Ask Me MD: Medical School for the real world

Michael Myers, MD - Mental Health Series - Physician Suicide and Prevention

September 25, 2020 D.J. Verret, MD, FACS Season 1 Episode 9
Ask Me MD: Medical School for the real world
Michael Myers, MD - Mental Health Series - Physician Suicide and Prevention
Chapters
00:00:00
Introduction
00:01:24
Interview with Dr. Myers
00:40:36
Top Three Things
Ask Me MD: Medical School for the real world
Michael Myers, MD - Mental Health Series - Physician Suicide and Prevention
Sep 25, 2020 Season 1 Episode 9
D.J. Verret, MD, FACS

On this edition of Ask Me MD, Dr. Michael Myers, professor of clinical psychiatry SUNY Downstate Health Sciences University in Brooklyn, NY, joins Dr. Verret to discuss his life long passion for being a doctor's doctor. Dr. Myers specializes in treating physicians with mental health issues and has been an advocate for preventing physician suicide.

Dr. Myers mentioned several websites during the podcast including:
Make the Difference: Preventing Medical Trainee Suicide
Dr. Lorna Breen Heroes' Foundation
National Physician Support Line - 888-409-0141
Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared


If you have questions or ideas for a show, send us an email at questions@askmemdpodcast.com. Hear the latest podcast at http://askmemdpodcast.com or through your favorite podcast directory.

Show Notes Transcript Chapter Markers

On this edition of Ask Me MD, Dr. Michael Myers, professor of clinical psychiatry SUNY Downstate Health Sciences University in Brooklyn, NY, joins Dr. Verret to discuss his life long passion for being a doctor's doctor. Dr. Myers specializes in treating physicians with mental health issues and has been an advocate for preventing physician suicide.

Dr. Myers mentioned several websites during the podcast including:
Make the Difference: Preventing Medical Trainee Suicide
Dr. Lorna Breen Heroes' Foundation
National Physician Support Line - 888-409-0141
Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared


If you have questions or ideas for a show, send us an email at questions@askmemdpodcast.com. Hear the latest podcast at http://askmemdpodcast.com or through your favorite podcast directory.

Announcer :

Ask Me MD, medical school for the real world with the MD Dr. D.J. Verret.

D.J. Verret, MD, FACS :

Welcome to another edition of Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret and today we start a new monthly series on physician mental health. Our first guest is Dr. Michael Myers, a Clinical Professor of Psychiatry at SUNY Downstate and author of several books on physician suicide. We'll be talking with Dr. Myers about how to identify physicians at risk of suicide, how we can help and what we can do ourselves to stay mentally fit. We'll be talking with Dr. Myers right after this. Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And today we have the great pleasure of talking with Dr. Michael Myers, Professor of clinical psychology, Psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York, and author of two separate books, "Why Physicians Die by Suicide" and "Becoming a Doctor's Doctor". We're going to be talking to Dr. Myers about physician suicide, and things we can do to identify our colleagues who may need help, or reach out for help ourselves. Dr. Myers, thanks for joining us.

Michael Myers, MD :

Thanks for having me.

D.J. Verret, MD, FACS :

If you can, just for our audience who may not be familiar with your work, could you give us a little bit of your background and the work that you've done into physician suicide?

Michael Myers, MD :

Okay, I'm I. I'm a dual citizen, I grew up in Canada, and that's where I did my medical school education. And then after that did my residency training in the US. But then I went back to Canada and I worked for 40 years in Vancouver, and I've only been back in United States since 2008. Working at SUNY Downstate, but I became interested in physician health. Well, actually, I didn't realize that at the time, TJ, but I became interested in physician health when my one of my roommates in medical school, there were four of us living together, he died by suicide over the Thanksgiving weekend, we were first year medical students. And that was in 1962. A long time ago, there was an enormous amount of stigma associated with medical student physician suicide back in those days. In fact, it was so bad that his death was really largely covered up. And it wasn't until I started training in psychiatry that I began to think about Bill. And also because I didn't go right into psychiatry. I back in those days, you did a rotating internship. And I worked as an emergency doctor for a year that I did internal medicine for a year. And it was at that point, then, that I began to realize that I wanted to become a psychiatrist. And that had a lot to do with dealing with suicide. I was so accustomed to looking after individuals in our emergency rooms and medical intensive care units, who were, in a sense, dying of their injuries. And you know, some of them survived, but unfortunately, many didn't. And I had this idea that I'd like to try to help the suffering individuals earlier, and that's why I went into psychiatry. And then from that, then that really led to my interest in physician health. And so after my By the way, my career has always been halftime private practice, and half time academic work. And after about 15 years, as a generalist, I decided to completely hone in on physician health. So I restricted my private practice to only looking after medical students, physicians and their families. So that's how I ended up with so much experience in this area.

