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Physician Suicide Prevention: A courageous conversation
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The most recent statistics show as many as 400 reported deaths by suicide of physicians in just one year - and that was before the pandemic. In this special episode, Hartford HealthCare’s Steve Coates explores the topic of wellness amongst healthcare workers during an extraordinary time. Steve’s guests are:
Dr. John Santopietro, Physician-in-Chief at the Hartford HealthCare Behavioral Health Network
Dr. Faiqa Cheema, Director of Transplant Infectious & Assistant Director of General Infectious Disease at Hartford Hospital
Dr. Listy Thomas, an Emergency Medicine Specialist, at St. Vincent’s Medical Center
National Suicide Prevention Lifeline
If you or someone you know needs someone to reach out to call 800.273.8255, The National Suicide Prevention Lifeline at 800.273.TALK (8255), or 911 immediately.
Hartford HealthCare's Behavioral Health Network is a national leader in the Zero Suicide Initiative.
300 to 400 recorded deaths by suicide of physicians. That's like basically pick a medical school. That's the whole medical school, you know, going under as if it were an airliner falling out of the sky.
SPEAKER_01The first three months I remember going 12 hours because I just didn't have time to eat and I didn't even have time to use a rush, which as you can imagine was hard and difficult.
SPEAKER_02We feel like the physician healed ISO. We should be able to manage it. We should be able to deal with it on our own. And so those are some of the reasons why physicians don't reach out for help.
SPEAKER_00Welcome to more life. We often cover topics of wellness for our patients, but what about the well-being of those who work so hard to heal us? The most recent statistics show three to four hundred reported deaths by suicide of physicians in one year. In this special episode of Hartford Healthcare's estate coach explores the topic of wellness amongst healthcare workers during an extraordinary time. Our guests are Dr. John Santo Pietro, physician-in-chief at the Hartford Healthcare Behavioral Health Network, Dr. Feika Tima, Director of Transplant Infectious Disease, and Assistant Director of General Infectious Disease at Hartford Hospital. And Dr. Listie Thomas, an emergency medicine specialist at St. Vincent's Medical Center in Bridgeport. Here's Steve Coates.
SPEAKER_03We're more than 18 months into the pandemic now. We've seen the rise of the Delta variants and restrictions have returned. This day-to-day uncertainty and that loss of control has got to be extremely difficult, and maybe that's an understatement. How can you maintain balance and prevent yourself from burning out physically and mentally?
SPEAKER_01It's been tough. What in addition has been very tough for us as infectious disease experts is that lately everyone thinks they're the expert on the most up-to-date medical information, which has uh perpetuated a lot of misinformation, causing the public to embrace it and leading them to make decisions that have not been in the best interest, resulting in loss of lives, which we feel as the medical experts is completely preventable. Having to watch that retrospectively and continuing to see that misinformation on the rise has been very exhausting. I think it's come to the point where, you know, I try to do as best as I can devote my free time to educating the community, uh, connecting with them, uh, making sure they have access to the right information. And for me, it's been really hard to stay on top of it, but also it's been hard for me to see everybody around me sometimes in the community negate all the information and the hard work we're trying to do to keep the most current information accessible to everyone.
SPEAKER_03So dealing with misinformation, maybe even some reluctance from patients in the community is probably something you're not used to dealing with as a provider. How can you manage that?
SPEAKER_01Yeah, infectious disease specialists. I went into this specialty specifically because I like problem solving. It's kind of what we do every day. But this has kind of been an added workload. Um, for me, it's been work in progress. Uh, I try to stay focused on my why and why I chose to do medicine. Truthfully, there have been some days where it's been hard where I spend around 15 minutes in the work parking lot just kind of refocusing on what my day will look like and why I'm here today and what I need to do to stay grounded in achieving those goals. So I look at it as a day-by-day thing. When I think about it in a broader sense, it seems very overwhelming for me, even at an emotional level, um, because I feel like I'm being pulled in 10 different directions. Uh the other thing I do is just I focus on my basic. I need to make sure I'm working out, getting some exercise, I'm eating food, I'm staying hydrated, and I'm making time to go use the restroom. In the first three months, I remember going 12 hours because I just didn't have time to eat and I didn't even have time to use the restroom, which was, which, as you can imagine, was was hard and difficult.
