Dr. Wible interview on physician suicide, PTSD, our hidden wounds

Pamela Wible, MD, on Redefining Medicine. View interview above or download/listen to MP3 here (plus full transcript below).

Known in the medical community as “Physicians’ Guardian Angel,” Dr. Wible has become America’s leading voice for ideal medical care through her continuous work with physician suicide, and the pervasive issue of mental health in the medical community. With parents who were both doctors, Dr. Wible experienced the ‘real dark underbelly’ of medicine as a child—which was only deepened through her tenure in medical school, and her own experience in being suicidal. After being forced to be a “factory worker” and practice “assembly-line medicine” in short increments—coupled with what she describes as rampant “human-rights violations” in medical training—Dr. Wible felt deeply abused, dehumanized, and dejected. Through leading town hall meetings, during which she asked communities to design their ideal medical clinics, Dr. Wible collected written testimony and subsequently designed a clinic based upon her findings. Describing the clinic as relationship-driven rather than production-driven, Dr. Wible models her practice today around what brings her joy, and continues to disseminate education surrounding the public health epidemic that goes largely unreported: physician suicide.

Welcome to Redefining Medicine, an intimate and personalized program that illustrates a different side of the practice of medicine. Our in-depth conversations will focus on mentors and motivators who are consistently reshaping, redefining, and rediscovering the field of medical healthcare.

Monica Goldstein: I am happy to welcome Dr. Pamela Wible, “Physicians’ Guardian Angel”—also known as America’s leading voice for ideal medical care. Dr. Wible, why don’t you share with us your story? You practice family medicine, correct?

Dr. Pamela Wible: Yeah, both my parents were physicians and as a little kid I used to follow them to work. My dad is a pathologist so I used to work with him in the morgue as a child, and my mom’s a psychiatrist so she would take me to the psych hospitals. Basically I was around seriously mentally ill people who are institutionalized, and dead human bodies as a child. That was like the perfect Petri dish for a blossoming healer to be able to experience the real underbelly of what goes on that’s usually hidden from children because parents like to read little happily-ever-after stories to their kids when they’re little. Getting to see real life made me wake up to the reality of human suffering and pain. Dad introduced me (even when I was six years old) as a doctor-in-training, and he would sit me between himself and his live patients. He would leave me, actually, with the dead patients too. He’d introduce them to me with the toe tags. I was a real talky child, so he just left me there talking to them. I was just like totally comfortable with death and mental illness in a way that most people (even adults) aren’t.

Monica Goldstein: So you went to medical school.

Dr. Pamela Wible: Yes, I always wanted to be a doctor.

Monica Goldstein: Where did you do your training?

Dr. Pamela Wible: I went to University of Texas Medical Branch at Galveston where my mom went to school. We just went to her 50th medical school reunion as a mother-daughter duo, which is probably very unusual for a mother and daughter to go to the same medical school. I had a really fascinating, fun experience during my medical training. It was traumatic when I started medical school because I just didn’t realize how the patriarchal reductionist philosophy was very heartless and soulless. They dehumanize you during medical training.

Monica Goldstein: You weren’t forewarned by your parents? Did they want you to be a doctor?

Dr. Pamela Wible: They did not want me to be a doctor as is very typical of physicians. They often don’t want their children to be doctors, yet they don’t necessarily explain to them why. So I think the interpretation that the child has is, “Maybe my parents don’t think I’m smart enough to do this.” My physician father and mother never really explained that it was like being in Afghanistan, I had PTSD. They don’t go into the details of their mental health wounds from the training, because I don’t even think they want to remember it. It’s almost like in the back of their consciousness, but they know they don’t want their kids to go through it. See what I’m saying?

Monica Goldstein: Yes, yes. Okay, so fast forward. You were in family medicine.

Dr. Pamela Wible: Yes. I still practice, and I do house calls, and I have my own little clinic and that’s really awesome.

Monica Goldstein: What was the trajectory to lead you to your focus today?

Dr. Pamela Wible: My focus on physician suicide—the passion comes from when I was suicidal as a physician myself in 2004, completely occupationally induced due to frustration with being forced to be a factory worker practicing assembly-line medicine in seven-minute increments—a complete assault to my soul. I saw medicine in its heyday when I went to work with my parents so I knew this was bullshit, basically. I hope you don’t mind the brutal truth.

Monica Goldstein: You can say that.

Dr. Pamela Wible: I knew better and so I felt like I was being abused. They just wanted a warm body in the room to generate as much revenue per millisecond as possible. They could care less about the patient’s health, or about whether I’m happy or whether I’m practicing at the highest level of my skills. That was not important. These are just corporations that unfortunately are about collecting revenue and maintaining their high-overhead infrastructure.

Monica Goldstein: You were actually cognizant of the fact that you were suicidal?