D.J. Verret, MD, FACS :

I've seen some statistics out there and just from the fact that you are able to to have a thriving private practice and helping physicians I suspect the statistics are accurate, but I've seen statistics that say we lose a physician a day to suicide in that the physician suicides are almost double the general population. Why do you think doctors have such a high suicide rate?

Michael Myers, MD :

Okay, good question. That's a very chilling statistic when you think of a doctor a day, although those of us who work in the area, there is some question now about the accuracy of that, but it doesn't matter. We don't have that kind of research. But what what is most recent, though, is that it is saying that since 1980, the number of deaths of doctors each year seems to be going down. But these are all. So you know, worldwide studies of research, and it's really hard to compare the methodology. It doesn't matter what the point though is, is it too many doctors are dying of suicide, including women in medicine, which have a higher rate than women in general. And so their rates of death by suicide are roughly the same as men in medicine. There's a lot of things. One of the basic understandings about suicide is that it's rarely if ever, just one thing that pushes somebody over the edge, it's, it's what we call bio psychosocial, meaning, there's a whole bunch of forces coming together all at once in a horrific, perfect storm, that makes that individual feel increasingly hopeless, desperate, and then does something so dire. We know a lot of this from interviewing, I have, I've interviewed a lot of doctors who made nearly fatal suicide attempts, but did not die. And some of the stories I have to tell her are amazingly powerful. So there's this, this bit of history, that there may be suicide in the family, there may be a previous attempted suicide in physicians, maybe a history of a psychiatric illness, the stresses of work issue, you know, there's, we're living through an epidemic of burnout, those kinds of things. And then just two really key points I like to make. Sadly, there are too many doctors dying by suicide, who have never received any care. And even some of those who have received some treatment, it's been inadequate. And the second one that puts us at risk is that we know how to kill ourselves. We learned that in medical school and beyond are toxicology and means and methods of death by suicide. And that, that makes it you know, especially dangerous for us when and if we've all very, very ill ourselves, because of our knowledge about what to do next.

D.J. Verret, MD, FACS :

It sounds like there's probably significant opportunity to intervene in these physicians who've contemplated suicide, since it since there are several different factors that come together. So I'd like to explore a little bit of that with you. Our Are there any specialties that seem to be at higher risk of suicide?

Michael Myers, MD :

For what we know, D.J., the the fourth, the top, and again, these data are some some of us, some from the UK, and some Australia, psychiatrists, anesthesiologists, primary care doctors and surgeons. And within the group of surgeons, I'm not really sure about the breakdown into the various specialties, because you get so that the number is actually in terms of epidemiology, epidemiology or small. Yeah, one thing I should say it's also felt that the numbers of doctors who die by suicide each year, it could be under recorded because they don't all get signed out as suicides. And so it could actually be suicide, and the ones that go before a corner and medical examiner, those are probably the most accurate ones.

D.J. Verret, MD, FACS :

That's interesting. You said psychiatrists, were in the top four there, I would think they would be most in tune with, with seeing some of the presenting signs. Is there anything in particular in the psychiatry field that seems to to, to cause an issue for physicians?

Unknown Speaker :