SPEAKER_03This podcast will air for the first time on September 17th, which is National Physician Suicide Awareness Day. And I'll have to be completely honest with you, I did not realize this was an issue, but it's a major one. 300 to 400 deaths a year by suicide for physicians. And John, I turn to you. This is before the pandemic, and with this feeling of hopelessness and lack of control and constant change, are you expecting those numbers to rise?
SPEAKER_04First of all, it's great to have this podcast, Steve. So I thank you and the organization. And one answer, I mean, I thought FICA did a great job, and there's probably 50 ways to answer the question of how do we deal with it and move forward. One answer that I have is we create and protect space like this to talk about it with each other. Because if we don't, it's the relationships that I think are real are gonna make the difference. And yeah, those are the numbers, Steve. I mean, 300 to 400 recorded, I mean, recorded, you know, deaths by suicide of physicians. That's like basically pick a medical school, that's the whole medical school going, you know, going under as if it were an airliner falling out of the sky. And the rate is basically twice the rate of death by suicide in the in in the country in the average sort of population, which I think you know there's lots of theories about, but you could boil it down to to stress is is one thing. And uh also when we talk about burnout, we talk about moral injury, which is you know, when people are organized in their life to do something, let's say, for good, and and then they have to deal with things, the the ground rules changing on them. And I think one of the things that's been difficult about the the pandemic is again to Pika's point, and this is not just docs, but the whole healthcare workforce goes in every day to really make a difference, including helping people with COVID, and then have to see whether it's on social media or the news or their friends, you know, that they're you know not doing uh what docs would want them to do to stay safe in terms of the vaccine, in terms of masking. And that's a particular kind of injury. To to answer your question, Steve, though, we don't have any data to know whether let's say the rate of suicide has increased, you know, during the uh or since the pandemic takes a while to get that data. But I think every effort we're making, like we're doing here during these weeks to raise awareness and have discussions, is absolutely essential.
SPEAKER_03Listy, I turn to you as an emergency medicine physician. ED doctors, maybe more so than any, are faced with constant change and uncertainty. Is there something about doctors in general that they simply won't ask for help when they're struggling? Maybe it's, hey, I'm a doctor, these are tough times, I can't show any weakness.
SPEAKER_02Uh sure. I think uh there are a fair number of what we call maladaptive behaviors that I think people going into medicine, being indoctrinated into medicine in residency, are just prone to, right? We're we are taught that we can't urinate during a shift, right? Because there's too many other needs that are greater than our own, right? We're taught that we have to be perfect, we have to be present um even when we're sick, right? So there's a lot of these behaviors that I think are the norm that is part of one of the reasons that if you start showing any signs of weakness or start showing any signs of like not being able to manage all of it, that it becomes something that you you might be at risk for not being able to seem like you can do your job as well as everyone else who you're working with. And so those are some of the reasons why physicians don't reach out for help. We feel like the physician healed I self. We should be able to manage it, we should be able to deal with it on our own. No one really understands what we go through. Um, even you know, the levels of moral distress that um John and Faika talked about, in addition to you know, the excessive workloads during a pandemic, the lack of control, as ER docs, we're faced with uncertainty every day. I walk into a shift, I have no idea what's gonna happen. But the uncertainty of COVID, in addition to basic things that we would expect our community to do, like wear masks and get vaccines, are not met. It's just, you know, it would be this equivalent to without COVID, you know, seeing car accidents after car accident with people not wearing their seatbelt, right? It took a while to educate the community that seatbelts are important. Um, and it prevented deaths and, you know, improved mortality in motor vehicle collisions, but we still have to get there as a community with COVID. And uh we're we're kind of faced in between that.
