Watch TV special investigation on Physician Health Programs
SEGMENT #1—Doctors fear controversial program made to help them
SEGMENT #2 in series—Doctor left destitute after seeking help from physician health program
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Excerpt from a conference call tonight on how to fall in love with your medical records—just in time for Valentine’s Day! Download and listen in to podcast below or read transcript for a journey through the history of the modern EMR—with fun solutions!
Once upon a time there was a doctor, a patient, and an index card. Here’s my dad and his box of medical records—all on 3 by 5 index cards in a recipe box.
Life was good. One doc with tiny handwriting—a man of few words—fit 30 years of a patient’s record on one index card. A friend told me she got an index card in some transferred records with 13 visits on the back and front of a 5 by 8 card and now she gets 8 pages from the podiatrist for an ingrown toenail—total insanity!
Need help designing your medical record system? Contact Dr. Wible here.
It wasn’t easy to separate doctors from their index cards. When an insurance company complained about his 3 by 5 cards, one old-time doc relented and switched to 4 by 6 cards. My dad always had his index cards with him in his shirt pocket—until his death, constantly taking notes (even during our phone calls!)
Don’t you wish you could have been a fly on the wall as they ripped the recipe boxes away from old-school docs and forced them to type on computers? Well, you’ll never believe this (and of course this would happen to me) . . .What are the chances that I would actually run into a brilliant anthropologist named John-Henry Pfifferling who actually followed docs around with a notepad for two years studying the index-card-to-computer transition? And he lived to tell about it!
As you might imagine physicians not only had resistance to EMRs but also to an anthropologist following them around taking notes on their behavior. The entire project was considered “too dangerous” because medicine just “wasn’t ready for anthropology.” Plus doctors and hospital admins found it difficult to believe that an anthropologist would actually be interested in modern cultures, particularly the profession of medicine and the transition to electronic records.
So I just read his 343-page PhD thesis from 1977: “Records and Revitalization: The Problem-Oriented Medical Record System in a Clinical Setting” that recorded the adoption of the problem-oriented medical record among practicing physicians.
Our current SOAP note originates from the problem-oriented medical record (POMR) and was developed by Lawrence Weed, MD for doctors—the only ones allowed to write in medical records back in the day. Weed’s hope was that the POMR would end chaotic, non-cumulative episodic and illegible medical charting—and lead to a new and exciting era in medicine—in which (fingers crossed) we could all work together. Imagine that!
Pros & Cons of Problem-Oriented Medical Record
Here are some of the advantages and disadvantage of moving into the electronic age with a uniform medical record system according to physicians interviewed in the anthropological study.
Advantages:
Systematic organization of medical data with problem-orientation rather than disease-orientation
Easily-accessed and complete problem list (that includes psychosocial)
Medical education reform—logical thinking vs. “tyranny of memorization”
More patient-centered & transparent
Uniform communication for teamwork (social workers, RNs can add to record)
Encourages honesty, continuity, and may weed out incompetence
SOAP acronym easy to remember
Legibility!
Disadvantages:
Forced segregation into patient problems fragments vs. whole-person narrative
Territorial loss of control by encroachment on doctor’s notes/orders
Leads to an “explosion of paperwork”
Reveals ambiguity in patient care
False sense security in titles of problems
Over-medicalization of life
Strong physician supporters trusted this charismatic leader, Lawrence Weed, MD, and his new model of organizing medical records—yet many doctors resisted. Surgeons were most resistant, the internists were ambivalent, psychiatrists demonstrated “damp enthusiasm,” according to the anthropologist.
Culture of Distrust
Most fascinating to me was the obvious culture of distrust in medicine generated by physicians themselves. Doctors back in the day displayed distrust of hospital administrators, nurses, medical students—and even each other! A few quotes from his thesis related to distrust of these four groups—bureaucrats, nurses, medical students, and physicians:
Physician-Bureaucrat Distrust
Ongoing tension between the entrepreneurial and autonomous physician and the bureaucrats has been present throughout modern medical history. Computerized medical records were welcomed by bureaucrats for the “systematizing, auditing, controlling potential” of doctors.
“One of the most common phrases that was used by resistant physicians was ‘the POMR is a conspiracy.’ When questioned further they indicated that it was a conspiracy by those in administration to function as administrators want them to: ‘pushing piles of paper around.’ It was also a conspiracy to ‘get the doctor.’ If the game was to get the doctor, then some requirement that everything must be documented would surely be a useful ploy.” (page 269)
Physician-Nurse Distrust
There was “polarization between doctors and nurses who could now question the logic behind a physician’s therapeutic plans on the computer so the ‘computer was voted out of the ward by a closed meeting of the senior medical staff” because it was “territorially unacceptable to those in power.” (page 80)
The “nurses’ SOAPed progress notes were renounced as “ungrammatical gibberish.” Physicians complained of “non-physicians ‘overstepping their responsibilities’ and were concerned about “who was in control of patient care, exemplified by satirical remarks on ‘nursing diagnosis’” The physicians in both the medical and surgical services spoke of the doctor-patient relationship as being “corrupted by nursing arrogance.” (page 250)
“Within days of the initial physician’s outcry, humorously characterized as ‘who’s writing in my notes?,’ several other physicians used the same ploy to denigrate the nurses.” (page 253)
Physician-Medical Student Distrust
Higher education is about learning and asking questions, yet I’ve found the medical hierarchy methodically oppresses medical students who may be discouraged from thinking independently or questioning their superiors. Some for the first time in their lives fear asking questions during medical training. Our trusted anthropologist writes:
“Within the U.S. medical culture, age, and concomitant status categories (medical student, extern, intern, resident, etc.), usually confer greater authority and greater power. As a medical student, the opportunity to affect peer and faculty behavior is minimal, and the well-documented passage from humanist to cynic occurs. Medical students are low in the professional hierarchy, and behave accordingly. For example, rarely do medical students display disagreement and displeasure to their medical school clinical faculty. As student physicians increase in age, credibility, and credentials they gain the right to assert their opinion. Innovativeness is not customarily rewarded medical student behavior. Only with the acquisition of clinical experience can the opportunity to innovate occur.” (page 145)
Physician-Physician Distrust
The anthropologist found that frequently physicians use “alienating humor” to converse with one another explaining that “much of the humor was at the expense of patients, at other specific physicians or services, at psychiatry or medicine in the surgical domain and vice versa, or commonly placed one physician in a subordinate position. (page 122)
“Internists rarely requested psych consults and had ‘disparaging remarks about the entire psychology and psychiatric services.’” (page 120)
“In medicine, the surgeons claimed that ‘heroic actions are rare in the medical service.’ The surgeons claimed that chronic care is the ‘ballpark of the internist.’ The internists criticized the surgeons as ‘one night stands’; ‘going in and cutting as spectacularly as possibly while we have to do the painstaking clean-up work.’ The ideological differences between internists and surgeons are well known. They begin in medical school, and are strongly reinforced in informal contacts between surgical and medical residents.” (page 253)
“Internists commonly described surgeons as ‘technicians’ and as ‘heroic princes.’ Surgeons referred to internists as ‘boy scouts’ and ‘pill pushers.’ I regret that I did not keep a systematic record of the insulting metaphors that were used by each department; the underlying feeling of division and competition was pervasive in the institution.” (page 141)
After reading the anthropologic study, most shocking to me was the resistance of physicians to befriend one another and how doctors actively attempted to “suppress physician friendships.”
“Many physicians had doubts about the strength, intimacy, and candor of their friendships. Often they mentioned that they worried whether non-physicians were friendly because of the security the physician offered those friends when they were in medical need. Some of the physicians, notably those in the surgical service, were quick to point out that they deliberately made every effort not to build intimate friendships with other physicians.” (page 121)
Of course the “attitude of the hospital’s administrative leaders were totally non-conducive to friendship formation.” complained physicians. (page 122)
So my question today is how is it even possible to create a uniform medical record system with so much animosity and distrust?
Physician Resistance To Innovation—A Paradox
I believe the origin of physician resistance to innovation is threefold: 1) Fear of change (universal among most people), 2) Territoriality and 3) Culture of distrust.
Our anthropologist points out “ . . . the medical record has traditionally been called the doctor’s record, and progress notes were labeled as doctor’s progress notes. If the record is to be considered the patient’s record and notes labeled as progress notes (with team participation), two areas of resistance can already be identified.” (page 261)
Medicine is conceived as “a discipline receptive to change—constantly and carefully evaluating innovations for better ways to help the patient. Paradoxically, any changes on the traditional doctor-patient relationship, on fee-for-service transactions, on review of medical care by non-physicians (or by peers), and on the demystification of medical terminology are fought vigorously.” (page 267)
On the one hand, the media reinforces “the desired self-image of dynamic medical and research progress” while “higher education is notoriously conservative and resistant to change”—especially in medicine. (page 268)
So that’s the backstory to electronic medical records. Now let’s look forward . . .
Why Medical Records?
The original purpose of a medical record was to simply record the patient encounter. The therapeutic relationship that flourished organically over time. Appointments were face-to-face with eye contact (no staring at a computer screen) and real conversation that allowed the doctor to get to know the patient’s philosophy, desires, culture, and address their medical needs in the context of their real life. Physicians back in the day could do that with no staff as a solo docs in a simple one-room neighborhood office—often right inside their homes. The record could be one sentence on one index card. Before hospitals dominated the medical scene, all records were primary-care outpatient-based and involved two people—doctor and patient.
Now the modern medical record has been overrun by so much complexity and competing interests that the doctor and the patient risk losing the very foundation of their sacred and healing relationship. The medical record system is a multi-page/multi-window experience that is often neither intuitive nor ideal for any specialty. Tertiary-care hospital-based record systems amass so much information from so many sources that sometimes what you are looking for can’t be found. So the SOAP note has turned into the APSO note so we can locate the assessment and plan amid all the crap entered by medical staff. Except maybe housekeeping, everyone seems to have the ability to add to this ever-more-complex medical record.
Medical records are now not so much used for the patient encounter but to document things done to the patient in ever-shorter visits with unreasonably lengthy documentation required for billing and coding in case of auditing or lawsuits. Of course, the sheer volume of material required for documentation requires more face-to-screen time with the computer than face-to-face time with the patient—and sadly encourages dishonesty and outright lying in the official record with boxes checked for questions never asked and entire sections cut and pasted over and over again on a bloated record based on distrust.
Doctors distrust patients who may sue them so the medical record expands due to CYA medicine and excess labs, tests (and additional documentation) increasing medical expense. Patients distrust doctors and don’t share what’s really on their minds (how can they in 7-minute visits?). Many patients have written me seeking help because their doctor profiled them in the medical record as a “drug addict” or a “bad mom” or “noncompliant” and they can’t get that phrase off their records. Even if they change doctors they feel labeled and experience discrimination. Let’s not forget these medical records are stored in the cloud and on systems that can crash and be hacked in a moment with all patient records and physician NPIs and social security numbers leaked to the world.
So if the truth of a patients life is no longer captured by a medical record due to distrust and bureaucratic bloat, what next? Meet some doctors who have actually fallen in love with their medical records
Welcome Your Ideal Medical Record!
You can actually create an ideal medical record! I did nearly 15 years ago. Back in 2004, fed up with assembly-line big-box medicine, I launched an ideal medical clinic designed by my community. And I created my ideal electronic medical record! I originally intended to buy a real EMR, but while searching for a system, I started my own electronic records on my apple laptop and turns out the system I created with primitive text edit files (now on password-protected Pages files) was better than anything that I could buy! I accidentally created my own ideal medical record and have been practicing happily ever after since 2005 having spent nothing on an EMR! My IT buddy claims that my electronic record may be one of the most secure in the country! How ’bout that?
Since 2005, I’ve helped hundreds of doctors launch ideal medical clinics—and find or create ideal medical records that work for them. One part of the ideal medical clinic experience is to enjoy—even fall in love with—an ideal medical record. So I encourage all doctors out there who are struggling and fighting with a medical record system you don’t like to STOP—and do it differently. Rather than continue weird workarounds to be more efficient and play better with a flawed medical record system, I’m encouraging you as an independent, entrepreneurial physician to create YOUR ideal medical record—even if just a weekend science experiment. You can even go back to paper or index cards if you want! You are the boss. Do what’s ideal for you and your patients.
Four Impediments to Ideal Medical Records
1) Third-party intrusion that treats doctors as economic units and patients as widgets. 2) Competition among health systems that won’t do what’s in the best interest of the patient. 3) Infighting among doctors. Academic vs. community, tertiary vs. primary care, MD/DO vs NP/PA vs. ND so is it really possible to have a system that works for everyone? 4) Patient distrust. Ask yourself if your current medical record system allows complete trust and transparency in your relationship with your patient? Is your medical record in any way impeding the ability of your patient to disclose the full truth of their life experience? If so, you must change!!
