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McFarland DC, Lee HB. Preventing Physician Suicide-A Role for Consultation-Liaison Psychiatry? J Acad Consult Liaison Psychiatry 2023; 64:489-491. [PMID: 37890786 DOI: 10.1016/j.jaclp.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Daniel C McFarland
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY; Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY.
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2
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Legha RK, Martinek NN. White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse. MEDICAL HUMANITIES 2023; 49:142-146. [PMID: 36241381 DOI: 10.1136/medhum-2022-012398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/16/2023]
Abstract
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
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Jahangiri S, Shaygani F, Ahmadi Marzaleh M. Suicide Among Medical Students and Residents in Iran: Potential Causes and Solutions. ARCHIVES OF IRANIAN MEDICINE 2023; 26:60-61. [PMID: 37543924 PMCID: PMC10685808 DOI: 10.34172/aim.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/30/2022] [Indexed: 08/08/2023]
Affiliation(s)
- Soodeh Jahangiri
- Endocrine and Metabolism Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shaygani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Martin A. Healer, Reveal Thyself. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:269-270. [PMID: 34751938 DOI: 10.1007/s40596-021-01555-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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5
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Arnold-Forster A, Moses JD, Schotland SV. Obstacles to Physicians' Emotional Health - Lessons from History. N Engl J Med 2022; 386:4-7. [PMID: 34979069 DOI: 10.1056/nejmp2112095] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Agnes Arnold-Forster
- From the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (A.A.-F.); the Center for Medical Humanities and Social Medicine, Johns Hopkins University, Baltimore (J.D.M.); the Program in the History of Science and Medicine, Yale University, New Haven, CT (S.V.S.); and the University of Michigan Medical School, Ann Arbor (S.V.S.)
| | - Jacob D Moses
- From the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (A.A.-F.); the Center for Medical Humanities and Social Medicine, Johns Hopkins University, Baltimore (J.D.M.); the Program in the History of Science and Medicine, Yale University, New Haven, CT (S.V.S.); and the University of Michigan Medical School, Ann Arbor (S.V.S.)
| | - Samuel V Schotland
- From the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (A.A.-F.); the Center for Medical Humanities and Social Medicine, Johns Hopkins University, Baltimore (J.D.M.); the Program in the History of Science and Medicine, Yale University, New Haven, CT (S.V.S.); and the University of Michigan Medical School, Ann Arbor (S.V.S.)
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6
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Duckwitz TM, Groß D. Searching for motives: Suicides of doctors and dentists in the Third Reich and the postwar period, 1933-1949. ENDEAVOUR 2021; 45:100800. [PMID: 35091257 DOI: 10.1016/j.endeavour.2021.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
The criminal practices of National Socialism not only led to millions of murders, but also to increased suicide rates. The present study examines a specific aspect of this phenomenon: the suicides and corresponding motives of 275 German doctors and dentists in the period from 1933 to 1949. The analysis is based on a wide variety of primary and secondary sources. Most suicides were due to National Socialist repression, with peaks in 1938 and 1942. One fifth of the cases were among National Socialist perpetrators, with a peak of those suicides occurring in 1945. The motives for suicide ranged from despair to a lack of career prospects to a final act of self-determination and political opposition; many of the doctors experienced or expected a social downfall before attempting suicide.
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Affiliation(s)
| | - Dominik Groß
- Institute for History, Theory and Ethics of Medicine, RWTH Aachen, Aachen, Germany
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Physician Suicide Prevention and the Ethics and Role of a Healing Community: an American College of Physicians Policy Paper. J Gen Intern Med 2021; 36:2829-2835. [PMID: 34076842 PMCID: PMC8170626 DOI: 10.1007/s11606-021-06852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
Suicide is a major global public health issue, and in recent years, there has been increasing recognition of the problem of physician suicide. This American College of Physicians policy paper examines, from the perspective of ethics, the issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention. Emphasizing the medical profession as a unique moral community characterized by ethical and professional commitments of service to patients, each other, and society, this paper offers guidance regarding physician suicide and the role of a healing community. The response to an individual physician suicide should be characterized by respect and concern for those who are grieving, the creation of a supportive environment for suicide loss survivors, and careful communication about the event. Because suicide is a complex problem, actions aimed at preventing suicide must occur at the individual, interpersonal, community, and societal levels. The medical community has an obligation to foster a culture that supports education, screening, and access to mental health treatment, beginning at the earliest stages of medical training.
