Physician Suicide and the Tyranny of Perfection

headinhandsby Danielle Ofri
Slate Magazine

Two newly minted doctors—dead within days of each other. Both took their lives leaping off the roofs of institutions of medical learning last month. The raw pain in the medical community is palpable. We physicians involved in medical education feel responsible for these students.

Physician suicide is no surprise: Doctors have the highest suicide rates of any professional group. We know that nearly every day, at least one doctor in the United States chooses to end his or her life. But it devastates us every time.  Especially when these are doctors just setting out in their careers after investing years of their life in preparation, with so much potential to help others and so much time to reap the joys and gratification of medicine.

A painful irony of these two deaths is that they took place the same week as the White Coat Ceremonies that induct first-year medical students into the profession. These ceremonies seek to impress upon these incoming students the solemnity and ethical commitments of a medical career. They also hint at the immense satisfaction that medicine can offer—the opportunity to help others and the ability to use practical tools to do so.

Yet it is clear that a career in medicine also brings on tidal waves of pain, confusion, stress, self-doubt, and fear. The eddies nip at our ankles from our first step into anatomy lab, gathering in force and ferocity over the years of training and practice. During medical school, at least half of students experience burnout, and some 10 percent contemplate suicide.

So much of medicine is a tyranny of perfection. Medical students are asked to absorb an immense body of knowledge. Prima facie, this is a seemingly reasonable request of our doctors-to-be. But the number of facts is larger than any human being can realistically acquire, and  is ever expanding. Yet, we act as though this perfection of knowledge is a realistic possibility.  No wonder nearly every student feels like an imposter during his or her training.

Once in clinical practice, we physicians are faced with a similarly reasonable sounding assignment—take care of your patients. But in reality this means covering all aspects of your patient’s health, following-up on every test result, battling with documentation, navigating insurance company hurdles and administrative mandates. You are exhorted to be cost-effective, time-efficient, patient-centered, and culturally competent. You much be conscious of patient satisfaction and quality indicators. You must avoid liability but not over-order tests. You must document extensively but not keep patients waiting. You must comply with every new administrative regulation and keep up your board certifications. And you must of course achieve those all-important “productivity measures.”

Burnout and stress are that expect doctors to cover every base—internal medicine, family medicine, and emergency medicine.

We’ve been asked for a perfection that is unachievable, yet the system acts as though the expectation is eminently reasonable. It’s no surprise that disillusionment is a prominent feature in the medical landscape today. It’s also no surprise that such burnout is associated with unprofessional behavior and more frequent errors.

To feel that you are falling short, every day, saps the spirit of even the most dedicated of physicians. We feel as though we have been set up to fail. Even when we do manage to preserve the joy of connecting with patients and helping improve lives, the festering stress of trying to achieve the impossible takes its toll—compromised family life, drug and alcohol addictions, depression, and thoughts of suicide.

Medical schools and residency programs have come to realize that it takes more than factual competence to make a good doctor. There is an increasing emphasis on student well-being, and an acknowledgement that stress is more than just a tolerated byproduct of our educational system. We faculty are exhorted to keep our eyes out for the earliest signs of strain so that help can come earlier. We’re also learning to do the same for ourselves and our colleagues. Nevertheless, many struggling students and physicians manage to stay under the radar.

We can’t know the specifics of the inner pain these two young doctors were experiencing, and perhaps their suffering was unrelated to medicine. But we do know about the environment in which we have placed them. We do know the body of research about the health effects of incessant stress.  We do know about the prominence of depression and substance abuse in the medical community.

When trying to help our patients achieve their best health, we would never steer them toward situations associated with  relentless stress. We would never subject them to impossible-to-attain goals that lead to a persistent sense of failure. We would never prescribe anything with side effects of depression, substance abuse and suicide.

Why would we allow this for ourselves or our trainees?
(from Slate Magazine )