The problem of suicide among doctors in recent years has been a concern in the world. Statistics from the American Psychiatric Association (2018) showed that those who save lives, deprive themselves of it two to four times more often than representatives of other professions.. In a Physicians Foundation survey (USA), 55% of physicians said they knew a colleague who was suicidal (tried or committed and died). The urgency of the problem is clearly demonstrated by the British series It Will Hurt (2022) based on the bestseller of the same name by A. Kay.

Studying the relationship of suicide with occupation (E. Agerbo et al) confirmed that doctors had the highest risk of suicide out of the 55 professions studied.. Suicide is more of a male problem, but in Australia its rates are 2.5 times higher among female medical professionals than for other professions (A. Milner et al.).

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Why doctors?

Not only professional, but also personal reputation and self-esteem of a doctor are closely related to his profession.. Therefore, problems that arise during the implementation of professional activities often lead to a dangerous psychological state..

High demands, competition, chronic fatigue, long working hours with lack of sleep (work at night, daily schedule) deplete the body's natural resistance. It is difficult to accept the disappointment of patients and their families when the expectation of a miracle of healing does not come true, especially when the doctor is blamed for this or he himself feels guilty..

Modern changes in the practice of a doctor often cause job dissatisfaction. Predominantly individual activity with high personal responsibility was replaced by work in a team, sometimes in a large team, with splitting of functions, standardization and control of treatment choice.. Evidence-based medicine, despite all its advantages, has led to a limitation of autonomy.

In the top reasons for the suicides of doctors in Russia are the initiation of criminal cases for medical errors or negligence and for the manifestation of corruption (such a universal problem as an incurable disease is only in third place). Factors that contribute to suicide were the deterioration of working conditions during the health care reform, the increase in workload with very low wages..

Silence deepens the risk of suicide: doctors do not talk about what worries them. Listening to and solving the problems of patients, they themselves are reluctant to seek help because of the stereotype common in society: if you use the services of a psychologist or, God forbid, a psychiatrist, you get the stigma of being mentally ill. Doctors called the reason for silence the fear of looking in the eyes of colleagues and relatives unable to cope with difficulties..

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Dr. Fern (USA) aptly compares the functioning of the modern health care system in the country with the "

There are also economic factors.. In developed countries, this is the need to pay off a loan for education, high contributions to insurance of professional activities (not yet a common practice in Ukraine, but everything is moving towards! ) or legal costs in case of claims of patients (their relatives). In almost all countries, the discrepancy between wages and the level of responsibility and social importance of work.

Of course, doctors, just like everyone else, have problems in relationships, parenting, mental or physical health, etc.. there are loss of loved ones, financial problems, attempts to avoid emotional pain. The presence of a traumatic brain injury, mental disorders or other diseases also plays a role. And finally, problems with the use of alcohol or drugs (more accessible than for others). And professional awareness of the potential for lethal effects of other drugs can become an additional factor in the ease of realization of suicidal intent (doctors used drugs twice as often as ordinary citizens).

COVID-19 as a suicide risk. Doctors are at risk due to the chances of both getting the infection repeatedly while performing their professional duties, and facing the so-called long-term COVID-19, which is associated with an increase in cases of depression and suicidal thoughts.. It has developed in approximately 150 million people in the world, some of whom are physicians..

However, even doctors who were lucky enough not to get sick themselves, especially in the first months of the pandemic, had prolonged stress.. Exhausting irregular work was supplemented by self-doubt due to the lack of scientifically based methods of combating coronavirus disease, fear for one's own life, responsibility to the sick and to their loved ones..

Burnout (physical, emotional or motivational exhaustion with reduced productivity and fatigue, insomnia) contributes to increased use of alcohol and psychoactive substances, the development of a number of diseases. The pandemic has significantly contributed to the spread of this condition among healthcare workers.