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Singh A, Garg A, Mandlik D, Vander Poorten V, Patel SG, O'Neill JP, Spriano G, Shaha A, Chaturvedi P, Cernea C, Shah J. Assessing the quality of life of head and neck healthcare workers during the COVID-19 pandemic-A self-reported global cross-sectional questionnaire study by the International Federation of Head and Neck Oncologic Societies. J Surg Oncol 2021; 124:476-482. [PMID: 34109640 DOI: 10.1002/jso.26571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Considering the pandemic's mode of transmission, the impact on quality of life (QOL) is likely to be exaggerated among healthcare workers (HCWs) who treat head and neck diseases (hHCWs). METHODS A cross-sectional self-reported QOL assessment was undertaken between July and September 2020 using the World Health Organization Quality of Life instrument sent out to hHCWs. Factors that predicted a poorer QOL were identified using regression models and mediation analysis. RESULTS Responses from 979 individuals across 53 countries were analyzed with 62.4% participation from low- and middle-income countries. The physical domain had the highest mean scores of 15 ± 2.51, while the environmental domain was the lowest (14.17 ± 2.42). Participants from low- and middle-income countries had a significantly worse physical (p < 0.001) and environmental (p < 0.001) domains, while a low coronavirus disease 2019-related mortality significantly impacted the environmental domain (p-0.034). CONCLUSION QOL-related issues among hHCWs are a vexing problem and need intervention at an individual and systems level in all parts of the world.
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Affiliation(s)
- Arjun Singh
- Department of Head and Neck Oncology, Tata Memorial Hospital and HBNI, Mumbai, Maharashtra, India
| | - Apurva Garg
- Department of Surgical Oncology, Choithram Hospital and Research Center, Indore, Madhya Pradesh, India
| | | | | | - Snehal G Patel
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - James Paul O'Neill
- Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Hospital and HBNI, Mumbai, Maharashtra, India
| | - Claudio Cernea
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Jatin Shah
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
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Sabroe I, Mather S, Wilson A, Hall-Flavin DK, Fricker M, Barron LA, Millard C. Error, injustice, and physician wellbeing. Lancet 2021; 397:872-873. [PMID: 33676623 DOI: 10.1016/s0140-6736(21)00512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ian Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; School of Health and Related Research, Faculty of Medicine, University of Sheffield, Sheffield, UK.
| | - Sally Mather
- Medical School, University of Sheffield, Sheffield, UK
| | - Amy Wilson
- Centre for the History of Science, Technology and Medicine, University of Manchester, Manchester, UK
| | - Daniel K Hall-Flavin
- Department of Psychiatry and Psychology and Dolores Jean Lavins Center for the Humanities in Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miranda Fricker
- Department of Philosophy, The Graduate Center, City University of New York, New York, NY, USA
| | - Lauren A Barron
- Medical Humanities Program, College of Arts and Sciences, Baylor University, Waco, TX, USA
| | - Chris Millard
- Department of History, University of Sheffield, Sheffield, UK
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Abstract
Physicians enter the field of medicine with a sense of calling to meet the needs of others. This sense of calling is a source of resilience and strength, inspiring physicians to defer their own needs in service to patients' needs. When this trade-off becomes chronic, as it does in dysfunctional work environments, burnout can result and both physicians and patients suffer negative consequences. Some of the sources of physician distress, like exposure to suffering and involvement in medical errors, are inherent to medical practice, while others are the product of workplace inefficiencies and flaws in how the health care system functions. Individual physicians can cultivate strategies to maintain resilience in the face of medicine's inherent challenges, while health care organizations work to reduce the systemic drivers of burnout and build cultures that support physicians to thrive. In this and next month's issues, we offer eight articles on aspects of physician well-being with the goal of inspiring and empowering individuals and organizations to take action to transform the health care system so that it can better meet the needs of physicians and their patients.
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Affiliation(s)
- Amy Wilson
- The Medical School, University of Sheffield, Sheffield S10 2RX, UK.
| | - Chris Millard
- Department of History, University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- The Medical School, University of Sheffield, Sheffield S10 2RX, UK
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12
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McFarland DC, Hlubocky F, Susaimanickam B, O'Hanlon R, Riba M. Addressing Depression, Burnout, and Suicide in Oncology Physicians. Am Soc Clin Oncol Educ Book 2019; 39:590-598. [PMID: 31099650 DOI: 10.1200/edbk_239087] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The best practice of oncology relies heavily on a mentally and physically healthy oncology clinician workforce. Historically, the mental health of physicians and clinicians has largely been ignored, perhaps in the spirit of a collective collusion to maintain the illusion of Oslerian equanimity. With exceedingly high and unacceptable rates of burnout and suicide in the practice of medicine and oncology in particular, a tacit disavowal of the problem is no longer acceptable. The practice of oncology presents several unique work-related issues that challenge the mental health of its clinicians and contribute to burnout, depression, and suicide. Oncologists work with patients at or nearing the end of life and face administrative and insurance hurdles to obtain needed anticancer medications, heavy workloads, paperwork and electronic medical record demands, and keeping up with expanding pertinent oncologic knowledge for practice and public relations issues. Although oncologists exhibit higher rates of depression with longer work hours than many other internal medicine colleagues, they have higher job satisfaction ratings. This article will (1) review the mental health of professionals in oncology, (2) explore similarities and differences between depression and burnout, (3) describe the unique nature of the oncology work environment, (4) examine suicide and its implications for oncology, and (5) review the evidence for interventions to prevent burnout and suicide. Although individual and system-level strategic approaches to the problem of burnout and its consequences are effective, combinatorial approaches offer the most hope for affecting the most long-lasting change and lessening burnout, depression, and suicide in oncology.