Yeah, thank you, D.J., for asking that. Because your you know, your question about that dovetails, really, with what so many other people well, in medicine, like you are, but also lay people, they find that really kind of odd, something, you know, that sort of thing that we should be able to recognize, you know, the signs and symptoms, go and get help and that kind of thing. Where it's problematic is that we could be possibly a little bit more vulnerable to begin with when we go into medicine. I mean, there certainly is a cluster of individuals who are attracted to psychiatry because of the fact that they've suffered some type of illness themselves, perhaps as a child, or perhaps during adolescence or maybe in college. And they're wondering or in medical school, and they're wondering what branch of medicine might be kind of like, friendly or something to someone like myself in case I get recurrence. So they come into psychiatry function very well as psychiatrists, usually. But the downside though, is that Believe it or not, there's a lot of internalized stigma instead Interest themselves or in my, in ourselves and being spectris myself, which again is, you know, is a paradox because you know, we work in the field, you think we had, we'd have purged ourselves. But yet when psychiatrists and I've looked after scores of psychiatrists, and so many of them just felt feel deeply ashamed that they have fallen ill with a psychiatric illness. And when I tried to reassure them, I said, Yeah, but I've heard of the odd cardiologist who has an MRI, or an oncologist who gets cancer, you know, I'm trying to use just a little bit of humor and a little bit of reality testing. But sometimes that helps, sometimes it doesn't, and too many of them self treat, you know, they because they have access to the medications. And let me tell you, having looked after so many doctors, they say, it's so hard to treat yourself, you know, when you're not feeling well. And that's why I said, then let me take over your care. You know, because I can certainly be more, you know, objective, that type of thing. So, so I hope that answers your question about that kind of irony.

D.J. Verret, MD, FACS :

It does. And it also brings up the old saying that a lawyer who represents himself has a fool for a client, you know, the same thing you even as physicians, we should be willing to reach out when when we need help or human. Have you seen any time periods that may pose a particular risk? In other words, maybe residents more likely than attendings, maybe first year into practice? Does there seem to be any temporal relation to increasing stressors?

Michael Myers, MD :

I'm going to answer that with a yes and no. Unfortunately, we see suicide at all stages of a of a medical careers, medical school residency, early career mid career, late career retired Doc's, but they didn't. But as you can imagine, both the dynamics are different, especially medical students in resonance, they're still in that early cluster of what we know about suicide epidemiology that there is a cluster of youth of individuals who are young. And when I see a deeply depressed and suicidal resident, sometimes what that has to do with is that they don't have the, it don't have the length of time in medicine to know that you can actually be ill and get well and have an amazing career. They, they, they feel so self defeated. And they're, you know, they're they're so worried about maybe getting plowed out of their residency, or their fellowship. And by the way, it's, I could, the numbers of doctors who are not able to continue a medical career because of psychiatric illness is actually very, very small. So there are a number of physicians who are experts in the field, or the luminaries in medicine, who are living with well treated, well managed psychiatric illnesses, all the way from depression, PTSD, bipolar, illness, things like that. But they they know their illness, you're under, you know, they, they understand it, they've got a good relationship with both your treating psychiatrist, perhaps a psychologist, perhaps your primary care doctor, and they work with that and can have, as I say, a wonderful career. So that's kind of the younger group. Then when you get into sort of, you know, there's practice here, sometimes it's the stressful event, it depends on on the work itself, lawsuits, that can be a real blow, especially when the doctor isolates and doesn't really talk to his or her peers about that. Even though the attorney might say, look at, be careful what you talk about, you can talk about the emotions around a lawsuit, but not the details. Other things too, we're living in this whole era, as I said, we talked about burnout. But the the acronym for burnout is moral injury. And when doctors feel that they're being forced to do things that they believe, are morally reprehensible to them, and touch on their personal ethics, and things like that, that makes it harder for them as well. You know, treadmill, medicine, those kinds of things where doctors really don't have a voice. You're so busy on the phone, dealing with insurers, electronic medical records, not having enough face to face time, actual face to face time with their patients. The things that they went into medicine for the you know, that doctor patient relationship, when that gets increasingly compromised. They just feel like, you know, sort of an automaton or a technocrat or something that can be very, very demoralizing. And then the final thing I'll say, once again, when it's when they're living with an unrecognized or untreated illness. I want to emphasize that because some of the illnesses that we deal with in psychiatry Are elusive, it's hard to tell sometimes just really how whether whether or not you have, you know, major depression or something like that. And sometimes take somebody, you know, interviewing you doing a thorough mental status examination and good history to figure out, you know, you do have something serious going on here that we got a treat. This is not just burnout, this is something that can be treated. So let's get going. And so when you can form that kind of Alliance, you know, with either your primary care doctor and or your psychiatrist, then that's really fundamental and foundational.