Dr. Pamela Wible: Yeah. For six weeks I didn’t get out of bed after leaving my last job.

Monica Goldstein: You had suicidal feelings and thoughts at that moment?

Dr. Pamela Wible: Yeah, I was trying to die in my sleep, yeah.

Monica Goldstein: Okay. Did you ever have these feelings when you were doing your training?

Dr. Pamela Wible: I was very depressed (not suicidal) my first year of medical school mostly, because they were having us do dog labs and killing previous pets is terrible. Murdering dogs as part of your training. I just couldn’t believe the amount of brutality I was witnessing, and that mass dehumanization, methodical dehumanization of me and my classmates. I thought it was just like a torture chamber. Spiritually and emotionally speaking, it was unreal.

Monica Goldstein: I can imagine. Okay, so take us back. How did you get yourself out of that?

Dr. Pamela Wible: Out of the suicidal thoughts?

Monica Goldstein: Yeah.

Dr. Pamela Wible: Well, I had like a dream, like a prophetic vision. It wasn’t really a dream, it felt very real. I think when you’re in a state of suicidal thinking you end up sort of melting away your ego. If you don’t care whether you live or die, you’re in a very receptive state, I think, to messages from the universe. I mean, it’s definitely an altered state. I ended up having a vision of like floating over the United States, seeing communities take back the healthcare system, and firefighters and police officers and nurses and doctors all holding hands and building their own clinics. I was just overtaken with the whole idea that I didn’t have to put up with assembly-line medicine anymore.

Monica Goldstein: You can change it.

Dr. Pamela Wible: That I could create a clinic based on what my community wanted, and I literally jumped up out of bed and called the newspaper, and started leading town hall meetings, and inviting my community to design their own medical clinic. I went from not moving and suicidal, almost like in a coma for six weeks, to running town hall meetings and inviting my community to design their ideal clinic. I collected one-hundred pages of written testimony, adopted 90% of what they wanted (and I said I would do whatever they want as long as it was like basically legal). Then I opened this clinic, the first one in the country designed completely by patients, just one month later with no outside funding. That’s where I’ve been practicing for 13 years and it’s awesome. Highly recommend it.

Monica Goldstein: What’s different about the clinic?

Dr. Pamela Wible: It’s relationship-driven instead of production-driven, so it’s kind of like the way doctors used to practice before third-party intrusions. It’s just me, I have no nurse, no receptionist. I check everyone in, I submit all their claims myself. I have it all streamlined so it’s super easy, and I just work afternoons and evenings three days a week, so I’ve never had to set my alarm clock for work in 13 years. Plus I never turn anyone away for lack of money. I see everyone who needs to see me. I am happy as can be, if you can’t tell, and so are my patients.

Monica Goldstein: That’s phenomenal. But you’ve also made it your mission to educate practitioners. Can you discuss that?

Dr. Pamela Wible: Yeah, I had no idea at the time when I was suicidal that it was an epidemic that had been covered up since 1858 in England—that’s the first time that the high suicide rate among doctors was written about. I thought I was the only one, which I think is very typical when people are suffering, especially physicians. They feel like they’re the only one, because if you look around everyone’s in their starched white coats doing the fake smile, acting like they got their act together, and they really are all suffering like they’re prisoners of war, basically, from our training, which is rampant with human rights violations. We can go into that in a minute. I just was shocked, and eight years after my suicidal thinking into having launched my practice as my solution to my occupationally-induced suicide, (being a real doctor with autonomy as an entrepreneur and business owner solved my suicidal distress). I didn’t want to be treated like a bad kindergartner, which is kind of how these corporations treat physicians, right? Terrible.

So, eight years later in Eugene, Oregon, I end up at a memorial service for the third doctor that we lost to suicide in our town in just over a year. I was in the second row of his memorial service and I just started counting how many doctors that I knew had died by suicide, and I knew like 10. I don’t know anyone who’s not a physician or medical student that’s died by suicide. I’ve never lost a patient to suicide. I have now a list that I’ve investigated of over 1,100 doctor suicides. I started running a suicide hotline and all these suicidal doctors keep calling me. Obviously there’s a huge unmet mental health need among doctors and they don’t feel safe enough to go to a psychiatrist because they don’t want it on their record, but they trust me for some reason because I keep blogging about this and talking about it nonstop.

Monica Goldstein: Is there a particular specialty that’s more at risk?

Dr. Pamela Wible: Yes. Anesthesiologists. Male anesthesiologists are at huge risk. In fact, anesthesiologists die by suicide at five times the rate of general internal medicine, and twice the rate of the next highest specialty, which is surgeons, and then there’s emergency doctors.

Monica Goldstein: Is it because they have more access?

Dr. Pamela Wible: Yes, access.

