Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 173 | June 27, 2022
Why Physicians Die By Suicide
Dr. Michael Myers
Vice Chair of Education - Downstate University Medical Center
Welcome to Difficult Conversations with Dr. Anthony Orsini. In previous episodes, we’ve had some guests that talked about the problem of substance abuse among physicians. We heard about an incredible film documentary on physician suicide, and we heard from physicians about their journey with burnout. This is an important topic because it doesn’t just impact doctors and their families. It also affects patients. According to one statistic, physician suicide affects 900,000 patients per year in the United States, and a physician dies by suicide in the U.S. on an average of one per day. That speaks to a significantly larger problem in healthcare. Recently, I read the book, Why Physicians Die by Suicide: and I knew I had to have the author on since he has a unique insight into this problem. Today, my guest is Dr. Michael Myers, Professor of Clinical Psychiatry at SUNY-Downstate Health Sciences University in Brooklyn. He’s a specialist in physician health, a researcher, teacher, and consultant, as well as an author of nine books. He’s a highly regarded speaker and lecturer on all aspects of physician well-being.
Michael shares the story about his medical school roommate who committed suicide. We find out how Dr. Myers started out in Internal Medicine and the game changing decision that made him take the leap into Psychiatry. Dr. Orsini and Dr. Meyers share their concerns on the “elephant in the room” problem, how we got into this crisis. Many physicians are asking for help, but as Dr. Meyers explains there is work being done to make it easier and more permissible to ask for help. We dive into Dr. Meyers book, and he shares stories about the hundreds of families he interviewed, and how this changed his life, To the family and friends of physicians out there, Dr. Meyers goes in depth on how they can identify the red flags To the physicians who are feeling depressed or having suicidal thoughts, he sheds some light on what the rules and laws are that protect them, and the best way to find the psychiatrist that is right for them. If you enjoyed this podcast, please hit subscribe on your favorite podcast platform. Go ahead and download this episode now!
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Dr. Michael Meyers (2s):
Not only do we have to somehow make it easier and more permissible and just normal to go for help. In fact, one of our main messages on a lot of the products on preventing suicide in doctors, is going for help is the smart thing to do. The smart thing to do or the responsible fighting to do. So we’re trying to work on that message. Okay. But there’s that, but then also one of the things that I speak so much to about my colleagues who do look after physicians is that we also have to do a better job. We have to realize that the person opposite us is yes, maybe somebody with PTSD, somebody with depression, some substance use, but they’re also a physician. And that does make them just a little bit different in certain ways, the shame they feel of having to come to see you.
Dr. Michael Meyers (47s):
The way that it’s going to be sometimes hard for them to kind of get with the program.
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members, or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 38s):
Well, Welcome to Difficult Conversations Lessons I Learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. We have done so many episodes surrounding the topic of physician burnout and physician suicide. In previous episodes, Stephen Wolt and Dr. Michael Sucher talked about the problem of substance abuse among physicians. We had Robyn Symon who shared her insights about her incredible film documentary about physician suicide. And I also had the privilege of interviewing Dr. Jonathan Fisher and Dr. Dike Drummond about their journey with burnout. And of course we have the incredible Wendy Dean talking about her work with moral injury. But this is such an important topic affecting everyone.
Dr. Anthony Orsini (2m 18s):
It doesn’t just impact doctors and their families, but according to one statistic physician suicide affects 900,000 patients per year in the United States. A physician dies by suicide in the U S on an average of one per day. And That speaks to a very larger problem in healthcare. That’s incredible. I have to believe that if we can’t keep our physicians healthy and things are so bad that they’re committing suicide, the whole system has problems. So recently I came across a book Why Physicians Die by Suicide? And when I read the book, I knew instantly that I had to have this author on. He was someone that really needs to have on the podcast cause he has a very unique insight into this problem. Today my guest is Dr.
Dr. Anthony Orsini (2m 59s):
Michael Myers. Dr. Myers is a Professor of Clinical Psychiatry at SUNY Downstate Health Sciences University in Brooklyn. He Is a specialist in physician health. As a clinician’s doctor, doctor, researcher, teacher, and consultant. He’s the author of nine books, two, which are relevant to this podcast. “Why Physicians Die by Suicide Lessons Learned from Their Families and Others Who Cared” that’s what I spoke about earlier and “Becoming a Doctor, Doctor A Memoir”. He’s a highly regarded speaker and lecturer around the world on all aspects of physician wellbeing. And he is simply a psychiatrist who specializes in physician health. Well, Michael, thank you so much for, I know you’re really busy.
