handle stress (a function of testosterone). Even with a legitimate reason to be angry, they may be punished by hospital admin for any outbursts—then labeled as “unprofessional” or “disruptive” and may then be mandated to Physician Health Programs than can be very punitive.
See: “Unprofessional”—how one word is used to censor, harass, and intimidate doctors.
Recently, on Dr. Oz I was asked to comment on a surgeon who had “strangled a nurse” with an elastic cord and of course, I wasn’t there and I don’t feel like I could comment on the a case; however, since I was placed on the spot I researched what I could. Here’s the situation: a surgeon is alleged to have strangling a nurse with an elastic cord. (NOTE: charges were later dropped as unsubstantiated). The issue as I understood it was related to a nursing medication error and the surgeon “overreacted.” Rather than blame somebody who is overreacting to a life-threatening situation that could injure a patient, I think we must address the system that creates an environment in which people (like anesthesiologists) feel trapped and so unsupported that their frustration leads to outbursts or other maladaptive and self-destructive actions—including intentionally overdosing with intravenous meds. (View 58-second TV clip below).
I work in an Emergency Department – actually the same Emergency Department for 26 years – as a registered nurse, not as a physician. I am considered, “The Go to Guy,” because of my length of time in the ED, by techs, nurses, physicians, and hospital administration, even though (by choice) I work as a staff nurse. My nurse manager, who has her MSN, is supportive, intelligent, and caring, but she doesn’t see the pressure I am under as an informal leader and resource person. Instead of following the chain of command or leadership/mentor structure, EVERYONE COMES TO ME. I feel a tremendous amount of stress, fear of failure, and inability to focus on our patients in the ED due to this demand on my knowledge, no matter how I try to direct staff members to the proper resources available and provided in our department. Even the hospitalists direct questions to me, stating, “A— knows, ask him, he’ll keep you straight until I write the orders.” I was a paratrooper, an Airborne infantryman and sniper, and then a squad leader, responsible for the lives and well being of eleven men in combat, but for years I have been responsible for the lives of thousands of patients who come through our ED, and also providing knowledge and answers to nurses and physicians who have their own patients! I am tired. My wife loves me and supports me, but I feel so drained when I get home, I feel like I am failing her. I have no outside social life except for my running friends, and I am no longer close to my grandchildren. My youngest son, who is 42, just attempted suicide, and is in an inpatient facility for treatment. He told his counselor he hates me, and I am the reason his life sucks. So now I’m responsible for a 42 year old man, while his two siblings, who received much less of my time, are successful and responsible adults. I read your articles, and try for self improvement, but I am tired. Please keep up your work, your encouragement, and your retreats. Maybe, I’ll find what I need to eliminate this feeling of hopelessness, and continue on for 12 more years. May God bless you and strengthen you.
While it is an honor to be the smartest guy in the room that everyone depends on in an emergency, it IS unsustainable as you have noted above. Medicine has a way of stealing your whole life out from underneath you. You deserve to be supported and to have proper boundaries so that you can function well within the ED and at home in your personal life. So I guess I’m begging you to set some boundaries and care for yourself. Ask your manager for help in enforcing the proper chain of command. Direct people to other resources. Limit your hours. Do what it takes to heal. I’d love to speak with you (actually sending you a private email now).
Sometimes formalize your leadership role helps. It gives you the authority to be more directive and compensates you. In order to justify this role you might try keeping track of how many interruptions you experience in a given shift. Once you document how much you are being used you probably could move into a different role. If you don’t want to do that, creating a script ahead of time that redirects folks to the nurse manager or back to dr can help. Requires being very consistent and boundaried even when it is uncomfortable.
I love the idea that male physicians are killing themselves because they aren’t allowed to scream at nurses in the OR! Maybe the physician population is no different than the rest of society, males choose more effective methods and thus die by suicide more often. Females attempt suicide more frequently but “fail” because of choosing more ineffective methods. There is an element of denial in this interview that men “dont get to” cry. Men definitely know how to cry and are allowed to cry if they want to. Men don’t cry because they trade the ability to feel/ask for help for higher status, value and respect. Men who do go ahead and cry and whine for help lose respect and position for doing so. For many men the preservation of their masculine identity and privilege is more important than their very lives (which is why they engage in dangerous behavior, join gangs and the military etc).
