High suicide rates among doctors

Nontraditional Premed Discussion
1

I read this interesting article in Slate today about why suicide rates are so high among doctors.


http://www.slate.com/articles/health_and_s cience/m…


Lots of food for thought in there about making people feel like they’re frauds for years and years, only to then get into practice and face other very real barriers to patient care.


This part really struck me:

  • Quote:
"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."





2

I’d love to see these stats on folks who enter medicine after age 30.


I’d take a guess that the suicide rate among those who enter medicine with real life experiences under their belt, is substantially lower.

3

Interesting thought, Path. I’d venture a guess that you’re right. More life experiences (including more failures, which really teach you so much!), a better ability to weather storms. Also, potentially the opportunity to really think through the decision to enter medicine more thoroughly: the costs, the sacrifices, the ups and downs as well as the benefits. Food for thought.

4

Great point. Part of that is not having worked since 15, for example, to become a doctor, only to not excel right away or all the time at it. Some of the perfection-or-death stereotypes of about traditional pre-meds/med students ring true.

5

Interesting thought, but I’d be worried about our non-traditional peers too.


To use a poker expression, we are far more “all in” than our traditional peers. We will frequently accumulate debts later in life making it much more difficult to pay them off. We frequently have postbac work, which is this side of useless outside of professional school applications. Most of us are on the wrong side of 30 or 40, meaning our “fallback” resumes are getting more irrelevant by the day.


Forgive me if I’m painting a dark picture. I’m not trying to be a spoiler on here, and writing this is as much catharsis for me as it is a response to the article. But, many of us are in this position, and the mental health anguish becomes pretty intense. (The only time I’ve been in a darker place was during a combat tour in Afghanistan.) I have a (mostly) supportive family, a significant other who loves and encourages me and a peer group that dusts me off when I fall. But, despite these blessings in life, I still go to really dark places when it looks like this isn’t going to work out.


So, watch out for our non-trad peers. We put on a tough exterior, but I suspect there is a fragility in us all that we’ve learned to hide better than our traditional counterparts.

6
  • james s Said:
To use a poker expression, we are far more "all in" than our traditional peers.



How so?

  • james s Said:
We will frequently accumulate debts later in life making it much more difficult to pay them off.



Exactly what is it about age that makes debt harder to pay off? Because I just don't see the relationship here.

From what I've observed, it's an individuals money management skills or lack of, that is the biggest influencer here. And because so many premeds in the 35+ age range are not going into medicine to impress others or for the money and go into fields with great need like FP which often have loan repayment programs, I'd say that we have a far EASIER time paying off debt.

  • james s Said:
We frequently have postbac work, which is this side of useless outside of professional school applications.



Doesn't this apply to traditional aged students too?

  • james s Said:
Most of us are on the wrong side of 30 or 40, meaning our "fallback" resumes are getting more irrelevant by the day.



In the last 3 years I turned my almost useless MS/BA degrees in Chemistry, into a FAR more in demand and lucrative career of Bioinformatics while pursuing....... wait for it........, post graduate courses. Put another way, the last Bioinformatics gig I interviewed for had a mid range salary of 90K, the Science gig ~ 50K. Plus, I wouldn't want to be in my 20's 30's again for all the money in the world!

  • james s Said:
Forgive me if I'm painting a dark picture. I'm not trying to be a spoiler on here, and writing this is as much catharsis for me as it is a response to the article.



OPM is about venting but I think it's important to keep things in proper perspective, a significant benefit of being older with more life experiences.

  • james s Said:
But, many of us are in this position, and the mental health anguish becomes pretty intense. (The only time I've been in a darker place was during a combat tour in Afghanistan.) I have a (mostly) supportive family, a significant other who loves and encourages me and a peer group that dusts me off when I fall. But, despite these blessings in life, I still go to really dark places when it looks like this isn't going to work out.



I've heard that love is a battlefield, but premed? Not even close IMHO and I've had my share of disappointing moments as a premed for the last 20+ years.

Might I suggest you read this article:

http://www.nfib.com/article/13-reasons-yo ure-not-a...

Nothing in the world kills a dream like doubting yourself, and even a high GPA, MCAT scores, and fabulous LOR's can't save it if the attitude is "off".

BTW, I'm 1500 miles away from my nearest close support systems, so if you've got that you're ALREADY ahead of the game. But I'm also a STRONG believer in regular "mental checkups" along with my "physical checkups" and I make sure to get them on a REGULAR basis.