D.J. Verret, MD, FACS :

You're bringing up really good points there, the moral injury, I've seen that in discussion, physician discussion forums all over the place, exactly as you described. In one of the other ones, I actually want to put a little my own experience on, you mentioned, younger physicians not having the experience to know that you can, you can go through a mental illness and come out and do very well on the other side. And we have physicians who are currently being treated for major depression and bipolar, but otherwise doesn't limit their practice of medicine whatsoever. And they're very good and productive members of the medical staff. So I just add that as well. But that don't, you know, don't don't worry about that most facilities will be very understanding.

Michael Myers, MD :

Yes, yeah. It's your your, your comments there, I think are very well spoken. Because as you as you're learning, I'm sure from the work that you're doing. You're finding too, that so many of them are really worried about, well, their credentialing applications, as well as their medical license. And as you know, the these these things vary tremendously from state to state. Like I happen to practice in New York City, when we take out a medical license or code or renew it, we're asking zero questions about our health period, absolutely nothing. Where is me, you know, many other places, you know, some states ask very what we call anachronistic and outdated questions that are in pure violation of the ADA, Americans with Disabilities Act. However, though, there's a sea change in this, the Federation of State Medical boards is making sure as best they can, to basically advise all states to use. This is a this is a template, but it's got to do with current symptoms as well as impairment. So in other words, the question to be asked is something like this? Are you currently suffering from any illness that is affecting your ability to practice safe and competent medicine? And if so, please explain to see what I mean, it's current, it's got to do with with impairment, and it's, and it doesn't partition off psychiatrists, substance use disorders, etc, etc, it lumps it all together. Because it could be Ms. It could be diabetes, it could be PTSD. It could be alcoholism, or whatever. But it's got to be current. And it's got to be impairing, because you can have illnesses and not be impaired.

D.J. Verret, MD, FACS :

And I think you what you mentioned that it varies state to state and even entity to entity. I think that's something to remember as well, because maybe if you don't have success in one state, that doesn't mean you can't move to another state and practice very successfully. So yes. So with all that knowledge, as as a physician, just on a medical staff interacting with others, are there any outward signs that I should be looking for, for people that might be in trouble for colleagues that might be in trouble that I could actually help?

Michael Myers, MD :

Yes. And let me let me talk about that a little bit. Because I have been preaching and writing for decades on we must be our brothers and sisters keeper in medicine. I believe this so strongly. And a lot of that that belief comes from looking after so many physicians sitting opposite me in my office, who admit that they would not be their word for the love and support. And sometimes the stickhandling in the strong arming of their colleagues in some of them resented that at first because they, they were not aware that they were as ill as they were, but they are so so grateful that they got into treatment, now they're feeling better, etc, etc. So things that you can watch for our you've probably heard of the quote unquote disruptive physician and see some of those physicians that's basically a physician who has trouble in the workplace, that people are noticing that he or she is rude to staff, throwing instruments, they are using foul language. They're basically causing, you know, work related stress and those around them. Those individuals always require a very detailed what we call bio psychosocial assessment. To try to find out whether or not there's something going on inside them, that is manifesting itself in those kinds of behaviors. when there isn't, well, then it's pretty straightforward. They just have a very bad personality. And that has to be managed differently than somebody who's actually got an unrecognized, untreated. So that that's, that's one form or the other, those individual kind of goes the other direction, who kind of withdraws and doesn't talk as much as he or she used to. Or you can see that their appearance seems to change, that they're not maybe quite as attentive to their, you know, to their hygiene, for instance, they're missing an action, they're late to come into the hospital. Nurses are concerned or patients sometimes are concerned, they seem forgetful. They look married, they look older than usual, blah, blah, blah, all that. So they just kind of look different. That's, that's another presentation. And then of course, then the other ones have something to do more with whether or not you might smell alcohol in someone's breath. But that kind of thing. Or you're wondering if they have access to things like fentanyl, depending on the branch of medicine, might they be using all that sort of stuff. But what I always say to people look at, if you see anything, do something, if you're better to overhaul it, always then to under color. And DJ, that's, that will probably prompt Your next question that went in if you suspect something. I'll let you pose that.

D.J. Verret, MD, FACS :

Yeah, you read my mind. So so see something, do something well, what what do I do?