Here’s how a great idea can turn into a shitshow. I asked several doctors, “What’s the most ridiculous thing you ever had to do on EMR?” 1) One hospital required progress notes to be dictated (could not be typed) into their horrific EMR. Notes would take several days to post, so most consultants (and even the primary team) had no idea what was going on with the patients. 2) Our EMR is a black screen with green print. 3) When I was working as an emergency physician, they switched EMRs. I was then told I had 1700 charts to complete which I had already done in the previous EMR. I refused to do this. They called security to escort me off the premises. 4) To dictate, have to use internet explorer. To prescribe have to use Firefox. So, to do one note have to use two browsers at a time. Frequently when saving what has been typed, I get a spinning wheel and then receive a message that there is an error and everything done is lost. 5) An gynecologist lamented a standard template that noted “gravid uterus” on every normal exam. She had to edit it to a default normal on every single note. 6) Family doc says: “Spent months doing stage 1 MU, correcting problems for EMR company. Finally switched to different EMR after much frustration then got audit from Medicare looking for MU screenshots from Old EMR which could not be done on read-only status. Wrote a letter of explanation and was told to pay back MU ‘bonus’ of $36K on top of the $75K we spent on IT support and staff time to be able to attest. Total loss over $100K not counting a year of my time away from my kids.” 7) Surgeon asks, “Isn’t the primary purpose of EMRs For the government to more easily track Medicare fraud?”
5 Ways Distrust Undermines Medical Records
As a patient, have you ever wanted a doctor to keep some things you share off the official medical record? Why? In one word—discrimination. Fear of discrimination makes comprehensive medical records a joke.
1) Pre-Existing-Condition Discrimination. “My entire GI tract was excluded based on one episode of stomach pain treated with antacids,” a friend reports. “Exclusions can go on for years. The Affordable Care Act greatly improved this, but if that were overturned?” he asks. Patients frequently request to use fake names or exclude diagnoses from chart. Genetic tests (like 23 and me) are done under assumed names (otherwise a gold mine for insurance companies to jack up rates). Doctors are often careful not to label a patient with a working diagnosis to prevent insurance company discrimination.
2) Drug-Use Discrimination. Due to federal government’s inclusion of marijuana as an illegal schedule 1 narcotic, even suggesting CBD oil can be seen as violation of regulations. In NY doctors say they cannot counsel patient to use cannabis products or any other schedule 1 under DEA regs or it’s a violation of their DEA license. Of course, any number of illicit and legal drugs are kept off the official record for a variety of reasons—including mental-health discrimination (see #4).
3) Sexual-Orientation Discrimination. Lesbian, sex worker, polyamorous relationships not declared to doctors leading to obvious difficulty is screening/risk reduction conversations and exams.
4) Mental-Health Discrimination. Physician mental health is a huge taboo for doctors. One physician writes:
“I’ve seen good friends denied disability and life insurance policies tiered to same as 1 pack per day smokers because of history of depression (even well controlled with meds). Coercive and unnecessary referrals to Physician Health Programs. Sometimes boards take away the physician’s freedom, dignity, even license. Agencies and some medical boards don’t differentiate between illness and impairment. They apply policies of the American Disability Act and HIPPA differently to physicians in the name of ‘protecting public safety,’ licensing agencies, corporate medicine authorities, and many other powerful bodies can mandate release of such information without even the slightest sign or evidence of impairment. One recent example is our physician ER colleague who had to fight 10 years for her license due to disclosing feeling the Baby Blues at work. discrimination SHOULD NOT and DOES NOT only apply to a few listed categories of race, gender. Discrimination due to one’s profession is also a type of discrimination that is not addressed enough when it comes to physicians’ rights.”
Veterans/firefighters/paramedics mental health is also an issue as it related to discrimination based on employment. The fear of denied benefits based on PTSD. Many will only talk off the record and away from prying eyes and ears…no paper, no pens, no electronic devices. Some have suddenly been fired after PTSD evaluations.
5) Legal-System Discrimination. Release of medical records to attorneys can cause huge problems so patients avoid disclosing their most intimate traumas. Workers compensation attorneys deny claims based on previous alcohol or drug use or experimentation. Medical records are a common point of attack in divorce, criminal, civil and child custody proceedings. A slip-and-fall case can lead to big disclosures in court displayed right on the big screen in front of 12 peers and anyone else in attendance (these court cases are public, by the way)
Dx: EMR TMI
“Our EMR’s are overly inclusive with way too much personal information on the summary sheet,” reports one doctor, “which can be viewed not only by other doctors but their nurses and nursing assistants and any one else who has to open your chart to take vital signs or document history. That’s a lot of eyes on your personal info. Curious staff can scroll through the whole thing right in front of you and make faces without realizing it and people talk.”
“My doctors at a clinic put my dependence on government housing in their summary of my medical history when referring me to another doctor,” says one patient. Another woman says, “I always laugh when I read privacy policies, knowing that they are lots of exceptions.”
Discrimination EMR Workaround -> Fake Names/Fake Charts
Doctor reports, “Our local hospitals routinely use fake names for VIPS and I have been asked to use a fake name to protect the patient from being shut out of life and disability insurance plans.” I personally know of medical students admitted under fake names for psych admits. How destabilizing is that for someone who is already having delusions? A psychiatrist reports placing “high-profile athletes” on fake charts with fake names and even keeping those charts with her and not left with other charts in clinic or on EMR when working corporate medical jobs. Patients request the use of fake names to order meds to avoid problems getting life insurance.
My Challenge to YOU—those of you no longer willing to submit to a system that is failing . . .
We are undergoing a transition in health care from centralization to decentralization, from tertiary care back to more primary care, from production-driven to relationship-driven care. Doctors and patients are not well served by big-box assembly-line medicine—it’s dangerous and unsustainable emotionally, spiritually, even financially. There is no way in the world you can deliver the kind of care that you dreamed of delivering to your patients in 7-minute increments while documenting on a computer system for twice as long as your face-to-face visit. I’m encouraging you all to think way out of the big-box. Your life is too big for your little cubicle. Your patients need the real you and your expertise. What medical record would allow you to create the ideal encounter in your ideal clinic with your ideal patients and help them heal?
I’m spending the next two weeks helping physicians create their most out-of-the-box ideal medical record for themselves that makes every patient encounter pure joy. I will report back our success!
My 3 Challenges For YOU. Ask yourself . . .
1) Should your ideal medical record be specialty specific? If you could create a specialty-specific medical record for your ideal clinic what would it look like? For your flow? For ideal patient encounters?
If you’ve ever felt that EMRs were created by people who according to one doc, “no fucking clue what your job is,” then why not create your own? If you don’t want to talk about blood pressures and arrhythmias and how many bags of NS given, and want to talk about mood, thought process and content, hallucinations, delusions, and suicidal thoughts, then go for it! What what would that medical record look like?
2) Is there a section/question you wish were in the medical record that is not? Maybe in contrast to the problem list, you prefer personal strengths and triumphs or a timeline of life events. Do you care about hobbies? Want to know what patients do for restoration and joy? Don’t want to limit social history to just tobacco and alcohol? You want details on relationships and abuse history, occupational and recreational exposures risk? Want a spiritual section or a diet history? Go for it!
3) Do you want to try paper charts? Lots of ideal docs in ideal clinics LOVE their paper charts!!! I really had no idea how many doctors I truly admire that are loving their paper charts in successful practices—and some still accept insurance! Create an ideal paper chart as a fun weekend science experiment.
Need help designing your medical record system? Contact Dr. Wible here.
In summary, we have a failed medical record system and slapping BandAids on something that is not working to try to make it work is not the answer. Maybe one of you innovators will come up with a med record that can be used by many more docs to bring them joy too! WE ALL NEED YOUR INNOVATION!
Now go have FUN! Then definitely share your successes! If you doubt that this can really be done, listen to these doctors who are living their dreams!
Join our fast-track and launch your dream clinic in less than 30 days.
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Physician reveals how US exploits J-1 visa doctors for cheap labor—resulting in doctor suicides, medical mistakes, and patient deaths.
Dr. Corina Fratila: In this completely foreign country, I came in pursuing a dream—and you’re let loose in a very high risk, intensive care unit, critical care unit, taking care of all these people being responsible for all these lives—having almost no idea what you’re doing.
Then the night ends up with this person coding, the other person coding, and you end up sticking yourself with a big-ass needle and getting who knows what? You started the shift at eight in the morning, and then you would finish the shift at four, five in the afternoon, the next day. So, that’s 24 plus 10? 34-hour shifts times three, that’s 102 plus in between, of course, you would work regular hours.
Dr. Pamela Wible: 126 hours per week.
Dr. Corina Fratila: About 126.
Dr. Pamela Wible: Were you working with mostly J-1 visas?
Dr. Corina Fratila: I’m Romanian, I had two of my best friends, one was Italian, the other one from Kosovo. People from Germany, from Lithuania, from Serbia. You come here to get training. You come here to get away from whatever political system or whatever stuff is going on at home—to pursue a dream. You come here on a J-1 visa. You end up in this residency program that throws you to the wolves in the ICU. The after you’re done with residency in order to stay and finally maybe build a family, or make a living and be a real doctor, you have to go to an underserved area for seven years where you don’t know anybody. Again, start all over and go through this purgatory in order to eventually be able to go wherever you would like to set up.
My residency program, I thought they were good to me, they were good to my friends. I think it’s just the system. The way they pull somebody out of nowhere and just throw them in the ICU. I thought that was extremely traumatic—that’s extremely irresponsible.
Eating was not at the forefront of anybody’s mind. Or sleeping. Of course, when you were on call in the ICU, you didn’t even hope to sleep. When you’re on call on the regular internal medicine floor, then you would sleep maybe for 15 minutes before a nurse would call you to tell you that patient needs an enema or a Dulcolax. You had to sleep with your beeper, you had to be . . .
Dr. Pamela Wible: Ready to jump.
Dr. Corina Fratila: Ready to jump, yes.
Dr. Pamela Wible: Do you think as a result of this working 126 hours, poor sleeping and eating, and poor supervision for some circumstances that you and others were placed in, do you think patients were harmed by medical mistakes?
Dr. Corina Fratila: How can you even think straight after even after 12 hours of nonstop work. You’ve been in a sleep-deprived state for so long. I don’t even think I know what mistakes I made. I didn’t have time to process all that. I’m sure that mistakes happened not only every day, but multiple times a day.
Dr. Pamela Wible: In the ICU?
Dr. Corina Fratila: Yeah.
Dr. Pamela Wible: Life-threatening mistakes for some people.
Dr. Corina Fratila: Absolutely.
Dr. Pamela Wible: Did you question why this was happening?
Dr. Corina Fratila: I didn’t question it. I just thought I had to survive. I just had to make it. How could I start questioning? This is what I think now—if I stopped and started questioning, I wouldn’t have been able to go on. Then I would have had to go back to my country. My parents would have asked, “Why are you back? What happened to you? Why are you changing your mind after you invested so much in this? Now you’re just giving up?” There was no way. I mean, I had to finish it. I had to start and finish, and I had to go through it. What questioning? This is the system. Who can afford to stop and question? And then, if you start questioning, what options do you have as a foreign medical graduate? “If you don’t like it, go back, okay? You don’t like it? You came here by your volition, you don’t like it? Go back. Who’s stopping you? We’re not stopping you. We have tons of other medical residents lined up. Other foreign graduates lined up to take your spot.”
I think now that if myself or one of my loved ones end up in an ICU, I would consider them dead. I mean, if they’re in such a situation that they’re that sick and they end up in an ICU with fresh residents and interns, I would just close the case. I would be, “Okay, there’s no hope of surviving here.”
Dr. Pamela Wible: How tragic for the resident to be an accomplice in poor medical care, possible death of a patient, and for patients to come to the hospital expecting that they can get good care, yet this is the norm in teaching hospitals.
Dr. Corina Fratila: Yeah, I’m pretty sure.
Dr. Pamela Wible: I know a lot of J-1 visa suicide cases, some fired from residency and deported back to their countries. In residency, people are abused. I just call it abuse and human rights violations. Do you agree? Do you think this is in the realm of human rights violations for patients and residents to be treated this way? This level of sleep deprivation?
Dr. Corina Fratila: Well . . .
Dr. Pamela Wible: Or you think I’m too harsh?
Dr. Corina Fratila: I don’t think you’re harsh at all. I’m surprised that you’re the first person to ever raise this issue. I just learned yesterday that in Japan companies start investigating human rights violations when their employees work over 60 hours a week. So I don’t see in what way working 126 hours or 80 hours a week is not a human rights violation.
Dr. Pamela Wible: That’s two to three full time jobs, right?
Dr. Corina Fratila: Yeah.
Dr. Pamela Wible: A full-time job is 40 hours a week. So 126 hours a week, you’re working equivalent of three full-time jobs in a foreign country with people on the edge of life and death. Does that seem kind of extreme or unusual to anyone listening? Or is it a revelation? Sometimes I feel like when I share this, it’s a revelation to the person who’s reflecting on it. You know like they never thought about it that way.
Dr. Corina Fratila: Yeah, so I think it’s a reflection of the health of this country. A reflection of the culture on health. If we cared (I‘m an American citizen by the way) if we cared about our health, these things wouldn’t be happening. If we cared more about health, we would ask when we have our loved ones in the ICU, in a teaching hospital, we would inquire, ”How much training did this person have? Where is the attending in charge? Where is the person who did a specialty in critical care? Where are they? Why is my father under the care of . . .”
Dr. Pamela Wible: Of a woman who just arrived here from Italy just learning English. Is there a language barrier too?
Dr. Corina Fratila: Of course, yes of course. Especially the first few months . . .
Dr. Pamela Wible: The first few months, somebody here who doesn’t even have a complete handle on English is working in the ICU . . .
