Doctors are killing themselves, and who is taking notice? [PODCAST]

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“I can do better. We can do better. Please partner with me and advocate for the ability for doctors and residents in our profession to receive medical and psychiatric care without fear of losing our licenses or having to face stigma and judgment. It can save lives. Please, we are more stressed than ever, and we need to speak the names of our fellow friends and colleagues who have died by suicide. We need to advocate for them and for all of us to have access unfettered by fear to utilize the very lifesaving treatments we recommend to our patients.”

Courtney Markham-Abedi is a psychiatrist.

She shares her story and discusses her KevinMD article, “Doctors are killing themselves, and who is taking notice?”

This episode is sponsored by Augmedix: Ambient medical documentation and live clinical support powered by virtual scribes. Did you know that nearly 75 percent of clinicians surveyed in a recent study say they spend over 10 hours per week on paperwork and medical notes?

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Courtney Markham-Abedi. She is a psychiatrist, and she wrote the KevinMD article “Doctors are killing themselves, and who is taking notice?” Courtney, welcome to the show.

Courtney Markham-Abedi: Thank you. Thank you for having me, Kevin.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Courtney Markham-Abedi: Yes. I am from West Virginia, a small town on the river across the border from Ohio called Point Pleasant, West Virginia. I grew up there, and I went to college in Ohio, and then I completed med school at West Virginia University. I did residency at the University of Kentucky, and I’ve stayed there, and I have been at the VA doing mostly inpatient work for probably going on about 14 years, so quite some time.

Kevin Pho: We’re speaking in the middle of January. Tell me what you’re seeing from a pandemic standpoint at the VA.

Courtney Markham-Abedi: My VA in particular has done a good job mobilizing forces and using the resources we have to do the best we can. Today we’re having a walk-in vaccination, and so I think that we’re really trying to get the vaccines out there and combat it that way.

Kevin Pho: And over the past few months, from a psychiatric standpoint, is there anything specific that you’re seeing as it relates to COVID-19?

Courtney Markham-Abedi: We’re seeing a lot of effects of isolation, people not being able to get in to see their practitioners. We’re seeing an increase in addiction, substance use, depression, and anxiety. And I think that the ramifications of this pandemic will be felt for decades from now.

Kevin Pho: So let’s transition now into your KevinMD article, “Doctors are killing themselves, and who is taking notice?” Now, for those who didn’t read that article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Courtney Markham-Abedi: Off social media, or Facebook, I had it come to my attention that the life of a fellow West Virginian, somebody who grew up in Point Pleasant like I did, had ended by suicide. And I was just struck by kind of the chasms and the loss, really the loss of anybody’s life. But this particular person was named Dr. Ray Thornton, and he was maybe 10 years older than me, but my parents were high school teachers, so I can remember my father talking about just how brilliant he was. And actually, he first went to Juilliard and graduated there with, I think, a degree in piano, and decided he didn’t want to be a concert pianist, I guess, and then he went back to med school and became a radiologist. So just a brilliant, brilliant person, and just the loss.

And I know that he had reached out for help that night, and I think this is kind of a pandemic thing too. They were going to have a Zoom meeting in the morning, but going in to see practitioners is not as easy in this pandemic time, so you wonder about that.

And I also, just on Facebook again, have seen somebody asking a question on one of the groups, “What should I tell a friend of a friend who is getting psychiatric care?” And now for licensure in some states, which I had no idea about, it will say, “Have you received psychiatric care in the last five years?” So you might have to write a letter; you might have to kind of say why it’s OK for you to keep practicing.

I hadn’t realized that, because in Kentucky it was a pretty broad statement. I do believe up to maybe two or three years ago it mentioned mental health and it mentioned addictions, but it just said, “Would this impair you from your practice?” It didn’t say, “Have you received treatment?” Now, I will say a positive thing, because I just re-upped my license. Now it doesn’t say that. It just says, “Is there any illness or reason that you couldn’t practice medicine?” Something very broad. But some states are very, very particular and say, “Have you received psychiatric care?” And it just struck me that that would have been a barrier to me, and I think to a lot of physicians, or other professions, with those kinds of questions. So that’s kind of what struck me and what caused me to write the article.

Kevin Pho: Now, there’s a perception among the public that physicians shouldn’t have anything to worry about. They get paid a lot of money; they have a steady job. Why should physicians feel depressed, and why are they committing suicide? Now, from your perspective as a psychiatrist, what are some of the underlying reasons that lead physicians to consider or even commit suicide?

Courtney Markham-Abedi: There’s a lot of moral injury that goes on in medicine, whether it’s in the training or then when you get out and you’re practicing, and the loss of patients, the idea that we kind of have to be perfect, but everybody makes mistakes. And so a mistake or a lawsuit or any of those things can really, really weigh heavily on physicians. And so I think that that kind of underpins some of the suicide.

