Guest Post from Dr. Pamela Wible

What I’ve learned from saving physicians from suicide

 | PHYSICIAN | MAY 27, 2013

A psychiatrist in Seattle had picked out the bridge. At 3am he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep.

A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late.

An internal medicine resident in Atlanta heard an anesthesiologist joking about the lethal dose of sodium thiopental. Alone in the call room, she would overdose that night.

Three planned suicides. All three physicians survived. Why? physician-suicide

While preparing to overdose, the internist was interrupted by an endocrinologist calling to check on her. Before grabbing her scalpel, the surgeon called several physicians pleading for help—I responded immediately. Two days before he was to drive off the bridge, the psychiatrist spotted my ad for a physician retreat. He called me begging to attend.

One week later, I’m hiking through the Oregon Cascades. The scent of cedar envelops me as I approach the lodge where I’m welcoming physicians who have arrived from all over the United States and Canada, all of us on a pilgrimage for answers.

Tonight we begin a retreat for doctors who yearn to love medicine again. Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: few seek help.

I ask the group, “How many physicians have lost a colleague to suicide?” All hands are raised. “How many have considered suicide?” Except for one woman, all hands remain up—including mine.

“Physicians have the highest suicide rate of any profession,” I explain. “In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. Even that’s an underestimate because many physician suicides are incorrectly identified as accidents.”

I tell them, “Both men I dated in med school are dead. Brilliant physicians. Loved by their families and patients. Both died young—by ‘accidental overdose.’ Really? How many physicians accidentally overdose?”

The room is quiet.

It’s easier to say accident than suicide. Doctors can say gonorrhea and carcinoma. Why not suicide? Maybe we can’t face our own wounds.

“I’m a family doc in Eugene, Oregon, where we’ve lost three physicians in eighteen months to suicide. I was suicidal once. Assembly-line medicine was killing me. Too many patients and not enough time sets us up for failure. Rather than kill myself, I invited my patients to help me design an ‘ideal clinic.’ It is possible to love medicine again.”

The Canadian doctor to my right wipes her eyes. “I’m feeling so discouraged. I want to give up and work at Starbucks. My head is exploding from banging it against the system.”

A bright-eyed, blonde woman reveals, “I just took a leave of absence from med school because it was ‘killing my soul.’ Three classmates attempted suicide.”

A newlywed couple join in. “I’m a nurse. My husband is an internist. He’s suffering, but I don’t know how to help him. Doctors don’t seek psychiatric care because mental illness is reportable to the medical board. He fears he’ll lose his license.” Her husband adds, “I was suicidal three months ago. On the edge. My wife and I are hoping to find answers here.”

Here, physicians, nurses, and medical students share their wounds and their wisdom—in community. We share new practice models, communication techniques, and strategies to care for ourselves—so we can care for our patients.

In four days, I witness more healing than in four years of med school. Once strangers, we’ve become family. Parting ways, the psychiatrist from Seattle thanks me again.

I didn’t know these doctors, but I know their despair. By speaking about my own pain, I validated their pain. By being vulnerable, I gave them the strength to be vulnerable too.

But mostly we healed each other by not being afraid to say the word suicide out loud.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

 

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Five excuses for not taking your medication – and why they are all stupid

Yes, I’m about to go on a rant directed at those dealing with an anxiety, bi-polar or depression diagnosis.

1) I don’t trust medication (doctors, hospitals, shrinks…)
Hmm, are you also suffering from paranoia? If not, then you can research several doctors online, ask for recommendations, ask questions of your team, research the treatment plan and the medications. But you’re sick so maybe you can’t do all that. Here’s where a trusted friend or family member can help you. Become informed and empowered or discuss a possible additional issue of paranoia or irrational thinking with your therapist.

2) I don’t need them
Really? If it has just been suggested that you take a medication, yet you’ve decided you don’t need them, let’s go back to what precipitated the doctor visits. Either you were sent to the doctor or were brave enough to go yourself. In either case, something was deeply disturbing and painfully obvious. A thorough physical exam was done and the medical fields of mental health and internal medicine converged with a diagnosis. With several years of experience in their fields and an acute awareness of the delicate nature of a troubled mind, a plan to address your issues was created and it included medication.
Perhaps you have been taking the medication as prescribed for weeks, months or years. But now because you are “feeling fine” or because you aren’t feeling better, you’ve decided you don’t need the meds. Bad strategy friend. Instead talk with your doctor and therapist to determine the best adjustments to make. Or find new professionals if you aren’t comfortable with your current team. You, by yourself, simply aren’t qualified to make those determinations.

3) I don’t want to be dependant
Ok, so you acknowledge that the medication is helping you feel better. However, you’ve become impatient with the healing process. “It shouldn’t be taking so long.” “How do I know when I can come off the meds?” Valid concerns that you need to take up with your health providers. If you’ve gotten the homework done on the doctors and your diagnosis, you then need to have patience to work your individualized and multifaceted plan.

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4) I forget sometimes
Your mental and physical health are important enough to set up a system to combat forgetfulness. Here’s another time family or friends can help. First, decide you are going to be accountable to someone for taking all medications as prescribed. Use one of those nifty pill containers with the days of the week on it. Before time to take them, I bring my meds from the medicine cabinet and sit them next to me. When I take one, I turn the bottle upside down. I have found this very helpful. Not missing a dose is super important to me. I’m aware of the dangerous safety issues that can occur if I allow the levels of medicine in my bloodstream to drop dramatically.

5) I don’t like the side effects
“I might gain weight.” “I don’t feel like myself.” “I just feel sleepy all the time.” “It gives me headaches.”
Yeah, but before the medications you were afraid to leave your house or crying uncontrollably several times a week or acting out sexually or unable to care for your newborn.
Talk with your doctors honestly about your side effects. They may be able to make or suggest changes to reduce them.
Sooo, if you really weigh the negatives against the possible positives, isn’t it short-sighted to use side effects as your excuse?

“A 2003 study published in Current Medical Research and Opinion found that 65% of the 1000 people surveyed said they had stopped taking their medicine, and half of those people cited side effects as the reason.”
-“Coping With Side Effects of Antidepressants” WebMD.com February 12, 2012

photo courtesy of http://www.123rf.com/12556053