American Medical News
  Government
  Profession
  Business
  Opinion
  Health Latest issue
By date
By region   Map
By health plan
By section
News briefs
Columns
Editorials
Letters
Topics   Series
Other years
Search Mobile edition
E-mail alert
Subscribe!
Staff directory
Author bios
Advertising
Classifieds
Permissions
Reprints
Site guide
AMNews FAQ
Contact info
Send feedback

Letters to the Editor - Nov. 17, 2003

---

Committing suicide while depressed is easier when a gun is at hand - Financial barriers hinder physicians who want to volunteer abroad - Cedars-Sinai revitalizing M&M conferences with 'Matrix' approach

---

Committing suicide while depressed is easier when a gun is at hand

In August, my friend killed himself. In his upstairs bathroom, overlooking his swimming pool, he put a gun in his mouth and literally blew his brains out. His wife and 3-year-old son were sitting downstairs when they heard the thud.

Imagine their horror.

Imagine his terror.

My friend was a physician in Wisconsin and a brilliant man who shone in all parts of his life until he fell into the black hole of depression. The usual treatments did not work well for him, leading to trouble at work, alienation from friends and trouble at home. He faced his worst nightmare: no hope, no future, his brilliant career and beautiful family in tatters.

Less than a month before his death, this passionately peace-loving man addressed his anxiety in the same way many Americans do: He bought a gun and took lessons in its use.

When he was seen by medical professionals during this time -- for exacerbations of his depression -- the suicidal mix of guns and his state of mind was overlooked.

He convinced those around him that he was fine, but he wasn't. His fear of failure had rendered him impervious to any fear of death.

Sadly, my friend's experience is not unique. Of the 28,000 people who die from gunshots in the United States each year, about 16,000 are suicides. In a slightly different scenario -- one that happens all too often in this country -- his suicide might have been preceded by him inflicting death or injury on his wife or his child; or of someone at his workplace.

Households with guns are three times as likely to have homicides and five times as likely to have suicides as similar households without them.

How can it be possible that one so vulnerable can so easily avoid help and find means to harm himself? The question is particularly salient for me because in my home country, Canada, he would not have been able to buy a gun without a background psychiatric check. In fact, in the country of his origin, India, a gun would have been equally difficult to obtain.

If this tragedy can become a cautionary tale, then the death of my friend will come to have some meaning. The fact is that those who suffer depression and its horrors have enough problems without also having easy access to a gun. Those who know, love or live with someone who is depressed must make sure that guns are not available.

As a physician, I know that a gun is not the way to treat the terrors of depression. As a friend, I know that when it comes to sharing that terror with friends, family and community, few things are more effective.

--Neil Arya, MD, Waterloo, Ontario, Canada

Back to top.

---

Financial barriers hinder physicians who want to volunteer abroad

Regarding "More U.S. medical students are studying abroad" (AMNews, Oct. 6): I was very excited to read your interview with Ian Mutchnick, MD. The article states "Nearly 39% of U.S. medical students studied in other countries in 2002."

My own medical career came similarly from being in the Peace Corps in 1972-74, when the numbers were much smaller.

I agree with Dr. Mutchnick's long-term vision. The problem is that the reimbursements from the middle class for care in the United States are shrinking so fast that no one will be able to go abroad to offer care in the kinds of charity programs he envisions, unless some new funding paths are made available. I hope he and others will work with the AMA to build programs of tax incentives for medical sabbaticals, reduced traveling fares for doctors who go on charity missions, and stipends for physicians who volunteer to teach in Third World medical schools.

This kind of work is simply indispensable in helping "ground" each of us in the most fundamental values of practicing medicine and making a difference. The existential misery caused by bureaucratic hassles here falls away. The doctor-patient relationship and our ability to be of service are paramount.

Also, the acquiring of foreign language skills can be a godsend here at home. The ability of physicians to have cross-cultural sensitivity and the ability to speak a foreign language should be reimbursed as a "best practice" model of care. The benefit to Hispanic, Chinese, Vietnamese and other medical students here would also benefit patients from those ethnic groups, as these physicians will also be reimbursed for language skills, and be encouraged to go places where their skills are most needed. Indeed, building medicine for a global civilization is an exciting future.

--Martina Nicholson, MD, Soquel, Calif.

Back to top.

---

Cedars-Sinai revitalizing M&M conferences with 'Matrix' approach

Regarding "Are patients safe now?" (AMNews, Oct. 13): The "potential treasure" to which Lucian Leape, MD, refers can be found in a well-run, well-attended and well-moderated morbidity and mortality conference.

Realizing that this conference had fallen into disrepair -- and, in many quarters, disrepute -- the department of surgery at Los Angeles' Cedars-Sinai Medical Center implemented the Matrix program. The Matrix program has redesigned, reconfigured and, many say, reinvented the surgical morbidity and mortality conference. The Matrix program converts the once ephemeral lessons and discussions of the morbidity and mortality conference into an ongoing error- and complication-reducing curriculum for the entire department.

--Leo A. Gordon, MD, Los Angeles

Back to top.

---

Copyright 2003 American Medical Association. All rights reserved.

American Medical Association - AMNews home - E-mail alerts - Mobile edition - Archives - Search - Site guide - FAQ - Subscribe! - Advertise