QUOTED: Suicide attempt during internship

[NotAProgDirector]

One of my close friends recently attempted suicide several months into his intern year. An intense overachiever, he has multiple degrees and selected one of the hardest (and top-ranking) programs in the country in his field. Both the program and the field are known for malignancy, which likely hasn't helped the depression he's been feeling for over a year.

After an attempt a few weeks ago which resulted in a 3-day psych hospitalization, my friend began discussions with his program director and the state board about a leave of absence for a month. During that month, he overdosed. This was his third attempt that I know of, and left him intubated in the ICU of his home institution. There's little doubt that his whole program knows.

Obviously, my chief concern is that he get better. But I also have questions about the difficulties he will face with obtaining a medical license and returning to work.

The two other cases of suicide attempt during residency that I know of didn't end well. One of my classmates returned from a LOA only to commit suicide a few months after returning, and one of our surgical residents returned after a LOA only to leave again and never return to medicine.

My friend is planning on taking more than a month off, but still wants to return to his current program this year.

Does anyone have any successful stories of residents getting help, getting better and getting back to work?

Is there any chance for getting a medical license in a timely fashion?

If you were a program director, what would you want this resident's course to be? Would you let him back into the program, and when?

Thanks.

This is a really tough situation. You've laid out three goals, none easy. 1) Getting better, 2) getting back into training, and 3) getting a license.

Getting better -- I'm not a psychiatrist, but it sounds like your friend has some healing to do. Multiple attempts in a short period like this are a marker for more serious attempts, and perhaps "success" at suicide. Even with his/her prior attempt, a 1 month LOA and then return to work was probably overly hopeful. This time, it's going to take 3-6 months at a minimum, perhaps more like 9-12.

It's an open question whether getting back to work is consistant with him/her getting better. Although work can be a good diversion for some, being a resident is a time intensive, sleep depriving, emotionally exhausting process -- not exactly an ideal combination.

Getting back to work -- I expect that your friend is out for an extended period of time. The program is likely to try to fill their spot. Getting a new spot is going to be difficult. Needless to say, anyone who takes him/her will know that the risk of further leaves or problems will not be zero, despite your friend's best assurances. I have posted similar thoughts in the past, only to be followed up by angry posters telling me that it's illegal to discriminate based upon medical history, or unfair/unethical to do so. I agree. But, it's a natural reaction and hard to defend against when another leave creates a huge problem for everyone else in the program.

Getting a license -- It's hard to know, and will be state specific. Many states will grant a license once there is clear evidence of treatment and improvement. If your friend overdosed on illegally obtained meds, that's another huge problem.

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[deleted435584]

I would take a long leave of absence completely heal myself, then I would seek a new residency because the current one was malignant...

 

[NotAProgDirector]

I would take a long leave of absence completely heal myself, then I would seek a new residency because the current one was malignant...

Reasonable advice, but easier said than done. Getting a competitive residency spot after dropping out of another program is a challenge.

 

[nitemagi]

I would recommend a full year LOA, possibly looking for a program that might allow easing back into it, like the half-time program at UCSF.

"Completely heal myself" may not be realistic. We talk about remission, not "cure" usually. Treatment may be difficult, and may depend on who he/she sees. Some providers are better than others. Either way, going back into a malignant program is unlikely to be helpful. Disclosure to the medical board will depend on many factors, including which state you're in.

 

[dragonfly99]

This person is not being realistic. He must be very smart but doesn't have wisdom/insight yet. There are many paths to success in medicine and life. One month is not enough time for him to get better. It may not be in his best interests to return to his highly competitive field. You sound like a good friend. Where is his family? Does he have family support, and someone who can help talk some sense into him? He obviously isn't thinking clearly right now.

 

[Janedoedoctor]

If the depression has been going on for over a year, resulting in such a serious attempt, I agree with the posters above that returning to work in a couple of months is completely unrealistic and likely to result in a new attempt.

A LOA of 6 months to a year, with intensive psychiatric treatment during that period, sounds more realistic.

Suffering from severe depression also tends to lower a persons coping abilities. Your friend should have a long hard think about whether graduating in competitive field X from top-ranking malignant program Y is really the only way he can achieve happiness and professional satisfaction in his life.
There are a lot of fields that are intellectually challenging and interesting without the gruelling hours. The ROAD specialties come to mind, but also ENT, pathology, psych.... There must be something there for your friend.
If he managed to get accepted into program Y for field X, he must be able to bring some serious achievements and good references to the table, that will help him get a spot in another program in spite of his medical history.