Doctors who complain about inhumane working conditions are often labeled as “burned out” or “lacking resilience” or even “disruptive.”
Their employers respond by mandating resiliency classes so they can learn mindfulness, deep breathing, or yoga. Victims get instructed in work-life balance, boundaries, and other ways to conform to their workplace abuse.
Here’s the problem: Meditation, yoga, and taking deep breaths are not treatments for human rights violations.
Doctors, if you are running an ICU on a 36-hour shift and have not eaten or pooped all day, you are experiencing multiple human rights violations.
Patients, if you are in the hospital and your doctor has been bullied, abused and is suffering from constipation, hypoglycemia, and sleep deprivation, you should be very, very concerned.
I’m not making this stuff up. This is health care in America:
The UN Declaration of Human Rights: Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
Other countries get in big trouble for violating human rights. Why does first world health care get a pass?
The solution? Start by telling the truth.
Lack of resilience is a misdiagnosis.
Diagnosis is human rights abuse.
Doctors need to eat, poop, and sleep just like everyone else. It’s true.
The deadly end result of not addressing these human rights violations:
Pamela Wible, M.D., is a family physician, an advocate for human rights in medicine, and an activist in medical student and physician suicide prevention. Please support our documentary to expose the truth.
I’m glad to see you’re making a movie about this. I can’t help but think one possible solution might be some sort of third part certification, that medical schools and hospitals could sign on too that would commit them to meeting certain minimum standards in the treatment of doctors. Similar to programs in the clothing industry the attempt to prevent abuse of workers in other countries. That said a lot of it does seem to be cultural. It is a badge of honor not to eat and sleep. I just read the memoir When Breath Becomes Air by Paul Kalanithi and while there most overworked doctors in their 30’s do not get cancer and die from it, it could not have helped that he was eating junk food, working 24 plus hours in a row and ignoring the back pain that was an indicator of his developing cancer. I mean there are thousands of studies – by medical researchers nonetheless – that show the severe impact of sleep deprivation and poor diet on both immediate and long term health, both mental and physical. Do doctors never read these studies? Is it do as I say and not as I do? Interestingly Kalanithi does mention in his book the suicide of a colleague and friend after a patient died of complications yet he doesn’t seem to make any connection between their working conditions and this incident.
Great points. The toxic work environments in many health care institutions actually can lead not only to psychological health conditions, but also physical ailments. Somehow medical professionals have just accepted these working conditions as “normal.” We would never counsel our own patients to continue working in companies that demand 36-hour shifts without access to food or bathroom breaks.
This conversation brings to mind the wonderful reminder “Our history becomes our biology”.
Given that you are paying out your hard earned cash for your healthcare – why aren’t more of you refusing to pay an “incompetent” – ie sleep deprived -doc? I for one don’t want anyone cutting me open, who hasn’t had sufficient sleep. If they can’t keep eyes open, how can they be sure they’ve prescribed what they think they have? If you can’t swing decent shifts as basic worker rights, can you swing them as a patient safety thing?
Huge patient safety issues. Some employers are now providing cab rides for physicians because they’re too fatigued to drive safely after their hospital shifts. See this: https://www.idealmedicalcare.org/blog/doctors-found-unsafe-to-drive-home-after-work/
Your question about whether doctors read studies about the impact of poor sleep and diet on health is a great one.
The is an overarching human condition called denial. It is what gives license to people to smoke, drink alcohol and engage in risk taking behaviour. We believe it won’t happen to “me” – until it does.
This goes to the heart of human intelligence. We can be remarkably intelligent and score incredible marks in our training and yet live without applying that same intelligence to our own bodies. I speak from experience and great compassion. But we as healthcare professionals have to wake up to our vulnerability and the fact that our bodies need respect (as a bare minimum) and deep care.
This is very, very scary. You have to wonder why there is a shortage of physicians (and growing) now. The abuse from administration and patients is a disgrace. God bless all of you. ~ Jen (ER Nurse)
Facebook message from doctor: “Sitting in a resident welcome breakfast, as a Chief – told that burnout affects our professionalism, but no one recognized that we haven’t been treated as professionals! So frustrating hearing that we are blamed for our experience.”
