I just woke up to a beautiful sunny day in Oregon. Then I got two emails about medical student/physician suicides and this Facebook message.
Student: Hi Pamela. I don’t know if you have heard. But there was a death at our school yesterday in the class of 2018. I’m hearing it was a suicide
Me: I’ve just heard of 2 others today. An orthopedic surgeon in Missouri and a Canadian med student. Can you share details?
Student: Female student. I’ve learned an apparent first name. And she had a Muslim quiet prayer service late last night. Oh Pamela. My heart hurts. I begged my school to start looking after our students after what happened to me.
Me: I can’t believe we are hiding all this in 2016.
Student: Pamela, it’s ridiculous and so hush-hush. I know nothing officially.
Me: Many med schools are seriously in the dark ages the way the treat students and teach “heath care.” Infuriating!
Student: This story repeats itself every 2 years at my school. I’ve seen/heard suicides 2012, 2014 (that was my friend), and now 2016.
Me: And what exactly are they doing other than deflecting blame on the victims?
Student: Wtf. She will absolutely be blamed. It makes me sick
Me: I need to write about this. Can I include our de-identified conversation?
Student: Sure. I’ve reached out to anyone I know in med school now (and even premeds) to let them know that I am here for them. None of this is worth a life. None of it. And it makes me sick that my medical school is so absolutely crappy and shitty at dealing with mental wellness and wellbeing of our own students.
Me: Ugh, and we pay tuition for this!
Student: They are more concerned with board scores, matching stats, and being the biggest medical school in the US. 4th year medical students are getting more and more dismissed if there is a chance they may not match, I’ve heard that. So dismissed over maybe one test screw up or “professional issues” that never used to be. Match has gotten so competitive they have gone crazy with it. The malignant practices are disgusting. I know good people and they will be thrown under the bus. Many administrators here are incompetent. And some decisions come from people without an MD/DO. Ugh, I’m sorry, I’m upset and very upset this happened AGAIN at my medical school.
Me: 🙁
Student: I’m just so sorry that anyone may have felt that helpless. It hurts my heart. How is it ok to sweep this under a rug?
Me: We have to stop this secrecy. Please share my TEDMED talk with your classmates. Tell them it is NOT their fault. Huge issue is that med students and doctors are unwilling to grasp they they are part of a cycle of abuse. We are perpetuating the abuse by protecting the status quo. We absolutely MUST be vocal and stand up for each other. This is NOT okay to sweep under the rug:
Addendum: Just lost another colleague after I published this post. Midwest urologist shot himself in the hospital. When will this end? When we shine a spotlight on these suicides. Stop the coverup. We need a national investigation. More than one million Americans are losing their doctors to suicide each year. This is a public health crisis and should be reported on CNN, NBC, CBS, FOX news. Let’s stop hiding the truth.
_____
Pamela Wible, M.D., is a physician on a mission to stop medical student and physician suicides and end the culture of bullying, hazing, and abuse in medical education and practice. Please help by sharing this TEDMED talk and this book Physician Suicide Letters—Answered. ** All proceeds used for suicide prevention.**
Wow! I am sorry IUSOM is like this! I certainly hope our school (MUCOM) is better supportive of our students!
Me too. I hope we can highlight some med schools that are doing things well. Let’s learn from models that work and schools that empower students to be true healers. We can do it!
Wayne State University has a good physician assistant studies program, which was modeled after their medical school. I’ve not heard of any suicides from either program (I’ll fact check that later)
I wouldn’t say that they were straight out nurturing but it did seem you could bring concerns of your well being-related to school or not – to the instructors and that they could offer an ear and maybe some help
Largest med school in the country?
Indiana University School of Medicine – Wikipedia, the free encyclopedia
Wikipedia › wiki › Indiana_University_S…
Mobile-friendly – With 1,404 M.D. students and 168 Ph.D. students in 2016, it is currently the largest medical school in the United States.
History – Curriculum – Hospitals and facilities – Students
My heart goes out to everyone affected by this. There are so many wounded spirits out there and it must be so painful to feel that there is no way out. I hope this encourages some of the people who are suffering to reach out for help. Has anyone thought about creating a network of physicians who would volunteer to act as a crisis connection for students, residents and doctors in need? I would be willing to help with a project like that.
If each one of us reached out the to docs in a 1 mile radius from where we are standing now, we could all start to heal one another. The answer is not “out there.” We are the answer. Each one of us. May we all be the change that we want to see in medicine.
I’m no fanboy/girl of medical school administrations, especially the one in question, but I don’t agree with the above students’ characterization of how the school handled this event. They have been surprisingly communicative and supportive, albeit in a post-facto way.
At the institutional level, schools could do much to make medical school more humane, but it’s hard to say whether that would decrease medical school and physician suicides that are probably often caused by previously existing mental illness unmasked by the rigors of training that would be present no matter what changes are made.
Regarding the secrecy of these events, I think institutional level data from most publicly funded schools could be obtained via open records laws. Public universities are generally included in those laws and subject to public requests.
Is there central location that is tracking medical school suicides per school? per state? This information should be widely available and transparent.
Probably not, and I agree there should be. The obvious organization to do this would be LCME, which has the most leverage vis-a-vis medical schools. If one of the questions medical schools had to answer in their “LCME Self Study Report” was “what are you doing specifically to prevent suicide and anxiety/depression?” then schools would be required to think harder about this. There are questions about counseling and schools are required to report that data (how many people requested counseling, how many were subsequently referred to psychiatry, etc), however those questions probably don’t go far enough.
That’s a great idea. How could we lobby LCME to do this? Is the “Self Study” report in its current form available anywhere?
Does AAMC to your knowledge monitor medical student suicides? Who at that organization would know/care?
I’m not sure how best to approach the LCME.
I don’t know about the AAMC, but I doubt they monitor student suicides. My understanding is that they are largely a lobbying group for medical schools and teaching hospitals, but they also happen to drive the MCAT and admissions process. I don’t think they have much control over what schools do – certainly not to the extent that the LCME does via the accreditation process.
I once heard of a study where researchers put rats on little rafts floating on water. When the rat fell asleep, he fell off the raft and woke up. In two weeks, the rats died from chronic sleep deprivation.
