The Silence We Can’t Keep: A Conversation on Physician Suicide | Ep7

Michael Hersh, MD

[00:00:00] I remember exactly where I was when I found out he was gone. He was a fourth year medical student. He was so close to graduation and becoming a doctor. He was loved. He was brilliant. He was kind and caring and funny, and seemingly he had it all and he was struggling and he died by suicide. We do not talk about this enough, but today we will.

Welcome back to Better Physician Life, how to get unstuck in your medical career. I'm really glad you're here today. Today's episode is a little different. It's very personal and it's heavy and it's incredibly necessary. We are talking about physician suicide, about medical student suicide, about what happens to the families left behind.

And about why we [00:01:00] can't keep silent on this topic anymore. This episode is being released on September 17th, which is National Physician Suicide Awareness Day. This day was established in 2018 to break the silence around physician and medical student suicide and foster open, compassionate conversations.

Why September 17th? It's a dedicated moment every year to accept a difficult truth. Physicians die by suicide at alarming rates in the US an estimated 300 to 400 physicians and likely more, and their own lives annually. That is more than one per day. Studies show that male doctors are about 1.4 times more likely to die by suicide than the general male population.

While for female physicians, that risk is an estimated [00:02:00] 2.3 times higher. and if those statistics aren't striking enough, over half of all doctors report knowing a colleague who is considered attempted. Or died by suicide. In fact, about 1 million Americans have lost their physician to suicide in a given year, and yet too often we stay quiet.

This episode isn't about blame. It isn't about finger pointing, it's about opening a door, about reminding us that seeking help is not weakness. Its courage in its absolute truest form, it's about remembering that your life matters. It matters to the people who love you. It matters to your patients, and it matters, most of all to you.

Today, we're telling one story in an effort to break that silence, and this one [00:03:00] is incredibly personal. My wife's cousin Kevin Dietl, died by suicide during his fourth year of medical school. Kevin shadowed me at the hospital when I was a third year GI fellow. He was a groomsman in my wedding. He was like a younger brother to me and my wife, and we miss him every single day.

So I would like to introduce you to Kevin's parents. John and Michelle Dietl, who have courageously and graciously agreed to share their grief, their memories, and their hope with us today. Welcome John and Michelle. Thank you so much for being here. Thank you, Michael. We're so glad we can do this. Yeah, it's an emotional time.

It's hard to believe Kevin's been gone 10 years now, and we are so grateful and proud of you for doing what you're doing to [00:04:00] help at least try to reach out to people who might be having difficulties with mental illness or any type of mental health issue. And it doesn't always have to be clinical, right?

It could be just a bad day or a bad time. Sometimes it can be reaching out for help can be as easy as going out for a pizza and a beer and just having a gripe session. Sometimes it can be going for a run or doing whatever you have to do, but the important thing is that you have to reach out for some sort of help because failing to do so can make your life so much more difficult than it needs to be.

especially our physicians, all of you are giving up a tremendous amount of time, of personal life and of mental sanity, if you will. The education process is very difficult. We know it was for our son. The experience you get when you get [00:05:00] into the field of treating is real difficult, and the pressures are much higher than you believe it.

They could be. And so we are asking, please reach out for help if you need help. I think when we think about Kevin like you said, super outgoing, terrific, wonderful guy. I think the things, if I had to draw a common denominator is that Kevin, like many people who choose medicine, and it is a very noble choice.

He had a picture of what medicine was gonna look like. As a matter of fact, I always say he, we would sit down, Kevin and I were very close. We talked all the time and he would say, dad, I want to get as smart as I can about medicine, learn as much as I can, and be around as many smart people as I can be around to see if we can learn to find ways to help.

Society and be part of the greater good. That picture I think is what most people go into medicine for, whether it's to become a doctor, [00:06:00] a nurse, any kinda healthcare provider or really anything that they do. Michelle and I are blessed to have a lot of people in our lives that the world will look at and say, wow, super successful.

