Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Physician advocate Kim Downey and family physician Todd Otten discuss their article, “Long-term impacts of physician suicide on patients and doctors.” In this engaging conversation, Kim shares her personal experiences with the departure of trusted health care professionals and the resulting emotional impact on patient care, while Todd reflects on systemic challenges, burnout, and the urgent need for change in our approach to provider well-being. Kim and Todd offer actionable takeaways that include prioritizing self-care, setting boundaries, and advocating for systemic reform to support both providers and patients.
Our presenting sponsor is DAX Copilot by Microsoft.
DAX Copilot, by Microsoft, is your AI assistant for automated clinical documentation and workflows. DAX Copilot allows physicians to do more with less and turn their words into a powerful productivity tool. DAX Copilot automates clinical documentation—making it available in the EHR within minutes—and clinical workflows, including referral letters, after-visit summaries, style and formatting customizations, and more.
70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.
Discover AI-powered solutions for clinical documentation and workflows. Click here to see a 12-minute DAX Copilot demo.
VISIT SPONSOR → https://aka.ms/kevinmd
SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme
I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus
Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kim Downey and Todd Otten. Kim is a physician advocate. Todd is a family physician, and we’re going to talk about the KevinMD article, “Long-term impacts of physician suicide on patients and doctors.” Kim and Todd, welcome back to the show.
Kim & Todd: Thanks, Kevin. Thanks for having us.
Kevin Pho: So Kim, we always start with you. You always bring us together as a physician advocate. Tell us what about this article appealed to you to bring, bring it to KevinMD.
Kim Downey: Sure. So I had Dr. Michael Hirsch, who you know, and Todd on my YouTube channel last fall to celebrate us each having a year of podcasting under our belts. And the plan was to talk about that and also the power of connection. And as I introduced the topic, Todd chose to spontaneously share that he was coming through a rough patch, partially stemming from unprocessed grief, including the deaths of four of his physician colleagues from suicide, and Michael went on to share some things that he had learned in his trauma-informed coach training, including that connection mitigates trauma. And I too have experienced resurfacing of the traumatic impact of my own doctor taking his own life. And it’s just so deep, and Todd feels it too, so after recording the episode, I reached out to Todd and asked if he’d like to collaborate on this article, because it’s just so meaningful to both of us.
Kevin Pho: And Todd, why don’t you go ahead and share more about the article and your story.
Todd Otten: Absolutely. You know, and Kim’s spot on. When going through school and stuffing everything into a box is just not the way to go. And when my box of previous trauma got opened last summer, it created a bit of a roller coaster for myself and my family, you know, that we’re still working our way through. And having gone through it now and realizing it, I can appreciate how our colleagues get to the point where they feel like there’s no hope. And I think that’s a big part of why this epidemic of physician suicide is out there and why I had the unfortunate experience of having four of my colleagues who are no longer here. And I think we have to just keep talking about this. We have to make it OK to not be OK and to reach out and ask for help and remove those barriers that exist when people need treatment.
Kevin Pho: So, Todd, I could only imagine one physician colleague committing suicide, but you unfortunately had four, and I’m so sorry to hear that. Tell me, just so those who simply can’t understand it, tell me the effect that that has had on you.
Todd Otten: Oh, wow. There’s a lot of layers to the effect, Kevin. Some of it is I didn’t grieve some of those losses like I should have, and that in and of itself is a tragedy. I think the biggest effect it’s had for me is my drive now to make change, you know, and hopefully on massive levels, if you will. You know, for those maybe watching, obviously I’m involved with Medicine Forward, and we’re all about catalyzing positive change. We’re working on a documentary to really peel back the curtain on this issue for the American public so they can really understand what’s going on with their clinicians, you know, because as Kim said before, it’s magical when that relationship is there between a physician or a clinician and a patient—it’s just magic—and so much healing can occur, not just for the patients but also for the clinicians. And so those losses of my colleagues over the year have just propelled me to keep going forward to make the necessary changes out there.
