Physician suicide: Where are the leaders? [PODCAST]

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“As a mother, a physician, and an educator, I refuse to accept this as normal. It is not! What should we tell the parents of these young physicians? How do we explain to them that their dream of being a doctor became a nightmare with a tragic ending? What do we tell their children when they ask for daddy’s good night kiss, or for mommy’s caring hugs? Where are the leaders? How did nobody notice their sadness, lack of hope, and deep desperation?

Sadly, this tragedy is not isolated. These types of events are happening around the country and in different institutions. The hopes of young physicians are transforming on fears, the excitement on stress, the smiles on tears. Where are the leaders? How did nobody know that something wrong was happening?”

Miriam Zylberglait Lisigurski is an internal medicine physician.

She shares her story and discusses her KevinMD article, “Physician suicide: Where are the leaders?”

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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 we welcome back on the show Miriam Zylberglait. She is an internal medicine physician, and she wrote the KevinMD article “Physician suicide: Where are the leaders?” Miriam, welcome back to the show.

Miriam Zylberglait Lisigurski: Thank you so much for having me again.

Kevin Pho: So for those who do get a chance to listen to our last few episodes, let’s briefly share your story and journey to where you are today.

Miriam Zylberglait Lisigurski: I am originally from Peru. I am an academic physician. I am an associate program director for an internal medicine residency program, so I have 45 residents who are my kids, my family, and some extra medical students. I am very into promoting wellness in my residents. I feel like in order to be a good physician, we need to be good people, and we need to take care of ourselves.

Kevin Pho: So you wrote this article, “Physician suicide: Where are the leaders?” And before we get into that, tell me about how you got so interested in physician wellness.

Miriam Zylberglait Lisigurski: So again, as an academic physician, I have the joy and, at the same time, the responsibility of teaching young doctors, to try to guide them in the right direction. The challenges that we face as physicians and as adults are big, but I believe that the ones that the residents and medical students are facing are even bigger, especially with COVID now. I don’t think that we are providing them with all the education and the skills that they need for this new era of practicing medicine in this country. I feel like providing them with education in leadership, in well-being, and emotional intelligence development will help them to be successful in their personal and also in their professional lives.

Kevin Pho: Now, over the years, are you seeing burnout in medical students and medical trainees? Is the frequency of burnout increasing over the years that you’ve been teaching them?

Miriam Zylberglait Lisigurski: I will say that officially, I probably will not have appropriate data. We don’t tend to screen formally. Unofficially, I will say that yes, and a big part of it, I feel like, is related to more administrative work instead of human contact. But I feel like students and residents feel this emptiness when they use their time, their energy, and their effort in doing tasks that are related to the computer, clicking buttons, and fulfilling metrics, instead of being close to patients and having this rewarding feeling of being in contact with another human being.

Kevin Pho: Now, of course, you and I, we’re attendings, and we’re certainly familiar with all the bureaucracy and paperwork that’s been increasing over the years. But from the perspective of a medical student, intern, and resident, give us an example of what kind of administrative burden they’re facing, whether they’re in training or even just coming out of training.

Miriam Zylberglait Lisigurski: Well, they have to be in front of the computer long hours. The notes, the orders, everything happens there. You really spend more time in front of this machine that gives you most of the answers, and you need to click all these buttons so you have the metrics and everything that you have to complete on time. And then the time that you spend with your patient is really minimal, and you are exhausted at the end of the day.

Beyond that, remember that medical students or residents still need to keep studying. We have to do it too, right? But they have the pressure of passing Step 2, Step 3, the boards, so they also have an academic pressure that they need to complete. And many of them are starting families. They are getting married, they have their first baby, they have family members who get sick. So it’s a big challenge. And I believe that we cannot forget about the financial burden that they have, knowing that they will have to pay for medical school for a long time. So that’s something that I feel adds to the pressure.

Kevin Pho: All right, let’s talk more about your KevinMD article. It’s titled “Physician suicide: Where are the leaders?” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Miriam Zylberglait Lisigurski: So normally, for those who know me, I am a very positive person, and I try to find the light at the end of the tunnel. That’s kind of different with this article. I was very frustrated, I was upset, and I was asking myself why. I came across an article that was describing the deaths of three resident physicians in one facility in a period of seven months. That got my attention, and I started reading the article, then clicking the links and seeing that these cases were not isolated, that there were very many cases, one after the other, in different places. And the first question that I had was, “Where are the leaders? How is this so quiet? What are they doing?” And I didn’t have many answers, to be sincere, and that’s how the article started.

