Michele and Kevin Dietl
It’s medical school graduation season!
Here come the caps. The gowns. The smiles. And sighs of relief . . .
Time to celebrate our brand new doctors.
Except for the families that can’t celebrate their child’s graduation. Or their child’s marriage. Or their child’s birthday—ever again.
Like Michele and John Dietl.
They lost their son, Kevin, just weeks before graduation. Now they cling to online condolences and family photos. And to the never-ending question: Why?
I’ve become a sideline specialist in medical student and physician suicide. Why? Mostly because I can’t stop asking why. Why both classmates I dated in medical school died by suicide. Why we lost three doctors in town to suicide. Why my cell phone feels like a suicide hotline. Why I’ve received hundreds of letters from suicidal doctors and medical students.
A distressed medical student writes:
“We have had two suicides within two years. Just months after starting first year, a male who was top of our class died by suicide. Another student found him after noticing he missed gross anatomy. The second was more public. An internal medicine intern who had just graduated jumped to his death in NYC. He was very charismatic, highly intelligent, and always willing to help out younger medical students.
The students mourned, including me, especially for the latter who I had just met. There have been no talks from the school regarding how to deal with suicide. I personally find it frustrating that my university does little about this. We have one counselor to all of our students and residents. As a community we are afraid to discuss the topic of mental health openly, and that two very excellent, compassionate people were lost to suicide.”
Since medical schools are doing “little about this,” I invited 176 medical students to share what should be done. In their own words, here are the top ten initiatives for immediate implementation:
1) Increase Awareness. Require all medical schools to establish a suicide-awareness campaign and program for early detection. There are marathons/fundraisers to bring awareness to just about everything. Talk about medical student suicide in public, out loud, and utilize every form of media. Alert students’ families to watch for warning signs. Let students know “you are not alone.” Practicing physicians must stop pretending this isn’t happening. To be accredited schools must meet a minimum level safety, requiring suicide prevention initiatives.
2) Decrease Stigma. Minimize stigma by addressing mental health throughout the curriculum. We need physician role models who admit to struggling academically and psychologically and are willing to share how they’ve overcome these struggles. Create a culture where it’s not just okay, but ENCOURAGED to seek mental health help. Never threaten a student. Never say that divulged information will be documented and used against students academically. This shuts down communication. Do not force medical leave for mental health issues. Some of us just need guidance, and high stress brings out our maladaptive coping mechanisms. Forcing us to leave school penalizes us for voicing our mental health concerns.
3) Share Resources. Students must know what is available and how to get help. Offer social/financial/academic resources. Students have real-life milestones during school, like death of loved ones and the end of long-term relationships. The message should be: if you find yourself in trouble, you have options and we’re here to help. We want you to graduate! Give students step-by-step instructions, easy to follow—even when at their lowest low—of what to do if students are contemplating killing themselves.
4) Institute a Hotline (Online & Offline). Establish suicide hotlines everywhere there are medical students. Offer a website messaging service answered anonymously by students who have survived depression and suicide. People who actually relate to our perspective and can offer hope. Online site would be overseen by licensed mental health professionals and would allow students to access help without time constraints, travel, or treatment costs. The support group atmosphere would allow anonymity, but also rapid intervention via Skype or video chat.
5) Start Annual Screening. Because most suicides come as a total shock, require meetings with a counselor. A mental health check might catch symptoms that others miss. Plus if everyone has to go then no one is being singled out. Let it be okay for students to ask for help with anxiety, depression, suicidal thoughts.
6) Provide Mentorship & Therapy. Match mentors with med students to give them a reality check and make sure that they’re okay psychologically. Ask students about their hopes and dreams! Send reminder emails every few months with ports of call for help and make it very obvious at a glance that the services will be confidential. Create intentional safe spaces in which students can work through feelings or grief and guilt that arise inevitably during rotations. Many feel traumatized in school. Trauma therapy can really help heal the wounded.
7) Humanize Medical Education. Avoid curriculums that dehumanize and completely molecularize the human body. Improve academic support for struggling students. Offer the opportunity to retake tests. Learn clinically relevant material rather than stupid factoids. Reform the board exam system so students don’t feel they have to study every hour of every day memorizing minutiae that is completely irrelevant. Integrate clinical work during first two years. Give students time to take care of basic needs like eating good food, sleeping at least seven hours per night, exercising, and caring for relationships. Mental health starts with self-care.
8) Offer Peer Support. Peer-run support groups at least weekly between classes where students can have heart-to-heart conversations about their day. Start a mental health advocacy group on campus and create a dialogue centered around openness and mutual understanding.