SPEAKER_03And we keep talking about this common theme, which is change and uncertainty, which after the pandemic will continue for physicians, for anybody working on the front line. I guess the question then is how do you manage that?
SPEAKER_04Yeah, it's a really good point, Steve. And you know, as a behavioral health person, I I would just make the you know a point about stress, which is that I mean, basically we're talking about stress. Stress is an important part of life. You cannot have life without stress, and you can't grow without stress, but it's very diff different if you're if the stress in your life is predictable, comes in moderate doses, you have a certain amount of control over it, and it's time limited, in which case you develop resilience, basically, as opposed to if the stress is unpredictable, um, extreme, prolonged. And to your point, if there's uncertainty, then um that becomes uh a problem. Human beings don't like uncertainty. I mean, and actually, especially healthcare workers, and especially docs, we like uh uh mastery is the word for it. Like when you learn how to tie your shoes, you know, that feeling of uh like we've been hearing, you know, uh I'm a problem solver, you know. So it's something I think very much at play here, Steve, in terms of thinking about, you know, what is the kind of stress that people are uh dealing with and how do we metabolize it. I mean, the good thing is we're talking, I'm I'm realizing, sure, there's you know, we're still in the midst of the pandemic, but um, you know, we've had vaccines and the the risk at work, the feeling that you're going in and and are putting yourself at at risk is I think in general kind of lessened. And it's there's a feeling of of hope I feel as I walk around and talk with people and uh that things are not as bad as they were and getting better, so that helps. But uh yeah, uncertainty is a really good word to throw in here, Steve.
SPEAKER_03FICA, you've been a powerful voice during the pandemic, especially on social media where you've really shown this amazingly humane take on the pandemic, the good and the bad. Someone who's listening might say, Man, how is FICA able to keep it together? I you know, listening to the podcast, we we we understand you do have your struggles as well, but what is your strategy? How do you handle the stress?
SPEAKER_01Um, John and I have talked about it previously. Uh, I think for me, the thing that has really changed the way I view myself and the way I view life around me is by understanding that I need to embrace my own humanity, which includes embracing my own vulnerabilities and understanding what my limits are and giving voice to what my struggles are and realizing that when I share my struggles, I'm making a connection with somebody else and then creating that bridge of empathy. Um, and as physicians, sometimes, especially during a pandemic, we've been doing such busy work and physical work and mental work that we forget to really stop and ask the person next to us, hey, do you need a helping hand today? Or how are you doing today? Or I see that you look distressed and worried. I'm here for you. Uh, I think making that connection of I see you, uh, I know that this is tough. I feel the same way. Having that recognition with another person is a big part of the healing process. And I think for me, I've been able to stay present in that with my work colleagues, uh, especially uh I work with severely immunocompromised patients. So the stress level is much more when you're working with them and making sure they're staying safe in a pandemic. And I'm very fortunate that I have team members who have been looking out for me and I have family who's been supportive. Uh, and I've also learned over time through the process of therapy, which is uh which has been transformational for me, to ask for help, to recognize the signals when I need help and to vocalize the need for help.
SPEAKER_03In speaking with so many people who work in healthcare on the front lines during the pandemic, one thing that I've heard, a kind of a theme, is that it's easier to connect with people that are in the same situation that we are that are working at the hospital. Some people are having the difficulty transitioning home and managing that balance. Is that has that been difficult?
SPEAKER_02I think for me, that was probably the biggest piece of COVID that um might you know be a stressor that we didn't anticipate. You know, when you think about mass casualty disaster preparedness, I think that loss of community, that isolation, that being in healthcare, especially on the front lines, created during the pandemic was really um hard because it made us lose our normal coping mechanisms, right? I would be able to go out and have dinner with some friends, talk about what happened. We'd be able to congregate in physician spaces, healthcare spaces, but those wound up being the actual danger spots, right? And I wound up potentially being a vector, right? And I think those pieces of the pandemic where you lost your sense of community in the isolation, I think that we all felt um throughout COVID, but especially as healthcare workers, that was um a major contributor to burnout as well. It still exists. I don't think it's we're not anywhere near done being vaccinated. I just remember like that sense of like empowerment that getting the vaccine. And then actually, like the first thing I did was schedule a dinner date with some other people who were vaccinated in my healthcare community. And I think that was just such a wonderful way to reconnect. Um, and so the vaccine offers us that.
