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This episode is part of my initiative to provide access to important court decisions impacting employees in an easy to understand conversational format using AI. The speakers in the episode are AI generated and frankly sound great to listen to. Enjoy!
Beneath the sterile drapes and surgical masks lies a devastating truth: surgeons have the highest suicide rate among all physicians. A staggering 15% report having contemplated ending their lives at some point in their careers, with 6% having such thoughts within just a single year.
The juxtaposition is jarring – these talented professionals represent the pinnacle of medical achievement, yet many battle profound personal demons in silence. Through Dr. Carrie Cunningham's courageous presidential address to the Association for Academic Surgery, we witness this paradox firsthand. Despite her Harvard professorship, research grants, and leadership positions, she openly shared her struggles with depression, anxiety, and substance use disorder. Her vulnerability challenges our assumptions that external success guarantees internal well-being.
The factors driving this crisis run deep. Medical training itself plants the seeds, with studies showing one-third of interns develop clinical depression. The surgical culture's emphasis on perfectionism, combined with sleep deprivation and high-stakes decision-making, creates tremendous pressure. Add to this the startling revelation that 45% of physicians experienced serious trauma before even entering medicine, and we begin to understand the perfect storm threatening our healers.
Most concerning is the pervasive fear preventing surgeons from seeking help. Many go to extraordinary lengths – paying cash for therapy, traveling to distant cities for treatment, self-medicating – all to avoid potential career repercussions. Physician Health Programs exist in every state with impressive 90% success rates, yet many doctors don't know about these resources until they're in crisis.
True progress requires fundamental shifts: moving beyond superficial "wellness" initiatives to address genuine mental health conditions, fostering cultures where vulnerability is seen as strength rather than weakness, and creating environments where seeking help doesn't jeopardize careers. The Dr. Lorna Breen Act represents a step forward, named for an emergency physician who died by suicide after working on the pandemic frontlines.
Have you noticed signs of struggle in a colleague or friend? Reaching out could save a life. What small step might you take today to create a more supportive environment for those battling silently around you?
National Suicide Prevention Lifeline
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Episode Transcript
OK, let's unpack this .
It might surprise you to learnthat surgeons well, the
professionals we really rely onactually have the highest rate
of suicide among physicians.
Speaker 2 (00:10):
Yeah, it's.
It's quite a stark statistic.
There was a study back in 2011,I think.
Speaker 1 (00:15):
That's the one it highlighted that get this 15
percent reported consideringsuicide at some point in their
career.
Speaker 2 (00:22):
Fifteen percent, and wasn't it something like 6% just
within that past year?
Speaker 1 (00:25):
Exactly 6% in one year.
When you hear a number likethat, it really no.
It makes you stop and thinkabout the immense pressures
people face.
Speaker 2 (00:33):
Definitely, even people who seem incredibly
successful on the surface.
Speaker 1 (00:36):
It's a truly striking paradox, isn't it?
These are individuals, you know, operating at the absolute peak
of a demanding profession.
Speaker 2 (00:43):
Top of their game.
Speaker 1 (00:45):
Yet they're grappling with such profound internal
struggles.
It just begs the question whatis it about this high stakes
environment?
Speaker 2 (00:53):
What is it that contributes to this reality?
Speaker 1 (00:55):
That's exactly what we're diving into today.
We want to explore the complexfactors, the things contributing
to these mental healthchallenges and surgery.
Speaker 2 (01:04):
And also look at potential paths toward you know,
support and change, real change.
Speaker 1 (01:09):
Right and to really get under the skin of this,
we're drawing on some prettycompelling material.
Speaker 2 (01:14):
We are.
We have the presidentialaddress by Dr Carrie Cunningham
Incredibly powerful and personalstuff.
Speaker 1 (01:20):
Given to the Association for Academic Surgery
right and thankfully there's aYouTube transcript available.
Speaker 2 (01:25):
Yeah, which is great, and we're also weaving in
insights from two articles thatshed more light on this really
serious issue of physiciansuicide.
Speaker 1 (01:34):
So consider this your kind of streamlined guide.
We want you to be well informedon this crucial topic.
Speaker 2 (01:41):
And our aim is to go beyond just you know listing
facts.
Speaker 1 (01:44):
Right.
We want to extract the coreinsights, understand the
complexities underneath andhopefully identify some
actionable takeaways.
Speaker 2 (01:51):
So where do we start?
How do we begin to unravel this?
Speaker 1 (01:54):
Well, I think Dr Cunningham's address is a really
compelling entry point, justbecause it's so rooted in her
own lived experience.