Michael Myers, MD :

Okay? I've always said to that, unless for some reason or other, you think that you're not the right person, or the bad person, a bad person, you reach out to that individual, then make sure though, that you find somebody who does, somebody has to reach out to that person. Okay. And I've always genuinely thought it should be the person who's really that concerned. But sometimes they feel that they'd rather have a colleague who knows the individual better do that, that's fine. As long as somebody doesn't, okay? To see you do do it, I always ask people, I said, No, just kind of think about a little bit ahead of time, what you want to say and do and make sure that you reach out to the person in a in a kindly way, or whatever. And make sure it's private and confidential. and preferably, if you can actually get the individual to go for a walk with you, or perhaps meet you for coffee. Even if it's like off the unit, but maybe down in the cafeteria or someplace it's private, or maybe even outside or something like that. And basically just mentioned two or three things. Well, first of all, thank them for meeting with you and say, look at why I wanted to talk with you is that over the last six weeks or so, I've noticed this A, B and C, like maybe three different things, even if you've noticed more stop at that point. And say, it's just kind of worried me, I just wanted to know, you know, are you okay? So. So like you've said very little, then you're reaching out and let them talk. It'll be the rare person who will tell you to buzz off or something like that. Who do you think you are that sort of stuff, by the way, when and if that does occur. And it's, it could be diagnostic, that this is somebody who really does need to be intervened on but they are so far along in their perhaps addiction, or in their illness that they do see you at almost in almost in a paranoid way. And certainly know they must trust you and your intent. But that's those individuals are in the minority, most will say something like, Oh, I didn't realize it was noticeable. Or what do you know, I'm not I'm not doing well, as you heard, you know, my wife and I split up six months ago, I was fine for a while, but now I'm not. Or you probably heard you know that, you know, I got food. I thought I was okay. But now I find I'm not sleeping. So so they begin to open up to you a little bit. Now you're not a mental health professional unless you are a psychiatrist doing this, that sort of stuff. But then the next thing of course, you ask what have they talked with anyone about this? Often they haven't. So that might be the next thing that they didn't even talk with appear. But if they are open to talking with a mental health professional, I've always said to people that you have, you should have a little bit of idea of what the resources are. So that you can you know, advise the person because both places have some resources. It's sometimes not enough to just say Look at mine, she gives so and so a call or you know, we got this service, you know, for other surgeons when you get that individual call that sort of thing. The reason I tell you that is that years ago, I did a videotape on physicians living with depression. And I learned that from the very first woman who spoken emergency physician she was given names of doctors to call that poor woman she would call the doctor and maybe Not gonna call back or when she did the doctorate. So you're pretty busy. I've got a bit of a wait list. Are you suicidal? You know, of course, she found that question so intrusive she was suicidal actually. But she felt I can't tell that to a complete stranger, or something. So she'd say no. And then, so they should hang up. And she said it would take her sometimes 10 days to get up, you know, the courage or the fortitude to make another call. And I was sitting listening to her while observing her this videotape, and I'm sitting there off camera thinking, woman, this is awful, that sort of thing. So when I'm getting to, is, it's a good thing to offer and say, Look, I have a colleague who's a psychiatrist, or I know somebody who is, leave this with me, I'm going to find somebody for you. I'm not going to disclose your name or whatever. But I find I'll find out their availability. Is that okay with you? Now, some will, some will welcome that because they can't do it themselves. And in my practice, I used to get so many I used to get sometimes one a week. somebody's calling. This is Mrs. So and So calling, I'm calling on behalf of my husband, he's willing to see you, but he can't make the call. Will you see him? Okay. But often it was a call it This is Dr. So and so, you know, one of the other oncologists in our department is going through a really rough patch. And she's she's open to seeing you, but she asked if I would give you a call, just see if you would see her, that sort of, okay. If they insist the one doing it themselves. They say no, no, no, no, I, you know, I'm fine. If they, it's okay, give them the name of the number, whatever. But please check back in a day or two, to see if they've done that. And, you know, because, you know, they may say, you know, actually I'm fine, I've been fine. Since then, you may want to temporize, okay, then maybe give them a few more days, maybe they are on the mend. But if they're not, and said, Look, I want to revisit this with you. And the reason I say all of this is that we've learned so much from in my research for the book on physician suicide, I interviewed so many grieving families of doctors, and so many of them said that, that they really wish that somebody else had kind of reached out to him or her and done something a little bit because he felt so less than, you know, when you're a doctor, and you're not feeling well, psychiatrically. It's your self esteem just goes down the toilet, you feel less than you feel a burden. Sometimes you can get a little suspicious that people are talking about you know, or etc, etc. And so they really need, you know, you know, the help. And I use the word love. Just the love of peers to get through that very, very rough time.

