Suicide prevention keynote gets standing ovation at AMSA

Joey Johnson:  We are honored to introduce our keynote speakers, Dr. Pamela Wible and Robyn Symon. Dr. Wible speaks widely on healthcare delivery and is a best-selling author of Physician Suicide Letters—Answered. When not treating patients Dr. Wible devotes herself to medical student and physician suicide prevention. An inspiring leader and educator of the next generation of physicians, Dr. Wible has been named one of the 2015 Women Leaders in Medicine and TEDMED calls her the “Physician’s Guardian Angel.”

Robyn Symon is a two-time Emmy Award-winning filmmaker, specializing in documentaries and television series. Her most recent film, Do No Harm focuses on the toxic culture of medicine and the effect on doctors, medical students and their families. We’re also privileged to have with us today, John and Michele Deitl, who will share their personal story of their son, Kevin—a promising medical student who was lost to suicide. Please join me in welcoming, with much emotion, Dr. Wible, Robyn Symon, and the Deitl’s to the stage. 

Robyn Symon: Thank you so much, it’s so great to be here, it’s an honor. This is actually the first time the film has been shown outside of MD Anderson. I took a little pit stop on the way over from LA to screen it. It was fascinating because it was a combination of administrators, faculty and residents. After the screening, people were in shock, the administrators were there to defend what they were doing or trying to do, some of the faculty were concerned about wellness were there to say, “This is just like lip service.” And the residents were kind of scared about what was happening and if they had any power to change anything. This film, we hope, is a conversation starter about the problem and we need to come up with solutions together because it’s complex. 

How many of you have seen the film last night? What did you think? Good? Awesome. It’s funny, I was watching the SIM operation here earlier and it just reminded me (I’m not a doctor, maybe I’m hoping an honorary one after spending four years at med school) if you ever go out to dinner with a group of physicians things can get very strange. We’re eating and all of a sudden (many times over the past four years) the conversation will turn to their latest surgery, with great detail, “Oh, we made this incision and there was this big mess there and he cut and I was looking at the blood spurting” and I’m looking at my food and it’s like, “This meal is over.” And they were like, “It was nothing.” So, it’s really an honor to be able to eat and talk like that. You guys are brilliant, brilliant. But just keep that in mind when you’re in mixed company. . .

I actually started this journey four years ago in 2014. Someone had sent me an op-ed story from the New York Times about these two young doctors who jumped from the roofs of their hospitals. Brilliant, young residents with their whole lives ahead of them. They had gone through so much to get to where they were and they jumped, right off the ledge. I just couldn’t understand it. So, I started to look into the reasons why; the competitions, the bullying, the hazing, the pimping, the sleep deprivation, the lack of coping skills that you’re given, its like a time bomb waiting to go off. So, let me show you this trailer and then we can talk a little bit about the reality of what’s happening and then let’s talk about you and how we can all make a difference together. So let’s roll that.

View official documentary website and request to screen film

Robyn Symon: Not to scare you . . . it’s still a noble calling but, it’s time for change. This has been a hidden epidemic for decades, nothing’s been done about it. I think with the advent of social media now is the time that we can change because we can all be in touch. It’s interesting, firemen, policemen, they function as teams and when things go wrong, they have each other to support each other. But physicians, for some reason, function like islands. So they don’t tend to lean on each other. Weakness is frowned upon. 

It’s interesting, my uncle was a surgeon for 40 years, and before he passed away last year I showed him 20 minutes of the film and he said, “If you do anything in this film, talk about that word [suicide]. We are not given any skills to cope with grief.” It’s like PTSD when you see people die every day, every week, even every month, and that has to effect you. In the medical profession, you’re not given any skills, so he said to me, he came up with his own ways of coping and I asked, “Well, what is it? What did you do?” And he wouldn’t share with me, as if it was this weakness that he had to cover up and it was his own private way and he couldn’t bring himself to talk about it. But he knew that it had to change. He wished he had some kind of peer group that he could discuss, like firemen do, like policemen do. He wanted that but it would’ve been a sign of weakness. 

So that has to change, this whole stigma of mental illness or just reaching out for help has to change. There is a fear that it could jeopardize your career if you reach out for help. That has to change. If you see people die every day or every week it has to effect you. You must be able to express it in some way. 

Doctors have the highest rate of suicide among all professions—almost twice the rate of the general population. The burnout rate is more than 50% in many specialties, at the top of the list is emergency medicine, trauma, anaesthesiology, over 60% and this is really a public health crisis because (as you saw on the trailer) when doctors aren’t functioning at their best patients can’t be getting quality care and you really owe it to your patients to give them the best care. 

 So how do we change this? Well, one thing that is very disturbing is in other professions (even in school) bullying is not allowed, yet in medicine it persists. As Pamela says it’s the wounded leading the wounded. So that cycle of abuse has to stop, and it can stop with you guys. If you see bullying going on, hazing, even pimping . . . Everyone know what pimping is? Put In My Place. You’re going to experience it in med school and beyond. So these are things that can stop with your generation, which is why we’re so excited to show this film here. 

