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Not just patients: Physicians also at risk
Risk managers focusing on the risk of suicide should remember that their own physicians also can be at high risk, says Matt Steinkamp, vice president of service delivery at Physician Wellness Services, a company based in Minneapolis that helps employers deal with impaired physicians.
Compared to the general population, physicians have a significantly higher rate of suicide, Steinkamp says. In the general population, the rate of suicide is much higher among men, but among physicians the rates of suicide are almost the same among men and women, he says.
"The reasons for the high rates of suicide among physicians are because they have the knowledge of how to effectively commit suicide and they have the access to the pharmacology that gives them the means to do it," Steinkamp says. "The success rate for female physicians is significantly higher, in the neighborhood of 200% to 300% higher, than for females in the general population."
There are several reasons for the increased risk. Physicians tend to hold themselves to high standards and can be perfectionists, so medical errors can have devastating effects. They also work in high-pressure situations and can be workaholics, he says. The resulting stress can be magnified for those who feel a strong duty to their patients, Steinkamp says. Health care employers are starting to recognize that the physician population is at special risk of suicide, and some are addressing the problem, he says.
Physician suicides take place in the health care facility, but providers are reluctant to talk about such instances, Steinkamp says. Particularly when the physician was diverting drugs, possibly for some time before the suicide, the health care provider will not be eager to draw attention to the matter, he says.
Preventing drug diversion can be one of the most effective ways to prevent physician suicide, Steinkamp says. Physician wellness committees and other resources for troubled doctors also can help. Physicians who are struggling will respond best to their peers, so a wellness committee or physician leaders who promote dialogue about stress and other concerns can make a difference, Steinkamp says.
Physicians also need to understand how the employer can help them with their problems, especially substance abuse issues. The doctor will be extremely concerned about losing his or her license, so the employer should stress that it will do everything possible to get help for the physician without endangering the license, Steinkamp says.
The culture at the hospital has to emphasize that physicians can get help without facing punitive measures, he says. Also, physician leaders and administrators should be on the lookout for warning signs such as being withdrawn, a change in personality, and irritability.
"If you've gotten to the point that the physician is diverting drugs and contemplating suicide, you've missed some warning signs," he says. "People don't just decide to kill themselves on the spur of the moment. There were signals there if anyone was paying attention."
Matt Steinkamp, Vice President of Service Delivery, Physician Wellness Services, Minneapolis, MN. Telephone: (888) 892-3861. E-mail: Matt.Steinkamp@workplacebehavioralsolutions.com.