Physician suicide and medicine’s culture of betrayal →

Kevin Pho: Hi, and welcome to the show where we share the stories of the many who intersect with our healthcare system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Pamela Wible. She is a family physician, and she’s the author of the free ebook Physician Betrayal: How Our Heroes Become Villains. Pamela, welcome to the show.

Pamela Wible: Thank you so much for having me.

Kevin Pho: So we’ll get into your book and excerpt in a little bit, but first off, can you share your story and journey to where you are today?

Pamela Wible: I’m a family physician. Both my parents are physicians. They warned me not to pursue medicine. And their warnings were economic predictions that have come to pass—loss of physician autonomy, assembly-line medicine, seven-minute visits. What they never warned me about was the emotional impact of the career. So all economic, not emotional. Never once did they talk about their own anxiety, depression, suicidal thoughts. And so I was left in a very isolated state feeling like I was the oddball, the only one having mental health problems, and come to realize we have a real physician suicide crisis that I stumbled upon by personal experience.

Kevin Pho: Of course, you need no introduction in terms of being at the forefront of bringing awareness to physician mental health and physician suicide. Tell me how you first got interested in this issue. And when did you realize that it is such a big issue?

Pamela Wible: We had three physicians that died by suicide in my town, in Eugene, Oregon, in just over a year. And that was in 2012. I was suicidal in 2004, and at the time, I thought I was literally the only suicidal physician that ever walked on this planet.

I’m currently writing my memoir and as I examine my repressed memories from childhood, I’ve realized, “Oh, yes, my mother is a suicidal psychiatrist.” I think I hid that from myself. A lot of us hide our own personal pain because it’s just too much. When I’ve been asked, “Why do you run a suicide helpline?” I’ve said, “Because I survived suicide as a physician, so I want to help my peers.” That’s a superficial answer. The truth is I was an embryo inside of a suicidal psychiatrist so I feel I’ve been running a suicide helpline since I was born or conceived, quite honestly. So I guess that would be the true answer.

Kevin Pho: So you mentioned you run a suicide helpline for healthcare professionals. Please talk more about that.

Pamela Wible: I never intended to run a suicide helpline, yet people were utilizing me as a suicide helpline. Since 2012, when I became vocal after the deaths in my town, people have been wanting to tell me the suicide stories of their children in residency, in medical schools. Suicidal doctors and med students are contacting me—even internationally from Germany and Poland. Especially amid the pandemic, I had a greater influx of calls. I do have a lot of passion for this, and people seem to be thanking me for helping them stay alive. At one point the most common first line in an email from those who sought my help was “I would have been one of your statistics, but you answered the phone, I read your article, I saw you on KevinMD or read your book.” If that’s the response, I feel compelled to keep going. Read more ›

Tags: Emotional sepsis

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My brother is a suicidal doctor. How can I help him? →

I frequently receive letters requesting help for suicidal friends or family members in medicine.

“Dr. Wible, I am writing to you on behalf of my brother. He was a medical resident, but was terminated. He has been a stellar doctor and wonderful teacher, but has been in deep depression and unable to move on with passive thoughts of suicide with no plans. I’m looking for some help to help him (I’m also a doctor). Thank you.”

My best advice:

1. Open Communication – Physicians rarely feel safe to share their most vulnerable feelings—even with peers or family. Be nonjudgemental and willing listen as long as your brother wishes to talk. I’ve been on calls with a suicidal doctors for more three hours. Once they feel safe, doctors may talk for a long time. To understand why doctors feel suicidal, here’s a free audiobook of physician suicide survival stories and a documentary film on doctor suicide prevention.

2. Peer Support Group – I’ve led many support groups for suicidal physicians and the comfort that isolated physicians feel in a group of like-minded souls is immense. One surgeon shared that the support he received in our surgeon support group (for suicidal surgeons and surgeons who lost colleagues to suicide) has been more helpful than all his inpatient and outpatient psychiatry and therapy sessions. Note: Specialty-specific support groups are best. I suggest your brother join a group for residents who have left residency (not unusual as I know many). When I curate groups on Zoom, I aim for six to eight per session to maintain intimacy. Fewer is better.