Monica Goldstein: Wow.

Dr. Pamela Wible: Yeah, it has a large part to do with it. I think veterinarians are also at huge risk, also due to access.

Monica Goldstein: Same access. When your parents found out that you were suicidal …

Dr. Pamela Wible: You know, I don’t think they really knew.

Monica Goldstein: But did they ever understand why?

Dr. Pamela Wible: Well, I was on the phone crying all the time my first year of medical school with them, and they didn’t really know what to do with me. I mean, they were like, “Yeah, everyone goes through that.” I didn’t find them helpful at all because my parents are not really emotionally and spiritually engaged people. My mom is more like a drill sergeant, you know what I mean? My dad is more like an absent-minded professor. They try to care, but they’re not emotionally accessible in the way that I needed at the time. I’m a super spiritual and emotional person, and I think I completely baffle my parents.

Monica Goldstein: Were you always this way?

Dr. Pamela Wible: Yes, because I’m on a spiritual journey through life, and most people in my family are more on the how much can they make in a capitalist culture journey. I don’t play that game, so I don’t think they understand what to do with me, or how to interpret my motivations, like why would I talk about suicide for six years? I don’t know. I don’t think my parents really “get” me.

Monica Goldstein: Do they understand and appreciate the clinic that you set up initially?

Dr. Pamela Wible: I think so, yeah. My mom was a business owner so she thinks that’s definitely the way to go, and my dad, yeah, I think they do understand that. I didn’t find them, as a first-year medical student, helpful at all. I mean, for the most part because I was suffering so much, it was like an existential dark night of the soul, and I think they understood medical school was hard, but I was crying constantly. I cried so much my first year of medical school that I woke up one day and my eyes were sealed shut. I couldn’t even open my eyes. I couldn’t go to class, I had to like feel my way to the bathroom in my apartment. I have never cried that much in my life, even when I was suicidal I wasn’t crying, I was just sleeping. My mom mailed me psych drugs in the mail so I could take them. That’s what my mom did. My dad just tried to be like, “Oh, it’ll pass, keep going.”

Monica Goldstein: You need to get through this time, first couple years.

Dr. Pamela Wible: Yeah.

Monica Goldstein: What would you like to see different?

Dr. Pamela Wible: In medical training?

Monica Goldstein: During the medical training period? Yeah. Medical school and training.

Dr. Pamela Wible: Students should be embraced as a family when they arrive. They should be welcomed. Like, you’ve jumped through enough hoops, you’re the cream of the crop, you’ve already proven yourself, you’re all valedictorians. We love you and we’re here for you and we’re going to support you till the end. Here’s my phone number, and I’m the dean, and you can call me anytime. If anyone has problems, you’re not alone. They should have a little mental health panel at the beginning where all sorts of other physicians who are highly esteemed in the school can share, like, “Hey, when I was a first-year medical student, I failed an exam, I had panic attacks, but hey, now I’m the chief of surgery.” So people can see examples of it’s okay to freak out, it’s okay to fail a test, it’s not the end of the world. Like, I’m loved, I’m welcomed.

Earlier I mentioned, before our interview, that a medical student wrote me and told me that she was less stressed in Afghanistan during active sniper fire in a war zone than medical school. So of course I called her, wanting to find out why, and she said at least when she was in Afghanistan she knew that the other people on her team … First of all, she know who was the enemy and who was on her team. In medical school you don’t know who’s going to undermine you, who’s really your friend, because they pit everyone against each other, and have you terrified for your life and your career and that you’re going to fail. They create a terrible, competitive, cut-throat, mean-spirited environment that makes sensitive, existential, humanitarian idealists freaked out. That’s not the way to handle gifted children, is to pit them against each other and treat them like bad kindergartners. They’re already motivated. You don’t have to scare them to learn. They already want to learn, they’re already valedictorians, you know what I mean? But they treat them like shit and scare them to death, that they end up just alone in their apartments crying themselves to sleep at night, which you don’t see during the day because they put on a smile.

Monica Goldstein: You don’t see that on Grey’s Anatomy.

Dr. Pamela Wible: No, you don’t. The thing is, she knew that if she got slaughtered by a freaking landmine, that her team there of American soldiers would pick up her body parts, put them back in a casket and put an American flag over it, and send her home. She knew she wouldn’t be left there. See, medical students, if that were to happen, they would just think everyone would walk right by and leave you dead on the floor, which is kind of what happens, actually. I led a candlelight vigil and a memorial service, a funeral for a female physician in NYC who was the third one to step off the roof of this building in Mount Sinai and they just freaking left her there covered with a tarp on the ground. Nobody brought any flowers, nobody did anything. I flew from Oregon to lead this woman’s memorial, because she’s a J-1 visa and her family was in Mauritius, they don’t even live in the US. They were just going to freaking put her in the body bag and drive off, and that’s it. They told everyone to get back to work.