Getting together as peers, supporting each other, that’s what’s going to make the difference. And I was talking to my son last night about how you change when you’re fearing for your job, when you’re worried after all the money that you’ve spent that you could be fired if you speak out, as many people have. Well, look what’s happening in Parkland, in Florida. They’re getting together and saying, “Enough is enough.” And they are standing shoulder-to-shoulder and forcing change. If that’s what has to happen, we can make that happen. We can use this film as a catalyst for change. But it has to start with you guys, coming together, acknowledging that your human—bringing the humanity back to medicine. For your sakes, as well as the sakes of your patients. So, we can save the healthcare system that we all love.

I’m going to pass the baton over to Pamela and we know we’re going to be doing Q and A afterwards. The time for change is now and it starts with you. So please join me and go to the Do No Harm website if you’d like to have this film screened at your school or at your medical institution. We have a screening tab on the website and someone from my team will get in touch with you. So thank you very much.

Pamela Wible: Alright I’m a little sleep deprived, I was in this room after the film last night until 1:00 in the morning, hanging out with medical students. It was awesome!

I went into medicine (probably like a lot of you) thinking that I was going to just help individual patients one-on-one. I really had no idea that what I was going to end up doing is help heal the entire medical system. I’d like you to open your minds to the idea that you can do so much more than helping that one individual in front of you. You can actually heal entire groups of people at once. You can heal entire healthcare systems—by using your voice and your power to heal.

If you are in this room, you are a healer. Don’t limit yourself to the specialty that you think you’re going for. You might be some other type of healer. When you feel called to be a healer sometimes it’s confusing to know which direction to go. I want you to keep an open mind, because I had no idea I was going to be a physician suicide expert running a suicide hotline for doctors. But your calling comes to you when you’re in a state of receptive silence. So spend some time with yourself every week just listening to what it is that you feel called to do—what the world is calling you for.

I want to share with you the two most important moments of my life and I want you to be on the lookout for when some of these most important moment of your life might happen. Be ready. One of them might happen today. So besides being born, the two moments that changed my life forever were October 28th, 2012 at 3:00 p.m. and January 26th, 2018 at 6:00 p.m. 

On October 28th, 2012 I was sitting in the second row at a memorial service for the third physician that we lost to suicide in my small, beautiful town (where there’s a farmers market on every corner and everyone’s smiling and hugging)  I live in a beautiful place. Why would there be three physicians suicides in a small town in Oregon within a year and a half? Everyone kept asking why but nobody said suicide out loud at the funeral—which I thought was very odd because how are we going to solve a problem that nobody will say out loud?

Sitting there, I started focusing on why—why is this happening, I was obsessed with the question why and now I can’t let it go—which I think is the sign of a really good scientist interested in solving any kind of problem. You get stuck on why. You can’t sleep. I started counting on my fingers how many physicians I knew that had died by suicide or very suspicious circumstances at a very young age. Within a few minutes I had counted ten. And I’m a young physician, just starting. 

I left this memorial early because I was teaching a physician retreat that evening (which is a business course I teach for medical students and physicians who want to launch independent practices).

 Apply here for retreat scholarship.

This retreat had nothing to do with mental health. I opened the retreat with a question, “How many of you have lost a colleague to suicide?” Everyone’s hand was raised. Every single hand in the room. Then I asked, “Well, how many of you have considered suicide yourself?” Every single hand was up, except for one female nurse practitioner.

I’ve spent every waking moment of my life since then completely dedicated to this topic. I started blogging, I started speaking, I could hardly stop speaking about this. My entire house is like a shrine with pictures of dead doctors everywhere. This is like my life’s purpose, I guess. 

People started contacting me, families who lost children to suicide in medical school. I started running a hotline, a hotline for physicians who are suicidal and medical students. So they keep calling me, I call them back and we’re on the phone for hours—at no charge. I just started doing this.

Then it accelerated. On January 18th of this year Mount Sinai lost the third physician to suicide in less than two years. Three women stepped off the roofs of buildings at Mount Sinai. And the last one was Deelshad Joomun. Soon after she dies I got three emails; one from an administrator at Mount Sinai, one from a resident who lived in the building where she died—stepping off the 33rd floor, the roof of the building—and another from a wife of a resident. They all demanded that I come to New York and investigate the hospitals, help with all the suicides so I just got on a plane and flew to New York to lead her eulogy and memorial service. I don’t even know this doctor. 

At our recent medical student retreat, a student asked, “What was the proudest moment of your life?” The proudest moment of my life is showing up and leading a memorial service for a woman who would otherwise be forgotten, a doctor who stepped off a roof in New York City. That is really the proudest moment of my life—I stepped forward to honor a beautiful physician, colleague of mine, who died in desperation and hopelessness.

So the message that I have for you today is—follow my lead when it comes to saving lives and honoring and helping your brothers and sisters in medicine—just act, don’t ask. Don’t ask permission. Don’t ask, “Do I have permission to go New York and help lead a memorial service?” Just do it. When someone is suffering in your class, don’t ask, “Should I run a suicide hotline or should I help?” Just do it.

You’re already a healer. You don’t have to wait until you get your diploma. You could actually heal people today that are suffering all around you. And there are people in this very room who are suffering right now. Look around. Help them. 

The predominant question last night after the film was, “What can we do now as premed and medical students?” I have five things I want to suggest that you consider doing now. 

