Janae Sharp’s physician spouse committed suicide. This lead her on a quest to try and figure out why physician suicides are up, way up. Though technology may play a role, there are other factors at work.
Good morning, today on Healthcare Pittstop I have Janae Sharp. How are you today? It’s nice to talk to you.
Janae Sharp: I’m doing well, how are you?
AP: Terrific. We were fortunate enough to meet at the HIMSS (Healthcare Information and Management Systems Society) conference. Janae has a very interesting story about her husband. I wanted to know what motivates you, and I want to talk a little bit about your story. Can you tell me a little bit?
JS: Yes. I mean, I have a lot of motivation. Part of my story is that I have three kids, and I was married, and I went to medical school with John Madsen. He was a musician, a dreamer, and an idealist. As he went through school, he started getting more and more kind of disillusioned with school and was upset and unhappy. I tell my story about being the spouse of someone in medical school and a physician, not really knowing, where he was, and wondering what was normal. And he got increasingly unhappy, using dark humor, and joking around about different ways to die.
Eventually, after warning signs and after other things, he died by suicide almost three years ago—it’ll be three years in May. I’ve shared my story about what it was like for me, both before and after he died, and what it was like for our children to go through the loss of their father. [I wanted to] get more coverage about physician suicide, because after he died I was kind of angry that I didn’t know more and that no one had warned me. Also, that there wasn’t more support for physicians or physicians in training and for their families. So some of my “why” is to create something better for people; to create something good out of that loss and out of that anger that I had.
AP: That’s a very tough tale. I really enjoyed meeting you and I saw your kids and I feel your struggle. I’m a soon-to-be three-generational physician family: My father’s a physician, I’m a physician, and my daughter will be graduating in May.
JS: Oh, congratulations!
AP: Thank you very much. Healthcare has good and bad, we’re able to intervene at really important times in people’s lives, but it also has additional stressors in terms of taking care of folks. I think of being a physician as a unique role because you get to be both a scientist; you get to work with really interesting things, but you also are somewhat of a priest because there are also really hard problems, and sometimes that becomes a little overwhelming. I found it interesting that you were presenting at that recent conference I was at—it’s called HIMSS, it’s probably better known as the Computers i
n Medicine Conference. It’s a huge conference of 30,000 people. Why do you think the HIMSS organization was interested in your story?
JS: Oh that’s a great question. The Health Information and Technology Conference was where we were presenting—and I was really glad we met, too. I think part of why they were interested in the story is that people say that they’re less connected with their patients. They say, “We have these electronic health records; they’re ruining care and they’re making it so I’m just a billing machine. They don’t have anything to do with me.” So since the mission of HIMSS is to look at health information technology and how it contributes to our health and how it contributes to the care continuum, it really was a great way to talk about that. To look at how health records could impact things and I wanted to know: What is it? Is it culture? Is it your technology that’s causing the increase in physician death? There’s been there’s been a higher rate—from 1999, the rates have increased 24%.
AP: That’s amazing. Physician suicide up a quarter, that’s amazing.
JS: Yes. That’s a huge increase, and it kind of looks like it might be alongside this transition from a paper chart to electronic health records. And I think it’s really their duty to look at how they can help physicians give better care and allow for healing and how they can make sure those EMRs aren’t causing more stress; and that’s kind of what we wanted to look at. [We wanted to know] if those tools would help physicians but also wanted to get more information about what it is—is technology really crippling us and causing more illness to the healer?
AP: I wrote a blog a while back and I said that your physician isn’t ignoring you, they’re just playing a video game. We’re often distracted by technology that’s brought into our world.
AP: We as clinicians feel like we’re moving from being clinicians to clerks. But I looked through your talk, and it wasn’t clear to me that you thought that that was the reason for the burnout as much, based on information that you had collected.
JS: Yes. I sometimes have a hard time with the EMR as a scapegoat. The saying, “Oh, it’s because of clicks.” There are a lot of things within medical culture that aren’t healthy. [Physicians] have accomplished a lot in their life, they’ve done very well. And then you put them in an environment where their expectations aren’t what they thought they would be. So I wanted to really get data about how strongly those are correlated. Also, one of the reasons I was pretty skeptical, is I’ve seen work from other countries that have different reasons that they say lead to their burnout, or lead to their dissatisfaction. So, when we looked at some of the research that KLAS (https://klasresearch.com/Home) did and some of the research that we’ve done on our own, it really wasn’t as strongly correlated as people say.
I’m not saying electronic health records are effective at their job, or that they really contribute to physician workflow. But they’re a proxy for dissatisfaction, for a lack of autonomy. Physicians used to be able to make more decisions than they do. Or they’ve been in school forever, and suddenly expectations aren’t what an idealist who wanted to go into medicine, and wanted to help people, [reality] is not meeting those expectations. I also think, especially since I work in health informatics, and I talk to people about information systems, we want to make sure that we’re able to solve the real problem. And part of that means finding out exactly what’s at fault.
