When Burnout Leads to Suicide
Kendra Campbell -- A few months ago, I received a phone call that I’ll never forget. An obviously distressed friend and fellow med student was on the line. In between the sounds of sobbing, she related to me the most unbelievable truth. Another friend and fellow medical student was dead. He had committed suicide the night before. I nearly dropped my phone. I was, of course, in complete shock and didn’t understand what was happening. Time has passed since then, but the shock has still not faded. I can’t believe he’s gone.
Unfortunately, my experience is not all that unique. Many studies have documented the fact that medical students have higher rates of suicide than that of the general population. And guess what profession has the highest rate of suicide? You guessed it, physicians.
We have known for many years that medical students and physicians have higher rates of suicide. Studies have shown that psychiatrists, anesthesiologists, and emergency physicians, in particular, have the highest of all physician suicide rates. It’s been posited that this is because these fields involve incredibly high levels of stress, and access to drugs of abuse. For years, researchers have documented that depression combined with drug or alcohol addiction contributes to the likelihood that someone will commit suicide. And perhaps not surprisingly, the rates of depression and drug or alcohol abuse have also been found to be high amongst medical students and physicians.
A study recently published in the Annals of Internal Medicine has started to shine some much needed light on one of the variables involved with med student suicide. The authors found that one factor, in particular, was linked to the probability of a med student committing suicide. And guess what that factor was? Burnout. Should we be surprised?
I wrote an article last month that expressed my own feelings of burnout, and questioned whether or not torturing medical students was a valid method of education. I’ve since had even more time to reflect on these thoughts. I’ve also spent a good deal of time thinking about the death of my friend, and the factors that might have contributed to him making the choice he did.
Can I say that the pressures of medical school absolutely led to his death? Definitely not. But do I believe that the unbelievable amount of stress and pressure to do well in school contributed to his choice? Yes, I think I do.
Just today, I sat in an open discussion at my hospital, led by a senior physician. One student spoke up and complained about the fact that some residents and attendings had been very mean to him at times. He also mentioned the long hours, and the sometimes belittling treatment that med students receive. The physician's response? That’s just the way it is. That’s what he himself had to deal with to make it through medical school many years ago. And he said that when that student eventually becomes a resident or attending physician, he will also treat medical students the same way.
So, are we to believe that this is all simply a fact of life? Is this just the way it has to be? Is the stress simply inevitable? Are the resultant deaths also simply inevitable? Must this cycle of abuse continue, similar to the cycle of abuse in families?
I’m sorry, but I refuse to accept this as truth.
I agree with you on this one. It is totally absurd to be mean to others just because somebody else was mean to you. If only those people learned to sublimate instead of displace their frustrations/anger. What surprises me is why isn't there someone who is willing to break the cycle? If it is the tradition to be mean generation after generation then isn't this one big stressed system?
Posted by: workaholic888 | Nov 5, 2008 3:42:56 PM
when we went to med school, we already know that it is going to be hard and stressful...mentally,physically and emotionally...and now that we are in that field,we should know that what we should do is to have an outlet for release... be it a 30 mins or an hour of yoga,a play of basketball,a swim in the pool, or merely a 30 mins of reading a pocketbook surely wont hurt :-)...and just because u have been treated harshly,doesn't mean u have to do it to others too...i guess ur senior physician wasn't telling u that u have to be harsh too in the future, i guess he was just referring to the fact that a lot of student who eventually becomes a resident or attending physician will also treat medical students the same way, which is really true enough...but it doesnt mean also that u cant make a difference,right? :-)
Posted by: ninette_umpa | Nov 5, 2008 4:15:11 PM
With what that senior physician said......has he not heard of breaking the vicious cycle? What a horrible attitude (but one that is encountered far too much). That is one of the really good things about being in a rural hospital as I am, a lot of the doctors don't have this attitude (surgeons, physicians and ED docs, not just the GPs who are usually the pioneers of sensible working conditions)
Posted by: dragonfly | Nov 5, 2008 5:46:09 PM
i think it comes with the pride of having "been there and done that." it's a big boost to the ego. i hear a lot of stories about the difficulties a doctor (or even an intern) has gone through to the present state s/he is in. between the lines it says,"i've gone through this much, and i have overcome, so i must be good. if you haven't been through the same thing, you probably aren't as good as i am." this actually makes me think that the medical profession is one big fraternity/sorority, where the initiation stage is being a medical student. im just glad that there also doctors i know who have achieved much and do not look down on others who are just starting on their journey. these are the role models i would like to imitate in the future.
Posted by: mocb,md | Nov 6, 2008 9:58:15 PM
Hi, I have been a regular reader of this blog since 2 years now, but I am commenting for the first time. I remember similar posts in 2007 and 2006 too, by Kendra Campbell, Anthony Rudine, etc.
Things are quite similar in India too, but there is no forum to share such experiences. I think there is a long long to way to go before things start changing. I saw 3 suicides during my medical education.
Reading 'the differential' reminds me of my own past experiences and helps me keep things in perspective too. I truly believe that those who forget history are condemned to repeat it.