1) Start a warmline. A hotline is more urgent, people are on the edge asking you for help when they got a gun to their head, that’s a little intense. Unlike a hotline, the goal of a warmline is to provide a reassuring voice for people before they reach a point of crisis. So you could run a warmline—put your number out there and let people know, “Hey, if you need someone to talk to, I’m here for you.” I would suggest that you all reach out to at least five or ten people in your class, maybe some people who are isolating themselves and don’t seem to have a lot of friends or are not very extroverted, and just give them your phone number and say, “Hey, do you want to go out to tea, do you want to hang out? I want you to know that I’m here for you and you can call me anytime.” It’s not that hard to do this and you can do this for your entire class, you can do it for four or five people. I’m doing it for the whole world, and it’s actually really fun and healing and I would suggest that you do that. 

2) Stop the abuse. The other thing is I want you to stop abuse. As a healer, it is your job to stop human right violations wherever you see it—even inside of medical education. There are human right violations, sleep deprivations, sexual harassment, hazing. If you see any of that—it is your job to stop it as a healer. How do you do this without getting thrown under the bus yourself? I’m gong to give you two examples.

First example: a pediatrician in his 60s told me that in his training there was a professor that would torment the students. He’d pick on people in the room who weren’t doing anything wrong and just torment them. He was an abusive man. So the class met and came up with a plan. Next time he started provoking somebody, the president of the class stood up and said, “We know nobody in the back of the room is being disruptive and we are going to walk out of your class.” And they all stood up, all 160 of them and they walked right out of his class together. And they went straight to the dean’s office and they let the dean know this is what’s happening, that professor was fired and they never saw him again. And that is how you handle bullying as a group. Very effective.  

One reason why abuse can continue is because abusers use the traditional divide-and-conquer technique. When you’re isolated, you have less power so that’s why it’s so important for you all to stand up for each other. 

Second example: So when they’re pimping—that is when the professor is searching for the weakest person who’s the most sensitive guy, who’s most likely to cry, the woman who may start crying and then everyone else hovers away because they don’t want to be the next one. Pimpers are usually asking very random, weird questions that are not even relevant. So what you do when you’re witnessing pimping?  You say, “Hey, I don’t think I know the answer to that question either, do you?” Then everyone goes around and says, “I don’t know the answer to that question.” So that it doesn’t give the professor a chance to pick on one person, as not having the answer. At the end you can all say, “Well maybe we’ll go look it up together.”  Podcast: How to stop pimping at your school (and heal yourself)

3) Band together. Don’t allow anyone be separated and abused. Befriend one another, I know of people in medical school who’ve died by suicide and the cause was loneliness. They died of loneliness that led to suicide. You should not let anyone in your class die of loneliness, please. You don’t want anyone in your class, their parents to get a phone call at 3:00 in the morning that their child died of loneliness. That is something that you can prevent now. 

4) Start a class petition. What I did in medical school, they had us back in the day killing dogs as part of the physiology curriculum, which I couldn’t believe.  Now, I didn’t ask not to do the lab, I basically wrote a letter to the physiology professor and I said, “I will not murder a dog as part of my curriculum. I will not do that.” He wrote me back, “Yes, you will. You’re already on team 11B and if you don’t show up . . .” He tried to strong arm me into it and he also told me, “These are not experiments, they’re experiences from which there is no alternative.” Dehumanizing experiences are not something that should be happening in medical school curriculum so anyway. So I started a petition and collected a bunch of signatures, went to the dean, and basically said, “I’m not going to kill a dog. I’m either going to drop out of medical school or you’re going to let me out of this lab. I’m not going to kill a dog.” And you know what he did? He diagnosed me with Bambi Syndrome, and let me out of it. Act, don’t ask. I did not ask really for the dean’s permission, I told him I will not do this dog lab and he relented. 

5) Host a mental health week. It’s really fun, the students at Louisiana State University in Shereveport just had me there (view talk here). They didn’t ask their school, “Could we have a mental health week?” They told them, “We’re gong to have a mental health week and Dr. Wible already agreed to come.” So I would like to invite you all to let your school know that you’re hosting a mental health week. Invite them to participate. And I know Robyn Symon will love for you to screen her film there at your school and I will tell you right now, that I’ll be the keynote speaker and I promise to come to your school and help you lead your mental health week so please contact me here. I’ll come to your school. There’s just no reason not to move forward with this. Thank you. 

I want to introduce two of my heroes, John Deitl and Michele. They are an amazing family, so much courage to share in their deepest grief with you, their beautiful son Kevin. 

John Deitl: Thank you. Well, hello. This turned out amazing. I’m so happy. You have no idea what it means to us to see so many people interested in our story and in this cause. Michele and I understand that time is probably the most precious item any medical student has. Yet, last night and again this morning, you chose to share some of that time with us to learn about an issue we think is very important. And just knowing that your interested in the issue, that you want to know more about it and want to understand it, it gives us really great hope for the future state of medicine and the wellbeing of our healers. But something you might not know is, it has a tremendously positive impact on not just our ability, but the ability of so many others to get through our healing process. A lot of us has some pretty devastating things happen in our life and just knowing that you’re here really helps us heal. And we appreciate it. 

