Hi. WOW...So sad, but understandable!!! I work as a SWer in the US...stress is tough in the human field and HEALTHCARE debate UGH!!! Rep/Dema?Indenpent...all sound like babies...Animals seem to think better...Please tell this beauty to stay inside...the world is not so nice!!!

Dr. Khuly, your post brings back lots of memories of the vet I had going on 10 years ago. He was brilliant (same vet school as you!) and incredibly skilled and yet chose suicide as his a way out of his marriage and addiction problems. He did not choose barbituates, but instead killed himself with a gun in the family home. He left behind two young daughters and a large extended family. I went to school with his sister and my parents knew the family well. His father too, was a veterinarian and as I recall, also died young. Perhaps he had the same end? I'm not sure anyone knows.
What I do know is that suicide steals the lives of people from all walks of life, not just veterinarians. There has been some research done on the patterns of suicide, too. There's been connections made to bi-polar disorder and suicide and also the increased tendency of suicide by people who have relatives that successfully killed themselves. Suicide affects all walks of life.
I think it is safe to say that suicide prevention could be bolstered for all professions with special attention to dentists (they also have a high suicide rate) and veterinarians. It is high time we looked at mental illness in all medical professions and the propensity of a certain population of those individuals to end their lives by their own hand. We need to start recognizing when people exhibit risky behavior that may lead to suicide. And we need to pay attention to those who may appear to joke about it, but are in fact planning to end their lives. In other words, awareness is a key factor in prevention.
The pain that one experiences when they've lost a trusted family friend and a person who clearly loved animals (more than people, most of the time) cannot be measured. I am still amazed that my old vet is gone because by all appearances he had a lot to live for - he just did not want to live for himself. He took his job seriously and saved the life of one of my dogs that I thought was going to die, despite his expertise. I will always be grateful for that.Incidentally, she outlived him.
I miss Dr. B to this day. May he rest in peace. Thank you for your post.

I have a few of my own. I knew three personally. One was in my class. The other worked for a brief stint at the practice I still call home. A third was an acquaintance, a specialist. All for different reasons, and all potentially preventable. Who knows?

I really think it is the third reason, as the same is true for chemists. "Regular" people make suicide attempts. Chemists succeed the first time. Veterinarians have even more easy access to lethal drugs and know exactly how to use them and have already used them. And like chemists, their suicide is not with a gun (choice of most males) or prescription pills (choice of most females), but with something specific to their profession.

You hear that people who attempt suicide don't really mean to do it, but based on what I know about chemists (and now veterinarians) I don't believe this. I think most people just aren't very good at it and botch the attempts.

Dr. Khuly, you noted rainy weather as a blue funk factor in your case. I know depression and suicides statistically affects a larger portion of folks who live in rainy climes, and wonder if the study you cite also skews that way?

I've lost two friends to suicide so far: one euthanasia solution, one other drug overdose. One of my drug reps told me an associate I did not know from a neighboring practice recently committed suicide, also with euthanasia solution.

It's no surprise to me, especially amongst younger grads: huge student loans (and the stress of repayment), huge time sacrifice, deferred family and personal life, and constant aggravation from that bottom 10% of clients who make every veterinarian's life miserable. We're also exposed to more death than any human physician, and on a far more personal level.

And I absolutely agree with Merlinsmom: there's a difference between attempting suicide and planning to succeed.

One of the most beloved vets we have ever had here also struggled with clinical depression for most of his life. He was amazing with both animals and people - he was very intuitive.

He chose to euthanize himself, even though he had a fear of needles. His friends believe that was so he would succeed the first time.

He had a mobile practice, and wasn't really accepted by the traditional clinics here. He didn't toe the line on billing, which seemed to be the most contentious issue between them.

His family and friends are missing a really important person in their lives. The animals have lost an advocate like no other. Preventable? I'm not sure. Suffering from clinical depression myself, I really empathize with his situation. Personally, I think he chose a pain free method, which can't be said for the majority of ways one can end their life. Maybe he shouldn't have had free access to lethal drugs but when a person is determined to die, they will find a way.

I had always read that dentists in the US have the highest suicide rate among medical professionals. Personally have no experience with a veterinary professional committing suicide.

My UK friend's foster child wanted to be a vet. However, she decided against it when faced with student loans that wouldn't be paid off until she reached her 40's. She's studying to be a solicitor/barrister instead. Evidently that's less expensive! Money pressures can be the source of extreme stress.