We're friends with pro athletes. We're friends with. CEOs of Fortune 500 companies with people like you, other established physicians, every one of 'em will tell you that the picture they had in their mind versus what reality was, is very different. Every one of them will tell you it was anything but a straight line, and that's what we hope people will understand and find some value in what we have to say today.

When I think the analogy I use, especially with these folks thinking they, they made decisions or made moves that they thought would be totally detrimental to what it is they wanted to do. They will tell you in the same breath that they needed to go through that, that the light they found at the end of that tunnel they were going through, and it gets dark.

There's no [00:07:00] doubt. It was so much brighter. And so much more fulfilling when they got there because they knew what they had been through and they understood what others they were now responsible for, needed help with when they got there. it is never as gratifying as if you earned it.

and that's where they are. If you think about a pitcher in baseball. Throwing a perfect game. They refer to that a lot of time as a Rembrandt, right? It's an artist that paints a picture that is so detail oriented and so perfect that You think it was a photo, right?

And that was what Kevin's picture was of medicine. As a matter of fact, one of the photos I typically show is a bunch of what I perceive to be medical professionals around a cadaver. And there's somebody working on a cadaver. And in my mind that's, what Kevin saw as wanting to be a medical professional was gonna be learning.

when reality hits, there's another picture I show, which is a [00:08:00] Picasso, and it's not as detailed. looks like somebody dropped a clay oz and glued it back together. But in the same respect, these are both extremely beautiful works of art. And in the Picasso I show there is a physician and there are other medical professionals surrounding them working on a patient.

The goal of being able to help people is being achieved. The goal of building knowledge is being achieved. Sometimes the road to get there is just not that easy and you think you've failed, and it's so easy to think that you're dumber than everybody else. That everybody else has got it together and that, anybody can do this.

Kevin, I remember him telling us, dad when I was in, he started out in a DPT program, a Doctor to Physical Therapy, which is a six year program. Very difficult. And he said, dad, I led that class. I carried a 3.98. I was carrying 21 hours a semester. So I could do pre-med and P [00:09:00] pt.

That's how bad I wanted this. And during that time, I trained for and completed a full marathon. He said, I figured if I could do that, I had the physical and the mental toughness to do whatever I needed to do. But then I got to med school, right? And in med school, you're in a room with about 150 other people who are just as determined, who are just as talented, if not more talented, and you suddenly feel like.

I went from being a superstar in undergrad, in high school, whatever. Now this is just what everybody does, and that's the silo you put yourself in, right? All your friends are out there. You see 'em on Facebook, new car, new job, getting engaged, and life is progressing for them, and you feel like you're stuck in this little thing, and you're gonna give up your twenties in a large part of your thirties.

Before you even can really start making any money or doing what it is you thought you can do. And that can be really scary. [00:10:00] You're taking on huge amounts of debt and you have sometimes instructors that wanna let you know just how little it's one of those things, like the more you find out, the less you know.

And so we try to . Reach out to people, let 'em know that, you're human like anybody else, if you need help, get help. And to your statistics. There was a statistic we've worked with Dr. A-C-G-M-ESlavin. He was at SLU and he had did a lot of the work up front to monitor medical students throughout and take away

some of the things that weren't as pertinent to medical education. And he had some great results, but in one of his statistics said that 80% of the med students that they had surveyed reported some sort of mental health issues, depression, anxiety, like almost clinical.

Okay? But only 50% reached out for help because it was seen as a sign of weakness. Now I'm really happy to tell [00:11:00] you that a lot of that's changing. Not a ton. We're turning a barge around in the middle of a creek, but the banks are starting to be carved out. A lot of the medical schools are providing resources that are capable of helping the students and making it anonymous.

A lot of the times you would see if you were. Doing an application for hospital rights or to try to get your license. Have you ever been treated for or hospitalized for mental health? And a lot of, that's disappearing. Okay? Why in the world would HIPAA let you do that? So there's no such thing as a perfect individual.

