This document discusses doctor suicide and provides strategies for prevention. It begins with introductions of the speakers, Dr. Louise and Dr. Walton. Statistics are then presented showing doctors have high rates of suicide, with female doctors at even greater risk. Common issues contributing to suicide include depression, substance abuse, stress from long work hours and demands of the job. The document recommends hospitals and medical practices implement wellness committees, confidential support programs, and policies to promote healthy work-life balance and easier access to mental health support to help reduce suicide rates among physicians.
2. ABOUT DR. LOUISE
▸ Clinician-Interventionist- Award Winner
▸ Educator- Speaker- Trainer
▸ Author, Falling Up!A Memoir of Renewal, Amazon Press
▸ Author- The Clinicians Guide to Addiction Intervention-Routledge in Press
▸ Widow-Wife-Mother-Grandmother
▸ SoulCycler-Adventurer
▸ email -DrStanger@allaboutinterventions.com
▸ www.allaboutinterventions.com-
▸ 619-507-1699
3. ABOUT DR. WALTON
KUDOS AND THANK YOU
▸ Lauren Walton MD, ASAM, APA
▸ President Los Angeles American
Society of Suicide and
Prevention
▸ Head of Addiction Medicine
Kaiser-Downey, Ca
▸ “You inspire me daily with your
goodness”LAS
4. OBJECTIVES
▸ Describe and Discuss Depression, Stress and Anxiety in the Medical
Community
▸ State statistics as it relates to physicians and suicicide including the
“July’ Effect
▸ Explain the correlation between depression and addiction as it
manifests itself in this population
▸ Demonstrate the efficacy of a robust bi0-psycho-social and questions
▸ Recommend strategies within medical practices and hospitals to
reduce risk
5. WHY DO YOU VISIT YOUR DOCTOR??
WHAT DO YOU THINK ABOUT?
▸ You are going because :
▸ You need a check up
▸ Something Is bothering
▸ You expect an exam, your vitals
checked , sample of blood, tests
run
▸ But do you ever think about what’s
going on with your doctor?
6.
7. DID YOU KNOW ?
▸ More then 920,000 Americans lose
their doctors to suicide each year
▸ Approximately 400 doctors
commit suicide each year
▸ Physicians are more then twice
likely to commit suicide then non-
physicians
▸ Female physicians three times
more likely then their male
counterpart to complete
8. STATISTICS
DID YOU KNOW ?
▸ Female completion rate is higher then
male physicians and exceeds general
population by 4 times the rate
▸ After accidents suicide is the most
common form of death amongst
medical students
▸ Common psychiatric diagnoses are
depression, anxiety , bipolar disease
and other untreated mental illness
▸ Substance misuse and abuse
▸ Also easy access to lethal means
9. ▸ In every population suicide is the
result of untreated or inadequately
treated depression
▸ Depression is as common amongst
physicians as the general
population-12%
▸ More common in residents 15%
▸ This is a global phenomena _Finland,
Norway, Australia, Singapore, China ,
Taiwan, SirLanka , Australia etc .
U.S .LOSES THE EQUIVALENT OF ONE SMALL MEDICAL SCHOOL TO SUICIDE
EACH YEAR OR ONE LARGE MEDICAL SCHOOL CLASS
DID YOU KNOW?
10.
11. PHYSICIAN BURNOUT RATES- MAYO CLINIC PROCEEDINGS
MALASH BURNOUT INVENTORY
▸ Emergency Medicine
▸ Family Medicine
▸ General Pediatrics
▸ Urology
▸ Orthopedic Surgery
▸ Physical Medicine & Rehabilitation
▸ Pathology
▸ Radiation
▸ General Surgery Subspecialties
12.
13. A CONFLUENCE OF ISSUES
▸ Educational Demand
▸ Extended Workdays
▸ Increasing Computerization Of Practice
▸ Chronic Stress
▸ Lack of Institutional Support
▸ Income not High Enough
▸ Feeling Like a Cog in a wheel
▸ Too Many Difficult Patients
14. CONFLUENCE OF ISSUES
▸ Lack of Institutional Support
▸ Availability of Addictive Substances
▸ “Conspiracy of Silence”
▸ Underreporting when a Physician is in Trouble
▸ A Spiderweb of Silence
▸ Perfectionism
▸ Family Issues
▸ Stigma
15.