You know if police die and firefighters die, they bring out firetrucks, they name a highway after you, everyone’s got American flags. There’s like teamwork. If you die in the military they blow bugles, or they give your family your outfit and the Purple Heart, and this, that, and the other thing. If you die as a doctor, they just consider you bad PR, lost revenue, throw you in the body bag and that’s it. It is brutal. I’ve seen this over and over again. Isn’t that terrible?

Monica Goldstein: There are no words. No words. My question to you is now, fast forward into practice. You’re out of medical school. The physician, I know you do not like the word burnout, and we’ll get to that in a second, but the physician burnout rate. I just heard it on the news again the other day, it seems like every year or so the media is getting a hold of it and putting it out there. What is it when they’re finally in practice, and yes, some of them are working for major corporations, but some of them are in private practice or in a small group practice, and they’re still taking their own lives.

Dr. Pamela Wible: First, the reason why I don’t like the word burnout is because it’s a victim-blaming term that blames the physician for a problem that’s not theirs. The system has abused them to the point where they feel safer in Afghanistan getting shot than they do in medical school. Medical school goes on for four years, plus three years of residency, so you have seven years of like a terrified person who not only is being treated like shit, but they’re also watching people die every day and delivering bad news, like, “Sorry, you had a stillborn,” and, “Oh, your three-year-old died in a car accident.” They have to tell people stuff like that, and people are screaming and crying. So, they have PTSD from just watching people die all day, plus they’re treated terribly, so when they get out and practice, they still have mental health sequelae—untreated trauma.

If you could see a doctors’ mental health wounds, you’d see third-degree burns over 90% of their bodies. They should all be on ventilators, but they put on that white starched coat and fake smile and pretend like everything’s okay. Doctors are wounded from their training—taught to be in a state of chronic self-abuse and self-neglect.

Monica Goldstein: It’s become an automatic.

Dr. Pamela Wible: They’re people pleasers, so they end up still, even after residency, working 80 hours a week, and taking all sorts of shit from insurance companies and their partners, and skipping meals all day long, not sleeping properly, not exercising, holding their bladder. They end up with all these problems. It’s just terrible. They’re not happy. I don’t know if you’ve met a lot of super blissed-out, happy doctors. They’re kind of suffering.

Monica Goldstein: The ones at A4M are pretty happy, but they’ve turned the corner.

Dr. Pamela Wible: They’ve turned their life around.

Monica Goldstein: Right. What advice would you give to somebody who’s either in medical school right now, thinking about medical school, graduated from medical school in practice. What kind of lifestyle changes and what kind of things should they be looking for within themselves, and what kind of changes and modifications should they be making in their life?

Dr. Pamela Wible: Number one is they need to follow their original dream that brought them to medical school. They all filled out this personal statement. Some of these doctors, a lot of them knew since they were eight years old that they wanted to be a doctor, like they had these visions of helping and serving and delivering babies. They need to stay with their dream and not let anyone steal their dream. Then they need to take care of themselves. You’re like a treasure to society, so you have to eat and sleep and do everything that you tell your patients to do, especially when you’re in your own practice. Work part-time, make less money, and take care of yourself. You only live once. If you are running ragged, stop taking insurance; if insurance is annoying you, then stop taking it. Model your practice around what brings you joy, and you deserve to be happy. That is the basic message. Don’t suffer, and if you’re suffering, call me. I can help you. I’ve run the suicide hotline, I know how to help doctors.

Monica Goldstein: You were given this sign, this message from above during the time of your suicidal breakdown. Most are not give that message. How is a physician or someone able to identify what manifestations are happening with them, for them to just stop in their tracks and realize, “Oh boy, this is bad. I need to stop doing what I’m doing and break the cycle”?

Dr. Pamela Wible: I think all physicians need to be getting mental healthcare because it’s a high-risk profession. If you look at, for example, dental healthcare. If you didn’t brush or floss for like 30 years and ate Halloween candy, your teeth would be hanging out of your mouth. The thing is, doctors are in a high-risk environment for mental health problems, and they’re not brushing, flossing, or doing anything. They’re just told, “Suck it up, get back to work. Oh, there’s a stillborn in room 3. Get in room 10, Mrs. Jones is having a heart attack. Oh, well, hurry, get in the next room, there’s like three people, gunshot wounds from a school shooting.” They just keep telling them keep going. If you think about it, that’s insane. They’re looking at things most people don’t want to look at, and they’re having to deliver terrible news to families.