AP: That’s super interesting. I really like your saying, “It’s a proxy for dissatisfaction” because I’m actually seeing that in my healthcare system, where the EHR that we have is actually being pointed to by both administration andphysicians as the problem. I just don’t believe that that’s the full problem. I do believe that the change in healthcare, you know, managing expectations has really caused an issue. I also believe that EMRs, for those who are not in healthcare, they don’t realize that EMRs are really a billing engine more than a care engine that we’ve all been kind of forced in to. So they don’t work super well. Let me go back for folks who are either physicians or spouses of physicians: Are there particular warning signs that you would tell people, “You need to pay attention if you’re feeling this way, or your spouse is this way” to avoid tragedy?
JS: That’s a great question. And some of what I tell people to do, what I recommend, is that they look up suicide prevention best practice. There are some warning signs that I didn’t really understand. And some of them are just casual talk, like saying, “Oh, I wish I was dead, I wish I could sleep forever.” People casually mention dying or suicide more often than we realize.
As a physician, if you heard that from a patient coming in the door saying, “Oh I just wish I could sleep forever,” it would set off an alarm for you. But if you hear it from your co-workers, joking around, you’d probably dismiss it and not know what to say. So some of those signs where people usually will tell you a little bit where they’re at, I didn’t really know how to deal with. So I just kind of dismissed them, or said, “This is normal stress.” Someone saying, “Oh, I hate this, I wish I had picked something else, I just feel trapped and with so much debt.” Talking about those things means that they’re trying to bring up something that’s wrong.
People should be careful not to ignore what people are actually saying to you. The other thing that I think people need to really look at is behavior change. And I’ve seen that a lot, talking to people from outside medicine who are wondering, “What is going on with my friend who’s in medical school? They used to be really fun, and now they’re just very stressed about working all the time, or studying, and they’re joking around about anatomy, or a hundred cc’s of insulin, and they think this is funny.” But it isn’t funny from the outside. And that behavior change means they’re at a higher risk. If they’re losing their friends, if they’re cutting off their family. Any time you see someone’s behavior drastically change, you should reach out to them. You should say, “That’s not normal.”
AP: Interesting. My bet is, and you may know better, but my bet is that the impaired physician, whether they’re depressed, or even going toward suicidal has some costs for the hospital, and for care in general. Do you have any sense of that?
JS: Yes, actually, that’s a great question. It costs our healthcare system a lot. And there are a few different ways you can look at that. One is that each year in the US, the equivalent of one million patients have lost their provider to suicide. And you can look at just the cost of hiring a new physician, but really, losing a physician to suicide where they’re a leader in society, they’re usually very visible, can have that trauma. People don’t know how to process it, “What does it mean for my outcome that my physician just died? They probably weren’t paying attention to me.” You have that question, but also, the question is correct. Physicians that have burnout, or physicians that are depressed, or have suicidal thoughts, they’re more likely to have medical errors. It’s really hard for them to be present with patients, so they might miss something that’s really important, so you see an increase in medical error, an increase in deaths.
So, not only are you losing a population—and we already have a physician shortage—we’re also putting more stress on the system, and not meeting people’s needs, and having increased medical error. It leads to more deaths.
AP: I would think it would be a super hard thing to measure, but I can imagine that there’s a real number tied to that.
JS: Actually is really hard to measure what that cost is, in terms of quantified costs. And some of that is that health care systems don’t want to say, “Oh, and we’re losing tons of money, because everybody hates us.” You know? [chuckle]
JS: “And we’re all overworked because that’s what medicine is, and… ” [chuckle] It’s just not something that people really can look at in terms of optimizing your work force. And they need more data about it.
AP: So you’ve identified a problem. I’m really into solutions, and I approach it from an informatics perspective, which is people, process, and technology. We’ve identified that there’s a real problem that the physician suicide rate is up. Depression is probably up. Do you have any perspectives on solutions both from the people perspective—things that we could do to give [people] better tools? And from the process or technology perspective—are there some ways that technology could actually help us identify these folks that are at risk? I’m wondering if you might be able to speak to those two approaches.
