For the past three weeks, we have talked about suicide.
We have talked about what it means to reach the point where living feels impossible. We have talked about the particular silence that can surround physicians who are struggling. And last week, we remembered Dr. Lorna Breen and Dr. Nakita Mortimer, two women physicians who died by suicide, and asked a question I cannot stop thinking about: Is medicine listening while physicians are still here?
Now September is ending. The awareness posts will slow down. The hashtags will change. The calendar will turn to October. The physicians who are struggling will still be here.
So where do we go from here?
Asking for Help Should Not Require Courage
Physicians spend our careers telling other people to seek help. Then many of us hesitate to do it ourselves.
The reasons are not difficult to understand. Physicians have reported concerns about stigma, confidentiality, licensing, credentialing, career consequences, and simply finding the time and privacy to receive care.
Some of those barriers are changing. As of May 15, 2026, 44 state medical boards and 3,392 hospitals, health systems, urgent care centers, and other care facilities had changed licensing or credentialing applications to remove intrusive mental-health or substance-use questions. More than 3.35 million healthcare workers now practice in states or systems covered by those changes.
That is real progress. But changing a form does not automatically change a culture.
A physician still has to believe that saying “I need help” will not alter how colleagues see them, threaten their livelihood, or become something they spend the rest of their career explaining. We have to make getting mental healthcare as ordinary for physicians as the care we encourage our patients to seek.
And We Cannot Put All of This Back on the Physician
Physician well-being cannot become another assignment handed to the physician. We cannot build an unbearable environment and then respond with a resilience module.
We cannot talk about wellness without talking about workload, staffing, schedules, administrative burden, confidentiality, psychological safety, leadership, and whether physicians have meaningful control over the conditions in which they practice.
Responsibility lives at three levels:
- The physician. We need permission, access, confidentiality, and time to seek care before distress becomes crisis. Asking for help should be treated as healthcare, not as a professional failure.
- Our colleagues. We have a responsibility to notice, listen, and respond. Sometimes that means asking the second question when “I’m fine” does not sound fine. Sometimes it means staying with someone. Sometimes it means getting additional help when what we are seeing worries us.
- Our institutions. Healthcare organizations must create environments in which asking for help does not feel dangerous. That includes examining credentialing language, protecting confidentiality, making care accessible, addressing working conditions, and making it genuinely possible for physicians to step away long enough to receive care.
All three have to exist at the same time.
What Can We Do Now?
System change can be painfully slow. People cannot always wait for it.
So while we continue changing policies, institutions, licensing practices, and workplace cultures, there is work we can begin wherever we are. Ask the second question when “I’m fine” doesn’t sound fine. Make confidential mental-health care genuinely accessible. Stop glorifying working while depleted. Examine the questions on your own organization’s credentialing forms. Make sure physicians actually know what happens if they seek treatment. Give people enough time to receive care. And when a colleague tells you they are struggling, resist the urge to immediately fix them.
Listen. Then ask what they need.
None of those actions replaces systemic change. They are how we keep people from having to wait for the entire system to change before they experience something different.
September Cannot Be the Work
September gave us a reason to talk about suicide. But awareness is not the destination.
If the conversation ends because Suicide Prevention Awareness Month ends, then we have confused remembering the problem with changing it.
The real measure of this month will be what happens next Tuesday. And next February. And on an ordinary overnight shift when there is no awareness ribbon, no hashtag, and no national day reminding us to pay attention.
Will physicians know where to get confidential help? Will they believe it is safe to use it? Will their colleagues notice when something has changed? Will their institutions examine what they are asking human beings to carry? And will we listen before someone’s story becomes a memorial?
That is where we go from here. Not toward another awareness campaign, but toward a culture in medicine where physicians do not have to become patients in crisis before we remember that they are human.
Let’s Keep the Conversation Going
I don’t want to end this series by asking whether physician suicide matters. We already know that it does.
I want to ask something much more practical: What is one thing your workplace could change right now that would make it safer for a physician to ask for help?
Hit reply and tell me. I read your responses.
September is ending. The work isn’t.
With love,
Dr. Lulu®
If you or someone you know is struggling or in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline or text HOME to 741741.