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Affiliation(s)
- Daniel C McFarland
- 1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fay Hlubocky
- 2 Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Bibiana Susaimanickam
- 1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin O'Hanlon
- 3 Medical Library, Memorial Sloan Kettering Cancer Center. New York, NY
| | - Michelle Riba
- 4 University of Michigan Department of Psychiatry and University of Michigan Rogel Cancer Center, Ann Arbor, MI
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13
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Avula VR. Suicide and depression in physicians and medical students. ARCHIVES OF MENTAL HEALTH 2019. [DOI: 10.4103/amh.amh_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Christie C, Wynn-Thomas S, McKinnon B. Pegasus Health Pastoral Care Programme. J Prim Health Care 2018. [PMID: 29530176 DOI: 10.1071/hc17033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In New Zealand, 41% of general practitioners (GPs) intend to retire by 2025. Increasing workforce shortages and other stressors are putting doctors at risk of burnout, which in turn can put patients at risk of harm. Offering a range of resources can signal an organisation's commitment to physician wellness while improving patient safety and organisational stability. AIM To replace the current reactive approach to impaired doctors with a proactive system of monitoring performance with the goal of identifying problems early. METHODS This paper reports on an initiative of Pegasus Health Charitable to provide pastoral care to GPs in Canterbury experiencing increased stress, burnout or problems leading to impaired performance. RESULTS The pastoral care programme has been running successfully for 9 years and has helped 32 GPs. Because of the low numbers, the programme needs to be individualised and confidential. CONCLUSION Recent developments have seen Pegasus Health adopt a systematic approach to monitoring and supporting health practitioners. This includes the monitoring of available data on GPs at risk. Data collection is being used to manage the "psychological health" of doctors, including complaints, prescribing, referral data and attendance at education sessions.
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Niforatos J, Rutecki GW. Thornton Wilder and The Angel That Troubled the Waters: A Plea for Physician Healing. J Gen Intern Med 2018; 33:129-132. [PMID: 28980118 PMCID: PMC5756172 DOI: 10.1007/s11606-017-4195-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Gregory W Rutecki
- Internal Medicine National Consult Service, Cleveland Clinic, Cleveland, OH, USA.
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Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC, Nasca TJ. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:976-983. [PMID: 28514230 PMCID: PMC5483979 DOI: 10.1097/acm.0000000000001736] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE To systematically study the number of U.S. resident deaths from all causes, including suicide. METHOD The more than 9,900 programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) annually report the status of residents. The authors aggregated ACGME data on 381,614 residents in training during years 2000 through 2014. Names of residents reported as deceased were submitted to the National Death Index to learn causes of death. Person-year calculations were used to establish resident death rates and compare them with those in the general population. RESULTS Between 2000 and 2014, 324 individuals (220 men, 104 women) died while in residency. The leading cause of death was neoplastic disease, followed by suicide, accidents, and other diseases. For male residents the leading cause was suicide, and for female residents, malignancies. Resident death rates were lower than in the age- and gender-matched general population. Temporal patterns showed higher rates of death early in residency. Deaths by suicide were higher early in training, and during the first and third quarters of the academic year. There was no upward or downward trend in resident deaths over the 15 years of this study. CONCLUSIONS Neoplastic disease and suicide were the leading causes of death in residents. Data for death by suicide suggest added risk early in residency and during certain months of the academic year. Providing trainees with a supportive environment and with medical and mental health services is integral to reducing preventable deaths and fostering a healthy physician workforce.
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Affiliation(s)
- Nicholas A. Yaghmour
- 1 N.A. Yaghmour is research analyst, Department of Education, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Timothy P. Brigham
- 2 T.P. Brigham is chief of staff and senior vice president, Department of Education, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and associate professor of medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas Richter
- 3 T. Richter is director, Department of Applications and Analysis, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Rebecca S. Miller
- 4 R.S. Miller is senior vice president, Department of Application Development and Data Analysis, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Ingrid Philibert
- 5 I. Philibert is senior vice president, Department of Field Activities, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - DeWitt C. Baldwin
- 6 D.C. Baldwin Jr. is senior scholar, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Thomas J. Nasca
- 7 T.J. Nasca is chief executive officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and professor of medicine and molecular physiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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17
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Botha D. Are we at risk of losing the soul of medicine? Can J Anaesth 2016; 64:122-127. [PMID: 27882452 DOI: 10.1007/s12630-016-0776-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Danie Botha
- Department of Anesthesia, Victoria General Hospital, University of Manitoba, Winnipeg, MB, Canada.