D.J. Verret, MD, FACS :

I think you touched on it a little bit there, but what what prevents doctors from actually going out and getting help when they need it?

Michael Myers, MD :

Stigma? Well, first, I mean, before I before I mentioned, stick with the check, thing, sometimes just plain dizziness. There's some doctors say look at Actually, I'm kind of open to seeing a shrink. But I work so goddamn hard that I don't have time. I had a call once from a doctor, as he said, Do you see people after 10 o'clock at night? I said, Well, when I'm on call in the emergency room? Or for my private practice? Yes, I see people after 10 o'clock, sometimes three in the morning. But did you mean like yes. Anyway, we had a little joke about it, I managed to get him to take a little break from his hard work to come and see me for one hour and that was the beginning of my helping him with his work hygiene. But anyway, my point is their business I want to adjust to our kind of rugged, they see themselves as largely look at you know, I'm a doctor, I'm not Asian. So I don't want to you know, I can take care of myself. I'm strong I you know, in many of them are they're survivors of so much. So they don't necessarily want to see someone. When you know so many of my colleagues who work in physician health and say why is it when a doctor calls you to make an appointment? Why do they always say sorry to bother you? And I said, That's just it. I hear it all the time to you shouldn't have to apologize to see a psychiatrist and see that's the way the doctor is feeling inside. So there's that let me get to stigma, internalized stigma, shame. That's just the way you feel with many of these illnesses you're feeling notice as a doctor, this shouldn't be happening to me to feel embarrassed. So that that prevents you from making that phone call. The other is external stigma. And that's very scary. That's the discrimination. Those are those questions that are asked on licensing better medical licensing applications that should not be asked. The ones on hospital credentialing questions that should not be asked. they're asked to a disability insurance forms that should not be asked those kinds of things that really are discriminatory and make you feel embarrassing, you're not allowed. We're not allowed to be human. We're allowed to have these things that our patients have or the rest of the world hats. And so that's why so many of us who work in physician health, we're forever fighting all that kinds of stuff. And I'm going to conclude your this answer DJ by just telling you every time I read an article in the New England Journal of Medicine or JAMA, especially a piece of my mind, written by a medical student, or physician, who opens up, who basically comes out about having been diagnosed or treated for a psychiatric illness, substance use disorder, PTSD, whatever, I always write them a note to thank them. Because it's so important, because what they have done takes a lot of courage. And it also is such a gift to the rest of us. Because they are chipping away at stigma by doing that. And I am just I'm always so proud of them and so grateful for that act.

D.J. Verret, MD, FACS :

That's That's a great idea of promoting that, that that kind of openness. You know, I've seen a couple of reports in the media during COVID-19 of physician suicides just seems like it's a little bit more prevalent over the last couple of months. Any thoughts on what we could do just to address the added stress of the pandemic?

Michael Myers, MD :

