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A Message from Your Council President: talking about physician suicide
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Council, May Messenger 2021 |
Posted May 13, 2021
By Dr. Louis Hugo Francescutti, CPSA Council President
Physician suicide is an issue that has upset me throughout my career. I hope to never see another classmate, learner or colleague die by suicide. Although it’s a difficult topic, if ever there was an important time to discuss physician suicide, it is in the middle of a relentless pandemic. Knowing the sustained, enormous pressure and uncertainty COVID-19 has introduced, as well as the mental, emotional and physical toll it’s taken on us all and our patients, we simply need to initiate this difficult conversation within our profession.
For as long as I can recall, when a physician dies by suicide a hush tends to descend on the profession. Like so many others who die by suicide, their obituaries say they died a sudden, unexpected death, rather than describing a lengthy and courageous battle with illness. Presumably because of shame, eulogies rarely mention the individual took their own life. Families are often silent in an effort to protect their loved one’s memory.
These tragic events are often not shared widely, yet recent Canadian Medical Association (CMA) studies indicate eight per cent, or approximately 7,000 Canadian physicians have experienced suicidal thoughts in the last year (2019). Additionally, CMA found one in three physicians screened positive for depression. The Canadian Journal of Psychiatry reported 85 to 90 per cent of people who die by suicide have been living with a mental illness. Additionally, those studies spoke to the families of physicians who die by suicide and indicated 10 to 15 per cent of those physicians received no treatment for their mental illness.
The CMA study outlines the unfortunate reality that physicians are at a greater risk of dying by suicide than the average person, and women have a higher likelihood than their male counterparts. Surely, with this knowledge, we all need to take steps to address this issue. We need to better understand physician suicide, openly talk about it and support each other in our day-to-day work. By doing this, we can decrease the stigma associated with suicide and hopefully get more of our colleagues the care they need before they take their lives.
Unfortunately, I have no quick and easy solutions to this problem. Rather, my goal today is to initiate a conversation so we can all consider different ways our healthcare system can adapt to create more supportive and ideally less stressful work environments. We at CPSA know we need to look at ourselves as well. For example, CPSA recognizes stigma is a significant contributor to physicians not accessing care for their mental illness. In addition, we know untreated mental illness is a contributor to suicide. Therefore, we are currently looking at the value of asking about mental illness on the annual renewal. Preliminary data from a study in the US indicates removing the question about mental health from the annual renewal may not have negative impacts on patient safety, which is why we need to consider if such reporting may increase the stigma related to mental illness and accessing care (2019). We also know stressful situations like receiving a complaint from the regulator may trigger an adverse reaction from someone with mental illness, and perhaps even the risk of suicide. The unfortunate reality is that complaints are a part of our professional lives as regulated professionals. Therefore, as a regulator we need to work with our partners to identify ways to better guide physicians to get the support they need while going through this process.
Physicians are fortunate in many ways to do a job they enjoy but nonetheless, some are struggling to keep up with the demands placed on them. This is likely contributing to mental illness and suicide. We need our profession and the greater health system to recognize this and look for new and innovative ways to reduce the stigma associated with mental health, increase access to care, and enable this difficult conversation. I believe the profession needs to start having a more open conversation about mental health and suicide, and stop dealing with this behind closed doors. We can’t help by just ignoring it—let’s not be silenced by stigma. I hope together we can be more open to the perils of mental illness combined with the significant pressures of practising medicine. I also hope by having these conversations, we stop ignoring the signs in those who are struggling.
My goal here is to simply start a conversation within the profession and ideally bring this serious issue into the light of day. If a physician reading this believes they are suffering with a mental illness or worse, are considering self-harm, please reach out to a distress line (1-833-456-4566, 24/7) or text 45645 (2-10 p.m. MT), speak to someone you trust, or visit your closest emergency department and ask for help. We would never shame a patient for asking for help, so we should never feel shame ourselves, or shame another physician for reaching out. Please don’t suffer in isolation and silence. Doctors are not super human, it is always right to ask for help. The AMA’s Physician and Family Support Program is a great resource, but there are many other supports available, including your family doctor.