Some people are wired differently, right? Some people can make it look easy, but they're struggling somewhere else and there's only room for one, number one. So just be part, it's gotta be enough sometimes to be doing great at what you feel like you need to be doing great at. So it has been an interesting journey.

I think Michelle and I have been blessed to [00:12:00] be able to share Kevin's story all over the United States at either medical schools medical conferences, high schools, colleges. And probably some of the work we did in Jeff City at our local legislature getting some laws passed to help in this area.

When you lose somebody like we did, you're lost. Everything you know of that you could count on is shattered. We only knew one thing. We wanted to do whatever we could to help. We didn't know what that was. We couldn't find the front door. The day after our son's funeral, we got a phone call from one of our local legislators, Dr.

Keith Redick. He was a orthopedic surgeon. Lived three and a half hours away from St. Louis, read about Kevin's death, drove to St. Louis for his funeral, and was so moved by that, that he wrote a poem for Kevin and he called us the day after his funeral. So we went from not knowing how we were gonna do it to suddenly opportunities [00:13:00] presenting themselves.

I know that had to be Kevin, and I always say it's probably a higher power, however you would care to assign that particular title. But he said that they had tried to pass this legislature called the Missouri Show Me Compassion Act, and it was meant to interview students and monitor med students.

Throughout the process and offer help if help could be offered. And it was being pushed back on big time by, at the time, all six Missouri medical schools. And I could understand change is hard. And again, Michael, like you said, we're not assigning blame. It was different. Okay. And it was something they needed to try to figure out.

The bill was gonna fail for the third time, and he was going up to vote on it. He was. Driving through the back roads of Missouri when he called us, he said, can I read this poem? This happens every day to everybody, right? This was unbelievable. We were having [00:14:00] Kevin's Shiva, our visitation when that was read on the floor of the Missouri House and it passed that day.

It took two more years of this amazing lady. Offering writing and presenting as well as myself testifying in Jefferson City about this issue. And the bill was signed into law. It took a while, now it was watered down, but the requirement was that all medical schools had to come together at least once a year to discuss this issue.

I'm happy to report that about four years ago they said, Hey. You know what, this is a good thing. So now they meet at least twice a year and they're adding things to it. We don't expect change right away. That's unrealistic. But seeing something like this really gives us hope.

Another piece of legislation that we testified on behalf of was the assistant physician, not the physician's [00:15:00] assistant, but an assistant physician for people who graduated med school but couldn't get. A residency and that's a whole nother bag of worms. It's difficult, right? And this would allow people in Missouri anyway to go to some of the lesser underserved markets and be mentored by a licensed physician to treat patients.

That took off big time that went into law. A lot of other states have copied that legislation. To be part of that is so humbling for us. It's just unbelievable. We're seeing that. The other things I will tell you that when Kevin started or let me back up here.

I'm sorry. At his alma mater, which was a DO school kirksville, k om at still university. They asked us to come start speaking like about six months or a year after Kevin passed away to their second year students. They were ready to go into [00:16:00] rotations. No one wanted to talk about it. the dean is in here.

We can't let the dean know, and she stood right up and said, look I'm here for a reason. I want you to be okay. She took this issue to the national do organization, and they made it a full day of discussing this, and I'm proud to say at Kirksville anyway, they have tripled their budget for help for these students.

And they also have a program where they train students. You can volunteer, you're a trusted resource, someone can come to you that's having an issue and it's all kept private. Nothing goes on the record. And if you have an issue when you're in the first two years of med school, which in my opinion they don't teach you anything about how to pass your boards, but that's another story.

They will follow you through your rotations. Just check up everything, all right, everything going on. Simple little things like that are just really what's, what gives our [00:17:00] hearts a lot of pleasure. Kevin, I know when he went into his, he was in his third year, and that's when you leave the school and now you've lost all the connections you had at school.

