Berks County Medical Society Medical Record Spring 2020 - 20

M e d i c a l R ec o r d F e a t u r e

Physicians and Suicide:
The Hurting Healer

by David A. Arena, Psy.D., J.D., MBA, M.A., M.Ed., LPC, Behavioral Science Director, Penn State
Health St. Joseph Family Medicine Residency, Clinical Assistant Professor, Department of Family
& Community Medicine, Penn State College of Medicine, darena@pennstatehealth.psu.edu

recall seeing the news of my favorite movie doctor's untimely
death by suicide more than five years ago. Robin William's
portrayal of Patch Adams was one of many great performances
from a career of a great actor and comic. Looking beyond the smile
and rapid-fire jokes, one could see a life filled with mental illness
and substance abuse. His role in the film and tragic death provide
an interesting parallel to the struggle of today's physician with
depression and suicide.

professional? What prevents a physician or medical student from
getting the help that they need? Who has the time in their busy
schedule? Where does a doctor go for treatment where they are
not recognized? A medical professional may think to themselves
that they know the realities of confidentiality of medical records
and don't want their personal business available to their colleagues
and whoever else has might have access. The stigma is still real and
especially prevalent in the medical community.

As a doctoral level mental health provider who also plays a
role in physician training through my position as a behavioral
science director with Penn State Health St Joseph's family medicine
residency program, I hope here to offer some of my insights from
30 years of working with, training, and often treating medical
professionals in my own private practice.

Being part of the residency interview process for the second
year now, I have read dozens of personal essays and heard equally as
many stories from interviewing medical students wanting to secure
that all important residency. One common theme that has come
across from reading and listening to these stories is a great deal of
pain, illness, and loss either personally or within the family that
often becomes a formative experience that guides these individual
to choose medicine as a career. I imagine that medical students
and physicians, much like mental health professionals, are guided
by their desire to help their patients maximize their quality of life
as they assist them toward a healthier path. The potential for the
"savior complex" as a way of eluding one's own emotional baggage
seems to be a hypothesis worth exploring. Furthermore, that selfless,
idealistic belief that these physicians can help everyone often leads
to the realities of "non-compliance" and the basic mortality of
their patients. Medical errors, adverse incidents, and patient deaths
are expected but nonetheless can take an enormous toll on the
physicians psyche.

All too often today, physicians, residents, and medical students
feel overwhelmed, depressed and anxious. This mix of mildly
uncomfortable to completely unbearable feelings coupled with
long work hours and insufferable stress can lead the physician
or physician-in-training to the brink of suicide. A meta-analysis
of studies on depression in medical residents found that 74% of
medical residents suffer from burnout while 20% meet criteria for
a diagnosis of depression (Mata et.al. 2015). Studies indicate that
male physicians have suicide rates as much as 40% higher than
their male counterparts in the general population while the rate
for female doctors is up to 130% higher than their counterparts
(Schernhammer, 2005). At an estimated rate exceeding 1 physician
suicide per day, physicians now have the highest suicide rate of any
profession (Andrew & Brenner, 2015).
We know that the statistics bear out this as a significant problem
and, as such, many professional organizations and accrediting bodies
are now focused on physician well-being. But, how does a medical
professional get the help and assistance that they need? Is it easy
for the physician who is supposed to "heal thyself " to admit that
they can't always do so and may need the help of a mental health
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With the pressure of board exams, documentation struggles,
uncooperative EMR systems, long hours, on-call responsibilities,
pressure for RVUS coupled with the normal ups and downs of
relationships, parenting, student loans and other financial pressures,
what does your average doctor do for self-care? Alcohol or some
other form of self-medication to cover up or escape the pressure? The
gym or running? Can you run away from your problems? When is
there time to just be in the moment and enjoy an opportunity for

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Berks County Medical Society Medical Record Spring 2020

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