We all need to be kind, listen, reach out and be honest about our own challenges. Let’s help one another by checking in with each other often.
I would appreciate hearing your thoughts below.
References:
https://journals.sagepub.com/doi/full/10.1177/0706743719856002
| Join CPSA Council President Dr. Louis Hugo Francescutti for a virtual Q&A!
The past year has made it challenging to connect with one another face-to-face. That’s why Dr. Francescutti is kicking off a monthly virtual Q&A session for physicians. This is your opportunity to engage with CPSA, ask your questions and hear directly from Dr. Francescutti on matters affecting physicians and Albertans. Join us for our inaugural session next Thursday, May 20 from 12-12:45 p.m. |
My honest opinion is that if we’re serious we should begin by adressing one of the earliest degradations of passionate and idealistic trainees. I suggest we get rid of call obligations especially for residents who face the brunt of the workload in my experience and have absolutely no say in whether they feel comfortable caring for patients with no sleep and receive only the most insulting compensation stipends for lengthy shifts with no time to eat, take a break, or in some cases go to the bathroom under the guise of educational benefit. Its barbaric, inhumane, and it has had a greater negative impact on me and colleagues than all other stressors especially during covid where so often the safety measures to protect oneself from the virus were laughably employed when faced with the reality of being on site for so long in one shift. The workload is not at a level congruent with good patient care or physician wellness. The practice seems to be an exercise in mock resilience, patriarchal ego (are we really so superior we don’t need sleep to do this demanding job?) or a demonstration of unhealthy dedication. Call erodes many of us and our passion early in training forcing us to act in opposition to our better judgment and sets a precedent that martyrdom and a race to the bottom is essential for good physicianship when I would argue it is contrary to all measures of success in our collective endeavor and serves only as an archaic vestige from a time when abuse was a tool of teaching.
If we want the outcomes to change, we have to change our approach. If the system builds broken doctors maybe we need to make real change instead of stopping short of the hard work of addressing the issue instead opting for further awareness efforts and soaking up free time with laughable wellness seminars forcing the issue onto those least able to address it at its source and offloading responsibility onto the individual for a system wide problem. I think this can be solved but not likely by continuing to talk about it ad nauseum while doing nothing to change. Let’s lift each other up especially our junior colleagues instead of holding each other down. I think this is a decent step though surely not the only one needed in a profession that has long endorsed by action if not words the isolated suffering of its members and we can do better. We need to do better.
Thank you for taking the time to respond and share your experience with call obligations. I think you have made some very valid and concerning points around intense resident workload not being conducive to both good patient care and physician self-care. We should be looking to set up learners for success, rather than inflicting burnout on the next generation of care providers right from the start. While I don’t have specific answers at this point, I am committed to bringing this topic up with my fellow Council members, as I feel it warrants an important discussion. Starting next week I’ll be hosting monthly Q&A sessions for physicians. The first session will talk about some of what I shared in my article, and I encourage you to join us for this important discussion.
I fully support the motion to remove mandatory reporting of mental illness on the CPSA annual renewal for physicians. The reduction of any barriers to accessing mental health care will benefit the entire system. As with any workplace, the risk of losing one’s job/income due to reporting a mental illness will decrease the likelihood of anyone accessing care to address that concern. We see this with our own patients all the time- why would it be any different for physicians? After all, we are patients, too.
Thank you for sharing your perspective and please know it’s noted. It’s a question CPSA is debating, and hearing perspectives like yours helps us make informed decisions. Your point that physicians are also patients is an important reminder and something many often forget. I appreciate your openness and candour—please join me for a physician Q&A on the 20th if you’d like to discuss this further.
Hi Louis,
This is Jim Ruiter, one of your classmates – yeah class of ’87!
