Suicide among doctors has long been a silent epidemic within the medical community. Pamela Wible's poignant first-person account brought much-needed perspective and attention to this issue ["Why so many doctors kill themselves," Health & Science, Jan. 16].

Doctors are not the only medical professionals among whom we see this tragic pattern, however. Individuals working across the entire spectrum of care are vulnerable to shock, guilt, anger, depression and suicide because of stress, large caseloads, long hours and fatigue. The loss or injury of a patient can often be the catalyst for self-harm in such a high-pressure environment. As Ms. Wible wrote, "Even when there's no medical error, doctors may never forgive themselves for losing a patient."

Caring for the Caregiver, an initiative designed in collaboration with the Maryland Patient Safety Center, of which I am president and chief executive, and Johns Hopkins Hospital's Armstrong Institute for Patient Safety and Quality, has helped hospitals and other health-care organizations create programs offering confidential "psychological first aid" and emotional support from trained peer volunteers to help caregivers continue to thrive in their roles.

It is vitally important for all caregivers to know that they are not alone and that help is available.

Robert H. Imhoff III, Elkridge

The nation's medical schools and teaching hospitals are concerned about the growing problem of student and physician burnout, depression and suicide. As a community of medicine, we must do all that we can to support and aid our nation's medical professionals in safeguarding their own health.

Our organizations are working with medical schools, teaching hospitals and residency programs to help learners and new doctors develop lifelong skills to improve their well-being as they encounter the challenges of a transforming health-care system. To address systemic challenges, we formed the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience, a network of more than 50 organizations dedicated to reversing trends in clinician burnout. The collaborative is working to improve baseline understanding of challenges to clinician well-being, raise the visibility of clinician stress and burnout, and elevate ­evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver. We know there is more work to be done, and we remain firmly committed to these efforts for supporting current and future physicians.

Victor J. Dzau, Darrell G. Kirch
and Thomas Nasca, Washington

The writers are, respectively, chair and co-chairs
of the National Academy of Medicine
Action
Collaborative on Clinician
Well-Being and Resilience
.