I strongly believe in order to change the toxic culture in medicine we need to muster up some compassion for each other and the complexity of the circumstances we find ourselves in when working in teams during life-and-death situations. Vilifying and demonizing others without solution-oriented discussion may help transiently release anger though won’t have the long-term impact in healing our dysfunctional medical system. I can’t imagine that you are serious when you write: “I love the idea that male physicians are killing themselves because they aren’t allowed to scream at nurses in the OR!”
Hi Pamela,
Just want to say how amazing this all is and how much it speaks to a soul and a heart that had been so adversely affected by medicine- yet I love medicine so much.
Hoping so sincerely I get to make it to a retreat.
Thank you for all you do- so many nights I have felt so hopeless so dark- it’s efforts like yours that pull me out just enough to keep me afloat and now give me the strength and courage to hopefully get back to residency and practicing.
Oh just called you. No answer. Left voicemail and email. I’m thrilled that I am able to play some small part in your healing and help you get back to the profession you love. When practiced properly—-without third-party profiteers stealing your dream—-medicine is the most fulfilling profession on the planet! Call me back 🙂
What a mess we’ve made of our “health care system!” How can anyone be/get healthy in an environment where compassion and the ability to speak our truth and honestly express our concerns exist only rarely? Thank you for this honest exchange!
Once patients understand what is really going on in our hospitals, outrage and public pressure should create huge culture change and halt these suicides. Unreal the tragedies I’ve witnessed.
Why is it ok for anesthesiologists to abuse drugs, but there are people out there who need their pain treated and can not receive help due to all the media hysteria about the opioid crisis. Now when a person goes to pain management its like a FBI interogation. It’s not enough to pass UAs, but your expected to worship these so called pain specialist.
I worked in surgery and ER for years and there is no excuse for any staff member to abuse medications. I was setting up for a surgery in operating room scrubed in and the anesthesiologists was stumbling around and he hit the floor. I pulled his mask down and his eyes were rolled in the back of his head. This was the second time he had over dosed in the operating room and then he was given a teaching job. I ran out into the hall and told the staff
bringing in pt. don’t come in here.
All people working in health care industry should have to do monthly unannounced UA’s and that includes
anesthesiologists, surgeons, nurses, surgical technicians, all ER staff the whole hospital, general practitioners every where. I don’t understand why hospitals go out of their way to hide the fact that anesthesiologists and surgeons abuse drugs while working in surgery? If all surgeries were recorded in video with audio that would help, but hospitals hide things and hiding hurts the pt. When will doctors turn in other doctors for abusing drugs? All the staff in the surgery is under stress and pressure not just the anesthesiologists.
There is no excuse for anyone in working in surgery or the ER to abuse medication that is suppose to be used for pts! If a anesthesiologists is suicidal or abusing medication he should quit or be terminated and no free pass. People who work in healthcare are suppose to be pt advocates.
Why is it ok for anesthesiologists to abuse drugs?
It’s not okay. That’s why I we did this podcast.
To shine a light on the lack of resources to help
our healers in the OR so they can care for us.
We all have something to lose when we ignore
the obvious.
Ms. Losee, it is not just the health care system alone, it is also in the rest of our society as well. Our bosses and many parents have a tendency to shut down people and it has been that way for a long, long, long time; otherwise, the USA would be like Denmark in being number one in the basic standard of living and the people being very happy with their lives. They also tend to condone bullying and narcissism in the workplace as well.
Dr. Wible,
I applaud your efforts at bringing attention to the lack of support, both systemic and emotional to the doctors that are out there suffering. It truly saddenes me to know that people who take care of others professionally are not able to get the necessary assistance.
I am but a patient with a chronic illness, however, have a brilliant daughter who is intent to pursue a career in medicine. I believe that your efforts to bring attention to this issue are so wonderful and needed. Thanks for your continued efforts to make change, in both supporting a profession that needs help and in educating the layman community.
