Three years ago on May 21, I got a call that John had died by suicide. John was always a creator. He wrote music. He was working on a novel when he died. We had three children.
I barely remember the next few days. I do recall that it was hard to get out of my closet. I remember my friends and family coming to visit and taking care of my kids and me. One of the most vivid memories I have is of being angry: Angry that my kids didn’t have the same support that they’d have had if John had died by some other means. There is a great deal of societal ambivalence about memorializing someone who died by suicide. No one sent my kids cards or flowers. The medical school John attended didn’t contact his classmates or us.
Suicide leaves a messy sort of grief and a difficult social support problem. The power of my own humanity floored me in how powerful my reaction was. I was drowning and not sure if I wanted to be saved. I tell people I am a non-example of how to grieve with grace. I had periods of anger punctuated by frustration with my own anger, which I felt was largely impotent. Blaming a system didn’t help bring back what we had lost. For all the analysis, we cannot bring back the ones we lost.
Physician suicide is an issue that is getting increasing attention in the media. The coverage is mixed, with some attention to the burnout that can lead to suicide, but it seems as though medicine is having a hard time diagnosing the problem or understanding the continuum of burnout and how it relates to suicide. A recent review found that physicians have the highest suicide rate of any profession. These numbers may or may not be accurate since suicide reporting can be inaccurate. Data about rates of suicide and burnout are not consistent or robust enough to provide absolute answers.
Three years ago, my children lost their dad. When John died, my children suffered. When physicians are not well, patient care suffers. Perri Klass, MD, wrote about how physician wellness impacted patients in his article “Taking Care of the Physicians.” Physicians who care deeply about patients are at risk for burnout. Klass summed up the cycle of disconnectedness:
“Physicians as a group do pretty well when it comes to the sense of personal accomplishment, but they tend toward emotional exhaustion and a sense of depersonalization, which can breed a cynical and dehumanized attitude toward patients.”
This depersonalization leads to greater medical error and worse patient outcomes. Tools that help physicians be emotionally present and mindful can only go so far; organizational change leads to better outcomes for physicians, families, and patients. Individuals with great social support are more likely to survive and thrive within our imperfect medical system, so solutions have to include community involvement and family collaboration.
The Sharp Index was born out of a place where there are no perfect answers. We talk to medical schools and healthcare systems about physician suicide and how we can use the EHR to help us ameliorate the working conditions of doctors so as to facilitate less stress and more job satisfaction. Endless notation after long shifts in a system, which contravenes everything we know about healing and the importance of doctor-patient connection, will be replaced by creating awareness of how changes can indicate a greater risk of burnout and depression. Humans were built to need each other. Solutions will involve coordinated community support, recreating the feeling of connection of the local physician.
In a complex world, we are losing physicians to suicide and losing patients to physicians who aren’t well. We need to give organizations better tools to visualize what they can do to solve the problem and facilitate connection with physicians. The imperfect stories are the stories that will heal us in the accomplishment-obsessed culture of healthcare. We collect the stories of physician suicide loss at www.mdsuicide.com.
Our legacy is to reduce physician suicide through better data and increased connection. Building a successful workforce means individual anonymous support and organizational transformation. I’m looking forward to allowing physicians and families and patients to have a place for healing and a better place to mourn. Together, we will heal the healers. I cannot bring back John, but we can change things for other physicians, their patients, and their children.
Janae Sharp is a friend of Optimum Healthcare IT and founder of The Sharp Index. We support her, and her mission is to reduce physician suicide and provide meaningful tools to improve provider quality of life.