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Suicide: The 'wounded healer'


National report — The suicide of Maryland-based phlebologist Scott N. LaBaer, M.D., this spring serves as a reminder that on average, doctors commit suicide more frequently than does the general population

Although dermatologists may face fewer suicide risk factors than other doctors, all physicians must remain vigilant against warning signs in themselves and their peers, sources tell Dermatology Times.

Dr. LaBaer, who had recently opened a vein treatment clinic, disappeared in late March. Police recovered his body from the Potomac River on April 16 and later ruled his death a suicide.

Why more prevalent?

Why is suicide more prevalent among doctors?

"We really don't know," says Michael F. Myers, M.D., clinical professor, department of psychiatry, University of British Columbia, Vancouver. "However, we don't believe it's just got something to do with leading a stressful lifestyle. That can be a factor, but a very important factor is whether or not there's a genetic predisposition to mood disorders among physicians."

According to a recent meta-analysis, more than 90 percent of physicians who die by suicide have either a mental disorder (most frequently depression), substance abuse problem or both (Center C et al. JAMA. 2003 Jun 18;289 (23):3161-6. Review).

"There's the notion of the wounded healer," Dr. Myers tells Dermatology Times. "Doctors tend to be hard workers and don't always relax or take time for themselves. Many physicians have a history of depression either personally or in the family. Depression is considered one of the major public health concerns at the moment. And there's been a long history of it being undiagnosed and underdiagnosed in men. It often lurks behind problems like alcoholism and drug abuse in men, including physicians. The combination of depression plus alcohol and/or other drugs is very deadly."

Herbert Hendin, M.D., says, "I don't believe physicians are educated to diagnose depression in their patients, let alone in themselves. Studies show that up to two-thirds of the time, seriously depressed patients are not diagnosed. Physicians don't ask the routine question: 'Are you depressed?' That's often enough to find out."

Dr. Hendin is medical director of the American Foundation for Suicide Prevention (AFSP) and professor of psychiatry, New York Medical College.

Triggers Suicide triggers for depression-prone doctors can include investigations into alleged wrongdoing. Such investigations attack not only doctors' licenses and livelihoods, but also their identities, Dr. Myers says. Marital discord and job losses represent other potential "last straws."

"I believe dermatology as a profession is somewhat less prone (to suicide) because as a rule, we're not surrounded with as much death and dying as other specialties," says Richard G. Fried, M.D., Ph.D., a board certified dermatologist and clinical psychologist (and clinical director of Yardley Dermatology and Yardley Skin Enhancement and Wellness Center, Yardley, Pa.). We also have the option of performing simple procedures that often make patients very happy. That makes us feel able and increases our sense of competence."

Upsides Performing cosmetic procedures likewise can help dermatologists offset the stress of declining third-party reimbursements. Dermatologists also enjoy fairly predictable schedules.

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