I wasn’t planning to post a PAAD today because I, like many of you, am attending the annual meetings of the Society for Pediatric Anesthesia and the American Society of Anesthesiologists (there will be no PAAD on Monday October 14). However, these reader responses to our recent PAAD on physician suicide was so important I didn’t think it could wait an additional week so I’m posting it today. Myron Yaster MD
From Alan Jay Schwartz, MD, MSEd, Aditee P Ambard,ekar, MD MSEd, Justin L Lockman, MD, MSEd on A young doctor’s final words offer a mental health warning for others
We want to thank Drs. Margolis, Ross, Yaster and Janosy for their PAAD1 about the danger of mental illness, which demonstrates their willingness to openly discuss what so many are unwilling or unable to acknowledge. In particular, we are honored by Dr. Ross’ decision to share with the entire PAAD community his personal story. We hope that his courage in doing so will inspire others in our community to seek help. As education leaders in Anesthesiology, we want to add our perspective to this discussion.
Isn’t it curious that when a resident, fellow or colleague has diabetes, we accept their illness and support their care needs without judgment or question. Indeed, we routinely embrace our own and other’s illnesses as a part of life without considering them personal deficiencies. Why is it so difficult for all of us, personally and as a community and a nation, to acknowledge mental health in exactly the same way we recognize other medical maladies? The answer to this query lies in the stigmatization of mental illness that has developed over centuries - defining it as a failure or inadequacy of coping ability and talking about it using phrases like “letting others down.” Because so few are as brave as Dr. Ross, the scarcity of transparent stories about mental struggles fosters an almost self-fulfilling feedback loop for more perceived “failure” and greater mental turmoil. Unfortunately, suicide is too often the only perceived solution for many physicians and others.
Unwittingly and unintentionally, our systems allow the Hidden Curriculum of medical education2,3 to negatively channel our socialization of residents, fellows and our staff peers. What we say, what we don’t say, what we do, and what we don’t do, together amount to shouting out our messages and underlying biases that too often batter those with mental health struggles.
What can we, must we, do to reverse the downward spiral of our trainees’ and colleagues’ mental health ailments? We offer several suggestions:
1. Acknowledge mental health as a disease with biological basis similar to any other and use empathy instead of judgment when talking about it.
2. Understanding the Hidden Curriculum as it pertains to mental health attitudes, and stop allowing it to impact our professional and personal interactions.
3. Speak openly and with transparency about mental health, and welcome stories like that of Dr. Ross when they are offered.
4. Guarantee that the ACGME requirement for programs to enable trainees to attend doctor’s appointments, a current standard in effect, is met despite the logistical challenges it can cause in anesthesiology. We should always make it work for a resident to “disappear” to go for any appointment when needed, with no questions asked!
5. Find out today what resources exist for your trainees, and establish/advertise a wellness/resource center if one does not already exist.
6. One of us [APA] openly measures trainee wellness using a voluntary “fuel gauge” biweekly via the trainee evaluation system that inquires, “How full is your gas tank?” I review responses regularly and reaches out to anyone who rates their fuel gauge ½ tank or less. This seems like a simple and easy strategy that all of us could implement as an early warning system. Discuss your observations with others teaching and working together with our trainees and colleagues so you don’t witness what one of us [AJS] experienced. When he discovered a new resident, a victim of suicide, everyone said in retrospect, they knew things weren’t right but never shared their concerns with colleagues. Prospectively announce a “small craft advisory” to avoid raising the “gale” or “hurricane” flag.
7. Brainstorm how to create a more psychologically safe environment for learners to come forward. We all work in systems that provide each trainee with multiple mentors/advisors that serve to promote camaraderie and psychological safety. But this is just the start – we also benefit from faculty actively working to create a psychologically safe environment for these discussions.
8. Recognize that there may always be a degree of inherent distrust in the system even if you’re doing everything you can. As one of my [JLL] trainees 10 years ago told me, “I’m worried that anonymous isn’t anonymous.” This concern is difficult to overcome, and we recommend trying to express, as genuinely as possible, “I care about you and I want to help you.”
Learn by example. Like Dr. Ross, Olympic gymnastics champion (and G.O.A.T.) Simone Biles provided us with a great example of what to do. Speaking openly and seeking help4, she successfully confronted her mental health “demons”. Listen to her own words.
SPA’s Pediatric Anesthesia Program Directors’ Association has held educational sessions for Program Directors on recognizing burnout and on wellness for trainees. But there is much more we can all do. The article “A young doctor’s final words offer a mental health warning for others”, as brought to our attention by Drs Margolis, Ross, Yaster and Janosy should serve a wakeup call for the entire pediatric anesthesia community!
References
1. Margolis R, Ross P, Yaster M, Janosy N. A young doctor’s final words offer a mental health warning for others. Pediatric Anesthesia Article of the Day October 15, 2024
2. Kalter L. Navigating the hidden curriculum in medical school. AAMC News July 30, 2019 (https://www.aamc.org/news/navigating-hidden-curriculum-medical-school) accessed 10/9/2024
3. Boer C, Daelmans HEM. Team up with the hidden curriculum in medical teaching. British Journal of Anaesthesia, 124 (3): e54ee58 (2020).
4. Good Morning America. April 18, 2024 accessed 10/9/2024
From anonymous
I knew Will West personally. We were roommates in college at BYU and close friends. Our lives took us different directions during training, but a lot of us friends hoped that we'd reconnect after our training was all over. We were all stunned and quite shaken when Will committed suicide. He was such a happy and deeply spiritual person in college, but I suppose that he was "fighting his demons" (that's what he said in other words to his family) that none of us knew about it.
Thank you very much for increasing awareness of this tragic experience in hopes of preventing this from happening to someone else's close friend.