And he called us up and told us I'm clinically depressed. I've taken the online test, but we said go get help, Kevin. It's okay. We understand. We've had this in our family before. He said I gotta pay cash and I gotta assume an alias. We didn't understand that. As a matter of fact, that's one problem that a lot of physicians and medical workers in general, you can't go home and talk to these things a lot of times to your friends and family.

'cause they just, and it's not, they're clueless or anything. they don't do that. And so your outlets are limited. We told him, do whatever you have to do. He did get help. He did pay cash and it did start to help. And then in his fourth year, he was doing away rotations and fell short of being able to do that.

He was accepted into a [00:18:00] psych residency at the end, but unfortunately he had gone into a very bad downward spiral. And we as parents, my wife will tell you. What do you do? You got a 26-year-old child, he's not a child anymore. The school's not gonna talk to you. What if you call, are you gonna ruin his career?

I know you were so kind, and so was Sandeep another family member who's a physician. I said, look, this goes on all the time. Unfortunately, it was normalized, right? It's just. We are, we're trying to find a way where parents can be notified if something like this is going on.

And it's really hard 'cause an adult and all the other privacy issues, but that's something we've been working on. We are also proud to say that Dr. Slavin, who left SL and is now with the A-C-G-M-E and he is writing papers and doing research on this very subject.

He called us to thank us. He said, I gotta believe I'm not a religious man, even though I was a slew, but I can't [00:19:00] help but believe Kevin, had a hand in this, because I go from somebody who's raging against the machine to being part of the machine that might help to make things better.

So life has an interesting way of turning it. If I can just give any one piece of advice to the folks out there. It's never as bad as it seems. It's life is about second choices. My professional athlete, friends, all the people that you would look at and say, oh my goodness. Even were friends with a guy that was the lead singer in Poco.

Unfortunately he passed away. he told us all about his second choices. It's okay to step to the side or step back. Because this next step up, we'll be done with a whole lot more knowledge and a whole lot more understanding about where you want to go and so please never discount that.

And the last thing, Kevin knew that nobody in his family would judge him if he walked away. Nobody. But yet it stuck in his crawl that he had a [00:20:00] responsibility to do this. And we even got caught up in it. we just don't understand when you're going through it. Last thing I'll say, Michael, is that we, as much as we've done in the medical community we also are trying to, early prevention is where we want to be.

Chad's Coalition for Mental Health is something we got involved with in a very odd way. Diana went to school with a young man who had struggled. They didn't know anything about it. He became the director of Development for Chad's. Chad is a young man who lost his life to depression and anxiety when he was 18, and his mom and dad went through the same experience we did.

What do you do? I know I wanna do something. What do you do? They started a nonprofit in the basement of their house When we got the email about what this young man had gone through and told us about how they had helped him, we shared that with Kevin right away. [00:21:00] And we agreed to go to a walk of remembrance for all those who had lost their lives.

And that was one month down the road. And little did we know Kevin's picture would be, up on that wall. And that's a reality that bites hard. We met Larry and Marian McCord, the founders that day, and it's amazing the words they said. They looked right into our heart. I don't know how, I guess it's 'cause they'd been through it, but they knew exactly where we were.

They knew exactly what to say and they said two very important things to us that day. One, this is something you just gotta go through. It's a lot of anger and a lot of heartache, but you have to go through it. Number two, you got a couple of choices. You can jump in a hole with them or you can share a story and help others, and they were absolutely right.

Our quickest route to recovery we're sharing Kevin's story. One of the [00:22:00] hardest things we had to do, one of the most difficult things we had to do, but each and every time. And I think it's just true in life. When you give something to somebody expecting nothing back and your happiness is derived by seeing them enjoy life or enjoy the gift you might have given them, there's no more sense of fulfillment ever in this world that'll ever match that.

And it really helped us. It helped us get there quick.

I know that if Kevin were here today, this is exactly what he'd be doing. Thank you. I just speaking to what you were just saying we never know the impact of the work that we're [00:25:00] doing, but we can't have any impact if we don't do the work.

