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Doctor suicide - the elephant in the examining room

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Objectives:
Describe and Discuss Depression, Stress and Anxiety in the Medical Community

State statistics as it relates to physicians and suicicide including the “July’ Effect

Explain the correlation between depression and addiction as it manifests itself in this population

Demonstrate the efficacy of a robust bi0-psycho-social and questions

Recommend strategies within medical practices and hospitals to reduce risk

Published in: Health & Medicine
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Doctor suicide - the elephant in the examining room

  1. 1. DOCTOR SUICICIDE- THE ELEPHANT IN THE MIDDLE OF THE EXAMINING ROOM
  2. 2. ABOUT DR. LOUISE ▸  Clinician-Interventionist- Award Winner ▸  Educator- Speaker- Trainer ▸  Author, Falling Up!A Memoir of Renewal, Amazon Press ▸  Author- The Clinicians Guide to Addiction Intervention-Routledge in Press ▸  Widow-Wife-Mother-Grandmother ▸  SoulCycler-Adventurer ▸  email -DrStanger@allaboutinterventions.com ▸  www.allaboutinterventions.com- ▸  619-507-1699
  3. 3. ABOUT DR. WALTON KUDOS AND THANK YOU ▸  Lauren Walton MD, ASAM, APA ▸  President Los Angeles American Society of Suicide and Prevention ▸  Head of Addiction Medicine Kaiser-Downey, Ca ▸  “You inspire me daily with your goodness”LAS
  4. 4. OBJECTIVES ▸  Describe and Discuss Depression, Stress and Anxiety in the Medical Community ▸  State statistics as it relates to physicians and suicicide including the “July’ Effect ▸  Explain the correlation between depression and addiction as it manifests itself in this population ▸  Demonstrate the efficacy of a robust bi0-psycho-social and questions ▸  Recommend strategies within medical practices and hospitals to reduce risk
  5. 5. WHY DO YOU VISIT YOUR DOCTOR?? WHAT DO YOU THINK ABOUT? ▸  You are going because : ▸  You need a check up ▸  Something Is bothering ▸  You expect an exam, your vitals checked , sample of blood, tests run ▸  But do you ever think about what’s going on with your doctor?
  6. 6. DID YOU KNOW ? ▸  More then 920,000 Americans lose their doctors to suicide each year ▸  Approximately 400 doctors commit suicide each year ▸  Physicians are more then twice likely to commit suicide then non- physicians ▸  Female physicians three times more likely then their male counterpart to complete
  7. 7. STATISTICS DID YOU KNOW ? ▸  Female completion rate is higher then male physicians and exceeds general population by 4 times the rate ▸  After accidents suicide is the most common form of death amongst medical students ▸  Common psychiatric diagnoses are depression, anxiety , bipolar disease and other untreated mental illness ▸  Substance misuse and abuse ▸  Also easy access to lethal means
  8. 8. ▸  In every population suicide is the result of untreated or inadequately treated depression ▸  Depression is as common amongst physicians as the general population-12% ▸  More common in residents 15% ▸  This is a global phenomena _Finland, Norway, Australia, Singapore, China , Taiwan, SirLanka , Australia etc . U.S .LOSES THE EQUIVALENT OF ONE SMALL MEDICAL SCHOOL TO SUICIDE EACH YEAR OR ONE LARGE MEDICAL SCHOOL CLASS DID YOU KNOW?
  9. 9. PHYSICIAN BURNOUT RATES- MAYO CLINIC PROCEEDINGS MALASH BURNOUT INVENTORY ▸  Emergency Medicine ▸  Family Medicine ▸  General Pediatrics ▸  Urology ▸  Orthopedic Surgery ▸  Physical Medicine & Rehabilitation ▸  Pathology ▸  Radiation ▸  General Surgery Subspecialties
  10. 10. A CONFLUENCE OF ISSUES ▸  Educational Demand ▸  Extended Workdays ▸  Increasing Computerization Of Practice ▸  Chronic Stress ▸  Lack of Institutional Support ▸  Income not High Enough ▸  Feeling Like a Cog in a wheel ▸  Too Many Difficult Patients
  11. 11. CONFLUENCE OF ISSUES ▸  Lack of Institutional Support ▸  Availability of Addictive Substances ▸  “Conspiracy of Silence” ▸  Underreporting when a Physician is in Trouble ▸  A Spiderweb of Silence ▸  Perfectionism ▸  Family Issues ▸  Stigma