Dr. Corina Fratila: Sleep deprived . . .
Dr. Pamela Wible: For equivalent of three full-time jobs, getting paid minimum wage, with American citizens who are probably the ones hooked up to the ventilator entrusting their care to these people. And hospitals allow this, condone it, and make money from it. How do you feel about that?
Dr. Corina Fratila: It’s beyond appalling. It’s like the worst nightmare that you could imagine. And how can there be any physician-patient trust? How can you build a healthy system? How can you have anybody have any trust in healthcare when when the foundation of healthcare is completely rotten? Why would we expect to be healthy? Why would we expect our patients to be healthy? Why would we expect the whole nation to be healthy? When this is the foundation of teaching doctors . . .
Dr. Pamela Wible: None of these people coming here expected to be placed in such an unfair situation, that’s quite scary.
Dr. Corina Fratila: Yeah, it’s traumatic.
Dr. Pamela Wible: So you obviously were caring for people who ended up dying on your shifts.
Dr. Corina Fratila: Sure.
Dr. Pamela Wible: Is there any help when you lose a patient? You have to tell the family. You have to deliver some bad news . . .
Dr. Corina Fratila: There was no support, there was no such thing. You’re supposed to toughen up and just move on with your day. Of course you have people dying. That’s why you’re a doctor. People will die. Right? You’re just supposed to be tough and just move on. Who cares that you’re going to have post-traumatic stress disorder for the rest of your life. That’s not the hospital’s problem. That’s going to be your life. It’s your responsibility. No?
Dr. Pamela Wible: Do you feel like you have PTSD from things that you saw?
Dr. Corina Fratila: Oh, completely. I lost my sleep 20 years ago. And it all roots back to the trauma in residency.
Dr. Pamela Wible: Which has lifelong implications for not just your mental health but probably physical health.
Dr. Corina Fratila: Absolutely. Panic attacks, anxiety, depression. I’ve never had any of these problems before. I didn’t talk about it to anybody because the stigma associated with mental health. I felt if I talked to anybody I would be considered weak and maybe I would lose my residency position.
The beginning was very hard because the phone calls, specifically. You know it’s much harder to understand somebody on the phone than it is in person. You can’t really read their lips or you can’t really read their facial expressions. So I remember the first phone call that I got. I got paged when you still used to carry those pagers. So the nurses would page you and then you saw a number you had to call the number back.
The nurse at the other end of the line, who was also a foreigner, somebody from the Philippines would tell you something in her Filipino accent, and that would go into my Romanian ear, and at the end I was too embarrassed to say I didn’t understand. I just said thank you. I hung up the phone. Once I hung up the phone, I realized I had no idea what she just said to me. I had no idea. And I had to somehow figure out what she meant to convey.
Dr. Pamela Wible: How did you do that?
Dr. Corina Fratila: I called the number back.
Dr. Pamela Wible: And . . .
Dr. Corina Fratila: And I got a different person.
Dr. Pamela Wible: With a different accent? Into your Romanian ear . . .
Dr. Corina Fratila: So that first phone call, it’s still a mystery to me. My first phone call as a medical resident, I still don’t know what the nurse wanted to tell me. So I hope that poor patient made it. The one that she was calling me about, that she didn’t die, you know? But, I mean that was my first instinct. To just pretend like I understood, say thank you, hang up and then realize it—I was lost.
Dr. Pamela Wible: Probably not the only one who’s feeling that way.
Dr. Corina Fratila: Most likely not the only one. Most likely one of the thousands.
If you are a physician struggling and need confidential help, please contact Dr. Wible here.
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Wildest keynote! Singing and dancing across stage with 4000 doctors in Las Vegas. Rowdiest audience ever (at a medical conference at least). Read transcript and/or download & listen to MP3 below:
. . . And now what we have all been waiting for, our keynote speaker on today’s theme of mental health. I give you Dr. Pamela Wible. Born into a family of physicians who warned her not to pursue medicine. Dr. Pamela Wible soon discovered why. In order to heal her patients she first had to heal her ailing profession. Fed up with assembly-line medicine Dr. Wible held town hall meetings and she invited citizens in her community to design their own ideal clinic. Open since 2005 her community clinic has inspired Americans to create ideal hospitals and clinics nationwide. Her innovative model is now taught in medical schools and hundreds of ideal community clinics have opened all across America even into Canada and New Zealand. An inspiring leader and educator of the next generation of physicians, Doctor Wible has been named one of the 2015 Women Leaders in Medicine and the “Physicians Guardian Angel.” Thank you for joining us Dr. Wible.
To be real. It’s got to be real. All right. Wow. How refreshing is it to be in a room with 4000 independent innovative thinkers who are disrupting the medical system. Let’s hear it for you guys. And this is a medical system that needs to be disrupted because our medical system (as you know) is endangering the lives of patients right now—and physicians. Think about it. How weird is it that with the highest suicide rate of any profession how can physicians actually lead a longevity movement. Does that make any sense when we’re losing so many of our brothers and sisters to medicine?
Among medical trainees suicide is the number one cause of death today. I’m pretty much steeped in this topic. It wasn’t necessarily clear from the introduction but I’ve been running a suicide hotline, a free suicide hotline for doctors for six years. I’ve spoken to thousands of suicidal doctors. I have a very deep understanding of physician psychology and I have personally investigated more than 1100 physicians suicides. But not to worry, my talk’s going to be really inspirational and uplifting because weirdly through the process of investigating all of these suicides I happened to stumble upon the fountain of youth for physicians—an anti-aging elixir for all health professionals.
What I discovered is more potent than any kind of hormone you could prescribe—and works faster. Even though I’m a big fan of fasting this is way better than any of the fasting protocols. In fact, with this fountain of youth that I discovered for health professionals you might as well just skip the vaginal rejuvenation and forget about stem cells for your erectile dysfunction. When I share this with you your libido will go through the roof. So anyone interested in this? Raise your hand if you’d like to know. All right. Here we go.
It’s about finding your bliss. So at one point you actually felt a lot of excitement about pursuing medicine. Some of you knew since you were three, four, five, even eight years old that you were destined to be a healer on this planet. You were so excited. You dressed up like a doctor for Halloween. You told all your relatives you’re gonna grow up and be a doctor—and you became a doctor. I know many of you were super excited when you got your acceptance letter to medical school. Does anyone remember like how exciting that was?
But then after that we went through this indoctrination process. I think a lot of us lost touch with this bliss thing. And so I want to just share how you can get your bliss back. But first I want to ask . . . there’s probably some of you that are super blissed out in here. I need to figure out who you are so I have three questions that I’m going to ask but you can sort of just privately honestly answer to yourself.
1) Are you the type of person that’s like super energized, like you cannot wait to get to work on Monday morning? Is anyone already like that? (laughing) Just keep it to yourself right now but think about it. Are you the type of person that like jumps out of bed before your alarm clock goes off on Monday morning, can’t wait to get to work?
2) Are you having so much fun at work that you would do it for free? Everyone’s laughing. All right. That’s the second question. (still laughing)
3) Do you love your job so much the thought of retiring is horrifying? You just don’t want to retire. Has anyone in here answered yes to all three of those questions? (laughter) Raise your hand. Whoa look at that. Look at that.
There are people that are super insanely blissed out right now. Take note. These are people that should be on stage next year because they have something to teach the rest of us about why they’re so excited. Okay. How many of you answered yes to at least one of the questions? My goal is for all of you to answer yes to all three questions. This is not like a made-up fantasy in my mind. People are actually feeling this way. I’ve met and helped hundreds of nurse practitioners, PAs, physicians recapture this bliss and I want all of you to feel it too.
But I believe what obstructs us from being able to do this is many of us think that we have something called burnout. If you feel like you might have burnout or you’ve had burnout in the past just raise your hand if that’s something you think you struggle with. Because what I’m going to do here is help everyone beat physician burnout. I have like a super-quick solution! In three minutes we’re gonna just get it out of your system—kind of like a group colonic cleanse—we’re just going to get rid of it. (laughter)
Honestly (I hope you don’t mind if I curse) I think burnout is bullshit and I don’t think it really exists, it’s a made-up term. I don’t know if you know the history of the word burnout but let me just tell you burnout is slang for end-stage drug addiction in 1972. Isn’t it weird that now we’re labeling the majority of doctors with burnout in 2018? Does that make any sense at all? Doesn’t make any sense.
Physician “burnout” is actually a misnomer. I think it’s a label that people turn to because of mental health stigma. They didn’t really want to say they’re depressed or suicidal so they’re were burned out. Psychologists popularized it on Oprah and TV and everyone was burned out. Housewives were burned out. Waitresses, everyone was burned out. This word holds no real precise meaning. It’s just a trash can label—not really even a diagnosis, a made-up term that is used as psychological warfare on physicians to control us. I’m being real. Telling you the truth. Victim-blaming term.
That’s why I don’t use it because on this suicide hotline that I’ve been running when I talk to physicians and I ask them when they first felt like they became suicidal or things weren’t quite right, it’s when somebody told them they were burned out or inefficient or somehow they were labeled as not fitting in. When those sorts of thoughts start spinning around in your mind you think well maybe I don’t fit in and maybe there’s something wrong with me and maybe I’m just not going to make it as a doctor and maybe the world will be better without me. This victim-blaming term is not helpful. We’ve been talking about burnout for like four decades—with no solution in sight. The reason why we don’t have a solution is it’s a misdiagnosis and a bullshit term. So the quickest way to get over burnout is to stop using the term because it’s a cover up for something much more serious going on in medicine.
So does anyone ever feel like this? Raise your hand if you feel freaked out, overwhelmed, paperwork, all these rules. This is not burnout by the way. This is abuse. (clapping and cheering)
And feeling the love in your heart for God while getting in a yoga position is not going to help you. Yoga will not help human rights violations and abuse. Yoga does not help prisoners of war. Yoga hasn’t helped people out of concentration camps, refugee camps. There are people suffering from human rights violations all around the world. And while meditation could I guess get you in a better state of mind before and during abuse, I just think it’s totally misdirected and I guess you do too because you were clapping. So we’re on the same page.
So I’m just going to lay it to you. Physician burnout it’s a smokescreen. It’s a coverup and it’s a coverup for human rights violations against our healers on this planet. And I’m going to just go through the details so you know a few of the categories of human rights violation because people just have trouble thinking of doctors in white starched coat walking around as suffering from human rights violations.
So let me just break it down for you. There’s a term called karoshi. Who’s familiar with karoshi? Have you heard of that term? It’s Japanese. Means death by overwork. This is actually a condition. Families can sue the employer financially liable for killing their own employees by overworking them (when they die of heart attacks, strokes and they’re found dead like by their computer because they’ve been working for so long).
Do you know the cutoff for the number of hours per week that will get your employer fined if you die from overwork is—60 hours? Just 60 hours is the death by overwork limit in Japan/Asia. ACGME thinks it’s fine for residents to work 80 hours a week! And that as an honor-system cap that nobody follows for the most part unless you have a really good residency director that likes to follow the rules. Residents in the USA right now may be working 100 hours a week, 120 hours a week. I know because I’m on the phone with them and they tell me what’s going on and I even know people that are working like seven days on, seven days off as hospitalists. So that’s like 168 hours straight. That is a death-by-overwork situation. As a result of working 168 hours per week (which is actually the number of hours in a week!) you’re probably sleep deprived. And sleep deprivation is really dangerous.
Three examples that I’ve heard recently. A physician actually ended up in status epilepticus, like in the ICU with event like almost dead from seizures as a result of sleep deprivation and overwork. Well, luckily she came out of this alive, went to a follow-up appointment with a neurologist who basically said, “Oh you’re a resident, we see this all the time in the residents.” So that’s normal, that’s okay to lose a few—collateral damage from seizures.
Then I was speaking with a woman who is six months into her psychiatry intern year. Cush compared to surgery. Right? She tells me in the first six months of her psychiatry residency she only saw her infant daughter for six waking hours of her life. Does that piss you off? Because it pisses me off. And this is not only causing a problem for her with sleep deprivation, it’s maternal deprivation on the child. I think we’ve already done those experiments and they’re not good. This is going to cause problems for the next generation. When you treat workers like this. These human rights violations are perpetuated in first-world brand-name hospitals.
One doctor was so sleep deprived in residency, he actually fell asleep while trying to start an IV on a comatose patient and they found him like in bed with the comatose lady. Like this is how sleepy people are. This can’t be good for you.
And then there’s bullying on top of that. They’re telling you you’re an idiot, you’re too slow, they’re writing you up as unprofessional because you said that maybe you need to sleep or something like that. They’re throwing scalpels at you in the OR.
Sexual harassment. I hear about this all the time. I mean you guys might not know so much about it as it’s mostly women who call to tell me some such things as “they’re groping me” and “the guy in the OR who’s my attending is walking by me and rubbing against my breasts.” If she complains (this universally happens, by the way) she is written up for unprofessional behavior. They blame the medical student. Tell her she is a difficult student and then preserve the career of the guy who’s the surgeon bringing in the money. Throw the woman friggin right under the bus. Is that what you want going on in our profession? This is happening. This needs to be dealt with. Sexual harassment is a human rights violation.
