Physician Suicide Prevention: Self-care and Seeking Help

By: Wm. Chris Woodward, DO

The first question I ask new medical students: “what is the most important thing you can do for your patients?” Typical answers are empathy, listening, compassion, talking to my patient, educating my patients among others. The correct answer, in my opinion, is “take care of yourself!”

If you haven’t eaten, slept, showered, had free time, exercised, or emptied your bladder then you will not be at your best.

A sleep deprived, hungry, and emotionally drained physician is at risk of making medical errors. Our main concern in medicine is patient safety so our ill-health potentially impacts our patients. Lack of self-care is a patient safety issue.

Although there will be times when you cannot leave a critical clinical situation; most clinical encounters, both inpatient and outpatient, are not critical. You can take a break!

You may believe that to be a good physician you must sacrifice your health, your emotional needs, your family, your friends, and a life outside of medicine. This is not true. You can and must have a work/life balance. It’s obviously essential for your own survival and your patient’s safety.

If inadequate self-care becomes a chronic pattern, then that practitioner is at risk of depression and suicide. Every year 300 – 400 Physicians complete suicide. We lose one of us every day. This is more than twice the rate of US adults. In the US general population, men are more likely to complete a suicide than women. In contrast there is gender parity in medicine. Depression is more prevalent in female physicians than would be predicted based on population data.

Depression still carries stigma. “It’s a lack of will power.” “You’re a weak person.” “You are (or going to be) a doctor. What excuse do you have to be depressed?” Many reasons trigger depression but ultimately, it’s a medical condition caused by pathophysiologic processes.

Depression viewed from this perspective is like Diabetes, Hypertension, Arthritis and many other chronic diseases that can be successfully treated.

In 2014, I became depressed. Feelings of helplessness and hopelessness quickly progressed to intrusive thoughts of hurting myself and eventually to suicidal ideation. I shared these thoughts with my therapist who immediately arranged for hospitalization. That admission, along with medication and counseling may have saved my life.

I freely talk about this time in my life to let other Health Care Professionals know that you are not alone and there is help. It also reminds me that I’m human and need help from time-to-time. Asking for help is not weakness; it’s strength. When I’m at my best, I can be of maximum service to others. When I’m not, I may be a threat.

On day one of a rotation, I tell medical students the bad news: “you are human and are prone to all the mistakes and afflictions humans suffer.” This includes chronic diseases, severe injuries, mental health issues, death at a young age from a terminal illness, alcoholism, and addiction. You are not super-human. You are fallible. You will make mistakes. You will do great things for others. First you have to accept that you are an imperfect Homosapien. Accepting our humanness with humility acknowledges that we have limitations.