Sunday, October 6, 2013

PHYSICIAN SUICIDE


People say, he took the easy way out. But these callous remarks are thoughtless and without empathy, in my opinion. Creativity, intellect and demanding hard work does sometime exact revenge. And this revenge comes in many forms. It can be tied to alcoholism, drug abuse or down right depression. But then one might ask, “How can someone with such talent, intellect and promise succumb to that?”

                                         

And therein is our story…

When I was a medical student, a taller gentler soul inhabited our classroom. He was gifted, hardworking and driven. He would spend countless days, dissecting muscles and organs to understand human physiology, when all of us were trying to get a shut eye. He spent many hours grating the chemicals to create the aspirin powder, in order to ascertain the whiff of medical drug. “I want to know how?” is what he said one time to his close friend. On the eve of a promising future, we heard that he had put a gun to his head and pulled the trigger. The shivers of fear, discomfort, confusion and internal turmoil spread through the campus. The why was answered as dibs and drabs of information seeped out, he had wanted to top the list of the graduating class. He came in second. Maybe there were “tiger parents” lurking in his midst, we would never know. But society was the poorer for it.

Many years later, while attending to patients in the hospital, I was made aware that a colleague of mine had passed away suddenly. The news blew the wind out of my lungs. He was young, smart and sported an affable smile. He was quick to befriend and equally reaching to put his hand on a troubled shoulder. At his funeral, I learned that he had taken his own life. What had happened? The story follows that he had been troubled with depression from time to time, related to patient care and facing a malpractice suit and a Board of Medical Examiner inquiry, was too much for his constitution.

Fast forward to a recent loss of another colleague, a big, burly, happy-go-lucky kind of a guy, with a beautiful family had decided that a financial loss and the troubles in his medical practice were too much to bear. His patients loved him. The insurers did not. His family adored him. His bankers did not. 

The somewhat older estimates suggest that 28-40 / 100,000 physicians take their lives annually. It roughly translates to about 400. Bring this number into a sharper focus and one finds that this number equates to about 2 average medical college graduates a year. Now bring into focus the total number of practicing U.S. physicians at 850,000, the number is even more significant when you estimate the rate of an average non-physician individual suicide rate is 12.3 / 100,000. So physician suicide rate is almost 3 and ½ times that of the average population. See here ... http://emedicine.medscape.com/article/806779-overview and here ... http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/35959 .

What gives?

Although many have propounded theories to assuage the mind with statements suggesting that it is linked to a high rate of drug abuse and alcoholism. These theories have been laid to rest since the rate of both drug abuse and alcoholism is not any more in the physician community than in the overall population. Others say this is because of depression, the catchall term.

But why?

Maybe, I might suggest that the depression follows a certain path on which physicians are forced to walk on. The patients, nay the society demands the physician be an empathetic, intelligent, all knowing, healer. That he be infallible in his approach to life. That he must constantly be aware of all that is available in medical literature. That no unintentional harm must come from any of his actions and that he must be a model citizen. He must stand the cold and hard scrutiny of a retrospective analysis from a prospective action meted out in the hot cauldron of a manifest disease. Now, that is more than the weight of an Olympian torch to carry for any human being. But most carry these burdens on a daily basis and if they cannot, they retire, leave for adifferent occupation or become academicians, protected by the glare of the florescent lights and the comforts of collectivism. And that maybe okay for them, for it is their choice, but it does show a frustration and subsequent change from the modeled system.

But before you think that this suicidal intent is a male thing, think again, women physicians are four times as likely to go into a state of depression with suicidal ideation. And any person with a grain of intellect will not callously ascribe that to hormonal imbalance or the like. Women, as men, practicing the art and science of medicine are equally bedeviled by the rigors of this profession.

Now add to the burdens of worrying about reimbursements for their hard work to keep the business of medicine afloat.  Add to that a constant meddling bureaucracy of EMRs, SGRs, P4Ps, MOCs and it takes away the patient-physician interaction- the most rewarding aspect of medical care. The whole game changes and instead of a warm and caring physician attending to a patient, we get a community of physicians who following the procedures,  forced upon them, acting as drones following the guidelines commandments of the few, appear un-involved, distant and callous while the larger society deems them to be greedy and disinterested. 

Meanwhile...

The birds eye-view of this societal scene, as it is being played out today is a breach of the very foundation of human to human interaction. This subjugation of the intellect, through the rigors of regulations, requirements, an artificial model of payment structure and other arbitrarily imposed terms and conditions is fast encroaching on a terrible discourse that must follow in the near future. Healthcare is indeed a problem for the entire world. The population is graying in the developed world and the needs of the many cannot be met by the work of a few and that number is dwindling rapidly. But the current method sought out in some Big Data dumps with p-value significance is not the remedy by far. In the US alone where 310 million citizens reside a paltry 1 in 350 physician-patient ratio will change to 1 in 400+ very soon and instead of developing the cadre of physicians, we are bent on destroying the nobility in this once noble profession. 

And, lest you take the low road, let me warn you, IT IS NOT ABOUT MONEY! IT IS ABOUT JOB SATISFACTION (The ability to provide good care and take pride in one’s work)!

Maybe it is time to take the foot off the accelerator on this downhill course that will end up in a tragedy we do not want to see. Maybe we need the “skin in the game” for all participants. Maybe we need to see the impact on the physicians and the overall effect it is about to have on everyone’s life in the very near future.
Physician suicide is just the tip of the larger unmet, unseen debacle that is unfolding before us. Maybe we need to think about the future a few quarters in the future, maybe a few years in the future. Maybe, just maybe, we need to think.

Think…for this is my silent language of grief!


Think!

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