UK HealthCast: Dr. Christopher Doty on raising awareness about physician suicide

UK HealthCast is a podcast series featuring interviews with UK HealthCare experts on a variety of health-related topics, from how to recognize stroke symptoms to what patients need to know about clinical trials and more.

In recognition of National Physician Suicide Awareness Day, this week’s HealthCast features Christopher I. Doty, MD, an emergency physician at UK HealthCare. In order to raise awareness about physician suicide, Dr. Doty explains the widespread issue of physician suicide and how to combat the issue.

Listen to the full podcast at the bottom of the page.

Physician suicide isn't often top-of-mind when we think of our doctors, but just how prevalent is this issue? 

Well, I think that's part of the problem: we really don't know how common this issue is, and even physicians don't really know how common it is. I had been in academic medicine for 15 years before I really looked into this. 

There was an article…that came out in the year 2000. The data showed that almost 400 doctors a year were dying by suicide. Now, that data only looked at 28 states and it didn't look at some of the most populous states. So, this number that floats around and was quoted in the New York Times a couple of years ago is underestimated. 

So getting more into it, why is this such a widespread issue? Are there factors inherent to modern medicine that contribute to it?

I believe so. There is some literature to show that that the practice of modern medicine may be separating the physician from the patient. We have electronic medical records, which are necessary with today's complex practice environments, and we spend more time on the medical records and less time at the bedside. Some literature has shown that the doctor-patient relationship is one of the things that's helping the resiliency of the physician. It's one of the things the physician uses to see that he or she is having impact and to drive satisfaction in their career. One of the other things that's happening is we have a culture within medicine and, you know, it's not healthy. The culture is, ‘don't be weak.’ The culture is, ‘don't ask for help.’ There has been some science, some literature that has looked at this and physicians are very unlikely to disclose that they are feeling inadequate or depressed or suicidal. And the more depressed they are, the less likely they are to disclose, and the less likely they are to seek help. So, we've created a culture where you can't ask for help — or at least it's not normal to do that. And the more you need help, the less likely you are to get it, which is terrifying because people are suffering in silence, afraid to ask for help. 

I can only imagine how COVID-19 is making this issue worse. Can you tell us more about that intersection? 

It's been devastating to healthcare workers. And, obviously, I come at this from a physician standpoint, but I think you could say the same thing about nurses and respiratory techs and other staff that are working with patients at the bedside. There are a ton of ancillary services that help everything work in a hospital. COVID has done a couple of things. One, it has atomized people, right? We are physically, socially and emotionally distant from other people —and that's on purpose. I mean, that's what the science has told us to do, that distancing is a good thing. So, we don't meet as often in groups, whether that be in the clinical area or outside of it. I have a wife and kids and I go home and I spend time with them, but I don't really go out with my friends much anymore. 

One of the things that's really tearing healthcare workers apart right now is the moral injury that's happening. We see patients that come in, they're terribly ill and we immediately separate them from their family. Not because we're trying to be mean, but because we have to quarantine and do infection control, mitigate the risk to other patients and their family. So, when you're sick with COVID … it's a lonely place to be. You're in the room. We try to minimize the number of times that we go into that room on purpose so that we can protect our staff. The last thing that I think the general public is not thinking about is that healthcare workers are doing all that they can to protect themselves and their families and their coworkers. And, quite frankly, not everyone in the public is. And that burns out healthcare workers when they feel like they're doing the best that they can and exposing themselves and potentially their family, and we don't feel like the public is doing everything that they can do by getting vaccinated and wearing masks and social distancing.

So what steps can be taken right now to help combat this issue? And what larger measures should be looked into in order to find solutions long-term?

I think that one of the things that physicians and academic healthcare can do right now … is to focus on this and talk about it, to try to provide real-time resources for people to use, to have counseling that is confidential. So, if I'm feeling particularly down or depressed, there's a place that I can go and I can talk to somebody and it's not likely to get back to my coworkers, my residents, my boss, or somewhere else in the healthcare system. So, saying, ‘Well, you know, the department of psychiatry is happy to talk to you;’ Well, that's not always a safe space. So, creating places for people to go that are confidential and what I'll call off-book or off-insurance is helpful. I don't want a mental health diagnosis on my chart at the place where I work, and I think a lot of people feel that way. 

That's something we can do today. We can begin to normalize the conversation around the everyday stresses of our practice. And that's not something for the administrators or the academic medical centers to do. That's something that we have to do as providers, as nurses, as doctors, as advanced practice providers or residents, medical students, respiratory techs. We need to be able to talk to each other and count on each other.