Dr. Anthony Orsini (3m 40s):
It took some time out of your schedule to talk to me a few weeks ago and coming on this podcast, we really do appreciate it.
Dr. Michael Meyers (3m 45s):
Thank you. I’m delighted to be here and thanks for inviting me, Tony.
Dr. Anthony Orsini (3m 48s):
So Michael, we spoke about a month ago and you told me your story and it really it’s fascinating and your story starts out. And I think you said 1962, when your medical school roommate committed suicide. So that’s probably a good way to kind of give us an idea of how you’ve evolved into this really important role. So tell us that story.
Dr. Michael Meyers (4m 6s):
So yes, you’re right. It was over the Thanksgiving weekend of 1962. There were four of us who are medical students sharing a flat. And I was the last person to see Bill alive. We have chatted just about some sort of minor incidental things. He seemed fine when I returned from the weekend to learn that he had taken his life over the weekend, I was just stunned. And I felt nauseated. I kind of felt sick to my stomach. I remember sitting down and just kind of getting hold of myself or whatever. The landlady lady explained what she knew from his parents calling and saying that he wouldn’t be coming back to medical school, that he died by carbon monoxide over the weekend.
Dr. Michael Meyers (4m 46s):
So that evening I spoke to one of the other roommates who was there. The other two were overseas studying tropical medicine, but he had an exam the next day. I think he was kind of stunned too, but didn’t want to talk about it. So anyway, the next day we hadn’t heard anything from our medical school. So I asked our biochemistry professor, if I could make a brief announcement before he started the lecture at nine in the morning. So I did, I stood up in front of my class. I can still see their faces. I can feel my quivering voice and my wobbly knees telling them Bill had died by suicide over the weekend. We didn’t know anything more than that, but that I would keep them posted. I sat down, of course you could hear a pin drop.
Dr. Michael Meyers (5m 27s):
The professor I mean, blindsided like this. He went back to the podium and he said, okay, let’s return to the Krebs cycle. And that’s a metaphor, right? Let’s not talk about this. This is heavy stuff. And let’s get back to the science of not our son or whatever, and away we went. And that’s exactly what we did. I think we all just buried ourselves in our studies and you know, how easy that is to do, but of course I, you know, I went by that empty room every day. And one thing has stuck with me is Bill’s image of him sitting in his desk studying when I’d walked by after class. And obviously I knew he was dead and then it would disappear. I didn’t know at the time, of course, because I hadn’t studied psychiatry.
Dr. Michael Meyers (6m 9s):
I hadn’t studied bereavement that seeing the image of a departed person that you’ve known after death of any kind is not that unusual. And it’s all got to do with just not being quite ready to let that go yet. And in an odd way, I wasn’t kind of freaked out by that. I didn’t think God I’m losing my mind. I’d seen more kind of comforting, but then of course it was over that sort of thing. So I think that’s the night us, Tony, that really kind of, because I’m someone who didn’t go right from there and after medical school into psychiatry or into physician health into a few other areas first, but
Dr. Anthony Orsini (6m 46s):
Yeah, you did internal medicine, right? And then what made you decide to take that leap?
Dr. Michael Meyers (6m 51s):
That was really quite straightforward. Actually. I think I really kind of felt I loved it, but I felt very, I think even disillusioned is too strong a word. What I was feeling was it, I am so busy with these very sick patients that I don’t get a chance to really get to know them at all. And it kind of felt like that. I knew there was more there in these people’s lives. And, but yet you make a diagnosis, you get them better as quick as you can get them out of the hospital, always more patients coming in to the empty beds and things like that. And then I had an elective after six months of general internal medicine. This was at LA County hospital in Los Angeles with a man who is board certified in both psychiatry and in gastroenterology.
Dr. Michael Meyers (7m 34s):
So he’s doing this elective in inpatient gastroenterology and this man came and he spoke to my patients in a way that I had never ever seen before. And I mean, I was mesmerized. I thought, woo. This is why this guy’s having an exacerbation of his ulcerative colitis. This explains his toxic megacolon all this sort of stuff I could. It was just unfolding before my eyes. And that was the game changer that I realized then that maybe if I went into psychiatry, oh, sorry, there’s one other piece. I had worked as an emergency doc in Detroit, Michigan Detroit receiving hospital for a year. And I had seen a lot of suicide attempts, nearly full or lethal suicide attempts.
