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Just hours before a new crop of medical students are to be welcomed into the world of medicine, Kaci McCleary, John Pienta, Aline Sandouk, Mark Moubarek, and Lisa Wehr confront one of the most uncomfortable topics in medical education: resident and student suicide.  Among doctors, suicide rates are much higher than among the general population.  The long hours, high pressure (from both one’s internal monologue and from outside sources) to succeed, fear of public humiliation regarding one’s shortcomings, isolation, inadequate supervision, the stigma against mental illness, the career penalties faced by those who admit to unwellness, and more, all contribute to the problem.  Institutions also have a difficult time addressing incidents of physician suicide effectively, as they try to walk a tightrope strung between respect for the privacy of the deceased, the needs of colleague survivors to talk about it, the desire to avoid adverse publicity.  Meanwhile, the work does not stop. The only breaks are a moment of silence, a visit with a grief counselor, or an “open forum” to discuss one’s feelings.

Fortunately, the culture may be changing to allow for more discussion, prevention, transparency. Institutions like the University of Iowa and Harvard University are adding counseling capacity, student groups to support struggling peers, and a greater openness to acknowledging without shaming the fact of mental illness among physicians.