Now, I got to be honest with you, Michele and I, we’re not used to standing on a stage in front of so many people and it’s a bit overwhelming. We’re not doctors, not PhD’s and I imagine you have to dig pretty deep in our transcripts to find even a graduate level course we might have taken by accident. See, we’re just two average parents who’ve chosen to share our son’s story in the hopes that anybody out there who might be having issues will feel compelled to reach out for help. Or if you see a loved one or someone you care about, that you’ll very lovingly and very kindly talk to that person and encourage them to get help as well. Because have you seen and heard from so many great speakers, this truly is a matter of life and death. And we think it’s just something very, very important to do. 

We are really very deeply appreciative and deeply humbled that you would join us today for this. Michele and I have a couple of goals; one thing we want people to know is that we’re not here to vilify medical schools or our practitioners. Quite frankly, we think we’re the best in the world at what we do. But, like any great machine, any great system, even a great computer program, they’re all subject to the environment around them changing. And trust me, this environment has changed. And unless you upgrade, unless you make updates I mean you can upgrade in your iPhone every three weeks when you don’t want one, like it or not, it comes in, right? 

It’s time to upgrade this, we think this is an area that we think has been neglected for a while. But we still have great hope and don’t want to scare anybody away from medicine as it’s a very noble cause, but it can be done right and it can be done where we all can have a very happy life. 

One of the questions we get is; what do you really want out of this? Why are you just including physicians and med students? Well, the fact of the matter is, this is where our son dropped us off. Right? And we really and truly believe he laid a path for us to follow this, to help others. Because I know if he were here, he would be up here right now. It’s just the kind of person he was. 

We also have a goal, we also have a vision to raise and get rid of the stigma of mental illness, from everywhere, for everybody.  Because that truly is the largest barrier, keeping people from going out and asking for help. Nobody wants that label. I know my wife, Michele, works very hard, in addition to scheduling us for any kind of speaking, things like this, speaking engagements, which we’re privileged to do. We feel absolutely privileged to do them. She also keeps us involved with NAMI and Out of the Darkness, which are two national organizations that provide resources and support for anybody who might have received a mental illness diagnosis. They also do research and development. I don’t know about you guys, but when Dr. Collins flipped that picture of that brain up on the screen, my heart filled with hope. It was just really tremendous to think, “Wow, man this could be the beginning of something really tremendous.” 

We also are very involved with a local organization called CHADS Coalition and what CHADS is, is they into grade schools, middle schools, high schools and colleges and they talk about depression and anxiety, but not just to the students, but to the educators, the faculty, and some of the counselors. Because if they do see early warning signs, if they do see things that might tip them off, they also teach them how to, very lovingly, approach these students and their families and talk about the issue and they also provide low or no cost resources for these people to learn how to deal with this diagnosis. A lot of times it can be something temporary, nobody knows. But that’s something that’s very, very near and dear to our heart and we do a lot of volunteer time with them. Michele is nothing short of amazing and that area. 

So, as you saw on the film, if you saw the film, or if you haven’t, go see it. We’re a very, very close family, all of us. And loved our son, Kevin, very, very much. He was my best friend and really, quite frankly, today and forever will be my true personal hero. 

Because, I … Excuse me [crying]. . . I’m a better man because of him. He used to share with us some of the things all of you guys are going through and experiencing in med school. How isolating it can be, how difficult it is to be constantly studying, wondering if you got this application in on time, wondering if you picked the right rotation side or you’re going to the right residency. 

And it gets overwhelming and I remember him saying one time, he said, “You know, dad, sometimes when I get minute, I want to check up on my buddies, right? I go on Facebook to see how they’re doing because that’s the life I remember as being normal.” And he said, “I never thought id be so envious of seeing these people do such mundane things as going to the theater, taking in a ball game, having a couple of beers, maybe taking an entry level job or getting our first apartment.” And he said, “I was talking of some buddies of mine, here at school and we thought, what would we write, how would our friends take it if we put … Just took on another $70,000 worth of debt, stayed up and pull my second all nighter this week, to study for an exam, eating ramen noodles and free cafeteria food, until my next disbursement comes in, so I can pay the bills, do the laundry and put some gas in the car.” 

He noticed that I was getting very concerned and he said, “Dude, but please don’t feel sorry for us, see we knew this when we signed on the dotted line, we understood that we would be giving up our 20s and a whole lot of our 30s to become part of something that were much bigger than we were with the intention of hopefully, positively impacting the greater good of medicine, so don’t worry about us, man. We are all freaked out. We’re all depressed, this is what we’re being told is normal.” 

When Kevin died life came to a standstill. I don’t know what to tell you. And we had no idea how we were going to move forward or quite frankly if we really even wanted to. 

But there is one thing we knew, it was emotion emanated from our heart and it rang very loudly in our conscious and it was almost immediate. We were not embarrassed and we’re not ashamed. And we’re going to do whatever we could, from keeping this from happening to any other individual or any other family. Because this is really, really hard.

 

I know if Kevin were here today, he would tell you that becoming a doctor should be hard. You are training and working very hard to become responsible for the health and wellbeing of many, many patients. What we’re here today, what this movie is all about, is to make sure you look after your own as well. It’s very, very important. When it comes down to it, when you really think about it, this movie, all the great work Dr. Wible does, Dr. Frederick you saw in the film, with the bills are speaking these are just tools we can put in your toolbox.