I don’t care if you’re a psychiatrist, a radiologist, whatever you are, you need to get mental health care at intervals or you’re going to have a mental breakdown. Because physicians are so good at compartmentalizing, they don’t recognize that they’re having a breakdown till they completely crack. Most of these doctors who’ve survived their suicide attempts, when I ask them, “How long did you know … when you finally decided you were going to kill yourself, how long before you grabbed the gun and shot yourself, or took the pills?” Three to five minutes. It is, at the end, a super-impulsive decision. However, there are hundreds of missed opportunities to help this person earlier because they compartmentalized it. All the time I hear these stories of like, “He just bought tickets for his whole family to go to Disneyland two hours before he shot himself,” or, “He just finished this major surgery with a great success on a knee replacement, and then we found him hanging in the closet.”

The last thing to go with doctors is their medical skill. They will be doing complex surgeries until their last breath, and then go and hang themselves in a closet. Most doctors you can’t even pick up. I would just assume all doctors are suicidal and be nice and help them. They all need love because they’ve been wounded, like in Afghanistan, essentially. They’ve been through a war zone of an educational experience. Some are in denial about their wounds because they just, big house, big car, pretend like everything’s fine, but they’re like wounded people. They’re like the walking wounded.

One simple thing that patients can do is just write thank you notes. If you’ve gotten good service from your doctor, please just write a note, even if it’s three sentences. “Thank you so much for explaining what’s going on with my kidneys. Nobody else had taken the time to do that. I really appreciate you.” These cards actually … Doctors have told me thank you cards have prevented their suicides. They save all these cards and read them over and over again, to remind them why they’re doing this work. Your actually thank you note to a doctor could save their life.

Monica Goldstein: I’m astounded to hear the fragility of the physicians. I think about my doctors and all the doctors that I’ve had in my life that have taken care of myself, my parents, my kids, what have you, and you don’t think about it. It’s a narcissistic relationship, and you don’t think about . . .

Dr. Pamela Wible: Them needing anything.

Monica Goldstein: They’re superhuman. They have superpowers. They’ve healed me, they’ve healed my parent, whatever. They didn’t heal my parents, unfortunately, but that’s a whole other story. It’s very hard from a patient perspective to change the paradigm and think about the physician. You don’t want to be so selfish, but knowing that it could ultimately save that person’s life . . .

Dr. Pamela Wible: Just to be nice.

Monica Goldstein: Just to be nice. It takes 30 seconds.

Dr. Pamela Wible: I know, it doesn’t hardly take any time at all.

Monica Goldstein: Wow.

Dr. Pamela Wible: And patients in the emergency room who will like bitch and complain because the doctor was a few minutes late giving their grandmother Tylenol. Well, they were in another room where a man just died of a gunshot wound. People are not understanding, your insensitivity and level of urgency for something that’s not that critical, and you put that on a doctor who’s just dealt with somebody dying or a stillborn. This isn’t like Chipotle burrito. Just calm down, wait your turn, and be nice. These people are stressed out.

Monica Goldstein: There’s so much talk about, and especially in the forum like A4M, there’s so much talk about the fact that now the physician has the time to show the compassion, to show the empathy, to listen, to spend time, an hour and a half with the patient if need be, to really get to a root cause of a problem. So, turn the tables a little bit to have that patient actually have the compassion and the empathy to be sensitive to their physician. Now, in an allopathic relationship, it’s almost unheard of for a physician to spend that kind of time and to be able … They might be compassionate, but seven minutes, you’re out the door. For an integrative, functional, anti-aging medicine, concierge practice, what have you, you have that time to build a relationship on both sides. I can imagine that from this perspective, the statistics of physician suicide are probably-

Dr. Pamela Wible: A lot less.

Monica Goldstein: Far less.

Dr. Pamela Wible: Doctors practicing in what I call relationship-driven practices versus production-driven practices.

Monica Goldstein: Have you heard of a physician who was suicidal, other than yourself, that recognized the fact that they were in danger of hurting themselves, and then started a concierge practice or an integrative practice?

Dr. Pamela Wible: I don’t know that I’ve heard of anyone that was that far gone with suicidal thoughts and then started a new practice. I don’t know if they got to the point of laying in bed for six weeks like I did, which I consider a first world luxury. If I was in a third world country, I would not have the luxury to be able to lay in bed for six weeks and be suicidal, you know what I mean? Some people, they have kids to feed, they have to sort of keep going so they’re compartmentalizing it, and they’re not feeling the pain, and yeah. I was lucky.

Monica Goldstein: You were very lucky. I feel fortunate to the fact that you were lucky because I feel lucky now that we’re able to disseminate this information which is so valuable. You were given the nickname “Physicians’ Guardian Angel” obviously for this reason. How did that come about?

Dr. Pamela Wible: I was invited to deliver a TEDMED talk, and they come up with these cute little tagline names in committee meetings, and apparently that’s what they named me. That’s how they introduced me on stage.

Monica Goldstein: Can you share with us a bit about what your TEDMED talk was about?

