August 06, 2021
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Healio interview
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Abraham does not report any relevant financial information.
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The death of Lorna Breen, MD, FAEP, the New York-Presbyterian Allen Hospital clinician who committed suicide in April 2020, redirected doctor suicide, and resulted in a bill that bears her name.
According to the Dr. Lorna Breen Heroes Foundation’s law aims to “reduce and prevent suicide, burnout, and mental and behavioral health conditions in health professionals.”
A February article in Perspectives in Psychiatric Care reported that 26 health professionals died of suicide during the COVID-19 pandemic.
Amanda Kingston, MD, wrote in an article in Missouri Medicine that there has been an increased suicide rate among doctors for at least 150 years, but that this “silent epidemic” has only recently received significant attention.
A 2019 systematic review and meta-analysis in PLoS One showed that doctors in the US were at higher risk of suicide than anywhere else in the world. Last month, analysis in Mayo Clinic Proceedings of a survey conducted prior to the COVID-19 pandemic found that 1 in 15 U.S. doctors had thought of suicide in the past 12 months. A recent survey by The Physicians Foundation found that 55% of respondents “know a doctor who has either contemplated, attempted or died of suicide in his career.”
“A major effort is needed to improve access to emotional support for physicians, to reduce the stigma associated with seeking help, and to promote self-assessment among medical students, interns and physicians,” write the authors of the policy paper.
ACP has made such an effort. The organization recently published a policy paper entitled “Medical Suicide Prevention and the Ethics and Role of a Healing Community” that states that suicide prevention interventions must be individual, interpersonal, community and societal.
“The medical community is committed to promoting a culture that supports education, screening, and access to mental health care, starting in the earliest stages of medical education,” ACP wrote.
Healio Primary Care interviewed ACP President George M. Abraham, MD, MPH, FACP, FIDSA, Professor of Medicine at the University of Massachusetts Medical School and President Emeritus of the Medical Staff of St. Vincent Hospital in Worchester, Massachusetts to learn more about the policy brief.
Healio Primary Care: What? spurred on the youngest AKP Policy paper to the suicide of a doctor?
Abraham: The ACP has continuously sought ways to improve doctors’ wellbeing and reduce the incidence of doctor suicide. The position paper should keep the subject of doctor suicide in the foreground.
Healio Primary Care: Data suggests that doctor suicide rates have declined over time in several European countries; however, no similar statistically significant decrease has occurred in the United States. Why do you think this is the case?
Abraham: We think there are two reasons for this.
No. 1 refers to different data sources. No. 2, in the United States, and probably even Europe, there is likely some underreporting and stigma of mental health problems, especially among doctors.
Most importantly, we find the pressures to practice medicine in the United States to be extremely stressful in today’s environment. Doctors, especially general practitioners, are frustrated with electronic medical records and keep pace with the workload and demands.
Family doctors are responsible for controlling drug costs, high-end imaging, and testing. You’re also responsible for prior permits and pretty much everything else. Many patients expect and also express frustration with their primary care practitioner if they do not receive immediate results for their condition.
I can’t motivate any of my trainees to go to primary care because everyone thinks it’s one of those sinkholes where they’re overworked and underpaid. Everyone wants to be a sub-specialist.
Healio basic care: Why are doctors so reluctant? seek psychological support ? What is your message to these doctors?
Abraham: Doctors are expected to be people who are never exhausted, never complain about themselves, and are always there for others.
In some states, receiving psychiatric treatment puts medical approval at risk. In a broader sense, one might think that the pursuit of mental health means that your employer may no longer want you in the workplace. So doctors try to cover up their mental health problems as best they can until they break down and can no longer take care of the patients. Doctors need to be able to have open conversations about treating mental illness like any other illness and being able to seek help without feeling intimidated or embarrassed. If we can return to or maintain our wellbeing, we should have fewer and fewer cases of someone feeling so stressed and burned out that they will go to the extreme of suicide.
Patients also need to recognize that everyone is human, whether they are a doctor or not, and that the expectations we have of doctors should be the same as those of all non-doctors.
Healio Primary Care: What Community Level Activities to Improve Physician Wellbeing Have Been Successful?
Abraham: Community groups that focus on wellness and self-care are a good place to start. There are pharmacological options as well, but these community groups should be researched before going this route.
References:
DeCamp M, et al. J. Gen. Intern Med. 2021; doi: 10.1007 / s11606-021-06852-z
Dutheil, F. et al. Plus one. 2019; doi: 10.1371 / journal.pone.0226361.
DrLornaBreen.org. The legislation. https://drlornabreen.org/about-the-legislation/. Accessed August 5, 2021.
Jahan I. et al. Psychiatric care perspective. 2021; doi: 10.1111 / ppc.12739.
Kingston AM. Mo Med. 2020; 117 (5): 426-429.
Shanafelt TD et al. Mayo Clin Proc. 2021; doi: 10.1016 / j.mayocp.2021.01.033.
The medical foundation. Physicians Foundation 2021 Physicians Survey: COVID-19 Impact Issue: One Year Later. https://physiciansfoundation.org/physician-and-patient-surveys/the-physicians-foundation-2021-physician-survey/. Accessed August 5, 2021.
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