I lost a friend and colleague this week to suicide. A talented, compassionate rural physician who was dedicated to working to meet the needs of the community. A physician who thought deeply and considered health from a global perspective. In the time I knew this individual they often challenged my thinking about how we deliver health care in our community, considering the provincial, national and global perspective. Yet somehow the illness of depression led to a dark and final place. And I feel responsible, as do all the physicians who worked with her, because somehow we feel we should have been able to help. We should have noticed more. We should have reached out more often. We should have been able to prevent this.
When a physician ends their life, there is grief and loss and guilt amongst their colleagues. Some of the guilt we assume on a personal level is likely not justified. But some guilt is due to the recognition that we work in a dysfunctional system and have not done as much as we could to change this. Rather than addressing problems, we hide them. We encourage trainees to develop resilience, while perpetuating many aspects of a toxic system. We pay lip service to removing the stigma of mental health for our patients, but are far less compassionate with our peers. Medicine as a career attracts people who are driven, perfectionist, self-reliant and proud. Too often our sense of self-worth is defined by our job. Given that medicine is demanding and sometimes full of tragedy, it is easy to assume the blame for the failings of the system or bad outcomes that we actually have no way of preventing. Our training encourages this exaggerated sense of responsibility. The current medico-legal climate and intense scrutiny from our licensing bodies and health authorities adds an insidious layer of anxiety about the caliber of our work, and the societal trend to always seek someone to blame when things do not go well often targets the physician. Yes, there are systemic failures and medical errors, but these are not the norm. Yet media, and social media in particular, would imply that the system is rampant with bad medicine and deviant doctors. Somehow I doubt anyone is more critical than we are of ourselves when we make a mistake.
Many times we do not treat our colleagues as we should. We are competitive by nature, but my success does not have to equal someone else’s failure. Too often we strive to make ourselves look better by making someone else look incompetent. Criticism is delivered in a humiliating rather than a constructive way. Our working relationships are full of the usual human emotions and we need to recognize and acknowledge that we are subject to the same conditions as everyone else in the human race. I know doctors who ignored personal physical symptoms that would have triggered urgent investigation in a patient, to the point of actually dying from the disease they denied could possibly happen to them. Mental health is even more challenging because we hide it. Deep down many physicians still perceive mental illness as a weakness rather than a disease. Well, guess what? We are just as vulnerable as everyone else, and due to the stresses and nature of our work even more so than the general public. “Physician heal thyself” is terrible advice – we need to look after each other and not be afraid or ashamed to seek help. Only then can we develop the healthy workplaces we all need and deserve.
Why have I shared this story? As long as we continue to hide and not address the issue of physician suicide and mental health it will remain a shameful secret to many. We can try to ignore the situation, but it will eventually happen to someone you care about. It is time to examine the system and speak out. We cannot change what was, but we can change what will be. So I say to my friend – may you find peace and joy and all the blessings of whatever comes after. You will live on in the many lives and hearts you touched. You were loved, and wish you did not have to leave us so soon. We will try to do better.