NEW YORK -- Nearly 200 clinicians, residents, and patients filled the Angelika Film Center here on Wednesday for a screening of "Do No Harm," a documentary on the national suicide crisis among physicians, who kill themselves at a rate twice the national average.

And on Thursday, hosted by the film's director, Robyn Symon, and physician suicide prevention advocate Pamela Wible, MD, a group of physicians, residents, and students gathered at the Watson Hotel here and marched to Mount Sinai Hospital in honor of doctors lost to suicide.

"Do No Harm" largely follows two families -- the Dietls and Mechams -- facing the consequences of the pressure-filled and stress-inducing demands of medical education, training, and practice, which leads an estimated 300 to 400 physicians to take their own lives each year.

"I believe this is the first film to pull back the curtain on the toxic medical culture that doctors have been trapped in for decades, but have been too disempowered to speak out on because of the fear of consequences to their career," Symon told MedPage Today. "The goal of this film is to open a dialogue because dialogue is the first step to change."

In the film, Hawkins Mecham, DO, attests to the unrealistic hours expected of residents, the highly competitive nature of medical programs, and his immense fear of making a mistake and losing it all. Eventually these factors -- along with the pressure of being hundreds of thousands of dollars in debt -- caused him to be stuck in what he described as a "tunnel vision," where in seeking a way out during his fourth year of residency, he made an attempt on his life.

During a panel discussion following the screening that featured Symon and Wible, as well as John and Michele Dietl (who lost their son Kevin to suicide 3 months before he would have graduated from medical school), Mecham described the path that led him there.

"I finally got to my first rotation of my fourth year and it hit me when I started getting interview requests and realized, just to be able to attend interviews, I had to take out private loans because I'd already maxed out my federal loans," he said. "It overwhelmed me among other things, and got to the point where I thought it wasn't worth it. The only way to erase this for [my family] was for me to die. That was part of my thought process in my spiral downwards."

Mecham got in touch with Wible, who connected him with the Dietls. The parallels between Kevin and Mecham gave John and Michele Dietl an opportunity to heal, allowing them to ask Mecham questions they were no longer able to ask their son. Namely, why?

"When we started doing this film I was very hesitant because I was afraid of Kevin's legacy -- what would he think of everyone in the world knowing what happened to him?" Michele Dietl said at the panel. "I want these students to know from a younger age: Get help. Don't wait until it's a crisis situation and you're ready to kill yourself because you think you're trapped and you have all this debt and you're never going to be able to get your license. I hope he'd be proud of us and not ashamed."

Also on the panel were Thomas Madejski, MD, president of the Medical Society of the State of New York (MSSNY), and Michael Myers, MD, author of "Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared."

When asked what the MSSNY is doing to help alleviate some of the stressors physicians face, Madejski cited the Physician Wellness and Resilience task force, which his predecessor Charles Rothberg, MD, created, as well as a collective negotiation bill they are working to pass. Additionally, he hopes to increase the number of physician-led health systems.

"Do No Harm" also spends time focusing on how overwhelming patient demands, 28-hour shifts for residents, and a lack of emotional support are leading physicians to commit an increasing number of errors. Today, medical mistakes are the third leading cause of death, following heart disease and cancer, and affect more than 1 million patients each year, according to the film. This has led this national epidemic to qualify as a public health crisis, Wible said.

"One thing we need to work on is acknowledgement of an error rate and acknowledgement that, like the rest of society, there's a certain percentage of physicians that are going to have issues throughout their life cycle," Madejski said. "How do we get better at picking that up and making that sustainable so people aren't isolated, and so we can identify people before they get into trouble?"

Madejski cited licensing applications as a particular problem because they have the potential to perpetuate stigmas by including questions regarding mental health, substance abuse, and suicide. According to Myers, functional questions that focus on a physician's current state, instead of his or her history, will be much more effective in eliminating the terror that prevents so many doctors from seeking help.

MSSNY Secretary Frank Dowling, MD, encouraged the development of a peer support system, where physicians could talk to other doctors when they were feeling overwhelmed, depressed, or alone.

"There's something in us and the way we interact with patients and our profession and the expectations we put on ourselves individually and collectively that doesn't allow us to identify that we have a problem," Dowling said. "Or if we do, we're terrified, and we saw that in the film. We need a wholesale cultural change, but we also need legislation that allows what we do to be protected."

Doctors March for Suicide Prevention Week

The group of physicians and medical students reached Mount Sinai Hospital around 4 p.m. on Thursday, where Wible delivered a eulogy for Deelshad Joomun, MD, who committed suicide at the hospital's West 59th St. residents' building in January.

"She was happy as a physician; her name literally means 'happy heart,'" Wible said. "So how in the world did someone 3 days into their job end up wanting to die this way?"

Physicians gather outside Mount Sinai Hospital to honor doctors lost to suicide.

Most attendees wore their scrubs and white coats, carrying roses and portraits of friends, colleagues, or family who had died by suicide. John Danyi, MD, an anesthesiologist, shared his story about attempting to take his own life, and the lack of support he received afterward.

"It's not like we don't have the language that is used to talk about a disease," Danyi said. "This is a disease in medical culture, and until we can learn to talk about it as such, it's not going to change. Shame loves secrecy and part of what we're doing here is bringing it out of the closet."

Magda Kowalczykowski, MD, a resident at Stony Brook Southampton Hospital in New York, was honoring a colleague she lost last week. After getting off his third hard rotation in the ICU, she said, he took his own life.

"We have this idea that we'll save the world, that we don't need sleep or we can stay in surgery and go 8 hours without peeing -- and I was proud of that," Kowalczykowski said. "Then I realized along the way, we are going to crash. We have a superhuman mindset, but a human body and it's unsustainable."

Pamela Wible, MD, and John Danyi, MD, comfort Candice Barr, a speaker at the memorial.

Symon has created a petition to urge members of Congress to pass legislation that would offer routine confidential psychological support for medical professionals and regulate residency hours -- currently, 80-hour workweeks are allowed by the Accreditation Council for Graduate Medical Education (ACGME).

"Since the ACGME has proven to be resistant to change and unwilling to protect the well-being of young doctors, it is time to take this fight to Congress," the petition states.

The petition cites the 80-hour workweeks, extended residency shifts (recently switched back from 16- to 28-hour maximum rotations), and an increase in patient demand as contributing factors to physician exhaustion, combined with sleep deprivation and student loan debt. So far, over 25,000 signatures have been collected.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Physicians laid portraits and roses outside Mount Sinai Hospital to honor doctors lost to suicide.