I also think the stigma, and not wanting to be known as somebody who’s getting psychiatric treatment, and then to be asked about it when you have to re-up your license, I think that’s a barrier, and I think that we need to be working on changing that.

Kevin Pho: Now, what are some of the ways where we could break down that stigma when it comes to clinician burnout or clinician psychiatric issues?

Courtney Markham-Abedi: Advocating and talking about how it’s OK to get therapy, it’s OK to get treatment for psychiatric illnesses. I think trainings in residencies, and I think we’re seeing that now, and even in medical school, about burnout, about imposter syndrome, about the things that we’re going to encounter in our practices, could go a very long way to not being a person out in practice all of a sudden having depression and not exactly knowing where to turn. And I know a lot of other professions, lawyers, dentists, and veterinarians, have this epidemic of suicide as well.

I think what to me is so important is that I think we’re a little bit different as physicians, in that I can almost kind of guarantee that we’re one or two degrees of separation from somebody who could help us: a psychiatrist, a mental health person, a primary care person, somebody to just point you in the right direction, whether we have somebody trusted in training. I mean, we’re just a couple of degrees of separation from somebody who could make the difference.

Kevin Pho: For the clinicians who may be listening to this podcast, can you share some of the symptoms and red flags that could lead that clinician down that path to depression and possibly contemplating suicide? And at what point should they consider seeking help?

Courtney Markham-Abedi: What you might notice first is a little bit of change in your sleep, maybe not sleeping as much, or sleeping too much. Then you could have changes in your appetite, your energy level. A very important one is one that we call anhedonia, which is you’re just not enjoying what you used to enjoy previously in your life. Just kind of the zest isn’t there. And so that’s one to look very carefully for.

But then, if you start to have thoughts about suicide, fantasizing, like, “Maybe I would be better off dead. Maybe my life isn’t worth living,” I think at that point you really need to start talking to somebody. But if your sleep is so impaired that you’re not really able to go about your day like you would like to, I also think that’s a time that you need to be reaching out and just asking for help in some way.

Kevin Pho: We’re talking to Courtney Markham-Abedi. She is a psychiatrist, and she wrote the KevinMD article “Doctors are killing themselves, and who is taking notice?” Courtney, we’re speaking in the middle of January, in the midst of the worst wave of the pandemic. Can you share how COVID-19 has exacerbated clinician burnout and clinician suicide over the last year or so?

Courtney Markham-Abedi: There’s more isolation, both in our practices and in our personal life. So even in practice, you’re not sitting in rooms talking to people anymore. It’s all by Zoom, and you don’t really have that connection, I think, that you’re used to. There’s no water cooler talk, so to speak. So we’re losing those connections. And then in our personal life, mostly we’re at home or at work, so we’re just not connecting with people. And I think connection is such an important thing for us as humans, and I believe that’s part of what we’re seeing.

Kevin Pho: We’ve approached clinician suicide from the perspective of that individual clinician, but how much responsibility is placed on the medical system itself and some of the stresses that the medical system places on its clinicians?

Courtney Markham-Abedi: I think that the medical system has a big responsibility in this. I think that we are kind of making changes, but the way that residents were trained and expected to work hours, not complain, come to work sick, I think that has affected what we see in medicine. There’s this idea that you can’t be sick, you can’t miss work. And so, of course, with depression, that’s even a point further, because then you add stigma to that. So I think definitely that the medical system, in the hierarchy that we’re used to, does have something to play in depression and physician suicide.

Kevin Pho: And what are some actionable things hospitals and medical centers can do to help alleviate the stresses placed on clinicians and hopefully make an impact on physician burnout?

Courtney Markham-Abedi: I think education about when you need to go see somebody. I think employee assistance programs, where sometimes you can get therapy right there and don’t have to go outside of the system. And I believe just kind of supporting, whether it’s supporting people with the electronic health records and scribes, or just kind of cutting down that administrative burden, I think is important. And then just being able to talk about when things go wrong, and somebody to talk to about that, whether it’s a friend or a colleague, and kind of making it acceptable to talk about when things go wrong.

Kevin Pho: Share any resources with my clinician audience, whether it’s online, or who can they talk to in case they may find themselves going down that path towards mental health issues?

Courtney Markham-Abedi: There’s a suicide number. I don’t know it off the top of my head. That’s a resource. And then I think just, if there’s anybody in your system that you could just reach out to and say, “Hey, can you give me a number for somebody?” I think that’s a good way to start too.

Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?

Courtney Markham-Abedi: Reach out to people in the profession. Reach out to people if you’re seeing that they aren’t themselves. Just say, “Hey, how are you?” And then on the other side, if you’re feeling that way, we’re helpers; people want to help. So send somebody a Facebook message. Send me a Facebook message. I may not be able to treat you, and that person may not treat you, but they can point you in the right direction. And so I think that’s what we kind of need: to be supporting each other and reaching out to each other in this time of isolation.

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Courtney Markham-Abedi: Thank you. Thank you.

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