Medical resident email: “We had our orientation wellness talk today. I chimed in regarding the semantics of “burnout.” One woman said it changed her whole attitude and outlook—just by changing that one word she suddenly didn’t feel like she was to blame, or that she was deficient somehow.” Burnout is a term of oppression. Stop blaming & shaming the victims.
I entered medical school with severe anxiety and depression due to horrific childhood sexual and emotional abuse. Compared to my childhood experiences, medical school wasn’t stressful at all. The problem was, I hadn’t remembered much of my abuse until I started seeing patients in an outpatient setting. My training had been exclusively hospital based. Memories began flooding me shortly after I started working for a large multi-speciality group with over 500 providers. My father had just died. I became very dysfunctional in the clinic setting as the intensity of training was no longer present.
I had recurrent flashbacks when I saw a male patients or men that reminded me of my father or any of the over 1000 men I had been “pimped out to” by my mother from the ages of 6-10. Having never been treated well by either parent (I was “scum”, “garbage”, and “aborted” per my mother) I knew I never wanted any one else to feel as poorly about themselves as I did so I became an extremely compassionate and empathic physician. To me that meant spending as much time with a patient as necessary. That approach left me with a waiting room full of patients waiting an hour to see me without a single complaint about my tardiness because they all knew they would get the time they needed. Period.
I was called in to the office of the boss of our very large multi-specialty group 3 times, each time being told I needed to go faster. It became unbelievably stressful to compromise my values with my job. About 6 months before I was terminated, I was sexually assaulted by a man that identified himself as one of my patients. He called my cellphone repeatedly saying “I know who you are but you don’t know who I am”.
After that experience my anxiety/PTSD increased dramatically each time I walked in to see a male patient, not knowing if that male was the perpetrator. One day I broke down and cried in my office and the head nurse reported me to the boss. I was terminated shortly thereafter.
I then sought intensive outpatient treatment and felt and felt well enough to return to a different job. That I had been terminated after being raped in my home shocked me and I was unable to feel a sense of security at any job at that point. I also held strongly to my ideal that everyone should be treated with dignity and respect which meant “I was still too slow” (i.e. could’t see 30 patients a day).
Because of my childhood I had a lot to give, but the system is so broken that it can’t tolerate doctors that don’t fit into a certain mode (read: money making).
Where is the balance? Each of us is unique and bring our own life experiences to the table, yet there isn’t room for that in the Big Box clinics.
I started medical school feeling like a super star but ended up feeling like a complete failure. Starting a private practice is a start in the right direction for most but I myself am too burned out, exhausted, and frankly too old to deal with this any more. To go from being the highest ranked student at my undergraduate school, to obtaining a Ph.D in physics at a very prestigious University after growing up with no exposure to elementary or middle school education and a high school experienced only through correspondence courses I can relate to many sectors of the population that many can’t.
It’s the patients loss, not the clinics.
I am sorry you were victimized by the profession all over again. I’m sorry you’ve hurt so much. I too thought I could contribute something good, but I feel like I am being trained to fail. Having an alcoholic father was a challenge for me but your story helps put things in perspective. Not a comparison, but just objective truth. Please dont give up, I want to believe that some people can get through and still want to do this profession. I want to make it, I’m just not seeing things changing past medical school unless I change. But I am kind of worried about what exactly that means changing into. Good luck if you read this.
Dr Wible, you have undertaken a very courageous and difficult path, addressing the why of the very high rate of suicide among medical trainees and in fact practicing physicians in the US.
They key is “in the US”–no where else are trainees so badly abused. The absolute vitriol that I have seen and been subjected to by supposed Attendings when a simple–hey you gave the wrong answer and here is the correct answer–happens no where else on the planet. I have trained and worked in France and Ireland–the foreign medical students that come to the US are horrified to see the lying disparaging and belittling treatment of American supposed Attending physicians. When the medical trainees are badly treated, it is no surprise that patients are subsequently badly treated.
These supposed Attendings are the same old fools who run AMA and ABIM–you will have your hands full attempting to address the blackguardism that is the backbone of the American Medical system.
When the Directors of Medical Schools are held responsible for the suicide rate at their school–things will change in a heart beat. JACO for the hospitals, suicide rate for the Medical School directors.
Thanks for you good work and please do not stop or give up.