Speaker 2 (02:01):
Absolutely.
I mean here's someone whoachieved remarkable success by
any conventional standard.
Speaker 1 (02:06):
Totally Former top junior tennis player.
Harvard professor of surgery.
Speaker 2 (02:10):
Yeah, with significant research funding an
R01 grant.
Speaker 1 (02:13):
And president of the AAS, a major surgical
association.
The list is impressive.
Speaker 2 (02:18):
It really is, and that's precisely what makes her
story so well resonant.
Speaker 1 (02:24):
Because, alongside all of that success, she bravely
shared her own long-termbattles.
Speaker 2 (02:29):
Yeah, with depression , anxiety and also a substance
use disorder.
Speaker 1 (02:33):
That juxtaposition, her professional triumphs versus
her personal challenges.
It really forces us to confrontthat common misconception,
doesn't it?
Speaker 2 (02:41):
That outward success equals inner well-being.
Yeah, absolutely.
Speaker 1 (02:44):
And what's particularly noteworthy is the
sheer courage it took for her tobe so open.
Speaker 2 (02:49):
Oh for sure she was fully aware of the potential
risks, the professionalrepercussions of sharing
something so personal on such apublic stage.
Speaker 1 (02:58):
And her motivation for taking that risk.
It was incredibly powerful.
Speaker 2 (03:01):
It really was.
It seemed to stem from thisprofound desire to prevent
others, her colleagues, fromexperiencing similar suffering.
Speaker 1 (03:08):
And specifically to reduce suicide right Inspired by
losing her friend Dr ChristinaRae Berkeley.
Speaker 2 (03:15):
Exactly that loss clearly had a huge impact.
Speaker 1 (03:18):
And it's crucial to note, she acknowledged her own
privilege even as she spoke.
Speaker 2 (03:23):
She described herself as, I think, capable, free,
white and with resources.
Speaker 1 (03:29):
Right, and she explicitly recognized how much
harder these struggles must befor others.
Speaker 2 (03:35):
For medical students, residents, people without those
advantages facing systemicbarriers.
That awareness adds real weightto her message.
Speaker 1 (03:44):
It really does.
Now, one of the key points shemade and this feels really
important was the need to movebeyond terms like burnout or
wellness, even Right, when we'reactually talking about serious
mental health crises.
Speaker 2 (03:55):
That's such a vital distinction.
She emphasized that, ok,burnout can contribute sure.
Speaker 1 (04:00):
But it's often not the fundamental issue and the
solutions aren't just, you know,more self-care.
Speaker 2 (04:06):
No, she put it very directly, didn't she?
Something like all the Pelotonrides in the world are not going
to make my depression go away.
Speaker 1 (04:12):
Exactly, and she paints a pretty sobering picture
of how these crises can develop.
Speaker 2 (04:17):
Insidious progressive .
Speaker 1 (04:19):
Yeah, creeping up over time until they reach a
point where, tragically, theperson might not even want help.
Speaker 2 (04:24):
Or even believe their loved ones would be better off
without them.
It's just heartbreaking.
Speaker 1 (04:28):
It really underscores the gravity, and the sources
also highlight the concerningprevalence of substance use
disorders among physicians.
Speaker 2 (04:36):
Rates higher than the general population.
Right we're on one in sevenphysicians.
Speaker 1 (04:40):
Yeah, and this is linked sadly to that higher
suicide rate we see in doctors.
Speaker 2 (04:45):
And the data she cited from the American College
of Surgeons survey.
Speaker 1 (04:50):
Wow, just alarming 13% of surgeons reported
suicidal thoughts in the pastyear 13% and 10% within the two
weeks before the survey.
Shocking, and what struck mewas that these rates were even
higher for certain groups.
Speaker 2 (05:04):
Women residents and associate professors.
I believe.
Speaker 1 (05:06):
Exactly, those are key demographics, likely
reflecting specific pressureswithin the system.
Speaker 2 (05:11):
Yeah, and that pervasive fear of seeking help
that came up again and again inthe sources.
Speaker 1 (05:16):
This massive obstacle fear of repercussions, fear of
stigma.
Speaker 2 (05:20):
Leading to really concerning behaviors like
doctors writing their ownprescriptions.
Speaker 1 (05:25):
Or paying cash for therapy, going to other cities
for treatment just to keep itsecret.
Speaker 2 (05:30):
It's this climate of secrecy and fear it seems so
deeply entrenched.
Speaker 1 (05:35):
And it's particularly troubling when you think about
the training process itself.