Kevin Pho: Well, Todd, when you said that you weren’t allowed to grieve properly, that really speaks to me because as physicians, we’re often accustomed to soldier on, see the next patient, despite everything that’s happened to us, despite all the trauma. So when you say that you didn’t have time to grieve properly, what would you have liked to have done?
Todd Otten: Well, I think in particular for my partner of three or four years—and, you know, I won’t say his name—he died by suicide, and it was really a horrific way that it had occurred. You know, and I went to the wake, and I cried at the wake, and maybe started that processing, but I immediately reverted back to my training to just stuff it in a box, put that on the shelf, and keep going. I mean, I was seeing patients the next day. We need to allow time to grieve and process and heal. And that’s not built into our fee-for-service, you know, productivity model that we’ve got. What is really problematic about it is all the secondary negative effects that occur when we’re not doing what we should be doing cost way more money, and there are all these downstream effects that often lead to disastrous outcomes. So what I would have loved to have had is, you know, a counselor, a therapist there around that come in and say, “Hey, how are you doing? You know, how are you feeling about this?” I think that in and of itself might have been enough for me to say, “You know what, I do need to spend a little bit of time processing this loss.” And that’s just a simple example. And I think about the group I work with now, Emergency Care Specialists. They have a therapist employed. We can just set up an appointment and go in and talk about these things and vent and let that pressure valve release and think about how that positively affects the culture of this group, right? Their retention is through the roof. People want to come and work there. They’re happy because they have these opportunities to go and heal from some of the most devastating things that happen. So that’s what I would have loved to have had back then.
Kevin Pho: Kim, you mentioned, unfortunately, that your physician also died by suicide. So speaking from the perspective of a patient, tell me the impact that event had on you.
Kim Downey: Sure. Well, it was the most traumatic thing that’s ever happened to me in my life. And I’ve had a few miscarriages and watched my dad take his last breath. But I think it was the tail end of me having three cancers and just everything that happened, and so it was traumatic. And when I was trying to move forward, after a year, I thought I should be feeling better. And Michael Hurst, Dr. Michael Hurst, is my physician coach, and he was saying, you know, nobody can tell you what to feel or how you feel, and that I was almost beating myself up. That was adding to it, that I was judging myself that I was still feeling, grieving deeply about it. And then I thought I was going to have to bring my mom to that place for her own test, and it was almost like a PTSD. And I didn’t, but then I had to go for myself because I just had another surgery, and I was really at a lot of anxiety about going back there. And it ended up feeling a little hollow and empty because when I did go, nobody was there from just a couple years ago. So it’s like nobody knew what transpired that day. And then also part of what I wrote in the article is if now I receive envelopes—you know, people don’t like to get envelopes that are like medical bills, but for me, I know if it’s a bill, but if it’s not, I’m afraid that something happened, that it’s a notice about something happening to my doctor, because this happened a couple of times that they were sharing that another doctor in that practice was leaving, and that’s what the notice was about. But I get this traumatic response. And I even just this Sunday, my doctor shared that he received a promotion, and my first thought was I got teary, and I was like, is he still going to see patients? Because now it’s just a traumatic thing that I’m fearful of losing my doctors.
Kevin Pho: And Kim, before you went to Michael Hirsch for therapy and got better after seeing him, you said one thing that caught my ear—that you judged yourself in that year after your physician’s suicide. Tell us more. What do you mean by that?
