View on NBC News. Full transcript below.
Medical Resident: Frustrating is way too benign of a word. It’s an infuriating system that we practice in.
Dr. Umut Sarpel: I don’t think most doctors get burnt out by doctoring, it’s everything else that comes along with it.
Dr. Pamela Wible: So we’re on the edge of life and death every day trying to save our patients’ lives, and for people to now start to understand that we have the highest suicide rate of any profession or that we are struggling en masse, this is not a popular thing to discuss. However, not to talk about it just perpetuates the problem.
Dr. Red Schiller: In many ways, we will look in this era as a dark age of medicine. As amazing as the advances are in technology, we’re failing in our ability to recognize our humanity.
Narrator: In today’s increasingly stressful, complicated world, we’re mentally, physically, and spiritually ill. And we turn to our doctors to heal us. But what most of us don’t realize is that many of them are more stressed and more burnt out than the rest of us. And it’s not because of the reasons you’d expect.
Dr. Umut Sarpel: A lot of medical students will ask, when they’re considering what field to go into, “How do you do surgical oncology? It would be so stressful.” That kind of stress, you sort of signed up for. I really love working with my hands. When I’ve done an operation, there’s something very concrete that you’ve accomplished, you know, technically challenging, but also really rewarding. Sometimes you just feel like the weight of the world is on your shoulders, especially when someone is optimistic you’ll remove the tumor. But, again, that’s the job that I signed up for, and people would be surprised that that’s not what wears you down at the end of the day. It’s everything else that comes along with it.
Narrator: There’s a silent pandemic that’s been spreading throughout the medical world. Doctoring is no longer just about doctoring. The amazing promises of technology have made for an exhaustive amount of bureaucratic tasks, like filling out electronic health records, or EHRs, which take doctors away from what they were trained to do, and put them, well, here. Today, for every hour a doctor spends with a patient, she spends at least double that charting it. So these EHRs, which lengthen already really long work hours, coupled with a lack of control and trying to diagnose and heal within a convoluted healthcare system, all contribute to doctors now having the highest burnout rate of any profession.
Dr. Red Schiller: In many ways, the healthcare system needs its own doctor. There’s this focus on quantitative performance that’s really altered the way in which doctors practice. And that’s not something that’s easy to do when people are receiving care with open-ended questions and complex concerns. People talk about a six-minute visit, a 15-minute visit, really sort of a helplessness that a lot of doctors feel that, “I spend all this time being educated, yet we’re really treated like, ‘Here’s the amount of time that you have, here’s the amount of people that you need to see, and here’s your quantitative goals that you need to meet at the end of the day, at the end of the quarter.'”
Dr. Red Schiller: Okay, thank you. Sounds fine.
Patient Bernice: I’m alive?
Dr. Red Schiller: More than alive. Vibrant.
Dr. Red Schiller: Medicine has lost its identity as a profession. So patients are really victims of the stress generated with people that they see.
Patient Bernice: I don’t know.
Dr. Red Schiller: So what would you like to talk about today?
Narrator: Bernice knew why I was filming, and so she went for it.
Patient Bernice: I really would like to talk about the medical profession.
Dr. Red Schiller: Oh boy.
Patient Bernice: No, not you. They don’t know who they’re talking to, and I’m constantly having to say, “Please look at me.” You look. You know who I am.
Dr. Umut Sarpel: I hear all the time people saying that they feel like their doctor never listens to them. And in the back of my mind, I want to say, “It’s because there’s all these other things going on that are wholly separate from taking care of the patient.” People would be surprised to know that when I’m seeing a patient and we’re doing surveillance to make sure that their cancer has not come back, oftentimes the insurance companies will deny a part of their scan. My office will have to discuss with the insurance company, I was going to say argue, but it’s not an argument, justifying that that scan is important. That takes time. That adds aggravation.
At some hospitals, the reimbursement scheme creates perverse incentives for physicians where you are rewarded by your productivity. And while productivity is a good thing, it doesn’t always equate with what’s best for the patient. We’ve been forced to shorten the amount of time that we allot for appointments, and we have a computer in the room, and there are some people who find the only way that they can make their day work is if they’re documenting at the same time that they’re talking to the patient.
Dr. Red Schiller: Yeah. Can you imagine other service industries where, a front desk at a hotel, where the person turned their back on you while you were trying to register? And these probably don’t always have simple solutions. But they’re crucial.
Dr. Umut Sarpel: I mean, there are doctors that would just rather completely leave the healthcare system than work within it.
