Forty-five percent of patients who die by suicide saw a primary care physician in the prior month. Physicians screen for suicide risk just half the time when seeing patients under treatment of depression. Meanwhile, suicide rates continue to rise in the United States and are the second leading cause of death among young people. In this episode, Saul interviews co-host Stefan, who is leading a national study of suicide in patients on chronic opioids who take their own lives after their physician tapered or cut off their opioids without their consent. They discuss the rich literature, theoretical and empirical, on why people take their lives, what stops them, and what a caring health professional can do to make a difference.

Please note: if you are in crisis, US-based crisis supports are available by calling 988, and at https://988lifeline.org. An international listing of hotlines is offered at https://blog.opencounseling.com/suicide-hotlines/.

Unfortunately, bad leadership is common, with 50% of American's leaving a job because of a bad boss, and medicine is no exception. Saul and Stefan, with a combined 60 years in academic medicine and clinical practice, share personal experiences and anecdotes that highlight the characteristics of dysfunctional and toxic leaders, and discuss their implications for health care training and practice environment, including the trickledown effect on patients. They consider why and how bad leaders end up in positions of power, and what to do about it, acknowledging the difficulties in identifying and promoting effective leaders.

Writing about the illness experience, medical sociologist Richard Frank described an unspoken agreement with his doctor that if he adopted their detached and clinical language when discussing his illness, "I would have at least a junior place on the management team." Initially it seemed like "not a bad deal," until he experienced the toll it took, concluding that, "No one should have to stay cool and professional while being told their body is breaking down, though medical patients always have to do just that."

Through three poems selected by our repeat guest, English professor Laura Greene of Augustana College, we see the pain and cost to patients when their doctors and nurses hold them at arm's length, unable or unwilling to see their humanity. We reflect on why, and what to do about it.