Maybe all the rats had a preexisting mental illness.
And we have learned from other very cruel experiments on animals that maternal deprivation doesn’t work either. Why would emotional deprivation work in medical training?
Kodiak,
May we assume that you have some influence at IUSOM given your insider knowledge of the handing of this suicide?
If so, can you exert that influence to help prevent another tragedy?
It certainly sounds as if bigger is not better in the student health department.
My soul weeps for our profession. As a former faculty member in both residency and medical schools, I remember being told that I was often too close to my charges. We had a responsibility to protect society from incompetent medical care, and if you got too close you could lose the necessary objectivity. I really wasn’t good enough at maintaining that distance so I had to leave academic medicine for regular practice. I loved teaching, but per the system I was not good enough.
You were probably just what your students really needed. The system is dehumanizing.
I am family physician practicing for 21 years. I believe that in the last 10 years to be a doctor lost it’s initial meaning. Now is papers, papers and more papers. And of course I am not referring to the green ones. Administrative burden is taking away that for wich we work so hard, to heal and help. Among other things I think this is having a big impact in our mental health. The worst is that all this ridiculous paperwork has no meaningful use and is good to nobody, except for big financial interest unrelated to patient care.
This is so sad and so awful. I know the students are afraid of speaking up, because anyone that stands out runs the risk of being the next target. The attending physicians out there really need to stand up for these students – pay attention to the warning signs – don’t be an a@#hole just because you’re in a “power” position – be kind – be human.
Yep. Be a healer. Not a victim. And not a victimizer.
I think there is a certain amount of “unmasking” a pre-existing mental illness with intense pressure and sleep deprivation/humiliation/self-esteem lowering that occurs in medical training. On the other hand, there is a culture of discouraging those who are “unmasked” finding help — licensing issues, matching issues, etc. Someone with well-controlled depression or anxiety can make an excellent physician if they are able to find help and support. There are so many of us who will have a depressive episode at some point in our lives (one in ten according to most statistics). Should we count out all of those people as physicians?
Yep. And there are also people without mental illness who are just sensitive, compassionate existential souls who would make great doctors. These people may be beaten to a pulp with an authoritarian reductionist medical model that is highly abusive. Everyone should be honored for their unique contributions to medicine and nobody should be prevented from seeking mental health care. The answer is not “better screening of applicants” which is also a victim-blaming strategy. It is time for us to reassess how we “train” people to be healers.
Of course we should not count such people out as physicians (I know it was a rhetorical question). People who have experienced illness of any kind make far better healers. We should probably screen for, and recruit them.
The percentage of physicians who experience depression is probably far higher than 10%, and that is especially true for women physicians.
There is the Americans with Disabilities Act that is supposed to protect people who have, or are regarded as having a disability, from job discrimination or discrimination in licensure etc. However, I am afraid it is routinely ignored in many medical settings, as have many other laws until some sentinel cases came to the attention of the medical powers-that-be.
The Department of Justice is however VERY INTERESTED in addressing this issue. If you are asked an ADA impermissible question (such as: “have you ever been hospitalized or diagnosed or treated for a mental illness”—without any qualifier such as “that currently impairs your ability to practice” on a medical school/residency application or a medical licensure board application, you should go straight to the DOJ. Or retain an employment discrimination lawyer. This has got to stop.
Thank you Louise for your commonsense approach! Time to stand up and speak out against these human rights abuses: https://www.idealmedicalcare.org/blog/youre-not-burned-out-youve-been-abused/
Dear Pamela and Louise,
Im so sorry about whats happening. These things hit close to our neighborhood a few years ago. Doctors lives have been turned upside down with litigations. Even if it is proven the dr. practiced within standards of care he’s usually not allowed to go to court and is made to settle out of court. Then the board gets notified also the npdb. I dont think I could go on if that happened to me.
Once one law happens it seems theres a bullseye painted on the Dr. and more copycat suits follow.
Where is good help for these drs Louise ?
Even the defense attorneys here mostly just say settle.
My husband was nonsuited even and it still showed up on his profile at the npdb ?
Others here have said the same thing.
Families go through intense worry and pain over this stuff.
I dont think theres a person out there (well maybe now) but generally speaking, who would want to pay huge amounts of money endure med school and residency only to be a big juicy target for all kinds of kooks and goons out there and get sued even once, much less numerous times for doing a good job.
Dear Dr. Wible,
Back when the earth was still cooling I had the opportunity to enroll in an M.D./M.P.H. program and to skip my senior year of undergrad (matriculation in 1978). It was an honor because this was/is one of the nation’s most prestigious academic medical institutions, and I wanted to practice some clinical medicine and do basic science research and perhaps some Physicians Without Borders work. After doing an undergraduate inpatient “internship” which was a small part of the beginning of this program, I knew medical school would be a relative breeze but thought my nervous system could not handle the 100+ hour weeks and the Machiavellian politics. The residents coming out of the various training programs were shells of their former selves. Looking at their entry photos compared to the way they looked when I met them (if they had completed an internship and were JAR/SAR or fellows), they looked and seemed dead behind the eyes with rare exception. I asked my faculty advisor if I could have a year off and was granted the year but never went back because I knew the unwinnable uphill political battle and compromise that was necessary at this institution and knew I could not do it and would probably be labeled a troublemaker and bounced out either late in medical school or public health school or if I matched there for a residency training program may have been bumped in my last year of residency which had happened to a couple friends who were excellent physicians but did not fit the stodgy ducky tie profile of this institution.
To make a long story short, there were 7 of us invited into this program and although everyone except me entered medical school (not all at this institution because tuition and fees were 4x+ that of the local and decent state school), the ones who did the 6 year program were unhappy at the end of their training and whenever I have been in contact with them they tell me I made the right decision because their practice of medicine was more an administrative nightmare than a healing practice. I do regret some of the perqs. but reading about the suicide rate of current medical students and residents (my sincerest condolences) is both saddening and shocking. It seems whenever the corporate administrative arm of an academic medical institution inserts its grimy paws into the practice of medicine they come out clean and everyone else gets soiled. One of the rudest people I ever met was the administrator for the NICU of the pediatric hospital on the campus and at that time entering residents were earning somewhere in the neighborhood of 17k dollars per year. I had the occasion to discover this administrator’s salary – 350K DOLLARS PER YEAR! Twenty times the amount physicians starting a residency earned. This fellow was responsible to cut cut cut and I could not believe the number of experienced nurses he had eliminated from employment and the concessions the remaining nurses had to make in order to keep their jobs (even though this was the lowest paying local institution for nursing care). People were there because they wanted to be surrounded by like minded academicians and to have access to incredible research facilities of the institution (which actually were undeserving of the reputation) and the ultimate reward of working in an incredibly stimulating environment and able to go on to do pretty much whatever they wanted by virtue of have a diploma and residency training certificate from this place.