There are doors we can open and we hope you will be able to walk through. Because in the end, it’s not about us, it’s about so much more. For us, it’s about Dr. Kevin Thomas Deitl and those who went before him like Dr. Greg Miday, those who’ve gone after, like medical students Sean Petro, and that’s to name just so very, very few. 

It’s about the brave people that you’ve seen in the trailer in the film like Dr. Hawkins Mecham, Dr. Gregory Mims, and a doctor you didn’t see in the film, but his name is Boyce, Dr. Boyce Fish, who on a very difficult time almost wound up leaving this world. But by the grace of God, they came back. And not only are they managing their issues, but they had the courage to step out into the light and say, “Hey man, we’ve been there. We understand and we want to help.” 

But most of all ladies and gentlemen, it’s about you. Like Dr. Wible and Robyn said, you are the ones who one day will be the attendings, you’ll be in charge of groups, you’ll be interacting with other people, all we’re asking, is that when you’re there, that you’ll remember what you say and you heard here today and that you will reach out to each other and that you will support each other. Whenever you have an opportunity to, you’ll do what you can to make positive change. 

I can think of no greater thing—no greater appreciation for life than to one day be invited to another seminar, to another conference, but this time our chairs will be down there in the audience and we’ll get to sit down there and listen to what all of you have done. The things you were able to do to make medicine a better place and when it happens I guarantee you, we’ll get another emotion emanating in our heart, but this time, the message going to our brain will be, “Hey, we heard you. See, we got this. And we’re rocking it.” Thank you.

Robyn Symon: We are happy to take questions. Some of you may be saying, “Well, I’m not at risk. It’s going to happen to me.” Well, let me tell you that it happens very quickly, going into this dark place. I’ve spoken to hundreds of med students and residents and physicians and they were shocked at how quickly they went from being a gold-star student to contemplating ending it all. In my research and through my investigation what was most disturbing was that it seemed like young doctors were set up to fail. Forced to work 80-100 hours a week, taking care of sick patients and patients have changed, when you heard your mentors and the older generation say, “Oh well, I did it so you do it. Tough it up, suck it up.” That’s what they say and the reality is, medicine has changed in the last ten years, it’s changed a hell of a lot in the last 20-30 years. 

Patients are more complex, patients are living longer than they ever had and their conditions are much more complicated. On top of that, it used to be (as you’ll you see in the film) patients would go to the hospital, they would stay for three weeks when they had heat surgery; they would spend a week after they delivered a baby. Now those beds are turned over every day or two. So, the acuteness of the conditions of that person in that bed is much greater, not to mention the electronic medical records that you have to do. Fifty click to order one prescription. Doctors are spending 10% of their time with patients and the rest of the time fighting with insurance companies and filling out these electronic medical records. So medicine has changed tremendously.

The sense of fulfillment in a job decreases when you’re not doing what you wanted to do when you started med school—which was take care of patients. So medicine has changed from when these older doctors went to med school and that has to be acknowledged. When you’re working 80-100 hours a week, doing scut work and you’re so tired, you’re like drunk, because at a certain point, after 16 hours, when you are sleep deprived, it’s like being drunk. And now you’re told to go take care of this patient and then that patient and you’re so scared that you could hurt somebody or kill somebody. That’s a fear that, every day you wake up with. Set up to fail, that as to change. 

In the film, we learned that there used to be a 16-hour shift limitation, 80 hours a week, well most programs don’t really follow that, even though there is this limit. Then in July, that cap for first year residents (for interns) was increased from 16-hour shifts to 28-hour shifts. In the film, you’ll hear from Harvard sleep experts, the top in the world, who say that after 16 hours you’re not functioning properly. So why would they do this? And the reason that they give is, “Well, you know there’s a danger in handoffs, when you handoff from one doctor to another. And so, that causes medical errors. So we want to improve the continuity of care.” But that’s ridiculous. What needs to happen is find ways to improve the handoffs. Find ways to improve communication, not increase work hours, not go backwards when there were no work hour limits at all. That’s not the solution. 

These two Harvard professors came up with a program called I-PASS. It reduces the handoffs, sleep deprivation was minimized, and medical errors decreased. So there are solutions out there. Only 5% of the teaching hospitals integrated the I-PASS program in their hospitals. Why? Why?  Well residents as you know don’t get paid that much. They’re cheap labor. So they want to work residents and get as much out of them as they can. And that’s just the reality. This is you guys in the future. What are you going to put up with? So, let’s take some questions. 

Patricia: I’m a second medical student at Lincoln Memorial University-DeBusk College of Osteopathic Medicine. I’d like to start off by thanking the Deitls so much for having the courage to share their story about Kevin today. As Kevin’s peer, I’m so thankful that we have advocated like you who have turned your pain into something so meaningful for us and we thank you so much, for doing what you’ve done. 

 My question today is, as a medical student, we’re not oblivious to the red flags that we see in our peers, we notice things we notice someone is unwell mentally of they’re upset and sometimes talking to them or offering to have someone to talk to is great and it works, but other times I’ve noticed people close themselves off even more when people get concerned or even, as a friend, and they close themselves off from everyone. I just want to know, what can I do when I see these signs and red flags to someone who is closing themselves off?