16.
17.
18. MEDICAL SCHOOL CULTURE-“HAZING ,
BULLYING, & NAME CALLING THAT
RESULTS IN “OCCUPATIONAL
DEPRESSION & POORER HEALTH CARE”
Pamela Wible MD ,”Why Doctors Kill Themselves”
19. AMERICAN FOUNDATION SUICIDE PREVENTION
▸ DRIVERS OF BURNOUT :
▸ WORKLOAD INEFFICIENCY
▸ LACK OF AUTONOMY
▸ LACK OF MEANING IN
WORK
▸ WORK-HOME CONFLICT
20. “THERE IS A STRANGE
MACHISMO …DRS LIKE ME,FEEL
PRESSURE TO PROJECT
INTELLECTUAL PROWESS…OUR
EXPECTATIONS SKYROCKET AS
IF THE CONFERRAL OF A
DEGREE WERE AN
ENCHANTMENT OF
INFALLIBILITY .. LITTLE
CHANGES , APART FROM OUR
LEGAL ABILITY TO WRITE A
PRESCRIPTION
Pranay Sinah MD, NY Times
21. UNPACKING DEPRESSION IN RESIDENTS DOCTORS
▸ Underreported-Underrecognized &
Untreated :
▸ Drs may be reluctant to seek treatment
▸ Have no time to seek treatment because of
grueling work weeks
▸ Easy access to prescription drugs
▸ Fearful of stigma
▸ Relational Issues
▸ Doctors if they do seek treatment get VIP
treatment feeding into Narcisstic
tendencies
▸ Prevalence of depression higher in residents then general population
22. ASSESSMENT QUESTIONS
BIO-PSYCH0
▸ Is their Family History MH ?
▸ Is there FH of Suicide?
▸ Has there been previous episode of
depression?
▸ Is there FH process disorder or
addiction?
▸ FH- sudden death, abuse, multiple
moves, et?
▸ Does Dr have hx. of substance misuse?
23. MORE QUESTIONS
▸ Past experience with prescription & non
prescription drugs ?
▸ Been treated for any disease per ASAM
2011 Criteria for addiction
▸ Any treatment for anxiety or insomnia ?
▸ Any Learning difficulties?
▸ Current Relationships
▸ What are views on getting and seeking
help? Self & Families
▸ Cultural and Religious view on MH,
Association, Suicide etc
24. RATES OF DEPRESSION -BRIGHT AND KAHN MAYO CLINIC
PREDICTORS OF DEPRESSION
▸ Relational Difficulties withdrs, staff
or parents
▸ Lack of Sleep
▸ Making Mistakes
▸ Loneliness
▸ 24 hour responsibility
▸ Self-Criticism
32. IN HOSPITALS AND PRIVATE PRACTICE
POLICIES & PRACTICES HR & WELL BEING
COMMITTEES
▸ HR Policies on Substance Misuse ,
Depression, Anxiety and Action
▸ Review of Work Hours
▸ Education & Resources about
Impairments common to medical
community
▸ Self-Referral Processes for Help
▸ Confidential Referral Process
33. GOAL OF WORKPLACE WELLNESS
▸ Healthy Behaviors are promoted,
encouraged and Supported
▸ Employees have easy access to help
them make better life style choices
▸ Employees have opportunity to
practice healthy lifestyle behaviors
▸ organizational Programs must ensure
that leadership, policies , practices &
the physical environment are
supportive & conducive to healthy
behavior changes
34.
35.
36.
37. CENTER FOR PROFESSIONAL RECOVERY
WELL BEING COMMITTEES
▸ Evaluation of complaints or
allegations to determine validity
▸ Monitoring of professional to protect
safety of patients until rehabilitation is
completed
▸ Proper reporting to appropriate
leadership when patient safety might
be compromised
▸ Initiating proper protocols if impaired
physician fails to complete prescribe
rehabilitation program
38. CENTE FOR PROFESSIONAL PROGRAMS
DIVERSION PROGRAMS-PHP
▸ Referral of Individual by patient, partner or
family
Evaluation of initial referral
▸ Notification is given to MD with option to
enter treatment & monitoring
▸ Comprehensive assessment
▸ Referral to Appropriate Treatment center
▸ Referral to Counselor
▸ AfterCare that includes ongoing counseling,
drug testing etc
▸ Involvement of Family in Treatment process
39.
