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This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.
The fact is each year we lose over 400 doctors to suicide — that’s like an entire medical school gone. Here’s Vincent’s med school graduation photo — just 25 years old and 2 months after starting a prestigious surgical residency in New York City, he dies by suicide. His mom says he became disappointed, disillusioned. He lived near the hospital, but drove an extra 45 minutes home at every chance he had just to sleep in his own bedroom. Just 24 hours before his death (he had relapsed), he met with his psychiatrist who arranged admission at a local rehab facility. His mom wrote this letter to the editor of the New York Times in response to a physician suicide article last month. These programs, which often offer no psychiatric oversight, serve as both treating and policing agencies, a serious conflict of interest. As an aside, I believe that Kaitlyn suffered less from depression and more from “feeling different and isolated” due to her high intellect.
I can guarantee that many medical students cry themselves to sleep at night in their pillows. Kaitlyn’s mother published her daughter’s suicide letter in a book she wrote about Kaitlyn. Here we have a spunky, happy 2-year-old girl who stood up to adults negotiating her way out of a bedtime, a bath time, and persuading her dad to get Slurpees and candy bars for dinner.
Just a few months into med school she develops major depression due to what she calls “barbaric and inhumane medical training.”Years later, fed up with assembly-line medicine, she’s suicidal. Meanwhile those in the know whisper blame-the-victim questions: Was he not doing well academically?
Non-medical institutions. Like the media could instantly stop the secrecy and alert the public about the high risk of suicide in medical students and physicians.
Right now while I’m standing here on stage we are actively tracking rabies in raccoons, bats, skunks, foxes, cats, dogs, cattle — even mongooses in Puerto Rico, but we’re not tracking the numbers of suicides in medical students and doctors. Let’s start with a holistic and humane medical education that de-stigmatizes mental illness. The goal:  help medical students be the self-actualized doctors described in their personal statements for which they were accepted into medical school in the first place. Meet safety and self-esteem needs using nonviolent communication (NVC) which is based on the premise that every behavior is an attempt to meet a need. Request: Would you be willing to lower your volume and speak with more consideration for Vincent’s feelings? If Vincent could have attended a Balint group, he might have shared, “This week I saw a 30-year-old male who presented with injuries after jumping from a 3-story window after raping a young girl. Build in support for transitions from second to third year, traumatic cases, and medical errors. We need physician-specific rehab for substance use, physical, and mental health issues that are unique to physicians and medical students. Another gang of cyberspace docs wanted to know what kind of training I have that allows me to do these psychological autopsies. I teach a biannual physician retreat in which physicians often (spontaneously and without prompting) start crying about cases from years ago.
Then a bearded guy in the back of the room raised his hand and asked a question I’ll never forget, “Is it possible to find a doctor who’s happy?”I collected 100 pages of written testimony, adopted 90 percent feedback and we opened one month later. Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. This workshop is designed to explore the life experiences that have shaped and defined you.
Bring something youa€™ve been working on, an idea you wish to develop, or simply come ready and willing to explore.
Guest speakers have included: Meredith Baxter, Tabby Biddle, Kelly Carlin, Terri Cheney, Lisa Cron, Hollye Dexter, Hope Edelman, Amy Friedman, Leslie Gilbert-Lurie, Annabelle Gurwitch, Wendy Hammers, Monica Holloway, Daniel M.
Karin Gutman, MFA, has been working closely with writers for over 14 years to help them uncover, develop and write their personal stories. I love your style of teaching, way of being, and the space you hold and the opening you create.
Karina€™s nurturing spirit cultivates an environment where all different types of writers can blossom.
It’s pictures of Drake with inspirational quotes written all over his mug in all types of swirly and boldfaced fonts. Above are some of the finer examples of Inspirational Drake, the last one being my favorite.
In terms of popularity, Inspirational Drake is on the really low end of the scale, which is great. But the real best way to think of these image macros, sorry!, is to picture them not written by lovesick teens or bloggers in hopeless unrequited love with Aubrey Graham (hi!), the real way to read these, and this may even be true, is to picture them being written by Drizzy himself. One can almost picture Drake, smelling like vacation, sitting with a laptop in front of an outdoor fire place, with his wacky brown-tinted glasses, and open jazzy man shirt. Then these girls quickly manage to grab screenshots of his messages and they post them to Tumblr.
In med school I protest the dog labs and I’m sent to the office of the dean — who diagnoses me with Bambi Syndrome. Kevorkian of Medical Taboos.”Before my wedding, my dad actually made my husband promise to keep me out of jail. He lost a lot of weight and his jokes and laughs were gone. His family was concerned, but they thought it was the adjustment to a demanding profession. How he and his partner fell asleep leaning against walls in the hospital while waiting for their patient’s turn for a scan. After an outpatient program his third year of med school, he was sober until his second year of residency. You may recall the article about the two young doctors — interns who jumped to their deaths in late August from their Manhattan hospitals.
Threatened loss of licensure deters vulnerable physicians from seeking help, and may even trigger a suicidal crisis.
