I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.

I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.

Why?

Here’s what I know:

A physician’s greatest joy is the patient relationship.

Assembly-line medicine undermines the patient-physician relationship.

Most doctors are burned out, overworked, or exhausted.

Many doctors spend little time with their families.

Workaholics are admired in medicine.

Medicine values competition over nurturing.

Many doctors function in survival mode.

Doctors are not supposed to make mistakes.

Caring for sick people can make you sick if you don’t care for yourself.

Medical education often dissociates mind from body and spirit.

Some medical students believe they graduate with PTSD.

Seeing too much pain and not enough joy is unhealthy.

For a physician, a cry for help is weakness.

The reductionist medical model is dehumanizing for patient and physician.

Many doctors are emotionally detached (especially male physicians).

Doctors are obsessive-compulsive perfectionists in an imperfect medical system.

Physicians are the nation’s social safety net with few resources to help patients.

Some doctors feel like indentured slaves.

Death is perceived as failure.

Doctors don’t take very good care of themselves or each other.

Many doctors are in denial about the high rate of physician suicide.

Physicians are often bullied by insurance companies, employers, and patients.

Doctoring is more than a job; it’s a calling, an identity.

Doctors are often socially isolated.

Doctors can’t just be people. They’re doctors 24/7.

Doctors can feel severe psychological pain.

Doctors can feel powerless.

Doctors can feel trapped. Some see no alternatives to their suffering.

Doctors have easy access to lethal drugs and firearms.

Doctors have the same problems as everyone else.

Doctors have marital distress. They get divorced.

Doctors have addiction to drugs and alcohol.

Doctors have economic hardship and unbearable debt.

Doctors have mental illness.

Doctors are human.

Watch the TED talk on physician suicide.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.