Why Are Surgeons Committing Suicide?

I wrote not long ago about the problem with sleep-deprived doctors.  Now I feel I must tell you that the person you are relying upon to perform delicate surgery may be so depressed that he’s contemplating suicide.

Why surgeons?  I used to be one and maybe I can shed some light.

Of course you can’t prove causality. Maybe just the fact that a person is a surgeon doesn’t mean he is at risk.  The same statement about “we can’t tell if there is something causing this or if this is an epiphenomenon” can be a criticism of almost any study, the way those invited to critique this study have spoken.

There is a problem, and this only hints at it.

Surgeons – who tend to be male — are envied by many.  They are “established,” with stable lives, highly educated and with “real” jobs and non-neglible incomes.  So why are they worrying, much more than the general population, whether life is worth it?

Oy.

The one factor cited here that is particularly unique to this profession is the knowledge that one has made an error.  Despite the constant vague inferences we all hear daily, the knowledge that one has made a mistake may be more painful and earthshaking when one is “set up” as some sort of superhuman, not particularly fallible entity.

When I started my neurosurgical residency, after my year of general surgery, I hung around for a good year before someone finally told me that the resident before me had been scraping off the back of a skull when the bone scraper slipped.

At the time, he was doing an intervention meant to decompress the spinal cord, increasing movement, giving freedom from pain.  Instead, he severed the spinal cord, condeming a middle-aged man to a life of quadriplegia and respirator-dependent breathing.

The neurosurgical resident killed himself the next day.  It was swift and painless.  Anybody who knows even a little about neurosurgery knows how to do that.

I could not cry for a young man I had never met.  I could wonder what I would have done, had I made the same easy-to-make error.  The only alternative I could think of was throwing myself at religion, at some non-professional frame of reference.  The profession would seem too painful.

But for many who choose surgery and its subspecialties, it becomes the whole of life.  Other interpersonal associations, besides those with colleagues, seem to pale.  There is simply not enough time to maintain them, given the intensity of training.

Chances to identify and treat problems are rarely taken.  They dilute the sense of power if not infallibility that is necessary to walk into an operating room and cut on people.

It would be very nice if we could humanize medicine, and surgery most particularly, for those who practice it –to create an atmosphere where errors are known and accepted, and not an organ of shame and malpractice and career jeopardy.

Perhaps those who look most powerful, even most stable, to the outside world are the most fragile.

It has been a long time since I studied the Balint group.  I was heartened to hear there is an American society devoted to such things.

It is often said that medicine is an art and not a science.  We do not have the dispassionate relationship between data and inferences that a theoretical physicist, for example, might enjoy.

We are humans who project feelings on our patients.  We all have different kinds of patients, collecting them around us not just because of who they are, but also because of who we are.  To understand this, to understand ourselves; we can do better.

Most surgeons I have mentioned any of these ideas to are uncomfortable even talking about such concepts.  The most efficient way to get people to think and talk differently about their profession would be to start approaching this in medical school.

But it is never too late to become human.

Maybe we have to fix doctors first, before we can fix health care.