On the evening of June 21, 2012, Greg drew a bath, lit candles, and put his iPod on speaker. He drank a copious quantity of vodka, and placed family photos on the ceramic ledge of the tub. At some point, he scribbled out a note that read:
My Family, I love you.
To others who have been good friends, I love you too.
This is just the end of the line for my particular train.
Earth wasn’t a particularly great place for me.
We’ll see what else is out there.
Will miss you all!
Am sorry for what it’s worth. Greg Miday.”
Then he climbed into the warm water and with surgical skill, punctured the arteries carrying blood to his hands and feet.
Greg Miday was a promising young doctor with a prestigious oncology fellowship in St. Louis. He spoke conversational Spanish, volunteered with the homeless, and played the piano as if he’d been born to it. He had rugged good looks, with dark wavy hair and a tall, athletic build. Everybody—siblings, patients, friends, nurses, professors, fellow doctors, and above all, his physician-parents—adored him. He was 29 years old.
Miday was one of a growing number of doctors who die by suicide each year. While no organization collects official data on physician suicides, Pamela Wible, a family medicine doctor in Eugene, Oregon, who writes about the phenomenon, says that at least 400 doctors kill themselves annually. That’s the size of an entire medical school class.
The little-noticed, little-discussed trend has enormous implications. Since the average annual caseload of most family doctors is roughly 2,300 patients, 400 physician deaths could mean that a million Americans lose their doctors to suicide each year.
Because doctors have the knowledge of anatomy as well as access to lethal doses of drugs, they have a far higher suicide “completion” rate than the general population. A 2005 essay published in JAMA found that male doctors killed themselves at a rate 70 percent higher than other professionals; among female doctors, that rate ranged from 250 to 400 percent higher.
There are many theories about why so many doctors kill themselves. They face the pressures of “assembly-line medicine,” merciless scheduling demands, fights with insurance companies, growing regulations, and an explosion in scientific literature with which their knowledge must remain current. Their debt burdens often total hundreds of thousands of dollars, and they work in constant fear of malpractice suits.
Internists routinely screen their patients for depression and anxiety—it’s considered the standard of care for an annual physical. But doctors, Wible says, must live up to a different set of standards. In medical school, professors teach their driven young students to put their own emotions aside, even as they attend to tragedy. “In general, we’re in a profession that will shun you if you show weakness or suffering in any way,” she says.
Small wonder, then, that many medical students report being depressed but consider it a weakness to ask for help themselves. One study found that only 22 percent of medical students who screened positive for depression sought help from a therapist, and that only 42 percent of those who had suicide ideation received treatment.
Instead, many self-medicate. About 9 percent of the U.S. population suffers from an alcohol- or substance-use disorder. Among doctors, that figure is between 10 to 15 percent.
In most states, doctors must disclose a mental health diagnosis or treatment history when applying for or renewing their medical license. A 2011 Current Psychiatry article notes that medical boards increasingly ask applicants about their mental health.
“Acknowledging a history of mental health or substance abuse treatment triggers a more in-depth inquiry by the medical board,” wrote Dr. Robert Bright, a psychiatry professor at the Mayo Clinic in Scottsdale, Arizona. “The lack of distinction between diagnosis and impairment further stigmatizes physicians who seek care and impedes treatment.”