Earlier this month, I heard about the suicides of two women from NYU. Andrea Liu, a 26 year old fourth-year medical student, and an unnamed psychiatry resident – both took their lives within days of each other. Andrea was on track to graduate and was months away from starting her radiology residency.
Earlier this year, Mount Sinai St. Luke’s newly minted nephrology attending, Dr. Deelshad Joomun, leapt off of the 515 West 59th St. resident building three days into her new job. This was preceded by two other female suicides at Mount Sinai St. Luke’s Hospital. First-year resident Esha Baichoo and fourth-year medical student Kathryn Stascavage jumped off the very same building in 2016.
And those are just the ones that have been reported by journalists. Another NYC female second-year medical student took her life late last year. I cannot imagine how many more cases have been swept under the rug by New York medical schools and hospitals for fear of bad publicity. How much more can we tolerate before we are ready to confront this issue head on? How is the system that was built upon the oath, Primum non nocere (First do no harm), failing to save the lives of our own community members?
Medscape recently published an article summarizing a systematic literature review presented at the 2018 annual American Psychiatric Association (APA) meeting1 by Dr. Deepika Tanwar (Harlem Hospital Center, NYC). They found that physician suicides occurred 3x more often than in the general population. More alarming was that although female physicians attempted suicide far less than women in the general population, their completion rates far exceeded that of the general population by 2.5-4x, matching that of their male colleagues.
What is driving these female physicians to suicide? The review revealed that the most common diagnoses were “mood disorders, alcoholism, and substance abuse.” Depression appeared to affect an estimated 19.5% of female physicians, while only 12% of male physicians. Medical students and residents reported depression rates up to 15 and 30%, respectively. Dr. Tanwar pointed out one 2016 study2 that showed that 50% of female physicians who self-reported depressive symptoms were reluctant to seek help for fear of stigma. In fact, only 6% of female physicians with diagnosed depression sought formal treatment.
As a NYC medical student, my personal experiences absolutely reflect the realities of the female physician experience. Mental health is still stigmatized, and we are taught to minimize our failures and strive for perfection. Yes, there are counseling services and wellness events in place, but that is the equivalent of putting a band-aid on the gaping wound of a much larger systemic issue. The culture of medicine needs to change. Taking time off for illness, doctor’s appointments, inclement weather, is still heavily frowned upon and often times, nearly impossible. OB-gym residents spend their days delivering babies but cannot find the time to have their own.3 We are expected to spend thankless hours in the hospital with no reprieve, either because our grades (and future) depend on our performance, or because our co-residents depend on us to show up early and stay late because we’re understaffed, or just because we’re supposed to be helping others. Right?
I agree. We should strive for excellence and aim for perfection because patient lives are at stake every day. It is what I would hope for my doctors if I were to be a patient. And the doctrine of always putting patient health and well-being #1 is important, but not if it is at the cost of our own.
Every time something like this happens, we engage in a dialogue about the importance of mental health. But how can we seek counseling or go to more wellness fairs if we are being penalized for our absence at work? Personally, I think the first step is for us to stop ignoring the real systemic issues and start openly engaging in dialogue about policy changes we can make. Better resident hours, standardized maternity leave, protected sick leave, are just a few steps we can take towards a more humane career. After all, how can we heal others if we cannot heal ourselves?
1Guide to the 2018 APA Annual Meeting. (n.d.). Retrieved May 24, 2018, from https://www.psychiatry.org/psychiatrists/meetings/annual-meeting/guide
2Gold KJ, Andrew LB, Goldman EB, Schwenk TL. “I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57 (Link).
3Hariton E, Matthews B, Burns A, Akileswaran C, Berkowitz LR. Pregnancy and parental leave among obstetrics and gynecology residents: results of a nationwide survey of program directors. Am J Obstet Gynecol. 2018 (Link).