Speaker 2 (05:38):
Oh yeah, Dr Cunningham mentioned that study
showing a third of internsdevelop clinical depression.
Speaker 1 (05:44):
A third and it persists.
It doesn't just go away afterinternship.
Speaker 2 (05:48):
And with the added trauma many trainees face during
COVID-19.
Speaker 1 (05:52):
There's a real concern those trends could get
worse.
Speaker 2 (05:55):
Absolutely.
Medical training is justinherently demanding Long hours,
high stakes.
Speaker 1 (06:00):
And often a culture that maybe implicitly values
stoicism pushing through.
Speaker 2 (06:06):
Right, and you combine that with any
pre-existing vulnerabilitiespeople bring.
Speaker 1 (06:10):
Like that statistic she mentioned 45% of survey
respondents had experiencedserious trauma before medical
training 45%, that's nearly half.
Yeah.
Speaker 2 (06:18):
It creates a potential perfect storm for
mental health issues.
Speaker 1 (06:22):
So, okay, let's shift towards solutions.
Dr Cunningham shared somereally impactful lessons from
her own journey.
Speaker 2 (06:29):
She did, and the first one that really hit home
was this fundamental principlePut health first.
Speaker 1 (06:35):
Yeah, and it wasn't just about your health, it was a
call to action for colleagues.
Speaker 2 (06:38):
To look out for each other.
Yeah, to step up if you thinksomeone's struggling, even if it
feels awkward.
Speaker 1 (06:44):
Right Checking in showing up those simple acts can
make a huge difference.
Speaker 2 (06:48):
She really emphasized that someone's well-being when
they're in crisis it justoutweighs any professional
concerns.
And she acknowledged howuncomfortable intervening can be
.
Yeah, that the person mightdeny it.
Get angry, pull away.
Speaker 1 (07:00):
But her message was clear If you're genuinely
concerned, act anyway, trustyour gut.
Speaker 2 (07:05):
Another critical lesson was about physician
health programs, PHPs.
Speaker 1 (07:10):
Right, she explained.
They exist in every state, avital resource for doctors
facing crises, includingsubstance use.
Speaker 2 (07:17):
And it was interesting that she admitted
she didn't even know about thembefore her own crisis.
Speaker 1 (07:21):
Yeah, and she made a strong point challenging the
common idea that they're justpunitive.
Speaker 2 (07:26):
Exactly.
While patient safety is part ofit, their main focus is also
advocacy and support for thephysician.
Speaker 1 (07:33):
Helping prevent unnecessary reporting to
licensing boards, guiding themto real treatment.
Speaker 2 (07:38):
And the success rates she mentioned from Washington
state were really encouragingOver 90 percent.
No further board issues.
80 percent maintaining sobriety.
Speaker 1 (07:47):
That's huge.
It sounds like her ownexperience with the PHP, though
maybe tough at first.
Speaker 2 (07:52):
She perceived it as punitive initially.
Speaker 1 (07:54):
yeah, but ultimately it was beneficial for her
recovery, and she stressed thatsobriety alone wasn't enough.
Speaker 2 (08:00):
No.
Addressing the underlyingemotional pain was crucial.
Speaker 1 (08:03):
And she was so open about her own diagnoses PTSD,
persistent depressive disorder,substance abuse disorder.
Speaker 2 (08:09):
That openness is just so important for
destigmatization.
Her third lesson was don'tassume anything.
Speaker 1 (08:14):
Right.
Everyone has unique experiences, vulnerabilities, hidden values
.
Speaker 2 (08:19):
And that stat again 45% experiencing trauma before
medical training.
It really drives that pointhome the invisible burdens
people carry.
Speaker 1 (08:26):
It does, and her point about change being
constant but growth being achoice.
Speaker 2 (08:31):
Yeah, requiring patience and hard work, and also
stating clearly depression isbiological, it's an illness, not
a character flaw.
Speaker 1 (08:41):
Such a crucial message.
Then her fourth lesson, aboutmastery through mistakes.
Speaker 2 (08:46):
Ah yes, Challenging that ingrained culture of
perfectionism in surgery.
Speaker 1 (08:51):
This one really resonated the idea that you get
better by learning from mistakes, not by trying to be flawless.
Speaker 2 (08:57):
She talked about how that fear of failure, of losing,
can be so destructive.
Speaker 1 (09:01):
And those internalized bruises from that
perfectionist culture.
Speaker 2 (09:04):
Yeah, they stop people reaching out for help
when they most need it.
