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Helping Doctors Who are Suicidal 2018 - Dr Mark Burgin

28/11/18. Dr. Mark Burgin BM BCh (oxon) MRCGP considers a different approach to suicide based upon the biopsychosocial model and response to potentially modifiable risk factors.

Suicide is not a leading cause of death overall it is usually in the top three causes in patients between 15-44 years and is a major preventable loss of life.

Although mental illness is commonly cited as a cause only a small fraction of those with depression will end their own lives and also those without a diagnosis can kill themselves.

Some explain this inconsistency blaming substance misuse or ‘hidden’ mental illness but this does not explain why the performance of tests to assess suicidal intent remains poor.

About 95% of those calculated at high risk do not commit suicide and 50% of the deaths occur in those considered to be lower risk. (1)

The experience of those working with suicidal doctors suggests that the current theories fundamentally misunderstand about what tips the balance. (2)


Denial

Doctors are at greater risk if they resist a mental health diagnosis for instance if they do not recognise their symptoms from the textbook descriptions.

Seeing the problem as external, blaming other people, is common so that those around the doctor are bullied or challenged for ‘not doing things right’.

This lack of tolerance of others leads to social and personal relationships souring and makes home and work environments difficult to the point of breakdown.

The doctor who does not recognise that they are becoming unwell may well feel victimised and even start legal challenges and blame any sick leave on their co-workers.

If the doctor does not gain insight they use more and more extreme steps to resolve the situation and will increasingly see suicide as a reasonable way forward.

Stigma

It is said that medical schools fuse the identity of the person and the doctor into one symbiotic organism so that losing the role of a doctor causes a profound loss of identity.

Doctors are taught to believe that they should be invulnerable, that their work is of the highest importance and they must never make mistakes.

This Doctor Delusion can cause ‘the imposter syndrome’ where the doctor is troubled by thoughts that their mask will slip or worse they will be publicly seen as flawed.

The truth that you cannot live up to these impossible demands is resisted by the unwell doctor and each failure will lead to more guilt and increase the fear of being found out.

The doctor’s response to tearing off their doctor’s mask can range from relief which has a good prognosis, to shame which at its worst is highly predictive of suicidal behaviour.


Lack of community

Doctors have many privileges associated with their role and for welling the most important is being part of an elite and spending time with other doctors.

Doctors work with, make friends with, marry and have children who are doctors so being excluded from this community deprives them of their social structures.

Ill doctors say that they feel that their friends have turned their backs on them and some will describe the loss of their community as being abandoned and a betrayal of their trust.

It has been argued that doctors cannot rely upon help from their colleagues because they know them socially and this will influence the care that they can get.

One reason that doctors will turn to suicide more than other people is that they can be left literally with no one to talk to for support when things go wrong.


Conclusions

The biopsychosocial model has been used to identify risk factors in a particularly vulnerable group that can be measured and modified and may apply more widely.

Doctors are not completely unique in having difficulty accepting a mental health diagnosis, being a public figure and relying emotionally on a community that is fickle.

The response to the biopsychosocial assessment is important with a breakthrough being protective and blocking indicating increased risk.

My experience of suicidal patients is that those who do not gain insight, suffer unrelieved shame and feel betrayed need emergency help to save their lives.

Returning to civilian life means finding the human inside the doctor’s shell and seeing that there is more to life than being a doctor and that leaving medicine is not the end.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

  1. Large M, Kaneson M, Myles N, Myles H, Gunaratne P, Ryan C (2016) Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time. PLoS ONE 11(6):

  2. The Wounded Healer 2018 The NHS Practitioner Health Programme. php.nhs.uk/the-wounded-healer-2018-videos

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