Understand that I am older than most people out here I would guess. This might be a bit unrelated but I am going to vent a bit and see what happens.

In the USA it seems that all labor categories are becoming more and more stressful, and unfortunately, it starts at childhood. I remember in all levels of school we had a few sports and generally less than an hour of homework. Now the children are encouraged to be in an enormous number of activities and the homework is now so much that the books are brought home in a heavy backpack. I have spoken to some of these teens and their schedule is ridiculous. Getting up at 4AM and on the go until they go to sleep at 11PM or midnight.

I work in a field where if I had worked a little harder, gotten a bit more education, or been willing to travel a bit more, and overall put myself towards my career a bit more, I would have more money, and what some consider more success. I exposed myself to a life of massive effort and dedication just long enough to see that it would, honestly, kill me or, at a minimum, shorten my life. So while my life history involves a high stress IT position and working in child services, neither is in my current or future plans.

I have an enormous amount of respect for people that can take class after class, pursue their MS/MA and Phd, and work 15 hours a day regularly. I thank God every day that I was willing to admit to myself I can't do it. I put in my 40hrs, work over when needed, and "kick in the high level motivation" when the job requires it. That being said, I know that in the long term, my body and mind will not tolerate such action as a lifestyle.

I put this out here because I know as well as anyone that we all can't be Veterinarians, or social workers, or high level 80-90hr/week managers. Some of us simply are not cut out for it. But what I see in the USA is now a requirement for anyone that wants to succeed to live that sort of life. You MUST get a BA to even be considered for a base level job, and a Masters, which used to be a very elite education, a requirement to move up at all. The cost, the requirement to work massive hours, to be a quarter million bucks or more in debt before you ever get to work in your profession is simply not a good thing. I see it as a death spiral of society. Sad, but true.

To relate to the subject at hand, it has more to do with HOW they are executing their profession and not what the profession is. The suicide rate for UK Vets is high, but I would bet research would show it is no higher than any other profession requiring that much effort, long hours, and stress. The sad thing is, the occupations where folks can work in a lower stress environment while still being considered a contributing member of society are quickly vanishing. It's a big ole bowl of not good if you ask me.

I was a grief educator and clinical counselor at a major veterinary school for most of my adult career and dealt with at least one suicide each year, as well as many students who were depressed and considering it. I think that because we had easily accessible counseling and a great deal of education about the signs of suicide and how to deal with someone who is exhibing those signs, we also prevented quite a few. Vet schools, as well as the profession, would do well to open itself to a greater collaboration with mental health professional. Your jobs, training, and responsibilities are too burdensome to deal with on your own. Everyone needs support and help once inawhile and there is no shame or weakness associated with that.

It has to be hard, I think, to be in a profession where you study really hard because, with some folk, it's a "calling." It's a calling because you want to improve the quality of care for animals who can not speak for themselves, but sometimes your hands are tied up tight because of whatever reason (economic contraints of the owners; ignorance of the owners; inability to offer payment plans etc etc.) If you were a mechanic, and a person brought in their Mercedes, but they couldn't afford to get it fixed, there would be a little "upset" or "disappointment," but these are living, breathing creatures. I think, sometimes, when you've studied for all that time and "paid your dues" and still you are powerless over the circumstances, that can be damned depressing. Couple that with the assumption that vets probably are a little more "tenderhearted" than the usual human being, and I can see where the thought of being at peace might be tempting. And if you have a period of time where there are a lot of frustrations, one on top of the other, it can be overwhelming.

Based on your thoughtful comments, I've decided to expand this post for a column in USA Today on Friday. Thank you all for what you've contributed so far.

EAB:

>>I would bet research would show it is no higher than any other profession requiring that much effort, long hours, and stress.>>

Okay, if that's the case, what other profession would you say is the equivalent of veterinary medicine in effort, long hours and stress?

The UK study compared veterinarians to physicians, dentists and pharmacists. While these professions are all approximately 2x suicide rate of general population, veterinarians are at 4x suicide rate of general population. I don't think being a veterinarian is necessarily more stressful, difficult or time-consuming than being a physician. Persuade me.

IIRC, police officers also have a suicide rate about 2x general population, similar to physicians, dentists and pharmacists.

I admit I was surprised when I saw how high the suicide rate is for veterinarians.