I like what you are doing.
You may – or may not – have heard that like so many of our colleagues, I burnt out of practice. When we had our reunion at your place some 15 years ago, I was on the edge. An edge I did not recognise at the time, since our warning signs are trained out of us during residency. However, my family – having known a close friend commit suicide a few years earlier – did. They saved my life and pulled me out of practice in 2008.
As I reflected – during my healing – I realised that I had responded to all those surveys you mentioned with cries for help.
No one came.
I sure hope that people, who respond to those surveys today in the way I did, are supported now. I know the surveys are anonymous, but surely a message after each survey in a newsletter, or a suggestion – as you have – to seek help would be a good step. Maybe even have the computer automatically pop in a phone number when you answer in a certain way… Surely there are ways to reach our colleagues and friends…
This is a hugely important topic. Thank you for bringing it forward.
Stay well.
‘Nicely healed and back on seriously solid ground’ Jim
“An edge I did not recognise at the time, since our warning signs are trained out of us during residency.”
Yes. This. Thank you for sharing your wisdom.
Hi Jim—thanks for your note and honest account of your situation. I’m sorry you had that experience and I’m disappointed to hear you didn’t feel supported when you were going through it. But mostly, I’m glad to hear you’re now doing well.
When a physician notes on their annual renewal that they are experiencing mental illness, CPSA’s Physician Health Monitoring will typically follow up with the physician, although CPSA’s primary role is in fitness to practice rather than a treatment resource. We do work with PFSP and other agencies to try to make sure physicians are supported when they contact us.
I would love to see you at my Q&A on May 20 at noon if you’re free.
“An edge I did not recognise at the time, since our warning signs are trained out of us during residency”
These words are so chilling and so true.
Thanks, Dr Ruiter, for sharing. Thanks, Dr Bisby, for emphasizing that statement.
Well written as always, thank you for that. It has been a difficult time for sure.
Thank you, Dr. Sails. In challenging times like these, one of the best things we can do is reach out and support each other. I’m hosting a virtual Q&A on May 20 at noon and hope you will join to chat further about this important topic.
Thank you for this very sensitive but necessary discussion. A platform to reach out allows physicians to not feel
Like they are weak or alone on this. I had no idea this pandemic would wear me out the way it does so I feel for so many front line hopitalists too.
Thank you for sharing your honest perspective and experience, Dr. Ahmed. This pandemic has challenged us in so many ways we could never have imagined. Thank you for the work you’re doing—please use the resources highlighted in my article which are available to physicians. Now more than ever we need to rely on our support systems to get through the pandemic. Feel free to join my Q&A next week if you’d like to chat further.
This is such an important topic and certainly needs more open discussion to destigmatize the suffering that many physicians feel they must go through alone, in silence.
Unfortunately, while many of the factors that lead to these increased risks are systemic and some are unavoidable, regulators, such as the CPSA, certainly have a negative impact on physician mental health as well.
Given many horror stories from colleagues I have heard over the years about the absolutely unacceptable way the CPSA handles complaints, as well as the stressors caused by being forced to disclose health information to the CPSA I am unfortunately not optimistic that there is any real desire from the college to improve itself. These issues are not new. The new stories I hear from colleagues year to year do not improve. I will only believe that the college is willing to do their part to improve after I have seen the evidence that it has already taken significant steps to do so.
To any colleagues who happen to read this an who are struggling. Please reach out to those who you trust. We need to support each other and there should be no shame is asking for help.
Hi Parker, thank you for sharing your perspective, and know you are certainly not alone in identifying potential systemic factors that could lead to burnout and mental health stressors. While complaints are an unfortunate reality for regulated professionals, I agree that CPSA has a role to play in examining how we can lessen the psychological burden on physicians throughout the process. CPSA is currently undergoing an extensive overhaul of the complaints process, and physician support is an area we are assessing and working to improve. Engaging physicians earlier and deploying strategies to improve timeliness of the complaints processes are two things we understand from speaking with physicians will make a difficult process less burdensome.
