Physician Suicide Awareness Day: Where are the patients?
I’m a patient and consumer advocate who has dedicated my career to improving the health care system. I’ve encountered the good, the bad, and the ugly of our health care system, but I was still not prepared for what I heard in April 2016 when I attended my first national medical association conference and listened to a resident share his experience with severe depression. He spoke about a never-ending list of demands and constantly being overwhelmed. He talked about loneliness and isolation. With an openness that will forever be imprinted in my mind’s eye, he talked about his past thoughts of suicide.
Tears streamed down my face as I listened to his story.
I continued to be stunned as luncheon speakers cited staggering statistics about the anguish hiding in large swaths of the medical community. I left the conference wondering how I could have been so unaware of this epidemic. I have many friends and colleagues who are clinicians. How could I not know how much pain our healers were experiencing?
As it turns out, I was not the only patient in the dark about the pain many clinicians experience and the degree to which the epidemic of physician and clinician “burnout” is negatively impacting the profession. When I returned home, I immediately dialed family, friends, and colleagues all of whom were universally unaware of even the term “physician burnout,” an epidemic apparently hiding in plain sight.
Here are some facts everyone should know:
Each year, more than 1 million Americans lose their doctors to suicide.Physicians struggle with one of the highest suicide rates among any profession.A doctor dies by suicide every day in the United States.
These truths beg the question: “How is this possible, and why isn’t anyone doing anything?”
In the last two years, I’ve watched as medical societies launch well-being taskforces (I participate in one) and medical systems convene conferences focused entirely on physician well-being. These efforts represent significant progress and yet today — on the second annual National Physician Suicide Awareness Day (NPSA) — I’m left wondering: “Are these efforts enough and how can patients be part of solutions?”
The “burnout” epidemic remains practically a secret to many outside the profession. I get it. It’s not unusual for subgroups to circle the wagons to hide things they perceive as shameful. And, given the culture of medicine, which requires clinicians to subsume their own needs to focus on their patients, it’s not surprising. But, I’m here to say: It’s shortsighted. The medical community is making a mistake in not making their pain more visible.
In a recent New Yorker article titled “Why Doctors Should Organize” Eric Topol notes that “doctors feel despair about their appalling working conditions and the deteriorating doctor-patient relationship” and asks, “why aren’t doctors standing up for themselves and their patients?” I have a different question: Why aren’t doctors and patients working together to stand up for each other? As a patient advocate, I know how frustrated patients are with the health care system. We’re tired of 15-minute office visits, we want health insurance plans to get out of our exam rooms, and we’re yearning to connect and partner with our health care providers. Sound familiar? From my read of the well-being literature, these frustrations mirror those of health care providers and are, in part, to blame for clinician burnout. This point deserves emphasis and repeating: Patients and providers want the same thing.
So, where’s the disconnect?
Eighteen months ago, I launched a project with my colleagues called The 3rd Conversation, which gives patients and clinicians a chance to sit knee to knee and share their respective experiences in the health care system. In these conversations I’ve watched as clinicians share deep wounds- for example, feeling like a failure when patients don’t get better or when their clinical recommendations are rejected by insurance plans that are based on “cookie-cutter” medicine. Time and again, I’ve witnessed patients respond with empathy and compassion. Likewise, as patients have shared their painful stories of feeling like a number in the health care system and their sense of loss at the inability to build continuous relationships with health care providers, clinicians have offered support and commiseration. Just last week during a 3rd Conversation event, a patient and clincian spontaneously hugged, and the patient shared that the clinician felt like family. They had only met one hour prior. During these conversations, patients and clinicians recognize that they share common goals and have similar needs, and they begin to see that they are potential allies in advocating for a system that better meets those needs.
Let me be clear: I’m not suggesting that clinicians start sharing their personal pain with patients during office visits. In fact, in recent focus groups conducted by the 3rd Conversation, patients couldn’t fathom the statistics shared about clinician depression and suicide and in some cases questioned the numbers. And, yes, they were afraid of what the statistics might mean for their quality of care. But, I’m very concerned, that our healers are trying to change the system on their own, especially if they are still insignificant personal pain. Most importantly, I shudder that their efforts will take too long and result in more clinicians jumping off of hospital roofs to escape their depression. It’s not enough to share the statistics, but patients do understand clinicians’ pain when they hear it from them directly in a facilitated dialogue. And, I’m hard-pressed to believe that if patients truly knew the pain clinicians were in that they wouldn’t be motivated to help.
As a community organizer, I’ve seen first-hand what can be accomplished when a group of passionate and committed individuals work together. There’s no question that there’s strength in numbers. What if instead of trying to change the system alone, patients and clinicians worked together? It will require clinicians and the medical community to pull back the curtain on their frustrations with the system and on physician depression and suicide, but if history has taught us anything, it is that silence can be lethal. So, my invitation to one and all is that we replace both silence and in-group conversations with a commitment to join a patient-clinician movement to design a system that better meets both of our needs.
Jennifer M. Sweeney is a patient advocate and co-founder, x4-health.