Susan lost her doctor to suicide. She wants to know why. →

Susan Kreischer is one in a million.

One of a million Americans to lose their doctor to suicide—each year.

She is still devastated years later.

“I had awful back pain—was barely walking when I met Dr. Ortiz and right away we bonded. Every time I went in, he’d give me a huge bear hug, lifting me off the floor (and I’m a heavy woman). He always had a big smile on his face. He was it. He was the man. He didn’t just hand me another pill. He actually got in there and solved my problems.”

Dr. Ortiz was a man who never gave up on his patients.

“Later when I had more back problems, he said I’d need my hip fused and he’d look for another surgeon since that wasn’t a procedure he was familiar with. Next time I saw him he told me that he didn’t find anyone he could trust so he was going to do it himself—and that’s exactly what he did. He learned that procedure for me! I was in awe that he did that for me.”

Staff in the operating room were in awe as well. Nobody could believe how perfectly Dr. Ortiz performed her fusion.

“I saw that man five times in a day and a half in the hospital, plus he went to see me another four or five times when I was in recovery. He called me every night at home to make sure I was okay—and I was.”

Susan wonders how she’ll ever replace him.

“I don’t trust other orthopedic doctors around here. I had some very bad experiences. I had so much faith in Dr. Ortiz because I knew he was being truthful—giving me his honest opinion. I adored him. He was a saint to me. He took so much of my pain away. He changed my life.”

How my patients prevented my suicide (& started a medical revolution) →

Today is the anniversary of my suicide survival story—a happy ending to six weeks of unrelenting thoughts of dying when forced to see patients every ten minutes in big-box assembly-line clinics. My lifelong dream of being a trusted, loving family doc doing housecalls was gone. I saw no way out.

Until I told my patients I was suicidal.

I begged for their help. I asked them to create an ideal clinic, even write my job description. I promised to do whatever they wanted. My life sucked. I had nothing to lose. I figured we could all escape corporate medicine together. They were game.

Soon more than 100 patients delivered written testimony. I was SO excited to read it all. We adopted 90% of their amazing ideas and just one month later (with no outside funding) we opened the first ideal clinic—designed entirely by patients. Today is our 14-year anniversary of the most beautiful gift a community could ever give me—the ability to be a real doctor.

Now I do housecalls. I absolutely adore my patients. And I’ve never turned anyone away for lack of money.

Read all about how we did it here.

Not “burnout,” not moral injury—human rights violations →

Burnout is a slang word for end-stage drug addiction first used on the streets of inner city America in the early 1970s. During that time, psychologist Herbert Freudenberger volunteered at a New York City free clinic treating addiction. He overheard the term and used it to describe himself and clinic staff in a 1974 article on staff burnout detailing long-term physical and psychological job stress.

He then authored a book on burnout in overachievers and another on burnout in women further popularizing the slang word which seeped into common lexicon. Burnout was no longer limited to Americans overdosing in back alleys. Now housewives and high achievers and anyone stressed at work suffered from burnout too.

“Physician burnout” first appears on my PubMed literature review in American Medical News in July, 1981. It is unclear to me who first applied the term to doctors. What is clear to me—is that despite medicine’s obsession with burnout for nearly four decades—the epidemic of physician cynicism, exhaustion, and despair is worsening.

So why are physicians experiencing physical and mental collapse from overwork? Psychiatrists define burnout as a job-related dysphoria in an individual without major psychopathy—meaning you’re normal; your job is killing you.

Meanwhile physician burnout books and breathing exercises are offered by burnout coaches on every corner. Curious why physician burnout is on the rise amid the plethora of burnout programs, I asked a physician burnout coach, “Don’t you think all your ‘burnout’ breathing exercises and EMR workarounds just prolong the agony for physicians in toxic working conditions?”

He replied, “Yes.”

Since that 2015 conversation, I’ve been debunking burnout as a victim-blaming buzzword that prolongs physician agony by avoiding the real issue leading to physician despair. So what’s the real issue? Enter Drs. Wendy Dean and Simon Talbot with their landmark 2018 article, Physicians aren’t ‘burning out.’ They’re suffering from moral injury. In it they explain:

The concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work. . . Physicians are the canaries in the health care coal mine, and they are killing themselves at alarming rates (twice that of active duty military members) signaling something is desperately wrong with the system. . .The simple solution of establishing physician wellness programs or hiring corporate wellness officers won’t solve the problem. Nor will pushing the solution onto [physicians] by switching them to team-based care; creating flexible schedules and float pools for [physician] emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques or participate in cognitive-behavior therapy and resilience training.

Yes. Thank you. Exactly.

Last week the anti-burnout buzz accelerated when ZDogg quoted my 2015 blog—Burnout is BS—in his viral video “It’s not burnout, it’s moral injury” echoing my advice that we stop saying the victim-blaming term.