“Docovid” report on burnout, depression and suicide among doctors (National Physician Burnout, Depression \u0026 Suicide Report 2019) recorded the presence of suicidal thoughts in 14% of respondents. During the peak of the pandemic in 2020, the figure rose to 22%! The Physician Suicide Report (2022) recorded depression due to stress at work: already one in five (21%) doctors indicated the presence of depression. Compared to pre-pandemic screening for depression in several hospital systems, the prevalence of signs of depression among physicians has tripled! One in ten reported suicidal thoughts (attempted suicide). But not all doctors who committed suicide had burnout syndrome (and, conversely, most doctors who experience it do not have suicidal thoughts).

In the USA, as it used to be in Ukraine, the profession of a doctor has long been prestigious (unfortunately, in most countries, its prestige is rapidly declining). The selection of applicants to medical universities according to their achievements has contributed to the fact that both the amount of knowledge and the level of professional expectations of graduates are higher than among applicants from other specialties.. Faced with the realities of work, especially in public medicine, where the workload and demands on the doctor increase, while the time and resources for recovery are reduced, it becomes unbearable for some doctors. And the gap between awareness of the time, effort and resources spent on obtaining a specialty, received high marks in exams and a feeling of inferiority in the workplace is very painful.. And if the reward does not cover the minimum needs (of his own and his family), this can also push the young doctor to thoughts of suicide..

Dr. P. Weebl, drawing on the experience of the suicide doctor help line, compares the current US healthcare system to assembly line medicine.. But organizations that declare the goal of protecting the health of doctors, preventing burnout, in fact, are not always effective in preventing suicide, because they do not look for the root cause, but teach some sedative techniques, meditation, etc..

Speak or shut up? Will the system help

The Medscape Physician Suicide Report 2023 is eloquently titled " Of 9,175 doctors, when asked if they had suicidal thoughts, 9% of men and 11% of women answered “yes”. And most often, “yes” was said by family doctors and psychiatrists.. It is symptomatic that 40% of respondents hush up these problems, a quarter consider it possible to discuss with colleagues, 38% turn to the family and only 36% resort to therapy..

Experts call the fact of recognition of the phenomenon and open discussion of the topic of suicide by doctors an important first step, but they rank low the confidentiality and effectiveness of existing programs. And perhaps the most important thing is to regain the trust of doctors, the feeling that the system in which they work is in their best interests.. Without this, only a small proportion of them will report problems and suicidal thoughts to colleagues or management..

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Ukrainian realities are unknown.

Such studies have not been conducted in Ukraine. Suicide statistics among doctors, as well as among the general population, are not currently available.. However, the burden that lies on our doctors today is heavier than that of their colleagues from countries where there is no war.. It was especially difficult for those who save lives at the front, in hospitals, occupation or captivity. During a conversation with a doctor from the de-occupied territory, I was struck by the words that the worst thing happened not under shelling, but when it was impossible to help, and, despite all your skills and knowledge, people were dying... This pain remains for a long time.

The reasons that can push a Ukrainian doctor to suicide can be divided into two groups: universal, which were mentioned (and which became more in wartime), and related to professional activities.. The latter, to some extent increasing the risk of a difficult life situation, can be considered high responsibility.; overload with additional work, incl.. due to lack of staff and irrational organization of work; insufficient protection for medical errors, isolation and rejection by management and colleagues in the event of prosecution; complexity due to excessive digitalization of activities and electronic documentation (especially for the older generation) and too much purely administrative tasks; fear of being laid off in the process of optimizing the work of medical institutions and tense relations with the administration. There is also a decrease in the public image of the profession, offensive rhetoric in the media, a sense of guilt towards patients who could not be helped....

All this increases stress, reduces job satisfaction and social status, and contributes to the development of depression.. And getting professional help is difficult:

according to a recent study by the Acting for Health project, Ukraine’s mental health system lacks continuity and consistency in service delivery, adapting services to the needs of different groups, while mistrust of medical secrecy contributes to refusal or postponing.

The President of Ukraine constantly emphasizes the value of the life of every defender, every citizen of the country. It is very important that the loss of lives of our doctors due to suicide should not be added to the victims of hostilities....

The data of the specialized portal Medscape are used.