Medical Resident: This system is exploiting everyone inside of it. So you have pharmaceutical companies bent on making as much profit as they can off of meds, health insurance industries bent on making profit off of people and denying people’s claims to get healthcare, we have hospital systems, sometimes for-profit systems or sometimes systems that operate like for-profits even though they don’t have those titles. So we have physicians who are going into that medical industrial complex that are supposed to operate inside of that, and I think that a lot of people don’t really realize the amount of anxiety, depression, and suicide among physicians.
Dr. Pamela Wible: I’m a family physician in Eugene, Oregon, and I run a suicide hotline for physicians who are suicidal. When I was 36 years old and I became suicidal as a physician, I thought I was the only suicidal physician in the whole world. This is a common experience because this is not discussed. In the general public, 12.3 out of every 100,000 will die by suicide. Among veterans and military, it’s 30. And among doctors, it’s 40 per 100,000. We lose approximately 300 to 400 doctors per year in the US—the equivalent of losing an entire medical school of medical students to suicide.
Medical Resident: The more that you are told, “You’re such a great person, and doing such a great job,” it’s much harder for you to admit that, “Maybe I am suffering just like the person in front of me that I’m supposed to be caring for and working with.”
Dr. Red Schiller: We don’t really encourage a strong sense of community among the people who are learning medicine, teaching medicine, and providing medicine. We have more robust health services, but there is still, in our profession, and really in our society at large, this sense that if you can’t cut it, you’re weak.
Narrator: Burnout has become so pervasive that medical institutions across the country have installed chief wellness officers to deal with it. And this is Mount Sinai’s.
Dr. Jonathan Ripp: One of the reasons why this is gaining more attention is that it’s not just affecting members of a healthcare professional team, but the patients that are cared for by them. And so, if you . . .
Narrator: Everyone.
Dr. Jonathan Ripp: Right. There’s a large literature that shows that burnout correlates with medical errors.
Narrator: Medical error is the third leading cause of death in the United States.
Dr. Jonathan Ripp: Productivity of physicians, I think they’re already talking about a physician shortage. So in some regards, you can think of it as a public health issue.
Narrator: Or maybe it’s a public health issue in all regards.
Dr. Red Schiller: As part of the Mount Sinai community, I want to recognize their commitment to making this difference. I think the challenge is that this is a problem that’s not going to get solved by tweaking the edges. There’s wellness programs, health insurance plans have wellness programs, and what they all tend to focus on is self-care.
Dr. Red Schiller: The onus is on individuals to get well. The reality is a lot of the things that are making people unwell are things beyond people’s control. So you can’t breathe yourself or meditate through the challenges of having an EHR.
Medical Resident: You can cover me in as many essential oils as you want and give me as many granola bars as you want, but unless you actually restructure how the system functions, then don’t talk about caring about me or my peers or anybody else.
Dr. Jonathan Ripp: I think everyone recognizes that we’re likely to have the greatest impact looking at those system-level drivers. We really need to be smart about how we think about the efforts that are going to improve well-being, and look for those that are likely to have win-wins both on the bottom line and in well-being.
Dr. Umut Sarpel: Maternity leave I think is a perfect example of how wellness is sometimes at odds with the hospital’s bottom line. It’s pretty clear that the right thing to do is to not apply a financial penalty to women for having children, and yet at the end of the day, from the hospital’s perspective, there’s a side that has a hard time seeing that they should be paid for that time.
Dr. Jonathan Ripp: Obviously the healthcare system has a pressure to meet its bottom line and a budget.
Dr. Pamela Wible: We have not been dealing with this like you would expect a profession that’s based on human health and relieving suffering and death. We have not addressed our own internal problems.
Narrator: Nurses across the country have been protesting unsafe staffing levels. Residents and fellows are joining unions. Everyone is feeling the strain. Yet things have truly yet to change. And at the heart of all of this remains that core question of how to deliver good care and how to heal.
Dr. Red Schiller: Think about Paris.
Patient Bernice: I’m planning a trip with my niece.
Dr. Red Schiller: You can’t talk though. Now you can. Thank you.
Patient Bernice: Is it bad or good?
Dr. Red Schiller: Good. Better than mine.
Patient Bernice: Yeah.
Dr. Red Schiller: It’s 122 over 82.
Patient Bernice: That’s good.
Dr. Umut Sarpel: What is at risk the most is the relationship with the patient, which is heartbreaking because, at the end of the day, we went into this field because we really want to help people.
Dr. Red Schiller: What we forget is that being a doctor is really a calling, and it’s a gift. In some ways, the place to start is to just recognize that both the patient and the people providing care bring all this stress to the interaction, and possibly just taking a moment to acknowledge that. I suppose that to me is how I try to deal with this on a day-to-day basis is just focusing on being present. The early days of my training were in the midst of an AIDS epidemic, and I saw things that were just horrible about people with AIDS being turned away. But it was certain people who are able to rise to the occasion and show others how not to be afraid, and I think each generation really needs to do that. You can’t do it alone.
