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After a Physician Dies by Suicide

By Ryan DuBosar

ACP Internist

This article shares resources and discusses the multiple factors that contribute to physician death by suicide. Highlighted tools include advocating for systems changes, destigmatizing mental health help-seeking in the culture of medicine, and creating supportive communities for those associated with or affected by the tragic event.

Doctors as Patients

By DEI Shift; Podcast Episode 5 (2021)

Clinicians are often referred to as heroes for the long hours we work and the lifesaving work that we do. However, this idea of the "invincible" doctor often does a disservice to our profession and patients by creating the idea that disease and illness are only experienced by our patients. Our guests, Dr. Justin Bullock and Dr. Mansi Sheth, share their stories of going through medical training with a chronic illness and discuss the limitations of our medical system in doing so. Trigger warning: This episode discusses suicide and suicidal ideation.

On Leaving Clinical Medicine

By Kyan Lynch, MD, MA

Annals of Internal Medicine | On Being a Doctor

Fortunately, I was blessed with one of the most effective treatments for suicidality: a solid support system. My residency program was accommodating and responsive. Once I expressed my distress, the chief residents and program administration acted quickly, securing a leave for me and coverage for my patients. I was not second-guessed or judged, and no one said that I “couldn't hack it.” This is one of the reasons I am alive today.

Building Community, One Connection at a Time

By Kerri Palamara, MD, MACP

Our monthly coaching calls with Well-being Champions and Crissy Walter and Kierston Scott from ACP have become a bright spot in our calendars. Many who join us have found a sense of community and camaraderie in these groups, even if it is not the same faces each time. Knowing there is a place to go where you can be in community with others, receive support and encouragement, and walk away with action items has helped many champions fight back against the sense of loneliness that has crept in for many. We can't completely blame the COVID-19 pandemic for this—we were a lonely society in the United States before COVID-19, and the pandemic has introduced new ways to feel lonely.

So, what is this concept of loneliness all about? Loneliness is defined as “a person's feelings about the adequacy and quality of his or her relationships in particular situations” (1). Contrary to what you might think, loneliness can occur when you work alone or are surrounded by people. Think of a busy nursing station, buzzing with activity and people, and a doc sitting at a computer, alone with their feelings. Loneliness is impacted by the same stressors that drive burnout and affects 3 in 5 adults in America (2). Chronic loneliness can have serious consequences, such as anxiety, depression, and substance use disorder (1–3). The statistic that really changed my view on the importance of addressing loneliness was this: The chronic stress of loneliness can be as risky as smoking 15 cigarettes per day and increases your risk for heart disease by 29% (3)!

Loneliness can be a viscous cycle: When feeling lonely, one tends to withdraw emotionally and stop participating in social events, which only furthers isolation. For example, how many times have you heard comments like, “Why should we invite Bob? He never comes to anything” or “Marie barely talks to anyone; I doubt she'd want to come.” The lonelier we become, the more we feel disconnected and insecure: Self-doubt creeps in and negative thoughts and ruminations become more persistent (2, 3). Those who experience loneliness in the workplace begin to disengage from the work itself and the organization, which can lead to loss of meaning and purpose, decreased productivity and creativity, and increased turnover (3).

If you aren't sure if you are lonely, the Loneliness Scale.pdf is a good place to start (4). U.S. Surgeon General Dr. Vivek Murthy helps us understand how to consider loneliness and its antithesis, connection, in his book Together: The Healing Power of Human Connection in a Sometimes Lonely World. He describes three levels of connections that sustain us: intimate (partner, spouse, best friend), or someone who knows you for who you truly are; relational (circle of friends), or people you want to spend time, dine, and go away with; and collective (community), or those with whom you find a sense of a shared identity (5). In his book, he recommends spending 15 minutes per day connecting with someone else with a mindful presence, free of distractions, as one way to combat loneliness.

Other suggestions to battle loneliness for individuals or organizations are:

Individuals	Organizations
Find a buddy to check in with regularly.	Examine the culture—ask about loneliness, connectivity.
Work in teams.	Educate leaders about loneliness.
Build mentoring relationships.	Connect new hires early, even before they start.
Don't eat alone.	Encourage mentoring and buddy programs.
Take breaks, and talk to someone!	Engage in frequent team-building activities.
Be present when connecting with others.	Sponsor lunches with no agenda.
Share with and listen to others.	Talk about loneliness; normalize it.
Perform random acts of kindness.	Look out for people who are isolating.
Express gratitude.	Build social/connectivity time into meetings; lead by example, and share!
Check on someone.	Wherever possible, give the team a say in decision making that affects them.

