I'm writing this diary because the other day I wrote a comment in a diary here and was shocked by the intensity of what I posted. (It wasn't rude or anything, I copied it below the fold.) Then today I read the Op-Ed that's listed below and the two seemed to fit together.
For what it's worth, surviving a suicide is something no one should ever experience.
The overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000.[1
These statistics are old. It is very difficult to get an acurate number, because most studies get "cause of death" from death certificates. They are known to markedly under report suicides.
Female physicians appear to be especially vulnerable. Suicide rates for women physicians are approximately four times that of women in the general population.[1,9] The rates for male and female physicians are roughly equal, whereas women in the general population are much less likely than men to complete suicide.
here is the link
With the above statistics in mind, I opened my email this morning to find this Op-Ed piece excerpted in a mass emailing. The Op-Ed was in yesterday's Baltimore Sun by "Dr. Claire Panosian Dunavan... a professor of medicine at the David Geffen School of Medicine at UCLA."
Dr. Dunavan's Op-Ed piece in the Baltimore Sun
She wrote:
The truth is, medical doctors are more likely to commit suicide than any other professional group. But facing this fact remains largely taboo. Fear of stigma is one reason broken healers often hide or self-treat their pain (with substances legal and not). Fear of repercussion from hospitals and licensing boards is another.
Dr. Dunavan begins the Op-Ed talking about a co-resident of her's many years ago who committed suicide during their residency. She then goes on to talk about a PBS documentary that was done on the subject that tried to soften it a bit and talk about some of the preventive measures that have been put in place.
Dr. Dunavan then writes:
One stark omission from the PBS show, however, is the contribution of external stressors to modern-day medical despair. Yes, brain biochemistry fuels major depression, but what about burnout from day-in, day-out exposure to death and suffering - or paperwork and bureaucracy - or waste and maldistribution in American health care - or sheer exhaustion?
I think I can add to this. The other day a commenter on a diary made a passing comment about how doctors see 5 or 6 patients an hour and therefore are making lots of money from medicare.
As I said above, my response was a little more forceful than it should have been, but here it is (un-edited):
At $300 per hour, with the requirement of seeing
six patients per hour, how many hours will your doctor have to work to pay $80,000 in malpractice insurance before any taxable income? Let alone the salary for the nurse and the receptionist?
Why do you think the doctor has to see 6 patients an hour? Do you think the doctor wants to do that? Do you think that is easy or fun? or good medicine?
Since we we're talking "medicare office visits," I used the $80,000 insurance cost as a marginal number (depending on specialty.) A surgeon would pay much higher insurance and might be paid $400 by medicare for a 3 hour procedure.
Most MDs leave medical school with close to $200,000 worth of debt - some more. If you pay them $50 per office visit and force them to see 5 or 6 patients an hour how long do you think you will have smart people going into medicine?
If I sound bitter, please understand, you are reading me correctly.
I was a little shocked later by my own tone and it was clear no one wanted to touch this issue.
We talk a lot about reforming healthcare (which desperately needs to be done) but most people don't really know how this system has been limping along. The people who pay for a lot of this are healthcare professionals who just help some people for free (or partially for free) because people need help. Now there are some things that can't be done for free - like surgery, because I believe it would be illegal and each person is limited by their own time and personality; but whatever pathetic, limping care exists in this country when it is not paid by patients (who can't afford it) or companies (who just don't want to pay) or the government (well...) is subsidized by Doctors and other healthcare professionals.
No matter how little they are paid by medicare or medicaid, doctors will never go on strike. It's not in the culture. I realize that doctors run hospitals and I realize hospital costs are incredible. I also know for every insane operating room fee, there is factored in patients treated for free, for whom the hospital knows it will never be paid. Some hospitals are kinder, some are worse - like people everywhere.
(There are hospitals where pharmaceutical company reps. skulk through the halls trying to be cheerful to anyone who will acknowledge them, knowing they are pariahs, but trying to hang on.)
Until recently, the medical profession has been predicated on a culture of being tough. "Suck it up and take care of the patient" has been the motto - at times to the detriment of both patient and doctor. The government and the insurance companies have been fine with this system - a healthcare system subsidized by healthcare professionals.
Dr. Dunavan went on in her OP-ED to discuss how medicine is changing:
"Where have all the doctors gone?" wrote the former dean of Harvard Medical School in a recent editorial in The Boston Globe in which he decried the flow of newly minted doctors into lucrative, lifestyle-oriented specialties as opposed to hard-core essentials - for example, family medicine and general surgery.
Doctors go into Dermatology because they don't have to stay up all night on call (after the first few years.) They don't have incredible malpractice fees. They can make people feel better about themselves, and they can save some lives including their own. They can have a marriage. Divorce rates are highest among surgeons.
Back to the Op-ed:
Today, evidence of physician dissatisfaction runs the gamut from severe depression to strategic expediency in choosing a specialty, practicing "concierge medicine" or refusing health insurance altogether. Perhaps these latter trends - which hurt the public far more than 300 to 400 doctor suicides a year - will finally focus attention on new ways of restoring health to a struggling profession. Mood elevators and talk therapy may help, but they are not the only answer.
I know that doctors are often at the brunt of criticism about the healthcare profession. Doctors in general have terrible public relations through the media. The media has fostered a view that everyone is entitled to get well and if they don't get well it's the doctor's fault. Maybe in the light of the Op-Ed, doctors feel that way too.
I heard somewhere that in ancient Peru the Incas held their doctors responsible so that if a patient died they executed the doctor. I have also heard the reverse version, where the doctor was killed if the patient got better (even though this makes less sense); either way, the amazing thing about the medical profession is, even then, amongst the Incas, whichever law was true, people were still willing to be doctors.