It is ironic that this topic was brought up today. I am a healthcare worker in a hospital. We had to Baker Act (commit someone involuntarily for mental assessment)a co-worker today because he told several people that we was planning his suicide within the next few days. In recent memory, 2 other people in our small hospital have successfully killed themself. My belief is that people that work in any aspect of the medical field are caring and especially sensitive people. We tend to take care of others before ourselves. In addition, the medical field is stressful because it literally is life and death, be it a pet or human life.

I organized a weekly lunchtime yoga class at my vet school because I felt like there was a whole lot of stress but not many options for stress relief. I spoke with a clinician in the hospital who said he wished he could participate in the yoga classes, but he didn't want his colleagues to see him as "weak". What a bummer than not only was he experiencing a lot of stress, but he also felt like couldn't do anything about it.

>>people that work in any aspect of the medical field are caring and especially sensitive people. We tend to take care of others before ourselves. In addition, the medical field is stressful because it literally is life and death, be it a pet or human life.>>

I think that's absolutely true, and it's probably why the suicide rate for physicians, pharmacists and dentists is 2x that of the general population.

But I do not think veterinarians - who have 4x the suicide rate of the general population, or 2x the suicide rate of physicians - are necessarily more caring, sensitive, or stressed than human health care workers. I think there are other factors at work here.

One reason is probably that we not only have knowledge, we have ready access to drugs. Most physicians (with the exception of anesthesiologists, who IIRC have an elevated rate of both drug abuse and suicide vs. other physicians) do not.

Another may be that veterinarians are more likely to be self-employed and thus have health insurance plans that provide very poor benefits for treatment of mental health issues (e.g., major depression). For example, my own plan will pay for 20 sessions with a shrink annually, and if I were to use this benefit I'd never be able to switch plans because I'd then have a pre-existing condition.

>>Another may be that veterinarians are more likely to be self-employed and thus have health insurance plans that provide very poor benefits for treatment of mental health issues...>>

I wrote this then realized that the study in question was done in the UK, where everyone is covered by the same national health care system. Oops.

"we have ready access to drugs"

And veterinarians use death to solve a great many problems. I don't mean that facetiously, it's just that euthanasia is frequently the answer to "What now?". I would expect that answer would be applied more frequently to personal problems too after a while.

I would also say that human medical, by it's occupation, makes more of an effort to take into account the toll on the human being, be it the patient or the provider.

One asked what other kind of field I would think of in regards to suicide rate being extreme. I am not one to get into a debate of who's death is more or less severe. I would think we could agree than any suicide is one too many, right? That being said, I would think child and family counseling and/or child services, Veteran care, prison counseling, hospice care, in home elderly care as well as nursing home as well. Again, I think the subject of suicide requires a high level of compassion and consideration regardless of the rate. We're talking about a needless death happening and in that light, there is no rate that is acceptable except 0%

I can't help but wonder how many aren't suicides but drug OD's (by accident), after all, if Michael Jackson enjoyed unconsciousness with Propofol, who's to say the euthanasia solution doesn't induce the same euphoria, not to mention, a weird-type challenge of "just enough, but not too much".

Have any drug analysis' been done post-mortem to find levels? Probably not to any statistical data base, anyways.

I read the article. Still, I think it more likely to become a substance abuser, unchecked--- whereas in the human medical field, it would be discovered, reported, and definitely not tolerated. Who's the check & balance in veterinary medicine? The secretary, the vet tech, the patient? The "patient" could be deprived and who's the wiser??

I think its more than just drug availability. Most MDs and DDs also have access to drugs. I think it is a combination of stress along with owners who don't care. You work hard to save an animals life and then the owners won't pay. Or an animal has a correctable condition but the owner can't or won't authorize treatment. These types of things don't happen in human medicine - at least the 'put them down - I won't spend the $ type of situations.' I'd find that really depressing myself.

>>I can't help but wonder how many aren't suicides but drug OD's (by accident...who's to say the euthanasia solution doesn't induce the same euphoria, not to mention, a weird-type challenge of "just enough, but not too much".>>

Do you also think there is an epidemic of Russian Roulette playing amongst police officers?

>>Have any drug analysis' been done post-mortem to find levels? Probably not to any statistical data base, anyways.>>

Suspicious deaths are generally classified as either suicide, homicide, accidental or undetermined. This study looked at suicides by profession.

>>I think it more likely to become a substance abuser, unchecked--->>

This is off topic: we do have a high rate of substance abuse, but I think dentists still have us beat. Most of the veterinarians I've met who are addicted abuse alcohol, BTW.