Dr. Michael Meyers (8m 17s):
I’d also seen them when it, during my internship, back in those days, they heavily prescribed barbituates and something called Dormin for sleep. And those were really lethal. I mean, despite peritoneal dialysis, our patients died under our watch. And so I had this sort of sense that these people at some of them were young and that was the other thing I thought maybe they’d be going into psychiatry. I could make a difference at an earlier point in this person’s life that wouldn’t get to that degree, that they were so desperate that sort of thing.
Dr. Anthony Orsini (8m 49s):
Last time we spoke something hit me because you talked about your roommate and I had nearly forgotten about it. But when I was in medical school, something very similar happened to me. For those of you who aren’t in, never went to medical school. You typically have four people around the cadaver when you’re a first year. And, And so we cadaver mates for lack of a better word we were. And after the Christmas holiday, one of the students, one of my cadaver mates didn’t come back. We inquired. And all we were told was that he passed away over the Christmas holiday. We asked about it. We were just told it was a private matter. And people always speculate. Was it drugs, et cetera. But of course he didn’t seem like that kind of person, but I wonder now if that’s what it was and it very well might have been after talking to Robyn Symon and after doing all this research, I’m wondering if this was what it was.
Dr. Anthony Orsini (9m 38s):
It would have been the perfect time to do it right Christmas and around the area. He was a little bit older. He was right out of college. I think he had worked for five or 10 years and lived by himself and he didn’t have any roommates. And when I still wonder to this day, if that’s probably that’s what it was, and it’s really, really sad. So you’ve done all this research and want me to talk about your book in a second, but this really speaks to this really large humongous problem. It’s the elephant in the room, just like my college, no one wants to speak about it. Doctors don’t want to speak about it. How do we get here, Michael? I mean, where do we get to this crisis that maybe we’re starting to talk about it now, but really not as much as we should.
Dr. Michael Meyers (10m 16s):
I think it’s twofold. It’s funny. The whole history of suicide in our world, not just in the United States is rooted in prime for one thing. It’s also rooted in sin. And that explains a lot of the stigma about suicide in general. Now I think where that dovetails with medicine is when you look at the history of medicine and there are some wonderful articles and books actually on the history of medicine and suicide, I’m friendly with a historian actually in the UK who has really studied suicide. Well in both the 19th century, as well as the 20th century, it goes back a long ways in medicine and the so-called golden era of medicine started around the turn of the century.
Dr. Michael Meyers (11m 3s):
So 1900 to about 1970. And that was the era of, I would call it sort of medical exceptionalism or elitism. That these are individuals who are talented, strong, smart. They save lives. That sort of thing, mostly men, of course, because we didn’t really see more women coming in until the late sixties and seventies. And that was kind of a stereotype. And so I think when I look at Bill’s death occurring in a medical student in 1962 that’s before 1970, and when physicians or medical students took their lives in that era, they were seen as outliers that in fact, this is a really sad anecdote toward the end of that year of that academic year.
Dr. Michael Meyers (11m 49s):
It was the spring when one of the professors said we all had seats in the, in the auditorium. He said, you know, I get sad every time I look at that empty chair, that empty seat in the front row. And I thought to myself, finally, he’s somebody is going to say something about Bill. And he said, it really saddens me that we didn’t fill that seat with somebody who is prepared to go the distance.
Dr. Anthony Orsini (12m 14s):
He actually said that, oh my,
Dr. Michael Meyers (12m 18s):
Yeah. And yeah. And yet I just, I think in a way maybe some of us partly kind of felt the same way or something, how competitive it was to get, I mean, not having much insight or understanding about the mental illnesses that drive suicide and stuff like that. There, it was a uninformed time. I would say Then, with the 1970s, that’s called the enlightened era. And so that’s when physician health programs began to spring up and people became interested in us as human beings and not just flawed people who maybe should be kind of plowed out. But yet, despite where we are in 2022, there still is a fair amount of both internal and external stigma associated with psychiatric illness in physicians,
Dr. Anthony Orsini (13m 7s):
From what I know and you’re the expert, but the system is so stacked against us. So Dike Drummond and talks about the big S on your chest. And you feel as a doctor, you have to be invincible. You’re perfect. You know, when you and I came up, it’s not so much now, but when you and I came up, we used to brag about doing 48 hours shifts, right? Oh, you know, the surgeons used to say, if you work every night, that means you miss half the good cases. Right? And so any kink in the armor was considered a weakness. And I think to this day, we’re still afraid to ask for help. We’re still afraid that somebody is going to find out the average person who’s maybe has a little depression, can take medications. If they’re having trouble sleeping, they can take sleeping medications, but a physician goes for credentialing or goes to a new hospital, they get drug tested, and then they have to explain why they’re on this.
