Those lost

A physician recounts colleagues she lost to physician suicide in her seven-year career as an attending hospitalist physician.

I had just come home from school and was settling in to do my homework. Suddenly, my mother jolted into the room with tears streaming down her face. She muttered that my cousin Ashish, a pediatrics resident in India, had died. I stared at my mother in disbelief of this news and of her despair. At the young age of 15, this was my first window into physician suicide.

Today, physician suicide is a phenomenon that is being spoken about nationally and globally. Research has found significantly higher rates of suicide among physicians than in the general population, with some studies citing as much as double the risk. The estimates vary depending on data sources and coding and are subject to limitations, which is understandable, yet clearly there is an urgent need for more accurate data and, more fundamentally, a public health approach to an unabated string of tragic cases.

Most colleagues and I can easily list colleagues we have lost. After experiencing my first loss, my cousin, I subsequently lost at least eight more colleagues and friends to physician suicide in my seven-year career as an attending hospitalist physician.

Memories of my cousin remain fresh in my mind, since his passion and dedication are what first sparked my interest in the field of medicine as a kid. He had always been a studious, kind-hearted young man. He was the role-model cousin, the apple of everyone's eye, with his kind demeanor and his piercing intelligence.

As he began medical school, his time was more limited with us. I remember sneaking into his room to pester him as he concentrated on his studies. I was dismissed as the disruptive, younger cousin. I admired his strong work ethic and his ability to buckle down.

In a scoping review on physician suicide, presented earlier this year at the annual meeting of the Society of General Internal Medicine, my colleagues and I analyzed 347 articles. Risk factors that may increase a physician's propensity toward suicide have been identified. Although the data on physician suicide are lacking and more research is needed, we do know that mental health disorders are associated with suicide in the general population and that physician suicide is also associated with axis I disorders, including depression. We also know that more advocacy, research, and policy efforts are needed to create a better system that is safe and just for physicians in order to prevent physician suicide.

As the division chief of hospital medicine at my institution, I have pushed to bring attention to wellness for residents and other clinicians. My research team and I have also been active in the American College of Physicians resolution process. We crafted a resolution with primary sponsorship by the Council of Early Career Physicians addressing transparency and community learning about physician suicide.

My cousin had certainly mastered the art of putting your head down and getting to work as he pursued becoming a pediatrician. As his studies progressed, his personal life also seemed to move forward, on the surface. By the second year of his residency, he had an arranged marriage with another physician. All seemed to be going well until we received the news that he had taken his life while on call. As a 15-year-old, the news was awful, although I could not grasp the full gravity of the situation. But throughout my life, as I lost colleagues and friends in the same manner, I would always reflect back on my cousin. The pain of hearing such news never became easier, and I refused to accept this as a norm for people in my profession.

Also bothersome was the huge amount of shame and guilt and secrecy associated with delivering the news in each case. There were immediate instructions to not share or discuss any related information, to proceed with the workday and move on. It seemed that the identities of the individuals were hidden rather than celebrated. This type of protocol shrouded in secrecy created additional layers of pain for all involved.

By the last year of my residency, I had weathered some harsh storms on the path to becoming a doctor while also enjoying some beautiful moments that confirmed my dedication and love for the profession. However, nothing could have prepared me for the news I got just five months before graduation. My friend and colleague, whom I had worked beside, laughed with, and shared stressful moments with during residency, had died by suicide.

The truth is, these losses will never sit well with me. I will never forget each beautiful life, the laughter shared and the positive impact of each person. I am upset, I am angry, I am hurt, and I feel there is a lack of empathy, humanity, and compassion for our own healers. However, I am inspired to action, advocacy, and research because I refuse to accept the situation as it is.

There is policy reform needed. To address the current gaps in research, policies, and prevention programs, my colleagues and I propose creation of a mandatory reporting system where the loss of physician lives can be tracked and measured. Collecting accurate information can help guide prevention. With accurate information, we can be moved to action, creating better policies and prevention efforts. Please email or if you would like to partner with us.