And so it's all just about putting our stories out into the world. And I have found over the last couple of years. And been surprised by how much impact sharing our stories can have. And so thank you. And I will never forget, I met Kevin. At Thanksgiving 2007, it was my introduction to your family, the larger aspect of the family.

It was very memorable. Thanksgiving for me. Kevin played a large role in why that Thanksgiving was so memorable and I think right here we are talking about him and there's so much of his story that is. All of our stories. When I met Kevin, he was in college. He was in his physical therapy program and he was doing that, but had.

The aspirations of going to medical school. And it completely resonated with, when I was in college, I was a chemistry major 'cause I wasn't sure was I actually gonna get into [00:26:00] medical school. And so you have your feet in, in these two boats and you're just trying to navigate and get there. And he was so determined and so motivated and this is what he wanted so badly.

And then just to clarify, he. Had matched he did ultimately receive his degree, right? He, yeah. He did receive, yeah. And the struggle is real. And as you were alluding to as we are achieving our dreams, it's not easy, right? And there's always going to be these challenges. There's always going to be the struggles and.

If we don't take a moment to take a step back and ask for help when we need it we can't learn, we can't grow, we can't progress in the way that we do. And as we were just saying our, we have impact. Our stories matter and. Asking for help is sometimes the simultaneously the biggest and the smallest thing that we can do to keep going.

And Michelle, you've been [00:27:00] quietly sitting there the whole time, and I just want to give you an opportunity before, before we close the episode, is there anything that you wanted to share or anything that you wanted to. We talked about the fact that depression and anxiety and mental health problems are stigmatized, and I think throughout this whole process from the very beginning I did not understand how this issue is stigmatized, especially within the medical profession.

I just couldn't believe it. Yeah, like John mentioned on your, a lot of licensing applications, you have to say whether you've had mental health treatment and as a physician organization, you know that it's a medical issue. So when you go for your license, you're not asked, do you have a heart problem?

do you have cancer? Do you have this, do you have that? No, it's, do you have any kind of mental health problems, which is so wrong and has been trying to get that changed as well. But, the other thing I wanted to mention is Kevin was doing a rotation during his fourth year.[00:28:00]

He was doing a rotation in the emergency room, and he, we were three hours away, so we weren't seeing his day-to-day, mental health. But when we realized what was going on with him it was clearly a psychotic break in my mind. I'm not a physician, but total break and the hospital, his attending nobody did anything about it.

I don't understand like how he worked with patients because he was so just, out of it. So that's the other thing I wanna mention is if you know a colleague that's having problems. You need to, it's really very hard to know what to do, but you have to do something. Yeah. Absolutely. So educating, and that's what Chads does too. It goes into the schools, it educates the kids what to do. If you have a friend that you're worried about, most kids don't know, they go into the fourth grade to start these programs, and they teach the kids Who do you talk to?

What do you do? Do something, so that's my message too, as. Physicians, please look out for yourself and also your colleagues. Yeah, because it's [00:29:00] really important. Look out for one another. It is. Absolutely. I'll leave you with with a couple of things. Number one. Like Michelle said, eliminating the stigma from everywhere and forever is our life goal.

And we won't stop and there'll be people going on after us. We hope that something like this helps to keep that going. Number two, when you say you never know who you're helping, we had a neighbor that lived down the street. They moved out. As you progress through life, there's a reason why at 18 to 26, you're more vulnerable for this.

There's a world out here and this sucks, right? Trying to process, that's difficult. One of the neighbors down the street sent me a text about a year ago with praying hands saying, from Chad's, one of our counselors has identified your child as needing attention. And so there's somebody we knew down the street that Chads was gonna help out, and she thanked us.

So very much until you've been [00:30:00] through something like this, until you've been exposed to something like this, you don't really know what it is. And that's why a lot of people just think, oh I'm different. I'm weird. I'm crazy or not. You're just human.