With much regard,
Heather
As long as we continue to address the truth of the bullying, hazing, suicide crisis in medicine, I can assure you that medical education will be much safer and saner for your daughter. Let’s keep going . . . we have lives to save!
Using words like “unprofessional” and delusion” to silence doctors who have legitimate complains is kind of like using the words “Communists”, “Socialists”, “anarchist” and “cop hater” to silence individuals and organizations that want political, social, economic and police reforms in the country. In addition, if you are in the military, the military would try to use their mental health department to labeled you in order to get rid of you because you dare to dissent from them. If you also argue with police officers on the Internet, they will tell you to take your medications, seek mental help, and learn how to write properly considering the fact that many of them are on medications (including alcohol), should have been mentally screen to see whether they can handle the job, need mental help themselves, and are incapable of writing a proper police report without a whole lot of grammar, punctuation, and spelling mistakes plus being able not to have their reports be torn apart by lawyers who are good at tearing them apart.
Nowadays, American society is definitely rigged against men with letting them have feelings and emotions and has been that way ever since we put stoic men on the pedestal like Clint Eastwood and John Wayne plus having the political, social, and economic system being rigged against them and being treated as expendable parts; however, too many guys don’t seem to realize it until is too late for them.
I have a few thoughts about anesthesiologist: first, they have ready access to lethal drugs and are skilled enough to be successful. Second, their workday is a lot like an air traffic controller’s, busy at the beginning and end of a case and mostly boring on the middle but they can’t leave their seat, then occasional episodes of pure terror. Third, they get blamed by the more glamorous and better paid (?) surgeons a lot. Time everyday to ruminate on and obsess over perceived failures. Also their schedules are completely tied to the surgeons’ schedules. The ones I know are also extra sensitive to pt pain and pain management lives in anesthesia in my institution, and they seem to feel patients’ pain more than other surgical people.
Pamela, I am a student in school interested in having a future with anesthesiology. This information was very helpful and gave me another view on this career that I would have never came up with on my own. I do understand that ofcourse, not everyone is the same but, If I were to pursue this career, would it be possible to work outside of a hospital (as a private party) and possibly switch to a different job if the environment is too difficult? What other work options would I have with a 12-year education and degree in anesthesiology?
-thank you very much
Many less options for autonomy outside of hospital system with a career in anesthesiology. Please review this article here to help you understand if your nature is one of employee, business owner, or entrepreneur. Very important to know this BEFORE you choose a specialty.
I think that the thing that prevents medical students and residents from speaking out is the overwhelming fear of pissing the wrong people off and effectively ending one’s hopes of ever becoming a doctor. It’s a huge, huge fear in my opinion. And, in my judgement, it is just this atmosphere (where there is no recourse against recurring and possibly much greater petty, malignant, and toxic behavior) that underpins the sense of helplessness that leads to these suicides. But, do you know what is almost as bad? When, once you are a practicing physician, you can be made to feel just as helpless. When I worked as an anesthesiologist at a community hospital, I was told point blank by the anesthesia department head that anesthesiologists were the “whores” of the OR implying that I would not be treated any better than a whore. The surprising this is, she was exactly right. What proceeded after that discussion was nothing less than a nightmare for me personally and later, for her as well. I could go into detail, but it’s unnecessary.
The Dr. Oz clip is very illuminating. 3 women discussing what is wrong with men.
Not in the medical field but just happened to read all of this subject matter.Am very much upset ?. Would like to help if possible.
What do you feel inspired to do? Love to help you help 🙂 Have you seen this campaign? Love letters for doctors. Great way to start.
My view is that apart from the psychological stress and long hours medical professionals are exposed to, a very important factor in physician suicide is their possible higher exposure to viruses, as a result of sick patient contact.
When I caught a coxsackievirus B4 virus, and this same virus spread to over 30 friends and family, it triggered depression, anhedonia and anxiety in several people, as well as triggering several physical illnesses in such as viral myocarditis, type 1 diabetes and bowel ruptures.
Viruses such as coxsackievirus B and echovirus are often never fully eliminated from the body, but may persist as a chronic low-level intracellular infection, called a non-cytolytic enterovirus infection (it’s similar to latency, but the virus remains active inside the cell).