Now we’re getting somewhere. But is it really moral injury?

Moral Injury is a term applied to combat veterans in 1998 by psychiatrist Dr. Jonathan Shay. Moral injury is damage to one’s conscience when perpetuating, witnessing, or failing to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct (often resulting in profound shame). Moral injury is a normal human response to an abnormal traumatic event—a deep soul wound shattering one’s identity and morality. Dr. Shay’s original definition was based upon his patients’ war narratives and Homer’s Iliad (762 B.C.) and required three components: (i) betrayal of what’s right by (ii) someone who holds legitimate authority in a (iii) high-stakes situation. Individuals with moral injury may see themselves and the world as immoral and irreparable. Read more ›

Tags: burnout breathing exercises, burnout in overachievers, burnout in women, Burnout is a slang word, Burnout is BS, Burnout is Bullshit, Dean and Talbot, Dr. Jonathan Shay, Herbert Freudenberger, human rights violations in medicine, medical student moral injury, Moral injury in doctors, physician burnout book, physician burnout coaches, physician burnout moral injury, physician moral injury, physician suicide helpline, racism in medicine, resident morel injury, resident physician food/water deprivation, sexual harassment in medicine, Simon G. Talbot, Simon Talbot, Wendy Dean, ZDogg, Zubin Damiana

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Living your spiritual calling in medicine →

Inspiring presentation to students at The University of the Incarnate Word School of Osteopathic Medicine that received a standing ovation. Listen in below to full three-hour event (including Q/A) and/or transcribed presentation below:

Each year our future physicians enter medical school with their mental health on par with or better than their peers. The best and brightest humanitarians with a deep desire to help and heal others soon find themselves in a career with the highest suicide rate of any profession. How did medicine lose its way? How can we inspire students amid a culture that undermines their own mental health? Breaking through a century of medicine’s mental health stigma, Dr. Wible demonstrates how to be true to your original calling, and why being congruent with your deepest spiritual values turns medicine from a job into the most fulfilling career on the planet. (Plus loving your life as a doctor just might be the antidote to our physician suicide crisis)

Mark Clark, PhD: With physicians stories certain things kind of stick out to me. Particularly on the lookout for things that I think are possibilities of looking beyond somebody as simply a role model and a mentor. First thing that struck me early on in Dr. Wible’s biography was the fact that she’s a family physician and she started out around the time I was starting to get into medical humanity so early 2000, somewhere in there. She got frustrated in the struggle with all the weight of family practice—the direction her profession was going. So what she did was go off into the community, lead a town hall meeting and she asked what kind of clinic they wanted. And from there she got started developing a solo community clinic.

This is not exactly the subject of her talk today, but I thought it was important because what I see happening is this finding yourself in the condition of helplessness or vulnerability—but responding to that in action. So she had the town hall and she got going. When we talk about “burnout” we feel a true lack of agency. So what I want you guys to look at in mentors, in role models, in physicians is where especially they find a way to act—despite whatever circumstances they’re in—there is this agency and this capacity to act. That can really make a difference.

So she may talk about that. It really struck me as part of who she is and something that was worth noting. So she’s very active still in her family medicine clinic. Because of her own life experience, she’s gotten involved with physician suicide prevention. She’s investigated more than 1,100 doctor suicides and her extensive database and suicide registry reveals high-risk specialties—and solutions. In between treating her own patients Dr. Wible runs a free suicide hotline and has helped countless medical students and physicians heal from anxiety, depression, PTSD and suicidal thoughts so they can enjoy practicing medicine again.

I had several delightful conversations with Dr. Wible leading up to this event and I just felt like we are on the same wavelength. I was just incredibly happy when she presented me with the title of her talk which I thought was completely in line with what we have going on in unit nine and all the way through these last two years. Healing our healers—living your spiritual calling in medicine. Welcome Dr. Wible.

Pamela Wible, MD: Thank you so much for having me. I’m very, very excited to be here. Thank you for getting up early for me. So yeah, did you know that I almost went to med school in San Antonio? I only interviewed at two places. Back in the day when you could get into residency with only two residency applications. I got my top choice of residency and med school—and I only applied seriously to two med schools as well. But there was a cool thing with Texas, I don’t know if they still do it, where you apply with one application that goes to all schools. That was awesome. So yeah, I ended up at Galveston.

In my San Antonio interview, this old-guard med school guy was like really scary. He tried to scare us or something and I just thought, “Oh I love San Antonio but that was scary.” I’ve got to go somewhere where it’s safe. So I went to Galveston and I had my own issues there. But I’m glad that I went to UTMB, and my mom went to UTMB as well. So we just went back a few years ago to her 50th medical school reunion and it was my 22nd and there’s not many mother—daughter pairs that can go back to their medical school reunions together so that was pretty cool. Plants the seed for you all. Have your children come here I guess 25 years from now—and you can enjoy reunion together too!