I read this article today: http://www.nytimes.com/2008/11/07/health/chen11-06.htm
Perhaps some people are thinking of change. Thinking is the first step to realizing it.
Posted by: Nomad | Nov 7, 2008 8:29:37 AM
Sure we can continue the cycle of abuse. Since that is a valid reason for abusing people according to some physicians then that ought to reduce the amount of people in jail because they are beating the heck out of their children or spouses because they were abused as children. Why not absolve ourselves of any responsibility to treat another human well, humanely? That simply reeks of effort. Let's continue the cycle - that makes way more sense.
Posted by: Connie | Nov 9, 2008 9:29:40 PM
Every single psychological research publication agrees on one universal fact about abuse: those who were abused tend to abuse others. Why did the older ones get abused in the first place? Well, because people before did it to them. And then before them and it keeps going into the past. No one ever seemed to question or to bother to stop the cycle.
At some point, someone needs to step in and say, "Enough, the cycle of abuse passed down from generation to generation stops here and now." In any other industry, it would be okay for someone to stand up and make a statement. Such labor practices would be subject to huge lawsuits and wouldn't even be remotely tolerated. Unfortunately, medical students, residents, and doctors tend to follow the rule of looking down on those who try to change or stand up for themselves. Instead of considering it bravery to stand up for one's rights and dignities, it's considered weakness.
What will really have to change is doctors' mentalities and the medical school curriculum.
Posted by: Savi | Nov 11, 2008 3:59:01 PM
Sorry to hear about your friend. Having been through similar circumstances, I wish you +++++Vibes+++++ and quick healing.
Posted by: DL | Nov 11, 2008 4:12:08 PM
I will be starting medical school in two months at the ripe old age of 39. I have experienced a lot in these almost four decades including military service. I know exactly what I can expect in terms of physical and mental stress with regards to the academics. I also know that at my age, I have earned respect which I freely give to those who have also earned it. Perhaps I am setting myself up for a rude awakening, but I guarantee that I will not tolerate, condone nor accept any verbal abuse from any senior or junior physicians. At the same token, I plan NOT to be THAT physician that all the interns shrink away from in horror as I walk the corridors of my institution. All those who will come in contact with me....consider the vicious cycle of abuse....broken.
Posted by: Natasha | Nov 11, 2008 4:51:38 PM
This is such a great blog, I have been reading it since I started as a first year in August. I chose my school based entirely on student recommendations about how awesome the school was, flexible, helpful faculty, the whole nine yards. The faculty are not kind, helpful, nothing. Sometimes they are not even civil. That fact, the daily experiencing of it has stressed me out more than I can say. I would like to see empirical data (we are supposed to be medical scientists right?) that proves that degradation, humiliation, sky high pressure, and endless mental demands actually make good doctors. I used to believe that medical school would make me a better person, now I am just trying to survive. I too believe that this is not how it should be.
Posted by: Marie | Nov 11, 2008 6:03:26 PM
i will start rotations for 3rd year next fall, and i wonder if i will have to take anti-depressants and anti-anxiety pills to be able to handle the stress of pimping and harsh words by drs... talking down to a student doesnt motivate or encourage them or give them confidence
Posted by: jesse | Nov 11, 2008 10:11:20 PM
hey! this is how i was feeling that day when i txted u lol...now i feel better...i was way too stressed out. After mssgin u i fell asleep b/c i was too tired ...anyways...i was just reading this article which i got in my mail,,,,so true yaar lol
Posted by: tania chakraborty | Nov 12, 2008 4:06:37 AM
I have been reading your blog for a long time. This too is the first time for me to participate.
It is a sad fact, but true....those who abuse have a history of being abused. I tried to break the circle while working as a resident when I had interns being abused and believe me it makes a huge difference. Not only to yourself but to the juniors. There are times you want to lash out just because you can and someone did to you but its a strength of character when you dont. It seriously feels better.
As Ghandi said once " An eye for an eye, the world would be blind"
Posted by: nujhat | Nov 12, 2008 11:29:11 AM
It's a sad irony that the professionals who are charged with saving lives take their own lives most, isn't it?
Posted by: Bob | Nov 12, 2008 1:10:53 PM
It's incredible the amount of pressure every and each of us has to deal with every single day. But what bothers me the most is that most of the time, the stress comes from other physicians (interns, residents assistants) and not the patients. Why do we have to poke into each other's eyes? I mean, knowing how stressful medicine could get, shouldn't be logic to back down a little bit with our own colleagues? We need to be healthy, both physical as well as mentally, to really help other people, the main reason most of us got into this mess
Posted by: EMB | Nov 12, 2008 3:13:17 PM
I've always been curious to know why are med students/ doctors worked like dogs beyond their capacity. I mean, why do u want them to work a straight 36 hours, or all those nite shifts with so little sleep...don't we all know that doctors need to be fresh and alert all the time, thus allowing them sufficient time to rest is the best thing to do?
I mean i still don't get it as to why doctors are tortured like that...and the worse part, they're tortured by their own fellow collegues to say the least...ppl who should understand them! Ironical!