3. Journaling – Releasing feelings into a journal is great way to process unbearable pain and anguish. Reading entries to family, friends, and therapists allows for more targeted interventions. I’ve led trauma writing retreats for physicians and they have been very beneficial (even for those who are just listening). I encourage a daily habit of journaling for all physicians. Gift your brother a journal. Encourage him to write and share passages with you.

4. Individual Therapy – Often physicians avoid seeking professional services due to career repercussions including discrimination by state licensing boards and hospital credentialing committees. To ensure 100% privacy and confidentiality, physicians may drive out of town/state to see therapists who use (non-discoverable) paper charts. Your brother should have a professional therapist/psychiatrist of his choice (much better than having one mandated by a board or randomly assigned by inpatient psychiatry). If his symptoms escalate, he can get the care he deserves with someone who knows him well.

5. Career Help – A physician’s identity is often wrapped up in their career. Loss of a career can feel like loss of one’s whole life. A physician’s motivation to pursue medicine may originate in childhood wounds. Gaining insight into one’s own wounds (pre-existing medicine) and trauma (during training and practice) can be helpful for healing and rerouting one’s career. Your brother is obviously a bright and motivated person, and he has so many options. I know students who have dropped out of medical school and/or residency who are happier now than ever. Several have launched their own healing centers or coaching practices—even without a medical license.

Need more help? Join a support group or live weekly retreat.

Tags: suicidal brother, suicidal doctor, suicidal medical student, suicidal pharmacist, suicidal sibling, suicidal sister

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Healing Physician Trauma with Drs. Gabor Maté & Pamela Wible →

Today I was honored to be a participant in a stellar physician panel of international leaders in the field of trauma with Gabor Maté, M.D., Rupa Marya, M.D., Will Van Derveer, M.D., and Jeffrey Rediger, M.D., M.Div.

View 5-minute clip above on healing physician trauma then view entire talk here.

We explore how traumatized medical students become traumatized doctors emotionally ill-equipped to succeed as healers  —and how trauma literacy can transform medicine. We also discuss how social conditions built along lines of inequality and power traumatize people and lead to illness   and how we can heal from “incurable” illnesses by connecting with the authentic self.

Trauma is the invisible force that shapes the way we live, the way we love and the way we make sense of the world. It is the root of our deepest wounds. Dr. Maté gives us a new vision: a trauma-informed society in which parents, teachers, physicians, policy-makers and legal personnel are not concerned with fixing behaviors, making diagnoses, suppressing symptoms and judging, but seeking instead to understand the sources from which troubling behaviors and diseases spring in the wounded human soul.

View The Wisdom of Trauma film trailer

This is an important film that brings greater awareness to the effects of trauma in our world and to the need for a trauma-informed society. In the film, you will see how different people access the wisdom of their trauma so that it becomes a teacher. Trauma can help us learn more about ourselves, our relationships, and the world that we live in.

Tags: physician trauma recovery

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I’m obsessed with doctor suicide. Here’s why. →

National Suicide Prevention Week starts today.

For nearly 10 years, I’ve run a doctor suicide helpline. Most frequent question I get: WHY?

Short answer: I was a suicidal doctor and I survived.

This year I wrote my memoir. Now I’ve got way more insight.

Here’s my mom’s favorite quote: Those who fail to learn from history are doomed to repeat it.

Here’s the version she wrote across the drywall before she left Dad: Those who do not remember the past are doomed to relive it!!” (see video)

I’d never seen graffiti inside a house. Not in our neighborhood. Do all psychiatrists scribble on the walls with their kids’ Magic Markers? Or just Mom? On the surface, Mom was warning Dad of our impending exodus. But what if her words were meant for all of us? What if I lack understanding of my own past, and my lack of insight has led to habituated behaviors that no longer serve me? As a control freak I’d like to at least voluntarily choose my behaviors rather than be doomed to unconsciously repeat the familiar psychopathies of my past. I’d also like to fully unpack my obsession with physician psychology and suicidality.

As a child, my primary parental figures were Mom (a psychiatrist) and Dad (a philosophy major turned pathologist). I also spent years without Dad while living with Mom and her lesbian partners, one year with Vera (a psychiatric social worker) and four years with Elena (a child psychotherapist).