And then one of my favorite—food and water restriction. I’m really into fasting but fasting is contraindicated if you’re diabetic and a number of other conditions I saw on the slide (in an earlier talk). Add residency up there too. This is not a good time to be on an intermittent fast for like seven years. Sleep-deprived hypoglycemic doctors are wandering around hospitals trying to steal apple juice and crackers from their patients or from the nurses station. They’re in terrible shape. The water restriction before prolonged surgeries, they’re withholding water so they’re not having to leave the surgery during the 10 hour case. As a result, doctors are getting kidney stones, having all sorts of dehydration issues—collapsing during surgeries.
Here’s an example of what happened when I was a third-year medical student during a C-section. I’m sure I wasn’t doing anything too important other than standing there with another third-year medical student. Then she collapsed onto the floor and they came in and took her blood sugar (she happened to be a little overweight and on Slim Fast, bad idea to be on Slim Fast during medical school I think). But anyway her blood sugar was 26. She was out. Now I was hyper as can be. For me, fasting is a lifestyle I think because my parents are both physicians and didn’t have time to feed me. I’m not kidding like my first family picture with my parents was when I was 45. They’re super workaholics. I mean seriously like I’m an expert at physician psychology. So anyway I was just like, “Hey, while you’re here since I’m spazzing out and bouncing off the walls like I wonder what my blood sugar is?” They took it and it was 24.
I made it through medical school on organic carrots, kale and lentil soup. I never used any caffeine. I was like super pure then. Isn’t that amazing? But I made it through with a blood sugar of 24. I don’t know, that doesn’t seem healthy either.
I was vegan for 22 years which was very healthy for me. I just thought I’d throw this in because it’s kind of an interesting story. So I didn’t even own a refrigerator for 10 of those years because I grew all my food in my yard. So I was like super-hard core vegan. Now I’m vegetarian and that was mostly because I had a foster child that moved in and I didn’t want to have food fights with him because I knew we were going to have other drama.
Racism is also a human rights violation. Particularly bad, the darker your skin and if you’re J1 visa and you’re female. There are clusters of J1 visa female suicides at some of our finest first-world medical institutions.
I want you to look at this list—actual human rights violations that are happening every day in our medical institutions to our brothers and sisters in medicine. Certainly the combination of these could cause karojishi which is an actual Japanese term that means suicide by overwork. That’s why physicians have the highest suicide rate of any profession.
We should be completely ashamed that this is going on in our hospitals. Covered up by the AMA. I was supposed to speak at the AMA at one point and they retracted the speaking engagement because they were “uncomfortable with physician suicide.” We’ve known that doctors have a high suicide rate since 1858 in the UK when it was first reported. So I’m just bulldozing ahead because it doesn’t seem like there’s many other people that are interested in taking it on and I’m tired of watching everyone die. I’ve lost both the men that I dated in medical school to suicide. Not while I was dating them. When they married other women. Left those women and their children behind.
I was suicidal myself as a physician and I survived that in 2004. So I live to tell the story of suicidal physicians—channeling the messages of those that we’ve lost by suicide. Three men in my town died by suicide in just over a year and I live in a small beautiful town where everyone holds hands and sings Kumbaya and goes to Farmers Markets together. In Eugene, Oregon. Top-rated doctors. The prime of their careers. So I wonder how many doctors are dying by suicide in Chicago? Philadelphia? New York City? Doctor suicide is a huge underreported problem.
So here’s my story. Basically I did everything right. Had a 4.0 GPA. I followed all the rules. I worked insane hours. I had no personal life. I did everything right. And I did this so I could help and heal others. As a result my life totally sucked. I was in a big-box clinic. See that little drawing of somebody saying help, trying to jump out. That’s me! Trying to get out. See two rows down from the top.
Yeah my life totally sucked because I was double booked. We didn’t learn about that in residency. That’s where they stick two people in the same slot for a 15-minute appointment which makes it a seven-and-a-half minute appointment. So seven-minute visits, unhappy staff, everyone’s exhausted. There were embezzlers in the clinic. You can’t really keep track of embezzlers rushing through seven-minute visits. So that’s a good time for someone to come in and steal all your money. Fraud and theft and depression. I felt like a lot of doctors feel—they feel like they’re locked into criminal rings committing insurance fraud just to stay afloat. Just being honest here.
Assembly-line medicine made me suicidal. My suicidal thoughts were 100 % occupationally induced. A lot of the 1100 doctor suicides I’ve researched are largely related to professional stress. And by the way, if they have personal issues the origin is probably professional stress because if you work 120 hours a week is your wife or husband going to be really happy with you? Probably not. Are you gonna be a good parent? No. So if you’re having problems at home it still tracks back to your career. Assembly-line medicine is absolutely dangerous. It’s dangerous and unsustainable; emotionally, physically, spiritually, financially for the patients—and for us.
And we need to just jump out of this as soon as possible so I commend you all. How many of you have jumped out and started your own practice? Woohoo!! You are part of the solution. Thank you.
Just to be clear again, meditation, yoga poses, and swing dancing is not the answer. Reason why swing dancing is on there is because I was at an AMSA convention and a wellness speaker actually suggested that the doctors and residents and medical students take up swing dancing to help their “burnout.” Like is that total crap? I mean how lost do you have to be to suggest swing dancing as the answer to human rights violations and overwork leading to suicide?
So how did this happen to us? Well, we had an inadequate medical education. I think you all probably agree because you’re here getting continuing medical education in things that you wish you would have learned in school. And you’re paying extra because your medical education lacked what you wished you would have received.
In medical school we basically learned the technical skills of patriarchal reductionist Western medicine. And we’ve got a ton of loans right we’re still paying off too. But we don’t learn any human skills. We don’t learn any business skills—a problem you might notice if you try to launch a practice or try to actually be a doctor. If you don’t have the human and business skills it sort of undermines your ability to even practice medicine properly with only technical skills (in seven-minute visits!)
So they teach you the technical skills and then they do this really interesting thing where they act like you have a lot of choices, like there’s so many options. Like what specialty do you want to pursue? Well, you could do treadmill OB. That sounds like fun.
You could do rat-race pediatrics, seven-minute visits with kids shoving needles in them.
You could do drive-by psychiatry. That’s really fun. That really helps. Yeah. Has anyone noticed that we have sort of a global mental health problem in the world right now? Well, drive-by psychiatry is not helping.
You could do assembly-line urology. That’s fun.
I like the next slide because look at his finger. There’s a better way. I have the solution.
I want you to understand if you’re feeling personally bad about where you are in life right now in your career I want you to know we were set up to fail. It’s not your fault. It’s not your fault if you’re not where you want to be right now with your income, with your love of the medicine. Not your fault. You were set up because medical education in its current form is an anti-mentorship program. You meet a lot of doctors you would never want to become. Is that true?
So as a result of losing our mentors in an apprenticeship profession we’re kind of just winging it—lost, like we’re sort of just out to sea. And so I want to help you. That’s why I’m here. That’s why they brought me. I think we need examples of people (like those of you who are insanely blissed, real doctors who’ve sort of figured it out and can lead the way like a sherpa up the mountain with a flashlight. People who know how to do it. I want to help you and here’s the challenge I have for you.
In less than 30 days you could be as blissed out as all the people that raised their hands in the room. You could have your dream … and some of you are looking at me like I’m insane but you could actually do this in less than 30 days. It’s not that hard. You could have your dream clinic. (FYI: if you want one-on-one help to launch happy to help you here).
I’m going to share my personal example of how I launched my clinic for $627. I launched my clinic. I’m making more than I made at my assembly-line job and it only cost a few hundred dollars.
And by the way—accidentally with no intention of earning more because I’m not even a money-driven person, I accidentally tripled my income. And I did this without turning anyone away for lack of money, in 13 years I’ve seen everyone who wants to see me as long as I have space in my clinic. And I make it work.
I did this by doing the right thing. This is not about two-tiered health care. Just taking care of the worried well or doing little gimmicks on the side to get people in and all this stuff that people do to try to generate money with ancillary services. I’m just actually providing really good primary health care. This is me doing house calls for the homeless on a street corner in my town which is not a big money maker but hey I have a lot of time on my hands now that I’m tripling my income, I can go hang out on a street corner under like overpasses and help people and hang out and talk and eat lunch with the homeless and do whatever I want. Which is awesome.
The coolest thing about it is when you’re self-employed you get to be a real doctor. Who wants to be like a real healer? Like reach your soul’s potential on this planet. And these are just little clips from news articles and shows because people find it really interesting when they meet a real happy doctor.
So my goal today is to share the wisdom that I have from 25 years as a doctor and 13 years in private practice in an ideal clinic. To give you the shortcut to your success. Help you reclaim your power as a healer. And get you back to being a real doctor and not an assembly-line worker. We’ve just got to stop with these big-box clinics, with this assembly-line medicine. This is not the way to practice, it’s dangerous for everyone.
And I have three secrets I’m going to share and I’ll go through each one separately.
Secret number one is how to launch your dream clinic in 30 days for less than $3000. You might be able to do it even for a few hundred. The reason why I’m sharing this is I don’t want anything to hold you back. Some people are like “Oh, I need a bank loan” or “I need a big building.” You don’t need anything, you could start right out of the gate. People are desperate. They need doctors. If you haven’t noticed the bar on customer service sucks in health care. All you really have to do is smile and be on time and have like two chairs and people will come and pay you cash. I mean really the need is huge. Then I’ll share secret number two—how to earn more seeing fewer patients and longer visits with no staff or interruptions. And number three—how to fill your practice quickly without spending any money on advertising.
So the first one, how to launch your dream clinic in 30 days for less than $3000. And those of you who already have your clinic launched, explore what I’m sharing now as an opportunity to redesign your current practice if you’re not blissed out. If you’re not currently blissed out and you are self-employed there’s still room for improvement and you still have a little ways to go to get to your dream clinic.
I assume most of you in here are not super specialized doing lung transplants and needing a helipad and tertiary-care hospital. Most of us are doing outpatient medicine. We’re cognitive specialists, not proceduralists by and large. If you’re a cognitive specialist that means all the important stuff is in your head which you paid $300,0000 in student loans to get. So that means you could pretty much run an office right here in these two chairs. You don’t really need anything else because you’re already smart. And what you don’t know, you can look up.
So what do you really need to start a clinic? Like if you really had to, if somebody basically said you had to start tomorrow and you didn’t have a choice and you had to do it. You would go to Goodwill or you’d pull two chairs out of your house. You’d bring people over your house or rent a space. You’d get a piece of paper, a pen and your stethoscope and if you’re a psychiatrist you could throw that out and you would be all set. I’m just breaking it down. I think we make this way too complex and the reason why it’s complex is you’ve got a lot of people making a nice passive income off your heart, soul and intellect and they don’t want you to understand that you could make triple the income with two chairs and a piece of paper. They don’t want you understand that. I’m just telling you the truth. Let’s get real.
Because the bottom line is all your patients really want—this is the secret sauce—this is the what’s been missing for those of you who are struggling trying to figure out what accessory things you’re going to add to your practice and how you’re going to do little gimmicks here and there, I want you to know the secret sauce is . . . YOU.
That’s what they want. They just want you. So you don’t need to do a lot of fluffy stuff here, there and everywhere. Just be the original healer that you felt called to be on this planet and people will line up in droves. I’m not kidding. This happens over and over again.
There are only a few ways where folks fail in launching their own clinic. If you have PTSD and you’re currently suicidal, it’s a bad time to open a wellness center because you need help yourself. I mean there are people who basically took all my advice but I didn’t understand how their untreated mental health issues could undermine their own clinic. So they’re wondering why no patients are coming. Well, you’re sort of not attracting patients when you’re sick. You have to be well yourself. Put on your oxygen mask first then help your child sort of thing.
What else undermines people? Sometimes they’re just like in the completely wrong area. If you want to help menopausal women but you’re working you’re near the Alaska oil rigs and there’s only men there. You know what I mean? So choose a proper place. There’s just a few simple things. Get some help with a mentor—like the people that raised their hands blissed out could probably help you. I’m happy to help you. My best advice no matter how big and fancy you ultimately want to get you should really start out with no staff.
Do everything yourself because it’s really fun! You get your own insurance checks. This physician was so excited she said, “Oh my God. I just got my first insurance check, this is actually working. My name’s on the check.” And I was like “Right. Yeah. That’s how it works. Yeah. Right.” Before, somebody else was getting her check—the revenue she was generating—and taking 70 percent!!! Just giving you scraps and writing you up as unprofessional.
Administrators know how to intimidate doctors and keep you in fear of losing the job that sucks. They would not want to empower you because you are their greatest competition. You can go across the street and earn three times as much. They don’t want you to know that.
Back to staffing—you can always hire people later but start with no staff because it’s really good to know how to do every little part. Now for me in my case I am solo-solo which means I have no staff. I do everything myself. I submit my own claims through an online clearinghouse. I schedule my patients. I currently have about, well I only work two half days a week now but most of the time for the last 13 years I’ve worked three half days a week; Monday, Wednesday, Friday, because I’m totally against working two days in a row. I just think that’s too taxing. It’s too much. I mean really you’re supposed to live your life too, right? Aren’t you supposed to have fun sometime? You don’t want to be one of those people that retires and you’re like what was this all about.