Dr. Anthony Orsini (13m 53s):
So can you elaborate on that? I mean, how do we get to this point where we’re just, everybody’s afraid to ask for help.
Dr. Michael Meyers (13m 58s):
And of course that’s not the whole story. I mean, there are indeed people of course asking for help. However, though, that’s twofold. Not only do we have to somehow make it easier and more permissible and just normal to go for help. In fact, one of our main messages on a lot of the products on preventing suicide and doctors is going for help is the smart thing to do or the responsible thing to do. So we’re trying to work on that message. But then also one of the things that I speak so much to about my colleagues who do look after physicians is that we also have to do a better job. We have to realize that the person opposite us is yes.
Dr. Michael Meyers (14m 38s):
Maybe somebody with PTSD, somebody with depression, somebody with substance use, but they’re also a physician. And that does make them just a little bit different in certain ways. The shame they feel of having to come to see you, the way that it’s going to be sometimes hard for them to kind of get with the program. I’m so used to it. I was so used to my physicians, not kind of, you know, following the drill, stopping their medication, self prescribing, things like that. And, you know, being a dynamically trained psychiatrist, you know, we’re used to kind of getting behind those behaviors to understand the individual, can’t be the model patients, so to speak because it’s hard to go from the doctor role to the patient role.
Dr. Michael Meyers (15m 23s):
And so these are things that I write about so much in my articles and in my books to really kind of explain that. Both for us, you know, in our hour of need where maybe we’re not the best place, but also
Dr. Anthony Orsini (15m 36s):
Dr. Michael Meyers (15m 37s):
When people look after us.
Dr. Anthony Orsini (15m 39s):
Speaking of the articles and the book. So let’s move into Why Physicians Die By Suicide, which is the book that really impelled me to call. That was a different angle that other people took. You interviewed. I think a couple hundred families tell us about the families and what you learned from that.
Dr. Michael Meyers (15m 55s):
In one word, it’s been profound. It’s changed my life. I preface the book by saying there’s so much that we already know about physician health and the illnesses that we can get the drivers, et cetera, et cetera. I wanted to interview individuals who knew the doctor intimately. So I started with the families, the parents, the spouses, the partners, the kids, sometimes grandparents, etcetera etcetera. But I extended that vote to roommates of doctors, to training directors, to deans, to friends. And then there was two other groups. I also interviewed patients who lost their doctor to suicide and what that was like for them.
Dr. Michael Meyers (16m 36s):
Those are compelling stories as well. And the fourth group is that I wanted to talk with doctors who had made near lethal suicide attempts, but did not die. Because most of them are so grateful to be alive. In fact, some of them suffer from survivor guilt. Why did I live? And yet, so many other doctors died from their suicide attempts.
Dr. Anthony Orsini (17m 1s):
You just brought up an interesting story about, I think it was a surgeon who tried to commit suicide and survived and her comment was, I can’t even do that. Right?
Dr. Michael Meyers (17m 10s):
Yeah. That’s why I really wanted to put that in the book, Tony, because I’ve just seen that in other forums where somehow we’re such perfectionists, even if we try not to be, you have to be somewhat perfectionistic to even get into medical school or then to get into residency or to keep up your mojo. I mean, to really be a safe, competent practitioner, et cetera, et cetera, it’s a lifelong learning, et cetera, et cetera. So I know I was really struck by that, you know, here’s my poor patient who thank goodness did not die of her suicide attempt, but fortunately she was able then to, and what isn’t captured in that short vignette is that she had been stockpiling her medications.
Dr. Michael Meyers (17m 51s):
She was just so reluctant to take it. I didn’t know that of course. And that’s what she overdosed on. But with that, so that was a real wake up call for her. That woman, I have followed her from a distance she’s been fine, has an illustrious career. And just an example of someone that I’m just so grateful that I could be her doctor and also help her sort of regain her health.
Dr. Anthony Orsini (18m 16s):
What did you learn from these families gave go with that?