John Deitl: Thank you and that’s a very good question for all of us. I know Kevin and a lot of other people would want to think, “Hey I got this, I can handle it, we’re strong, I made it this far.” But I do know that even going to them and talking to them, if they shut you off, don’t give up, don’t be annoying obviously what a lot of people so is say, “Oh wow, this guy or gal is showing weakness.” If you really and truly care, you’ll go back and say, “Hey, you doing alright?” It doesn’t even have to be about what they’re saying or doing, just communicating with them and let them know someone cares. Because I know Kevin told us a couple of times when he was having bad week, he had a friend and invited him over for a barbecue. And that was big. 

Make no mistake folks, this could have happened to Kevin even if he was trash hauler or won the lottery, we don’t know. What we’re here to say is, he was afraid to reach out for help. And that’s what really, really concerns us. Does it help you a little bit?

Patricia: Yes, it does. 

Michele Deitl: I just wanted to add one more thing and I think hopefully with this film and getting the message out and starting the conversation about this, it will help improve the expectation that Kevin said, “Everyone’s depressed. My whole class is depressed. We’re all anxious, we’re worried about the next exam, we’re depressed because we’re not at the top of our class anymore.” So many reason why they felt down and depressed and even speaking to his friend after his death, one of his best friend had a conversation with him and Kevin said, “you know my parents are worried about me, they think I’m having problems that I’m not right and what do you think? Do you think I’m having some mental health problems or whatever?” And his buddy told us this afterward when we had dinner with him afterward … Our son passed away and he said, “I told him, ‘Yeah Kevin, I do, I do think you’re having some issues. We’re all having issues.'” 

So I think that’s another thing that needs to be addressed in medicine, like this is not acceptable, this shouldn’t be the norm and peers to peer shouldn’t think well, “I think there’s something wrong with you but it’s okay, because we’re all the say way.” That’s just got to change. So, I appreciate your question and thank you very much. 

Mary: My name is Mary, I am from Florida Atlantic University and this year I started an interest group called Mental Health and Medicine in Research. I am a survivor. Six years ago, I never imagined myself being here today, with pre-medical and medical students and I just want to thank each and every one of you for making this apparent to the world, because a lot of people don’t want to seek that help. I didn’t and I almost lost my life too. Sorry. So … 

John Deitl: Are you okay?

Mary: Yeah, I’m great now. And I just wanted to say that although you did lose your son’s life, he’s still saving lives and is with you. So, thank you guys for being brave enough and using this as a reason to save everyone else’s lives. Because mental health is just as important as physical health. 100%. That is my motto for my group. And actually March is our suicide awareness month and we are doing a Out of the Darkness walk. I’m sorry I totally lost track. I’m not a good public speaker. Silence kills and so we speak. So thank you so much for all that you do. 

Robyn Symon:  I just want to say, as a patient, that doctors are human too, and doctors’ lives or doctors’ health is just as important as patients lives. And you have to know that and patients have to know that too. I don’t think they think that, I think they feel that doctors are just robots, they just represent something. They’re always supposed to be well and of course we want our doctors to be strong because we’re coming to them for a service, but if a system exist that doesn’t allow you to take care of yourselves physically or emotionally then it’s bad for society. So you’re just as important as the patients you serve. 

Lindsay Harris: Hi, my name is Lindsay Harris. I am from Texas State University. And I wanted to, first of all thank you guys for sharing such personal stories and for doing the work that you do. And I wanted to get some advice on being that advocate at my school or for my chapter for the university and how you guys take that weight and responsibility of hearing that every day especially Dr. Wible, with that’s what you made your life for the past six years or so, how you hear that every day but don’t let it get you down as well, hearing such stories and taking that and helping others and especially those who haven’t experienced a friend or family member or has been on the other side of suicide and had that personal connection. 

Pamela Wible: So the question; how to stay well yourself if you’re taking a leadership role in advocating for the mental health of the students at your medical school and how do I stay well, doing the suicide hotline. I think it’s because I go to therapy every week and I really love it and I look forward to it and actually prepay a year in advance so I have therapy every single week. 

Let’s compare our mental health to our dental health. I think that’s a good analogy. So we’re all on a dental health maintenance plan, we all brush and floss at intervals and we all go the dentist probably every six months. So that’s just kind of a maintenance plan so that your teeth aren’t falling out of your head.

Now you might want to think about what are you doing as a mental health maintenance plan, because I think everyone on this planet needs a mental health maintenance plan. And if you’re in a high risk profession like firefighter, police, physician, you need more of a mental health maintenance plan, than the average person walking down the street. And so I would like to encourage everyone in medical school to have a therapist. If you don’t have a therapist and you need one, let me know. There are people that you can Skype with at all odd hours of the night, that I can hook you up with so that you’ll never be alone without somebody to help you and one  other thing that I wanted to say by the way is I  get a massage almost every week and I live in a beautiful place and I walk through the woods, I sing gospel songs (and I’m Jewish).

There’s just a lot of things that I do that are uplifting and weirdly, I know this might seem really strange, but a lot of the doctors who’ve died by suicide, there are pictures all over my house, I talk to them, some of them talk to me, and I get into a spiritual zone and I think if you can take yourself out of the reduction of medicine, like if I save the patient I’m a hero, if I don’t I’m a failure, I think if you can have the perspective of the quote, “Do your best and let God do the rest.” Don’t hold yourself to such superhuman standards. Just be the best version of yourself every day and that’s all you can do. 

