In this episode of the MDedge Psychcast, Sidney Zisook, MD, gives a Masterclass lecture on physician suicide and Dr. RK talks about what can be spoken into existence. 

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Show NotesBy Jacqueline Posada, MD

Introduction

• Suicide in general population increased by 30% since 1999. The suicide rate was 14 people in every 100,000 up from 10.5 people per 100,000 in 1999.
• 400 physicians die per year. However, there is not great data collection about profession-specific suicide
• Suicide is the leading cause of death in male residents and the 2nd leading cause of death in female residents
• This represents a serious loss of the medical profession as well as the thousands of patients who lose their physician as well 

 

Risks factors for physician suicide  

Psychological:

• Physicians tend be contentious, perfectionistic, and compulsive. They are able to cope with delayed gratification, and this may lead to a false sense of ability to cope with all obstacles, without failures.
• Medicine presents physicians with many obstacles such as the deaths of our patients and human frailty. Human imperfection and physician failures are juxtaposed against these traits listed above

Historical and genetic risk factors:

• Past suicide attempt and presence of mood disorder
• Untreated depression is an especially high risk for physicians as they may leave their mental illness untreated due to stigma
• As of 2017, 32 of 48 state licensing boards continue to question doctors about their mental health history.
• There is increased risk of suicide with the presence of the long arm version of the serotonin transporter gene and history of childhood trauma

Workplace risk factors:

• Physicians identify electronic medical records (EMR) and increased documentation demands as contributing to burnout and less job satisfaction
• EMR means that doctors feel like they spend more time with records than face to face with patients. With EMR there is less eye contact and direct connection with patients so it’s hard to foster relationships
• Physicians feel the stress of increased use of technology and connectivity via cell phones and the need to “keep up” 

 

Change in culture

• As a profession we are starting to talk about physician suicide; acknowledgment of the issue can lead to change.
• ACGME and other workplaces are starting to integrate physician wellness into curriculums and culture.

References: 

• NCHS Data Brief No. 330. 2018 Nov.“Suicide mortality in the United States, 1999-2017”
• Yaghmour, NA et al. Acad Med. 2017 Jul. 92(7):976-83.“Causes of death of residents in ACGME-accredited programs 2000 through 2014” Implications for the learning environment”
• Babbott S et al. J Am Med Inform Assoc. 2014 Feb;21(e1):e100-61. Electronic medical records and physician stress in primary care: Results from the MEMO Study”
• Gold KJ et al.Gen Hosp Psychiatry. 2013 Jan-Feb;35(1):45-9. “Details on suicide among U.S. physicians: Data from the National Violent Death Reporting System”
• ACGME Symposium on Physician Well-Being