Dr. Michael Meyers (18m 19s):
There are a lot of things I’ve learned one of the first things, and this is the one that is, I find chilling is that roughly, I don’t know, 15 to 20% of the family members of doctors who died by suicide, that I interviewed the deceased doctor had not received any care at all. And I mean that no primary care, no psychologists, no psychiatrists didn’t even go to the clergy. Anybody who might have tried to help. As you can imagine, family members were frantic, terrified that this individual was maybe going to do something, but they kept saying, you know, all of these kind of fears that we hear so much about, I’ll lose my job.
Dr. Michael Meyers (19m 3s):
I’ll lose my admitting privileges. My credentialing I’ll lose my medical license, my malpractice insurance, or go up. I won’t be able to get a health insurance, all kinds of things that are hard to reason with when somebody is feeling so agitated and so ill, that sort of thing. So there’s a public health imperative there. And I’d like to know all of my mental health colleagues look at, we got to do a better job. We somehow have to make it easier for symptomatic physicians to come to us. We have to do this work with medical licensing boards, credentialing committees, and get those messages out there. Not to be discriminatory, not to violate the Americans with disability act.
Dr. Michael Meyers (19m 43s):
All those kinds of systemic changes. So that’s one of the biggest things. The others were family members who are desperate for information of what to watch for. And they felt in hindsight, you know, if I kind of just knew some of this stuff I would have, this is hindsight, but look at, I would have just insisted. I would have taken my husband. I would have locked him in the car and driven to the emergency room or driven to a doctor and said, look, it you’ve lost your rights, but I didn’t know. All I knew was that he was not the same, that kind of thing. Or he kept making excuses and kept saying, I’ll be fine. Don’t worry about me. No, no, I’m not suicidal. I’m not suicidal, et cetera, et cetera. Next thing you know, he’s dead.
Dr. Michael Meyers (20m 25s):
In these people, by the way, have become absolutely fundamental in our prevent suicide work. These are people who are speaking, they’re going to conferences. They’re telling their stories. The other things too, that I’ve learned is the how stigma gets right into the, so even when a doctor does go for help. So often they fall through the cracks. They have to be looked after by people who are experienced, who are used to individuals who don’t want to be there. And you have to make them feel accepted. You have to be gracious. You have to be kind, you have to drop so much of your jargon. You have to let them be the patient and you have to be the doctor or the psychologist or whatever the mental health professional is in charge.
Dr. Michael Meyers (21m 8s):
Not in an authoritative way, but in a strong and firm way. Like I expect when I go to my heart surgeon or to my urologist or whatever, I’m going to turn over my care to that individual. So, but you don’t have stigma there so much as you do in my branch of medicine. Those are, so those are some of the, the highlight. The other thing too is yeah. Is the under-diagnosis that sometimes not only, I’m very careful not to blame us as physicians when we’ve become ill for hiding our symptoms. Because when we do, it’s generally only because we’re terrified or ashamed, it’s not to be deceptive with our treating physician. And also sometimes I’ve seen this in my practice.
Dr. Michael Meyers (21m 49s):
Some of my patients are much sicker than they realize. And that includes my psychiatrist patients. When I conclude at the end of the consultation visit of what I’d like to discuss in a way of a treatment plan, they look at me and say, what you want me to take an antidepressant? They’ve lost 20 pounds. They’re sleeping about two hours a night. They can’t concentrate. They almost have a pseudo dementia. They’re agitated. But see what I mean? Like the sit low. I’m not that bad. Am I? So again, this has said without judgment Tony, it’s just, when we get sick, we can’t always see it.
Dr. Anthony Orsini (22m 25s):
Yeah. And being in medicine, we’re always second guessing the other doctors, even if it is a cardiologist, although to a lesser extent. So To the family and friends of physicians out there, what you’ve learned, what would you say to them? Like these are red flags, this is something, is there a few things that you can tell us that really is consistent with physicians who are super depressed and maybe getting to that point where they’re considering suicide?
Dr. Michael Meyers (22m 50s):
Absolutely. Yes. I think he even lay people are pretty good at that. They say, look, I’m not exactly sure if I know what burnout is, but this is more than burnout. I’m so worried about my wife. Oh my God. You know, she’s not eating, she’s not sleeping. Let’s finish up or she’s drinking. And she’s been a social drinker. And in fact, I’m not even sure if she’s being complete, I found a bottle under the bed. That’s not her, et cetera, et cetera. And she insists that she’s okay, et cetera, et cetera. So those are some of the red flags. Of course, I always say to people, look for some of those physical things like loss of appetite or overeating or oversleeping, or under sleeping, the agitation, trouble concentrating irritability, sometimes even over-functioning.
