I love you. I’m going to miss you.
It was a goodbye letter, basically. He had killed himself
or was about to kill himself. Actions of mine contributed to a man’s death.
Those things have profound effects on physicians.
We know from the data that half of physicians are burnt out, a
third of them are depressed. We’re still seeing a high number
of suicides for this profession. The stigma around mental illness
and medicine is so strong. People were coming to me and
saying I’m a doctor, I don’t want it on my record. In general, the medical
profession contributes to the problem. The board’s mission is to
protect the public. The best way to
protect the public includes making sure the physician is healthy and well.
No physician should be dying from suicide, right? I am a killer. That’s a fact. That thought goes through
your head. That thought doesn’t leave. Actions of mine
contributed to a man’s death. I was paged to take this patient
to the operating room so we could repair his bleeding. We
put a breathing tube in to enable a surgery to find the
bleeding. When I put in the new breathing tube his heart rate
went down to zero. It became clear he was not going to wake up. Then afterwards when I did read the obituary for this man, he had children, very young. Everything became more like just
going through the motions. He wasn’t as invested at home with
me or after our kids were born. So I was just waiting for him
to get back to himself. I definitely cried about this
every day, going into work and going home. There’s always a
sense in a question of like, well where’s the justice in this
situation? There’s only way to make this situation right. And
that answer was suicide. Physician suicide is a problem.
We see bad things happen. You know we see people die, we see
people lose their children. Those things have profound
effects on physicians. When there are traumatic things that
happen, helping the caregivers get through that is not usually
the first thought. I had all the materials. My plan was I was
going to commit suicide, just start an I.V. on myself, inject
the medicines. I’d stop breathing. Things would take
their course in 20 minutes and that would be that. I opened the
door to my room and there was a spiral-bound notebook and a
laptop sitting on his spot on the bed. “I’m sorry I’m not
there. I still love you.” …and realized the bottom line
was he had killed himself or was about to kill himself. I didn’t know
what stage of his plan he was in. I was completely surprised
because although he was obviously depressed for going on
a couple of years, let’s say, I didn’t know that he had ever
thought about it. I didn’t know that he was capable of ever
thinking about it. I was very angry that he would from my
perspective destroy mine and his children’s lives based on this.
The main thing I remember is she grabbed my hand, put it over her
heart. She said well can’t you feel this? Why haven’t you said anything? Why would you want to
leave? I got tons of education on how to prevent disasters and
accidents. I had no education on what to do if and when one
happens to you. I think in general the medical profession
contributes to the problem of physician depression and
physician suicide. One of the things I learned when I became a
physician is that people are willing to tell you their story.
What you learn is that there is a lot of struggle with mental
health issues. I got interested in the fact that this was going
on in our own profession. I definitely see patients in my
practice who are physicians and they will come to me and say
don’t put this on my record. I’m a doctor. I don’t want it on my
record. So it’s OK for our patients to have it but I kind
of wondered why is it so different for us compared to
everybody else. The numbers that we use for physician suicide
don’t have great data about them they’re mostly based on expert
opinion. Suicide is a hard thing to track down because it’s
stigmatized. It probably is hidden somewhat because of their
status in a community. If a physician committed suicide it
might be reported as something else. “Oh, Dr. Jones had an
accident.” In the research I’m doing now I’m reading through
literally thousands and thousands and thousands of
reports of how people died in what situations were going on in
their lives. And what my research is showing is that yes
it does look like physicians have a higher rate of suicide
than the general population. I mean, it’s worrisome in my mind
because it’s a) it’s a group that you would expect to have
access to care and b) I know that I am probably way
underestimating the numbers. I can remember getting the call.
As soon as she called and told me that he had disappeared I
think I just knew. They found him. He pulled into a cul-de-sac
and then kind of like down like a little ravine and just pulled
back there and shot himself in the heart. This is Glenwood
Avenue. It’s where I got the sad news about Dr. Hardison. I had
to pull over and think for a few minutes, you know, and get
myself composed. And it was because I said to myself, this
man had the perfect life. He was good at whatever he did.
It’s always in the back of your mind, like that thing happened, we’re
the family that thing happened to that people whisper about.
Sometimes I’ll wake up and I’ll just be so pissed, just so angry
and then other days I wake up and I think why am I mad at
somebody who was so distraught that they did this terrible
thing? I can remember patients coming up to me and just saying, you look so much like him. This is a box of all the letters that
we got from my dad’s patients after he passed. “The shock of
suddenly losing this wonderful man must feel too great to bear.
It’s odd he knew so much about me and I knew so little about
him, but I know he was a warm and gentle soul.” All of these
guys are doctors in this photo. Even though they were my dad’s
closest friends, he wouldn’t have talked about that with them.
