Physician suicide a hidden health crisis
News-Journal - 3/18/2019
March 18-- Mar. 18--DAYTONA BEACH -- It was during medical school that Dr. Pamela Wible said she began to lose her way.
"I thought I was the only suicidal doctor," Wible said. "I was really depressed during med school and I became suicidal during our training clinics."
When she held up photos of herself at high school graduation and then at her medical school graduation from the University of Texas, the change in her expression was striking.
"I don't have that same exuberant 'I-can't-wait-for-life' attitude," Wible said of the med school photo. "I look like I survived a war and I was forcing a smile because I was graduating from med school and that is what I was supposed to do."
Wible, a physician from Eugene, Oregon, was the keynote speaker at "Healing Healers," a recent event on physician wellness, suicide and how to thrive as a physician presented by the Volusia County Medical Society and Florida State University College of Medicine at the Museum of Arts & Sciences. The event in late February was attended by more than 200 doctors, medical students and others in the healthcare field.
Wible started the "ideal care movement" in 2004 after becoming fed up with "assembly line" medicine and held town hall meetings where citizens designed their own ideal medical clinic. Her own struggles with depression and that of her fellow co-workers led her to actually build the clinic where she practices today.
Wible is a nationally recognized speaker and author on the topic. Her involvement in the topic began in 2012 while she was at the funeral for a co-worker. She began to count all the physicians she knew who committed suicide. At the time it was 10.
Suicide among the medical community is often kept below the public's radar because of the stigma surrounding suicide as a whole. Wible's goal is to get physicians to talk more about their struggles with depression. While no organization collects official data on physician suicides, Wible estimate that at least 400 physicians kill themselves annually, the size of an entire medical school class.
"By Oct. 28, 2017, I knew 547 (who committed suicide) and now I know 1,208," she said. "It's a public health crisis.
According to Wible, the medical profession has the highest rate of suicide of any profession. Among doctors, anesthesiologists are the most likely to die of suicide based on her study. She found that male doctors commit suicide at a rate that is 70 percent higher than other professionals; among female doctors, that rate ranged from 250 to 400 percent higher. Of the 1,208 suicides she's analyzed, 40 were in Florida. Only two of those suicides were women.
"Seven of them were gunshot wounds; with men it's a popular way to go," Wible said. "Other popular ways were overdose, jumping off a building and hanging."
Some of the reported reasons for suicide were untreated depression, financial issues from student loans or divorce, and whistle-blower and fraud accusations.
"Physicians are so caring and loving and they martyr themselves to save others," Wible said. "We are not making it easy for people to get help."
Wible said she overcame depression and suicidal thoughts by asking for help from the right people.
Clayton and Julia Wittman didn't see their son, Matt's, death coming.
They hadn't talked him in months. He didn't call. He didn't discuss his challenges. He didn't tell anybody about his depression. Matt was failing two classes at Florida State University College of Medicine where he was in his second year. He had accumulated more than $100,000 in student debt.
"His depression was unknown to us," Clayton Wittman said. "The rare times he did call home it was taboo to talk about finances, about school, even about church."
In February 2017, the Wittmans' phone rang. Matt had taken his life.
"It was a compete surprise to us, to his friends, his classmates," Wittman said. "At his funeral everyone wanted to know if we had any insight. We didn't."
The pain hasn't gone away for Clayton Wittman, but he used that pain to reach out to other students and physicians.
"You are not alone in this," Wittman said with tears in his eyes.
To honor Matt, Wible said medical students and physicians need to have a plan B, not isolate themselves, share their feelings, seek mental health care and realize that life is more important than their career.
"If we are trying to figure out what to do here we need to be revealing of our true feelings," Wible said.
But it's often hard to identify physicians who are struggling with depression and suicidal thoughts because they hide behind a fake smile and they hardly ever waver in their dedication to their job, Wible said.
"They are shining stars at work right up until they kill themselves," Wible said. "I have interviewed those who survived their suicide attempt and it's an impulse move at the end."
One of the ways Wible wants to help lower the number of suicides in this profession is to educate students before they reach medical school.
"People who have already had suicide attempts in high school, anxiety attacks in college or have battled addiction should know how stressful being a medical student and physician is before they pursue these careers," Wible said. "We should be having these conversations with them while they are premed students."
On Feb. 8, 2017 the medical community lost another member, Oak Hill Hospital Spinal Surgeon Dr. Steven Ortiz, to a self-inflicted gunshot wound. The hospital is located in Spring Hill, just north of Tampa.
Before his death, Ortiz refused to do surgeries, especially for elderly patients, when he felt there were other safer and more effective treatments available. He was referred fewer patients and lost 30 percent of his income, according to Wible.
Ortiz called his mother the night before he killed himself and shared his troubles with her. He wrote a letter naming people involved in ruining his career and what he had witnessed. Details are not available because of an active investigation. He sent an email to registered nurse Sherry Cleveland asking her to tell everyone goodbye for him.
At 2 a.m. he checked on all his patients and wrote orders to make sure they were all OK. At 3 a.m. he went to his truck in the hospital parking lot and shot himself in the heart.
"I was devastated," Cleveland said about the email from Ortiz. "I opened my email and I was numb."
When Cleveland arrived at work, she saw police in the parking lot and knew it was for Ortiz.
"I didn't know what to do or think," she said. "I was the person he felt comfortable enough with to share that information and to be his messenger. It was a lot of weight to hold."
It's been two years and Cleveland said it's still hard.
"I can't work on spinal cases anymore," she said through tears. "It hurts too bad."
Raising awareness of physician suicide is Wible's main goal. But she also wants to help suicidal and depressed physicians and medical students get the help they need. She has her own physician retreat in Oregon, where they can go to relax, talk and get any help they need.
Some things she suggests medical facilities can do to help their physicians is to offer on-site mental health care; train staff members in physician PTSD, depression and suicide; have doctors debrief after a traumatic case; have a recovery room for doctors after a traumatic case; and have a chaplain available to doctors.
"These physicians who die of suicide are being dis-remembered in death," Wible said. "If I were not here, these people could be at risk of being left in perpetual isolation in death just like they were in life."
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