So long as administrators and other pencil pushers with NO medical training or people with medical training for the sole purpose of garnering a high level executive job with one of the large health insurers, hospital corporations, HMOs etc. control the dialog it is going to get uglier and uglier in medicine. One of my best friends now is the medical director of a large N.Y. Metropolitan ED. She always says “had I known I would be spending the better part of my day jumping through paper hoops to get a pittance of reimbursement and not able to spend most of my time training residents, practicing medicine, I would never have enrolled in the first place.” Unfortunately, out of the original 7, 5 share this attitude and I dissented by withdrawing. There is probably a clause that precludes you from informing your patients what 3rd party payers actually reimburse you. I think people would be shocked to find out that the “reasonable and customary fees” allowed by these insurers appear to have been gotten from the 1950s and 60s and that insurance and copays simply cannot cover the cost of operating a medical practice let alone paying practicing physicians an amount commensurate with their tremendous amount of responsibility, extraordinary costs (such as malpractice insurance, medical equipment, payroll, etc., enormous educational loans) and a life of continuing medical education. The public is simply ignorant of the costs incurred in medical practices and that physicians often get the smallest piece of this pie. This is such a terrible tragedy – the loss of these young lives with such bright promise but having seen medicine from the inside sadly it is surprising to me MORE don’t decompensate and reach this level of despair. I am so sorry that this is happening and really think by raising public awareness about what exactly physicians are reimbursed versus expenses and the tremendous amount of financial, emotional and physical stress, it may be the beginning of making the public aware of who is really getting the money in medicine and it certainly is not physicians. My primary care physician does not accept insurance and I pay him cash – $175 a visit plus annual $100 fee and it is a bargain. He is with me for over an hour each visit (4X a year) because my medical hx is complex as a result of profound immune deficiency secondary to untreated Lyme disease (which was not treated until it was WAY too late). Anyhow, bless all of you and if people only knew what medical training, then practice, is really like for the majority of physicians they’d probably be quite surprised. Who else works 60-80 hours a week or more that is “winding down” a career that has spanned 35 years? Take care. Best Regards, Ed S.
Ed, seems you made a wise choice for yourself. Those of us in medicine need to stand up for ourselves and stop the cycle of abuse before we injure the next generation of doctors (and patients). This really is a cycle of abuse. Even the victimizers don’t see themselves are perpetuating this cycle. A sad state of affairs. Silence will not save us. The truth will (eventually) set us free. There is some resistance now among medical professionals to grasping the truth. Many are suffering from Stockholm Syndrome.
This sounds an awfully lot like my medical school. In law school I did my thesis on discrimination in academic medicine. Based on that school and my residency training institution.
My condolences on the Lyme and other issues but congratulations on your early decision to jump ship. At least you are not drowning like the rest!
I have an idea:
– create Doctor appreciation badges/ribbons that you can sell on the Internet (and beyond)
– start a #doctorappreciation social media hashtag
– the goal is to have patients give this to their doctor on their next doctors visit (talk about improving the doctor-patient relationship)
– have proceeds go to sponsoring a struggling doc or student attend one of your retreats
– ultimately save lives and medicine 🙂
I am in the 2018 class at this school, and I have to say school experience is very different at satellite campuses. Our administrators and faculty are extremely supportive and genuinely care about us. I’ve gone to administrators more than once to discuss personal matters and they’ve been kind and caring. The only time I have ever been force fed school agenda on step, grades, match etc is when the big wigs from the big campus come down. We mostly just eat the free lunch they bring and ignore them. I’m sorry life is so different up on the big campus.
SDN Members don’t see this ad. About the ads. Someone is imminently planning to commit suicide. He/she has ordered Pentobarbital through the mail and has been discussing his/her plans on reddit. Post seeking help is at:
The person is using a throwaway account but has highly specific personal details that can probably be used to ID someone. I’m not saying there needs to be a witch hunt, but if someone here reads these personal details and thinks, “Gee, that sounds a lot like X” TALK TO HIM/HER. If you’re suspicious, report to someone. If this person doesn’t get help *they are going to die.*
He/she is
* Is a practicing Muslim
* Is in the Midwest — no school named mentioned
* In 2nd year of medical school/ M2
* Is 26
* Is *probably* male
* Has six younger siblings
* In August, school said that students should complete “2000 qbank” test questions before January (this might help narrow down the school)
* 21 or so days ago, his/her medical school finished the anesthesia block
* Also mentioned that his/her medical school has “a lot of extra stuff” that one needs to attend from 12-5 after lectures from 8-11.
This person doesn’t need to die and it breaks my heart that they feel they have no one to talk to and they only way they can get out of this is through suicide. It’s also disgusting that there is an entire forum encouraging him/her.
This was posted over a med.forum. so sad about what happened.
And in fact this Muslim MS2 did die by suicide as reported on Facebook on my blog above. What a tragic end to a beautiful woman and healer. We will continue to lose our brilliant compassionate medical students and doctors (and other health care workers – oh and patients) unless our medical institutions take this as seriously as say, ummm . . . reminding our patients to wear seatbelts and stop smoking.
Every suicide is a tragedy.
1. The public may get the impression we place a “higher value” on the lives of med students and physicians lost to suicide than the general public.
2. We don’t, and the fact is, physicians have a lower mortality rate for all diseases, compared to general public, except for suicide. Why? (Do the math.)
3. It will be difficult to do a study (RCT) to prove Kodiac’s take that the medical profession’s suicide victims all had “pre-existing mental illness, unmasked” during their training. Unlikely–not if we look at the stat of # 2.