SPEAKER_03And as we're winding down today, just your advice for anyone out there listening who might be struggling.
SPEAKER_04Well, I would say, you know, first of all, definitely to know there is help. It really works. And um, having you know been involved in this from a mental health standpoint and just a well-being standpoint, dealing with lots of folks, I think docs in particular, all healthcare workers, we're not trained to look for the signals within ourselves, you know, and don't wait till they get so bad that you're you're really suffering before reaching out. Reaching out can just be reaching out to a friend or reaching out to a family member or or reaching out, you know, to your primary care doc, or there's all kinds of anonymous national hotlines now, and and vice versa, reaching out to somebody if you're worried about them. I think there have been many times people look each other in the eye and have a sense, hmm, I wonder if something's going on here. And is that person gonna, are you gonna make a connection and reach out or or not? And we would definitely recommend that you do reach out because health is definitely here.
SPEAKER_02Uh I think the the most important thing is to know that you're not alone, that whatever you're feeling, probably the person next to you is feeling, whether they're, you know, your your team of nurses and medical assistants, they might be feeling it more than you or your physician colleagues, and that there is normalcy in knowing that this is something that other people are experiencing too. And if that's the case, then it probably isn't something individualized, but more systemic and process-driven that might need to change. And that in thinking of it in those ways, like what can the institution do? What can my work environment do? What can the department do to help this situation that you know might be very, very trivial to someone else's eyes, but is causing me as I work, you know, a great deal of harm, right? Um, harm that I might take with me, home, harm that might uh be, you know, translated to the next patient I encounter, right? So I think just making having space to kind of think about not just reactionary, but preventative measures that you can employ for yourself as well as for your work environment to preserve patient safety and safety for ourselves. I like to think of taking care of mental health or being cognizant of mental health almost like brushing your teeth. Like it's something that we need to do. We need to do and be aware of every day, because without that, I think it's so easy for the mind to give a million excuses for why you are feeling a certain way or why you know you're you're responding in a certain way.
SPEAKER_01Um, you know, we have to remember that as humans, we judge others harshly, but what we judge ourselves even more harshly. And as physicians, we set ourselves, set really high standards for ourselves. Uh, and when we struggle and have uh setbacks, we tend to just do that in silence and with, you know, in a sense of isolation. My advice to everyone is that we're all suffering. Uh, we've been suffering even before the COVID pandemic came about. Uh, I think it's important to understand that, you know, when we share our struggles or give our struggles a voice, it opens a dialogue and creates a very meaningful connection and it helps you realize that you're not alone, that you're not the only one going through this, uh, that you have people or community who are here for you, who will be there to support you. And it's important to remember that we are all worthy and we all belong, and we've worked hard to belong here. Uh, and we need to remember that we just shouldn't give that up due to a profound sense of shame that we feel. And, you know, to Listy's point, I think we need to raise the bar about how we rethink mental health illness uh in the healthcare workers, especially physicians. We need to rethink how we challenge and support each other. And there's still so much work uh that we need to do. And um, as John has always said, this leadership on this really, really matters and will make a big difference in how we approach it and make uh changes.
SPEAKER_03I thank you all for being here today and facilitating, helping to facilitate this important conversation. And also thank you for everything you've done for our patients, for our colleagues, for the community throughout the pandemic and beyond. Thank you.
SPEAKER_00Thank you. If you or a colleague is in need of support, help is out there. Please reach out, check the notes in this episode for important local and national resources. And share this episode with healthcare professionals, colleagues, friends, and family to help us raise awareness. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to more life.