Kim Downey: That, well, I kept thinking that as time went on, that I either shouldn’t be feeling it so deep because I actually only met him three times and talked to him on the phone three times. So the fact that he got that much in my heart, but everything that happened is—I’ve shared my first tribute, my first article to you was about him, and the first podcast I ever did was talking about him, you know, because the things that happened were unusual. But I think in retrospect that those things were meant to happen. Because I think sometimes when something traumatic happens, that’s what propels people to find their purpose or their mission. So if that didn’t happen, I wouldn’t be doing any of this, and people have shared with me that I’m making a big impact. But I just felt like I only met him three times, I only talked to him three times—like, why is this affecting me so deeply? And I—I’m a physical therapist, and I was on the ambulance corps when I was 16, so I’ve seen people die, and I’ve dealt with suffering, just like doctors have, and nothing ever affected me this deeply. But again, as Todd said, there are some things—just hearing doctors talk about these things—I realize so many things that I never unpacked, too. Like you, I’ve walked into—you think you’re going to see a patient, and they’re not there, you find out they died, and you have to go into the next room. So there’s a lot of things that doctors experience where they might feel alone, and they don’t talk about it, but actually PTs, we never talk about it either.
Todd Otten: I think one of the things that’s become very obvious to me recently is that trauma—whether we’re talking big T’s, little T’s, micro trauma or whatever, however you want to call it—affects all of us in one capacity or another. And the more I’m getting into my own journey with this, you’ve got to embrace it. You have to lean into the pain a little bit, ultimately, to heal from it. You know, for a long time with my partner, I felt guilty because I never asked him how he was doing. And I think about that, and I get teary and think about, I wish I would have just asked him once, you know, and that might have been all the difference in the world. And we’ve got this culture of—I’ve recently been joking lately, “suck it up, buttercup”—we have to get away from that. We’re all human beings. Everybody has emotions and families and things they want to accomplish, and we have to appreciate that. And I think, you know, going back to what you said, Kim, I think that’s why some of these relationships are so meaningful and have such a big impact, because we’re being vulnerable, and that vulnerability strengthens that bond very quickly with doctor-patient. And I totally get what you’re talking about, why it can be so devastating.
Kevin Pho: So, Todd, I was going to ask about the next chapters in your journey. I know it’s an ongoing healing process. It could never be completed, so talk about some of the things that you’ve done to help yourself along with that healing process. What kind of changes have you made?
Todd Otten: Well, probably the simplest one—I never really realized that I was always running from a lot of these things and not necessarily staying in the moment. You know, and that could be a kid’s game, right? Where you’re just there, but you’re not really there, and you’re kind of numb because you’re trying to protect yourself from all this other stuff that’s occurred. So that’s one thing—just trying to stay in the moment, and it’s OK if it’s not perfect, right? And there are going to be mistakes made. I’ve learned to be more compassionate to myself. You know, as a physician, you get a thousand feedbacks, and if 999 of them are positive and only one of them is negative, which one are you focusing on and spending all the time worrying about? That one, right? I mean, you can’t live like that. That’s not healthy. Some of the personal things that I’ve been doing—and I think it’s important to share this so that our younger colleagues know it’s OK—is going to therapy. I’m planning myself to start some trauma-informed coaching. I recently have been doing some EMDR—eye movement desensitization and reprocessing—so that those previously very painful memories don’t take over a day and make it miserable. But it’s a lot of work. I never really realized how detrimental compartmentalizing stuff and then never going back to it really truly was until this past year. So yeah, a lot, and hopefully by having these conversations, it empowers and inspires our colleagues to ask questions or maybe reach out to a colleague and say, “Hey, are you OK? How can I help?” And that might—like I said, that might save a life. It really might.
Kevin Pho: And Todd, just those simple questions—asking about someone’s mental state, simply just asking how they’re doing—sometimes it can uncover things that ordinarily they wouldn’t be vulnerable about.
Todd Otten: One hundred percent. I mean, the floodgates could literally open, and I think what’s amazing about that, Kevin—and Kim—is that I think there are a lot of people out there who are just desperate to have one person be attuned to what is truly going on and say, “Oh, they’re not OK.” I think back to the times I was struggling, went through burnout—and people will say what they will about the word burnout, you know, is it depression or is it moral injury or all these other things. Having lived through it, I think people can resonate with that term a little bit, so I tend to stick with it. There were so many red flags during that period—me walking out of the clinics just beyond upset and basically leaving in the middle of a clinic day, walking out of a meeting in tears. I’m glad those things happened, Kevin and Kim, because it’s led me on the journey I’m on now. Do I wish somebody would have asked back then? Yeah, but everything happens for a reason, and I think the work that’s being done by Kim, myself, by you, Medicine Forward, all these other wonderful organizations out there will get us to a better place.