Kevin Pho: Now, in those cases where the residents tragically took their own lives, what was the response of their leaders?

Miriam Zylberglait Lisigurski: It’s very interesting. There is not a lot of information there. I have to say that I am blessed. I never had the personal experience. I know that when I asked my residents and medical students, more than one raised their hand, saying that they had a friend or a colleague who died by suicide in the past. I have never been in a situation like this, and I don’t want to be in a situation like this.

I believe that we need to focus on preventing these types of things from happening, and in order to do so, we need to create awareness, we need to understand the type of challenges that we are facing, and we need to start to be proactive. You cannot recover the life of someone after he’s gone, and that breaks my heart.

Kevin Pho: So give us some examples of what physician leaders can do to address burnout, potential behavioral health issues. What are some of these proactive examples physician leaders can do?

Miriam Zylberglait Lisigurski: I believe that it depends on the type of leadership, right? Because we will have it at a national level. I believe that leaders need to promote the idea that physicians and any other health care provider should have access to mental health support without any retaliation. And that means that none of us will have to put in our license application or our job application that we had required support from a psychiatrist or a psychologist to cope with burnout or anxiety or depression. That’s a big limitation, and that’s something that I believe comes from higher leadership.

In the institutions, academic institutions, hospitals, or medical schools, I believe that we need to foster an environment that is free of discrimination, free of retaliation, where residents or medical students and physicians in general feel free to express concerns, where we feel that we belong, that we are treated with respect. And that’s easy to say and more complex to get done. But if we don’t start educating the leaders, and I believe that that’s where we have to start, we need to educate the leaders. We need to educate those who are making decisions, so they understand that there is a risk, that in medicine not everything is about metrics, that we need our providers to be healthy, to be happy, to be 100 percent focused on what they are doing, so we can really help our patients and we can grow the institution where we are working. And I don’t think that that’s really understood by non-physician leaders in the health care system.

Kevin Pho: Today we welcome back on the show Miriam Zylberglait. She is an internal medicine physician, and she wrote the KevinMD article “Physician suicide: Where are the leaders?” Miriam, you mentioned that you supervise 30 to 40 medical students, interns, and residents. Now, what are some of the things that you do to check to see if there are any behavioral health issues and to assure the behavioral wellness of the students that you supervise?

Miriam Zylberglait Lisigurski: So I’m very lucky that in my institution, at a national level, they have a wellness committee. So at the national level, we are working on projects to foster well-being, to try to understand the challenges, and to provide support to the local institutions, to be able to create local projects. In my case, in the hospital where I work with my residents, we have a local wellness committee that is run by the residents. They organize activities, from parties, well, now it’s a little more complex with COVID, to different types of interactive activities, including painting, for example, or yoga relaxation, so we can have a fun time that promotes well-being and good, positive interaction between us.

We are giving lectures and presenting workshops that promote the idea of stress management, communication, and prevention of burnout. And recently, actually, we had a day of movie time, let’s call it, where we showed them a documentary about physician suicide, and we had the opportunity to have a conversation after that to create awareness.

Beyond that, we have a peer mentorship program. We feel like the ones probably most at risk of having any challenge at the beginning are the interns, so every intern has a peer mentor who is a senior resident, who welcomes them into the program and helps them not only with the academic part or the clinical part, but with where to find clothes, who cuts your hair, these silly things that are so important when you are coming from another country or another city, and especially when you have family. So that’s what we are trying to create: an environment that makes us feel that we belong and that we are a family, and that there’s someone there to support you.

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

Miriam Zylberglait Lisigurski: Take care of yourself. Pay attention to yourself. Be nice to yourself. And after you do that, enjoy medicine and take care of the ones who are around you. And try to identify red flags. Don’t let things happen.

Kevin Pho: Miriam, thank you so much for coming back on the show and sharing your time and insight. And thanks again for your time.

Miriam Zylberglait Lisigurski: Thank you so much.

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