The other thing for me is I haven’t set an alarm clock for work in 13 years! I’m not a morning person. I like to stay up till 3:00 in the morning and then go to sleep, wake up around noon like when my body tells me. I don’t want to hear loud noises that force you out of bed. That’s the worst thing ever. So I think one of the joys of having your own practice is you can set it up so it’s in alignment with your circadian rhythm. Patients really love that too because I work afternoons and evenings like 3:00 to 7:00. I’ll stay as long as the patients need but the deal is like people love that they can come after work or that you do house calls—and that you’re in a good mood. You know what I mean? People will pay good money for their doctor to be in a good mood. That in and of itself is rare these days.
Now think about how much space you really need. And some people end up in high-rent medical space by the hospital. You don’t need 2000 square feet. I’m in an office that’s 280 square feet. I mean how much space do you need for your brain and two chairs? Not much. Right?
Like anything else you’re paying for, you’re paying for all the extra square footage that’s around your chair. I would just get these two little blocks here and sit. As long as you can sit and get people in the door. You could do it in a broom closet. And actually I want to tell you about a nurse practitioner who did start in a broom closet because her clinic wasn’t ready yet. She was having all sorts of fancy stuff done. She’s in Alaska. The hospital actually gave her a free broom closet to set up in because they really were desperate. Alaska by the way has really high reimbursement, highest in the country, if you want to make a lot of money just go to Alaska for a short time, you can really make like probably about ten times as much as you would make if you lived in Ohio for the same work. Very interesting story behind that.
But this nurse practitioner she actually is making close to a million dollars a year and she started doing that just out of a broom closet generating that much income because you can bill a 99215 in a broom closet. It works. Insurance pays that. Patients will pay you cash too. Even in a broom closet!
So I’m going to share some of the actual rent that I know that doctors are paying. I know doctors who’ve gotten free space, completely free, because people are so excited they’re opening a clinic in an area that’s under-supplied with physicians. They’re like “Take this space for free, we love you.” That’s awesome. That’s available for you too if you’re not in a saturated area. And by the way even if you’re in a physician saturated area I bet it’s saturated with assembly-line medicine big-box clinics and it’s not saturated with real doctors like you. So don’t be deterred even if there’s like a doctor on every corner. But they’re probably like unhappy, even suicidal doctors. If you’re the happy one in your own clinic you can still do really well for yourself. I know somebody that got her clinic building for a dollar per year. I mean they had to somehow charge her something so this town in Westerlo, New York made her a special deal, a dollar/year. It’s pretty good. Main Street location.
I know people that had their whole first year of rent waived. I know people who got like a philanthropist to give a $100,000 loan to start even though she didn’t really need that much money but that’s pretty nice. When I started my clinic 13 years ago I paid $280 a month for 280 square feet and now it’s gone up over 13 years to like 425. Recently a physician got a really cool space in a skilled nursing facility, I think she rented like an empty room for $118 a month which is great.
So look around. Be creative. Even in high-rent districts like Brooklyn, New York and Chicago I know physicians getting awesome deals, $600 a month rent on their offices. So I’m just throwing this out here because I want you not to be deterred by price. You can start right away. And just make it like a fun contest like how low can you go and still be a real doctor. That’s what I wanted to know, like how scrappy could I get. How frugal could I get and still be taken seriously on planet Earth. And you can go pretty low. I got my overhead down to seven percent. Before that it was 74 percent.
So here’s my launch. The actual numbers to start my practice and start collecting money. I got chairs from Goodwill for $40, wicker chairs, I’m still using one of them, 13 years later it’s holding up. Why get a new one? Office rent $280. And then malpractice which is billed quarterly so for my first year I paid $307.50. So for $627 I had a medical clinic in the United States and was getting money rolling in without doing Botox, without doing special weight loss stuff. I mean you can do that if you’re really into it but I just was being a real doctor treating strep throat, UTI, Pap smears, pneumonia, like all the regular stuff that people are running away from because they want to do these little niche practices but people really need all around good care and if you want to be like a family doc people will love and adore you. You’ll be the town hero for $627. And by the way, here’s How to save 86 percent of your malpractice insurance.
Here are some examples of people who started clinics recently. Janice Hudson started a clinic for $630 and she breaks it down. $280 was rent. Rent was $350. She had a down payment on malpractice $280 but see most of us already own a stethoscope and we already own a computer like you don’t have to like recreate the wheel. You can add stuff as you go along.
Kayla, this woman is amazing. She started a clinic for $85. How do you start a clinic for $85? Look she moved to a new town and launched 48 hours later. She’s like super nomadic and adventurous. She spent $85 on a bookshelf. When she launched her clinic she actually hadn’t paid any rent yet because they hadn’t collected it. So she made $330 her first day and paid rent later. Is that cool or what? Is that amazing? Do you guys love that? Who wants to do that? Isn’t it fun?
All right. So I want you to be aware of procrastination tactics. Doctors are so perfectionistic. We don’t want to start until we have a logo. Who cares? Nobody cares. People are dying and you’re waiting for a logo. Don’t. You don’t need a logo. I’ve never had a logo. I never even understood what branding and logo was. Its like isn’t that me, like can I just be me, do I have to have a brand and a color, that seems too marketey, like just “I’m here. Hi. I’m open.”
Website. You don’t need a website. I personally have one because I have a blog. If I didn’t have a blog I probably wouldn’t even … you don’t need a website. Everyone thinks, “Oh, can’t start my clinic until I have my logo, I have to figure out my colors, my website, letterhead.” I don’t have letterhead.
Office space. If you can’t find office space just start doing house calls. It’s so funny some doctors who I’d helped with this they’re like, “Well my office isn’t set up yet so I told her ‘Well it’s not set up so maybe I can come to your house.'” Don’t apologize. Don’t explain it like that! Say I’m having a special. I’m going to come to your house and do a house call because you’re special and they’ll be so impressed they’ll pay you extra. This one doctor because her office wasn’t ready, she had to go to the patient’s house and she tells me, “Well I decided not to charge her because I wasn’t ready.” Not charge her? Are you kidding? Charge her twice as much. You came to her house.” The woman was there with cash and was throwing at her and she’s like “No, no, no, no. I’m a perfectionist and my office isn’t ready yet. So I’m a loser so I don’t deserve any money.” Oh my God, this is distorted thinking patterns of perfectionist abused people.
All right. Your EMR. I have a do-it-yourself EMR created on my laptop, I didn’t pay any money for it. I’ve had it for 13 years. It works great. You can still use paper, who cares. Get out a pen. People are dying waiting for your logo. Don’t hold them up. Okay. People I’m serious. They have cash ready to throw at you but you’re wondering how to write the perfect office policies. Who cares. Just open the door and let them in.
Staff. You don’t need staff. If you get so popular … One woman contacted me yesterday. She’s like “Oh my gosh. I’m open six months now and now I have a waiting list and maybe I should hire more people and open a satellite.” I’m like “Do you really want to like complicate your life? Just stop right now. Take care of the people that you have. Unless you want to be like some famous doctor with 13 sites in 12 states just stop and enjoy the patients that you have or you’ll drive yourself nuts. Mentor other residents who rotate through your office.” That’s what I did. I had a waiting list after six months but I kept it just so I could give it to the next doctor and help her launch her practice. I can’t take care of everyone.
And Band-Aids and supplies. A psychiatrist, oh is so funny, she needed Band-Aids because I guess there’s an injectable psych med that she does only four times a year on one patient. And so what did she do? She ran to Walgreens and got a Band-Aid. BFD. You can do that. You don’t have to have all the stuff with you on day one. Oh you don’t have a sink in your office. This woman calls me, she goes “Thank you. That was such a great idea. I got a portable sink. I’m all set. Great, get a portable sink. Open in a boat. It doesn’t matter. Just get going.
I’ve never had a bookkeeper. What I do is I take my taxes on vacation with me and I take them out to dinner and I get room service and I have fun with all my receipts once a year. It’s like a party. I really recommend when you do stuff that you otherwise hate like balance a checkbook just take it out to dinner. I got divorced. I took all my divorce paperwork out to dinner, I got non-alcoholic drinks all night long going through it (I’m a lightweight and can’t drink alcohol). Stuff that’s not fun don’t do it alone moping at home, go out to a fancy restaurant and tell the waiter, they’ll be cracking up that you’re there.
I’ve never had a CPA until recently. But for most of the time I did my own taxes. This is really easy. Schedule C by the way stands for creativity. You can get really creative. Write everything off.
Attorney. I never had an attorney except for my divorce. And computer, I already owned a computer. You don’t need a phone system I’m sure everyone already has a cell phone so just get going.
Sharps container, look I am still using the same sharps container I got 13 years ago and I do skin procedures. That’s because I’m very frugal. I only take off the needle I throw the other part in the trash can so it only has the needles. It takes a long time for needles to stack up and fill up even the smallest sharps container. Seriously you don’t have to spend a lot on that. And that psychiatrist I know who does the four injections a year she cracks me up like you wouldn’t believe. She doesn’t have a sharps container because she only has four needles a year. She takes it to the casino. Everyone’s dropping theirs in casino bathrooms in Oklahoma. There’s like those little sharps containers, she just takes it down there to the casino every time she has to throw out some. So you can be really frugal. I think we’ve overcomplicated the delivery of medical care. Would you guys agree with me? Geez.
Exam table. Just have them get up on their bed. Like whatever, it doesn’t matter. Use a massage table, rent an office one day a week from a masseuse and use their massage table. No board certification? No problem. I gave mine up and I’ve never been happier. You can do it too.
Others drop needles in the casino, have no website, or forms with headers, and no logo. Just jump in. Make money. All cash. My friend Keely won’t even take credit cards (I don’t either) because her husband’s cheap and doesn’t want to pay 3 percent to the bank. So she’s all cash and a child and adolescent psychiatrist in Tulsa and she should be a stand-up comedian. She is a crack up.
And Kayla there’s her bookcase that she spent $85 on to start a clinic. Everyone could do that. You don’t have to be special. You can go to a second-hand furniture store and get one.
The most popular way of procrastinating is continuing to consider other job options that are obviously not right for you. Don’t do that.
So secret number two, how to earn more seeing fewer patients and longer visits with no staff or interruptions. Look this is an example. You see a patient for 20 minutes and diagnose bronchitis, the patient pays you $100. How much do you think you got to keep when you’re an employed physician, an employee?
Well, look this is my true story. They gave me $26. My overhead was 74 percent.
That does not seem like a good deal because right now I keep $90 because my overhead’s about 10 percent.
So if you think about these numbers here’s a quick math problem. So $90 divided by $26 equals you just earned 3.5 times as much per patient. Who wants to earn triple your income per patient? Raise your hand. Would you like to earn three times as much? Just be self-employed. You can triple your income.
The secret to secret number two is actually having low overhead. When you have low overhead you keep the money that you earn. See when I was paying 74% overhead that’s as bad as moving to a state with 74% income tax. Would anyone do that? Would anyone move to a state with 74% income tax? You just took a job that’s the same thing. That makes no sense and people are doing this because they’re afraid they’re not smart enough to open a clinic but most of the people that work in a clinic just have GEDs or low-level education and are doing the same repetitive tasks. They would never be able understand the Krebs cycle which you understand and all this other stuff. So trust me, you have the IQ to open a clinic. It’s not that hard.
And here’s how to fill your practice quickly without spending money on advertising. This is a cool thing that I did. I was so suicidal I could not function. I had this idea that like if I couldn’t figure this out maybe somebody would help me in my town since everyone holds hand and sings Kumbaya. I just threw a little town hall meeting while I was just sort of coming out of my suicidal stupor and I said, “Hey I’m not happy as a doctor, you guys might not be so happy as patients, why don’t we just start over? Let’s design an ideal clinic and see if it works.” And people submitted 100 pages of written testimony. I pretty much told people I’ll do whatever you want as long as it’s basically legal. And I was able to do 90% of what my community wanted and open one month later with no outside funding. Is that great or what? You could do that too.
It’s so funny. People ask, “How do I start my town hall meeting? Where do I go to the city or the mayor? I was like, “You don’t ask anyone, just throw a town hall meeting and get going.” I didn’t get permission. Should I wait for Obama or Trump to come to town and lead a town hall meeting to find out what people want for healthcare in Eugene, Oregon or should I do it? It totally makes sense that I would do it because I already live there and I already love everyone in my town. So you probably like where you’re living so just do the same thing.
This is actual testimony—what people submitted at my town hall meeting. They wanted a doctor that’s self-employed or works in a small clinic doctor owned. Somebody wrote, “I’d like to see a relatively relaxed physician in a calm space, someone who has plenty of time off.” Would you like that job? Anyone? Interactive low overhead, kept small and personal and one gal asked, “What equipment is really necessary?” What is really necessary? Nothing. Just your brain.
So one happy patient can actually fill your practice. I was totally confused one day when I had like 5 people from the Relief Nursery calling for an appointment. It’s because I saw one person from that Relief Nursery as a patient and they went and told everyone in the lunch break room about what an awesome doctor they saw and then everyone called for an appointment. I mean one happy patient is like a little megaphone running around town telling everyone else and they’ll fill your practice. You do not have to take out newspaper ads, put billboards on buses, you don’t have to do anything like that.
And in case you’re not aware, the Titanic is sinking. Big-box medicine is failing. I think that’s why you’re here at this conference. You’re making your plans. You’re ready to get in your life raft.