Kevin Pho: Kim, we talked earlier about the power of connection, and you’ve been at the forefront of this, connecting doctors over the last couple of years in terms of getting them to be vulnerable, talking about our stories, talking about our trauma. How about you yourself? How has that power of connection helped you in the healing process?
Kim Downey: It means everything, and a lot of my own healing—I feel like when I talk to these doctors, we’re helping each other heal. They feel, you know, like somebody who just wants to talk but doesn’t want something from them, you know? And that’s why I think a lot of times if they find me on LinkedIn, sometimes our first communication is in a private message, and they might share that they’re miserable, and then I’ll say, you know, do you want to have a chat, or they’ll ask if we can chat. And then I just sit and listen to them. And then I also had done an introductory episode for my YouTube channel—it was between episodes three and four—where I just share my story as briefly as I can in 20 minutes. So sometimes I share that if they haven’t seen it. And if they haven’t seen it, I just share it in a few minutes, and they really appreciate that someone who’s been through a lot and even had some negative experiences is trying to take a positive route and make an impact, you know, for doctors, and they appreciate that. So just having our conversations together is healing for both of us. And then sometimes they’re hesitant, I think, to reach out to other doctors because they kind of feel siloed. So when I talk to somebody, I give them shout-outs on LinkedIn, and then my doctor friends feel comfortable reaching out to them. One experience actually—that’s what happened with Todd and Michael, right? Once I talked to the two of them, and then they had a phone call themselves, and then I had them on together. And I help other doctors deepen relationships with each other, so I feel like they say that phrase, you know, we’re all walking each other home.
Kevin Pho: So I’m going to ask each of you the same question in terms of what physicians or clinicians listening to you on this podcast can do, because I’m sure that the stories both of you share aren’t unique. And there are a lot of clinicians who are hiding and suppressing these stories. So Kim, through what you’ve learned with all the different connections that you’ve made, what are some pieces of advice that you could share that could really move the needle with some of the doctors who may be undergoing trauma or repressing trauma?
Kim Downey: Well, I would say one thing—and whether you’re on the receiving end or would like to offer support—is when you say, “Hi, how are you?” or “How are you doing?” or something, right, everybody just says, “I’m fine.” But if you slow it down and you ask again, like, “How are you really doing?” and you look them in the eye, that can make all the difference because then they’re getting the sense that you do really want to know and you do really care. So on the giving end, that is something that I would—and to do that regularly, like if you’re in a good place yourself, to just check on your friends, like anybody, just check on that. That’s what they say now, a friend check, right? But it’s really important.
And then if you are a physician who’s struggling, as we’ve talked about, sometimes if you’re in a bad place, even asking for help can feel like so much work, but that’s what you have to do. You have to find a safe person just to tell something to, whether it’s a friend, a pastor, a coach, a therapist, anybody. And there are people out there who can help you if you don’t know where to turn. Any of us, right? All of us would have resources. Send any of us a message, but just share with somebody. And then, like I said, Todd has shared some things that have helped him and that I’ve heard have helped other people as well, like things like looking into EMDR and things like that. So I’ll let Todd continue.
Kevin Pho: And Todd, why don’t we go to you with the same question. What are some tips that you can share that can really move the needle with some of those doctors who may be listening?
Todd Otten: Well, I was going to ask, Kevin, how much time we have, because I could probably go on for quite some time relaying some things that I think would be helpful to our younger colleagues, but just maybe to highlight a couple. I think that we’ve talked about relationships, we’ve talked about connections. If you’re not OK, find a senior physician or reach out to somebody on LinkedIn or come to Medicine Forward. I want to help the next generation through some of these struggles. I want to make the landscape better in a big way. So I think that’s one thing.