9) Require Physical Education. It sounds really trite, but so many students talk about how they’d love to go for a run if they could just . . . Group exercise or class outings into nature. P.E. Yeah. Physical education. We have all kinds of required science classes that build stress and keep us sitting, but we need a reason to get up and get moving. Depression builds when we sit all day. Helping medical students be physically active would reduce depression and hopefully, suicide.
10) Stop Bullying. The #1 recommendation: a learning environment free of bullying, with harsh consequences for negative or mean instructors. If we disagree with something the school does, we should not be worried about being in a hostile work environment. Let students know it’s okay to make mistakes and stumble and fall along the way. That is how we grow. Instead of bullying, it’s going to sound silly, but dole out hugs. Like the “Free Hug” movement (where people stand around town, holding a sign: “Free hugs”). Such a basal connection, free from malice. When our loved ones hug us, the release of endorphins and feeling of security is unmatched. Tell medical students it is 100% acceptable to feel what they feel, and to be anything other than honest with themselves is not okay – that the best physicians remember their shared humanity.
A few weeks ago I got to hug Michele and John Dietl. They were so gracious and kind to me. Honestly, I haven’t had a man open a door for me in decades. They treated me to lunch at a wonderful Italian restaurant in St. Louis. And they told me all about their sweet, beautiful son. Because Kevin was only three weeks from graduation when he died, they told me the school went ahead and printed his diploma.
So Michele and John have their son’s white coat. They have their son’s diploma. They just don’t have their son.
This doesn’t have to happen again.
But today I was just told about another one in San Diego.
* * *
Pamela Wible, M.D., is a pioneer in the ideal medical care movement. When not treating patients, she devotes her time to medical student suicide prevention and leads medical student and physician retreats. Dr. Wible is the recipient of the 2015 Women Leader in Medicine Award. Photo credit: Dietl family.
Pamela,
This piece about Kevin Dietl’s suicide makes me very sad, but many of the medical students’ requests make complete sense.
Most medical school administrations are poorly equipped to respond to such events, and systems to confidentially support (and if necessary, treat) medical students are often non-existent or underfunded. The same mental health crises that plague medicine at large, affect medical students needing care also. Plus in my view, our medical culture is way crazy in its emphasis on being indefatigable superheroes, rather than embracing our humanness.
I’m cautious about the idea of “required” annual screenings, since these can be SEVERELY mismanaged and turned into something useless at best, and hurtful at worst. Each school would need a cadre of skilled, compassionate, accessible PHYSICIAN counselors willing to provide these services. I say physicians because although there are many other excellent mental health professionals, only physicians know what these students are going through. Having KIND physicians as such mentors can help normalize the idea that the healer’s inner self matters just as much as his/her skilled hands and clever minds do.
The “peer counseling” model can be a great one. I have helped get this going in 1 medical school, and the students seemed to love it. It’s important to have good backup for these students though, as they can end up in situations that are beyond their clinical ability to manage. In the context of a larger overall plan to improve and sustain well-being in a school, peer counseling can be an essential piece.
Overall, I think we practicing physicians need to review how we’re treating ourselves and each other — and see where we might improve. Many of us are chasing our tails as you know though. I’m grateful for your work helping people see practice options beyond managed care crank-’em-out medicine, because that model is killing both patients AND doctors.
Best wishes,
Pam
Thanks Pam! Totally agree. Of course, all of this can be implemented well or poorly. Or sadly, not at all. Takes initiative to do something different. Takes even more to do something the right way. That’s why I’ve labeled them “initiatives”. It’s going to take some serious initiative to get people who are comfortable with the status quo up and out of their chairs and into action.
Such simple solutions really . . .
Sometimes all we lack is the will.
I think that even requiring meeting with a physician mentor would be helpful. Get some Drs together who are passionate about med ed and provide a short course on suicide prevention and mental health. Programs like QPR only take a few hours, SafeTalk only half a day (I think?). Then when students see them they can do a quick check on their stress levels and other potential problems. Hell, sometimes just knowing someone is there who will understand what your going thru can make the biggest difference in the world.
Many young people are far more comfortable texting than using a phone or video chatting when in crisis. There is a Crisis Text Line that is up and running and is available to all: text 741-741 and you will receive a reply within minutes. It operates like a suicide hotline, but by text. This service was described in a recent article in the New Yorker. Post this number in medical schools and residency programs everywhere!
Thanks Laurel!