4. A cloak of secrecy is wrapped over each med student and physician’s death. Because it’s an “embarrassment” for the respective facility.
It is not an embarrassment, it is A CRISIS, an EPIDEMIC which the medical community at large choose not to discuss. The elephant in the room. The medical profession is at risk of losing its soul. Let’s stop deluding ourselves.
5. Silent no more.
6. As with rape victims. We have to stop blaming and shaming the victims. They are not incompetent, loser-doctors. I am not condoning drug abuse by MDs, but we have to weed out bullying, harassment and abuse in our hospitals, med schools, and health institutions.
7. Much can and has to be done.
There is no neutral ground.
8. Let’s become informed. Become investigative journalists.
9. Primum non nocere. First, do no harm. (For our patients.)
To that, we now have to add: Ultimum, medico nihil nocet. Last, do the physician no harm.
Thank you for sharing, Pamela!
OMG. I love you Danie. You get it. Sometimes I feel like I might be talking to a wall. It is unbelievable that we have known the high rates of suicide among doctors as far back as 1858. Yet 158 years later what exactly have we done to address this? Nothing.
Ignoring these suicides will not stop future suicides. Hiding these suicides will not stop future suicides. As men and women of science we need to stand in the truth so we can stop this medical student and physician suicide crisis that is claiming the lives of our bright and compassionate healers. Anything less than the truth is not science, it’s deception.
You started the Ideal Medical Clinic perhaps it is time to create the Ideal Medical School. If we can pull all the students from these inept Medical institutions perhaps they will feel the financial crunch and sit up and take notice!
Exactly. Working on that! 500 medical educators are onboard here: https://www.idealmedicalcare.org/blog/how-to-grow-a-happy-doctor/
Thank you 100 times for systematically documenting and reporting this. It’s the way real change is made.
Had I not withdrawn from medical school shortly after entering in the fall of 1985, I would have been at risk for suicide.
It’ so tragic to reading this post. I am a patient of a well respected doctor in the health clinic I attend. He is always understanding of my health issues of which there are several. But I can tell on some
particular visits when he has had a particular harried day! I always make it a point to tell him how very much I appreciate the time he spends with me and his expertise.As patients, we should do this each and every time we have an office visit–everyone wants to hear that they have made a difference in another human being’s life. My daughter is family practice doc and I have seen the long hrs. she puts in at the office and at home. The public is generally not aware of this–they just assume because the person is an MD and is pulling in supposed “big bucks” they should deal with the stress. Everyone has a breaking point and there should be no shame in seeking mental health help or no follow up repercussions. By speaking out as patients and supporting our doctors, maybe the major health corporations will begin to think over their methods of operations if the truth comes to the surface. And the truth generally sets us all free! Thanks to you,Pamela, for bringing this tragedy into the light of day!
Sending compassion and love to all concerned with these tragic events. “When will we ever learn?” Certainly not until we find the courage to tell the truth.
I shared your mission with my psychiatrist, and then asked him if he has anyone to keep an eye on his own wellness. Yes, he said, his wife very much has his back.
Dentists also, military, japanese teens, the elderly, American and Canadian Indian teens, and drug users.
Stress is all over.
Diet, the broken Microbiome, poor eating habits of doc’s, poor sleep, chemicals.
No one can stand the stress.
Crazy xenoestrogens, 84 autoimmune conditions now.
Thank you for bringing this subject out to the public! I worked at a 2 major academic hospitals in Philadelphia and I witnessed such intense competition within one, which is a prestigious medical school/hospital. My boyfriend was a general surgery resident. He was depressed, mostly because he never slept and hardly ate! He survived. It was absolutely unacceptable to be weak in any way. I watched senior residents torture visiting residents and debase them openly. The residents were wiped out, stressed out and the work never ended. Some would leave to spend time working in the lab. One first year resident had to repeat a year because she could not find a match, she was very bright, a great doctor, but the “system” sucks! She was always put down by the others. One resident needed lung surgery….. He took exactly 2.5 days off and was back at it, running the floors of the hospital! Even though any other patient would never face this type of recovery. I brought food in for our residents, because they really did not have access to food on night shift, ridiculous! I pray all these docs are making what they are worth and enjoying their practices… They worked so hard for the patients!
I hope they were able to get therapy. Took me more than a decade to recuperate from what I experienced in my medical training. And I still have flashbacks when I hear of the barbaric things that continue to happen to these bright humanitarians in our “teaching” hospitals. Shameful.
I’m so glad that you wrote the statement, “Took me more than a decade to recuperate from what I experienced in my medical training.”
I thought I was the only one.
It was at least 3 years post residency before I felt even able to start to process what I’d experienced during three years of pediatric residency (2000-2003, prior to regulated hours laws.) Thirteen years later, I will never willingly return to the city my residency training occurred in.
Unfortunately I’m licensed in a state with a strongly punitive point-of-view about physicians and mental health. Otherwise, I probably would seek care for myself.
I would greatly like to see the current state of affairs be radically improved, during my life time. Unfortunately, after thirteen years as an attending in primary care pediatrics; I have such severe caregiver burnout, and so many that demand a “piece of me”, that I don’t have any pieces left to be the change myself.
Keep up the fight Pamela. You’re the voice for so many who feel voiceless.
I have a counselor I can recommend who can help you via Skype. Off the grid. I’ll email you.
I do not know how this comment will be received but I feel that I have to say this. This post is extremely one sided and it feels very much like you are twisting the details of a tragedy to fit your rhetoric. I am a student at IUSM and during my 4 years at this school we have had 3 tragic losses from suicide. That being said, the administration along with the student body has been working tirelessly to find a solution. I think we can all agree that the problem of physician suicide is not going to have an easy fix but it is plain inaccurate to say that IUSM has not tried. The atmosphere is anything but malignant. We have endless opportunities to meet with faculty and administrators, we are provided near constan outlets to voice our concerns, several members of my class even founded an extensive mentor program (titled College and House program) to give underclassmen a sense of belonging. Physician suicide is obviously a plague on our profession and it pains me greatly that it has touched our school once again. However unless you can point to the specific problems at this institution, it is inappropriate for you to use our classmates death to make accusations for which you have no evidence.