Dr. Pamela Wible: My TEDMED talk is called “Why doctors kill themselves,” and I was basically reading suicide notes from doctors who died by suicide while their pictures were up behind me and then dropping their notes on the floor.

Monica Goldstein: How did you obtain those letters?

Dr. Pamela Wible: I’m now friends with all these families. I’m on the phone with mothers who’ve lost their only child to suicide in medical school.

Monica Goldstein: My son the doctor . . .

Dr. Pamela Wible: It’s very sad.

Monica Goldstein: . . . Is now dead because he killed himself.

Dr. Pamela Wible: Right, and they don’t see it coming. Like, their perfect star child, the one that made straight A’s, that never cursed, that was always, you know, the responsible one. If you had multiple children, the really responsible one that never gave you any trouble . . .

Monica Goldstein: That you would least expect.

Dr. Pamela Wible: The police are calling you to tell you they’re dead.

Monica Goldstein: What do you attribute the rise and the increase of physician suicide to?

Dr. Pamela Wible: When my parents were practicing medicine, obviously in the heyday before production-driven medicine, most physicians will say even now today that the primary joy that they receive from practicing medicine is from the relationship with the patient. That’s been stolen from them by all this third-party intrusion, because you perfectly pointed out in a seven-minute visit you’re not getting a lot of joy of the personal relationship. You’re just getting rushed through computer windows and not even getting to look at them. The EMR and all sorts of government mandates and all the infrastructure that’s grown up around physicians to steal their income and leave them with scraps and patients …

And the student loan debt. These doctors are graduating with like $300,000 of student loans, so they don’t see how they’re going to pay that off, so they feel trapped. A number of these younger ones who’ve died by suicide, they don’t necessarily leave a suicide note, but they have all their loan repayment paperwork out on the kitchen table for their parents to find. They’re obviously stressed out about how they’re going to pay their debt and the only way they can think of paying it is by killing themselves and having it wiped clean, because you can’t file bankruptcy somehow with student loan debt. You keep it forever.

Monica Goldstein: There’s been a growing amount of media attention on this, but how come there hasn’t been any change?

Dr. Pamela Wible: Because the powers that be in medicine are somewhat resistant to addressing the core issue, which is the system is sick. They’re really good at telling doctors they’re burned out and trying to get them to do yoga and meditation, but that’s like telling somebody that’s a prisoner of war to meditate their way out of the prisoner of war experience. Basically, when you are sleep deprived to the point of having seizures, which some of these physicians have, and food and water deprived because you’re doing 10-hour surgeries and you have to do water deprivation before or you’ll pee during the surgery, so you can’t drink water. They’re getting kidney stones, they’re fainting during surgeries, and they’re getting bullied and thrown scalpels at. They’re being treated like shit. Sexual harassment. All this stuff is happening. Yoga is not going to solve that. That’s just something else on their to-do list. When are they going to do yoga? They haven’t slept. You can’t do yoga when you’ve been up for 120 hours on a work week.

The problem is the system that has generated the environment that is killing these people, and is quite culpable for these deaths, and should have class action lawsuits and wrongful death lawsuits leveled against some of these hospital systems for all these deaths… There’s clusters of suicides at particular schools, three in six months at one school, all residents that died by suicide. Three within two years at another school. Brand name, first world country schools. Yoga and green drinks aren’t going to solve this. The system needs to be accountable and say, “Wow, these are human rights violations, not burnout.” When you tell somebody they’re burned out, they feel like, “Oh, I don’t fit in, it must be my fault.” They don’t think this is a human rights violation. It’s hard for people to make that connection. This was a valedictorian who was president of every club. Do you know the history of the word burnout? Really interesting. It’s a slang term from 1972 used to describe end-stage drug addicts dying in alley ways.

Monica Goldstein: Oh my goodness.

Dr. Pamela Wible: That has nothing to do with the majority of physicians in 2018. This word has been sort of latched onto by the general public. Because of mental health stigma, people don’t want to use the real term “I’m depressed, I’m suicidal.” They would rather say, “I’m burned out,” so it doesn’t sound as bad, but it’s an inaccurate label that doesn’t really claim the true problem. It’s like, if you don’t come up with the right diagnosis, the treatment plan will never work. They’re telling like the majority of doctors that they’re burned out. That doesn’t make any sense. They’ve been talking about this for 40 years.

Monica Goldstein: They’re placing the blame on the doctors.

Dr. Pamela Wible: They’ve been talking about physician burnout for 40 years with no freaking solution in sight.

Monica Goldstein: How many Americans will lose their physician this year?