Getting ready to start medical school in August, this article strikes a profound chord in my heart. I have worked hard in life to become more human and heartfelt and I am not interested in undoing all this work as I go through school! Pamela, one message that really sticks with me is the idea of helping fellow students, not only for them, but for myself! Instead of a culture of isolation and competition, I hope to foster a togetherness so that we can help each other out without letting someone fall through the cracks.
I watched your lecture about how to get through medical school without killing yourself, and you mentioned reaching out to students you don’t know, someone you might not connect with.
I think, like most med students, I have a tendency to withdraw when I’m emotionally compromised because I fear the repercussions of letting someone see I’m human!
I will do my best to be fearless when faced with sadness, frustration, despair and embrace my own humanness, while keeping an eye out for fellow students who may be doing the same.
I am so grateful for who you are and the awareness and action you’re bringing to the world.
Don’t let anyone “fall through the cracks!” We just had an earthquake a few moments before reading this. Yes!!
Such simple solutions and none are very high tech.
I read about Kevin the other day. I stared at the foto. What came to me was that he is smiling yet if one looks at his eyes, no one is home, a vacuous look.
The tragedy of this scenario is so disturbing that I can’t help but wonder how Michele and John wake up each morning, get out of bed, dressed and to work.
My condolences with a cloak of love draped around them.
>>>>>The #1 recommendation: a learning environment free of bullying, with harsh consequences for negative or mean instructors.<<<<<>>It’s going to take some serious initiative to get people who are comfortable with the status quo up and out of their chairs and into action.<<<<<<
My first reaction is "The medical professionals at med schools think that doctor suicide is part of the status quo?" The medical profession needs to take a strong look at themselves and revamp physician education. I can guarantee that the first med school to do so, say so, and become transparent will be the school of choice for many more applicants. The others will follow suit…because medical school is a business, after all.
If they don't, then we're doing what allopathic medicine tends to do: treats the symptom & not the problem. When I think of 'death by suicide' and status quo, it leads me to believe that horrifically, like big pharma when sued, these deaths are written off as the "cost of doing business.'
When I read that the cause of death of young gay men from 16-25 was suicide, I added a section specifically to address gender identification with panels and hand-outs. It's not written up in 10 year old health textbooks.
Without question, this is an emergency situation that Dr. Wible has brought to our attention. I'm here to do whatever is asked. I know if someone really wants to commit suicide, they can. I just want to make it as difficult as possible, to buy time in order to get the thinking straight again and the person back on track of being okay w/ simply being human.
Lastly, I can't help but wonder, "how many medical students are on meds with side effects of suicidal ideology?" Having had 2 best friends commit suicide, a psychiatrist under the influence of drugs and alcohol & the other, an addiction counselor, I am convinced that the problem is compounded by side effects of psycho-meds.
I just want to make as difficult as possible for this population to commit suicide. I want this difficulty to buy time in order to get the thinking straight again and the person back on track of being okay w/ simply being human. It makes me wonder how administration sleeps at night, wondering who's next? When faced with an epidemic, don't places like the CDC/med schools have protocol? Shouldn't these professonals be acting in a manner that indicates that this is of top importance??
Thank you, Dr. Wible, for your consciousness-raising. If you ever want to do "good cop/bad cop" scenario, I make a good 'fall guy,' am expendable, can plant a seed, don't mind being fired as a direct result, and you can carry on implementing a 'treatment' plan for med schools. Manipulation [w/kindness] is called for & has positive outcomes in these life & death situations.
Students shouldn't be doing this work for the schools setting up peer counseling for each other and all. I mean, seriously, one pays a small fortune for the degree! They have enough to do. It's the job of administration to care for their students. The environment is not safe: it feels more like a war zone to me.
Hugs.
Karen
I am happy to connect you to Kevin’s parents if you like. And your comment makes a ton of sense. Students pay good money for these degrees and should be PROTECTED, not harmed.
Dr. Wible,
Thank you for all you are doing to create awareness against this devastating issue. Kevin was a very dear friend of mine, the most caring, funny, selfless person. He is so deeply missed like many of the others who suffered this same horrible fate.
Just knowing that there someone like you who can “speak the language” and “walk the talk” making a difference in so many lives in beautiful.
All I can say is thank you for being aware. This is a huge issue in the medical community. It saddens me. It is nice to know people are becoming aware and working on ways to help our future doctors. Please keep doing what you do.
I have a question, which you may be able to answer, Dr. Wible. Did Kevin match into a residency (vs. not at all or just an internship)? The reason I ask is if maybe he hadn’t, that might explain the feelings of wanting to commit suicide. Needless to say medical students don’t wish to confront this issue at all and many times just want to graduate students.