And the one thing I wanted to share is that I’ve been on the phone with so many physicians and medical students who’ve been suicidal and a number of times people have mentioned, “You know what, it’s the colleagues and classmates I have that aren’t going to therapists who I really worry about.” It’s the doctors who are going to therapy that are actually healthier. 

So I think we need to kind of change the way we look at mental health maintenance and care for our mental health with the same level of seriousness we have for our dental health—like going to the dentist and brushing and flossing. Good. Okay. I hope that helps. 

Lindsay Harris: Yes, thank you so much. 

Melissa Tanner:  I’m Melissa Tanner. I’m a second-year medical student and I saw the video last night and bawled my eyes out basically, so I wanted to ask you in the video you talked about that this isn’t just in the USA, this is international. It’s all around the world that physicians are committing suicide and some places hide it more than others and that kind of thing. So, you’re talking about sharing it with the students and coming to the schools and does that include these international schools? Because I’m in Mexico, that’s the school I’m in and although it’s closer than some of the other international schools, despite how much we might want to feel included, we can’t help but sometimes feel like I might not be part of that group. 

Robyn Symon: Yes, we are planning an international film tour. What’s happening now with the film is we’re just finishing it up, we still have a few more things to do with the film, so it will really be done by the end of April. Then we’ll start entering film festivals and talking to distributors and also we’re starting right now to launch a international film tour. So we have a partner in Asia, where it’s a huge problem, Mexico we’ve heard from some people, all over. Canada, because it’s interesting that although we haven’t managed care and the assembly line medicine is a big part of the disillusionment. A lot of the suicide comes from the sleep deprivation and the bullying and the hazing that we see so, that combination doesn’t matter as Pamela Wible say in the film, it doesn’t matter what pay system it is necessarily when those two things are at play sleep deprivation causes depression and bullying and hazing, when you’re told you’re not good enough and you’re hurting people and you shouldn’t be here and then your have these ruling schedules, it doesn’t matter, we have many suicide counts in Canada, for example, that has socialized medicine. 

So, while this managed care may exacerbate the problem, and it does increase the level of disillusionment, it’s not the sole cause of why we see so many suicides. So yes, we plan on bringing this around the world to medical schools, teaching hospitals, medical conferences and eventually to allow schools to use this as a teaching tool. We’re talking to someone about having CME’s, so you can actually get credit when you are a doctor in a couple of years for sharing this film, and we’ll have a discussion guide, so we have big plans for this film to make an impact for years to come and we’re so glad that you’re a part of the team. Thank you.

Melissa: Thank you so much.

Levy: My name is Levy and I just want to thank you all again for taking on such a noble cause. This is an issue which is very personal for me and in my own personal experience, being vocal about my own issues was hard for me as I was growing up, but once got a little bit older I recognized that being open about it was going to be the only way that I can receive any help. It was really hard, once I was open a lot of people were very dismissive and that’s really tough when you’re trying to be vulnerable and people tell you like, “No, that’s not a real issue you’re having.” And I’ve conquered that and that’s been great but I wanted to know more about the pushback that you all experience from the system itself. 

I know how stigmatized mental health is and I can’t believe that even in medicine that’s something that still happens. Where we have the group that should be the most educated on these types of issues but I know from the film that you guys experienced, the administration, saying that like, “No, this is not that big of an issue, like this is how things are supposed to be done.” Why is that still happening? Why can we not overcome that? Once we hear and once we learn more about it, it’s an issue that’s so easy to get on the right side. Why do we have people that are still not handling this correctly? 

Robyn Symon: You would think that the medical community would hold itself to a higher standard, because you’re in medicine. But it’s actually the opposite. Hawkins Mechum who is here Are you here Hawkins? Where are you? He’s the star of the film. And we’re so happy he’s here. 

I didn’t put this in the film, but Hawkins I don’t know if you remember what you said to me, when he was feeling suicidal and he shared this with his primary care physician, and his doctor told him, “That’s selfish. That’s selfish, you’re going to be a doctor. Selfish of you to think about suicide and hurt your family, hurt your future patients.” What did he do? He went home, crawled up in a ball and cried in the fetal position for hours. That’s not the kind of care that doctors should be giving to someone. Even if they are a doctor themselves. When they’re crying for help. We need to stop that, it’s not selfish. 

Pamela Wible: To answer your question, I think the reason why we get the response we get from the more resistant elements and medical institutions is because of shame and also because of some guilt. They really have set up the circumstances that have led to 10,000 plus body bags of doctors over the years and I don’t think they really want to take accountability for what they’ve participated in. 

Of course the solution right now is not really demonizing anyone but we do need people to come clean and recognize these are systemic human rights violations. FYI, I don’t use the term “burnout.” I’m really against the term because “burnout” is a victim-blaming term that blames and shames an individual who’s been up for 28 hours on a shift for being defective and inefficient, which is really not the case. The case is the system has set you up to fail and so I really do feel like the word “burnout” it’s counterproductive because we really need to not use these sort of trashcan diagnosis and labels. 

