Friday, September 5, 2014

Why Do Doctors Commit Suicide? -

Two weeks ago, two medical residents, in their second month of residency training in different programs, jumped to their deaths in separate incidents in New York City. I did not know them, and cannot presume to speak for them or their circumstances. But I imagine that they had celebrated their medical school graduation this spring just as my friends and I did. I imagine they began their residencies with the same enthusiasm for healing as we did. And I imagine that they experienced fatigue, emotional exhaustion and crippling self-doubt at the beginning of those residencies — I know I did.

The statistics on physician suicide are frightening: Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts). Some 400 doctors commit suicide every year. Young physicians at the beginning of their training are particularly vulnerable: In a recent study, 9.4 percent of fourth-year medical students and interns — as first-year residents are called — reported having suicidal thoughts in the previous two weeks.

Hospitals and residency programs recognize the toll residency takes on the mental stability and physical health of new doctors. In 2003, work hours were capped at 80 hours a week for all residency training programs. Residents are provided confidential counseling services to help cope with stress. My residency program offers writing workshops and monthly reflection rounds. We have a wellness committee that organizes social events such as bonfires on the beach and visits from therapy dogs.

But despite these efforts, people still fall through the cracks. While acute stress, social isolation, pre-existing mental illness and substance abuse may be obvious factors to consider, we must also ask if there are aspects of medical culture that might push troubled residents beyond their reserves of emotional resilience.

More ...

Wednesday, September 3, 2014

Humiliation tops list of mistreatment toward med students | MSUToday | Michigan State University

Each year thousands of students enroll in medical schools across the country. But just how many feel they've been disrespected, publicly humiliated, ridiculed or even harassed by their superiors at some point during their medical education?

Recently, researchers at Michigan State University were the first to analyze 12 years worth of national survey data from the Association of American Medical Colleges, or AAMC, questioning graduating students about their medical school experience during the clinical portion of their education.

They found that up to 20 percent of students reported some form of mistreatment each year.

Additionally, only an average of 31 percent of those who indicated they were mistreated actually reported the incident to faculty or university administrators.

Public humiliation or belittlement topped the list, with sexist remarks and requests to do personal favors coming in second and third, respectively.

The research can be found online in the journal Academic Medicine.

Although the survey definition of mistreatment has evolved over the years, more recently, the meaning has focused on specific behaviors such as being disrespectful or humiliating others, as well as sexual, racial/ethnic, gender and sexual orientation mistreatment.

"The goal was really to uncover the nature of the problem and better understand what needs to be done to change these experiences," said Marsha Rappley, dean of the College of Human Medicine at MSU. "The feeling of mistreatment often happens in stressful environments like a clinical setting involving patients, and it's up to everyone to respond in ways that are respectful."

Recently, both the AAMC and the American Medical Association have acknowledged that mistreatment is an issue and should be addressed.

"If our students are experiencing these negative feelings, then everyone else is probably feeling uncomfortable as well," Rappley said, who is also the chair for the AAMC Council of Deans. "Not everything is polite and clean all the time, but if we think of the whole notion of education as treating people respectfully while giving them good feedback on their work, this could help build resiliency in moments where tempers may flare."

Rappley also said that proper safe reporting mechanisms are needed to ensure that students feel protected when reporting an incident.

"Across the country, med schools continue to look at ways to improve safe reporting practices whether it's using an ombudsman or implementing an online system," she said. "We all may be using different approaches, but ultimately it's about what makes the students feel safe."

By having serious discussions about specific behaviors that are perceived as disrespectful and offering up tools to help manage conflict and feedback, Rappley said that resident physicians and students could work even better as teams and help each other in intense situations.

"Collectively, we can figure out a solution," she said.