I, too, have been attending IUSM for the last 4 yrs. While I agree with you that the administration and student body have both been attempting to find a solution to the problem, I believe that there is a bigger problem in existence then the “College and House” program will be able to solve… I can recall one suicide per year I’ve been here, and therefore it seems to me that there is a fundamental problem in the way our education is approached. I don’t feel that this is a problem with IUSM specifically, because although I have no data to back this it seems as though if you took a random sampling of 1500 med students from anywhere in the US, it’s likely that you would see one suicide per year. Both physician and medical student suicide is much bigger than Indiana. Fortunately, you and I are in the right spot at the right time. Who better to start a cultural revolution within medicine than the students living in the trenches? At the very least, let’s start being vocal about the fact that there is a serious problem and something must change!
It’s a global phenomenon. Failure of the patriarchal reductionist medical model that is extremely dehumanizing. National and international spotlight is required to address this issue which is a huge and underreported (even censored) public health crisis.
College and House is a ridiculous example of academic groupthink, not something to be celebrated as a solution to student disengagement. Call me crazy, but as a general rule, I’m skeptical of proposals that 1) add additional layers of organizational complexity and bureaucracy to an existing monolith 2) are based on fan fiction (Harry Potter!) and 3) are largely aimed at bolstering the match prospects and academic medicine careers of a select group of medical students and administrators concerned about the reaccreditation process.
Simply put, you can’t outsource leadership and compassion for individual, unique human beings by passing the buck down an ever-expanding organizational chart.
Exactly! Here’s the keynote I just gave in DC to 500 medical educators. https://www.youtube.com/watch?v=zRRjNIzXJYM
Hi Pamela,
As we’ve discussed, this is an issue in the Veterinary community also, I know of three DVMs that have committed suicide over the last 3 weeks.
My Masters degree project to design a nonprofit organization dedicated to suicide prevention and mental wellness education is nearing completion. The project is designed, so that it could be replicated for Physicians and Dentists.
The new organization (temporary called the VMHA – Veterinary Mental Health Association) as designed will have a 24/7 hotline staffed with volunteer Vets who will understand the caller’ stressors. It will also have an wellness education, physical and virtual networking/support services, and mental health professional referrals.
I’ve been in contact with the AVMA to see if this could be implemented as part of their services, since I don’t have the resources to start it myself. My hope is that my plan could be used for the other medical profession. If anyone is interested in seeing the plan, I will be glad to share after I turn it in next week.
Please keep up the excellent work you are doing.
Ditto. Group effort. Let’s learn from our successes.
I believe medical doctors commit suicide because they are locked into a system they know is unethical and doesn’t work. Hospitals REQUIRE them to
perform unnecessary surgeries, such as C-sections, circumcisions – yes, they have QUOTAS, so they are forced to pressure patients into unnecessary procedures – and sometimes they seriously harm patients. They WANT to be healing and the system is bunk and yet they cannot get out of it. They do NOT want to harm, yet they are being required to – AND their patients are beginning to catch on and probably don’t trust them much any longer – and just might tell them so.
If you haven’t yet watched “The Corbett Report” on “Rockefeller Medicine”, do so asap. It is designed for profit, like all things the Rockefellers have their fingers in. Hence, the goal of the system is to “keep customers coming back” – not to truly care for and heal the patient. This has to be exceedingly disheartening for a sincere MD. I am glad you, Pamela, are helping them see there is another way of doing things.
Doctors don’t know this when they enroll in med school. i once knew a pathologist who opted to work in the morgue rather than to play the game.
There are many things the current model of medicine and hospitals force doctors to do, but I seriously doubt performing unnecessary surgeries is one of them . Rather, it is becoming more and more difficult to perform the surgeries patients need. Too much substituted judgment, hoops to jump, cookbook criteria to check off before you’re “allowed” to do a hysterectomy for example. Honestly, it took all the fun out of gyn surgical practice, watching patients suffer and unable to help. There is less and less respect for the medical judgment of the dr with their hands in the patient, and more and more administrative control of practice. It really sucks.
What a sad state. The rite of passage, hierarchical, chain of command, prideful attitudes in the medical field need to be put to pasture. It is almost like some sick power play game that ends up in passive aggressive or blatant bullying, belittling, and lambasting of the underlings by insecure, miserable, and nasty superiors. It is as if more years since being a newbie in medical training or after residency apparently equal more greatness and right to treat anyone behind in whatever way he/she chooses. It is tragic that these suicidal lost souls ended up to the point they did, but are we sure they were the ones with a psychiatric problem? What about the mental state of those potentially bringing on the abuse towards the victims? Even if they did not end up committing suicide, whatever torment, if inhumane, should not have occurred to begin with.
The younger med students and docs have more debt, more hoops to jump through, and more information to be tested on compared to what docs who graduated long before them had to endure. Then, to have rotations with some docs who failed to be lifelong learners who have lost proper, current medical knowledge, but think they are God’s gift to medicine, and try being the young learner student or doc who speaks up with correct information–not to one up the superior, but to be able to actually apply knowledge they invested lots of time to attain in order best care for patients–just to be targeted and put in the “proper” belittled and bullied place the young learner “deserves” to be in, whether it be publicly humiliated or set up to fail in future endeavors by obvious and disgusting retaliation by the superiors.
It should not be about stepping on others to gain accomplishments on paper, and it also should not be about one test score that lots of docs study for and forget the information right after the exam anyway. Of course, everyone wants to get the best score possible and pass. People in the medical field need to be humble and kind, and yes, they also need to have a great medical knowledge to care for patients properly. But, openness and respect to all docs’ (even including students’) ideas on the team should be imperative, and if someone is right or wrong, they should be commended or corrected in a decent manner. Check the egos at the door.
I also hate to say it, but in certain areas of the great USA, unfortunately cultural and ethnic discrimination still exist within the medical field. Come on people. With all the bureaucracy and hoops most practicing docs have to go through this day in age, mistreating each other really is not the solution.
Sorry to write such a rant post, but I have been a lurker for awhile, and I am deeply saddened by what the field medicine has become. I hope really it gets better soon.
Thank you for your wise words. Time to revamp and humanize medical education. The antiquated patriarchal reductionist medical model is not the way to train doctors in 2016.
