I am a physician, a urologist, but what most people don’t know about me is that I am a survivor of mental illness, physician burnout, and multiple suicide attempts. Today, I write about the condition of the medical profession, its problem with burnout, and its solutions.

I began practicing general urology in 1987. My subsequent life as a physician can be divided into two very different eras. In the first era, I had a happy, busy, successful life and clinical practice. I practiced and lived with little compromise. My whirlwind existence was characterized by long hours, commitment to medicine, and dedication to my family, community, and church. However, two catastrophic medical illnesses began a downward spiral that culminated in my retirement from clinical medicine in 2003.

In 1998, I contracted sepsis after a family trip abroad. Foolishly, I did not seek medical care and awoke one night with shaking chills and fever. Within hours, I was being intubated for respiratory failure and septic shock. I spent six weeks in the intensive care unit with all the manifestations of sepsis: ARDS, DIC, hepatic and renal insufficiency, tracheostomy, chest tubes, and a 40-pound weight loss. After ten months, I was able to rehabilitate and return to clinical practice, only to have a snowboarding accident just one year later. Once again, I faced ICU admission, surgeries, tracheostomy, and another 40-pound weight loss. Yet, I managed to rehab and return to my urologic practice.

When I returned to medicine, I was not the same. I faced a life of overwhelming black depression, anxiety, and difficulty fulfilling my desire to practice medicine. I tried to return to my committed lifestyle, one of total dedication to medicine and family. I thought that if I only tried harder, my life could be as before. However, I began a downward spiral into darkness, plagued by burnout, mental illness, suicidal ideation, and behavior. After three suicide attempts, I realized that in order to save my life, I must retire from clinical practice.

After nearly twenty years as a medical hermit, shying away from the profession, I now speak out about the condition of our noble profession. The medical profession is sick. The overwhelming number of physician suicides per year, nearly 400, is enough to fill a Boeing 747 or two graduating medical school classes. While suicide is often multifactorial, nearly all of these cases are attributed to a dysfunction within the medical profession, so-called physician burnout.

What is the cause of this disturbing phenomenon? I believe the root source of burnout is the continuing deterioration of the sacred doctor-patient relationship. Examples of this phenomenon are myriad and continue to accumulate daily.

I divide solutions to our physician burnout problem into two groups: personal physician solutions and medical professional solutions. Personal solutions include:

Physicians need to recognize the culture of overwork. If you think about it, we overwork to get into medical school and carry out our post-graduate residency training. Physicians, as a group, are naturally selected for this behavior. This performance of overwork is encouraged and spills over into our clinical practice and lifestyle.

Physicians need to take better care of their personal needs. They must create boundaries for a more balanced life with family, hobbies, exercise, and spiritual awareness.

Physicians need to seek mental health care when needed. Society, and especially our profession, frowns upon this.

Attention to financial planning, awareness of early retirement options, and the use of sabbaticals are essential.

These lifestyle issues should be discussed continuously throughout medical training. I envision a course in medical school that runs parallel to clinical and basic science courses, addressing what it is like to practice medicine while maintaining personal well-being.

The medical profession must better cope with the physician burnout crisis. Some solutions include:

Emphasizing the sacred doctor-patient relationship. This is the most significant factor and should be considered at every opportunity. Remember that big business should not make clinical decisions better reserved for the physician and patient in the exam room.

Physicians must have more input into their clinical environment.

Pet peeve: Patients should not be called consumers or physicians’ providers. The terms physician or doctor and patient should be used at all times.

Tort reform is critical. The threat of malpractice suits and actions is overwhelming for practicing physicians.

Physician mentor programs should be developed and encouraged. Ideally, a young physician should be paired with a more senior colleague for a lifelong relationship, providing someone to consult as the inevitable difficulties in practice develop.

Anonymous telephone helplines need to be developed. Too often, physicians are wary of discussing their difficulties. Helplines allow for discussion without fear of hospital privilege, legal concerns, or licensing issues.

Alternative mental health insurance is mandatory. This insurance allows physicians to seek mental health care outside their medical group, reducing some of the stigma associated with these issues.

Our noble profession is sick. We must save clinical medicine. The subject is uncomfortable but crucial to the profession. I would like to close with a pep talk—a list of synonyms for the word noble.

The practice of medicine is noble; it is honorable, moral, decent, and upright. The practice of medicine is proper, good, ethical, right, and worthy.

William Lynes is a urologist.