The Journal of the Arkansas Medical Society Med Journal Feb 2019 Final 2 | Page 6

by CASEY L. PENN
Time to Talk
About Healing
The Importance of Acknowledging
Physician Distress Before it
Becomes Physician Suicide
by Suicide; The Consequences for Physicians of
Acknowledging Mental Illness.”
“It’s hard for me to
fathom … I don’t
think I ever truly
wanted to die, but
I made a legitimate
attempt at it.”

– Troy Birk, MD
O
ne wearisome night in May
2017, Orthopaedic Surgeon
Troy Birk, MD, tried to take
his own life. He was employed at National
Park Medical Center in Hot Springs at the time.
Thankfully, he found the clarity to get help before
it was too late.
A living reminder of the devastating near-
ness of physician burnout and suicide, Dr. Birk’s
surprise at his own actions are a relatively com-
mon sentiment among physicians who survive an
attempt. “Doctors choose suicide to end their pain
(not because they want to die),” wrote family prac-
tice physician-turned-activist Pamela Wible, MD,
in the Medscape article, “Why ‘Happy’ Doctors Die
“In absence of support, doctors make impul-
sive decisions … I asked several male physicians
who survived their suicides, ‘How long after you
decided to kill yourself did you take action? The
answer: 3 to 5 minutes … with a great work ethic
until their last breath, doctors are often checking
in on patients, reviewing test results, and dictat-
ing charts minutes before orchestrating their own
suicides. Many leave apologetic, heartfelt letters
for friends, family, and staff, detailing the reasons
for their suicide. One orthopaedic surgeon simply
wrote: ‘I’m sorry I couldn’t fix everyone.’”
As healers, we are aware of depression and
suicide, but that doesn’t make it easy to discuss
the loss of someone within our ranks or to under-
stand the reasons why. Dr. Birk attributes some
portion of the problem to the exacting standards
that come with the territory in this “saving”
profession. “We’re often expected to be perfect
when, of course, none of us are,” he said. “Also,
we’re often trained to show no weakness, so
many times our weaknesses are internalized or
manifested in other ways.”
Once suicidal herself, Dr. Wible has devoted
years to researching the reasons why. A prolific
author and speaker on the subject, she has gath-
ered information on well over a thousand suicides
so far. “High doctor suicide rates have been re-
ported since 1858,” she wrote. “Yet 160 years
later, the root causes of these suicides remain
unaddressed. Physician suicide is a global pub-
lic health crisis. More than one million Americans
lose their doctors each year to suicide—just in
the United States.”
174 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
There is evidence to suggest that we should
approach the topic of suicide with care.* However,
not discussing it cannot be the answer, stressed
Dr. Wible. “Ignoring doctor suicides leads to more
doctor suicides … Blaming doctors increases sui-
cides. Words like ‘burnout’ and ‘resilience’ are em-
ployed by medical institutions to blame and shame
doctors while deflecting their own accountability
for inhumane working conditions in failing health
systems. When doctors are punished for occupa-
tionally induced mental health wounds, they be-
come even more desperate. Suicide is preventable
if we stop the secrecy, stigma, and punishment.”
In the aftermath of his suicide attempt, Dr.
Birk is grateful each day for life, and he shares his
story now for the benefit of his peers. “There was
no ‘good point’ to it, but if there were, it would be
that I was forced to take some time off and un-
dergo treatment to work on the things I was strug-
gling with.”
Picking Up on the Signs
Whether or not we call it “burnout,” high
stress levels do correlate with physician suicide.
For Dr. Birk, many factors – and more than a little
time – pushed him to a breaking point. “Personally,
I burned out way before I had the crazy idea to kill
myself. I was having issues in my home, mostly
self-inflicted, and I tried to take too many things
on my shoulders. I shouldn’t have. There were dis-
connections with family, and there was guilt over
that. It felt like every decision I made, in turn, com-
plicated another decision.”
Add to that work, and lots of it. Having missed
very few days in 12 years of practice, Dr. Birk
was a hard worker who got along well with his
patients. “I had no issues with patients through-
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