My best friend and MD Linda Simko committed suicide. I believe she never recovered from medical school. What a loss to us, she was an excellent doctor.
Do you have an obituary you can post. Can you share more about her. I’m tracking these deaths. So sorry. We can prevent these deaths.
It was in 1992. I can tell you all about her! Anything specific?
Whatever you are willing to publicly share. These people have been buried for far too long.
Unfortunately we have lost focus of what medicine is about. The schools have become too preoccupied with test scores that they do not bring in well balanced students but rather bring in students that are not capable of losing. The new doctors of today lack compassion and the old doctors of yesterday are retiring early due to profound disillusionment.
Student loans are another piece of this. It is ridiculously expensive to go to med school. Interest piles up during residency. And if you don’t stay the course, you’ll never make enough to pay your loans. Which, notably, go away if one dies or is permanently disabled. Don’t for a second think that doesn’t go through the head of someone who wants to quit but can’t saddle their families with that kind of debt!
Hi Dr. Wible, this isn’t highly publicized, but it should be because its another tragedy. I am a student at IUSM and just this past weekend another young, terrific, soul, and medical student sadly took their life. This makes 3 people total that have committed suicide that I recall in my 4 short years here. I didn’t know this person, as she was an M2 and I am M4; however, I have a lot of friends that I checked in on who knew or were aware of her. Just thought you may want to know since you seem to be the only physician advocate speaking out about this physician and medical student suicide. Hope all is well.
I would like to add the IUSM is one of thee worst schools in term of student success and happiness. Medical school is difficult but through networking I have met students all across the country who attend institutions that are well balanced and actually show concern for student lives and affairs. I am a rising MS4 of what is now the largest medical school in the country and it is just that, large, like a big machine. Students are spread out amongst 9 campuses and despite some offering smaller class sizes, you are just a number, not a person, no matter where you go in Indiana. After this suicide, I polled a few internal medicine residents (DO and MD) regarding any student or faculty suicides at their respective institutions during medical school and got an answer of ‘no’ from every one I spoke with. N=8. One resident (from a DO school) also went on to say that students at IUSM are treated like crap and provided several compelling reasons as to why from a residents perspective. Previously, at IUSM there were one or two faculty administrators who were actually student centered, and within less than 2 years these faculty were essentially fired and demoted to full time clinical work only. The mental health and wellness aspects at IUSM our so terrible that we have our own psychologist for medical students and residents. I have spoken to students who have been to her and had mostly neutral to negative experiences. Additionally, it is extremely difficult to get an appointment with her, ie 2-4 month wait at various times of the year. She is a PhD, so she unfortunately is unable to prescribe medication, which a lot of students at IUSM are on, and even more probably need. In summary, IUSM just does not care about student and resident success/happiness. I could go on and on. I can honestly say that this school is run very poorly and it is not student centered at all. My heart goes out to the family, lives, and souls of the deceased. I IUSM has had an unprecedented number of student/resident suicides in the past 4-5 years, more than any institution that I am aware of. Suicide is multifactorial and very complex; however, one common link is IUSM. I sincerely hope that the administration offers more support, expanded mental health services and providers, and gets rid of this ‘more work is better’ attitude. Every single email sent out to the student body after this tragedy had a phrase reminding us students to reflect on our lives and take care of our own health. Unbelievable.
I’m muslim and arab too. I started out medical school with a very positive attitude. I am a naturally curious bubbly and energetic person. I love to laugh and learn and feel empowered when i learn. When I saw that people saw me as a joke and as a person they couldn’t take seriously they told me I needed to change who I was. I stressed out a lot felt judged and isolated my self. Other’s jusdgemt got to me pretty badly. I studied and it want enough. And they told me i was incompetent i couldn’t follow directions and i was unprofessional. I was weird. I wasn’t normal and no body liked me. no body wanted me to be there and I hated seeing them all
I am not sure what the trigger was (maybe stress and feeling incompetent) but i developed a very isolating attitude where I had to be alone, craved to be alone and had urges to hurt myself. I would not leave the apartment for days and talk to nobody for days. My grades were below average in medical school . My MCAT score was above average and so was my GPA for my school. What happened?
One of the doctors at school told me i wasn’t thriving which hit me hard because she was the same person who told me to change – it made no sense-. She recommend I seek counseling which i did who then recommended me to a psychiatrist. I went; i was actually going to skip it that day because i felt perfectly fine.
He asked me question and I answered with few words (which is unlike me because i talk a lot) . Then I cried. A lot. out of no where. He gave me meds for depression and rumnations I was having.
After the internal struggle of whether i wanted to take meds or not i decided i should give it a try. I was just a normal medical student we are supposed to be unstable and stressed out. BUT THATS JUST IT ARE WE?? Are we
supposed to get to a point where normal is not normal for a normal person. Is this culture worth sustaining so that it carries on to residency too???I didn’t think i need meds but decided why not. I realized a lot at that appointment – i couldn’t function normally- i had no motivation, i couldn’t eat sleep or study properly. I was not normally functioning. I hated everyone and was emotionally unstable. Everything made me cry like trips in the car – i dreaded going to class. I hated it.
But I loved learning – where did that passion go?
Side effects were bad, numerous episodes of diarrhea and wacky dreams later i switched up the med. Which then triggered in me my first hypo-manic episode. $4000 later and a pastel painting later, and not enough money to pay rent- I am on my third drug for bipolar. i think medical school made me crazy- I lost human contact isolated myself and literally went crazy.
I was easily affected but the negative attitudes that many students had where it was normal to suffer and normal to not sleep and normal to hate everything and lack empathy for patients- or even worse people at home. I am not even sure if I need meds- am i having a normal reaction to a bad situation or am I actually bipolar. I don’t know who to trust.
What med school took away from me was my passion and curiosity and my personal health. I loved to learn and now my goal was to get through it not benefit from it to help others. It was dry and robotic. and it made me nuts , it triggered in me a crazy person that did weird things.
Maybe medical schools need to give students leaves of absence without them feeling ashamed if they do so, or give them time to be human. I don’t know what the answer is.
I am so sorry to hear of another suicide(s) among med students and doctors in general. What is/are the main reason why doctors/students are ending their life in this manner?
I think we underestimate the mean spirited behavior of administrators and other physicians who label and abuse other doctors/students.