What we need to do is identify with precise terminology of what’s really happening, which is that these beautiful, highly intelligent people, you are all in the top 1% of compassion, intelligence and resilience in the country. You don’t need another resilience class. You’re already the most resilient. You came in with compassion, so you don’t need to have that beat out of you in training and then receive a multiple-choice test on empathy on the way out to see if you can show you have a good empathy score. So I think if we can just get to the foundational elements that are causing harm to you all wonderful people on the way in, we will have amazing physicians and better healthcare for everyone. 

Robyn Symon: I do want to add that, because medicine is what it is today, this culture with managed care you do need some training to just navigate into this world. So you need both. You need to stop the abuse, the same time you do need to live in the system that’s not really going to change that much, managed care and at the same time we need to acknowledge that, that’s what we’re dealing with right now. So I do believe you need both. But not the kind of resiliency training that we see too much of and what we roll our eyes about like, “Smile, take a swing dancing class.” You don’t have time to do that when you’re working 80-100 hours, so those aren’t the kinds of things that you need, you need something much more thoughtful and much more strategic in helping you cope with the system that we’re in, at the same time ending the abuse. 

Perry: Hi, my name is Perry. 

Joey Johnson: Excuse me, I’m sorry, really quick I was trying to find an interjection point. This will be our last question unfortunately, but there will be a book signing at the exhibit hall and there will be books that are for sale, beside the book signing. 

John Deitl: We’ll be out there to answer any questions, we’ll stay in the hall. 

Pamela Wible: Yeah, we’re all going to stay in the hallway and we will answer. I’ll stay up until 2:00 in the morning with you, whatever you need . . .

John Deitl:  Perry, that is a world class jacket, dude, I’m serious, I can never make it look as good as you do.  I’ll be number one in the nursing home, I swear.

Pamela Wible: That is a pretty cool combo.

Perry: Thank you, I appreciate it. I’m a graduating medical student at UNC Chapel Hill and also the president elect of AMSA so I’m the upcoming president of next year and I just want to thank you all for coming and I want to let you know that I am with you and AMSA is with you 100%.

Robyn Symon:  Thank you.

Perry:  We have a strong history of advocating for a lot of the issues you all were talking about such as resisting extending those residency work hours. We have a wellness and student life action committee, we even have a member benefit that’s a free month of therapy for better help, anything we can do to tackle this. I appreciate all your stories and what I want to know more about is, with your conversations on the research you done on advocacy, what are the glimmers of hope that you’re seeing? Do you think that we’re reaching a tipping point? Do you think that change is coming? Where do you think that AMSA can continue to apply pressure and really make a change come as fast as possible? Thank you.

John Deitl: That’s a really good question. When Michele and I started down this path and first met Dr. Wible and Robyn and Dr. Frederick in our minds we we’re realistic. We thought we’d be long gone from this earth before anything would change and we are so encouraged by what we’re seeing. It is really amazing. We will go to speak at any medical school or anybody who is kind enough to invite us because we think the message is important. Even at St. Louise University Medical School at Saint Louis, which is probably one of the toughest schools to get into and get through and they have established literally a hotline you can call anytime day or night. If you have issue and you want to talk and it truly is confidential. They tripled their budget to help students who might be having an issue like this. They ave established a mental wellness and just a wellness week. The dean (when we go to speak) stands right by our side, and encourages the students to talk to one another, to reach out. 

As a matter of fact, the reason she asked us to come up, was because the students were still afraid. We can’t have this happen. So when they do reach out to the counselors who are available, and it is anonymous, there is no record kept of it on any kind of medical record, these people they follow up with them, they go to their third and fourth year because it’s a whole new experience in your third and fourth year. Dr. Slavin implemented a program which took anxiety from 60%, clinical anxiety 30%, clinical depression and he changed the curriculum. Very, very simple curriculum change cost like $15,000 for everything. Think about what you guys are spending, $4000 and that’s not per person, that’s for the whole damn program. Within seven years he brought that down to 14% anxiety and 4% depression and board scores went up. For that effort, he was recognized very widely for what he did and right before they fired him. He had the courage to stand up, he made changes, but that seed are planted, man. It’s in all of you now, you understand, you know what to do and you know how to spread the message, but we are seeing some great headway.

Michele Deitl: I just wanted to mention that this year the American Association of Colleges of Osteopathic Medicine at their annual conference in DC, several months ago, the theme was physician wellness and they had several sessions on mental wellness and they’ve also started a test course which we have been invited to participate in. We’ve had one conversation with them, but they are really taking this seriously and like John said we didn’t think we’d see this in our lifetime. It takes generations to change the culture and this has been a problem for so long, but we’re really encouraged by the fact that they’re stepping up to the plate and recognizing it’s a problem and the steopathic community is trying to do something and they even talked about following these physicians from day one of medical school until they retire. So they’re really into it for the life of their physicians, so it’s really encouraging. 

John Deitl: Yeah, it was really encouraging. The DO programs I think we were more in tune with mental health awareness.  Kevin was a DO but there’s probably a lot more going on in EMD. Look we’re at AMSA talking to you guys, right? We were invited to the American Osteopathic Association of Surgeons. They dedicated four hours to this subject. 

Robyn Symon: There was one doctor who said it was the first time in 30 years he had been going to these conferences, the first time there was a seminar on resilience, so we are seeing change and we’re excited about it, we’re excited to be a part of it and we really appreciate this opportunity from AMSA to share this with you. So thank you so much. Appreciate it