We need to research the mental health effects of viruses such as coxsackievirus B.
Fram an anesthesiologist friend who reports her thoughts on why this specialty leads in suicides:
1) There’s always the individual story at play, but in general I think there’s a little anxiety that goes into being a good anesthesiologist: we tend to be a little OCD, it’s something that helps see the sharks in the water and diminish patient risk. That may relate to some PTSD from growing up.
2) There’s ready access to controlled substances so I think substance abuse is higher, partly from that. And that’s clearly associated with suicidality.
3) Often Admin’s is pushing throughput: as in, be as fast as you can. This is the first hospital I’ve worked in (18 yrs) that isn’t timing the turn-around time to get into the OR. This turn-around time, even if not our fault, is often blamed on anesthesia.
4) Surgeons don’t actually very often care what we are concerned about in terms of mitigating patient risk. One of the reasons I left anesthesia to do a pain fellowship was a 1.5 hour conversation with an orthopod who was angry I cancelled his elective 2 level lumbar fusion for a patient whose Na+ was 114.
5) It’s not uncommon for the surgeon or the CRNA or the charge RN of the OR to be malignant narcissists. The sociopathic nature of that disorder wrecks havoc on one’s self-esteem and otherwise destroys a life.
6) EMRs suck for us too. Like the current one takes literally 5″ to start up and 5″ to close down, that causes all sorts of issues when that time is the most dynamic for us with the patient.
7) Patients are often in life-threatening situations.
In addition she mentions: “There’s one other BIG thing. That’s that the CRNAs, generally, think their education is equivalent and we have nothing to offer the patient. CMS, when I was a resident, allowed their sickest patients to be cared for without an anesthesiologist pre-operatively. Then in 2015 or 2016, CMS allowed CRNAs to do interventional pain medicine WITH NO TRAINING WHATSOEVER. That was quite a blow personally, when I left a successful private practice to go to a pain fellowship at 1/8th the salary because I wanted to take care of that complex population as best I can.”
I have been an anesthesiologist for 25 years. I left surgery in residency because of hazing and absurdity which you have appropriately described in your blogs/articles. Anesthesia not much better. The abuse from most surgeons and the lack of respect from Administration is beyond rational. . The pressure to keep some of these morbidly obese hypertensive multiple medical problem-ed patients alive for unnecessary surgery which pays for the hospital administrators Tesla payments…. never mind the inherent stress of trying to keep people alive for a living. Combine all this with a vast knowledge of pharmaceuticals, physiology and the access to controlled substances and you get addiction and suicide. In a couple of European countries the mandatory retirement age of anesthesiologists is 55 – mostly for the reason that after that age one can not stand it any further for a multitude of reasons. I completely understand being almost 55
55 years ago I spent the summer between my freshman and sophomore years at college as a surgical orderly at California Hospital in LA. Bringing patients to OR and taking them to Recovery brought me into contact with all the anesthesiologists. Dr Potter was the very best. He had been chief anesthesiologist at the hospital during WWII and was the epitome of the profession. He always wrapped a towel around the respiratory assist bag and placed it on the floor to operate with his foot. His cart always had whatever meds might be required to reverse anaesthesia if problems arose. He had an audible tone heartbeat monitor (1968) so he didn’t need a stethoscope. When taking patients out of OR he wanted the gurney reversed so he could elevate the head if needed. I never saw him miss on a spinal placement. The Musicant brothers were also goid and perfect with spinals. Then there was an anesthesiology group and they were much lower their quality. Too many times patients twitched when they botched needle placement. Considering that general anesthesia is a major risk during surgery, how many marginal (for whatever reason) anesthesiologists have “lost” or injured patients? This would doubtless weigh on them.
By the end of that summer I recognized that the majority of patients could have avoided surgery had they made better choices. I concluded that medicine was not for me, and I am forever grateful for the lessons I learned that summer.
My focus ever since has been on nutrition and natural healing, and now, at 74, I take no meds, prescription or OTC, and raised 2 children who never needed to visit a pediatrician. Jab free seems to be the healthy choice as the Amish community has proven.
I wonder if now anesthesiologists have eclipsed psychiatrists as having the highest suicide rate?