Yet Another Physician Suicide He was the go-to sports guy in Washington, DC. A masterful surgeon with countless academic publications, he trained orthopedic surgeons across the world and was the top physician for professional sports teams and Olympians. Dr Benjamin Shaffer Dr Benjamin Shaffer had it all. Yet Ben was more than a stellar surgeon. He was a kind, sweet, brilliant, and sensitive soul who could relate to anyone—from inner-city children to Supreme Court justices. He was gorgeous and magnetic with a sense of humor and a zest for life that was contagious. Most of all, he loved helping people. Patients came to him in pain and left his office laughing. They called him "Dr Smiles." Ben was at the top of his game when he ended his life. So why did he die? Underneath his irresistible smile, Ben hid a lifetime of anxiety amid his professional achievements. He had recently been weaned off of anxiolytics and was suffering from rebound anxiety and insomnia—sleeping just a few hours per night and trying to operate and treat patients each day. Then his psychiatrist retired and passed him on to a new one. Eight days before he died, his psychiatrist prescribed two new drugs that worsened his insomnia, increased his anxiety, and led to paranoia. He was told that he would need medication for the rest of his life. Devastated, Ben feared that he would never have a normal life. He told his sister it was "game over." Ben admitted that he was suicidal, with a plan, though he told his psychiatrist that he wouldn't act on it. Ben knew he should check himself into a hospital but was panicked. He was terrified that he would lose his patients, his practice, his marriage, and that everyone in DC—team owners, players, patients, colleagues—would find out about his mental illness and he would be shunned. The night before he died, Ben requested the remainder of the week off to rest. His colleagues were supportive, yet he was ashamed. He slept that night but awoke wiped out on May 20, 2015. After driving his son to school, he came home and hanged himself on a bookcase. He left no note. He left behind his wife and two children. Hiding Chronic Anxiety I feel a kinship with Ben, partly because I used to suffer from chronic anxiety that I hid under academic achievements, but mostly because I'm a cheerful doctor who was once a suicidal physician, too. In 2004 I thought I was the only suicidal physician in the world—until 2012, when I found myself at the memorial for our third doctor suicide in my small town. Despite his very public death, nobody uttered the word "suicide" aloud. Yet everyone kept whispering, "Why?" I wanted to know why. So I started counting doctor suicides. Within a few minutes, I counted 10. Five years later, I had a list of 547. By January 2018, I had 757 cases on my registry. As of today, that number is 1013. High doctor suicide rates have been reported since 1858.[Physician suicide is a global public health crisis. More than 1 million Americans lose their doctors each year to suicide—just in the United States. Many doctors have lost several colleagues to suicide. One doctor told me that he lost eight physicians during his career, with no chance to grieve. Public perception maintains that doctors are successful, intelligent, wealthy, and immune from the problems of the masses. Of these 1013 suicides, 888 are physicians and 125 are medical students. The majority (867) are in the US and 146 are international. On my registry, surgeons have the greatest number of suicides, followed by anesthesiologists. However, when accounting for numbers of active physicians per specialty, anesthesiologists are more than twice as likely to die by suicide than any other physician. Surgeons are number two, then emergency medicine physicians, obstetrician/gynecologists, and psychiatrists. On my registry, for every woman who dies by suicide, we lose four men. Suicide methods vary by specialty, region, and gender. Women prefer overdose. In the US, men use firearms. Jumping is popular in New York City. In India, doctors are found hanging from ceiling fans. Male anesthesiologists are at highest risk among all physicians. Most anesthesiologists overdose. Many are found dead inside hospital call rooms. Doctor suicides on the registry were submitted to me during a 6-year period (2012-2018) by families, friends, and colleagues who knew the deceased. After speaking to thousands of suicidal physicians since 2012 on my informal doctor suicide hotline and analyzing registry data, I discovered surprising themes—many unique to physicians. Public perception maintains that doctors are successful, intelligent, wealthy, and immune from the problems of the masses. To patients, it is inconceivable that doctors would have the highest suicide rate of any profession. Even more baffling, "happy" doctors are dying by suicide. Many doctors who kill themselves appear to be the most optimistic, upbeat, and confident people. