Tips for Assisting Medical Communities After Physician Suicide

In my last blog I wrote about what to expect and look for in medical communities that are trying to cope with the loss of a physician colleague who has killed herself/himself. Should you be contacted, here are some ways in which you can assist.

• Make some type of empathic statement to the caller such as, “I am so sorry to hear this sad news.” This could be followed with a question (“How can I help?”) or statement (“I’m willing to help in any way that I can”). This will ease the reticence or awkwardness of the individual who is reaching out to you and convey a message that you can be of assistance. This is a rudderless time for the affected community, and your words and certainty will be very soothing.
• As noted earlier, try to understand that survivors of suicide loss are left with a sense of abandonment, betrayal, and responsibility. Unlike deaths from illness, there has not been a proper goodbye. There are many questions and very few, if any, answers. The bereavement of the deceased doctor’s colleagues may be fierce and the definitions of normality quite broad. This will help to prepare you for your visit. It is probably best (but this is purely anecdotal) to meet within a week or two of the funeral or memorial service, but not too long afterwards when colleagues have moved on a bit and do not want to revisit those early days and weeks.
• Negotiate with the person calling you as to what might be the best or most proper setting in which the group can assemble to meet with you. I have most often met at the hospital, medical center, or clinic or university medical school — in other words, the workplace or site of training. This enables the largest contingent of those who may want to attend to be present because it’s during the workday. However, I have also been invited to meet in the evening in the home of one of the physician colleagues of the physician who died. It’s wise to remember that a home venue (where alcohol might be served) creates a different milieu than the workplace. There are pros and cons with each.
• When everyone is assembled, welcome them for coming and being together at such a difficult time. Acknowledge the profound emotions that suicide triggers. Make a statement urging all present to respect and protect everyone’s confidentiality and privacy about anything said in the meeting. Invite them to speak as they feel comfortable. Remember that your role is that of facilitator of the group and as someone at arm’s length, a cogent enabler of that process. This is not the time to give a lecture or PowerPoint presentation (translate: intellectualized distancing) on physician health, illness, and the epidemiology of suicide!
• By using good listening and focusing skills, you can encourage and promote ventilation of the myriad feelings and thoughts that the doctors are experiencing (see earlier blog). Be prepared for raw, intense, primitive, and contradictory emotions. Don’t forget that physicians are human beings first and that they are in the acute stages of grief. Honor their candor and ability to drop the doctor persona and characteristic armor that we all use in our professional lives. Try not to judge. If tension arises between or among the participants, especially around the subject of blame, explain that they are all individuals who are unique and have a right to own their feelings and actions. You may need to address questions they pose about the parameters of grief. It is wise to give a wide margin of norms emblematic of death by suicide.
•  Field questions about reaching out to the family and how to do this with respect and empathy (don’t forget how stigmatized the loved ones of those who die by suicide feel and how comforting the enduring support of colleagues is). Answer questions about the value of supportive resources, which might range all the way from onsite Employment Assistance Programs to grief counselors to suicide support groups to individual therapy, including psychiatric assessment if indicated. Again, be careful not to give a mini-lecture on the subject. Be generous and revert back to the group for their suggestions and input, especially the local sources of help.
• Ways of remembering their colleague is a common theme. Encourage discussion about this and brainstorm about creative ways. Some groups form a small committee to meet with key family members to explore things like a memorial lecture, a bursary for a student or resident, a plaque, a named prize at graduation, and so forth. Everyone wants to remember the physician for how she or he lived, not how he or she died.
• At the end of the day suicide is very humbling. We must always respect the mystery of life and death. We must take care not to project our personal and collective notions of what it means to be a physician onto others. But we must simultaneously continue our research into the biopsychosocial reasons why doctors kill themselves and commit to prevention.