A young doctor’s final words offer a mental health warning for others
Rebecca Margolis DO FAOCA, Patrick Ross MD, Myron Yaster MD, and Norah Janosy MD
Will West MD was a 3rd year ophthalmology resident at George Washington University School of Medicine and Health Sciences (GW) in Washington D.C. who committed suicide at the age of 33. “There is no way to know for certain what led Will to end his life. But what is known interviews with Will’s family, George Washington residents, and national experts show is that despite a growing acceptance nationwide of the benefits of mental health care barriers persist in residency programs that keep doctors from seeking help during a time when many need it.”1
Today’s PAAD comes from the Washington Post and reminds us that residency training is hard or as Samuel Shem wrote in his classic book The House of God “they can always hurt you more.” The perceived stigma associated with seeking mental healthcare prevents physicians from seeking the care they need and deserve. Trainees “feel compelled to hide their struggles fearing the repercussions that disclosure might bring. Success in their programs is critical to landing the jobs that will launch their careers.”1 Although the focus of the article is appropriately focused on Dr. West and suicide in house staff it is by no means limited to trainees. We are all at risk.
Before he died, Dr. West left a letter to his family that the family shared with the Washington Post and the GW community because “it holds a warning or other residents and those who oversee them.”1 We would urge all of you, particularly those of you who are in training or who oversee trainees, to read this 15-minute article in its entirety.
From Dr. West’s last letter to his family and colleagues:
"To those who will be negatively affected by my actions, I’m so sorry. I have simply run out of gas and have nothing left to give. To those in a position of authority over residents, a simple reminder that we come to you seeking the possibility of a better life. Some of us with challenges you do not see or backgrounds of which you are not aware. There are other residents right now fighting a true life and death battle — one that is waged both inside and out at the clinic/hospital. Often that battle may cause symptoms that look an awful lot like laziness, lack of motivation, or waste of intelligence, all unforgivable sins in our profession. I hope that an effort can be made to understand, support, and mentor the residents rather than simply to assess and drive them toward their highest potential as doctors. To be clear, there are other people at real risk here at GW.”
He signs off with kind words for his friends and mentors: “Thank you so much for being there for me. I wish you all the very best. Sincerely, Will West"
Physician suicide is not limited to house staff. As we discussed in a previous PAAD (July 26, 2023), physicians are at increased risk of burnout, depression, substance use disorder, and suicide when compared to the general population.2 Indeed, a 2019 study found that 119 physicians die by suicide each year.3 This is almost certainly an underestimate due to the study’s strict inclusion criteria and pervasive underreporting of death by suicide. Whatever the exact incidence, we are losing approximately one medical school class each year to suicide.
The causes of suicide are multifactorial, but it is generally associated with inadequately treated mental illness. Depression is common amongst physicians, affecting 12% of males and nearly 20% of females, which is at least as high as the general population. Gender-based differences exist within suicide rates as well; the suicide rate among male physicians is 1.4 times higher than the general population and 2.3 times higher among female physicians. The risk for suicide increases with self-medication and substance-use disorder.
Anesthesiologists are at heightened risk for death by suicide4 although the reasons we have higher rates than other medical specialties remain unclear. The American Society of Anesthesiologists is currently conducting a survey led by Dr. Michael Fitzsimons to better understand associated factors. "The fear of stigma associated with disclosure [of mental illness or struggles], the impression that seeking care is a sign of inadequacy, concerns about confidentiality, worries about disclosure on medical licensure and privileging applications, and fear that patients and peers will lose respect for the are just some of the reasons for reticence to seek help.”
On a personal note, I (RM) once asked a colleague during the height of the COVID pandemic if he was okay and got the very unexpected answer: “I am thinking about killing myself.” I felt unprepared for this moment; I was flooded with imposter syndrome and a guttural fear for my friend and his family. His wife and daughter flashed repeatedly in my head. After a moment, I realized I didn't need to fix everything; I just needed to get him to a professional. His disclosure was an invitation for help. He received the mental healthcare he needed and is now a thriving survivor and advocate for reducing stigma. As the survivor in this story (PR) I really don’t know if I would have done more to get help prior to this simple question from RM. The stigma, fear of being judged, and fear of losing my ability to practice led me to believe it was best to hide my symptoms and hope it would get better. For me the intervention was someone really asking if I was OK and taking an earnest interest in my wellbeing. I have read similar stories from others that have had suicidal risk. In training we learned a lot about them-care but very little about self-care. As a Society comprised of compassionate people can choose to destigmatize the need for mental healthcare. It will take time, but we can normalize caring for ourselves and others.
Wondering what you can do today? Ask someone who seems a little off if they are okay. Learn about the resources at your institution. The ASA has an excellent resource guide. Not sure how to start the conversation? Refer to this SPA one pager. We can all help prevent suicide.
Send your thoughts and comments to Myron who will post in a Friday reader response.
References:
1. Portnov J. A young doctor’s final words offer a mental health warning for others. The Washington Post. 2024 10/05/2024.
2. Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. Jama 2015; 314(22): 2373-83.
3. Gold KJ, Schwenk TL, Sen A. Physician Suicide in the United States: Updated Estimates from the National Violent Death Reporting System. Psychol Health Med 2022; 27(7): 1563-75.
4. Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PloS one 2019; 14(12): e0226361.