This anonymous entry stands out: “Thank you for being nice to even the unpopular kids in high school.

The only difference between these cases is she survived and she is now speaking for the other three who can’t. All brilliant, sensitive people who felt alone in a highly competitive and inhumane environment. Because sending your child to medical school or a surgery residency is not like sending your kid to law school or to cashier at Walmart. That’s me and you questioning these deaths, and Greg’s mom seeking audits of PHPs for fraud and abuse. Kaitlyn’s school started a fund in her name for donations to their wellness center so that presumably Kaitlyn’s classmates could seek the help that she didn’t. If we can deliver over 6 million oral rabies vaccine baits yearly to raccoons (and I’m talking about guys dropping these from low-flying planes over the Appalachian Mountains and dudes running through dark urban alleys), we’ve gotta be able to do something for med students.
Now I want to preface this with something else I learned about Kaitlyn’s mom who also suffered from depression. Actions that prevent healthy medical students or physicians from developing a condition that would lead to suicide. Early diagnosis, referral, and rapid initiation of therapy after illness onset or suicide risk factors develop in asymptomatic medical students or physicians. Rehabilitation of suicidal medical students or physicians and return to maximal function with minimal risk for recurrence. Social needs can be met by allowing students to feel part of a community with time for intimate friendships. We can try to change others’behaviors by using shame and blame or we can listen and educate compassionately. These are small group clinical case presentations that focus on the patient-physician relationship and enhance our ability to care for patients.
Offer Balint groups at lunchtime and meet physiologic needs too since students do need to eat! We learn to do blood pressures, ear and throat exams on each other, let’s learn emotional support too and give first and second years the real-world experience of being on call — for each other. We’re all going to make an error and we should not have to feel like a failed perfectionist who can never be a good doctor.
The message usually goes something like this: “Let us know when you’re off the ventilator so we can put you back on the call schedule.”What kind of support is that?
And an ideal clinic is a sanctuary, a safe place, a place of wisdom where we can learn to live harmlessly, listen with empathy and observe without judgement. And yet, in sharing our stories, we often overlook what is particularly extraordinary about our lives. Through a wide variety of creative exercises, youa€™ll find the *spark* to unleash the stories that reflect the uniqueness of your personal journey. Jaffe, Sandra Kobrin, Carlos Kotkin, Leslie Lehr, Regina Louise, Greg Miller, Maureen Murdock, Jennie Nash, Laurel Ollstein, Dennis Palumbo, Shelly Peiken, Paula Priamos, Ann Randolph, Laurenne Sala, Adam Skolnick, Jennifer Gay Summers, Lea Thau, and Pat Verducci. During her tenure as co-executive producer of Spark Off Rose, the popular spoken word series in Los Angeles, she cultivated fresh, new voices and often worked with deeply personal material.
Listen, I grew up as the Internet grew up, and between the mystery AIM screen names we used to bully each other, the group Xangas where we trashed our friends, and the real life Gossip Girl clones and college slut-shaming sites that popped up as I grew up, I know that the Internet can never be a nice place. If it were a movie in 2012, it would have to be The Five-Year Engagement, that sleeper romantic comedy with Emily Blunt and Jason Segel.
Without the incomparable ease of Picnik, Drake must have to use MS.Paint to create all of these beauties.
One can imagine Drake crouched over his computer, snapchatting models inspirational messages of his face painted with unreleased lyrics. He spoke of his doubts about saving this one guy who jumped out of a building when caught raping a young girl who was also being treated in an adjacent room. A brilliant clinician, never impaired at work, but a Physicians Health Program (PHP) mandated a 90-day treatment facility 300 miles away, where Greg felt marginalized, belittled and was 3 months behind in completing residency.
Medical Boards have the duty to safeguard the public, but the assumption that mental illness equals medical incompetence is an archaic notion. An introvert with social anxiety, Kaitlyn always had a few close friends, but none in med school.
Maybe she had hoped that when she entered medical school she would finally be with her tribe — a social circle of more like-minded intellectuals. Death certificates are miscoded by physicians even when there is clear evidence of suicidal intent including a suicide note!
These questions focus blame on the victim, and they deflect blame from the medical school, residency, clinic, hospital, and health care system. Except for Greg’s parents who are aware of the occupational hazards of medicine, families had no idea their child was at high risk of suicide until the police called to tell them their child was dead. It’s more like sending your kid to Iraq or Afghanistan and it requires a completely different level of vigilance. Again, medical students and physicians should not be left to cry themselves to sleep in their pillows alone at night with no support. If you lose a peer, will you hold an M&M conference or perform a psychological autopsy?
I didn’t even know I was doing psychological autopsies until I discovered the term in a suicide article.
We can all reach out to faculty who use shame-and-blame teaching, call attention to the violence, and offer alternatives. All medical students and physicians would benefit from a weekly lunchtime case conference, a structured release valve for the trauma they have witnessed. At the time of Kaitlyn’s death she was dating a man in Michigan who was a 99 percent match on OkCupid. It’s a place where a revolution starts where we rediscover our priorities with relaxed appointments, smiley-face balloons and fun flannel gowns — a lady at the town meeting even volunteered to make them for me. Each week we will uncover the various aspects of a€?youa€? through the spoken and written word with the opportunity to share works-in-progress.
