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Essential Reading
The New England Journal of Medicine recently published two articles that are absolutely galvanizing (1, 2). I urge all readers concerned about the well-being of physicians, including our medical students, to have a look. Both pieces add to the growing corpus of knowledge about how stress and illness affects us and how, tragically, all of us are knocked off our feet when we lose one of our own to suicide.
Dr. Adam Hill is a “human being, a husband, a father, a pediatric palliative care physician, and an associate residency director” at Indiana University School of Medicine and the Riley Hospital for Children in Indianapolis. This quote is from the first line of his article. He explains later how he has reordered the hierarchy of his needs since undergoing treatment for suicidal depression and alcoholism, and that he has learned that elusive lesson in medicine that we must take care of ourselves before we can properly care for others. This is the first of a series of lessons he conveys.
MORE: Physician Suicide: Lessons Learned From Those Left Behind
The second lesson is about how alcoholics are stereotyped in negative and pejorative terms. “I am the face of alcoholism” he writes and given how much its sufferers live with shame, fear and guilt, he rightly calls for understanding and tolerance. His next lesson confronts stigma and he drills down on shame. The shame he experienced when he relocated and applied for a medical license—and was required to write a public letter outlining his treatment. This kind of detail only adds to the inner sense of feeling faulty and different. He argues that this is societal and we are all responsible for shaming and “it’s up to us to stop it.”
The fourth lesson addresses our vulnerabilities as doctors. He writes beautifully and openly about how his vulnerability has unleashed creativity, innovation, growth, and resistance in himself and how this enables him to find and cherish authenticity in those around him. His fifth lesson is a nod to professionalism and impairment: the safest doctors are those who have faced their demons and are now well, not those hiding in fear with untreated illnesses. His final lesson is about having a healthy network of supportive family, colleagues, and friends. They keep us accountable and pick us up when we fall.
MORE: Preparing Residents for the Aftermath of Patient Suicide
The second article, “Kathryn,” is penned by Dr. David Muller, Dean for Medical Education at the Icahn School of Medicine at Mount Sinai New York. It is a heartfelt, compassionate and powerful piece about the death by suicide of Kathryn, one of the school’s fourth-year medical students, on August 17, 2016. Dr. Muller walks the reader through the immediate aftermath of her death, including its impact on (and outreach to) her classmates, residents, the institution proper, and her family. Dr. Muller accompanied Kathryn’s mother to the medical examiner’s office and afterwards to her daughter’s apartment. He describes the mother’s selflessness, her inclusiveness, and her concern about the many people reeling from her daughter’s death. As he writes about being humbled by the outpouring of support that he received from others near and far, I was moved by his own actions, so humanistic, caring, and loving.
The reaction of Dr. Muller and his institution to Kathryn’s death must be highlighted. In the not so distant past, suicide deaths of trainees in the house of medicine were hushed up or swept under the carpet. Not at Mount Sinai. Kathryn will not have died in vain. Dr. Muller and his task force call for all kinds of institutional and national changes: improving student health; fighting stigma attached to seeking help; examining staffing of mental health resources; considering annual mental health checkups and so forth. But he calls for much more on a bigger and systemic level: a serious examination of the culture of performance and achievement that permeates our training programs and the applicant process. He writes: “We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take other bold steps to relieve the pressure that we know is contributing at least to distress, if not to mental illness, among our students.”
Both of these articles call for change. Their urgency is palpable. And we are all part of the solution.
References
- Hill AB. Breaking the stigma – a Physician’s Perspective on Self-Care and Recovery. New England Journal of Medicine. 2017;376(12):1103-1105.
- Muller D. Kathryn. New England Journal of Medicine. 2017;376(12):1101-1103.
Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of 8 books, the most recent of which are "Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared" and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr. Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.