>>whereas in the human medical field, it would be discovered, reported, and definitely not tolerated.>>

Hope you aren't planning to have surgery anytime soon, but I suggest you Google "anesthesiologist drug abuse". It's relatively easy for anesthesiologists to divert drugs intended for patients. Mass General in Boston, MA has even resorted to random drug testing of its anesthesiologists. Problem anesthesiologists are generally (eventually) detected when their patients consistently awaken screaming in pain.

>>Who's the check & balance in veterinary medicine? The secretary, the vet tech, the patient?>>

The DEA. Every schedule II drug a veterinarian orders is recorded using specific paperwork. It's not perfect, but I do know veterinarians who have been investigated for odd usage patterns.

>>The "patient" could be deprived and who's the wiser??

That's a nasty insinuation.

The one major reason to divert drugs meant for one's patients is if one is relatively well-supervised and thus must resort to extreme deception to hide one's addiction. Either veterinarians are relatively well-supervised (as is the case with anesthesiologists) or generally ignored and able to order and abuse drugs with impunity. You can't have it both ways.



To return to the original topic, I think veterinarians have a high suicide rate because they know how to cause death and are so familiar with the process of dying they no longer fear death. I think veterinarians use euthanasia solution frequently for the same reason police officers use guns: they're familiar with its use, and it's readily available.

I'm glad you're alive.

"Do you also think there is an epidemic of Russian Roulette playing amongst police officers?"

Yes. They off themeselves more than the general population (3x in NYC), and there is also a high frequency of domestic violence tho' the numbers I found aren't solid.

>>Do you also think there is an epidemic of Russian Roulette playing amongst police officers?>>

Yes. They off themeselves more than the general population (3x in NYC)>>

Police officers definitely have a higher suicide rate vs. the general population. They tend to use guns, as I stated in the last paragraph of my previous post.

My comment, however, alluded to the earlier comment that veterinarians may actually die accidentally while playing a "weird-type challenge" game with euthanasia solution vs. intending to commit suicide.

I think that's ridiculous - just as ridiculous as saying police officers who shoot themselves aren't suicidal but merely playing Russian Roulette.

Would you ever suspect propofol to be abused? Do you think MJ was intentionally murdered or said "hey, doc, how about boosting it up another ml.?"

Are you saying in "low doses" sodium pentobarbital is assuredly "fatal"? That is my point.

Heroin deaths aren't (usually) intentional, but the abuser builds tolerance and boosts the dose in increments. Some abusers (like MJ) mix drug cocktails, right?

I wasn't trying to make unbelievable insinuations, because substance abuse and depression and suicides are serious, sad, and harmful to the affected and surrounding family & friends, and crosses all groups of people.

You did confirm a valid issue, where are the "checks" in the profession? Particularly the small one & two person clinics?

>Would you ever suspect propofol to be abused?

By whom?

To remind you, this article was about suicide, not substance abuse.

>>Do you think MJ was intentionally murdered

No. I do think his physician failed to meet the standard of care and should lose his license to practice medicine, though.

>>Are you saying in "low doses" sodium pentobarbital is assuredly "fatal"? That is my point.>>

That is actually a complicated question. I've seen animals die after being given less than half the standard dose and I've seen some require two or more times the standard dose. Biological systems are not as predictable as one might think.

Has pentobarbital abuse ever happened? Probably. But I don't think it accounts for an accidental-death-misclassified-as-suicide resulting in a suicide rate four times that of the general population. That was your original argument, IIRC, and I think it has no merit whatsoever.

>>Heroin deaths aren't (usually) intentional, but the abuser builds tolerance and boosts the dose in increments. Some abusers (like MJ) mix drug cocktails, right?>>

How is this related to the original discussion?

>>I wasn't trying to make unbelievable insinuations

No, I think you were trying to explain why you find it more believable that the dead veterinarians in this study abused drugs and died accidentally rather than committing suicide. As I stated earlier, this was a study of deaths classified as suicide, not deaths classified as accidental. The suicide rate is real. The explanation for this phenomenon is still being examined and debated, obviously.

>>You did confirm a valid issue, where are the "checks" in the profession? Particularly the small one & two person clinics?

As I already stated, the DEA has final authority.

Somehow, I do not think you are interested in discussing the topic addressed in the original blog.

Well.. as sad as this is, human's have a way of taking the instant, "easier" way out, which is why there are so many suicides, in my opinion.. But when it comes to vets, I wonder what really makes them tick.. and what makes it happen? You bring up a lot of really great ideas/points in your post, but it seems like there could be more to it as well.

- Doug (Heartworms Researcher)