Written by: Sarah Nayeem
Physicians die by suicide at an alarming rate which has been escalating since the onset of the Covid 19 pandemic. It is only from within that one can fully appreciate the intense ableism, stigma and discrimination within the Medical community against Physicians with mental illness and chronic conditions. Combined with the normalization of abusive working conditions this is a deadly combination for many. Medical culture normalizes unhealthy practices like avoiding drinking fluids to avoid bathroom breaks which there often isn't time for. Employers and team leaders reward 'toughing it out' and promote the 'self-sacrificing hero' archetype as the standard to achieve rather than acknowledge our needs as humans. Medical culture and 'bravado' reinforces isolation, exhaustion and likely contributes to the increasing suicide rate among us in its unending demand for selfless participants that are willing to shoulder the responsibility for the system's short staffing and shortcomings.
Leadership and administrators frown upon and penalize time off to go to doctor's appointments or even worse to care for your family or your own needs. It is easier to die a martyr in healthcare than to speak out and demand the right to a healthy life and time to take care of yourself first. The Covid pandemic exposed this dynamic clearly with the applause for front line workers but no funding allocated for PPE or actual support for us to safely do our jobs. Program Directors are now urging for change as they witness trainees dying by suicide in alarming numbers in some cases being expected to work over 100 hours a week and the expectation to work even through personal sickness. State licensing boards require each applicant to indicate if we have ever received mental health treatment, medications or hospitalization in our lifetimes. If an individual has such a history, they are met with scrutiny, testing and discrimination, more than if they had the same condition and avoided seeking help. Physicians experience the highest suicide rate of any profession according to a 2018 abstract by the APA. Witnessing the stigma patients experience every day by medical teams and the health care system wears on all of us. Ableism is rampant in our healthcare system. It is common for healthcare workers to 'hide' their medical and psychiatric illnesses out of fear of being fired or worse reported to medical licensing boards who require extensive testing and interrogation to assess 'fitness' for any Physician with a medical or mental condition. Rather than improve quality of care, these measures deter individuals from reporting their illnesses and therefore have to practice with without support. For many, the knowledge of scrutiny and likely discrimination and fear of being exposed prevents their support and care and therefore is much riskier for everyone involved. Most physicians in practice today know a colleague who died by suicide or have experienced suicidal ideation themselves. The immense burden of trying to make a broken system function ethically for patients in itself is overwhelming, let alone long and isolating hours and spending more than half your life training to do this work incurring massive debt from student loans. Managed care reminds us with every patient encounter that US Healthcare is a business and financial concerns steer our decisions. against our will and better judgment in some cases. If insurance does not pay, the patient does not have access to our best recommendations and it is up to us to formulate a financially feasible plan with limited social supports in the community due to defunding of critical programs and infrastructure. Without universal healthcare and measures taken to address basic needs and infrastructure like housing, food, climate justice, education, maternal mental health and abolition of the police and carceral state we will continue to perpetuate chronic stress, preventable medical illnesses and reduce the impact and effectiveness of mental health interventions for individuals and populations. Physicians deserve the right to their full humanity including acceptance of the reality that medical illness, psychiatric illness and addiction also affect us and we deserve the right to treatment and career safety for doing so. Lived experience informs some of the most compassionate and effective Physicians and health care workers and these experiences should be encouraged by openness from state licensing boards and administrators. We should be a model for our patients for what healthy approaches to illness are- including seeking support, medications when needed and making time to take care of ourselves. We deserve to work in a system where the basic infrastructure of communities is prioritized, where every patient is insured and can therefore have equal access to recieve the best care. Physician suicides are on the rise and without systematic change, a massive shift in medical culture away from abusive working conditions, discriminatory practices, racism, microaggressions and stigma, more 'health care heroes' will die preventable and tragic deaths by suicide. Health care workers should be granted the simple grace to be human beings, who are equally vulnerable to illness, addiction and life stressors and worthy of support and care. Resources if you are a physician or know a healthcare worker experiencing a mental health crisis: Call the Physician Support Line a volunteer run 24/7 hotline run by Psychiatrists www.physiciansupportline.com 888-409-0141 National Suicide Hotline 800-273-8255 (TALK) Go to your nearest Emergency Department or Urgent care RAINN Rape Abuse and Incest National network (800) 656-4673 Friends for Survival a bereavement group for those grieving friends/family lost by suicide (800)-646-7322