Since I was raised by a suicidal psychiatrist, a psychiatric social worker (who died by suicide), a child psychotherapist, and a philosophy major with failed marriages to two psychiatrists, a psychiatrist friend suggested I read Children of Psychiatrists and Other Psychotherapists—the first book to “explore the paradox”— of why “the very group of people who ought to be the best prepared for raising sane, mature, ‘normal’ children is reputed instead to fail at a spectacular and grotesquely comical scale.”
I’ve read the book three times and stalked the author to thank him by phone. Now I get why I’m trying to save doctors’ lives. To survive my childhood, I had to master physician psychology—to save my physician parents from their own psychopathologies. Now I’m helping my colleagues.

I guess my history IS repeating itself.

Repetition compulsion is a defense mechanism in which we unconsciously & habitually repeat an event over and over again—until we consciously decide to stop. So why compulsively repeat our most painful events? In our quest to gain a belated mastery over our own trauma, we yearn to relive it so we can finally create what we’ve always yearned for—a happy ending.

It’s why my dad married two psychiatrists.

It’s why I’m compulsively helping doctors.

I’m just trying to have a happy ending.

If I can help save a doctor, maybe I can somehow save my parents.

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Remembering our fallen physicians →

For Labor Day & Suicide prevention week, may we remember our physicians who worked until their last breaths. All published with permission.

Dr. Greg Miday admitted the greatest number of patients to Barnes Hx as a nocturnist. Years after his suicide, patients still post on his obituary “I will never forget he gave me the sweetest look and said I am bringing him back. Danny was terminal, but because of Dr Miday we had 2 extra years with our husband, Dad and Papa.”

Dr. Steven Ortiz, beloved spine surgeon, hospital corruption whistleblower, spent the early hours of Feb 8th checking on his patients before shooting himself in the heart in the hospital parking lot. His truck covered with flowers for nearly a month.

Dr. Wayne Gunkle, orthopaedic surgeon, bought the rope on his way into his office Sunday morning. After dictating charts, he left a note “Sorry for all the patients I couldn’t help.”

Kaitlyn Elkins, died by suicide near the top of her class with dreams of becoming an anesthesiologist.

Dr. Varun, sent me this letter 2 years before his suicide

Dear Pamela,

Hi, dear. You don’t know how thankful I am to you for writing that article on physician’s suicide. I really wanted to hug you after reading it. I had really rough day after seeing 130 outpatients and 60 emergency admissions in a 12 hour duty. I work as a final year MD internal medicine resident in one of the busiest hospital in India. I saw a part of myself in every page of your article Just couldn’t stop reading. It’s 3:00 am in the morning and after a demanding day of work and studies reading your article was the best thing today.

It takes me 5 hours by flight to reach my home from my hospital. I have my wife and 6 month old son (whom I been with for 15 days since his birth) at home. I work day in and out just to be with them once in 3 months. I don’t see my colleagues smile, I hear my patients misery every day. I smile and crack jokes even when I am sad so I can bring joy into my patients sorrowful life.

Today I saw this patient who died, married with a son, the only earning member of his family …….his widow just wouldn’t accept that he was dead. She kept talking to him. I just didn’t know what to feel ….. I was numb for a minute thinking what if that was me …. And the kid is my son…..

I see deaths everyday in ward …..I don’t know if you would believe me, but 4 deaths per day in a single ward of 40 beds overcrowded to 125 patients admitted at a time. Two patients on a bed, two lying together on the floor. Poverty, misery and pain all around. I’ve declared 12 patients dead in a day. I just don’t feel death anymore, just don’t feel human. My uncle died recently, I felt nothing deep inside just some memories and that is it.

I write this mail hoping that the way I survive my day would help you in helping others.

I always ay hi to everyone my colleagues, the ward sweeper to the guard in the ward. I never eat alone and always make sure I share my food. I always smile whenever I talk to my patients. I hold their hands when I talk. Listen to music whenever possible. And everyday whenever possible I talk to my wife, father, mother, and brother (all of them are doctors).

But still this profession demands too much from us. I’ve thought of giving up and suicide a thousand times ……the misery was too much for me to see 12 people die in a day. The only thing that keeps me moving forward is my family and friends.

I appreciate what you are doing. It took me 4 hours to write this mail. It is 7 am in the morning. But your article was worth it. Thank you. Thanks a lot…..

Dr. Varun

Just 5 of the more than 1600 doctor suicides I’m aware of.

Rest in peace my sweet brothers & sisters in medicine

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