  12. 12. MEDICAL SCHOOL CULTURE-“HAZING , BULLYING, & NAME CALLING THAT RESULTS IN “OCCUPATIONAL DEPRESSION & POORER HEALTH CARE” Pamela Wible MD ,”Why Doctors Kill Themselves”
  13. 13. AMERICAN FOUNDATION SUICIDE PREVENTION ▸  DRIVERS OF BURNOUT : ▸  WORKLOAD INEFFICIENCY ▸  LACK OF AUTONOMY ▸  LACK OF MEANING IN WORK ▸  WORK-HOME CONFLICT
  14. 14. “THERE IS A STRANGE MACHISMO …DRS LIKE ME,FEEL PRESSURE TO PROJECT INTELLECTUAL PROWESS…OUR EXPECTATIONS SKYROCKET AS IF THE CONFERRAL OF A DEGREE WERE AN ENCHANTMENT OF INFALLIBILITY .. LITTLE CHANGES , APART FROM OUR LEGAL ABILITY TO WRITE A PRESCRIPTION Pranay Sinah MD, NY Times
  15. 15. UNPACKING DEPRESSION IN RESIDENTS DOCTORS ▸  Underreported-Underrecognized & Untreated : ▸  Drs may be reluctant to seek treatment ▸  Have no time to seek treatment because of grueling work weeks ▸  Easy access to prescription drugs ▸  Fearful of stigma ▸  Relational Issues ▸  Doctors if they do seek treatment get VIP treatment feeding into Narcisstic tendencies ▸  Prevalence of depression higher in residents then general population
  16. 16. ASSESSMENT QUESTIONS BIO-PSYCH0 ▸  Is their Family History MH ? ▸  Is there FH of Suicide? ▸  Has there been previous episode of depression? ▸  Is there FH process disorder or addiction? ▸  FH- sudden death, abuse, multiple moves, et? ▸  Does Dr have hx. of substance misuse?
  17. 17. MORE QUESTIONS ▸  Past experience with prescription & non prescription drugs ? ▸  Been treated for any disease per ASAM 2011 Criteria for addiction ▸  Any treatment for anxiety or insomnia ? ▸  Any Learning difficulties? ▸  Current Relationships ▸  What are views on getting and seeking help? Self & Families ▸  Cultural and Religious view on MH, Association, Suicide etc
  18. 18. RATES OF DEPRESSION -BRIGHT AND KAHN MAYO CLINIC PREDICTORS OF DEPRESSION ▸  Relational Difficulties withdrs, staff or parents ▸  Lack of Sleep ▸  Making Mistakes ▸  Loneliness ▸  24 hour responsibility ▸  Self-Criticism
  19. 19. THE NEW C0HORT OF RESIDENTS 36,000 THE JULY EFFECT
  20. 20. IN HOSPITALS AND PRIVATE PRACTICE POLICIES & PRACTICES HR & WELL BEING COMMITTEES ▸  HR Policies on Substance Misuse , Depression, Anxiety and Action ▸  Review of Work Hours ▸  Education & Resources about Impairments common to medical community ▸  Self-Referral Processes for Help ▸  Confidential Referral Process
  21. 21. GOAL OF WORKPLACE WELLNESS ▸  Healthy Behaviors are promoted, encouraged and Supported ▸  Employees have easy access to help them make better life style choices ▸  Employees have opportunity to practice healthy lifestyle behaviors ▸  organizational Programs must ensure that leadership, policies , practices & the physical environment are supportive & conducive to healthy behavior changes
  22. 22. CENTER FOR PROFESSIONAL RECOVERY WELL BEING COMMITTEES ▸  Evaluation of complaints or allegations to determine validity ▸  Monitoring of professional to protect safety of patients until rehabilitation is completed ▸  Proper reporting to appropriate leadership when patient safety might be compromised ▸  Initiating proper protocols if impaired physician fails to complete prescribe rehabilitation program
  23. 23. CENTE FOR PROFESSIONAL PROGRAMS DIVERSION PROGRAMS-PHP ▸  Referral of Individual by patient, partner or family Evaluation of initial referral ▸  Notification is given to MD with option to enter treatment & monitoring ▸  Comprehensive assessment ▸  Referral to Appropriate Treatment center ▸  Referral to Counselor ▸  AfterCare that includes ongoing counseling, drug testing etc ▸  Involvement of Family in Treatment process
  24. 24. CONTINUING CARE PHP ▸  After Care Programming -PHP-IOP ▸  Long Term Monitoring- Including Counseling and Drug Testing ▸  Family , Friends & Medical Team Counseling ▸  Routine Reports To Medical Board ▸  Reassessments and Evaluations ▸  Lifestyle Coaching & Trigger (Relapse) Prevention ▸  Finding Joy