Dr. Michael Meyers (23m 34s):
Some doctors will treat their own sort of depression or whatever by overworking thinking that, well, if I just work harder, then maybe I’ll feel better or something like that. So those are things that I speak with an audience of survivors of physician suicide. They’re all nodding their heads because they’ve seen it in their loved ones, that sort of thing. So then the next step of course is if your husband or wife doesn’t even have a primary care physician, you can still call someone as a physician I’ve received calls over my career from a number of spouses of physicians, kids of physicians. Look, you know, I hope you don’t mind my calling, but I’m really, really worried about my father.
Dr. Michael Meyers (24m 14s):
I was a medical student of yours, worried about my dad. He’s very depressed. You won’t see him. So my take home message is the same way. Just be honest, tell him you’ve called me. And that I said, of course, I’d be open to seeing him. And then get back to me though, in a day or two, we’ll be able to find it, whether he did, he did call or not. Other times I’ve even made the phone call myself saying, you don’t know me. My name is Dr. Meyers. I’m a psychiatrist, but your son who is a medical student of mine has called me. He’s worried about you. Would you be willing to come and see me? That’s kind of an unconventional. Not all psychiatrists do that, but yet, sometimes we don’t always follow the rules to care ourselves so that, you know, we have to do these things sometimes to really get the person…
Dr. Michael Meyers (24m 58s):
Tony I like to believe that if I can get that person in my office and try to be a good physician to that person that they’ll come back.
Dr. Anthony Orsini (25m 9s):
So that’s the family. Now let’s go to the doctor. Who’s feeling the depression. Yeah. Shed some light on what the rules are that protect him or her. So now you have a physician out there maybe having suicidal thoughts, super depressed, but I’m so afraid to tell anyone because I’m going to lose my privileges. What are the rules of the laws that protect him or her?
Dr. Michael Meyers (25m 31s):
Okay. A big question. Well, let me go there. A common call I used to get with, Hey, Dr. Myers. My name is Dr. Brown. I’m feeling kind of burned out the last three months or so at least I think it is burnout. My wife thinks I’m clinically depressed. I don’t know the difference. Can I come see you? Of course. Okay. So that’s what I want to sort out because especially if they’ve started to have suicidal thinking, the research has controversy on this. Some people say you can get suicidal thinking and action with straightforward burnout, but most of us psychiatry field that it’s shifted into something else. It’s moved into major depressive disorder or to PTSD or to substance use disorder. All of which have overlapping symptoms.
Dr. Michael Meyers (26m 10s):
The point though is that this is an individual in trouble and really does need to be assessed. And if I can’t get the person into my office, well maybe I’m going to be end up seeing them in an emergency room. One of the products that we use so much in our teaching is a product that’s through the American foundation for suicide prevention and the Mayo clinic, which has just a four-minute video. That is really very helpful in getting these messages across in teaching centers or something like that. So, but I wanted to come back to something else that you said the other thing too, is to, I do best to try to reassure them. Now that doesn’t mean false reassurance because when they say I’m worried about my license credentialing, I say, yes, legitimate worry.
Dr. Michael Meyers (26m 54s):
You are practicing in a state where questions are asked but trust me with regard to those, I am going to assist you with all of that kind of thing. See, because at the end of the day, what most doctors don’t know is that it usually except for the odd horror story in some states, most of those states that do require a disclosure. What it may require is a letter from the treating psychiatrist, psychologist, or whatever that the individual is stable, is well. And they will renew the license or give them a license for the first time. But unfortunately, those horror stories are out there and they terrify when you’re feeling vulnerable, but you’re not very trusting.
Dr. Michael Meyers (27m 37s):
I happen to practice in the state of New York. We’re one of about 10 or 12 states where no questions are asked at all about our health when we apply for a license or when we apply for renewal every two years. So you have to honor those fears that make a pledge to your patient, that you’re going to assist with us. That you’re going to be their advocate. Advocacy is so much of my work. It’s not just what you do in the office. When the door is closed, I’m advocating with licensed board, credential training directors with families and things like that. I think sometimes we have to be the spokesperson for individuals who at one level, because of stigma are not able to speak for themselves.
Dr. Michael Meyers (28m 17s):
It’s too risky or dangerous. And that’s why so many of us who work in the physician health movement, we have strong feelings about this, about changing the systemic changes. You mentioned Wendy Dean. I mean, she’s an example of this. We have to drill down and look at moral injury and see how it relates to burnout, et cetera, et cetera.