I’d suggest that you jump in as soon as you can and start your own clinic. You could do it within 30 days. I’ll help you. There should be nothing holding you back. I think I’m making this very clear. Very easy. I could teach a 4th grader to launch a clinic. They couldn’t deliver medical care, but they could totally learn to run the clinic. It’s not hard but somehow people with all this education think it’s too hard.
So you could be in your ideal clinic. I suggest you don’t wait until your emergency. What is your emergency? Well, I run a suicide hotline so I hear from a lot of doctors with PTSD. I hear from people who are suicidal in the ICU. They just were on a ventilator and they’re calling for help. Please ask for help before you’re on a ventilator after your suicide attempt. Get help before. I know physicians are so resistant to asking for help but please, please, please do it before your divorce, before your financial ruin, before your malpractice case and before you’re locked in a psych unit.
And by the way just a reminder, you don’t need an MBA, an MPH, you don’t need any more board certifications, you don’t even need to complete your residency, you can do this after just your intern year. You don’t need a second residency. I met a guy who had five residencies like when are you going to start seeing patients? Who knows. He’s still reading the books. You don’t need any special certificates. You don’t need to ask permission. You’re already adults. Isn’t that cool? You don’t have to ask permission. I’m giving you permission today to do it. You are smart enough now to do this.
Here are some examples of blissed out doctors. . . .
And then I have so many ideal clinics that I’ve helped docs open. I tried to keep a map on my website but I can’t keep track of them all because everyone’s doing it, it’s really fun.
Surprise! A few more slides, your loans can be forgiven if you open a non-profit. You don’t have to work at an FQHC or anywhere else to get your loans forgiven. Make your clinic non-profit and after ten years, eight years, I forget what it is, your loans will be completely forgiven from medical school. How about that? Is that cool?
And just three more slides. I want to introduce you to Kayla. She’s the one that started with an $85 bookcase. She does sort of a DPC-type practice and she’s super cool and she basically bills people on the new moon every month. She has her whole thing set up, it’s all moon cycle medicine. She’s super organic makes like dinner for her patients every Friday night and they all hold hands and she’s looking real happy. By the way in residency she became psychotic from sleep deprivation and was forced into a Physician Health Program. This is ridiculous. These people who have so much potential are having their souls slaughtered right in front of us. I’m so glad Kayla came back to life and is launching clinics in all different states now. We love her. (so much clapping for Kayla!)
Meet Leslie McPherson. She wanted to be a family doc in her small town in North Carolina because there’s no doctors there. She literally had to go to school in the Caribbean, leave her kids to be raised by her parents temporarily. Finally made it back, I gave her a $10,000 scholarship which I do once a year for somebody who really inspires me and makes me cry (happy tears) and I just loved her commitment so much that I gave her the money. She got a down payment on that farmhouse taken care of and now she rents the top as an Air BnB and runs a clinic to serve all the poor people in her small town. Is that awesome? She’s like a total hero. Let’s hear it for Leslie. (clapping)
Finally here’s Keely Wheeler who dumps her sharps container shit in a casino. She is so funny but the thing about Keely that’s awesome, so many things about Keely are awesome, but Keely after two years in her practice lost 125 pounds, ends up running marathons. And people ask her all the time because before she was eating Whataburgers that her husband had to sneak her under a bullet proof glass window at a stupid psych clinic that she worked before where the administrator said, “You’ll never succeed on your own.” But as soon as she opened they sent their own kids to her because they know how sucky their own care is at their clinic. Of course their kids need psych care because their asses. And so anyway Keely I just want you to know like people go up to her and they ask her what diet she’s on because look how healthy and happy. She has candlelight dinner in her office. You know what she says, “I’m on the I love my job diet.” That’s what she says. (Clapping)
So I want you all to be on the “I love my job” diet. I want you to have the best sex you’ve ever had. I want you to be in love with your husband and wife. I want you to have the most amazing life ever. Thank you very much. (Want to launch your ideal clinic? Here’s how.)
Thank you for that powerful address. It is not an easy topic Pamela, but we are all the better for your bravery to speak on it.
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Pamela Wible, MD, on Redefining Medicine. View interview above or download/listen to MP3 here (plus full transcript below).
Known in the medical community as “Physicians’ Guardian Angel,” Dr. Wible has become America’s leading voice for ideal medical care through her continuous work with physician suicide, and the pervasive issue of mental health in the medical community. With parents who were both doctors, Dr. Wible experienced the ‘real dark underbelly’ of medicine as a child—which was only deepened through her tenure in medical school, and her own experience in being suicidal. After being forced to be a “factory worker” and practice “assembly-line medicine” in short increments—coupled with what she describes as rampant “human-rights violations” in medical training—Dr. Wible felt deeply abused, dehumanized, and dejected. Through leading town hall meetings, during which she asked communities to design their ideal medical clinics, Dr. Wible collected written testimony and subsequently designed a clinic based upon her findings. Describing the clinic as relationship-driven rather than production-driven, Dr. Wible models her practice today around what brings her joy, and continues to disseminate education surrounding the public health epidemic that goes largely unreported: physician suicide.
Welcome to Redefining Medicine, an intimate and personalized program that illustrates a different side of the practice of medicine. Our in-depth conversations will focus on mentors and motivators who are consistently reshaping, redefining, and rediscovering the field of medical healthcare.
Monica Goldstein: I am happy to welcome Dr. Pamela Wible, “Physicians’ Guardian Angel”—also known as America’s leading voice for ideal medical care. Dr. Wible, why don’t you share with us your story? You practice family medicine, correct?
Dr. Pamela Wible: Yeah, both my parents were physicians and as a little kid I used to follow them to work. My dad is a pathologist so I used to work with him in the morgue as a child, and my mom’s a psychiatrist so she would take me to the psych hospitals. Basically I was around seriously mentally ill people who are institutionalized, and dead human bodies as a child. That was like the perfect Petri dish for a blossoming healer to be able to experience the real underbelly of what goes on that’s usually hidden from children because parents like to read little happily-ever-after stories to their kids when they’re little. Getting to see real life made me wake up to the reality of human suffering and pain. Dad introduced me (even when I was six years old) as a doctor-in-training, and he would sit me between himself and his live patients. He would leave me, actually, with the dead patients too. He’d introduce them to me with the toe tags. I was a real talky child, so he just left me there talking to them. I was just like totally comfortable with death and mental illness in a way that most people (even adults) aren’t.
Monica Goldstein: So you went to medical school.
Dr. Pamela Wible: Yes, I always wanted to be a doctor.
Monica Goldstein: Where did you do your training?
Dr. Pamela Wible: I went to University of Texas Medical Branch at Galveston where my mom went to school. We just went to her 50th medical school reunion as a mother-daughter duo, which is probably very unusual for a mother and daughter to go to the same medical school. I had a really fascinating, fun experience during my medical training. It was traumatic when I started medical school because I just didn’t realize how the patriarchal reductionist philosophy was very heartless and soulless. They dehumanize you during medical training.
Monica Goldstein: You weren’t forewarned by your parents? Did they want you to be a doctor?
Dr. Pamela Wible: They did not want me to be a doctor as is very typical of physicians. They often don’t want their children to be doctors, yet they don’t necessarily explain to them why. So I think the interpretation that the child has is, “Maybe my parents don’t think I’m smart enough to do this.” My physician father and mother never really explained that it was like being in Afghanistan, I had PTSD. They don’t go into the details of their mental health wounds from the training, because I don’t even think they want to remember it. It’s almost like in the back of their consciousness, but they know they don’t want their kids to go through it. See what I’m saying?
Monica Goldstein: Yes, yes. Okay, so fast forward. You were in family medicine.
Dr. Pamela Wible: Yes. I still practice, and I do house calls, and I have my own little clinic and that’s really awesome.
Monica Goldstein: What was the trajectory to lead you to your focus today?
Dr. Pamela Wible: My focus on physician suicide—the passion comes from when I was suicidal as a physician myself in 2004, completely occupationally induced due to frustration with being forced to be a factory worker practicing assembly-line medicine in seven-minute increments—a complete assault to my soul. I saw medicine in its heyday when I went to work with my parents so I knew this was bullshit, basically. I hope you don’t mind the brutal truth.
Monica Goldstein: You can say that.
Dr. Pamela Wible: I knew better and so I felt like I was being abused. They just wanted a warm body in the room to generate as much revenue per millisecond as possible. They could care less about the patient’s health, or about whether I’m happy or whether I’m practicing at the highest level of my skills. That was not important. These are just corporations that unfortunately are about collecting revenue and maintaining their high-overhead infrastructure.
Monica Goldstein: You were actually cognizant of the fact that you were suicidal?
Dr. Pamela Wible: Yeah. For six weeks I didn’t get out of bed after leaving my last job.
Monica Goldstein: You had suicidal feelings and thoughts at that moment?
Dr. Pamela Wible: Yeah, I was trying to die in my sleep, yeah.
Monica Goldstein: Okay. Did you ever have these feelings when you were doing your training?
Dr. Pamela Wible: I was very depressed (not suicidal) my first year of medical school mostly, because they were having us do dog labs and killing previous pets is terrible. Murdering dogs as part of your training. I just couldn’t believe the amount of brutality I was witnessing, and that mass dehumanization, methodical dehumanization of me and my classmates. I thought it was just like a torture chamber. Spiritually and emotionally speaking, it was unreal.
Monica Goldstein: I can imagine. Okay, so take us back. How did you get yourself out of that?
Dr. Pamela Wible: Out of the suicidal thoughts?
Monica Goldstein: Yeah.
Dr. Pamela Wible: Well, I had like a dream, like a prophetic vision. It wasn’t really a dream, it felt very real. I think when you’re in a state of suicidal thinking you end up sort of melting away your ego. If you don’t care whether you live or die, you’re in a very receptive state, I think, to messages from the universe. I mean, it’s definitely an altered state. I ended up having a vision of like floating over the United States, seeing communities take back the healthcare system, and firefighters and police officers and nurses and doctors all holding hands and building their own clinics. I was just overtaken with the whole idea that I didn’t have to put up with assembly-line medicine anymore.
Monica Goldstein: You can change it.
Dr. Pamela Wible: That I could create a clinic based on what my community wanted, and I literally jumped up out of bed and called the newspaper, and started leading town hall meetings, and inviting my community to design their own medical clinic. I went from not moving and suicidal, almost like in a coma for six weeks, to running town hall meetings and inviting my community to design their ideal clinic. I collected one-hundred pages of written testimony, adopted 90% of what they wanted (and I said I would do whatever they want as long as it was like basically legal). Then I opened this clinic, the first one in the country designed completely by patients, just one month later with no outside funding. That’s where I’ve been practicing for 13 years and it’s awesome. Highly recommend it.
Monica Goldstein: What’s different about the clinic?
Dr. Pamela Wible: It’s relationship-driven instead of production-driven, so it’s kind of like the way doctors used to practice before third-party intrusions. It’s just me, I have no nurse, no receptionist. I check everyone in, I submit all their claims myself. I have it all streamlined so it’s super easy, and I just work afternoons and evenings three days a week, so I’ve never had to set my alarm clock for work in 13 years. Plus I never turn anyone away for lack of money. I see everyone who needs to see me. I am happy as can be, if you can’t tell, and so are my patients.
Monica Goldstein: That’s phenomenal. But you’ve also made it your mission to educate practitioners. Can you discuss that?
Dr. Pamela Wible: Yeah, I had no idea at the time when I was suicidal that it was an epidemic that had been covered up since 1858 in England—that’s the first time that the high suicide rate among doctors was written about. I thought I was the only one, which I think is very typical when people are suffering, especially physicians. They feel like they’re the only one, because if you look around everyone’s in their starched white coats doing the fake smile, acting like they got their act together, and they really are all suffering like they’re prisoners of war, basically, from our training, which is rampant with human rights violations. We can go into that in a minute. I just was shocked, and eight years after my suicidal thinking into having launched my practice as my solution to my occupationally-induced suicide, (being a real doctor with autonomy as an entrepreneur and business owner solved my suicidal distress). I didn’t want to be treated like a bad kindergartner, which is kind of how these corporations treat physicians, right? Terrible.
So, eight years later in Eugene, Oregon, I end up at a memorial service for the third doctor that we lost to suicide in our town in just over a year. I was in the second row of his memorial service and I just started counting how many doctors that I knew had died by suicide, and I knew like 10. I don’t know anyone who’s not a physician or medical student that’s died by suicide. I’ve never lost a patient to suicide. I have now a list that I’ve investigated of over 1,100 doctor suicides. I started running a suicide hotline and all these suicidal doctors keep calling me. Obviously there’s a huge unmet mental health need among doctors and they don’t feel safe enough to go to a psychiatrist because they don’t want it on their record, but they trust me for some reason because I keep blogging about this and talking about it nonstop.
Monica Goldstein: Is there a particular specialty that’s more at risk?
Dr. Pamela Wible: Yes. Anesthesiologists. Male anesthesiologists are at huge risk. In fact, anesthesiologists die by suicide at five times the rate of general internal medicine, and twice the rate of the next highest specialty, which is surgeons, and then there’s emergency doctors.
Monica Goldstein: Is it because they have more access?
Dr. Pamela Wible: Yes, access.
Monica Goldstein: Wow.