  25. 25. RESOURCES DR. LOUISE STANGER ▸  Doctor Suicide The Elephant in the Middle of The Examining Room https://www.huffingtonpost.com/entry/ doctor-suicide-the-elephant-in-the- examining- room_us_596d04c4e4b05561da5a5992 ▸  All About Interventions www.allaboutinterventions.com ▸  Thrive Global Louise https://www.thriveglobal.com/authors/ 3258-louise-stanger-ed-d-lcsw-cdwf-cip- roger-porter ▸  Huffington Post https:// www.huffingtonpost.com/author/louise- stanger-edd-lcsw-bri-ii-cip
  26. 26. RESOURCES ▸  Wellness Committee Guide http://www.shawhankins.com/wp-content/uploads/2014/11/ Wellness-Committee-Guide-2-1.pdf ▸  Creating A WorkPlace Wellness Committee A Toolkit for Employers https://msdh.ms.gov/msdhsite/_static/resources/6663.pdf ▸  Wellness Tool Kit https://www.cigna.com/assets/docs/wht/wellness-committee- toolkit.pdf ▸  Center for Professional Recovery https://www.centerforprofessionalrecovery.com/? gclid=EAIaIQobChMI5rb9gL3J2gIVi8pkCh2nagIkEAAYASAAEgJH MvD_BwE
  27. 27. RESOURCES ▸  Physician Suicide Letters, Pamela Wible https://www.amazon.com/Physician-Suicide-Letters-Answered- Pamela/dp/0985710322 ▸  Match Day 2017 https://www.statnews.com/2017/03/17/match-day-residency- international/ ▸  Match dayhttp://www.nrmp.org/main-residency-match-data/ ▸  Headed to the Hospital? Beware the July Effect https://health.usnews.com/health-news/patient-advice/articles/ 2014/07/21/headed-to-the-hospital-beware-the-july-effect
  28. 28. RESOURCES ▸  The Tennis Partner, Abraham Verghese https://www.amazon.com/Tennis-Partner-Abraham-Verghese/dp/0062116398 ▸  Hidden Epidemic Of Doctor Suicide https://www.fastcompany.com/3056015/the-hidden-epidemic-of-doctor-suicides ▸  Why Do Doctors Commit Suicide ? Pranay sinhahttps://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit- suicide.html?_r=0 ▸  Kahn on Depression https://www.khanacademy.org/test-prep/mcat/behavior/psychological-disorders/v/ depression-and-major-depressive-disorder ▸  https://www.mdedge.com/psychiatry/article/64274/depression/depression-and- suicide-among-physicians
  29. 29. RESOURCES ▸  American Foundation for Suicide Preventionhttps:// afsp.org/our-work/education/healthcare-professional- burnout-depression-suicide-prevention/
  30. 30. Resources for healthcare professionals and medical educators Accreditation Council for Graduate Medical Education (ACGME) Resources – Resources to share with programs, institutions, residents, and fellows that promote a culture of physician well-being and provide support in the case of burnout, depression, or suicide. Breaking the Culture of Silence on Physician Suicide – A sharable graphic and information about physician suicide from the National Academy of Medicine. Creating a Safety Net: Preventing Physician Suicide – An article by AFSP Chief Medical Officer Christine Moutier, M.D., for the Association of American Medical Colleges’ AAMC News. Reducing the Stigma: Faculty Speak Out About Suicide Rates Among Medical Students, Physicians – An article by Dana Cook Grossman, for the Association of American Medical Colleges’ AAMC News. Preventing Suicide in Physicians, Residents and Medical Students (Video) – Dr. Christine Moutier addresses the American Psychiatric Association, May 20, 2016. Symposium on Physician Well-Being – A symposium held on November 17-18, 2015 by The Accreditation Council for Graduate Medical Education (ACGME). Leaders in Academic Medicine Address Physician Well-being and Resilience – A news release from the Association of American Medical Colleges. Preventing Physician Distress and Suicide – Tools for identifying at-risk physicians and facilitating access to care from the American Medical Association. Make the Difference: Preventing Medical Trainee Suicide (Video) – A 4-minute PSA from Mayo Clinic and the American Foundation for Suicide Prevention that explains how everyone can help