Start with the students: Addressing the future of physician suicide

The first day I sought counseling, I felt like I was committing a crime.

Our afternoon anatomy lecture had just ended, and the entirety of our first-year medical class—clad in hunter green scrubs and reciting the intrinsic muscles of the back—paraded in what looked like a single-file line to our cafeteria.

“Act natural,” I thought. “Don’t let anyone find out what you’re up to.”

My friends veered right to enter the cafeteria as I continued straight. Aren’t you coming to eat lunch with us? They had caught on, sensed my impending absence from their mealtime ritual as I departed the cluster of starry-eyed student doctors.

“Uh, yeah, just one sec, I have to pick up some paperwork.”

I lied.

I continued onward, looking left, looking right, and sharply looking over my shoulder to identify any potential witnesses. This single speck of hunter green—me—was so obviously discernible in the August sunlight. I quickened my pace, hoping that I would escape my classmate’s line of vision. But everyone knew I was up to something—something terrible, something deviant, perhaps something criminal.

My mind was in a dark place. I was stressed and overwhelmed, and I needed help.

It comes as no surprise that physicians face the highest suicide rates. Long shifts, complex patient interactions, and the pressure to achieve perfection in all aspects of patient care are a few of many contributing factors to the epidemic. However, where in this conversation do we insert the medical student, the soon-to-be physician? Why is their mental health never talked about?

When committing to medical school, students subscribe to the notion that they are about to endure four years of rigorous coursework. These years are meant to be hard. They’re meant to rank the best of the best. They’re meant to drain you. What follows is that the mental health of medical students often goes unaddressed, consistent with the idea that they should be miserable. They’re medical students, after all!

This leads to problems down the line. We accept this misery as a hallmark of our profession, in both medical school and in clinical practice.

The reality of medicine, though, is that it does not necessarily get better. Right now, we have histology and microbiology, board exams, and clinical rotations, but tomorrow we’ll have a full roster of patients, an 18-hour shift, a death to pronounce, and perhaps even a husband or wife or son who needs help with his math homework. Oh, and don’t forget to pick up bread from the grocery store. The challenge, then, is to fix this issue at a grassroots level: How do we train the medical students and faculty of the nation’s medical schools to acknowledge their students’ mental health?

I don’t have the answer, but I do know that conversations like these must happen. The students we train today about personal mental health—about wellness—will be the attending who politely educate their future students, rather than unnecessarily pimping them in effort to shroud them in a veil of embarrassment. We will be the physicians who will not overwork our residents as a form of cheap labor.

But ultimately, right now, we can be the students who will remove the criminal stigma of the student who simply needs to vent to his counselor about how he has no idea how to memorize the intrinsic muscles of the back.