I have heard professors say that if a school does not like a student, the administrator of the school will communicate with the USMLE Board to fail the student. Also, if students are not in the top percentage of the class, administrators would request those students be failed.
We are trained to be critical thinkers in medicine, yet if we challenge the status qua, we are penalized. My question is: what does it take to overhaul the medical education in the USA? Do we have to wait until a politician child who is a medical student commit suicide for something to change?
Change is coming. Even administrators are on board. Watch my DC keynote to 500 medical educators here (inspiring & funny): https://www.idealmedicalcare.org/blog/humanizing-medical-education-how-to-grow-a-happy-doctor/
Compelling presentation on a most difficult topic. Like most physicians I know, I have lost more than one physician friend to suicide. Your description of the culture and the problem it produces is spot on.
I agree with the need for change. Our current system from the bottom up is burning out our physicians with Work Overload, Lack of Control, Absence of Fairness, Breakdown of Community, Insufficient Reward and Conflicting Values. When physicians burnout in the extreme they will sometimes act out with drugs, alcohol, and sadly, even suicide. Still, I am hopeful things will change if we are intentional about it.
Thanks Clark ~ We can change! First step is to stop victim blaming and shaming. We must stop using the term “burnout.” Here’s why: https://www.idealmedicalcare.org/blog/youre-not-burned-out-youve-been-abused/
Thanks Pamela. I do use the term burnout (I am know as Dr. Burnout) as described by Dr. Christina Maslach in her seminal work on the subject which was published in 1981. She developed the Maslach Burnout Inventory. The MBI is still the industry standard for measuring job related burnout, not just in medicine, but in any profession. I do think it is a useful term. Also, I do not think it is in opposition to what you are doing. The blaming and shaming you mention can certainly be a part of what leads to burnout. Burnout is just a constellation of symptoms and does not represent the underlying causes. I very much appreciate what you do for my fellow colleagues who are suffering.
Yep. Burnout is absolutely a known phenomenon. It is not the correct diagnosis here. Similar to a patient with hypoxia – you can give all the oxygen you can and insert nasal cannulas but if you don’t get to the root problem (the correct diagnosis) of the pneumonia and treat with antibiotics the patient will die. These are human rights abuses and they need to be diagnosed as such. Meditation is not the solution for human rights abuse. It is a coping strategy for victims and it certainly would not have saved anyone at Aushwitz. It’s time to start telling the truth. The real diagnosis is abuse.
I’m adamant about this because I’ve been on the phone with so many suicidal docs and med students who feel that THEY are the problem because they have been labeled with terms like “burnout” that deflect responsibility from the system that has perpetrated these crimes against them. These individuals feel defective and that leads to a spiral and ultimate decision to end their lives in cases. They need to know that they are NORMAL and they are having the normal response that anyone would have to an abusive environment.
Thank you Dr. Wible. Over the past fifteen years, I have dealt with many depressed, addicted, recovering and suicidal physicians too. I still don’t think we are much in disagreement. At the very least, I’m not disagreeing with you but on just one point. I DO think the system is responsible. I DO believe the current practice environment is abusive, from the bottom to the top and out in all four directions. I have NEVER recommended coping strategies, stress management, yoga, or meditation for physicians suffering from burnout. Whether you call them human rights abuses or I call them workplace-physician job mismatches, I have always advocated for changes in the workplace which will eliminate the dehumanizing aspects of practicing medicine in today’s practice environments. Where the work environment can not be changed, a different practice venue is recommended. Again, burnout IS NOT a diagnosis. The context under which the term should be employed should never be as a diagnosis. Certainly, Dr. Maslach never intended the term to be used as a diagnosis. It is a SYMPTOM of a toxic work environment. An sign of internal rot, the causes of which must be removed before any meaningful individual recovery can be achieved.
I enjoyed your TEDMED piece.
Thank you for your heart.
The degree to which accountability has been transferred from the “system” and the patients to the physicians and the extreme sense of entitlement in our culture, brings about sense of apathy and hopeless-ness into our medical society. Those who are deemed “sucessful”, turn the true culture of healthcare to another morph of @industry of healthcare”… Neither side will be happy or fulfilled… It is not just the culture of abuse within our educational system, it is the culture of disregard for your life and caring for your life and being responsible for your life and expecting them from the physician that drives the carriage off the cliff!! The healthcare culture has been robbed off its soul, and has been replaced by charts, data and run by tech savvy corporates for financial control.
Killing ourselves because we cannot fathom killing what we gave our lives to save. But realizing, there is no way out. No one to help. No one that wants to listen.
We are rich, smart, and live in houses and drive cars that everyone wants to have. Right? (yea)
Slowly squeezed by “the system” until there is only one breath and tremor left. Any doctor knows what that means.
Gagged, Handcuffed, Ridiculed, Accused, Exposed and convicted in the court of public opinion and put to open shame without recourse.
Only deeply sociopathic people can survive that. The moment we begin to touch our feelings, the solutions begin to appear. So does the option of suicide.
I know. I was at the edge. I had a plan. It was easy. I am a doctor.
I don’t know why I am still here. Maybe because I am too vain and didn’t like how I would look if someone saw what I looked like when they found me.
I found a way out. Call me chickenshit or fed up or just to fr-ken tired. I gave it up. So I am going to find some other way to help. As you can see I haven’t given up my reason for wanting to be a doctor. I came to believe that God called me to this. I just got mixed up with the wrong way to do it.
I know how you feel. I am close to getting out of the healthcare before it leaves a bitter taste. But my passion for the profession keeps me going.
I am not a doctor. I am a patient that has seen the dead eyes many times on such young people who are in the medical field. When I come across one who is not, I always let them know how inspiring they are, how enlightening, how nice it is to be with one who is human, and not trying to “talk over you”, or who really does care, but has a quota to make for whom ever they work for. I let them know just how important they are as a human being. I’m 62 yrs old. I have traveled the world through being born into the military, and then marrying into the military. So 38 years of my life was military. In those years you meet more different docs than a normal person will see in a life time. I’ve met some that should have been on aderal, some on anti-depressants, some who just needed some time off or a kind word. There are many problems in the medical field, from the ground up, it won’t get fixed in this life time, nor likely the next. It doesn’t mean you don’t try. It is going to take a grass roots movement to really get anything started. All the facebooks, tweets, hashtags, and what ever the buzz word for the day is; will not help. Not until they are all united. How do you do that? You could plug along as many of you are, or you could throw a huge spot light on the whole situation. My guess would be to bust something, or someone wide open. I don’t have the answer, I only know what it took to stop the Viet Nam war. I’m sure there is a lesson there somewhere to learn. How did all those people without the media toys you all have today get started, and so quickly? How?
