`It Is With a Heavy Heart That I Write This…`

The evocative title of this blog piece is the subject line of an email sent by Dr. Chris Doty to colleagues in Emergency Medicine last January. Chris is Program Director, Department of Emergency Medicine, University of Kentucky-Chandler Medical Center in Lexington. We met some years ago when he held the same position at SUNY Downstate Medical Center in Brooklyn. What his email contains is the sad news of the death by suicide of one of his residents. I spoke with him on June 1^st and he shared the email with me. Here are segments of what he penned:

The unbearable has happened at the University of Kentucky. Last Friday we discovered that one of our residents was tragically taken from us. It appears that the resident took their own life in response to acute grief over a moribund family member.  

This is a catastrophic loss for our program and for his family and friends. While I am immensely embarrassed that I lost a resident "on my watch” and guilty that I didn’t see this coming, this needs to be said. Honestly, I have struggled on whether I should write this email at all. I make this information public in order to shine a bright light on a problem that often lurks in the dark. Suicide, and specifically suicide in our trainees, is a significant risk and we are at higher risk than the general public. In order to face this issue, we must acknowledge its existence. We must "speak its name”. We must learn about it and talk about it.

His communication to his colleagues continues with some additional background about physician suicide and the elusive nature of personal struggle and illness in trainees. As a seasoned program director, his message is a call to arms. He alerts his peers to the recent focus on wellness of the ACGME (Accreditation Council for Graduate Medical Education). He urges them to pay very close attention to any residents in their programs who are struggling and to redouble their efforts of vigilance, understanding, caring, and support. He attaches a couple of articles on physician suicide to his dispatch. And most incisively, he nails that chilling isolation that we mental health clinicians see so often in our doctor-patients: “I am absolutely devastated that one of my residents felt so alone and so afraid, that he chose to end his life.”

There are several reasons why I’ve chosen to focus on physician suicide, specifically resident suicide, yet again, in this column:

1. It isn’t going away. We don’t have updated data on the oft-quoted statement that “300-400 physicians kill themselves every year in the United States” but as a physician suicide researcher, I continue to be notified not infrequently about self-inflicted deaths in doctors across the nation – and beyond.
2. My qualitative study of loved ones of physicians who have died by suicide (in process, unpublished) has found a distinct and significant cohort of medical students and physicians who kill themselves without ever receiving any mental health treatment. There is no precedent for this in other branches of medicine. I will be presenting some of my research at the next International Conference on Physician Health in Boston in September of this year.
3. The humiliation and fear attached to seeking help, and the stigma associated with suicide, need our undivided attention. Many national, systemic, and individual efforts are underway (as noted by Dr. Doty), but we must continue this surge. We have not changed the hearts and minds yet of those individual physicians who, faced with symptoms of mental health distress, do not book an appointment with their doctor as they would do if they were having chest pain, GI distress, or hematuria.
4. But most importantly, I want to recognize Dr. Doty. Not all program directors have the courage and commitment to “go public” with that horrible sense of loss, shame, guilt, and confusion when one of their residents dies by their own hand. His sentence “We must ‘speak its name’” embodies the urgency, the mandate of what needs to be done to bring this dark subject out of the medical closet. Speaking openly not only lessens the inner anguish but simply tells the truth. We should not have to whisper about or avoid the authenticity of how this young man died. We honor his short and accomplished life with the truth. And we give pause, reflect, examine, learn, and push forward with enriched attitudes and standards. Thank you Dr. Doty. Your email message extends way beyond your colleagues in Emergency Medicine. You are carrying the banner of former Surgeon General Dr. David Satcher who prophetically stated in 2001 “Suicide prevention is everyone’s business.”

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 seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) 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.