Yes. Let me comment on that a little bit. One is that I seen those same reports. We think that anecdotally, you're right, there might be, but we're not sure because it's too early really to have those kinds of data. However, I'm sure in Texas because this was really no one all over the world. Generally, when Dr. Lorna green, you're in New York City, emergency physician at Columbia, Allen hospital died by suicide that has galvanized this nation. In fact, last Thursday was the third annual National physician suicide Awareness Day in this country. And we, for our we had a presentation at SUNY Downstate that I set up where I interviewed Dr. Breen, sister, and brother in law, and the things that they had been doing since April 26. When Dr. Green took her life as an absolutely phenomenal what they are doing in Congress, what they are doing in medical schools, the lectures they're giving. In fact, let me make a plug for the Dr. Lord of green heroes Foundation, because they are obviously looking for any funds and donations of doctors who care about this subject. Because one of the sad things is that Dr. Greene herself, suffered from terrible thoughts of Ruin in her career. So she had COVID-19. And while she was off, medically went back to work, but she wasn't recovered. In in the midst of that recover, she plummeted into a very severe, almost like a catatonic depression, received psychiatric care, but died, I think about six days after leaving the hospital. But they say that what she really struggled with was just these these awful feelings that she would lose her job that people wouldn't respect her anymore. And she was an administrator. She was a talented emergency physician, intense, so many other things that were balanced in her life, and had never had any previous history either of psychiatric illness. And this, what this tells us is that we don't know this virus is still a bit of a mystery. We certainly are now uncovering many more neuro psychiatric complications of COVID-19. But as you I'm sure you know, there are cardiovascular ones, there are gi ones, musculoskeletal ones, etc, etc. So in this COVID era, there's some of the things that we need to do is, and now that we've got a little more time with it, obviously the treatment approaches are a little bit better than we had right here in New York City when we were the the epicenter at the beginning of what we did is we set up peer groups right away that very first weekend that that our hospitals were just filling up with critically ill COVID-19 patients. So we have support groups, weekly support groups, emergency Doc's for the hospitalist all the critical care doctors, as well as nursing, medical students, all of the residents for the residents seven days a week, we set up in we also set up something on what's called op docs, which is private confidential counseling on a one on one and all of us in our Department of Psychiatry volunteer on that line. So we do that, you know. So that was something that was offered as well. And also, there's a national physician support line that's also been set up for doctors with I think over 700 psychiatrists who have volunteered to man the phone lines. And that goes for about, I think it's 16 hours a day, I think seven days a week. Now, so and it's called physician support line, national physician support line, something like that. in the workplace, though, it's important to know that most places, I think, have better PPV. And hopefully, that will, but it's recommended that all hospital settings should actually have an ethics committee, to wrestle with these things about who gets a respirator who gets taken off life support. What are some of the issues around treatment? See, it's the isolation of the health care professionals on the frontlines themselves feel from each other, of course, because of all the other PPD and the contagion in the virus, so that is distancing as well. But I'm sure as you've read or treated any patient yourself when you're separated from their families like that. So critically, Ill families are outside the hospital. So they're all having to communicate through FaceTime, or through other social media, and not being able to be with your dying loved one. That is the stuff that has been so heart wrenching. And that's been very hard on the physicians themselves. So when we're able to kind of make some debt and some of those things, that's why doctors need to be spelled off to and take time for themselves. One of the things we recommend you look at when you go home from work, don't turn on CNN, I mean, you just can't be, you can't be reading all of this latest stuff. It's just too hard. You, you've been on the front lines for 12 hours, you can go home and listen to opera or something or dance, have a dance with your wife or something like that, you know, whatever. It might be in play with your kids. Anything that's a diversion.

D.J. Verret, MD, FACS :

It sounds like the real take home there is just be proactive when you know that there's stressors like COVID-19 in physician health.

Michael Myers, MD :

Yeah, I think the preparation for a possible second surge is in place, a lot of hospitals are going to be at a much administratively all the way from the CEOs down. If they're in a much better position now, and we're certainly back in March, February.

D.J. Verret, MD, FACS :

We're going a little bit over time. But if you have a minute, I'd like to hit one or two other topics kind of real quick. I saw you have a new book that you just finished publishing, "Becoming a Doctor's Doctor". And and I didn't have time to read it, but I'm I'm fascinated by the title. Could you maybe give us a little sneak peek on that one?

Michael Myers, MD :

I will. Thanks for thanks, D.J.. In fact, I was thinking about it a little bit earlier, you know how you were talking about the work you're doing. I think of the hospital with doctors who maybe come before the medical staff because of illness or symptoms or something like that. I put in this book. I mean, most of the cases are disguised in the common sense. However, I do have four actual cases that in I've got the signed release and permission of my patients. Recently, I put those in there because one was a medical student, another was a resident, when they first came to see me, and I just I wanted people to see it, see how ill somebody could be a wealthy do with three men and where their lives are today. Because these are all individuals who are leading unbelievable careers, and are so you know, happy, you know that they're feeling well, etc, etc. Some have had some bumps along the way, but nothing like it was you know, way back at the beginning. When I wrote the book, I basically wanted to, I wanted to, I wanted to bring out the humaneness of physicians. And so for laypeople who read the book, it will also give them some insight into us that yes, we have, you know, these wonderful careers and calling if you want to call it out into medicine, and the work we do, etc, but we're also human and, and so I was I just tried to portray not just our vulnerabilities, but some of the other things too, that physicians do in their lives that have nothing to do with medicine. And so it's really sort of a journey that you know, so so it goes all the way from my medical school days back in the 60s, to this spring when I attended a virtual funeral for a colleague of mine who died of COVID-19

