In the second part of our interview with Janae Sharp, she discusses why she feels she has been a different kind and less restricted voice for physician suicide awareness. She notes that it is important for physicians to speak on this issue and that there is true power in community. However, she feels physicians are more silent on this issue as they tend to avoid "unsafe" and "uncertain" topics and are ultimately afraid of the potential repercussions to their licensure. Using her background in social determinants for health, she also answers a challenging question of whether physicians "deserve" our attention and help.
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David Carreon: I think there is a lot of bravery in approaching this topic no matter where you come from or what your background is and I think that especially so, when some people might say that this is kind of a intramural problem, that this is a physician problem and physicians need to deal with it. Or maybe alternatively that this is a health care problem and so physicians need to deal with it. What would you say to that perspective? Are you, you said you've been silenced, but should this be something that is only for physicians to talk about?
Janae Sharp: The difficult thing about having physicians be the only people who talk about it is that a physician has a direct financial impact in their lives by this topic. If you have a serious mental illness as a physician, that can mean you lose your job. If you have a financial incentive as a health care system to not employ a physician with a mental illness, what does that mean in terms of disability rights and what does that mean in terms of our ability?
So I think physicians know a lot. I think they're super accomplished and I think they really value academics and I really like that they want things that are validated, I like the healing belief. I also think they don't have the freedom that the system, the system isn't designed for them to criticize itself. It's designed for them to perform. Or not perform.
So someone like me, it had the biggest direct financial impact as like the loss of the, you know the loss of all that medical school and all that training directly impacted my kids financially, obviously, and I had a bigger loss than a specific physician would have. I mean not a physician that's losing their job, or passing away, but those voices are sometimes lost and the people in the conversation can't, they aren't as unfettered as we want to, we need them to be to make honest decisions and discuss that honestly.
Jessi Gold: But you feel less limited by external forces, because it's your life and your story not some story controlled by their job?
Janae Sharp: Yes. Like this is something where I don't have to put it on my licensure, my complete mental health history, which I think in 29 states they ask you to do that, even in your renewal. I don't have to report to my employer. When you've already had a suicide loss, there's nothing to do lose anymore. And physicians want that stability and they want that safety that they've confined in academic medicine and within knowing what's right and wrong, but this isn't a safe topic.
So I think it's important for people like me, to be there and say, "Yeah, but, you guys are saying all this stuff." Even when you talk about it sometimes, it's like an alternate universe. They talk about it as if physicians are all saints or all so sad, instead of they're really just human, you know. Some of them are jerks. Some of them that you work with, you don't like and you can talk to nurses and doctors about that. So maybe it needs more sarcasm.
David Carreon: Oh, I don't know if I've ever met a nurse or doctor that I don't like.
Janae Sharp: Never. Never. I've never, I've literally never met an unreasonable either and neither have you.
Jessi Gold: It's just like, you know, it's the same. Like there's sad ones, there are happy ones, there are people who get better, there are people who don't. It's the same.
Janae Sharp: Right. Yeah. Like everyone knows that one guy who they just didn't like, and like how when we're talking about mental health and when we're talking about a healthy system, we need to separate those two. So it's not just like that one selfish guy who thought he was the best person ever, now he's talking about how he's the best person ever with mental health, and he's going to make things better for everybody if you were just more like him. You know? Because that's a little off putting.
Jessi Gold: Yeah.
Janae Sharp: Yeah. So I think it's, I actually think it gives me more freedom, because I can say things like, "Yeah, but it was shocking to me how much some of the people that I've met in medicine do coke, or other performance enhancing drugs and they don't think it's a big deal because they're just enhancing their performance." So I can talk about the culture but not be controlled by the culture, because I don't have the same requirements for having the best school, having the best resume, having those things to check off my list, because I was just married to one. And I wasn't trying to compete with everyone.
So I think that it's been positive for me in a lot of ways to be outside that, because I, because they're not threatened by it and I'm not competing with them. Like the one-up-manship, I'm like, "Well, that's too bad, you went to medical school, that sounds brutally awful. That sounds like something I would not do."
Jessi Gold: And you didn't.
Janae Sharp: And maybe I would. You know? I thought about that. We never know where life will take us. And so yeah, that's a great question too, because I think part of the stigma is that no one wants to hear the rich doctor whining either. Like, because they do in a lot of ways have a lot of privilege and they have a lot of respect and authority in the community. So hearing them say how hard it is sometimes, please are like, "Really?" You know, it's hard. It's hard for people to really grasp that.