Posted by: Anna | Nov 12, 2008 3:55:58 PM
First let me congratulate you on your blog, it's very interesting and i enjoyed browsing it's articles.
Secondly, the fact that Medical students are more likely to commit suicides is sadly true even here in Libya.. why, 2 students committed suicide last year, and that's alot.. I mean they were both still so young, pups in 2nd year, and they didn't see nearly enough stress, disappointments and humiliation, like what we saw in the last years.. I'm in fifth year, and i'm struggling with my studying.. i've had examiners laugh at my face, tell me that i'll never pass. i've endured long nights of grueling studying, only sleeping one hour a night on super cram sessions. I've been lonely, sick and dog tired for years. If there's anything I've learned from this school, it's how to take it like a man. I am capable of smiling at Interns or residents who choose to mock me for fun, and not letting it get to me. I learned to deal with failure and disappointment, and to get back up again. It hurts me that these kids found no way out except death.. it's very sad that they had no one to teach them how to shrug the little things off, be it cruel doctors, sneaky interns, or envious colleagues. I find the medical society to be the ugliest "cloak and dagger" pit. With a lot of slander, unjustified pompousness, and general hard feelings between everyone and everyone else. I like to sit back and watch, chuckling and waiting patiently for my graduation, after which i will find a nice place to do my PhD in research, with more benchwork than bickering with snotty interns...
Keep up the good work, please continue to echo the feelings of all sensible people in the medical profession
Posted by: Tamim F. | Nov 12, 2008 4:06:20 PM
After completing my first clinical year, I'm a tad worried - not because I've been treated badly in the hospital, rather that I haven't. The clinicians I've had teaching me have for the most part been understanding ranging to just avoidant, whereas some of my peers are in tears after their first day on the rotation. From all these stories, I think I'd rather be put through hell now, rather than be lulled into a false sense of security and have me ego battered where I don't expect it. These people can influence the outlook of an entire day/week with just one sentence, I guess what I'm saying here is, there ARE people out there who are compassionate, and they inspire you to do the same when you're in the same position.
Posted by: Dinusha | Nov 12, 2008 4:28:47 PM
Well... I can understand... i've been in the care of a psychiatrist ever since i started my clinical years at med school... yes... because after failing a mock test for which i was well prepared, i ruminated on suicide intensely for a week...besides i couldn't bear the passivity of some attendings as regards teaching and the horrible verbal abuse in front of colleagues, other Doctors and patients... and i'm on medication now... plus psychotherapy...
Posted by: cider | Nov 12, 2008 5:30:40 PM
There is definitely hope to end the cycle of abuse. Many frats and sororities are now bound by law in many states to not engage in hazing, which is what we go through, why can't a legal approach be taken in this circumstance as well? I can easily think of cases of psychological abuse occurring in hospitals, I'm sure you can too. If tradition-entrenched, wealthy frats can be forced to play nice, hospital/IPA employees can be as well. This isn't to say there is NO hazing going on anywhere at all, but ask anyone involved in the Greek system and they will say it's much better than it was 10 years ago.
Posted by: Jennifer | Nov 12, 2008 5:50:16 PM
It's bullying. Pure and simple. What worries me the most is the dilemma of standing up for myself despite being at the bottom of the food chain versus jeopardizing my grades.
Posted by: CMR | Nov 12, 2008 6:22:16 PM
From my point of view, the senior physician you mentioned may be trying to show some sort of personal pride in having successfully gotten through hardcore medical education.
Conservative, resistant to better change and probably a bit of arrogance in there somewhere.
Posted by: Ray | Nov 12, 2008 7:51:52 PM
Most everyone in my class is on antidepressants.
At the same time I find myself just as stressed on my outpatient psych rotation as I did during my overly independent surgery rotation. They both have something in common. Im a Physician Assistant student and I seem to have hit a run of clinical sites who do not really "like our kind of schooling". Hmmm..... why both precepting if were so beneath you?
Posted by: meg | Nov 12, 2008 9:06:19 PM
As an undergrad, I was hazed. Fraternities too have a tradition of passing along demeaning traditions. My fraternity pledgeship my was riddled with quizzing or "pimping", second-class citizenship treatment by members, over-programming, and unrealistic and unattainable expectations. Years later, as a respected leader in the chapter, I built a vision for replacing hazing with positive traditions. For example, instead of pimping, open discussions were held. I would not tolerate members treating ANYONE as a lesser person. "Experience and knowledge does not grant you power over others, only power over yourself", I often preached.
I wonder if traditions of transferred tension and show-of-power are worth all the trouble and undesired consequences. Are there are more productive and less wasteful methods of training our future physicians?
Posted by: Doug S | Nov 12, 2008 11:10:55 PM
That is why I always treat everybody in the profession with respect, be it medical students or consultants or even the healthcare assistants who take vital parameters for patients.
I always believe that someone who wants to help you will point it out properly to you so that you learn from it, not belittle or insult you. Those in the latter category do not deserve any attention at all.
And I will not hesitate to protect my integrity and honour should anyone cross the line of respect against me. That is a story for another day.
Posted by: Kj Wong | Nov 13, 2008 9:39:21 AM
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