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Reflections On A Crisis And Moving Forward

Patrick DeHeer DPM FACFAS

07/18/2019

I received an unexpected phone call one Friday afternoon. A local colleague of 25 years called me to ask for help. The specifics of our conversation were personal so I will not elaborate. I offered a couple of viable solutions and I thought our conversation ended on a very positive note.

I was wrong. The following Monday, the Chief Medical Officer of the hospital where I serve as a residency director called, which wasdefinitely unusual. His message hit me like a ton of bricks. The same podiatric physician I spoke with a few days earlier, an attending at the residency program, had committed suicide.

I was about to begin my monthly APMA Legislative Committee call as chairperson. I could not breathe, let alone run a committee meeting. I called APMA’s Legislative Advocacy Director and canceled our meeting.

The next 12 phone calls I made were to our program’s three graduating residents and nine current residents. These were tough calls to make but I wanted my residents to hear the news from me first. St. Vincent Hospital in Indianapolis provided tremendous resources for residents and attendings as we grieved the loss of our colleague, teacher, and friend. I struggled my way through the following week, which was capped off by his celebration of life. The room of those that loved and cared for him overflowed. His brother spoke beautifully about him. We wept, sang and grieved. We are still healing.

I decided our program was going to take this tragedy and use it to help others within our podiatric family. I see all my colleagues as family. Our residency took a well-being survey used by the Internal Medicine and Family Practice programs, and modified it to take a look at a specific subsection of the podiatric community. Our goal is to gather the data, compare it to the robust data on our allopathic and osteopathic colleagues, and publish our results. We then want totake our findings to key stakeholders in podiatry to build upon and add to the healthy resources on the APMA website (https://www.apma.org/wellbeing) for those at-risk and to educate the entire podiatric community.

We need your help to get our survey to podiatric residents around the country. There are approximately 1,700 to 1,800 podiatric residents. We hope to obtain a significant amount of responses to validate our data. APMA is the only key stakeholder thus far to disseminate our survey and I call on every other organization to step up and help get our survey to podiatric residents.

To give you an idea of the seriousness of suicide in podiatry, I e-mailed about 50 leaders within the podiatric profession. Within this small sample, I learned of at least 10 separate suicides within our podiatric family. It is time we took this seriously. In the Accreditation Council for Graduate Medical Education (ACGME) Institutional Requirements, section III.B.7 contains phrases like “must oversee” and “must educate” well-being for residents. The Council on Podiatric Medical Education (CPME) document 320 does not contain any such language. I hope with the forthcoming rewrite of this governing document, CPME follows the ACGME lead.

In regard to well-being, ACGME III.B.7 states:

“a) The sponsoring institution must oversee its ACGME-accredited program’s fulfillment of responsibility to address the well-being of residents/fellows and faculty members, consistent with the common and specialty-/subspecialty-specific program requirements, addressing areas of non-compliance in a timely manner.

b) The sponsoring institution, in partnership with its ACGME- accredited program(s), must educate faculty members and residents/fellows in identification of the symptoms of burnout, depression, and substance abuse, including means to assist those who experience these conditions. This responsibility includes educating residents/fellows and faculty members in how to recognize those symptoms in themselves, and how to seek appropriate care.

c) The sponsoring institution, in partnership with its ACGME- accredited program(s), must:

1) encourage residents/fellows and faculty members to alert their program director, DIO, or other designated personnel or programs when they are concerned that another resident/fellow or faculty member may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence;

2) provide access to appropriate tools for self-screening; and

3) provide access to confidential, affordable mental health assessment, counseling, and treatment, including access to urgent and emergent care 24 hours a day, seven days a week.”

Please spread the word and share our survey with podiatric residency programs and residency directors at https://www.surveymonkey.com/r/podiatricresidentwellbeing. Thank you.

I am still mourning the loss of my colleague, our residents are mourning the loss of one of their attendings, and the Indiana podiatric community is mourning the loss of one of our own.

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