Cases and Commentaries

Physician Suicide examines the multiple risk factors that account for the higher rates of burnout, depressive symptoms, and suicide risk physicians experience compared with the general population. Suicide is typically caused by a convergence of factors, chief among these are untreated or inadequately managed mental health conditions. Physicians are less likely to seek professional help for these conditions -- in part, because of fear of professional repercussions -- and many seek to address their symptoms by self-medicating with alcohol or drugs. Burnout is especially common and is frequently due to workload, work inefficiency, lack of autonomy and meaning, and work-home conflict. The author explores these issues through the lens of a series of beautifully written and fascinating case studies that allow the reader to get inside the minds of his subjects and understand their lives and the stressors they face. The only volume of its kind, it provides an in-depth and nuanced approach to the topic of physician suicide in the context of the broader topic of physician health and wellbeing: The book covers the full range of physician mental health issues, from lifestyle and professional expectations and burnout, through depression, anxiety, addictions, personality disorders, and aging, carefully noting the many interactions with suicide and suicidal behavior. Prevention of these diverse problems -- at the individual and organizational level -- is addressed, with emphasis on the response of health care organizations and institutions to the issue of physician health and wellbeing, and the impact that well-organized physician well-being committees, taking on the function of a physician health program, can have on individual physicians. The chapter-long case studies resemble short stories that realistically capture the mental health challenges doctors confront in the cultural context of medical training and professional practice. These represent the core of the book, and they succeed in making the issues discussed "personal" and engaging for the reader. Accompanying each case study is a concise literature review that offers commentary and emphasizes the most important points. A detailed reference list is also offered for readers who want more extensive background material. The author calls clearly upon the medical profession to take serious actions to improve physician health and thereby reduce the number of physicians who kill themselves each year. "Physician Suicide" is a case-based textbook of physician health and wellbeing that can be used in courses teaching physicians and medical students about self-care. There is little mention in the health literature of the daily pressures inherent in the physician lifestyle, which may lead to unintended consequences, of which suicide is the most extreme. Physician Suicide is an attempt to document the pain and suffering that physicians are trained to deny, especially in front of their patients, in the hope that such discussion may improve the lives of current generations of physicians and prevent further suffering in future generations.