By Paul Ziaya, M.D.
The Joint Commission
It was an alarming read, to say the least.
In early September, an op-ed by Dr. Pranay Sinha, titled “Why Do Doctors Commit Suicide?,” appeared in The New York Times. The author spoke to the tragedy that is suicide, specifically about new physicians as they negotiate the difficulties of residency education. The statistics alone were worth the read – nearly 10 percent of fourth-year medical students and first-year residents reported having suicidal thoughts in the prior two weeks.
Residency is a very stressful time. We all remember that.
So despite the nationally implemented reduction in weekly hours for residents and programs implemented to assist with coping, suicide remains a risk. For physicians in general, there may be as many as 400 completed physician suicides each year in the United States. This is a worldwide issue and, as Dr. Louise Andrew noted in her Medscape article, “Physician Suicide,” “Depression is at least as common in the medical profession as in the general population, affecting an estimated 12 percent of males and 18 percent of females. Depression is even more common in medical students and residents, with 15-30 percent of them screening positive for depressive symptoms.”
The factors that may lead to suicide are many and, perhaps related to physician knowledge of and access to medications, physicians have a higher rate of completing an attempted suicide than in the general population.
Depression is difficult enough to recognize in others, but even when physicians recognize depressive symptoms in themselves, the majority fail to seek help; why is a complicated question. Perhaps it’s due to concerns about the potential effect on their careers or the sense that they are supposed to be the healers, not those needing healing.
Joint Commission standard MS.11.01.01 is specifically written to encourage medical staffs to identify and manage matters of individual health in ourselves and our colleagues. Separate from actions taken for disciplinary purposes, it focuses on education of physicians to recognize issues in others and also encourages self-referral in an effort to result in confidential diagnosis, treatment and rehabilitation to “retain and to regain optimal professional functioning that is consistent with protection of patients.”
Physicians, despite all their knowledge, are like everyone else in their risk for depression and suicide. Yet they have trouble getting effective treatment. While resources exist to help, we must continue to remove the stigma and other barriers associated with getting the needed assistance. That perceived stigma is thought of as a dangerous thing to a career or a physician, but we all must remember it pales in comparison to the depression itself.
Yes, The New York Times piece was alarming. Hopefully it’s an alarming reminder that despite efforts over more than a decade to recognize and improve the factors that may affect the rate of suicide in physicians, there still remains much to be done, and we as medical staff leaders and colleagues have an important role to play.