Dr. Pamela Wible: Over one million Americans are going to lose their physicians each year to suicide. A million Americans. This is a public health crisis that’s not being tracked by the CDC. In fact, I’m sitting here in my bedroom at home tracking all these suicides. Nobody else is really tracking these properly with the amount of detail required to understand why these deaths are happening. Nobody is tracking medical student suicide either. We don’t even know how many medical students die each year by suicide. It’s like they don’t want to track it because it’s bad PR. Does a medical school really want to say, “We had three suicides this year?” Doesn’t sound that good. You know what I mean? But to ignore it just perpetuates these deaths.

Monica Goldstein: Sweeping it under the rug.

Dr. Pamela Wible: Right, yeah.

Monica Goldstein: How are things going to change?

Dr. Pamela Wible: By a grassroots revolution going on now. What’s changing is that medical students coming in and residents are intolerant to the abuse that their elders sustained. Any revolution is led by the younger generation. Civil rights . . .

Monica Goldstein: Well, there’s not going to be a walkout of kids in medical school, so what are they doing?

Dr. Pamela Wible: They’re not tolerating some of the bullying, they’re standing up for their rights, they’re going to get therapy, they’re talking to each other. Social media, you can’t hide some of these … Once a suicide comes out … Maybe in the 1800s they could hide what was going on. We have social media, so as soon as they see a body covered with a tarp in front of the hospital, everyone’s like texting each other trying to figure out who’s under the tarp.

Monica Goldstein: But there’s still the same amount of applicants trying to get into that medical school program. Nobody’s walking around to see, “Oh, are they smiling on campus? Are they smiling in the hospital when they’re making rounds?” They’re not doing what they do like when you walk into and you’re touring colleges.

Dr. Pamela Wible: That’s because there’s an oversupply of applicants for medical schools, and they don’t understand that there’s an undersupply of residency slots for the number of medical students that are accepted. It’s kind of like they lack informed consent about what they’re getting into, which is part of the problem.

Monica Goldstein: Do you have any optimism that there will be change?

Dr. Pamela Wible: I have optimism all over the place. I am truly a totally optimistic person. I’m just pointing out the problem because there’s no way to solve it if you don’t point out the problem.

Monica Goldstein: But are you optimistic that you will be able to, not just you, but you and everybody else advocating for change will be able to effect change in the near future before too many more physicians are taking their lives?

Dr. Pamela Wible: Yes. Absolutely, yeah. I was working on solutions for quite a while, I’ve been on this for six years, and I was kind of frustrated with the lack of traction, but my therapist pointed out to me that you can’t really solve a problem that nobody knows exists. I was like, oh, I gotta go back to increasing public awareness and decreasing professional denial, because there’s still physicians who will say, “We don’t have a suicide problem.”

Monica Goldstein: But the media has been reporting this for years.

Dr. Pamela Wible: You know how people can keep their heads in the sand if it doesn’t fit their paradigm.

Monica Goldstein: So if it’s on Dateline, they don’t care. It’s just another media story.

Dr. Pamela Wible: Yeah, they don’t. Fake news or whatever they’ll think of it. Who knows? Why do a million people that are Christian all disagree with the Bible? You can read the same verse and everyone has a different opinion. The same thing here. Not everyone believes that it’s a problem. Most people I talk to do, but the resistance, there’s resistance on the part of older generation physicians, and medical systems, and the old guard that runs the medical profession, at addressing this.

Monica Goldstein: Oh, needs to be a changing of the guard, right?

Dr. Pamela Wible: Right, yeah. I just want to point out, there’s a new documentary that came out, Do No Harm. That’s going to create a lot of culture change because it’s a full-feature documentary by an Emmy winning filmmaker that really digs into why this is happening. When you have a really good film and movie theaters and DVDs and Netflix, people are going to see that in a way that … This wasn’t available, this information was not so widespread. Once people have this information and social media, they can make different choices about whether going into medicine is right for them.

Monica Goldstein: Let me ask you from the patient side. When they go to see their practitioner, in addition to, obviously, writing the thank you note or just telling them how important they are in their lives or what have you, what clues or cues should they be on the lookout for to just be able to better identify if their physician is struggling?

Dr. Pamela Wible: Obviously if they’re sort of grumpy and … If there’s been a change, if their practice just got bought out by a hospital, and now the doctor’s grumpy, and now they’re running behind an hour and the used to be more on time. You can kind of figure out like, “Oh wow, they don’t look so good.” They look depressed. There’s sometimes signs like that, but a lot of times there’s no signs.

Monica Goldstein: I’m just thinking, it’s like I just want to make an appointment with my doctor just to do a head check, to make sure they’re okay. Nothing to do with the fact that I need to get a physical or whatever. Is it okay to cross that line?

