Sulome Anderson’s feature last week, “How Patient Suicide Affects Psychiatrists” is a great inversion of a big social problem. Most features on suicide and mental illness (including the great The Cost of Not Caring series by USA Today) tend to focus on the individual who committed suicide and the impact on their family and community. Anderson did quality journalism to create this feature, which helps humanize doctors who naturally become the bad guys in some of these cases.
Personally, last year someone I knew tried to end their life- I had talked to them the a few hours prior to the attempt, having a short conversation about family relations that turned out to be much more important in hindsight (they wanted to know if I had special insight on why I have a good relationship with my parents, and they had the opposite. I wasn’t helpful, though I tried to be). When I visited this person the following day, they were still attempting to die in the confines of the hospital room. Never have I seen desperation more fully realized. It’s profoundly disturbing, and the feature gets across that this sentiment crosses all lines of profession or experience. You don’t become truly adjusted to suicidal people in your life, even if you chose psychiatry as a profession.
Personally, I thought that my history of mental illness would help deal with this experience. I’ve never been particularly suicidal, but my choice to be an activist and socialize within the community has put me into contact with many people who are open about their past with suicide. Turns out that was all (I suppose) wistful thinking. It’s horrible to witness, even in the context I had, where I had some time to mentally prep.
This feature helped develop a three-dimensional picture of the tragedy, which I wish was available with all social problems. Everyone loses someone in a suicide, and we each lose a part of ourselves when someone we know personally attempts or completes it. And yes, as Anderson comes to- sometimes there is nothing that can be done. Zero suicides is an ideal to strive towards, but no free society can ever attain it.
We are all humans with flaws and we are not omnipotent. There is only so much we can do for those we love. All we can do is our best.
Yesterday, an unusual series of nationwide events were held on college campuses and in hospitals. Medical students marched in white coats and staged demonstrations against police violence. They staged die-ins in public areas. I was at the event at the University of California, San Diego, which was held in the highest-traffic area on campus. At the end, all in attendance raised their hand and recited the Hippocratic Oath (the modern version).
It was quite an event. The events were planned well- public areas, the use of a distinctive symbol of medicine, and the use of the Oath as a unifying statement- all great, and less common than they should be. Medical students are not on the front lines of the social justice movement in the way law students or politicized undergraduates are. That is a shame, because medicine cannot be apolitical.
The reality of medicine is that world conflict and society place obstacles in front of doctors and aid workers. Certain populations and areas of the world face political oppression and in some cases genocide. If doctors accepted and only treated people where it was legal to do so, they would be condemning others. The Red Cross is a great institution of neutrality, but that sometimes their inaction can cause harm. Why do Doctors Without Borders exist? Because they thought the Red Cross were undermining the duty to heal by staying out of certain conflict zones. But to practice medicine without heed to borders means going outside the system. Whose lives are saved is at some level a political decision.
In the United States the political establishment has intruded on medicine. In Florida is now illegal for doctors to ask their patients about gun ownership, and whether that gun is safely stored. Guns are a major political issue, but they are also a major public health problem. Owners using a convenient gun to kill themselves, or the dozens of children shot and killed by other children who found an unsecured gun are something physicians have a clear duty to prevent. But they are being prevented from doing so in Florida, and many other states are considering similar laws.
With regards to abortion, physicians have been tied by unfair standards in their clinical practice, all to prevent them from performing a legal medical procedure. In states like Ohio, efforts are being made to restrict what doctors can talk about, what information they provide, and preventing doctors that perform abortion from providing sex education in schools. Laws are also attempting to provide anti-abortion doctors cover to lie to their patients, even though such conduct is grossly unprofessional.
Doctors are confronted with a healthcare system that is grossly inefficient and still very expensive. Their expertise has always been in conflict against insurance companies who will only pay for certain treatments and drugs, and stretched by patients who have no money to pay out-of-pocket. A dysfunctional system has led to incredible rates of infant mortality, obesity, and heart disease.
And why is the rate of infant mortality so high? One key part is the terrible poverty many kids are born into- the gap widens postnatal, not prenatal. Poverty is a public health crisis. There are diseases of the poor, and life expectancy drops dramatically based on race and income.
At the event, I saw a medical student with a sign stating “Homicide is a Public Health Issue”. Of course. Doctors must deal with the after-effects of crime, including violence by police officers on suspects. Physicians cannot heal those that the police kill, and unnecessary force is a danger, like smoking and not wearing a seat belt.
The health of a society is rooted in political decisions. Economic inequality due to tax breaks, black poverty caused by bad schools and unjust police action. Thousands and thousands of unsecured firearms that doctors in Florida can no longer ask about. Doctors are not the only experts being hemmed in and told how to do their jobs- mandatory minimum sentences have swelled prison populations while crime itself has gone down. Judges used to have wide discretion and take each criminal case as unique, but now laws have tied their hands. Not to idolize judges or doctors, but their education and experience is important, and shouldn’t callously be discarded by legislation.
Get onto the streets, medical students, residents, fellow, and fully specialized physicians! More of these events need to happen, the medical lobby is powerful but also conservative. The rank-in-file need to push for a healthier world, and that requires wading into politics. The American people sure need a new, clean bill of health.