40. CONTINUING CARE PHP
▸ After Care Programming -PHP-IOP
▸ Long Term Monitoring- Including Counseling and Drug
Testing
▸ Family , Friends & Medical Team Counseling
▸ Routine Reports To Medical Board
▸ Reassessments and Evaluations
▸ Lifestyle Coaching & Trigger (Relapse) Prevention
▸ Finding Joy
41.
42.
43.
44. RESOURCES
DR. LOUISE STANGER
▸ Doctor Suicide The Elephant in the Middle
of The Examining Room
https://www.huffingtonpost.com/entry/
doctor-suicide-the-elephant-in-the-
examining-
room_us_596d04c4e4b05561da5a5992
▸ All About Interventions
www.allaboutinterventions.com
▸ Thrive Global Louise
https://www.thriveglobal.com/authors/
3258-louise-stanger-ed-d-lcsw-cdwf-cip-
roger-porter
▸ Huffington Post https://
www.huffingtonpost.com/author/louise-
stanger-edd-lcsw-bri-ii-cip
45.
46.
47. RESOURCES
▸ Wellness Committee Guide
http://www.shawhankins.com/wp-content/uploads/2014/11/
Wellness-Committee-Guide-2-1.pdf
▸ Creating A WorkPlace Wellness Committee A Toolkit for Employers
https://msdh.ms.gov/msdhsite/_static/resources/6663.pdf
▸ Wellness Tool Kit
https://www.cigna.com/assets/docs/wht/wellness-committee-
toolkit.pdf
▸ Center for Professional Recovery
https://www.centerforprofessionalrecovery.com/?
gclid=EAIaIQobChMI5rb9gL3J2gIVi8pkCh2nagIkEAAYASAAEgJH
MvD_BwE
48. RESOURCES
▸ Physician Suicide Letters, Pamela Wible
https://www.amazon.com/Physician-Suicide-Letters-Answered-
Pamela/dp/0985710322
▸ Match Day 2017
https://www.statnews.com/2017/03/17/match-day-residency-
international/
▸ Match dayhttp://www.nrmp.org/main-residency-match-data/
▸ Headed to the Hospital? Beware the July Effect
https://health.usnews.com/health-news/patient-advice/articles/
2014/07/21/headed-to-the-hospital-beware-the-july-effect
49. RESOURCES
▸ The Tennis Partner, Abraham Verghese
https://www.amazon.com/Tennis-Partner-Abraham-Verghese/dp/0062116398
▸ Hidden Epidemic Of Doctor Suicide
https://www.fastcompany.com/3056015/the-hidden-epidemic-of-doctor-suicides
▸ Why Do Doctors Commit Suicide ? Pranay
sinhahttps://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit-
suicide.html?_r=0
▸ Kahn on Depression
https://www.khanacademy.org/test-prep/mcat/behavior/psychological-disorders/v/
depression-and-major-depressive-disorder
▸ https://www.mdedge.com/psychiatry/article/64274/depression/depression-and-
suicide-among-physicians
50. RESOURCES
▸ American Foundation for Suicide Preventionhttps://
afsp.org/our-work/education/healthcare-professional-
burnout-depression-suicide-prevention/
51. Resources for healthcare professionals and medical educators
Accreditation Council for Graduate Medical Education (ACGME) Resources – Resources to share with programs, institutions, residents,
and fellows that promote a culture of physician well-being and provide support in the case of burnout, depression, or suicide.
Breaking the Culture of Silence on Physician Suicide – A sharable graphic and information about physician suicide from the National
Academy of Medicine.
Creating a Safety Net: Preventing Physician Suicide – An article by AFSP Chief Medical Officer Christine Moutier, M.D., for the
Association of American Medical Colleges’ AAMC News.