My condolences to the families; both sets of families. They will be in my prayers.
I think the big spotlight is coming in this documentary: http://donoharmfilm.com (please watch the trailer). It’s all about breaking through the media glass ceiling. We are on our way. Every little crack, tweet, blog helps. TEDMED Talk on physician suicide is a huge crack. Soon the entire paradigm will swing to sanity and restored humanity. In my lifetime. I got a good 50 years left:) Let’s do it!
It doesn’t stop Pam. Today at my facility we ( doctors) were mandated to work a Saturday… At s place where we are supposed to have weekends off. Doctors are silent. We are like lambs. No one says anything! I will refuse to work. I will insist I deserve time off.
What is wrong with our system ???
We suffer from acute on chronic human rights abuse. Physicians have very serious mental health issues and most are unwilling to stand up for their human rights. If we are complicit with abuse, we will become the perpetrators.
WVSOM is like this. I was a student there, and barely walked away with my life. A suicide the year before me. Several psychotic breaks. A clear pattern of malignancy and a hidden curriculum of ruthlessness. Empathy is no longer a required trait.
I need to get in contact with you
Always available confidentially through my contact page.
The blame culture and fingerpointing in healthcare will fracture the system into millions of pieces and shatter untold numbers of lives. MUST move away from this model of interaction. We NEED to pull together and stick up for each other.
You are right. Divide, conquer, and isolate is not helping the victims.
Pamela, The University of Nebraska Medical School Class of 2010 lost a classmate to suicide last week. I don’t know if you heard about it. His name was Dr. Noah Beadell. He was a neurologist with a specialty in strokes who worked in Lincoln, NE. Our class is shocked by the news. He was the kindest person you could ever meet. He will be missed by his family, friends, classmates, patients and colleagues.
Yes, I know about this as he did his training at OHSU in Oregon. I’ve been watching the beautiful videos of him online. He was so full of life . . . unreal that these suicides continue at this pace. I am so sorry. Thankfully we are FINALLY addressing the medical culture that leads to so many of these lost lives.
We are so busy taking care of others, we neglect our own health, even our mental health until its too late. We need to shine light on this crisis and make our med schools and medical institutions provide education and support in this matter.
Check out the forthcoming documentary movie trailer: http://www.donoharmfilm.com The shining light will be on the BUG screen soon!
In my med school, University of Arkansas, first day of class 1989, our Dean told us statistics show 1-3 of us in that room would commit suicide. He encouraged us to look for help if we felt that way. That was day one. As far as I know, only one person completed his suicide.
Glad he encouraged you all to ask for help rather than give you instructions on how to complete your suicide such as the professors below:
Dear Pamela,
Thank you so much for the truths you speak for so many. Many times in my years of medicine I have said to trusted friends and to several therapists, “Something happened to me in med school.”
I was happy, secure, and mostly unafraid until med school. I recall in vivid detail the first orientation day. Our anatomy professor stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers and said these words: “If you decide to commit suicide, do it right so you do not become a burden to society.” He then described in anatomical detail how to commit suicide.
I have o en wondered how many auditoriums full of new students heard those words from him. I am sure someone stood in front of us and told us what a wonderful and rewarding profession we had chosen. I do not remember those words. But I do remember how to successfully commit suicide—with a gun.
~ Anna
My response:
Dear Anna,
Sadly, there have been other auditoriums and other professors who gave the same lecture. Another physician wrote, “An anatomy professor did inform us that we would commit suicide at a higher than average rate and told us from the lectern how to accomplish it successfully. I considered following the instructions on three occasions: once in my third year, once as an intern, and most recently when my four-year-old patient died.” So Anna, you are not alone.
Pamela
These are excerpts from chapter 1 of Physician Suicide Letters—Answered.
Dear Dr. Wible,
I’m so glad you are bringing this to light. It really needs more publicity and this should also include nursing school programs. I’m a first semester Master’s Entry Program nursing student at a top university. I routinely am only able to get 3-4 hours of sleep a night. We are punished should we get sick or desperately need to schedule a doctor’s appointment and need to miss lab, class or a clinical site day. Many of these cannot be avoided given most medical office hours the the sheer amount of time we are mandated to be in class, 4 hour labs, all day clinicals and then try and rush home to do bucket loads of homework, study for exams every other week and handle group projects. Regardless of a doctor’s note or state of condition, if you miss class, lab, lecture or clinical site, you are given a “clinical warning” that amounts to a 5% mark down of your grade plus an additonal 5 page essay to write on top of the already impossible workload. Our lessons are full of hypocrisy teaching us to be kind, patient caring nurses and educating people about preventative health while the whole time, we ourselves are restricted from having time to care for ourselves. Instructors do not care when you bring up medical issues. They simply warn you that you will receive a clinical warning and that it’s simply our own fault for not having good time management skills. Blame is placed on the student when they wind up in the Emergency Dept due to exhaustion, sleep deprivation and dehydration. This school likes to say, “those students were not practicing self-care.” How could we when we receive academic punitive measures for taking time to rest??? These abusive pedagogic teaching methods in nursing and medical schools needs to end! How can you expect to create good, competent, kind nurses when they’re already burned out from nursing school and can barely remember their address from chronic sleep deprivation and PTSD? How is this conducive to good learning much less sustainable numbers of nurses remaining in the field once they graduate? I keep asking “why” with no answers. I’m considering not becoming a nurse. I used to be a kind, patient, cheerful person. I’m withdrawn, quiet, often not mindfully present due to sleep deprivation and too stressed to be able to help others because I myself need help.
One should ideally get healthier during training—not become suicidal and lose the joy of healing. Educational reform needed and coming soon! We can’t continue as we are. Losing too many bright and beautiful people.