D.J. Verret, MD, FACS :

We're talking with Dr. Michael Myers, Professor of clinical Psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York and author of books on physician suicide about physician suicide. We're gonna take a quick break. And when we come back, we're gonna ask Dr. Meyers, his top three. Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret and today we've had the great pleasure of talking with Dr. Michael Myers, Professor of clinical Psychiatry at SUNY Downstate about physician suicide. As we do with most of our interviews, I'm going to ask Dr. Myers, his top three and and Michael, I'm actually asking you two top threes because I think you have a really unique position in interviewing physicians who've who've had issues. So one is what are the top three things you would tell physicians who are feeling overwhelmed? And on the flip side, what are the top three things you would tell physicians who see a colleague that they're really concerned about?

Michael Myers, MD :

Okay, you do the first one, what I tell physicians who are feeling overwhelmed. The first one, I say is, take care of yourself first. Because you know, sometimes we don't do that we've gone into medicine, because you want to help others. And everybody's using that analogy, these days of flying, you know, and the oxygen mask is supposed to quit on you first. That kind of thing. Because, you know, the more we take care of ourselves, the better are we we are to take care of others. So take care of yourself first. Now what I mean by that, get a little rest, watch your sleep, watch your diet, build in some exercise, because so many people feel I've lost all kind of order in my life, take a break, if you can afford to like a little bit of volunteer for a little vacation, even in stress relieving apps, there are a lot of apps these days for people who are technically inclined, that are so wonderful. And you know, then you can get into other things like meditation, yoga, you know, all that kind of stuff. The second thing I tell people is talk to someone, don't just don't just follow this up, talk to a trusted loved one. If you have one, someone in your family, or best friend, and be honest with them to let it all hang out, you know, there's such relief in that people feel so much better when they're just talk with somebody doesn't have to be a trained professional, to somebody who cares about them is interested, just don't isolate because isolation makes things worse. That's why we worry so much about the isolation associated with COVID-19. In the third one is get a primary care physician and go to that person. And let yourself be a patient. Because see that way, then your primary care physician, especially trying to find a primary care physician who's comfortable looking after other doctors, that that individual then will do a very thorough appraisal of your situation, and decide with you whether or not you should or could benefit from seeing a psychiatrist, a non medical person, like a clinical social worker, or psychologist, or speaking with the clergy, or whatever it might be. So those are the top three things that I would, I would say to somebody who's feeling overwhelmed. Now to your second question, and I like that one. You know, what advice do I give to physicians who, who are concerned about a friend of theirs? So I kind of touched on some of this stuff earlier. But the first one, of course, is to reach out to that individual. And, or if if you're not the one, make sure that somebody else does, somebody really needs to do that. The second thing is to listen, and listen carefully and do more listening than talking. And to try to create that kind of atmosphere, the individual kind of opens up a little bit. And don't be afraid to use the S word to actually ask about suicide. There's a lot of mythology out there that oh my gosh, you don't want to go there. You don't want to upset them, you can make them worse. It's just the opposite. People are grateful that somebody has asked them about that. And just take it seriously. And then if they say well, yes, actually I have been having thoughts like that. And then you can just say thank you for sharing that with me. We're gonna get through this together. I'm sorry that you're feeling that way. So you don't you don't respond with oh my god or something. There's a wonderful videotape called, is only four minutes long. It's called make the difference. It's on YouTube. Maybe The difference. It's basically what to say and what not to say to a medical colleague who you think might be suicidal. And the third thing is just to be kind to just help them, help them get their life back on track.

D.J. Verret, MD, FACS :

Dr. Myers, thanks so much. That is excellent information. And I think the way I've looked at it is if we can even save one physician, I think it was it was worth our time talking.

Michael Myers, MD :

I agree. I agree.

D.J. Verret, MD, FACS :

We've been talking with Dr. Michael Myers, Professor of clinical Psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York. Author of life physicians died by suicide and recent author of becoming a doctor's doctor a memoir. You're listening to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. Until next time, make it an awesome week.

Announcer :

Thank you for joining us for another episode of Ask Me MD, medical school for the real world with Dr. D.J. Verret. If you have a question or an idea for a show, send us an email at questions at ask me Md podcast.com.

Introduction
Interview with Dr. Myers
Top Three Things