Reducing the Stigma: Faculty Speak Out About Suicide Rates Among Medical Students, Physicians – An article by Dana Cook
Grossman, for the Association of American Medical Colleges’ AAMC News.
Preventing Suicide in Physicians, Residents and Medical Students (Video) – Dr. Christine Moutier addresses the American Psychiatric
Association, May 20, 2016.
Symposium on Physician Well-Being – A symposium held on November 17-18, 2015 by The Accreditation Council for Graduate Medical
Education (ACGME).
Leaders in Academic Medicine Address Physician Well-being and Resilience – A news release from the Association of American Medical
Colleges.
Preventing Physician Distress and Suicide – Tools for identifying at-risk physicians and facilitating access to care from the American
Medical Association.
Make the Difference: Preventing Medical Trainee Suicide (Video) – A 4-minute PSA from Mayo Clinic and the American Foundation for
Suicide Prevention that explains how everyone can help prevent suicide by being alert for the signs of depression and escaping stress
and how to be most helpful. This film can be used in medical school physician wellness, humanism and professionalism curricula.
Featured at top of this page.
Why Physicians Die by Suicide – Dr. Michael Myers guides readers through the variety of factors that contribute to physician suicide. He
then makes practical, across-the-board recommendations in an effort to prevent this tragedy, arriving at the encouraging conclusion that
everyone has a role to play in saving a doctor’s life.
Struggling in Silence: Physician Depression and Suicide (DVD) – An award-winning, one-hour documentary from AFSP, that sheds light
on the topic of physician mental health and suicide prevention, featured on public television stations nationwide. This film can be used in
medical school physician wellness, humanism and professionalism curricula.
52. Make the Difference: Preventing Medical Trainee Suicide (Video) – A 4-minute PSA from Mayo Clinic and the American Foundation for
Suicide Prevention that explains how everyone can help prevent suicide by being alert for the signs of depression and escaping stress and
how to be most helpful. This film can be used in medical school physician wellness, humanism and professionalism curricula. Featured at
top of this page.
Why Physicians Die by Suicide – Dr. Michael Myers guides readers through the variety of factors that contribute to physician suicide. He
then makes practical, across-the-board recommendations in an effort to prevent this tragedy, arriving at the encouraging conclusion that
everyone has a role to play in saving a doctor’s life.
Struggling in Silence: Physician Depression and Suicide (DVD) – An award-winning, one-hour documentary from AFSP, that sheds light on
the topic of physician mental health and suicide prevention, featured on public television stations nationwide. This film can be used in
medical school physician wellness, humanism and professionalism curricula.
Collateral Damage: The Impact of Patient Suicide on the Physician, a DVD film of several physicians speaking about their experience of
patient loss to suicide, and group discussion. Psychiatrists featured in this educational film include Drs. Glen Gabbard, Sidney Zisook, and
Jim Lomax. This resource can be used to facilitate an educational session for physicians, psychologists, residents or other trainees. Please
contact education@afsp.org to request the DVD.
American Medical Student Association – The oldest and largest independent association of physicians-in-training in the United States.
Suicide Risk in Physicians – Emergency Physician Dr. Mel Herbert produces a popular podcast called EMRAP for healthcare professionals in
Emergency Medicine. In this 26-minute podcast he speaks with Dr. Christine Moutier about suicide risk and prevention for physicians and
trainees.
Nurse Suicide: Breaking the Silence – The National Academy of Medicine released a landmark paper in 2018 as a call for action regarding
nurse suicide.
53. Prevention programs
Interactive Screening Program (ISP) – AFSP’s signature intervention program, the ISP is an online tool used by medical schools across the
country as a method of connecting to students, residents and faculty, and encouraging them to utilize available mental health services before
crises emerge. ISP is listed as a Best Practice for Suicide Prevention and is an integral part of a comprehensive suicide prevention and
mental health promotion strategy.1, 2, 3, 4
Web-Based Cognitive Behavioral Therapy for Medical Trainees (Guille, C., et al., JAMA Psychiatry, 2015)
Intervention to Promote Physician Well-being (West, C.P., et al. JAMA Intern Med., 2014)
Stanford’s Burnout Prevention Approach (Schulte, B., Washington Post, 2015)