I think the courage to say no is critically important. As physicians, we are taught to just keep going and do more and do more and do more, and honestly, that’s been abused, in my opinion, in terms of productivity in this fee-for-service world that we live in, and we’ve got to stop that. So the power of no is critical, but also self-care is paramount. If you’re not well as a physician, you are not giving your best to your patients, and we’ve just proven that that’s lunacy. You’ve got to take care of yourself. So maybe those are three simple things that I would suggest.
Kevin Pho: We’re talking to Kim Downey and Todd Otten. Kim is a physician advocate, Todd is a family physician. Today’s KevinMD article is “Long-term impacts of physician suicide on patients and doctors.” Now, guys, both of you, just end with some take-home messages that you want to share with the KevinMD audience. Todd, why don’t we start with you?
Todd Otten: Absolutely. One of the things that I’m super excited about at this point, Kevin, is we’ve got a physician-led—not exclusively physician, but a physician-led—group that is working on a documentary that is very much going to hit on this topic, and I’m super excited about it. We’re hoping to release it on September 17 of this year, National Physician Suicide Awareness Day, so if you’re interested, let me know, and I’ll show you that I’ve got—well, I’m probably not doing it right—an earring in with teal and purple and a semicolon showing my support, so I’m going back to my college days with the earrings. So, yeah, if you’re interested, reach out. Let me know.
Kevin Pho: And Kim, we’ll end with you, so your take-home messages.
Kim Downey: Yeah, so I have several things to say, because I know that your audience isn’t just physicians. So just to kind of encapsulate some of the understanding for people who aren’t physicians is that it starts in medical training, you know, through the years and around the world. And besides Todd’s book, Ripple of Change, which is so important—we’re all going to make a difference—I believe you’ve also had on Simon Craig from “Hurting and healing, delivering love to medicine and health care,” and through my conversation—and I’ve had him on as well—that’s how we know that it’s been through the ages and around the world. It’s not just an American problem, and it’s not just recent.
It’s like you take smart, compassionate, driven individuals, you set them up to compete against each other for entry to the best colleges, then med schools, then residencies, then attending positions. You teach them the patient always comes first and ignore their own basic human needs like sleep, food, water—if you’re in a surgery and they don’t give you a water break—connection to family and friends, your mental and physical health, not to set boundaries, not to say no. And then you pile on human suffering, trauma, and death with no training or support to process it all. And in addition, many doctors have their own personal history of trauma even going back to childhood, and it’s heaped onto all of that, which many times they’ve never unpacked. Then you dump them into a system where they have an incredible amount of responsibility yet so little control, and they often have at least a couple hundred thousand dollars in loans to repay. It’s just—the whole culture of medicine has to change.
And one thing every single one of us can do is thank a doctor. And as you know, Kevin, I’ve just submitted an entire collaborative article speaking to that with the goal of making a huge impact for Doctors’ Day, March 30. Let doctors know that you understand how hard things are right now and how much you appreciate them being there for you. Many are leaving medicine, understandably, and we need doctors. And the pressure is increased even more on those who remain. So thank you. You know, you’ve both received a personal thank you from me with my deepest, sincerest gratitude, and I mean that with my whole heart. And I’ve started a group that’s addressing patient empathy and clinician well-being, so reach out to me if you’d like to be involved.
And I’ll end with a question. The three of us have each been told we’re super connectors, each in our own way. Is there anything else we can do together to best maximize these ripples of change, or are we already doing it?
Kevin Pho: Kim, Todd, thank you again for sharing your story, some insight, and thanks again for coming back on the show.
Kim Downey: Thank you, Kevin.
Todd Otten: Thanks, Kevin. It’s always wonderful. I appreciate you.
