I wrote last year about physician suicide as a silent epidemic. The silence is not lifting. The losses are getting closer. The grief is heavier. We all feel it. This month, we lost Dr. Nolan R. Williams. He advanced care for severe, refractory depression and pushed neural stimulation science forward. Then he died by suicide. His death landed like a shock wave across medicine and beyond and the lesson is hard. Even our brightest healers suffer and even those building new treatments for despair can be overwhelmed by despair.

We have been here before. In 2017, a federal jury acquitted Wisconsin physician Dr. Charles Szyman after a five-day trial. Months later, he died by suicide. He had won in court, yet the pressure did not end and the weight of years of scrutiny and litigation did not let go. We mourned a colleague whose name should have faded back to normal life, not into an obituary. I wrote about that in my book Doctor Not Guilty.

Words matter here. Say died by suicide. Not committed. Not successful or failed. Neutral, humane language reduces shame and it invites help and respects families. This is the guidance from our field, and it is basic decency.

The data does match what many of us live, as a recent JAMA Network Open study reviewed deaths among U.S. medical residents and fellows from 2015 to 2021. Suicide was the single leading cause, responsible for nearly one in three resident deaths, with risk concentrated early in training. You do not file numbers like that away, you act on them and build systems around them.

I am a physician. I have seen the pressures inside the white coat. The pager never sleeps and the messages never end. The performance demands never loosen. You absorb patient stories all day, then hold your own. You move from room to room with a steady voice. Your back stiffens. Your jaw locks. Your spirit thins. Media coverage shapes behavior. It can inform and protect. It can also harm. Reporting should avoid detailed descriptions of method or location. Avoid glamor. Avoid blame. Emphasize recovery. Emphasize help. Use died by suicide. Include resource links. These are safety measures, not semantics. They reduce contagion and guide people to support.

To my colleagues: You are not weak if you are hurting. You are human and the mask you wear to keep others safe can suffocate you. Take it off long enough to breathe. Talk with a therapist or call a friend who can hold the weight with you. Tell your program director what you need. Call your pastor or imam or rabbi. If you must, open your chart and write your own name in the patient slot. You are not a liability for seeking care. You are an asset for surviving.

To trainees: Your risk is not theoretical. The first months of training are dangerous for mood and sleep. Build a plan now. Two peers on speed dial. One faculty advocate. One professional in your phone with after-hours access. One ritual that protects your sleep. Hold to it like you hold to sterile technique. The stakes are the same.

To program leaders: Align your operations with the risk data. Stand up a transition protocol for every intern. Staff peer mentors outside the line of evaluation. Print one card with key numbers for urgent support. Normalize mental health sick days. Protect sleep. Debrief after deaths and codes. Track near misses tied to fatigue. The cost of prevention is modest. The cost of each loss is infinite.

To hospital executives: Stop asking for resilience while rewarding self-erasure. Measure wellness like you measure RVUs. Publish the numbers. Tie leadership bonuses to psychological safety, retention, and access to care. Fund confidential, off-site therapy with no billing trail to the hospital. Cover it for spouses. Strip intrusive mental health questions from credentialing and privileging. Focus on current impairment only, not history. Align your policies with national recommendations. Then audit compliance.

To journalists and influencers: When a physician dies by suicide, you cover more than a person. You cover a system. Follow evidence-based reporting guidelines. Name help. Avoid method. Avoid speculation. Ask experts to speak to recovery and prevention. Your choices carry real effects on real people.

Finally a note to the public: Your doctor is not invincible. Your nurse is not made of stone. Your psychiatrist does not live outside the reach of despair. If your clinician sets a boundary to protect health, accept it. If your clinic delays a convenient refill because a doctor took a day for therapy, bless it. If you run a plan or a clinic, make space for care teams to be cared for. You want your surgeon rested. You want your psychiatrist supported. Your family’s safety depends on the health of the people who treat them.

We also need to talk about meaning. Many clinicians draw strength from prayer, community, and service. Make room for it. Chaplains who understand moral injury help. Time to reflect on why we practice helps. Medicine without meaning empties you. Medicine with meaning can heal both ways. Policy matters. Congress and state boards set levers that shape our days. Fix Medicare payment that punishes time. Simplify prior authorization. Fund graduate medical education at levels that meet demand. Expand loan repayment tied to service in shortage areas. Protect whistleblowers who report unsafe workloads. Invest in evidence-based treatments for depression, including neuromodulation and rapid-acting antidepressants, with equitable access. Honor Dr. Williams by accelerating safe, effective care for those most at risk. Accountability matters too. In high-profile prosecutions, the public debate often ignores the human cost after the verdict. Dr. Szyman’s case reminds us that acquittal does not end pressure. Years of headlines, suspensions, and lawsuits leave scars. If we want justice, we must measure the downstream harm of process itself. We must build reentry support for exonerated professionals. We must end stigma for those who ask for help. Otherwise, we risk more funerals for people who did their best to help others. A word on language again. Families carry enough pain. They do not need words that imply crime. Say died by suicide. Say we miss them. Say we will fight for the living. Follow the field’s guidance. Model it in clinics, classrooms, and newsrooms.

What next.

For physicians: Book your own visit today. Set a recurring peer check-in. Audit your sleep. Check your state’s licensure language. If it is punitive, organize to change it.

For program directors: Run a 30-day sprint. Map interns at highest risk. Put an attending on wellness call at night. Hold a monthly protected hour where no one presents a case. People speak as people. Pilot it. Measure it.

For health systems: Publish a quarterly wellness dashboard. Share it. If numbers go the wrong way, own it. Fix it.

For media: Add 988 to your template. Keep it there. Follow safe-reporting guidelines. Consult experts before publishing sensitive stories.

For the rest of us: Hold each other tighter. Ask a colleague, how is your heart, and wait for the real answer. If you are in crisis, or worried about someone, call or text 988 in the U.S. The Suicide and Crisis Lifeline is open 24 hours, confidential.

We lost Nolan Williams. We lost Charles Szyman after he won his case. We have lost too many. Speak with care. Act with urgency. Build systems that protect the people who care for you. Refuse to normalize preventable deaths. Refuse to let the next obituary be someone you know.
Muhamad Aly Rifai is a nationally recognized psychiatrist, internist, and addiction medicine specialist based in the Greater Lehigh Valley, Pennsylvania. He is the founder, CEO, and chief medical officer of Blue Mountain Psychiatry, a leading multidisciplinary practice known for innovative approaches to mental health, addiction treatment, and integrated care. Dr. Rifai currently holds the prestigious Lehigh Valley Endowed Chair of Addiction Medicine, reflecting his leadership in advancing evidence-based treatments for substance use disorders.

Board-certified in psychiatry, internal medicine, addiction medicine, and consultation-liaison (psychosomatic) psychiatry, Dr. Rifai is a fellow of the American College of Physicians (FACP), the American Psychiatric Association (FAPA), and the Academy of Consultation-Liaison Psychiatry (FACLP). He is also a former president of the Lehigh Valley Psychiatric Society, where he championed access to community-based psychiatric care and physician advocacy.

A thought leader in telepsychiatry, ketamine treatment, and the intersection of medicine and mental health, Dr. Rifai frequently writes and speaks on physician justice, federal health care policy, and the ethical use of digital psychiatry.

You can learn more about Dr. Rifai through his Wikipedia page, connect with him on LinkedIn, X (formerly Twitter), Facebook, or subscribe to his YouTube channel. His podcast, The Virtual Psychiatrist, offers deeper insights into topics at the intersection of mental health and medicine. Explore all of Dr. Rifai’s platforms and resources via his Linktree.