Dr. Pamela Wible: Yes. I would recommend highly to do it more in written form than in person, just because they’re sort of suspicious by nature and distrusting because they’re prisoner of war survivors, you know what I mean? They’re intellectual people, so they like to digest material by reading it and thinking about it. You could talk about how much you love them or whatever in person, they might not like take it in, and they have another patient waiting so they’re trying to get out of the room. If you sent them a thank you card, they would read that over and over and over again, so it would have a lifespan for possibly decades, depending on where they save it. I think it’s much better to write it and let them digest it in pieces later versus trying to hug them and give them flowers or, I don’t know. Some of them might be uncomfortable because they don’t know what your motives are. They’re like, “Oh, does this person want narcotics? Are they being nice to me to … ” They don’t really understand some of them.

Then there’s the whole gender thing, you know what I mean? Like, oh, it’s a woman giving flowers to a male doctor. It’s just better to do the thank you note, I think. Just keep it simple and meaningful and related to your true appreciation of their care.

Monica Goldstein: You’re doing God’s work, Dr. Wible.

Dr. Pamela Wible: Oh, thank you. I guess that’s why they call me the guardian angel.

Monica Goldstein: Guess so. Any final thoughts?

Dr. Pamela Wible: Well, I started in December a love letter campaign for doctors and medical students, so that’s very fun and something that anyone can do. For example, I happened to mention it to … And I just say love letters because I like the sound of it, but it’s really like appreciation letters. It’s not like falling in love with your doctor letters. I mentioned it to a few people in my town and they’re like, “Oh wow, that’s such a great idea. I’m going to do this with my church at Christmas.” Because one idea is on Christmas after you finish opening your presents, why not sit down and write thank you notes to the doctors in the emergency room that can’t be with their families and go deliver them? You know, for example. There are doctors that don’t get appreciation and it would mean the world to them, and nurses, and others. Medical students could leave anonymous love letters for each other in the library. There’s sort of this trend to just random acts of kindness, being loving to one another. There would be huge culture change. If we only did that, it would be a much more beautiful medical education and practice for everyone.

Monica Goldstein: Thank you so much for sharing this wisdom, for enlightening us on this terrible, tragic epidemic that seems to be happening, and for just making it your mission to effect change.

Dr. Pamela Wible: I didn’t pick this, like these suicides picked me. That’s how I feel about it, like they come to me. I have a whole wall of my house covered in pictures of doctors who died by suicide in my home office. I just feel like I can’t not answer the phone when a mother has just lost her child to suicide because I have so much information and wisdom to share, and who else are they going to call? I have so much. I even started leading retreats for widows who lost their husbands to suicide. I just feel very compelled and like I was somehow chosen for this, so I’m just channeling, I guess, the messages from the doctors, who come to me in my dreams, by the way. I know that’s kind of weird, but some of these doctors who died by suicide, they come to my dreams, they talk to me. It’s like I get all this insight into what they want me to do and say, and how to help those of us who are still living to prevent these deaths. I don’t feel alone doing this, because I feel like these dead doctors are with me all the time. It’s really profound.

Monica Goldstein: Wow.

Dr. Pamela Wible: It’s intense. I mean in a cool, good way.

Monica Goldstein: It’s an extremely cool way. It’s a shame that they couldn’t reach out to you before.

Dr. Pamela Wible: Except then I have a philosophy that some people, their work is done at a certain age, and they have bigger plans that involve the spiritual realms, so I don’t always know obviously the big picture of their soul’s destiny.

Monica Goldstein: Well, I guess we have a lot of angels helping.

Dr. Pamela Wible: Yeah, yeah. There’s a lot of guardian angels. I personally believe that we should be able to have a world where people don’t have to leave a suicide note in their 20s and 30s because of a cruel medical system. It should be a never event in our hospitals and medical schools that anyone should die by suicide, and see, that’s the thing, when parents send their kids to medical school, they think that their kids are in the safest place if anything were to ever happen to them. Like, if they fell and broke their ankle, they’re surrounded by a hundred doctors. They would get the best care. Or if they had a panic attack. But the parents have no idea it’s walking into a Afghanistan-like situation for their mental health. That’s why it also takes the parents who are not physicians by surprise.

All I’m saying is the simple solution is having a culture of kindness where people really are expressing love to one another. Even if everything stayed the same, all the stresses, but if we were just nice to each other, the stress wouldn’t matter as much, because we know that we are loved, appreciated. The medical student knows that the attending really loves them and is looking out for them. I think it’s just the stress plus isolation and loneliness that causes the suicides.

Monica Goldstein: Thank you, Dr. Wible.

Dr. Pamela Wible: Thank you. And, by the way, if anyone wants to reach me, I’m at idealmedicalcare.org, and I return every single email and every single phone call. So if anyone’s suffering with depression or panic attacks or suicidal in healthcare, please reach out to me here. I talk to people for free all day long who are suffering.

Monica Goldstein: Thank you for sharing that.