Speaker 1 (09:07):
And the emphasis on self-compassion really stood out
.
Speaker 2 (09:10):
Definitely that we're often kinder to others than
ourselves.
Speaker 1 (09:13):
And relying on external validation is just not
sustainable in the long run.
Speaker 2 (09:17):
Her fifth lesson linked recovery and identity.
She broadened the definition ofaddiction.
Speaker 1 (09:22):
Right Not just substances, but any behavior
used to avoid vulnerability.
Speaker 2 (09:26):
And recovery isn't just stopping the behavior, it's
this whole process.
Speaker 1 (09:30):
Self-reflection processing, trauma building,
healthy coping skills, nurturingconnections.
Speaker 2 (09:36):
And consciously separating your professional
identity from your personalworth.
That's vital in a field likesurgery.
Speaker 1 (09:43):
Where the job can so easily become everything.
Her point about reconnectingwith other parts of life, other
values, was powerful.
Speaker 2 (09:50):
Then the sixth lesson authentic connection is
everything.
This really hit the core ofthat isolation many struggling
physicians feel yeah, thatloneliness.
Speaker 1 (09:58):
She mentioned depression as maybe grief for
lost connections.
Speaker 2 (10:02):
And that connection itself is like an antidote to
addiction and despair.
Speaker 1 (10:06):
It's a stark reminder , isn't it?
Caregivers feeling so isolatedthemselves.
Speaker 2 (10:10):
And the impact of things like patient death,
medical errors.
They take a huge toll.
Speaker 1 (10:15):
Which is why proactive peer support programs
are so essential.
Speaker 2 (10:18):
In her seventh lesson .
Just listen, Such practicaladvice for supporting someone.
Speaker 1 (10:24):
Being present, validating feelings, not jumping
in to fix things.
Speaker 2 (10:28):
Just simple human connection and knowing when to
encourage professional help.
Speaker 1 (10:32):
Her final lessons really packed a punch too.
Feel the pain.
Speaker 2 (10:35):
Yeah, that numbing emotions also limits joy and
love turned towards discomfort.
Speaker 1 (10:40):
Vulnerability isn't weakness, it's strength and hope
.
Hope requires action.
Speaker 2 (10:46):
Goals plans, flexibility, perseverance,
agency, all of that.
Speaker 1 (10:51):
And exposing shame and fear reduces their power.
Progress is slow but steady.
Speaker 2 (10:56):
And she finished with a strong call for cultural
change and advocacy.
Speaker 1 (11:00):
We need open, honest conversations to tackle stigma
and bias.
Speaker 2 (11:05):
She pointed out the contradiction Difficulty
accessing your own mental healthrecords, yet pressure to
disclose them.
Speaker 1 (11:12):
And highlighted the Dr Lorna Breen Act as a vital
step forward.
Speaker 2 (11:15):
Creating safer environments for seeking help.
Speaker 1 (11:18):
It was so important learning about Dr Breen herself
the ER doc who died by suicideafter working on the pandemic
front lines Tragic.
Speaker 2 (11:25):
And the foundation in her name is doing such crucial
advocacy work now.
So the consistent threadthrough all this material is
that surgeons face asignificantly higher risk of
suicide compared to the generalpublic and even other doctors.
Speaker 1 (11:36):
The demanding work, sleep deprivation, high pressure
, perfectionism yeah, it alladds up.
Speaker 2 (11:41):
But that reluctance to seek help because of stigma
and fear of consequences, thatremains a critical barrier we
have to break down.
Speaker 1 (11:48):
It really paints a picture of a community committed
to healing others, yetstruggling with its own
well-being.
Speaker 2 (11:54):
Dr Cunningham's story , plus the broader data, just
underscores the urgent need fora cultural shift.
Speaker 1 (12:01):
A fundamental shift around mental health in the
profession.
Speaker 2 (12:04):
Absolutely Embracing vulnerability as strength,
fostering connection asnecessity, prioritizing mental
health as well essential.
Speaker 1 (12:13):
For the individual surgeon and for the health of
the entire profession.
Couldn't agree more so as wewrap up this deep dive.
I'm thinking about the broaderimplications here.
Yes, we focused on surgery.
Speaker 2 (12:23):
But the pressures, the identity struggles, the fear
of asking for help.
Speaker 1 (12:28):
These themes resonate way beyond medicine, don't they
?
In many high stakes fields,maybe even in our own lives, For
sure.
So a final thought for youlistening what small concrete
step could you take today tomaybe help foster a more
supportive For sure?
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