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18
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Finlayson AJR, Iannelli RJ, Brown KP, Neufeld RE, DuPont RL, Campbell MD. Re: physician suicide and physician health programs. Gen Hosp Psychiatry 2016; 40:84-5. [PMID: 26874652 DOI: 10.1016/j.genhosppsych.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A J Reid Finlayson
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA.
| | - Richard J Iannelli
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA
| | - Kimberly P Brown
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA
| | - Ronald E Neufeld
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA
| | - Robert L DuPont
- The Institute For Behavior and Health, Inc, Rockville, MD 20852, USA
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Genovese JM, Berek JS. Can Arts and Communication Programs Improve Physician Wellness and Mitigate Physician Suicide? J Clin Oncol 2016; 34:1820-2. [PMID: 26926683 DOI: 10.1200/jco.2015.65.1778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jacqueline M Genovese
- Stanford Health Care Communication Program, Stanford Medicine & the Muse Program, Stanford University School of Medicine, Stanford, CA
| | - Jonathan S Berek
- Stanford Health Care Communication Program, Stanford Medicine & the Muse Program, Stanford University School of Medicine, Stanford, CA.
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20
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Eckleberry-Hunt J, Lick D. Physician Depression and Suicide: A Shared Responsibility. TEACHING AND LEARNING IN MEDICINE 2015; 27:341-5. [PMID: 26158336 DOI: 10.1080/10401334.2015.1044751] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
ISSUE Although the exact number is often disputed, it has been reported that approximately 300 to 400 physicians in the United States take their own lives annually. Despite calls from key interest groups for prevention and treatment protocols of physician suicide, little systematic change has taken place. EVIDENCE Research on suicide risk factors among physicians has expanded. Increasing reports are surfacing that highlight suicidal ideation and depression in medical school, residency training, and later professional practice. IMPLICATIONS The purpose of this article is to draw attention to the problem of physician suicide with an emphasis on the role of medical education. Multiple accreditation bodies should be involved to effect a change in physician suicide prevalence. Thirty years have demonstrated that without mandates, large-scale change will not occur. We adapted some of the 2012 National Strategy for Suicide Prevention goals to medical education as a guide.
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21
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Flett GL, Hewitt PL, Heisel MJ. The Destructiveness of Perfectionism Revisited: Implications for the Assessment of Suicide Risk and the Prevention of Suicide. REVIEW OF GENERAL PSYCHOLOGY 2014. [DOI: 10.1037/gpr0000011] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although perfectionism is recognized as a factor that is linked with suicide, we maintain that the role of perfectionism as an amplifier of the risk of suicide has been underestimated due to several factors. In the current article, contemporary research on the role of perfectionism in suicide is reviewed and summarized. Several themes are addressed, including: (a) consistent evidence linking suicide ideation with chronic exposure to external pressures to be perfect (i.e., socially prescribed perfectionism); (b) the roles of perfectionistic self-presentation and self-concealment in suicides that occur without warning; and (c) how perfectionism contributes to lethal suicide behaviors. We also summarize data showing consistent links between perfectionism and hopelessness and discuss the need for a person-centered approach that recognizes the heightened risk for perfectionists who also tend to experience hopelessness, psychache, life stress, overgeneralization, and a form of emotional perfectionism that restricts the willingness to disclose suicidal urges and intentions. It is concluded that when formulating clinical guidelines for suicide risk assessment and intervention and public health approaches to suicide prevention, there is an urgent need for an expanded conceptualization of perfectionism as an individual and societal risk factor. We also discuss why it is essential to design preventive programs tailored to key personality features with specific components that should enhance resilience and reduce levels of risk among perfectionists who hide behind a mask of apparent invulnerability.
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Affiliation(s)
- Gordon L. Flett
- Department of Psychology, LaMarsh Centre for Child and Youth Research, York University
| | - Paul L. Hewitt
- Department of Psychology, University of British Columbia
| | - Marnin J. Heisel
- Department of Epidemiology and Biostatistics, Western University
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22
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Suicidal behavior among physicians referred for fitness-for-duty evaluation. Gen Hosp Psychiatry 2014; 36:732-6. [PMID: 25085717 PMCID: PMC4254198 DOI: 10.1016/j.genhosppsych.2014.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not. METHOD Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n = 2) or completed (n = 5) suicide versus the remainder of the sample. RESULTS Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P < .05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher's Exact Test, P < .05). CONCLUSION Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.
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