David Carreon: Yes, say more about that. I think that especially nowadays there's this idea of sort of that we get a lot of attention and probably justly to those who are victims, or those who are underprivileged, or in fact even some of your own work on social determinants of health and outside of work hours, physicians have pretty good social determinants of health, usually. So how do we balance giving our I guess presumably limited stores of compassion, why should physicians get any because we make a lot of money?
Janae Sharp: That's a great question. I think no one has to be compassionate to other people, first of all. That's bad to say. I mean they don't have to be compassionate to physicians. The reality is a lot of them have tons of debt. Some of them have great social support. Some of them have crippling anxiety and desire to perform. If you're living in poverty where you can't feed your children, sometimes you forget that other people are struggling, but you're not able to remove yourself from the immediacy of your pain.
And that's a triage that our society isn't very good at. We aren't very good at allowing people to have pain if we have pain. And I think some of that is a little bit competitiveness. When John died people would say, "Oh, I'm having a bad day but I don't want to tell you about it." And there are two things that I learned there. One, if I was in a very bad place and didn't have a lot of energy to give, I wasn't as good at being present with them. I just wasn't. And two, that didn't lessen the fact that they were hurting.
So we can say, "Oh look, they have a lot more money than I do, they have a great car", and they're still having enough mental pain that they die by suicide. That's something that we need to be able to talk about. How can we come together and have enough community support that we can allow everyone to have a healthy life and not say it's a limited commodity. And that's something I think about with social determinants of health. They say your community support has a huge impact on whether or not you're going to survive an illness, whether or not you're going to make it through a burnout, or your risk of suicide. And that lack of support can exist at any level and any socio-economic status. And just because I have less doesn't mean someone with more doesn't also have more mental pain than they can manage.
Jessi Gold: So like you're saying community support's important.
Janae Sharp: Yeah.
Jessi Gold: But you're also sort of criticizing the physician community a little bit on how we deal with things. What do you think we're doing wrong, what do you think we need to do better as a community to be supportive of this as a thing?
Janae Sharp: Oh, that's a great question. I think as a community they need better support but also more honest dialogue. So I mean criticizing the community is difficult, because a lot of people really want to do what's right and I think of it in terms of the suicide prevention community too. A lot of people involved there have lost someone by suicide and if you haven't lost someone by suicide you don't assume that it touches you and the physician community is kind of the same way, where you don't want those things to touch you.
And if you treat it like leprosy, like something that is contagious, that's really difficult. And I think a lot of the times, people want to be safe. Like in the physician community too, they want to be safe, they want to have their job. They've done a lot of work, to accomplish what they do, and they want to achieve something. And everyone is that way. They want to be safe and they don't want to have the things that they love threatened.
And in terms of society fixing that, we can, we need to re-evaluate our standard of measure for success. That's not saying that people won't be very successful or we need to lower our standards. It's saying, what can we do to make a place where people can talk about thoughts of suicide and some people that are physicians will think of that every day of their career, and is that something that you should talk about.
And we need better integration with ... And I think some of this is understanding. We don't really understand or since I like data, we don't have very good data or very good math models to predict your suicide risk or to predict your mental health. And you see that with pharmacology, people don't really know 100% what's going to happen with your prescriptions and medicine doesn't like if they don't have good data that they can back up all their decisions and say this is for sure going to be the outcome that we want.
So maybe it just needs more attention and better research so that we can have better data, but maybe we also need people who admit that they don't know everything and that this is an unpredictable thing.
David Carreon: So you're saying that maybe the metrics of how many hours have I continuously been awake or how many hours above a 100 did I work this week might be bad metrics?
Janae Sharp: Well, we don't really use those metrics though to predict like, you don't ... There are some ways that you could use metrics like that to avoid scheduling and those would have a direct impact on physician burnout, if we treated it more like how are we going to optimize someone's health and get some neurologist in there, what happens to your brain and your performance after you've worked 100 hours? How can we manage and develop the work flow and our workforce to look like that?
That would be success. I'm saying we don't know exactly what's happening to people after those 100 hours and them taking a stimulant and continuously working. What's going to be the impact on your ability to interact with people and to relate and to maintain a level of empathy seven years from now, if you're doing that to yourself now.
David Carreon: Yeah. No, it's sort of the slow burn, or the burn out, I suppose is the metaphor that we're using.
Janae Sharp: Yeah.
Janae is always looking for collaborators (she wants more psychiatrists!) and donors, so if you are interested in getting involved contact her at Janae@sharpindex.org. For additional information or to learn more about Janae’s work for physicians, survivors, and families please visit the following websites: MDsuicide.com and Sharpindex.org. Find her on Twitter @CoherenceMed.