Suicide Prophylaxis: Form Your Tribe

Submitted on behalf of the Mental Health Task Force of the Resilience Committee

Jackie McParlane, DO, FACOEP Beaumont Health, Botsford Campus Farmington Hills

Loice Swisher, MD Drexel University College of Medicine

The Scenario

The sun was just rising after a hellish night shift as the intern drove from the hospital’s parking lot.  He thought about the overflowing department with the endless stream of patients.  There barely seemed enough time to say hello to the patients, get a brief history, enter orders, then it was on to the next patient.   The attending seemed to think that interns should do more than he felt able.   A mistake, his mistake, could kill someone.  Is this what he signed up for?  Maybe emergency medicine wasn’t the right fit for him?


Merging onto the freeway, he remembered it had been a dream to become a doctor.   Now that it was here, the reality was a nightmare.   To get to this place there had been so many missed family functions.   Connections with friends ceased.  Sleep hardly happens any more.   When was the last time he exercised or ate good food?  Maybe being a doctor wasn’t right for him?


It was impossible to quit.   There was a sea of debt.   Flying down the road at 70 miles an hour, an answer sprung forth.    It would be so easy to plow the car into the cement retaining wall.  It could all be over in an instant.  Maybe this was right for him?



The Question

As educators who are dedicated to guiding these young physicians thru the maze of residency, how do we prevent them from acting on these feelings?   Can we prevent this even if we don’t know when or which ones are at-risk?



Suicide Prophylaxis?

It was July- another new intern class.  There was a new mom.  Another was an alternative student now having to take orders and be in a submissive situation after being in charge for years.  Almost all were from out of state without  a support system.  And just a week before a new attending in a neighboring community took his own life.


As an educator concerned about physician wellbeing, what could be put into place to prevent these new doctors from making that same decision- a decision made by one or two US doctors every day?   Too many times we hear “we didn’t see it coming”, “no one guessed”,  “we missed it”.  Could anything we do make a difference?  An idea was born:  EM R1- Wellness Check-Ins.


Orientation Physician Wellness Presentation:

The interns were asked to look around the room.  This was their “Tribe”.  They were going to get each other thru by celebrating the good times, and having each others back in those difficult moments.  It was emphasized that this is not a journey you can do on your own.


Specific information was provided on suicide.  The residents were told about the employee assistance program (EAP), but they were also given a wellness champions phone number. They were told that that phone was on.  Someone was always available.  They were never alone.  It was never so bad that they had to end their life.  They had a name and a face in their House of God that always would support them.


Monthly Lunch and Chat:

The residents were invited to join together with their wellness faculty champion for a free lunch  at a Mexican restaurant just down the street monthly to chat about the residency. The lunch check-in’s were a chance for many discussions.  We could laugh about some of the craziness of residency, and have a chance to tell their stories about what they were doing.  They realized they were not alone in their frustrations.   They had a safe place to vent, knowing that some issues can’t be solved but being heard is important.  It was our opportunity to build our tribe.


If one can’t make the lunch, they are missed.  After a lunch, an email is sent about what we learned from each other.  Sometimes these meetings lead to solutions.  One meeting led to a survey being developed for them to give feedback to faculty in the residency.




This original case is not theoretical.  It happened to me and my residents.


This young resident chose not to drive into the wall.  Instead he reached out to a fellow resident.  That resident then contacted me so we could support him together.  He was made aware that we were there for him.  We checked in.  Made sure he turned the corner, and was no longer having the thoughts of suicide.


There is a way to make a difference with intentionally providing a better coping mechanism and social supports before a crisis moment.   I believe in low tech/high touch.   This means reaching out to have an impact on physician wellbeing.   Residents want to know that we care- ongoing care.   Caring is not just an email, but an action to say “I’m here for you. I have your back.  I will listen.”


Each residency has its own make-up.  These ideas seemed right for our group.  The formula of being there face-to-face and listening are critical.  What will work for your residency?  Take their pulse, and find a way to bring them together to form their Tribe.  It is in our connections that life has meaning.  As educators, we can foster those connections and perhaps make some sense of the craziness of our training.





One comment

  1. Culture and community are the glue that keeps us all on purpose. Unfortunately, left to its own devices, the default culture of our medical education is to focus on our tendencies to be workaholic, lone ranger, super hero perfectionists with two prime directives – the patient comes first and Never Show Weakness.

    Tribe is the antidote to all of this. It is a place where we can come together as a community of Light Workers to support each other with this difficult work. It is something you can install in a residency cohort with only a little effort if it is on your radar as a key objective of the residency process rather than leaving your residents to simply fend for themselves.

    My two cents,

    Dike Drummond MD

    Liked by 1 person

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