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André Picard

Suicide should not be an occupational hazard for doctors Add to ...

On Nov. 17, 2014, the inanimate body of Émilie Marchand was found in a parked car in the north end of Montreal. The 27-year-old medical resident at the University of Montreal died by suicide, from an overdose of the painkiller hydromorphone.

Unlike most suicides, Ms. Marchand’s death garnered a lot of media attention. It occurred at a time when the dysfunctional administration at U of M-affiliated hospitals was under scrutiny, and came on the heels of a damning report by the university’s ombudsman about another medical student’s suicide.

Now Quebec coroner Jean Brochu has weighed in, pointing a finger at the University of Montreal for sitting idly by while a sick, troubled student was “slipping slowly and solitarily toward a dead-end of desperation.”

While his report looked at a specific case, the coroner noted that it was part of a much larger problem – astronomical rates of depression among medical students and residents, coupled with the troubling reality that as many as one in seven had seriously contemplated suicide.

Suicide is now considered an occupational hazard for physicians: About 400 doctors take their own lives in the United States annually, as do a few dozen in Canada. And the problems begin early: Medical students face significantly higher rates of burnout, depression and mental illness than those in the general population.

Medical students – and residents in particular – face tremendous pressure, including punishing exams, a cutthroat atmosphere and gruelling hours.

But stress is not the sole explanation.

As both the coroner and the ombudsman note in their reports, the medical classroom and workplace are brutal: Bullying and psychological harassment are commonplace in hospitals, and the stigma about mental illness is pervasive in the medical profession.

In short, medical education is too often imbued with a macho attitude that learners have to be broken down and toughened up and that those who can’t take it are weak and unworthy.

Perversely, many physicians take pride in this boot-camp mentality. When efforts were made to eliminate the insane 100-hour workweeks of residents, old-timers quietly (and sometimes not so quietly) dismissed the younger generation as wimps.

Even Quebec Health Minister Dr. Gaétan Barrette, when asked about medical-school suicides, reacted dismissively, saying: “The pressure they are dealing with is a lot less than it was 15 years ago.”

In fact, what’s different today is not that young people are weaker, it is that expectations are so much higher and isolation is so much greater, in spite of (or perhaps because of) so-called social media. Medical students and residents are also headed into a world of uncertainty, not one where they are guaranteed a life of privilege.

There is also an open recognition of the problem – when residents and doctors killed themselves before it was hushed up, now it is at least talked about. But while the system has become adept at collecting data on depression and suicide, it has done little concrete to offer help and invest in prevention.

Émilie Marchand, like all her classmates, had stellar marks and, from the time she was in high school, dedicated herself heart and soul to the goal of becoming a doctor – in her case a specialist in internal medicine.

When she was in medical school she was diagnosed with a personality disorder and, in residency, suffered from bouts of depression so severe that she had to be hospitalized. She also had a previous suicide attempt, using the same drug, hydromorphone.

But Ms. Marchand continued her studies full bore and – her friends testified later – lived in mortal fear that her illness would be exposed and her career derailed.

Increasingly, research is showing that so-called super-performers (like those attracted to medical school) are particularly vulnerable.

Paradoxically, the very qualities that make someone a good doctor – empathy, caring, perfectionism – make them vulnerable to burnout, depression and suicide.

The students attracted to medical school are among the best and brightest of their generation. They are smart, talented and driven. But many are also anxious, overwhelmed and lost – sick, not weak.

We cannot simply respond to the wounded healers with the age-old admonishment, Cura te ipsum (Physician, heal thyself).

We must create an environment where our future doctors can learn to heal, beginning with caring for themselves.

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Follow on Twitter: @picardonhealth

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