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by Internet Medical Society

This article was adapted from a lecture presented at the 2014 American Academy of Family Physicians Assembly held in Washington, DC, in October. 

Why Did You Go to Medical School?

I'm a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I'm unhappy with the direction of my profession (and I'm not the only one). Then I get this crazy idea: What if I ask for help? Not from the profession that wounded me. Just from random people on the street. So I hold a town meeting and ask patients to help me—design an ideal medical clinic. I promise to do whatever they want as long as it's basically legal. That's going out on a limb.

I'm a go-out-on-a-limb kind of doctor. In med school I protest the dog labs, and I'm sent to the office of the Dean—who diagnoses me with "Bambi Syndrome." In residency, I'm caught giving patients recipes for kale salad. I'm sent to the office, reprimanded for not getting approval from the patient education committee. I'm 46 and I'm still handing out unapproved kale salad recipes—now I'm taking on physician suicide.

My therapist calls me the "Dr Kevorkian of Medical Taboos." Before my wedding, my dad actually made my husband promise to keep me out of jail. "Always pushing the limits," Mom says, "always going out on a limb." Today I invite you to join me.

Why do we do what we do? To save lives. Why did you go to medical school? Seriously. Why spend your 20s studying while all of your friends are at parties? To make a difference—to save lives. What is your calling? They recruited me for pediatrics, but I kept asking, why? Why this kid's got asthma? Why the parents smoke? Why they live next to an incinerator? I'm a family doc because I can't stop asking why. So why are you reading this? Maybe you lost a colleague to suicide, a friend in med school. Maybe you are struggling now. Maybe (like me) you just want to know why our colleagues die by suicide at twice the rate of their patients. And you want to save lives.

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Suicide. I hate everything about that word. I hate even pronouncing it. Have you thought much about it? What do you know about suicide?

Virtually all animals kill, intra- and inter-species. Only Homo sapiens deliberately self-kills. It must have something to do with that forbidden fruit in the Garden of Eden.

All cultures and religions experience suicide; most abhor it and try to prevent it. A few celebrate suicide, especially when it is used as a method of warfare. Many religions hold "life after death" as a basic tenet; believers often say that the deceased has "gone to a better place," while doing anything possible to prevent or delay dying. Some religions believe in sin, and in forgiveness of sin, if sought by the sinner. Such religions hold suicide as unforgivable, because it is so final.

As a clinical toxicologist, I have encountered attempted suicide by drugs innumerable times. As a forensic pathologist in three countries, I have investigated successful suicides innumerable times. In Sweden, suicide was recognized and the manner of death accepted. In England, such was the stigma that the forensic pathologist could not label a death a "suicide" unless there was a suicide note. In Coroner's Court, I would have to call obvious suicides, by New York standards, "death by misadventure."

I have known many people who have killed themselves. As a patient, I had a surgeon who killed himself shortly after operating on me. Physician suicide is a big deal in the United States. As a profession, in American medicine, we lose the equivalent of two or more full graduating classes of physicians each year to death by their own hands.

I belong, or have belonged, to a large number of medical organizations. To my recollection, none have seemed to care enough about physician suicide to try to do anything about it. Why is that?

Many physicians believe that suicide is abnormal and a result of psychopathology (such as depression), and that depression can and should be treated, in large part to prevent suicide. Many others believe that the decision to end one's life can be a thoroughly rational act. I agree with both points of view. But I consider suicide to be deeply sad for everyone, and if it is a physician suicide, a particular waste for society. I consider suicide to be abnormal, a behavioral aberration, even a disease. You, I, we are all at risk.

Take care of your mental health. Be kind and helpful, not mean and spiteful, to your fellow physicians. And that includes medical students, residents, and fellows. You know who the bullying and abusive physicians are. Confront them, in a redemptive manner, but don't let them get away with it.

We all owe a great debt to an outstanding and unusual family physician from Oregon, Dr Pam Wible. She has been forcefully and repeatedly writing and speaking about physician suicide and what can be done about it. Do an Internet search for Dr Pam Wible. Pay close attention. Act on her suggestions. The life you save may be that of your colleague, or even your own.

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