The HEART Acronym: Recognizing Suicide Warning Signs
Sep 19, 2024
Dr. Lorna Breen, a beloved emergency physician, died by suicide in 2020 after working relentlessly for weeks treating COVID-19 patients during the height of the New York City surge, at times covering two departments in a single shift, until she reached a point of physical and emotional exhaustion beyond what she could sustain. She had no prior history of mental health struggles. She lived what those around her describe as a vibrant, connected, joyful life. And she died by suicide.
A Sobering, Persistent Reality
Physician suicide remains a serious, ongoing crisis. Estimates suggest more than 400 physicians die by suicide annually, not abstract statistics, but colleagues, friends, and mentors who dedicated their careers to caring for others. National Physician Suicide Awareness Day, observed each September 17, exists specifically to confront this reality directly rather than allow it to remain unspoken.
Why This Requires Active Attention
Medicine's culture often prioritizes patient care above nearly everything else, including the wellbeing of the physicians providing that care. Chronic burnout, exhaustion, and emotional strain can push people toward a genuine crisis point, which makes paying deliberate attention to both personal wellbeing and colleagues' wellbeing, and building a culture where asking for help is genuinely accepted, more important than it might initially seem.
The HEART Framework
A useful framework for recognizing warning signs, in colleagues and in yourself, uses the acronym HEART:
Health. Increased use of alcohol, medication, or other substances, and any comments suggesting a wish to not be present or not exist, are significant warning signs worth taking seriously.
Emotions. Persistent mood swings, expressions of hopelessness, or a noticeable shift in overall demeanor and how someone carries themselves are worth paying attention to.
Attitude. Unusual negativity about personal or professional circumstances, outbursts of anger, or extreme sadness can all indicate genuine struggle beneath the surface.
Relationships. Withdrawal from friends, family, and colleagues can signal an underlying belief that one has become a burden to others, a common and serious warning sign.
Temperament. Increased anxiety or uncharacteristic recklessness can signal deeper distress. A sudden, unexplained shift toward calm or energy after a period of visible struggle can, in some cases, indicate that a decision toward self-harm has already been made, and deserves immediate, direct attention rather than relief that things seem to have improved.
Bringing This Into the Open
Physician culture has long treated suffering as something to be managed silently. Genuine physician wellbeing requires treating mental health support as routine and normal, not exceptional or shameful. Breaking that silence, watching out for one another directly, and reinforcing that seeking help reflects strength rather than weakness are all necessary parts of addressing this crisis meaningfully.
If You Are Struggling, or Concerned About Someone Who Is
If you or someone you know is struggling, please reach out directly:
- Physician Support Line: 1-888-409-0141 (anonymous, staffed by volunteer psychiatrists)
- 988 Suicide & Crisis Lifeline: Call or text 988, available 24/7
- National Physician Suicide Awareness Day: npsaday.org
The Bottom Line
Physician suicide is a serious, ongoing crisis that deserves direct, sustained attention rather than silence. The HEART framework offers a concrete, practical way to recognize warning signs in colleagues and in yourself, and reaching out, whether for personal support or on behalf of someone showing these signs, remains one of the most meaningful actions available.
FAQ
What does the HEART acronym stand for? Health, Emotions, Attitude, Relationships, and Temperament, five categories of warning signs that can indicate someone may be at risk for suicide, useful for recognizing concerns in colleagues or in yourself.
Why is a sudden shift toward calm sometimes considered a warning sign rather than a relief? In some cases, a person who has been struggling visibly may appear suddenly more at peace or energized after having made an internal decision toward self-harm. This shift, following a period of visible distress, warrants direct, immediate attention rather than being interpreted as improvement.
How common is physician suicide? Estimates suggest more than 400 physician deaths by suicide occur annually in the United States, representing a serious and persistent crisis within the medical profession.
What should I do if I notice these warning signs in a colleague? Reach out to them directly and ask how they're doing. Encourage them to contact a resource like the Physician Support Line or the 988 Suicide & Crisis Lifeline, and consider staying with them or helping them connect with immediate support if the concern feels urgent.