Dr. Umut Sarpel: I think 10 years ago, there was no discussion of wellness. Maybe we were expected to be the bastions of wellness, and that’s obviously not true. So I think this added attention is important, and hopefully something will come of it. I hope there’s hope.
Narrator: Our society still thinks of doctors as these all-knowing, always correct people on a pedestal. But the truth is they are people too, and stress tremendously affects them. And this is why being conscious of what’s happening outside of the exam room is so important for our own health. And it’s also why the big changes that have to be made to this system are vital for the well-being of clinicians everywhere—and for us all.
Not burnout, not moral injury—human rights violations
Excellent!!
The MBAs and IT people and lawyers and media have decided to make money off the of doctors by sabotaging them. There’s a finite amount of resources and those must be treated preciously. Doctors need to realize all the this. Stop taking gigantic loans. Stop buying gigantic things you can’t afford so that if you reach a limit you can quit and your family can still eat. The laws of economics never fail.
Pam, scribes nice but not the only answer. More humanity and a lot of other coping strategies. Time for family and hobbies. Big groups ss you point out can be the enemy. Larry
Full revamping of medical education so that students are empowered, not victimized. The abuse cycle in medicine is tragic and passed on from one generation to the next.
so true and rarely admitted. If medical education is revamped to encourage collaboration, create a safe space for students to talk honestly and without retaliation, to respect emotional insight, to value the enormous energy devoted to “doing your best”, cultivates an environment where discussions can take place-again without retaliation-things could change. But the “stakes holders” are bent on keeping the “status quo”-because too much money is being made off the backs of these doctors. Any change, any meaningful change-reduces revenue for those linked to what a doctor does. The doctor cares for patients-while the industry makes money. The “stakeholders” are well aware of what is being done to doctors-and they simply do not care about the doctors. They are banking on people turning away from the endemic problems facing doctors-so they can get on with the real goal-making money off of the sick and injured. Doctors soon realize they are simply a cog in a huge machine that cares very little about them. Doctors have less and less power-yet we retain all of the responsibility. Patients need to be educated to know “we are not in control of their health care. Insurance companies, pharmaceutical companies, administrators, managers-are in control of their health. There is no way one can do their job and give decent health care to most people when you are mandated to see over 25 patients in an 7 hour work day. Doctors have learned to take the bulk of their work home. A 15 minute visit requires over an hour of work at home. There becomes-no actual home life, no time left over for children, husbands, wives. Most doctors work in dark, unlit, cramped rooms no bigger than a closet-to finish their records. If patients knew how doctors are treated outside of the exam room-they would be horrified.
What a remarkably informative video clip.
The menace is real. The problem has become very deeply ingrained in the system. I have been at MSH since 1960 and the difference in the QOL for a physician then and now is dimensional. I would like to contribute any way I can to your activities. How?
Robert S. April MD
Just emailed you. So many ways to contribute. Volunteer at your local med school or residency, mentor, teach. Love to hear more of your interests and happy to guide you.
I have no idea what Dr. Wible emailed you, but I want to suggest to Dr. April and anyone who reads this that if you can’t do anything else, just speak up about this at your institution. Take PGY depression seriously without patronizing or belittling them. I tell nurses, put your arm around a resident when they are having a hard time-they are human beings! Keep advocating for them. But please, keep talking about it and don’t let it get pushed under the rug!
R Braga MSN, RN
Agree. Be kind to each other. Infighting among victims does nothing to help any of us.
Thanks for posting this Pamela – a really informative video.
As the founder of Doctor Lifeline, a 501(c)3 nonprofit charitable organization whose sole purpose is the prevention of physician suicide, I applaud Dr. Wible’s tireless efforts to prevent doctor suicides. Her book is a “must-have” for those in medical training or employed by corporations. I have personally known 5 physicians who killed themselves. Doctors find themselves in extremely toxic practice environments, and the system gives lip service to their concerns but remains remarkably resistant to meaningful change.
The next time you’re with your doctor, remember, he or she statistically is 3 times more likely to commit suicide than you. Your kind words or expressions of gratitude could literally save your doctor’s life.
The elephant in the room is the toxic nexus of cartels. NRMP, ACGME, AHA all colluding to get indentured slaves ( fresh MD’s), make them work in sweat shops at below minimum wage, ostensibly under the pretext of ‘teaching’ and hold them by their balls. The monopoly of single track to licensure is the cause which leaves graduates with no choice. You think I am making this up….how do you explain the Congress approved immunity for hospitals from class action suits by residents (Jung v. Association of American Medical Colleges, DDC 1:02CV00873.
15 U.S.C. §§ 1 et seq). This is indentured servitude slavery in action. The emperor is naked.