T Khan et al. NEJM 2026; 395: 529-531. Doctor’s Dirty Little Secret — The Cost of Silence
An excerpt:
No one would suspect that for the past month I’d been plotting my death. Death felt like the only way to let go of the fear and exhaustion that was swallowing me whole…
“You know we don’t lock people up just for having suicidal thoughts anymore, right?” The on-call emergency psychiatrist’s tone, though comforting, was edged with frustration…
“Most of us have had thoughts of suicide at some time in our careers,” she said plainly. “It’s an occupational hazard — like a needlestick or missing your kid’s recital.”
With those matter-of-fact words, she named the doctor’s dirty little secret: we are human. But we believe this admission could cost us everything. That curbside consult saved my life. For the first time in a long while, I didn’t feel alone.
I’d been an emergency doctor for nearly half my life, running on a steady drip of cortisol. By my 40s, my body struggled to keep pace with the demands of the job…
I was responsible for everyone and everything all at once — crisis, illness, intoxication, and circumstance colliding, each person having been carried to me by whatever fear or fate had gripped them. I absorbed the frequent interruptions along with the urgency and blame, until the weight of it all settled as a constant heaviness in my chest…
I was deep in burnout.
And I am not alone. In the United States, female physicians die by suicide at more than 2.27 times the rate of women in the general population, and male physicians at 1.41 times the rate of men in general.1 These statistics are not abstract. They reflect the real suffering of physicians, who are also children, spouses, parents, siblings, and friends, and they reflect a story I never expected would one day become my own. The data challenge the enduring myth that doctors are somehow superhuman…
Despite copious literature on burnout, effective solutions remain scarce…many of us find deep meaning in our work, which fuels perseverance even in the face of adversity…
It took crashing into a wall for me to understand the delicate dance between grit and resilience. Grit is the pedal that drives us forward; resilience is the wheel that helps us change course. Resilience guided me to seek help — which was surprisingly difficult to find…
I kept my license, my family, and my life — for now. But many physicians aren’t as fortunate. Shame, stigma, and institutional failures may keep them silent, but silence is not strength. And asking for help is not a betrayal of the profession.
Related article: A Albert. Gastro & Endo News July 2026. Listen to Your Youngers: Why Gen Z Doctors Refuse to Die for RVUs Open Access! “I think we do better by our patients when we do better for ourselves…The younger generation isn’t “killing” medicine. They’re trying to survive it. They’re realizing that an exhausted, dehydrated doctor who hasn’t seen sunlight in three days isn’t “dedicated”—they’re a liability.”
Related blog posts:
- What is the Difference Between Burnout and Depression? (with more than a dozen links to other posts on this topic)
- Physician Burnout -“Hidden Health Care Crisis”
gutsandgrowth 
Hospitals have built an operating model around physicians’ altruism. Every time a doctor stays late, skips a meal, answers messages after hours, covers an understaffed service, or accepts another uncompensated responsibility “for the patient,” the system receives free labor. Eventually altruism stops being a virtue freely given and becomes a resource the institution expects to consume.