Impossible to give up. The paradigm shift is happening. These human rights violations WILL stop. And we will finally have a humanized health care system. The only question is the velocity of this change. American hospitals and medical schools must comply with the UN Declaration of Human Rights or they will face severe penalties. Very soon.
After burning out after 20 years as a Registered Nurse, I would have to add that many Nursing professionals struggle with this as well. Speaking the truth is met with many labels in addition to “burned out”…like: “Insubordination, not a team player, unwilling to pull share of overtime without being compensated with overtime wages, selfish to think of yourself and set boundaries, etc.” This being said, burn out and stress-related illness is very real. with very real consequences. That’s why I became a life and wellness coach, and made my mission to help heart-centered, purpose-driven professionals to burn brightly without burning out. We have lost too many good people in helping professions and we MUST take care of them. Strategy AND Soul in business make a balanced success combination. We are human beings, not human doings.
Thanks Christina for your courage in speaking the truth and assisting the victims. Abuse trickles down to all health professionals. We must unite and confront these human rights violations urgently. Suicides are the tip of the iceberg.
I am a recently retired Emergency Physician. I was in practice for 34 years. The only way to cope was to slowly decrease my hours so that for the last 10 years I worked 1/2 time. I still suffered through no BR breaks, interruptions every 10 seconds and no breaks for food OR water. It’s a human rights violation and needs to be remedied. My wife is still practicing full time. Morale at our facility was at an all time low when I left. We have moved To another state but I’m concerned for my wife’s mental health.
Human rights violations of health care workers are extremely serious and must be addressed urgently. Physicians have nor organization protecting them from these widespread egregious abuses. Time to speak up.
Hello Pamela!Great Post i really liked your mention.You Point out on a burning topic.we Elizabeth also the Certified meditation specialist doctor.
Resilience is the greatest lie healthcare providers have been sold. It is a form of putting the blame for systemic failure on the staff. You have accurately pointed out that everybody suffers under this system.
I also agree with the lie of mindfulness training – it is nothing more than a bandaid tactic to distract struggling medical staff from awareness that there is something profoundly wrong.
I grow up in a house hold of medical professional my father was a ob/gyn and my mother was a nurse . I always knew I was going to be a doctor at the age 5 . My dreams were crushed. I wanted to practice with my dad . He died of leukemia when I was 17 .
It was a struggle in undergrad and my best grade were my last two years . I was excepted in to crieghton university . I received a full scholarship. It was funny the first two years I did well in the classes but 5 days before the 1 test I was sexually assaulted in my apartment . I was multiple sexually asssult by a senior medical student that was helping my through this . I still took the test and failed by 5 points . I stayed in the dorms and continue to go to court to put him in jail the first person in jail . I did not tell anyone about the medical student . Who by the way knew my father when he was younger he had actually worked with him . I regret that I did not say anything because he became a Ob/ gyn . I did seek group counseling but I found myself helping instead of receiving true therapy . I continue to have test aniexty after that incident . I could not control it and I went on to fail then past the 2test but I pass the 3 test .
During the rotations in the 3 and 4 year were painful and challenging. I remember my Surgeon told me I was not serious about Med school because I had fail my test . I stopped him and said before you assume . You should ask a student what they went through before the test . I explained what had happen that I past and kept my scholarship. I am sitting in front of him and that should tell you my character . I failed but I got back up . He did not say much after that. In restrospect I still do not have many people to talk to . I am often the one everyone come to for help . I am glad that you have a place we’re we can vent and share . It make it bearable .
As a African American female student I had to speak to sexual harassment and often time they would talk through rounds when I was specking . I would just give them my notes .
Residency
I did not match in ob/gyn but I was blessed to stay for a family practice residency. It was hard work . Some day 36 to 48 hour on . Yes I would have my fellow student drive me home and pick me up due to sleep deprivation. We were family . In our hospital the family practice doctor were always on the holiday because we rotated through the other residency . It was not just family practice hospital
My last year of residency I had my child . Thank God she was born after my family practice board which I passed .
My practice life . I have worked as employees , own my practice and now parttime practicing at a wellness center.
I have gone through divorce , death and Grief along the way .
I am Christian physician who take the time with my patient but I also recognized I was often burnout and may have not alway been there for myself , family and friends .
Or the patient. Yes medicine can be your lover and consume your life .
I do counsel students and talk to my doctor friends .