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs-up to the team after a successful surgery—and hours later they shoot themselves in the head. Doctors are masters of disguise and compartmentalization. Turns out that some of the happiest people—especially those who spend their days making other people happy—may be masking their own despair. Reading this excerpt from the 1858 Manual of Psychological Medicine, I'm reminded of so many brilliant doctors I've lost to suicide: Carlini, a French actor of reputation, consulted a physician to whom he was unknown, on account of the attacks of profound melancholy to which he was subject. The doctor, among other things, recommended the diversion of the Italian comedy; 'for,' said he, 'your distemper must be rooted indeed, if the acting of the lively Carlini does not remove it.' 'Alas!' ejaculated the miserable patient, 'I am the very Carlini whom you recommend me to see; and, while I am capable of filling Paris with mirth and laughter, I am myself the dejected victim of melancholy and chagrin.' The Consequences for Physicians of Acknowledging Mental Illness Many of our most inspiring and visionary leaders—artists, actors, even doctors—suffer from mental illness. Blaming doctors increases suicides. Words like 'burnout' and 'resilience' are employed by medical institutions to blame and shame doctors while deflecting their own accountability. Yet, students enter medical school with their mental health on par with or better than their peers'. Suicide is an occupational hazard in medicine. Doctors develop on-the-job PTSD—especially in emergency medicine. Patient deaths—even with no medical error—may lead to self-loathing. Suicide is the ultimate self-punishment. Humans make mistakes. When doctors make mistakes, they are publicly shamed in court, on television, and in newspapers (that live online forever). As doctors, we suffer the agony of harming someone else—unintentionally—for the rest of our lives. Blaming doctors increases suicides. Medical institutions employ words like "burnout" and "resilience" to blame and shame doctors while deflecting their own accountability for inhumane working conditions in failing health systems. When doctors are punished for occupationally induced mental health wounds, they become even more desperate. If physicians do seek help, they risk being disciplined. Doctors rightfully fear lack of confidentiality when receiving mental health care, as private conversations with therapists could be turned over to medical boards and illegally accessed by their supervisors via electronic medical records at their institutions. So physicians drive out of town, pay cash, and use fake names in paper charts to hide from state boards, hospitals, and insurance plans that interrogate doctors about their mental health and may prevent or delay state licensure, hospital privileges, and health plan participation. With a great work ethic until their last breath, doctors are often checking in on patients, reviewing test results, and dictating charts minutes before orchestrating their own suicides. Many leave apologetic, heartfelt letters for friends, family, and staff, detailing the reasons for their suicide. One orthopedic surgeon simply wrote: "I'm sorry I couldn't fix everyone." Doctors choose suicide to end their pain (not because they want to die). Suicide is preventable if we stop the secrecy, stigma, and punishment. In absence of support, doctors make impulsive decisions to end their pain permanently. I asked several male physicians who survived their suicides, "How long after you decided to kill yourself did you take action—overdose on pills or pull the trigger?" The answer: 3 to 5 minutes. Ignoring doctor suicides leads to more doctor suicides. Let's not wait until the last few minutes of a doctor's life when heroic interventions are required. Most physician suicides are multifactorial, involving a cascade of events that unfold months to years prior. So reach out to "happy" doctors today—especially male anesthesiologists and surgeons, who are least likely to cry or ask for help. Do No Harm In honor of Suicide Awareness Month, there will be a special medical community sneak-preview screening of the groundbreaking documentary film Do No Harm. Two-time Emmy-winning filmmaker Robyn Symon follows four people bonded by tragedy on a mission to expose a toxic medical culture that puts the lives of doctors and patients at risk. Showings will be on September 12 and 13 in New York City. A live panel discussion will follow the movie with filmmaker Robyn Symon and Dr Pamela Wible. Source