He had some issues of trying to get help. He was
afraid it might impact his license. I never thought that
doctors would be depressed or need support or things like
that. It really was a wake-up call to me. The stigma around
mental illness and medicine is so strong that I don’t even
think he would admit it to his closest friends. Honestly, I
don’t even really know if he admitted it to himself. He was 100 percent positive that if he came forward and said he needed help that there would be a reprisal of some sort. Since the
medical board deals with your licensing, there was a fear that
if you sort of admitted that you needed help it would undermine
who you were as a doctor and they would start digging into
things that hadn’t even been done incorrectly and that would
just result in like smearing your name or losing your license
or you know just possibilities like that that were terrifying.
Most physicians are worried about reporting anything to the
medical board. They want to be honest but they’re very very
afraid that if they admit to something this may lead to a big
investigation. So when you start to apply for a license there’s
an initial license in every state. The way some of the
states are set up now there are questions on there about mental
health and it might be about diagnosis, it might be
hospitalization, it might be treatment. If you indicate that
you have had a diagnosis or have been hospitalized or that you’ve
had impairment from this, then they usually require you to do
additional steps. What they require depends completely on the board.
The board’s mission is very simple it’s stated in
statute, basically to protect the public against people who should not be
practicing medicine. Question number thirty. Have you been
diagnosed within the past five years with a physical condition
or a mental health disorder involving potential health risk
to the public? If yes, please provide a detailed explanation.
With mental health. We don’t go into specifics, but we do want
to make sure that our providers are stable individuals. Again,
to prevent any harm to patients. I think boards are very
concerned, understandably so, about patient safety but we
don’t have any data that identifying that someone has a
diagnosis makes it safer for patients. Not that I’m aware of. That may be a question for the board in our department to review. The first thing I did is I went to my board, the North Carolina Medical Society. And I said, and I shared the story with them,
and I said we have an obligation to do something about this now.
The tragedy opened up some serious discussions with people
that are involved in licensure. The medical board revised the
question and took the one out that was a little bit more
intimidating because they recognized that it wasn’t
helping them anyway. It also was a message to say, you know, it’s okay to seek help, you’re not going to lose your license over it. This is the nation’s state medical and osteopathic
medical boards coming together to deliberate and to talk about
policy recommendations for the states. I was invited to this
FSMB meeting to talk about some of my research which has
influenced their recommendations to state medical boards about
asking about mental health questions. So the Federation of
State Medical Boards has done a report on physician wellness and
burnout and they have come up with 35 recommendations. The
first 10 recommendations which were all about what state
medical boards should ask if they’re going to ask questions
related to mental health and the first recommendation is, we
don’t think it’s helpful to ask questions about mental health,
and we do think it prevents physicians from getting
treatment. I think it’s pretty big. I mean this is really the
first time FSMB has come out saying consider not asking these
kinds of questions on state boards. Do physicians with a
history or diagnosis of mental health problem pose a risk to
patients? We have very little data that this is true. In the
mental health questions, only half of states asked about
current impairment. And many of these states asked about
unlimited time periods. So when you were in eighth grade and
your parents got divorced and you got dragged to the therapist
who felt that you had oppositional defiant disorder,
technically you need to report that. I think if there were more
lawsuits where people said wait you can’t ask me about 20 years
ago or have I ever had a mental health problem in my entire life, I think there would be more restricted questions. ADA says you can ask whatever you want, but if the question is
whether you have a diagnosis, and you make only those people
submit more information, that’s putting a special burden on
people with a disability. There’s quite widespread concern
that many of these questions would not hold up if they were
challenged in a court of law because they’re very broad, they
don’t talk about current impairment. So every state board, there are 70 of them, has a delegate who is represented
here. So each of those delegates is empowered to be here to vote.
So it’s kind of like a mini Congress. Good afternoon
everyone, I will now call the role of delegates… Alabama…
Alaska… It does have a lot of meaning when the nation’s state
medical boards decide to support a particular point of view on
anything. All in favor of accepting the document as an
amended, please signify by saying aye? Aye. Any opposed? Excellent. The motion passes and the document is adopted. Honestly, I think he would be thrilled that something about
his life helped somebody and horrified that this story is
public, and that’s almost to me the reason why we have to do it
because he felt like it couldn’t be talked about and it shouldn’t
be something anybody knew. And I don’t feel that way. Even though
the world out there thinks that we are somehow superhuman and
make no mistakes, we’re still human and we still make
mistakes. Unfortunately the consequences of our mistakes can
be much more serious. Recovery is possible. No matter what it
is you think think you’ve done or what’s happened. It’s one of
the great parts of life. I don’t think he’s distant but I don’t
think we’ve recovered everything that was lost during that time.
It’s like an injury that hasn’t fully healed. It’s still there.
I know every day there’s two orphans. I know there’s a widow.
I don’t know how much good you have to do how much healing you
have to do to make up for the harm you felt you’ve done. I
don’t really ever want to reach the point where I feel like I’ve
done enough where it makes up for that.