So I thought we would do this in a really interactive and fun way where we could all learn together. Hopefully you all have index cards because I have a little experience for you all. I’m going to ask three questions. So on your index cards if you could just put one, two, three, one on top of the other. First question (don’t think too hard, just sort of stream of consciousness) is how old were you when you very first had the idea that you were born to be a healer or a doctor on this planet? The very first time you thought this could be your destiny. If you are on faculty, please answer these questions as well. You might want to make a note on your card that you are faculty. I would love to collect these at the end and just sort of see what everyone has written down. It would help me understand where medical students are today versus my experience 25 years ago.

So that’s the first question. Number two—what was your primary motivation back at that age when you first had that idea? What was your primary motivation in one or two words? Why is it that you wanted to pursue this profession?

And then number three. Same age. Take yourself back to that moment. What was your big dream that you had? Your original dream when you were four or five, eight years old—that original dream that you had to cure cancer, you wanted to be an amazing pediatric oncologist. Whatever it was that you thought that you were going to be at that moment. Maybe just a pediatrician in a small town or a family doctor. Write that down as well.

Physician “burnout”—a coverup for human rights violations in medicine →

Since 2015, I’ve advised doctors to stop using the word “burnout.” Here’s why.

Each year our best and brightest, most compassionate students enter medicine—a career with the highest suicide rate of any profession. Each year more than 1 million Americans lose their doctors to suicide. Jumping from hospital rooftops. Found hanging in hospital chapels.

Classic response? Blame the victim, then cover up the suicide with medicine’s favorite victim-blaming buzzword—burnout—a slang word from the 1970s for end-stage drug addiction—now weirdly applied to doctors! Here’s how it works . . .

Physician “burnout” blames the victim NOT the medical system that actually kills doctors—and patients! Plus it’s a cash cow for physician predators and profiteers—all the burnout coaches cannibalizing the corpses of their colleagues—divided and conquered by bullying, hazing, and sleep deprivation—the foundation of medical training that forces new med school grads to legally work 28-hour shifts treating heart attacks, gunshot victims, and delivering stillborns—with no debriefing for their trauma. No bathroom breaks. No time to eat, surgeons collapse from dehydration and hypoglycemia. Here’s a doc found sleeping on an elderly comatose woman while starting her IV. (All true stories) An ICU doc forced to keep working during a seizure. Another doctor working while miscarrying her baby.

These human rights violations lead to suicide (and families destroyed by suicide) plus lifelong physician PTSD, anxiety, depression, divorce, strokes and heart attacks—when our doctors are forced to work 80, 100, even 120 hours per week—that’s two to three full-time jobs! Criminal in Japan where companies are held liable for suicides when employees work just 60 hours per week.

Now doctors are standing up against the abuse. So hospitals are retaliating with FORCED WELLNESS on the overworked. With mandatory 6 am sleep deficiency lectures (after 24-hour shifts!) and mandatory resilience training for military doctors with crayons and adult coloring books.

FYI: Appointing Chief Wellness Officers while perpetrating abuse is like putting a Band-Aid on a ruptured aorta. Enough burnout bullshit guys. Claim responsibility for human rights violations at your medical institution. Stop abusing your staff. Then apologize to victims (and their families). If you’re being abused, please leave your abuser (who may in fact be your burnout coach keeping you caged in your cubicle).

How to stop human rights violations in medicine

Human rights are universal moral principles that apply to the treatment of all human beings no matter sex, ethnicity, religion, culture—or profession. These are basic freedoms and standards of human behavior protected by law—both internationally and nationally—from birth until death. Sadly, these laws often do not protect medical students or doctors.

Recognize human rights violations in your medical institution and speak up against unsafe and inhuman work hours (> 60 hours/week), sexual harassment, bullying, food/water deprivation, sleep deprivation, hazing, racism, censorship and lack of freedom of speech, intimidation, and prohibition of peaceful assembly after a physician suicide (to name a few).

Since 2012, I’ve been running a physician suicide helpline and have spoken to thousands of physicians suffering from occupationally-induced anxiety, depression, PTSD, and suicidal thoughts as a result of chronic human rights violations—and lack of access to mental health support in a profession that involves constant exposure to suffering and death.

What physicians need now

Protection by labor laws standard in other industries including mandatory meal and bathroom breaks

Protection by the Americans with Disabilities Act including immediate removal of invasive mental health questions on applications for state licensure, hospital privileges, and insurance credentialing.

Access to non-punitive mental health care to prevent occupationally induced lifelong mental health sequelae from chronic exposure to death and suffering.

Protection under the Unites States Constitution that guarantees freedom of speech and a right to peacefully assemble—especially in the aftermath of a physician suicide.

Archived articles on human rights violations in medicine

More on the fallacy of physician “burnout”