While these changes will take time, one change we recently made was the switch from using the term “patient advocate” to “complaint navigator.” The name in-and-of-itself was not inclusive to physicians, and we want to ensure anyone navigating a complaint feels they have someone to connect with for questions, concerns or further information. I recognize this is a small drop in the bucket, but please know it’s indicative of larger systemic changes to come. Our goal is that, in the future, you will see and hear about these changes and start to evolve your perspective of CPSA.
I know bringing these issues to the forefront isn’t always easy, but I appreciate the time and openness to share your thoughts and the experiences of your colleagues. I also encourage you to join one of my monthly Q&A sessions for the opportunity to further this important discussion—the first one is on May 20.
I applaud you on your courage and frankness to bring this up with the CPSA. Indeed the CPSA is an added stressor to what we as physicians are already going through, especially now with the COVID 19 epidemic. We are at war, yet we are answerable and held to the highest standard. Not an easy feat.
Hi Dr. Bozdech, thanks for writing in to share your honest perspective. As I shared with Parker, CPSA recognizes that we have an important role to play in determining how we can lessen the mental health burdens on physicians when it comes to going through our complaints process. We’re beginning work to extensively overhaul our complaints process, and revisiting how physicians are supported throughout the process is one part of this shift. If you have any thoughts you’d like to share, I’d love for you to join me on Thursday at noon for my virtual physician Q&A.
I appreciate this message and would strongly encourage CPSA to remove the question about mental illness from the annual license renewal, if the evidence is not strong that it increases patient safety to have it there. I share concern that the question increases stigma. I’d also highlight fear and uncertainty around what would come next, if a physician indicated “yes”. Given the high prevalence of mood and anxiety disorders, I would imagine many physicians already struggle with knowing whether their condition is at a level that should be flagged “yes”. Unfortunately I believe the question actually incentivizes avoiding getting a formal diagnosis, which might also mean creating a disincentive to seeking restorative care.
Hello Dr. Fitch, thank you for sharing this important perspective. The unintended consequences of a physician being disincentivized to seek care is a concern to me and my colleagues at CPSA. Feel free to Join my Q&A on May 20 if you’d like to discuss this further.
From my experience, along with a stigma against discussing mental illness, our current system in Alberta also stigmatizes taking time off while actively promoting a culture of workaholism and self-sacrifice at all cost. The combination of abuse by the UCP government and the pandemic have highlighted this for me.
There is no shame in taking time off and there is no shame in walking away if that is what you need to do to take care of yourself and your family. It is okay to have limits to your sacrifices. It is okay to set down the very heavy burden you have been carrying these past two years. Self-care is important, and not because without it, you cannot take care of others (although this is true). Self-care is important because you are loved and have worth, whether you are working or not. Full stop. These are the messages we need to hear from our leaders right now if we want to preserve the well-being of our profession, our colleagues and ourselves to care for our patients another day.
Dr. Bisby, I agree completely that making time for self-care is a necessity, and I know my colleagues at CPSA would support this as well. I don’t have solutions to share with you yet, but I do fully endorse and support a physician’s right to make time for themselves, particularly when they know they’re burning out. Please join my Q&A on May 20 if you’d like to discuss this further.
The first reply to this post shows the deep anguish in our physician community. I have been in practice more than 10 years and i see no meaningful change. Just more performative gestures from our employers and our institutions including the CPSA. My leaders in AHS regularly tell me that i make too much money and i dont work hard enough. My productivity is tracked and i am blamed for workload increases or decreases that i have no control over. With the start of the pandemic we saw physicians undergoing incredible stress and burnout – there was a focus on individual resilience. Now i see the CPSA wants us to be kind to each other; as if its a magic bullet that will solve all.
It will not.