prevent suicide by being alert for the signs of depression and escaping stress and how to be most helpful. This film can be used in medical school physician wellness, humanism and professionalism curricula. Featured at top of this page. Why Physicians Die by Suicide – Dr. Michael Myers guides readers through the variety of factors that contribute to physician suicide. He then makes practical, across-the-board recommendations in an effort to prevent this tragedy, arriving at the encouraging conclusion that everyone has a role to play in saving a doctor’s life. Struggling in Silence: Physician Depression and Suicide (DVD) – An award-winning, one-hour documentary from AFSP, that sheds light on the topic of physician mental health and suicide prevention, featured on public television stations nationwide. This film can be used in medical school physician wellness, humanism and professionalism curricula.
  31. 31. Make the Difference: Preventing Medical Trainee Suicide (Video) – A 4-minute PSA from Mayo Clinic and the American Foundation for Suicide Prevention that explains how everyone can help prevent suicide by being alert for the signs of depression and escaping stress and how to be most helpful. This film can be used in medical school physician wellness, humanism and professionalism curricula. Featured at top of this page. Why Physicians Die by Suicide – Dr. Michael Myers guides readers through the variety of factors that contribute to physician suicide. He then makes practical, across-the-board recommendations in an effort to prevent this tragedy, arriving at the encouraging conclusion that everyone has a role to play in saving a doctor’s life. Struggling in Silence: Physician Depression and Suicide (DVD) – An award-winning, one-hour documentary from AFSP, that sheds light on the topic of physician mental health and suicide prevention, featured on public television stations nationwide. This film can be used in medical school physician wellness, humanism and professionalism curricula. Collateral Damage: The Impact of Patient Suicide on the Physician, a DVD film of several physicians speaking about their experience of patient loss to suicide, and group discussion. Psychiatrists featured in this educational film include Drs. Glen Gabbard, Sidney Zisook, and Jim Lomax. This resource can be used to facilitate an educational session for physicians, psychologists, residents or other trainees.  Please contact education@afsp.org to request the DVD. American Medical Student Association – The oldest and largest independent association of physicians-in-training in the United States. Suicide Risk in Physicians – Emergency Physician Dr. Mel Herbert produces a popular podcast called EMRAP for healthcare professionals in Emergency Medicine. In this 26-minute podcast he speaks with Dr. Christine Moutier about suicide risk and prevention for physicians and trainees. Nurse Suicide: Breaking the Silence – The National Academy of Medicine released a landmark paper in 2018 as a call for action regarding nurse suicide.
  32. 32. Prevention programs Interactive Screening Program (ISP) – AFSP’s signature intervention program, the ISP is an online tool used by medical schools across the country as a method of connecting to students, residents and faculty, and encouraging them to utilize available mental health services before crises emerge. ISP is listed as a Best Practice for Suicide Prevention and is an integral part of a comprehensive suicide prevention and mental health promotion strategy.1, 2, 3, 4 Web-Based Cognitive Behavioral Therapy for Medical Trainees (Guille, C., et al., JAMA Psychiatry, 2015) Intervention to Promote Physician Well-being (West, C.P., et al. JAMA Intern Med., 2014) Stanford’s Burnout Prevention Approach (Schulte, B., Washington Post, 2015)
  33. 33. DOCTOR SUICIDE- THE ELEPHANT IN THE EXAMINING ROOM Louise Stanger Ed.D,LCSW,CDWF,CIP

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