Physician Suicide and the Tyranny of Perfection
by Danielle Ofri
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 )
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