Support + REGULAR physical/mental checkups sounds a like a winning strategy for med school admissions to me!
7

My mom and I actually talked about this the other day (I’m living with her right now). My mom and dad met while my mom was finishing her MSN and my dad his MD. My mom told me about both a medical student and a resident she knew of committing suicide during that time. I realize that’s only anecdotal, but when it’s names and faces rather than numbers, that can change your perspective. So yes, I agree that it’s a real problem.


We can argue until we’re blue in the face as to whether OPMs are better suited for the psychological challenges of medical school or not. I think that in general OPMs are, but that it really depends on the person and the situation. That’s just my opinion though.


What I think we are failing to look at is the systemic problems that put ALL medical students at risk for emotional/psychological difficulties, OPM or traditional student. Another opinion of mine is that the environment at many medical schools – cutthroat, competitive, grade-focused – makes things much worse for people who may already be high strung to begin with. One of the reasons I chose Cornell is that it has the opposite environment (or attempts to). It’s Pass/Fail, with a focus on oral/written exams, and less focus on multiple choice. Class rankings are NOT published. The idea is that you’re supposed to work with your fellow students – which is what happens in real life – rather than compete with them for the #1 spot, or for more questions correct on a particular exam. That’s not to say there is no competition. Just that there is an attempt to tone it down a bit. Whether it works remains to be seen. But it was a big selling point for me as I made my medical school decision. I want to work WITH my fellow medical students, not AGAINST them.


I wonder what other OPMers think about how grading systems and the medical school environment impact the mental health of medical students? Just curious …

8
  • terra_incognita Said:
I wonder what other OPMers think about how grading systems and the medical school environment impact the mental health of medical students? Just curious ...



Again, I think OPMs are far less likely to be negatively impacted by this type of grading system due to being more mature (for the most part).

I'd say that strong confidence in my academic studies also plays a significant role, again, the result of having developed good study habits over time.

As I understand it, a number of the top medical schools use P/F grades. And having been on the medical school campuses of a few of them I'd say that despite the P/F grades, the snooty "attitudes" about academics are very much still present. And this "attitude" seems to get's passed down from faculty, IMHO. At the numerous "state" med school campuses I've visited over the years, folks are a LOT more laid back, with DO schools being the most "chilled out".


9

With so much emphasis placed on grades, MCAT scores and focused extra-curricular activities as criteria for admission, it’s no wonder our medical schools are full of stressed-out uber-achievers. Maybe I’m just becoming curmudgeonly, but I swear some of the students I’m coming into contact with lately are the human equivalents of overbred show dogs. They can rattle off biostats and mechanisms of action like nobody’s business, but they can’t connect with a patient to save their lives. God forbid you give them any constructive feedback; they decompensate on the spot.


I have to agree with Path, Terra and others that non-trads ARE better equipped to handle the rigors of medical education. There’s also shorter ramp-up time when non-trads move into residency (my opinion and observation).


My medical school was on a traditional grade system, but class rank was not published so the competition was self-directed. Sadly, I don’t think that’s the case anymore.

10

I am going to approach this from the perspective of what I see at work - every day.


We have raised a society of people who are, across the board, unable to socially function, and unable to cope. They cannot convey their thoughts in writing, much less in speech. Their listening skills, and ability to understand what they hear is HORRIBLE. Yes, they lack basic skills that are necessary for the healthcare profession - the ability to “connect”, the ability to ask the right questions, the ability to synthesize the information given them, the ability to partner with the patient in care, empathy, compassion. MISSING in many fields, not just medicine.


Add to that, parents who have raised children to not see or understand normal life experiences - failure, death, pain, heartache, illness, aging, parenting. Every day I see young parents who know nothing about parenting and stare endlessly at their phone. I see people who have never been to a funeral, or gone through the dying process with a loved one. No one knows how to grieve. I met people who are completely traumatized by cuts, scrapes, falls, bumping their head or thier toe, or simple medical procedures (MRI,Injections)


A generation of people who do not perceive normal parts of life as normal, and who perceive their own emotions as alien.


I do not think it is isolated to the medical profession. I see an epidemic of it in the work I do.


So take one of these people, who cannot grieve, have no empathy, and do not see the cycle of life as normal, and highly educate them, and thrust them into a medical system full of death, pain, and high emotions.


Yes, they get depressed and overwhelmed. And they think there is something terribly wrong with them…spiral on down…throw in overachievement, societal pressure to succeed, and parents who live vicariously through their children…


And the recipe is complete to induce suicidal thinking.


But I am but a mere social scientist, with a background in cultural anthropology.


I might see things differently.

11

Not a social scientist but a theologian by education yet I see the same. I call it the “gospel of ME.” It’s unfortunate how very wrong the self-esteem movement was and how it has devastated the lives of so many. As a people we cannot keep to the middle we’re either on one extreme or the other.