Dr. Pamela Wible: Yeah, it has a large part to do with it. I think veterinarians are also at huge risk, also due to access.
Monica Goldstein: Same access. When your parents found out that you were suicidal …
Dr. Pamela Wible: You know, I don’t think they really knew.
Monica Goldstein: But did they ever understand why?
Dr. Pamela Wible: Well, I was on the phone crying all the time my first year of medical school with them, and they didn’t really know what to do with me. I mean, they were like, “Yeah, everyone goes through that.” I didn’t find them helpful at all because my parents are not really emotionally and spiritually engaged people. My mom is more like a drill sergeant, you know what I mean? My dad is more like an absent-minded professor. They try to care, but they’re not emotionally accessible in the way that I needed at the time. I’m a super spiritual and emotional person, and I think I completely baffle my parents.
Monica Goldstein: Were you always this way?
Dr. Pamela Wible: Yes, because I’m on a spiritual journey through life, and most people in my family are more on the how much can they make in a capitalist culture journey. I don’t play that game, so I don’t think they understand what to do with me, or how to interpret my motivations, like why would I talk about suicide for six years? I don’t know. I don’t think my parents really “get” me.
Monica Goldstein: Do they understand and appreciate the clinic that you set up initially?
Dr. Pamela Wible: I think so, yeah. My mom was a business owner so she thinks that’s definitely the way to go, and my dad, yeah, I think they do understand that. I didn’t find them, as a first-year medical student, helpful at all. I mean, for the most part because I was suffering so much, it was like an existential dark night of the soul, and I think they understood medical school was hard, but I was crying constantly. I cried so much my first year of medical school that I woke up one day and my eyes were sealed shut. I couldn’t even open my eyes. I couldn’t go to class, I had to like feel my way to the bathroom in my apartment. I have never cried that much in my life, even when I was suicidal I wasn’t crying, I was just sleeping. My mom mailed me psych drugs in the mail so I could take them. That’s what my mom did. My dad just tried to be like, “Oh, it’ll pass, keep going.”
Monica Goldstein: You need to get through this time, first couple years.
Dr. Pamela Wible: Yeah.
Monica Goldstein: What would you like to see different?
Dr. Pamela Wible: In medical training?
Monica Goldstein: During the medical training period? Yeah. Medical school and training.
Dr. Pamela Wible: Students should be embraced as a family when they arrive. They should be welcomed. Like, you’ve jumped through enough hoops, you’re the cream of the crop, you’ve already proven yourself, you’re all valedictorians. We love you and we’re here for you and we’re going to support you till the end. Here’s my phone number, and I’m the dean, and you can call me anytime. If anyone has problems, you’re not alone. They should have a little mental health panel at the beginning where all sorts of other physicians who are highly esteemed in the school can share, like, “Hey, when I was a first-year medical student, I failed an exam, I had panic attacks, but hey, now I’m the chief of surgery.” So people can see examples of it’s okay to freak out, it’s okay to fail a test, it’s not the end of the world. Like, I’m loved, I’m welcomed.
Earlier I mentioned, before our interview, that a medical student wrote me and told me that she was less stressed in Afghanistan during active sniper fire in a war zone than medical school. So of course I called her, wanting to find out why, and she said at least when she was in Afghanistan she knew that the other people on her team … First of all, she know who was the enemy and who was on her team. In medical school you don’t know who’s going to undermine you, who’s really your friend, because they pit everyone against each other, and have you terrified for your life and your career and that you’re going to fail. They create a terrible, competitive, cut-throat, mean-spirited environment that makes sensitive, existential, humanitarian idealists freaked out. That’s not the way to handle gifted children, is to pit them against each other and treat them like bad kindergartners. They’re already motivated. You don’t have to scare them to learn. They already want to learn, they’re already valedictorians, you know what I mean? But they treat them like shit and scare them to death, that they end up just alone in their apartments crying themselves to sleep at night, which you don’t see during the day because they put on a smile.
Monica Goldstein: You don’t see that on Grey’s Anatomy.
Dr. Pamela Wible: No, you don’t. The thing is, she knew that if she got slaughtered by a freaking landmine, that her team there of American soldiers would pick up her body parts, put them back in a casket and put an American flag over it, and send her home. She knew she wouldn’t be left there. See, medical students, if that were to happen, they would just think everyone would walk right by and leave you dead on the floor, which is kind of what happens, actually. I led a candlelight vigil and a memorial service, a funeral for a female physician in NYC who was the third one to step off the roof of this building in Mount Sinai and they just freaking left her there covered with a tarp on the ground. Nobody brought any flowers, nobody did anything. I flew from Oregon to lead this woman’s memorial, because she’s a J-1 visa and her family was in Mauritius, they don’t even live in the US. They were just going to freaking put her in the body bag and drive off, and that’s it. They told everyone to get back to work.
You know if police die and firefighters die, they bring out firetrucks, they name a highway after you, everyone’s got American flags. There’s like teamwork. If you die in the military they blow bugles, or they give your family your outfit and the Purple Heart, and this, that, and the other thing. If you die as a doctor, they just consider you bad PR, lost revenue, throw you in the body bag and that’s it. It is brutal. I’ve seen this over and over again. Isn’t that terrible?
Monica Goldstein: There are no words. No words. My question to you is now, fast forward into practice. You’re out of medical school. The physician, I know you do not like the word burnout, and we’ll get to that in a second, but the physician burnout rate. I just heard it on the news again the other day, it seems like every year or so the media is getting a hold of it and putting it out there. What is it when they’re finally in practice, and yes, some of them are working for major corporations, but some of them are in private practice or in a small group practice, and they’re still taking their own lives.
Dr. Pamela Wible: First, the reason why I don’t like the word burnout is because it’s a victim-blaming term that blames the physician for a problem that’s not theirs. The system has abused them to the point where they feel safer in Afghanistan getting shot than they do in medical school. Medical school goes on for four years, plus three years of residency, so you have seven years of like a terrified person who not only is being treated like shit, but they’re also watching people die every day and delivering bad news, like, “Sorry, you had a stillborn,” and, “Oh, your three-year-old died in a car accident.” They have to tell people stuff like that, and people are screaming and crying. So, they have PTSD from just watching people die all day, plus they’re treated terribly, so when they get out and practice, they still have mental health sequelae—untreated trauma.
If you could see a doctors’ mental health wounds, you’d see third-degree burns over 90% of their bodies. They should all be on ventilators, but they put on that white starched coat and fake smile and pretend like everything’s okay. Doctors are wounded from their training—taught to be in a state of chronic self-abuse and self-neglect.
Monica Goldstein: It’s become an automatic.
Dr. Pamela Wible: They’re people pleasers, so they end up still, even after residency, working 80 hours a week, and taking all sorts of shit from insurance companies and their partners, and skipping meals all day long, not sleeping properly, not exercising, holding their bladder. They end up with all these problems. It’s just terrible. They’re not happy. I don’t know if you’ve met a lot of super blissed-out, happy doctors. They’re kind of suffering.
Monica Goldstein: The ones at A4M are pretty happy, but they’ve turned the corner.
Dr. Pamela Wible: They’ve turned their life around.
Monica Goldstein: Right. What advice would you give to somebody who’s either in medical school right now, thinking about medical school, graduated from medical school in practice. What kind of lifestyle changes and what kind of things should they be looking for within themselves, and what kind of changes and modifications should they be making in their life?
Dr. Pamela Wible: Number one is they need to follow their original dream that brought them to medical school. They all filled out this personal statement. Some of these doctors, a lot of them knew since they were eight years old that they wanted to be a doctor, like they had these visions of helping and serving and delivering babies. They need to stay with their dream and not let anyone steal their dream. Then they need to take care of themselves. You’re like a treasure to society, so you have to eat and sleep and do everything that you tell your patients to do, especially when you’re in your own practice. Work part-time, make less money, and take care of yourself. You only live once. If you are running ragged, stop taking insurance; if insurance is annoying you, then stop taking it. Model your practice around what brings you joy, and you deserve to be happy. That is the basic message. Don’t suffer, and if you’re suffering, call me. I can help you. I’ve run the suicide hotline, I know how to help doctors.
Monica Goldstein: You were given this sign, this message from above during the time of your suicidal breakdown. Most are not give that message. How is a physician or someone able to identify what manifestations are happening with them, for them to just stop in their tracks and realize, “Oh boy, this is bad. I need to stop doing what I’m doing and break the cycle”?
Dr. Pamela Wible: I think all physicians need to be getting mental healthcare because it’s a high-risk profession. If you look at, for example, dental healthcare. If you didn’t brush or floss for like 30 years and ate Halloween candy, your teeth would be hanging out of your mouth. The thing is, doctors are in a high-risk environment for mental health problems, and they’re not brushing, flossing, or doing anything. They’re just told, “Suck it up, get back to work. Oh, there’s a stillborn in room 3. Get in room 10, Mrs. Jones is having a heart attack. Oh, well, hurry, get in the next room, there’s like three people, gunshot wounds from a school shooting.” They just keep telling them keep going. If you think about it, that’s insane. They’re looking at things most people don’t want to look at, and they’re having to deliver terrible news to families.
I don’t care if you’re a psychiatrist, a radiologist, whatever you are, you need to get mental health care at intervals or you’re going to have a mental breakdown. Because physicians are so good at compartmentalizing, they don’t recognize that they’re having a breakdown till they completely crack. Most of these doctors who’ve survived their suicide attempts, when I ask them, “How long did you know … when you finally decided you were going to kill yourself, how long before you grabbed the gun and shot yourself, or took the pills?” Three to five minutes. It is, at the end, a super-impulsive decision. However, there are hundreds of missed opportunities to help this person earlier because they compartmentalized it. All the time I hear these stories of like, “He just bought tickets for his whole family to go to Disneyland two hours before he shot himself,” or, “He just finished this major surgery with a great success on a knee replacement, and then we found him hanging in the closet.”
The last thing to go with doctors is their medical skill. They will be doing complex surgeries until their last breath, and then go and hang themselves in a closet. Most doctors you can’t even pick up. I would just assume all doctors are suicidal and be nice and help them. They all need love because they’ve been wounded, like in Afghanistan, essentially. They’ve been through a war zone of an educational experience. Some are in denial about their wounds because they just, big house, big car, pretend like everything’s fine, but they’re like wounded people. They’re like the walking wounded.
One simple thing that patients can do is just write thank you notes. If you’ve gotten good service from your doctor, please just write a note, even if it’s three sentences. “Thank you so much for explaining what’s going on with my kidneys. Nobody else had taken the time to do that. I really appreciate you.” These cards actually … Doctors have told me thank you cards have prevented their suicides. They save all these cards and read them over and over again, to remind them why they’re doing this work. Your actually thank you note to a doctor could save their life.
Monica Goldstein: I’m astounded to hear the fragility of the physicians. I think about my doctors and all the doctors that I’ve had in my life that have taken care of myself, my parents, my kids, what have you, and you don’t think about it. It’s a narcissistic relationship, and you don’t think about . . .
Dr. Pamela Wible: Them needing anything.
Monica Goldstein: They’re superhuman. They have superpowers. They’ve healed me, they’ve healed my parent, whatever. They didn’t heal my parents, unfortunately, but that’s a whole other story. It’s very hard from a patient perspective to change the paradigm and think about the physician. You don’t want to be so selfish, but knowing that it could ultimately save that person’s life . . .
Dr. Pamela Wible: Just to be nice.
Monica Goldstein: Just to be nice. It takes 30 seconds.
Dr. Pamela Wible: I know, it doesn’t hardly take any time at all.
Monica Goldstein: Wow.
Dr. Pamela Wible: And patients in the emergency room who will like bitch and complain because the doctor was a few minutes late giving their grandmother Tylenol. Well, they were in another room where a man just died of a gunshot wound. People are not understanding, your insensitivity and level of urgency for something that’s not that critical, and you put that on a doctor who’s just dealt with somebody dying or a stillborn. This isn’t like Chipotle burrito. Just calm down, wait your turn, and be nice. These people are stressed out.
Monica Goldstein: There’s so much talk about, and especially in the forum like A4M, there’s so much talk about the fact that now the physician has the time to show the compassion, to show the empathy, to listen, to spend time, an hour and a half with the patient if need be, to really get to a root cause of a problem. So, turn the tables a little bit to have that patient actually have the compassion and the empathy to be sensitive to their physician. Now, in an allopathic relationship, it’s almost unheard of for a physician to spend that kind of time and to be able … They might be compassionate, but seven minutes, you’re out the door. For an integrative, functional, anti-aging medicine, concierge practice, what have you, you have that time to build a relationship on both sides. I can imagine that from this perspective, the statistics of physician suicide are probably-
Dr. Pamela Wible: A lot less.
Monica Goldstein: Far less.
Dr. Pamela Wible: Doctors practicing in what I call relationship-driven practices versus production-driven practices.
Monica Goldstein: Have you heard of a physician who was suicidal, other than yourself, that recognized the fact that they were in danger of hurting themselves, and then started a concierge practice or an integrative practice?
Dr. Pamela Wible: I don’t know that I’ve heard of anyone that was that far gone with suicidal thoughts and then started a new practice. I don’t know if they got to the point of laying in bed for six weeks like I did, which I consider a first world luxury. If I was in a third world country, I would not have the luxury to be able to lay in bed for six weeks and be suicidal, you know what I mean? Some people, they have kids to feed, they have to sort of keep going so they’re compartmentalizing it, and they’re not feeling the pain, and yeah. I was lucky.