He matched into a psychiatry residency. Here is a TV segment that covers his death that just aired last week (link is dead). Also please see this talk I gave in DC that describes how the tendency is to blame the victims rather than the system: https://www.idealmedicalcare.org/blog/physician-suicide-101-secrets-lies-solutions/
Sorry this should say, medical schools don’t wish to confront this issue. Many times I believe they are active contributors.
Aha! That may actually make sense. Though some students and many physician remain in denial too. Hard to solve a medical condition if we are unwilling to admit the condition and we continue to hide the bodies.
This seems like a good beginning. Doctors are people first, just like the rest of us and sometimes have too many disappointments at a time. A friend who committed suicide’s parents blamed her when she was molested by an older woman. I thought the boy she was interested in wasn’t good enough for her.
She was an artist not a Dr. A teenager when she was molested and interested in the young man. In her twenty’s when she felt the need to leave.
I’m believe she may have survived either major disappointment as a young person. She was sent to a home for deliquent girls, then was in a mental health facility, when there was much stigma attached and most of the other people were into drugs and anti social behavior which wasn’t the case with this young woman until after these punitive experiences.. She was the victim not perpetrator. This was the sixties in Illinois and we thought our mental health system was one of the best at the time. I think early success at her own decision making. and acceptance by family and friends would have made all the difference. We were afraid she would hurt herself. I may be a robot…..after…all 🙂
I am so glad that the mental health of physicians and medical students is finally getting attention. Please also mention that a large number of us high achievers made it through college, Med school and residency with bipolar disorder. The manic phase of bilpolar really enabled me to survive those all nighters! But then this manic high made it very difficult to say NO to all the temptations that were available after being up all night: clubbing, parties, running half marathons, sexual promiscuity, volunteering to take on another load of patients, hosting a big party, studying for the next days work, dating, etc when I really should have been sleeping! Sleep deprivation is the worst thing for this condition. After a manic high, a wave of depression hits you like a brick. This is when you are prone to alcoholism and illicit drug use to lift you up. Luckily I did none of that. You can feel depressed with suicidal thoughts if not properly diagnosed and treated. I had a suicide attempt when I was 11 yrs old but I was not diagnosed until after residency when my poor judgment led to two failed marriages and a suspended medical license. I was misdiagnosed with depression and the medications made me more manic! I was re-diagnosed as bipolar when I literally lost everything (family and career) and a close friend urged me to see a new psychiatrist. I am now stable on the correct medications and my license is back. Not all depression symptoms, suicide or suicidal thoughts are clinical depression. It may be the depression phase of bipolar disorder!
Thank you for this important story.
My deepest condolences to the Dietl family for your loss.
Suicide ideation is a complex syndrome. Only by speaking up can others be helped, plans to support them established. The medical practitioners are at especially high risk. Unfortunately, to date, patients at high risk for suicide have also been excluded from clinical trials for new medicines.
Thank you for this important story.
My deepest condolences to the Dietl family for your loss.
Suicide ideation is a complex syndrome. Only by speaking up can others be helped, plans to support them established. The medical practitioners are at especially high risk. Unfortunately, to date, patients at high risk for suicide have also been excluded from clinical trials for new medicines.
JED is particularly focused on working with colleges to establish comprehensive mental health & suicide prevention programs.
Here is my Hanukkah/Christmas FaceBook post for students, interns and residents.
“I recently met with a student who chooses to see Medicine as I; sacred yet often cruel. The journey through four years of the most rigorous undergraduate training such that most others choose different paths isn’t enough. It is followed by four years of life and soul changing rigor and often shameful abuse, that causes us, on occasion, to lose a precious life to suicide. Even then, it is not finished for the survivor; the most grueling part of the path emerges in the form of internship, residency and often further specialty training. In large part, the traveler has a fundamentally altered world-view. You, my young friend, can cleave tight to your belief in the fundamental goodness of service to those who suffer. You, my young friend, will not be a slave to a culture of abuse. You, my young friend, will emerge transformed, galvanized and ready to do battle with the evil which claims you are nobody because of the color of your skin, your sexual identity, or the zip code of your brothers and sisters. Do not bend to the mistaken notion that Medicine gets it right; rather, take from it the thread of truth which makes it great and forgive the darkness that hides decaying, unloving moral claims unworthy of the profession. To my last breath, I will shield you, nurture you and encourage you so that you may join with other good souls to take the reigns of leadership on this earth so that we may all live our truth in peace; free, no longer slaves.”
Gus W. Krucke, M.D.
Thank yo SO much. A caring mentor in medical school is so essential. Thanks for loving your students Gus.