Another component to consider in connecting people with each other at work is that we have become a bit socially awkward as a nation! We aren't used to being in close contact with each other and having unmasked or in-person conversations. In addition, for some, there may not be a ton to talk about if life is a bit mundane. Getting people talking through a team-building or connectivity exercise is a useful tool to get over that hump! I designed this exercise to get people talking and also to help them start to consider what good days look and feel like. In doing so, we can empower people to be active contributors to their well-being by building supportive environments and connections. Try it out, and let me know how it goes!

More Good Days

• Make time to pause and think about what is going well, what contributes to good days, and how to build more of that into our days.
• The goal is to have more good days and to know what good days look like for us.
• Identify tangible components of our days that contribute to our well-being.
• Build a sense of control, self-efficacy, and self-advocacy to construct environments in and outside of work that are supportive and sustainable.

What makes for a good day?

• What makes for a good day at work these days?
• What makes for a good day outside of work these days?
• Be specific! What about these things makes you feel good?

How do we get more of the good?

• What would it take to have more of that in each day?
• What do you need to have more good days?
• What can you tell yourself on the tougher days?

Next Steps

• Based on this, what do you want to ask for? This could be of yourself, of someone else, etc.
• What commitment are you ready to make?

References

1. Vantage Circle. Workplace loneliness—the silent killer of your organization. 11 February 2019. Accessed at .
2. MindTools. 8 ways to beat loneliness in the workplace. 2021. Accessed at .
3. Cigna. Loneliness is at epidemic levels in America. 2021. Accessed at .
4. AARP. How lonely are you? 24 September 2010. Accessed at .
5. Murthy VH. Together: The Healing Power of Human Connection in a Sometimes Lonely World. HarperCollins; 2020.

Connecting through the Power of One Theory

By Shradha Gupta, MD

While preparing for my talk on peer coaching and the Power of One theory at the national ACP meeting, I looked back and realized the journey I have taken.

As a child, I had many conversations with my neighborhood peers. I remember hearing from them over the years and thinking that those conversations changed our lives. Growing up and following my passion for medicine, I have noticed the importance a single conversation can have. I could see the connections that I made and how they influenced my patients and colleagues.

Along my journey as a coach and mentor, I somehow discounted the power of one conversation until recently when I felt helpless while trying to bring about a big change in the world. During a conversation with Dr. Palamara, I recognized that change starts with one. I recalled being this overwhelmed new mother as a third-year resident: one conversation with my associate program director about her personal experience of being a mother and a resident made me feel supported and not lonely. Finding commonality is the best way to showcase and support compassion.  

As a chief resident, I remember having one-on-one conversations with my fellow colleagues and residents; some of those talks influenced their future life choices. Those discussions involved not only clinical cases that intrigued us, but also behavioral skills, communications, relationships, and life-changing decisions. When I look back, I realize that those conversations have shaped my life as well.  

I specifically remember sharing my personal challenges with my fellow colleagues, which made them believe that they were not alone. During that period of my life, I was trying to extend self-compassion. I was greatly influenced by Dr. Kristin Neff, whose model promotes common humanity as a key ingredient to cultivating self-compassion.  

On my path to becoming an attending physician, I remember conversations over coffee, while charting, or at the nurses’ station that revolved around challenges with child care, practice, travel, relationship, career, finances, and more. Many examples come to mind but some of them specifically shine: As we were talking, a colleague decided to change her problematic work environment; she went on to do great things and is now very satisfied in her workplace.  

During my coaching certification, I remember doing an introductory session for a colleague: now, a few years later, she and her physician daughter are both certified coaches. The magnitude of change that a 1-hour conversation brought about cannot be discounted. I totally understand that not all such conversations will lead to big changes, but I completely believe that they will enrich our lives.

As I look back, I did not think much of those initial talks, but now I can see that those one-on-one conversations have enriched my life and hopefully the lives of my colleagues.  

So, as a person who wanted to change the world, I believe in the theory of one: That one action can have a ripple effect that can help us make a huge impact.

Complement Resources

Call the Physician Support Line for free and confidential just-in-time peer support. Visit their resource page for tools to maintain and enhance your well-being.

Establish formal peer support by using the free buddy check reminder system, and use quick check-ins (face-to-face, telephone, text, or e-mail) to provide encouragement and reminders.

Want to be featured in our newsletter? Share your success stories and those of inspirational colleagues (both ACP Champions and partners) by e-mailing acpwellbeing@acponline.org.

Back to the September 15, 2023 issue of ACP IM Thriving