Dr. Anthony Orsini (28m 39s):
And so the message here is if you are having these thoughts, if you are depressed, it’s okay to come forward. You’re not going to lose your license likely unless something severe happens. And, but you need to find the appropriate psychiatrist. Who’s there to treat doctors. And how hard is that? I mean, with any psychiatrist, do you look in the phone book I’m showing my age? There’s no such thing as a phone book, you look up psychiatrist or does it have to be specific?
Dr. Michael Meyers (29m 2s):
It’s a wonderful question and usually by word of mouth. So what I do for instance is it, cause I do a lot of teaching for the American psychiatric, or I taught a course called treating medical students and physicians. It was just a primmer. It was only four hours, but it was to capture those largely early career psychiatrists who have maybe been referred their first patient. And they felt a little bit nervous about that or whatever it went well or didn’t go well because I’ve been forever training junior colleagues to get interested in this area that there’s so much you can do. You can save lives. And it’s very, very rewarding and essential work. So there’s that. So it’s kind of by word of mouth. I got a phone call yesterday from the mother of a medical student, asking if I would see her son in consultation.
Dr. Michael Meyers (29m 49s):
I told her I was retired from private practice, but I was able to give her the names of two or three people who might be able to see her son or that kind of thing. So that’s what I meant by sort of word of mouth.
Dr. Anthony Orsini (29m 60s):
So for the doctor in Nebraska, for instance, or Iowa, who’s looking for some help. What do you suggest he or she do to find the right doctor?
Dr. Michael Meyers (30m 8s):
Sometimes if it’s not a local person, like your primary care physician who might be able to assist. And also sometimes in, in some states, like for instance, I worked in Vancouver, British Columbia for decades. It wasn’t unusual for me to look after doctors from via joining province or from Washington state, which was just below the border. These are usually high profile physicians who, despite rules around confidential and privacy. They were too nervous to see anybody in their home town. And now with tele-psychiatry and telemedicine, there are people who are seeing specialists in psychiatrists, in another state, another province, that sort of thing.
Dr. Michael Meyers (30m 49s):
So you can get that kind of care. The main thing is to get care with somebody who’s comfortable looking after other doctors who is open to listening to programs like this, continuing medical education and looking at some of the nuances that can occur when one doctor treats another doctor.
Dr. Anthony Orsini (31m 8s):
Okay. All right. Two more questions, Michael, before we end, this one is probably impossible to answer, but you can give it a shot. How do we fix this? Where do we go from here?
Dr. Michael Meyers (31m 18s):
Okay. I’m very positive. Despite all of the work I’m done, I’m very positive. I’m looking to the young one area that I’m working on right now is a so-called lived experience movement whenever a medical student, a resident, or a physician of any sort publishes an article, a story about their experience with psychiatry, eating disorder, PTSD, alcohol. If I can find their email for habit, I write them. I thank them for their story. I tell them that they’re chipping away at stigma. And just that sort of thing. I have met so many people that way because they really are what they’re saying. What they’re arguing is, why can’t we talk about our vulnerabilities?
Dr. Michael Meyers (32m 1s):
What’s wrong with this profession. And in fact, Tony, another area has been a watch for articles where the person says, when I applied to medical school, I wanted to tell my story. I was discouraged by my mentor said, don’t put that stuff in your personal statement. You’ll never get into medicine. That’s not correct, but yet they’re doing that. So these same students are saying, I don’t want to do that. I want to be transparent. I want to be honest. In fact, some will say it’s because of my eating disorder that I got interested in medicine. It’ll make me a better physician. I know what it’s like to be a patient. It’s humbling, et cetera, et cetera. I salute those individuals.
Dr. Michael Meyers (32m 41s):
I think they’re going to be the doctors of tomorrow. Some of them will go into your field, my field or whatever. So I’m encouraged with it’s taking a while, but increasing numbers of states are changing the questions that they’re asking for medical licensure. We still got a ways to go with credentialing. But again, some of my anecdotal experience with credentialing is actually quite humorous where a physician is posed all these stupid questions and puts an X through them and says, I’m not going to answer these personal questions. And then of course gets the job. So, and then I taught with a woman and she says, you know, I’m so glad he did that because we’d been going to change those questions for the last 10 years, but we never got around to it.
Dr. Michael Meyers (33m 23s):
We are now. So it’s things like that, that we’ve got to. And I don’t know when I just see more and more people who are telling their stories, it’s humanizing medicine. I think the pandemic has done that in some ways I’ve seen doctors using much more what I call affective or emotional language as they’ve been negotiating themselves through the pandemic and with their patients, with their trainees. That’s been, if there’s any sort of silver lining to this, I think it does have to do with returning the humanity, to the field of medicine.
