When osteopathic medical student Kevin Dietl took his life in 2015, he brought the crisis of depression and suicide within the medical community into sharper focus.
Though there are, sadly, many cases of doctor, resident and medical student suicide in the U.S., Dietl’s tragedy sparked a push for mental health advocacy by his parents, who agreed to be part of the documentary film titled “Do No Harm: Exposing the Hippocratic Hoax,” by filmmaker Robyn Symon, a two-time Emmy-award winner.
The documentary, which is in final edits and expected to be released in early 2018, was created to share the message widely. Planning is underway to launch a grassroots outreach effort for screenings at medical schools, teaching hospitals, medical conferences and clinics throughout the country and internationally.
“I’m hoping that this film not only leads to some broader discussion about the culture of medical training,” says Symon, “but also to greater compassion and understanding of what our doctors are going through and, ultimately, an improvement in the relationship between patients and doctors.”
Kevin Dietl was a bright medical student when spiraling depression caused him to take his life near the end of his fourth year at A.T. Still University-Kirksville College of Osteopathic Medicine (ATSU-KCOM) in Kirksville, Missouri, according to the film trailer. He was 26.
Since then, John and Michele Dietl, Kevin’s parents, have traveled across the country speaking out about the need for change in medical education and training.
The Dietls’ loss is a central part of the documentary, as is the story of Hawkins Mecham, a fourth-year medical student who attempted suicide and survived. The students’ families were brought into the documentary by Pamela Wible, MD, a physician once suicidal herself. Dr. Wible runs a blog, a suicide prevention hotline and a retreat for physicians, residents and medical students struggling with depression.
“When you have such wounded people at the helm of caring for others, the subtitle of the film—Exposing the Hippocratic Hoax—really makes a lot of sense,” says Dr. Wible. “We’ve created a glamorized image that encourages our brightest and most compassionate students to pursue medicine as a career, yet nowhere do they receive the informed consent of the life-threatening risks involved in medical training and practice.”
The risks involved
The statistics on physician depression and suicide highlight the crisis. An estimated 300-400 doctors commit suicide every year, and young physicians starting their training are particularly vulnerable.
A 2004 study found that male physicians are 1.4 times more likely to kill themselves than the general population, and female physicians are 2.3 times more likely.
In a 2016 meta-analysis by the Journal of the American Medical Association, the overall prevalence of depression or depressive symptoms among medical students was 27.2%, and the overall prevalence of suicidal ideation was 11.1%.
The reasons for the high rates are long and varied, but the film highlights sleep deprivation as a major catalyst, as well as an immersion in human suffering, the fear of making a major medical mistake and the perception that doctors can’t ask for help because of the red flag doing so could place on their record.
‘Environmental health crisis’
Also featured in the documentary is Keith Frederick, DO, an orthopedic surgeon practicing in Rolla, Missouri, and a member of the Missouri House of Representatives.
Dr. Frederick chairs Missouri’s Health and Mental Health Policy committee, where he drafted and helped pass a bill—the Show Me Compassionate Medical Education Act—that calls on the six medical schools in Missouri to create an evidence-based research committee to determine the root causes of depression and suicide among medical students. The committee will also be asked to identify changes in medical school culture that could reduce the risk of depression and suicide in students, as well as recommend changes to state law and medical licensure to make it easier to seek treatment.
“The fundamental message regarding the mental health crisis in medical schools and beyond is that this is an environmental health problem,” says Dr. Frederick. “This is not something we’re going to cure just with mindfulness and resiliency.”
Toward physician wellbeing
Besides the groundbreaking legislation Dr. Frederick helped pass in Missouri, more changes are starting. Due to the recent outcry of stakeholders in American medicine, as of July 1 physician training programs must now follow new “core” requirements that provide access to confidential counseling and urgent care.
The new guidelines by the Accreditation Council of Graduate Medical Education (ACGME) also strive to reduce the isolation that comes with the stress of an 80-hour work week and to foster connections between residents and faculty to identify signs of burnout and depression.
To help address increased rates of physician burnout, depression and suicide, the AOA House of Delegates in July adopted its Physician Wellness Task Force strategy, which takes an osteopathic approach to physician wellness, recognizing that physicians’ needs will differ depending on where they are in their training or careers, says Robert Piccinini, DO, chair of the task force. For details on the strategy, go here.
Medical schools are also heeding the call to action. Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM), one of Missouri’s six medical schools, last year launched a host of services, including expanded counseling and “wellness checks” throughout the year for every student to give support before depression and anxiety become serious issues.
This year, KCU-COM began offering personalized treatment plans to each student assessed to have high or medium risk for burnout, depression and anxiety in order to help them overcome these obstacles. The school also formed a student-led wellness committee that collaborates with the university on ideas for reducing student stress. A change in mid-term and final exam testing schedules was recently implemented due to the joint effort.
“Do No Harm’s” director Robyn Symon hopes that all the efforts make a significant impact.
“It’s a system that can work and there are solutions to create a better culture,” says Symon. “Ultimately, we want our healers to be healthy.”