An excerpt from Physician Suicide: Cases and Commentaries.

“Dear Richard and Yvonne,

I feel I have no choice but to end my life and am doing so in the hope that you will take this letter and employ it in the way that I suggest below. Please use what has happened to me as an example to help prevent the same tragedy happening to the patients of elderly physicians who have continued practicing past the time when it was safe for them to do so. I now know, as a result of the recent tragedy that led to the suspension of my medical privileges, and which effectively ended my career in disgrace last week, that I have “Mild Cognitive Impairment” which may be the beginning of dementia. Some may think me weak, but I cannot face the inevitable investigations that will occur into my errors, and so I prefer to die …

I had to finally face the fact last week that I was no longer competent to practice medicine, and cannot face the knowledge that it took my mistakes, and the unnecessary deaths of two patients, for me to understand this. As we have talked about on the phone I had this one dreadful day in the clinic where everything happened at once, and I just couldn’t cope. We were short-staffed that day, and I was the only attending present, but that is no excuse. To have two patients suddenly get really sick at the same time was bad luck, or so many observers might say, but I know that a few years ago, I would have managed them fine. The reality is that last week, I was a major part of the problem, and I couldn’t manage the two patients together …

I am so sorry to have made you suffer through my obstinacy, and my insistence on continuing to practice medicine when I was not fit to do so. I am going to join your mother and hope that she will understand and forgive me. I love you both. Dad.”

Having read the note, Dr. Bryant carefully folded it and put it back in the envelope addressed to his son and daughter. He sighed and took a last sip of his scotch, setting the crystal glass down on the small table beside his note. He stood up slowly and stretched as he looked around the garage. He could see the camping gear, garden tools, and old paint cans from projects he and Ethel had done together over decades. He noticed the thick layers of dust everywhere as he had not touched anything in the garage in the past few years.  He climbed his wooden ladder and steadied himself by holding a rafter in his left hand, while he put the prepared noose around his neck with his right hand. He made sure the knot was at the back of his neck, well centered, so that it would break his cervical vertebrae and spinal cord without any difficulty, glanced briefly at the box of his prize butterflies hanging on the wall, and stepped off the ladder.

Commentary

Dr. Bryant’s tragic story is, sadly, not unusual. A very sad finish to a lifetime of service and care that was preventable, and should have been avoided. He most likely had a combination of mild cognitive impairment (MCI) and depression, both disorders leading him to be unable to respond flexibly in an emergency situation, where rapid thinking and decision making is required, even though he may have appeared to be cognitively competent and capable of handling most routine day to day medical work. As a consequence his actions in the scenario led to disaster and revealed his lack of continuing competence to function as a physician in a way that was personally humiliating and medically appalling.

Like the rest of the U.S. population, physicians are also aging, and a 2016 report from the Association of American Medical Colleges has shown that physician demand continues to outstrip supply, with over a third of active physicians predicted to be aged over 65 years within the next decade. The AAMC notes that as of 2016 physicians between the age of 65 and 75 already account for 11% of the active workforce, while those aged 55 to 64 make up another 26%. The key question to consider is how can society best make use of the experience and commitment of the great majority of elderly physicians, many of whom wish to continue working past the normal retirement age. The great majority of physicians are likely to be physically and psychologically fit to practice into their 70s and 80s and occasionally even longer if they wish. There needs to be a process to allow them to be able to do so as long as they maintain their fitness for practice, while at the same time ensuring that those physician’s who become unfit to practice, are able to cease working and retire with their dignity, reputation and safety record intact.

Peter Yellowlees is a psychiatrist and author of Physician Suicide: Cases and Commentaries.

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