When I wrote the essay “We Burn Out, We Break, We Die,” it was in the wake of the death by suicide of my friend and fellow medical student. While his death seemed to permeate every corner of my medical school, I took the news especially hard because I understood what it felt like to be in his shoes. The feelings of imposter syndrome and isolation, the constant fear of failure and what it would mean to my family and community. And of course, the suffocating depression that had left me more breathless with each passing day.
I understood how the mind of a promising medical student, especially a student of color, could drift into darkness. Earlier in medical school, I came close to succumbing to that darkness, until I found light in the form of cognitive behavioral therapy (CBT), mindfulness, effective tutoring, and love. But the guilt of keeping my story a secret, seeking comfort through silence, consumed me following my classmate’s death. I kept asking myself, why hadn’t I done more? Why hadn’t I recognized the same signs I had demonstrated just 2 years earlier? Why hadn’t I told everyone just how bad things could get? But most importantly, why hadn’t I told them what worked?
Until my friend’s death, I thought the problem was with me — that I was unique, and my experience was extraordinary. But then I learned I wasn’t extraordinary. I was part of a trend. I quickly found that medical students are “three times more likely to die by suicide than the rest of the general population in their age range in other educational settings.” Furthermore, suicide is the leading cause of death in male residents and physicians die by suicide at higher rates than the general population.
Clearly, this is a systemic problem, but it is hardly new — the issue of suicide among physicians was first addressed in JAMA in 1903. So why hadn’t anything been done about it?
While various institutions have taken steps to address the issue, there is no consensus on how to tackle the problem nationally. I wrote “We Burn Out, We Break, We Die” for the journal Academic Medicine specifically to reach deans and policymakers who could change the culture of medical education. I shared my own narrative, while outlining evidence-based strategies employed at various academic medical institutions for solutions.
While I hoped it would inspire reforms at my own institution, I had no idea how many other institutions would hear my call for change and act. And the responses I’ve received have taught me this: students and physicians must continue to break the silence, make our voices heard, and push for change. We are powerful. We can make a difference and save lives — and I’m not just talking about the lives of patients, but of our peers and ourselves.
The Impact of Speaking Out
The first response to my essay came from our dean at the Larner College of Medicine at the University of Vermont. He not only acted on each point I mentioned in the article within the medical school, but also brought these changes to the University’s health network across the state!
Now, a working group is assessing our mental health services to make them more effective, along with a suicide prevention campaign to help destigmatize mental health services for health professionals.
I began receiving hundreds of emails and messages on social media from physicians and trainees around the globe, echoing the call for reform and explaining how they intend to use the outline in the article to change their institutions. I have spoken before members of numerous health and medicine organizations. This is a heartening response to the call for cultural change.
I appreciated the innovative response by Thomas Schwenk, MD, dean of the School of Medicine at the University of Nevada at Reno. He tasked each second-year medical student to read my article and use a word to describe how they felt about it. Then he asked them to think of words they would use to describe a culture in medical education that promoted mental health and well-being. He had them type these words into an online word cloud, revealing the results in real time. From that exercise came a powerful and productive conversation that helped develop institution-specific actions, which included hiring a mental health professional devoted to medical students.
But what has impacted me the most are the phone calls, emails, and messages from fellow medical students who have found, through my story, that they are not alone. Several told me the disclosure of the darkest chapter of my life helped them through the darkest chapters of their own, some of which included suicidal ideation. Others told me they’ve been inspired to tell their own story in the hopes of evoking continued change. MedPage Today was kind enough to write about this issue for a broad medical audience.
The humility and gratitude I feel towards each of these incredible people is indescribable. Through our stories and actions, we are the force that will begin to change this culture. We are the ones that will ensure a better future for ourselves and our patients. And we are the voices that will end the silence that equates to far too many deaths in our profession.
Optimism for the Future
As I prepare for my first day of residency, I’ve discovered an optimism rooted in the potential for needed change. I will continue to fight for every medical student and trainee to reach their full potential while preserving their mental health.
For me as a resident, this means continuing to advocate for the well-being of my colleagues both within my own program and across my profession. As a new mentor and clinical teacher for medical students, this translates into serving as a trusted ally for support and guidance, and being a voice for them at the leadership level. As a community leader, I hope to begin researching methods of bringing practices like CBT, dialectical behavioral therapy, and mindfulness to marginalized communities like my own, in a culturally competent and relevant manner.
Change is coming to our profession, but it requires persistence, patience, and advocates at every level of medical education to make it happen. From the responses to my essay from deans and medical students, I am confident we are moving towards a dynamic future that is more accepting, forgiving, and understanding for all of us.
Christopher Veal, MD, is a family medicine resident at Carle Foundation Hospital/University of Illinois Urbana-Champaign.
If you or someone you know is considering suicide, call the National Suicide Prevention Hotline at 1-800-273-8255.