As a second year medical student, a member of my medical school class committed suicide. I didn’t know him well, but his death impacted me. Made me ask a lot of questions. Why didn’t I know him better? Had I gotten to know him, could I have made a difference? Who did know him well? Were they surprised? Or did they see it coming? And what brings a young doctor-in-training to a point of such despair?

Estimates are that in America we lose a doctor a day to suicide. That’s a staggering thing-it sounds so much greater in those terms than quoting a statistic (300 to 400 doctors per year). It sounds even worse from the patient’s point of view: each year more than one million Americans lose their doctor to suicide. Medicine is the second most suicidal profession, while dentistry is the third. And it begs the question: why?? As Pam Wible, MD, writes, “It’s the ultimate oxymoron: the barefoot shoemaker, the starving chef, the suicidal doctor.” Why is this happening in American healthcare? Why are our caregivers facing the ultimate failure in self-care?

In some ways, the answer is easy: suicide is almost always the end result of untreated depression, and doctors simply don’t treat their own depression. But underneath this easy explanation lie a multitude of more complicated answers.

Doctors are under mounting pressure to do more and to do it all perfectly. As this opinion piece from STAT News points out:

Much of the chronic distress that physicians experience is due to the culture of medical education and practice, the nature of our work, and stress imposed by the current health care environment. We are supposed to see more patients in less time and provide much more documentation. We work daily with human tragedy, illness, death, and loss. Many of us don’t take time off or debrief after adverse events or patient deaths. Instead, we move on to the next patient. It’s no wonder that more than half of physicians report being burned out.

And, as the pressure mounts, we simply add the new requirements to our load and keep trudging through our days. Most of us don’t even realize how must stress we are under. Like the proverbial frog in boiling water, we have become so accustomed to our stress that we are completely unaware of its dangers. The burnout that can result, and which I discussed previously in this blog, is real and has consequences. It is an important piece of the physician-suicide puzzle. On the other hand, many of us have experienced symptoms of burnout yet have not become suicidal. There must be more to the story.

The rest of the world doesn’t understand our stress, let alone sympathize with it. Patients see doctors driving fancy cars and living in the suburbs, and they feel as though doctors might just be in it for the money, especially when their last appointment was rushed and they did not feel they were heard. They don’t understand the insurance system, so they resent getting a bill they believe should have been covered by their insurance. Since the doctor is the personal face of the entire healthcare system, the doctor often becomes the scapegoat for all the problems of the system. It’s hard to garner a lot of sympathy for doctors’ mental health issues. Who wants to give money or time to support a profession they see as wealthy? And who wants to see a caregiver who is ill himself? If mental illness is still stigmatized in the general population, how much more so among those whom society expects to have it all together and to do it all right? Doctors, probably rightly, fear losing patients’ trust if they show any kind of weakness. And depression and burnout would be pretty big weaknesses to expose.

Beyond the trust of patients and society, exposing weakness puts the doctor’s very license at risk. Haven’t you had to check boxes like this on your medical license renewal or hospital credentialing paperwork?

• • Do you currently have any condition or impairment (including, but not limited to, substance abuse, alcohol abuse, or a physical, mental, emotional, or nervous disorder or condition) that in any way affects your ability to practice your profession in a safe, competent, ethical and professional manner?

• • Have you ever been denied health or life insurance?

Answer “yes” to one of these questions and you open a Pandora’s box of writing letters to the medical board and obtaining written assurances from your physician that you are competent to practice. And these onerous requirements can remain in place for years. No wonder we are reluctant for our credentialing entities to discover any mental health issues with which we may be struggling.

So, as a profession, we are burned out, isolated and scapegoated, and we fear punishment or professional restriction if we seek mental health treatment. In light of all of this, is it surprising we simply soldier on until the day comes we just can’t do it anymore?

If you are one of these physicians-depressed and not seeking help-do it! Give yourself the same good advice you would give a patient. You would never want to see a patient hide his mental illness to protect his professional status, because you would know it was dangerous for him. Well, it’s dangerous for you, too! Maybe more so, since you are part of this respected profession of healers who so often do not care for themselves.

If you yourself are not depressed, watch your colleagues. Remember that, somewhere in America, a physician is committing suicide every day. Keep watch on your city’s medical community in case today’s victim is someone you know. Could I have helped the young man in my medical school class? I don’t know. But I wish I had known enough to try.