JS: Yes. Obviously, it’s a huge problem and anytime someone dies by suicide, there’s not one reason. With solutions, there’s not one solution that needs to happen, and from a certain perspective, it’s policy that people need to look at. If you have physicians that are working so much that they are exhausted at work, or they physically have psychotic episodes because they’ve been up too long, that’s something that needs to change from a policy perspective. But also, one of the things that we looked at, was: How often are people using electronic health records, what does that look like for physician burnout? We looked at what people say is wrong and thought, “What solution could we find here?” One of the things we found is that people are probably aren’t sleeping enough to optimize their health, or even to make it. And the second thing we looked at is that, when people’s behavior patterns change, when they stop doing their documentation, and when you can tell they’re not doing well, you can actually track that from how their behavior is at work. And electronic health records are actually a really good way to see, “Oh, this physician is at higher risk, because they’re not able to finish things. They’re unhappy. Maybe something has changed.”
AP: Yeah. I usually get the call [from administrators]. But rather than yell at me because I have incomplete records, maybe it’s an opportunity to say, “There’s been a change in your recordkeeping. What’s up with you?”
AP: That’s interesting. Super interesting.
JS: Yes. What’s going on? And it has to come to a system level too, where you sit down with physicians like you said, and instead of saying, “Hey, by the way, thanks for being terrible at records—that really hurts us.” They should say, “It looks like we need to do something to improve the workflow here. We need to do something to make sure you have the tools you need.” And leaders need to sit down with physicians and that’s something that is so commonsense, but it’s very uncommon to be able to do. Instead of reaching out with anger, to instead say, “This is an opportunity for us to improve care.”
AP: Yes, super interesting. How about from, I’ll call it the warm and fuzzy place, we come together to try to support each other
AP: Anything from the people perspective that you’ve seen that seems to help?
JS: Yes. Well, there’s a few things that we’ve worked with, and one of them that I’m really excited about is, we partnered with Stellar Care, and we’ve done an anonymous peer support group, and what we do with them is that we give people coping tools. We’re not saying, “Your healthcare system is great,” and we’re not saying, “Your job isn’t perfect.” We’re giving them tools on their own time that they can look at. You know, it’s like, “Did you want to get out of bed today? No? Get out of bed anyway.” Some things that people who work in behavioral health are better at.
But people don’t always know they have stress in their life, that they have anxiety and depression. They don’t want to say that. So why don’t we give them the tools that they need without saying to them, “You’re broken, you’re really ineffective at your job, and you can’t handle the stress.” Why don’t we just say, “Well, when you feel this way, your thoughts are not you, and this is how you can act on them.”
JS: And I think it’s great because we’re not saying they have depression. We’re not saying we can fix the system with that. We’re just saying, “Here’s something to do when you can, and here’s a tool that you can use.”
AP: I really think a lot of healthcare systems could benefit from your engagement in trying to tell your story and your observations, because you’ve clearly spent a lot of time in the space. I have one last question. I’d like to know… Suicide is viewed differently than other deaths. I’d like to know how your friends and how the healthcare system responded to your loss.
JS: That’s a great question, and that’s a hard topic for me, because if you look at things a few years ago, GoFundMe released data about the types of death that raised money. Suicide deaths weren’t as great at fundraising. And if you look at the stigma, a lot of religions still say suicide death is a sin. Or with the healthcare system, they’re not always reporting that, and some of that is to respect privacy, and some of that’s because it’s a highly stigmatized death.
I was frustrated that the school didn’t reach out to me, that there was no memorial from the school. In speaking to some of the other physicians that he trained with, they didn’t really hear anything about it; they were not offered support. And as a parent, I was livid because I wanted to make sure that my children had the same kind of honor. As a healthcare provider, if we’re saying we can support people, and mental health and mental illness is real, that means that we acknowledge it and that we honor it. And I think suicide death is so difficult for people to process that a lot of the time, even from a systems level, you just turn it off and try to avoid it.
That conversation, where we say, “Things weren’t perfect here, things were crazy.” And we don’t know if we’re even supposed to use the word “crazy.” We don’t know how we’re supposed to say if they committed suicide, if they died by suicide, there’s so many questions, so many places that you could go wrong, that people don’t know how to approach it and people aren’t talking about it and they aren’t supporting it. And for me, it has a direct impact on my life. It had a direct impact on my children. I decided that I needed to do something to fix that, because my kids deserve the same kind of honor and the same kind of positive change that you can see with other people who have died. And so I wanted to build a memorial for them, so they know even when someone dies, we don’t lose hope and we don’t stop taking care of the living.
AP: I really, really appreciate your time. I think that wanting to kind of push it off to the side probably leads to some of the rising suicides that we see because there’s just—we can’t embrace the support. I really want to thank you for your time. I’m going to post your email, if that’s okay with you, for others that might want to reach out to you.
JS: Absolutely, yes.
AP: But really appreciate you sharing your story and really some of the work you’re doing to change things. Thank you so much.
JS: Thank you.
Janae Sharp works as a consult for healthcare IT companies with a focus on social media and marketing.
She can be reached at firstname.lastname@example.org