Pressure and Isolation Lead to Tragedy John Dietl, father of then-26-year-old Kevin Dietl, a fourth-year medical resident who committed suicide in 2015, brushes aside his tears when he talks about his deceased son. "Kevin thought he was all alone in feeling the way he did," Dietl told Medscape. "Looking back, he was very isolated. All he did was study. He had no time to keep up with friends." "Our son thought he was the only one. He had a psychotic break. He felt very isolated and felt no other way out," said Dietl. Kevin's mother, Michele Dietl, added, "When Kevin came home, he seemed down, but he didn't talk about anything being wrong, and we didn't want to probe. Others said, 'Well, everyone goes through this in medical school,' and we felt that he would get past it and feel better." But Kevin's depression didn't lift. His gunshot suicide destroyed his family's world. John and Michele appear in the new movie Do No Harm: Exposing the Hippocratic Hoax, a powerful documentary about medical resident suicide, by Emmy award–winning writer/producer/director Robyn Symon. I met the Dietls and Symon at the recent New York screening of the movie. The theater was sold out on both nights of the screening and was packed with residents, med students, attendings, and other practicing physicians, many of whom I knew from other venues. The movie also tells the story of another former resident, Hawkins Mecham, who had attempted suicide by slitting his wrists. He survived and now cares for patients. It was wonderful to see him smiling and happy at the movie screening. "I come from a family of physicians, but we never spoke about the depression, disillusionment, sleep deprivation, and the inability to seek emotional help," says Symon. "Four years ago, someone sent me an article about two young doctors who jumped from the roofs of their buildings in New York. I was shocked. I wanted to know what would cause them to feel so desperate." The climate that creates depressed and burned-out physicians can also lead them to make unintentional errors when caring for patients. "When I linked those conditions in our medical culture that patients don't see to the alarming rate of medical errors, I realized that this is a subject that impacts everyone," says Symon. The Fear That Getting Help Could Ruin Their Future Kevin Dietl had gone for counseling, said his father, but like many physicians and healthcare professionals, he was worried that if anyone found out, it could ruin his career. Kevin went to a therapist far away and paid cash so that no one would know about it, his father told me. In my own experience, I've encountered physicians who felt that they needed psychological help. They, too, found therapists at least 2 hours away from home; they also paid cash, and they often used an alias when making the appointment. Sadly, with all of the strides we've made in de-stigmatizing mental health issues, physicians can still have it held against them professionally when they seek help for themselves. Helping Physicians Deal With Depression and Burnout Pamela Wible, MD, a family physician from Eugene, Oregon, and an activist against the conditions that lead to medical resident and physician suicide, describes her own experiences and her work in the film. Wible now runs a suicide prevention hotline and a retreat for physicians, residents, and medical students struggling with depression. In the film, Wible highlights several key points that contribute to resident and physician suicide, including lack of sleep, too many working hours, and lack of communication with others who are feeling similar pressures. What Needs to Change? Wible notes that it's unacceptable and dangerous for residents to work 80 hours a week or more; they're sleep-deprived, unable to function, and drained of the physical and psychological resources needed to fight back or sustain themselves. Counseling and psychological help is imperative too, says Wible. "When there's a school shooting, what happens afterward?" she asks. "We bring in counselors for the survivors and the other students. We have a memorial ceremony. We honor their memory." By contrast, she says, when resident suicide occurs, hospitals typically stay silent. They don't take action to address what happened, and often there are no counseling services made available for the resident's friends or colleagues to help deal with the loss. A small number of medical schools have started to make it easier for students and residents to get needed help, according to Dietl. "Some medical schools have increased the number of anonymous counselors who are available to students," said Dietl. "The counseling centers are located away from campus so that no one can see students going to them, and students can remain anonymous when getting help." Have Lunch or Coffee With a Colleague Robyn Alley-Hay, MD, a physician coach based in Dallas, Texas, who attended the screening, said she herself was suicidal at one point in her education. Residents and physicians tend to keep their suffering to themselves, which ultimately exacerbates the problem, says Alley-Hay. "Connections with colleagues could help save their lives," says Alley-Hay. "When we are in our own heads, our thoughts get distorted. We think we are the only ones going through this. But when you find other physicians going through a similar experience, it's very helpful." She added, "Having [people] to talk to who can say, 'We get that. We understand' is helpful. The connection is the first, most important step, even though it's so hard to do," says Alley-Hay. "Put up your hand and say that you need help. I have heard physicians look at this issue and say, 'There but for the grace of God go I.' And what saved them? Someone said to them, 'Let's have lunch, let's have coffee.' Or they asked someone for lunch or coffee and to talk. Lunch saved them." While coffee or lunch doesn't change the underlying problems of pressure and sleep deprivation, having that interaction can be a help to those who are struggling. Each screening of Do No Harm: Exposing the Hippocratic Hoax has garnered heartfelt support from medical residents and others within the community. As Wible points out, "We shouldn't just address the problem by trying to make doctors more resilient. That's like making the physician the cause of the problem, implying that he or she is not resilient enough." Regarding the difference between the cause of a problem and its cure, a physician in an article I once read said, "Just because aspirin may help cure a headache, that doesn't mean the headache was caused due to lack of aspirin." (Disclaimer: The author has no financial or any other vested interest in the film Do No Harm: Exposing the Hippocratic Hoax). Source