The responsibility always falls on the individual physician to solve system and cultural issues
Instead we need our employers and institutions including the CPSA to make changes to the system. Some ideas:
1) on call hours limited – not just for trainees but practicing physicians.
2) any physician who has a CPSA complaint filed against them is offered one session at least with a psychiatrist or mental health therapist
3) decrease the amount of time it takes a complaint to be resolved by the CPSA. It takes too long
If i disclose my mental health struggles to the CPSA will the CPSA divulge this to the health minister if asked. CPSA ultimately answers to the government and we know this government is anti doctor.
Thank you for taking the time to share your experience with me. There is no question that society as a whole expects a lot from physicians, and the COVID-19 pandemic has only added to physicians’ feelings of being overworked and sometimes undervalued as you’ve shared with me in your comment.
As much as I wish it could, you’re right that being kind to one another won’t solve all the problems and challenges we as physicians face, and there are larger systemic issues that must be addressed to truly make a difference. As I shared with another commenter, CPSA is in the process of examining how we can work to lessen the psychological burden the complaints process has on physicians. We do already make sure that any physician receiving a complaint notification is aware of the support services available through the AMA’s Physician and Family Support Program (PFSP). Through this they will have access to mental health supports, but of course CPSA won’t know how many people use that as the PFSP service is confidential.
CPSA is currently undergoing an extensive overhaul of the complaints process, and physician support is an area we are assessing and working to improve. Engaging physicians earlier and deploying strategies to improve timeliness of the complaints processes are two things we understand from speaking with physicians will make a difficult process less burdensome.
While these changes will take time, one change we recently made was the switch from using the term “patient advocate” to “complaint navigator.” The name in-and-of-itself was not inclusive to physicians, and we want to ensure anyone navigating a complaint feels they have someone to connect with for questions, concerns or further information.
Regarding physicians who report a mental health concern to CPSA, I can assure you that any health information is kept confidential and not shared with third parties without the physician’s explicit consent.
If you’d like to talk further, please feel welcome to join me on Thursday at noon for my virtual physician Q&A.
Let’s name the beast: The college complaints process is a driver of physician suicide.
It is easy for other physicians not in our shoes to criticize and judge fellow men & women.
Doctors who commit suicide typically do not ask for help. They feel isolated.
Most people can cope with one or two chronically stressful situations. But add a CPSA complaint into the mix of all the other ongoing negative stresses we face in our professional and personal lives, and the toxic potentially fatal brew is made.
CPSA should have the ability to reject vexatious complaints. Often these are made out of spite or revenge. They are also a way of gathering information for a lawsuit with minimal effort on the part of the initiator. Complainants have their own motivations – how can an adult with full mental capacity not know full well the implications to the physician victim? There are no repercussions to those making false accusations due to malicious intent.
Thank you for sharing your perspective with me. It’s true that complaints are one of the difficult realities of being a regulated health professional. As an ER physician, I fully understand the fear of a complaint, but also realize it comes with the responsibility of being a physician.
You may have read in some of my other comments that CPSA recognizes the impact receiving a complaint can have on a physician and is taking steps to lessen the psychological burden receiving a complaint can cause. We’re doing this by taking a step back to review and overhaul the current complaints process, and physician support is one area that will be taken into account. One change CPSA has already made is changing the term “patient advocate” to “complaint navigator.” The term “patient advocate” was not inclusive to physicians, and we want to ensure anyone navigating a complaint feels they have someone to connect with for questions, concerns or further information.
When CPSA receives a complaint, the Professional Conduct team takes time to review the concern and determine the best approach to resolution, which can include outright dismissal in cases that involve vexatious complaints. Physicians are also given the opportunity to respond to the complaint and share their perspective on the matter to ensure both sides of the story are heard. If you have questions about the complaints process or want to know more, you can contact a Complaint Navigator or visit the complaints page on cpsa.ca.
Thank you again for taking time to share your honest thoughts and feelings.