Thank you both so much. Thank you Michael. Thank you for doing this. As we close today, I wanna leave you with a few reflections and a reminder that we can all play a role in preventing physician suicide. And as you guys were just mentioning, prevention begins with recognizing the signs, and you were talking about CHADS and some of the work that they do.

And so I wanted to offer an acronym that I have seen online, which is the HEART acronym. Which can help us remember the vital signs that can be a clue when someone may be struggling. And so heart stands for the H is for health, which means keeping an eye out for the increased use of medications, alcohol or drugs, or if someone [00:31:00] is talking about wanting to hurt themselves or die, the E is for emotions.

Recognizing extreme mood swings or if somebody is feeling hopeless or there's no purpose. A is for attitude, meaning that we observe growing negativity about professional or personal lives, outbursts of anger or sadness. R is for relationships, so if we notice that our loved ones or our friends or our colleagues are withdrawing.

And specifically if we notice that they're talking about being a burden and then that he is for temperament. So if we notice that someone we care about is acting, anxious, agitated, reckless, or expressing unbearable, emotional or physical pain, all of these things count. So if you notice these signs in a colleague, a loved one, or in yourself.

I hope you'll remember that it's okay to open up [00:32:00] and start a conversation. It may feel uncomfortable, it may feel like it's not your place, but as John and Michelle were just saying, reaching out can be the very first step that helps someone get the support they need and it can life saving. You do not have to wait for the perfect moment.

You can just find a calm, quiet space that doesn't feel rushed or full of distractions. And remember, you don't have to fix everything. You just need to listen. Truly listen and be a reminder that they're not alone. If you or someone you know is struggling or in crisis, please reach out for help. You can call or text nine eight eight or chat at 9 8 8 lifeline.org.

These services are free 24 7 and completely confidential. And if you're a physician or medical student needing a safe place to talk, you can reach out to the physician support line [00:33:00] at 1-888-409-ZERO 1 4 1. It is staffed by volunteer psychiatrists who understand the unique challenges physicians face, and for additional mental health support, you can reach the National Alliance on Mental Illness Helpline at 1 5 0.

6 2, 6 4, and I'm gonna share all of these resources in the show notes. Again, if you are concerned about a colleague or a friend, do not wait. Suicide can happen quickly and early conversations really matter. And while individual awareness and conversations are critical, we cannot ignore the fact that system level change is also necessary.

Healthcare workers deserve access to mental healthcare without the fear of losing our licenses or our jobs. Many doctors are delaying seeking help [00:34:00] because of intrusive or stigmatizing questions on licensing and credentialing applications. Despite these questions often violating the Americans with Disabilities Act.

There are programs like the Wellbeing First Champion Challenge and caring for caregivers that are working to change this, advocating for hospitals, health systems, and licensing boards to remove unnecessary barriers so that healthcare workers can get help without fear. so if you are in a position to influence these systems, your voice can be part of this change, because your life matters, matters to your patients, matters to your colleagues, and your family and your friends, and most importantly, it matters to you.

So if today's conversation brought up feelings you didn't expect, or if you feel heavy, please give yourself permission to pause. Step outside. Take a [00:35:00] breath. let someone you trust know how you're feeling 'cause you don't have to carry it alone. Thank you for being here today for holding this conversation with us, for holding space for your own humanity within the practice of medicine, because we need you here.

Thank you so much to John and Michelle for the work you're both doing. For raising awareness and for breaking the silence. Michael, I wanna thank you for having us, and I just wanna let you know how much Kevin loved you and how much he respected and looked up to you. And I know he would be very proud of all the work you're doing.

Absolutely. And you are saving people, so Thank you. I've been trying to hold it together this whole time. I know. Me too, my friend. But that's part of being real. Yeah. It's part of being there. And that brings me to thanking Kevin for always being a light in our lives. He will forever be in our minds and [00:36:00] in our hearts.

Yeah. Until next time, please take care of yourselves and I will see you on the next episode of Better Physician Life.

Thanks.