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.