A former story analyst for Creative Artists Agency and 20th Century Fox, she is a published author and has written and developed projects for Nickelodeon, the Jim Henson Company and National Geographic Kids.
I really love how you protect and nurture writers and writing, and the wonderful way you love through your work. Also, I’m not sure what Internet everyone else has been using, but my Internet in 2012 was filled with subtweeting and shit-slinging all around.

Ten years later, I’m unhappy with the direction of my profession (and I’m not the only one). I’m sent to the office, reprimanded for not getting approval from the patient education committee. With suicides, we perform a psychological autopsy — an investigation into a person’s death by reconstructing what the person thought, felt, and did before death, based on information gathered from personal documents, police reports, medical and coroner’s records, and interviews with family and friends. Notice the difference between his childhood photos and his medical school graduation picture. We begin our careers in the anatomy room, a ghoulish lab in which many ‘civilians’would faint.
Medical Boards must stop participating in the stigmatization of mental illness. We cannot afford to lose another physician to shame. Greg transected his bilateral radial and dorsalis pedis arteries with a scalpel in the bathtub, candles lit, music playing, some wine, vodka, surrounded by family photos.
From the time she started preschool, she never needed any help with her homework or anything. But medical school rarely creates an environment for students to develop intimate friendships with one another. All hid their depression and appeared highly functional until their suicides and all left notes because we’re trained to do and we’re so darn responsible! Physicians hide suicides from patients who never find out why they can’t get a follow-up appointment with their doctor who left the clinic so suddenly. When we’re authentic with our patients and ourselves, we build resilience and connections with other people here on Earth.
A suicidal hanging becomes asphyxia, a suicidal overdose is suddenly an accidental overdose, a suicidal jump becomes an accidental fall, a self-inflicted gunshot wound is officially an accidental gunshot wound, a suicidal motor vehicle accident is just another motor vehicle accident.
Compelled to act, Vincent’s mom starts a foundation that sponsors an annual lecture on mental health for residents at Vincent’s school. I asked, “If Kaitlyn worked at Walmart, would she and your wife still be alive?”He says, “Yes.
Not by grieving mothers launching “rabies awareness campaigns.” Not by donations to a wellness program.
Medical students should feel honored and respected for their contributions and level of mastery in medicine. Meet the conflict with confidence using NVC using a simple 4-sentence sequence — a stated observation, feeling, need, and request.
A group of cyberspace docs recently asked me, “What gives you the right to perform a psychological autopsy?
FYI: families with suicided children are eager for someone to take a sincere interest in their kids’deaths. The small group environment cultivates a safe, dynamic space, allowing for group interaction as well as individual guidance and feedback.
She has taught at Cal State Fullerton, UCLA Extension Writersa€™ Program and UCLA Arts and Healing, and currently offers workshops and one-on-one coaching to writers under her Spirit of Story banner. I’m 46 and I’m still handing out unapproved kale salad recipes — now I’m taking on physician suicide.
His Aunt Edna told me in catholic grammar school Vincent has his feet up on the chair in front of him.
We cut our teeth in bloody operating rooms and intensive care units from which few people leave intact. These young sensitive and brilliant people are left to fend for themselves in survival mode with an overwhelming amount of material to master in a short time with little emotional support. Physician suicide is medicine’s darkest secret and our code of silence is maintained by layers of lies. It separates us from our hearts and souls which is what gives our lives meaning and keeps up wanting to live here on Earth. He told me it was after she completed nursing school in her 30s when she worked in a nursing home with a high census in which she was witnessing unsafe conditions for patients — and staff. I can’t handle another.”This man has a real risk of losing more people in his family than we lose in a year to rabies! We’re just supposed to just shove all this down day after day, week after week, year after year with no release valve?
We are well paid, intellectually stimulated, and, if we are lucky, trusted and maybe even loved by our patients. Ultimately she publishes a book examining suicides in the exceptionally gifted like her daughter.
So I hold a town meeting and ask patients to help me — design an ideal medical clinic.
She ran like 10 to 12 miles before class everyday and still excelled in med school, acing her step one exam. When Greg called his mom (a psychiatrist) for help, his PHP therapist said, “Oh, you had to call your mommy?”What kind of treatment is that? Like medical students who start med school with their mental health on par with their peers.
We need personal physician oversight so our vulnerable colleagues are not abused and traumatized when they need help. She left a 2-page suicide note in which she claimed lifelong depression, but hid it to protect her family and herself.
Should we rely on grieving mothers — suffering in isolation as were their children — to solve this? Every medical school, hospital, and clinic should teach their students, physicians, staff — even administrators and CEOs how to speak with kindness and compassion.
We can IF we have a way to process our feelings in real time before we start plotting our suicides. Maybe (like me) you just want to know why our colleagues die by suicide at twice the rate of their patients.

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