Dr. Anthony Orsini (33m 59s):
I feel. I’m optimistic. We’re talking about it a lot more. I mean, I’ve done five or six episodes, myself and my small little podcast. I also noticed that there’s a difference in the younger doctors coming up and their general attitude towards medicine, good or bad. I think it’s a good thing. But yeah, the younger doctors seem to be more aware of their work-life balance before the blue laws in New York city. I remember you, we used to work 36 hours shifts and we’re very proud of it. Now. They’re very aware of, I don’t want to overwork the very aware of how important sleep is. They’re very aware of this is a job. And so I think that’s a positive that they don’t walk around with the big S on their chest like we used to. Would you agree?
Dr. Michael Meyers (34m 38s):
I agree completely. And it’s all part of this. I think movement toward quote, unquote wellness too, and balance in your life because the world has changed. I mean, when you look at it, many more physicians have quote unquote dual career marriages. I mean, decades ago, of course, there were more traditional marriages. You rarely see those today and look at the diversity in medicine, the different cultures, the different ethnicities, sexual orientation, gender identity, there’s such a mosaic.
Dr. Anthony Orsini (35m 6s):
And 15 years ago, I don’t think there was a chief wellness officers. And in fact, I’m in the process, as I mentioned to you, but for me, we’re on air. I’m moving down to Jupiter. I’m taking out a new role as a director of a NICU there, but also will be the chief wellness officer for 300 doctors. And so that is a new role. I’ll be the first one, but I never heard that term before five or 10 years ago. So it shows that there’s an awareness. That’s right about this. I am also optimistic Michael, before we go. And I don’t think sometimes I warn my guests ahead of time. I don’t think I warned you about this, but it also is a little test to see if you’ve listened to any previous one. But the last question of every podcast since the name of this podcast is called Difficult Conversations. I like to ask my guests the same question at the end.
Dr. Anthony Orsini (35m 49s):
What do you think was the most difficult conversation you’ve ever had and give us some pearls of wisdom on how you were able to navigate that for someone who needs to,
Dr. Michael Meyers (35m 58s):
I’m going to answer that by, and I’ll make this brief of looking after a physician, patient who wasn’t getting better. Despite all of my expertise, I think I was at the 25 year mark. At that point, she wasn’t getting better. Wasn’t getting better. Pediatric doses of medication were too much for her sort of thing. The difficult conversation I had was keeping her alive. I mean, there were several of these conversations. One of them was, she was so ill wouldn’t come into hospital. Wouldn’t have ECG. Any of this stuff, all talk therapy. I remember she said, would you stop asking me about suicide? Can’t you tell, look at me, I’m such a, she used an explorative mass that I couldn’t put it together to kill myself anyway.
Dr. Michael Meyers (36m 42s):
But what she was saying is just be there, just listen. And when I wanted to get a second or third or fourth opinion, she said, no, no more of that. Just I think she was saying, don’t abandon me, just wait this out with me. And that’s what happened. It took about four years and I got consultations myself. And all of that was very, very helpful. This is another success story done. Well,
Dr. Anthony Orsini (37m 10s):
The take home message. There is sometimes you just need to listen. All they want is just people to listen. So well, that’s great advice, Michael, this has been a lot of fun. I think we could probably go on for another couple hours. I want to thank you for bringing to light this really important problem. You know, people have said to me, Tony, this is the sixth or seventh episode you’ve done. I mean, we’ve been doing this for two years, but so it’s not a large amount, but it’s important enough to do six or seven episodes on this. And I want to thank you for your work. I want to thank you for the time you’ve been on. And this has been great. What’s the best way for people to get in touch with you, Michael?
Dr. Michael Meyers (37m 42s):
Yeah, probably the best way is through my website, www.Michaelfmyers.com.
Dr. Anthony Orsini (37m 48s):
And we’ll put that in the show notes for those of you who are driving. Thank you. If you enjoyed this episode, please go ahead and hit like follow or subscribe depending on the format you’re on. If you’d like to get in touch with me, you can get in touch with me through my website, the Orsini Way.Com. Thank you everybody. And thank you, Michael, for being such an awesome guest.
Dr. Michael Meyers (38m 6s):
Thank you for having me, Tony.
Announcer (38m 8s):
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