I want to do more now that I am in a place in my life . Medicine does not determine or dictate who I am .
I just read your book . Please let me know how I can help .
Hey Grace – impressive your tenacity and determination. Contact me here and I’d LOVE to speak with you! I’ll email you now.
Thank you for your historic and ongoing efforts in addressing the abuse of Physicians by Medical Boards and Physician Health Programs. Long ago when I had various opportunities treating and “protecting” Physicians tormented by the Medical Board along with one of my closest friends (an attorney), it became obvious that we as Physicians should NEVER self report any Medical conditions to a State Medical Board. Subsequent encounters with Addictionists (in which I sub-specialize) would insist that their respective Physician patients self-report their addiction and/or Medical/Psychiatric condition(s) to the Medical Board ostensibly to “do the right thing”, I vehemently disagreed and let it be so known to those particular uncaring, arrogant, fools, masquerading as honorable Physician-Addictionists. My friend and I would often appear before the Medical Board and so called Physician Health Program advocating for our mutual patients/ clients. In and around that period my friend and I were well known as highly qualified in our respective guilds and practices. Our mutual patient/clients welfare was always the most important element in the horrific experiences with the asses of the Board and/or PHP. My attorney-friend (since deceased…a tremendous personal loss) never allowed the Board or PHP to manipulate his clients into the inane “agreements” that they would attempt to force upon the seemingly down and out Physicians-clients. This work was incredibly challenging and difficult as we would refuse the Boards/PHP “agreements”. I found myself often assisting my patients via conversations with Deputy AGs and or Judges whom, over time we came to know and like. Through our work we invariably side-stepped the Board and or PHPs much to their respective disdain, and succeeded in our patient/client receiving the proper and appropriate treatment and legal representation. We also both worked pro Bono when necessary as a human beings life, at times, was at stake. Yes we were empathic, caring, loving, and effective rogues and proud of same. Today I live and work in a very different environment and would not even consider doing the kinds of things called for that my friend and I did. Older and hopefully a bit wiser, still missing my friend but happy to watch things from a different perspective. My only hope and wish is that a savvy attorney file class-action lawsuits against Medical Boards and PHPs that invariably coerce Physicians to “seemingly agree” to allowing their ADA and HIPPA rights to be violated. Nevertheless, one thing remains true; it is NEVER a good idea to DISCLOSE any Medical issue a Physician may have, to a Medical Board and/or PHP. If ones Medical Board ever approaches you (as a Physician), say nothing and get a tough, brilliant attorney, willing to fight for your rights.
Love to hera more of your escapades. What worked? What did not work? Please do reach out to me here if you like to share more confidentially: https://www.idealmedicalcare.org/contact/
Jamaica Hospital has treated me with disrespect Long Island Jewish emergency room has disrespect me and treated me nasty and I need help in a lawyer to understand where I’m coming from but nobody will help me I need help for these people they doing it they not burnt out these people are actually treating people messed up I am a lesbian woman and they thought I was a man but I’m a woman they talked about it they laughed and he sent me about my way my sugar was 595 and my doctor sent me to the hospital
You know something doctors just don’t commit suicide being burnt out they commit suicide because what they have done to people and it conscious that’s tearing them apart don’t believe that cuz they burned out cuz you got days and you you have vacation so yeah it’s okay that’s because what they’ve done to people they have killed people and got away with it and they conscious and it goes to Spooks them yes talk to me my name is Kim Nelson and I will tell you all Jamaica Hospital Long Island Jewish Queens Hospital yes they treat you disrespectful the reception that they knew Judy Mookie treat you real nasty go down there at 910 Riverside Drive and see how they talk to people I’m surprised that the clients having committed suicide 910 Riverside Drive the reception is so nasty her name is Judy mookie and Dr new at violated and end up sleeping with her and end up saying that the da person has stopped him but that’s her running and I cannot leave my doctor email I had to get a new doctor this thing is getting out of control doctor in new e n u the lady name is Judy Mookie 910 Riverside Drive I wish somebody would come and talk to me for real I’ll tell you all that’s going on even where I live at when I’m feeling now they didn’t kill people here is a sister living they kill people here I’m getting sick because I ask them to clean up something now they came in here and fix something hbd came now I’m sick because I touched my daughter they put something on my door it’s crazy door not door the door0⁰