Monica Goldstein: You were very lucky. I feel fortunate to the fact that you were lucky because I feel lucky now that we’re able to disseminate this information which is so valuable. You were given the nickname “Physicians’ Guardian Angel” obviously for this reason. How did that come about?
Dr. Pamela Wible: I was invited to deliver a TEDMED talk, and they come up with these cute little tagline names in committee meetings, and apparently that’s what they named me. That’s how they introduced me on stage.
Monica Goldstein: Can you share with us a bit about what your TEDMED talk was about?
Dr. Pamela Wible: My TEDMED talk is called “Why doctors kill themselves,” and I was basically reading suicide notes from doctors who died by suicide while their pictures were up behind me and then dropping their notes on the floor.
Monica Goldstein: How did you obtain those letters?
Dr. Pamela Wible: I’m now friends with all these families. I’m on the phone with mothers who’ve lost their only child to suicide in medical school.
Monica Goldstein: My son the doctor . . .
Dr. Pamela Wible: It’s very sad.
Monica Goldstein: . . . Is now dead because he killed himself.
Dr. Pamela Wible: Right, and they don’t see it coming. Like, their perfect star child, the one that made straight A’s, that never cursed, that was always, you know, the responsible one. If you had multiple children, the really responsible one that never gave you any trouble . . .
Monica Goldstein: That you would least expect.
Dr. Pamela Wible: The police are calling you to tell you they’re dead.
Monica Goldstein: What do you attribute the rise and the increase of physician suicide to?
Dr. Pamela Wible: When my parents were practicing medicine, obviously in the heyday before production-driven medicine, most physicians will say even now today that the primary joy that they receive from practicing medicine is from the relationship with the patient. That’s been stolen from them by all this third-party intrusion, because you perfectly pointed out in a seven-minute visit you’re not getting a lot of joy of the personal relationship. You’re just getting rushed through computer windows and not even getting to look at them. The EMR and all sorts of government mandates and all the infrastructure that’s grown up around physicians to steal their income and leave them with scraps and patients …
And the student loan debt. These doctors are graduating with like $300,000 of student loans, so they don’t see how they’re going to pay that off, so they feel trapped. A number of these younger ones who’ve died by suicide, they don’t necessarily leave a suicide note, but they have all their loan repayment paperwork out on the kitchen table for their parents to find. They’re obviously stressed out about how they’re going to pay their debt and the only way they can think of paying it is by killing themselves and having it wiped clean, because you can’t file bankruptcy somehow with student loan debt. You keep it forever.
Monica Goldstein: There’s been a growing amount of media attention on this, but how come there hasn’t been any change?
Dr. Pamela Wible: Because the powers that be in medicine are somewhat resistant to addressing the core issue, which is the system is sick. They’re really good at telling doctors they’re burned out and trying to get them to do yoga and meditation, but that’s like telling somebody that’s a prisoner of war to meditate their way out of the prisoner of war experience. Basically, when you are sleep deprived to the point of having seizures, which some of these physicians have, and food and water deprived because you’re doing 10-hour surgeries and you have to do water deprivation before or you’ll pee during the surgery, so you can’t drink water. They’re getting kidney stones, they’re fainting during surgeries, and they’re getting bullied and thrown scalpels at. They’re being treated like shit. Sexual harassment. All this stuff is happening. Yoga is not going to solve that. That’s just something else on their to-do list. When are they going to do yoga? They haven’t slept. You can’t do yoga when you’ve been up for 120 hours on a work week.
The problem is the system that has generated the environment that is killing these people, and is quite culpable for these deaths, and should have class action lawsuits and wrongful death lawsuits leveled against some of these hospital systems for all these deaths… There’s clusters of suicides at particular schools, three in six months at one school, all residents that died by suicide. Three within two years at another school. Brand name, first world country schools. Yoga and green drinks aren’t going to solve this. The system needs to be accountable and say, “Wow, these are human rights violations, not burnout.” When you tell somebody they’re burned out, they feel like, “Oh, I don’t fit in, it must be my fault.” They don’t think this is a human rights violation. It’s hard for people to make that connection. This was a valedictorian who was president of every club. Do you know the history of the word burnout? Really interesting. It’s a slang term from 1972 used to describe end-stage drug addicts dying in alley ways.
Monica Goldstein: Oh my goodness.
Dr. Pamela Wible: That has nothing to do with the majority of physicians in 2018. This word has been sort of latched onto by the general public. Because of mental health stigma, people don’t want to use the real term “I’m depressed, I’m suicidal.” They would rather say, “I’m burned out,” so it doesn’t sound as bad, but it’s an inaccurate label that doesn’t really claim the true problem. It’s like, if you don’t come up with the right diagnosis, the treatment plan will never work. They’re telling like the majority of doctors that they’re burned out. That doesn’t make any sense. They’ve been talking about this for 40 years.
Monica Goldstein: They’re placing the blame on the doctors.
Dr. Pamela Wible: They’ve been talking about physician burnout for 40 years with no freaking solution in sight.
Monica Goldstein: How many Americans will lose their physician this year?
Dr. Pamela Wible: Over one million Americans are going to lose their physicians each year to suicide. A million Americans. This is a public health crisis that’s not being tracked by the CDC. In fact, I’m sitting here in my bedroom at home tracking all these suicides. Nobody else is really tracking these properly with the amount of detail required to understand why these deaths are happening. Nobody is tracking medical student suicide either. We don’t even know how many medical students die each year by suicide. It’s like they don’t want to track it because it’s bad PR. Does a medical school really want to say, “We had three suicides this year?” Doesn’t sound that good. You know what I mean? But to ignore it just perpetuates these deaths.
Monica Goldstein: Sweeping it under the rug.
Dr. Pamela Wible: Right, yeah.
Monica Goldstein: How are things going to change?
Dr. Pamela Wible: By a grassroots revolution going on now. What’s changing is that medical students coming in and residents are intolerant to the abuse that their elders sustained. Any revolution is led by the younger generation. Civil rights . . .
Monica Goldstein: Well, there’s not going to be a walkout of kids in medical school, so what are they doing?
Dr. Pamela Wible: They’re not tolerating some of the bullying, they’re standing up for their rights, they’re going to get therapy, they’re talking to each other. Social media, you can’t hide some of these … Once a suicide comes out … Maybe in the 1800s they could hide what was going on. We have social media, so as soon as they see a body covered with a tarp in front of the hospital, everyone’s like texting each other trying to figure out who’s under the tarp.
Monica Goldstein: But there’s still the same amount of applicants trying to get into that medical school program. Nobody’s walking around to see, “Oh, are they smiling on campus? Are they smiling in the hospital when they’re making rounds?” They’re not doing what they do like when you walk into and you’re touring colleges.
Dr. Pamela Wible: That’s because there’s an oversupply of applicants for medical schools, and they don’t understand that there’s an undersupply of residency slots for the number of medical students that are accepted. It’s kind of like they lack informed consent about what they’re getting into, which is part of the problem.
Monica Goldstein: Do you have any optimism that there will be change?
Dr. Pamela Wible: I have optimism all over the place. I am truly a totally optimistic person. I’m just pointing out the problem because there’s no way to solve it if you don’t point out the problem.
Monica Goldstein: But are you optimistic that you will be able to, not just you, but you and everybody else advocating for change will be able to effect change in the near future before too many more physicians are taking their lives?
Dr. Pamela Wible: Yes. Absolutely, yeah. I was working on solutions for quite a while, I’ve been on this for six years, and I was kind of frustrated with the lack of traction, but my therapist pointed out to me that you can’t really solve a problem that nobody knows exists. I was like, oh, I gotta go back to increasing public awareness and decreasing professional denial, because there’s still physicians who will say, “We don’t have a suicide problem.”
Monica Goldstein: But the media has been reporting this for years.
Dr. Pamela Wible: You know how people can keep their heads in the sand if it doesn’t fit their paradigm.
Monica Goldstein: So if it’s on Dateline, they don’t care. It’s just another media story.
Dr. Pamela Wible: Yeah, they don’t. Fake news or whatever they’ll think of it. Who knows? Why do a million people that are Christian all disagree with the Bible? You can read the same verse and everyone has a different opinion. The same thing here. Not everyone believes that it’s a problem. Most people I talk to do, but the resistance, there’s resistance on the part of older generation physicians, and medical systems, and the old guard that runs the medical profession, at addressing this.
Monica Goldstein: Oh, needs to be a changing of the guard, right?
Dr. Pamela Wible: Right, yeah. I just want to point out, there’s a new documentary that came out, Do No Harm. That’s going to create a lot of culture change because it’s a full-feature documentary by an Emmy winning filmmaker that really digs into why this is happening. When you have a really good film and movie theaters and DVDs and Netflix, people are going to see that in a way that … This wasn’t available, this information was not so widespread. Once people have this information and social media, they can make different choices about whether going into medicine is right for them.
Monica Goldstein: Let me ask you from the patient side. When they go to see their practitioner, in addition to, obviously, writing the thank you note or just telling them how important they are in their lives or what have you, what clues or cues should they be on the lookout for to just be able to better identify if their physician is struggling?
Dr. Pamela Wible: Obviously if they’re sort of grumpy and … If there’s been a change, if their practice just got bought out by a hospital, and now the doctor’s grumpy, and now they’re running behind an hour and the used to be more on time. You can kind of figure out like, “Oh wow, they don’t look so good.” They look depressed. There’s sometimes signs like that, but a lot of times there’s no signs.
Monica Goldstein: I’m just thinking, it’s like I just want to make an appointment with my doctor just to do a head check, to make sure they’re okay. Nothing to do with the fact that I need to get a physical or whatever. Is it okay to cross that line?
Dr. Pamela Wible: Yes. I would recommend highly to do it more in written form than in person, just because they’re sort of suspicious by nature and distrusting because they’re prisoner of war survivors, you know what I mean? They’re intellectual people, so they like to digest material by reading it and thinking about it. You could talk about how much you love them or whatever in person, they might not like take it in, and they have another patient waiting so they’re trying to get out of the room. If you sent them a thank you card, they would read that over and over and over again, so it would have a lifespan for possibly decades, depending on where they save it. I think it’s much better to write it and let them digest it in pieces later versus trying to hug them and give them flowers or, I don’t know. Some of them might be uncomfortable because they don’t know what your motives are. They’re like, “Oh, does this person want narcotics? Are they being nice to me to … ” They don’t really understand some of them.
Then there’s the whole gender thing, you know what I mean? Like, oh, it’s a woman giving flowers to a male doctor. It’s just better to do the thank you note, I think. Just keep it simple and meaningful and related to your true appreciation of their care.
Monica Goldstein: You’re doing God’s work, Dr. Wible.
Dr. Pamela Wible: Oh, thank you. I guess that’s why they call me the guardian angel.
Monica Goldstein: Guess so. Any final thoughts?
Dr. Pamela Wible: Well, I started in December a love letter campaign for doctors and medical students, so that’s very fun and something that anyone can do. For example, I happened to mention it to … And I just say love letters because I like the sound of it, but it’s really like appreciation letters. It’s not like falling in love with your doctor letters. I mentioned it to a few people in my town and they’re like, “Oh wow, that’s such a great idea. I’m going to do this with my church at Christmas.” Because one idea is on Christmas after you finish opening your presents, why not sit down and write thank you notes to the doctors in the emergency room that can’t be with their families and go deliver them? You know, for example. There are doctors that don’t get appreciation and it would mean the world to them, and nurses, and others. Medical students could leave anonymous love letters for each other in the library. There’s sort of this trend to just random acts of kindness, being loving to one another. There would be huge culture change. If we only did that, it would be a much more beautiful medical education and practice for everyone.
Monica Goldstein: Thank you so much for sharing this wisdom, for enlightening us on this terrible, tragic epidemic that seems to be happening, and for just making it your mission to effect change.
Dr. Pamela Wible: I didn’t pick this, like these suicides picked me. That’s how I feel about it, like they come to me. I have a whole wall of my house covered in pictures of doctors who died by suicide in my home office. I just feel like I can’t not answer the phone when a mother has just lost her child to suicide because I have so much information and wisdom to share, and who else are they going to call? I have so much. I even started leading retreats for widows who lost their husbands to suicide. I just feel very compelled and like I was somehow chosen for this, so I’m just channeling, I guess, the messages from the doctors, who come to me in my dreams, by the way. I know that’s kind of weird, but some of these doctors who died by suicide, they come to my dreams, they talk to me. It’s like I get all this insight into what they want me to do and say, and how to help those of us who are still living to prevent these deaths. I don’t feel alone doing this, because I feel like these dead doctors are with me all the time. It’s really profound.
Monica Goldstein: Wow.
Dr. Pamela Wible: It’s intense. I mean in a cool, good way.
Monica Goldstein: It’s an extremely cool way. It’s a shame that they couldn’t reach out to you before.
Dr. Pamela Wible: Except then I have a philosophy that some people, their work is done at a certain age, and they have bigger plans that involve the spiritual realms, so I don’t always know obviously the big picture of their soul’s destiny.
Monica Goldstein: Well, I guess we have a lot of angels helping.
Dr. Pamela Wible: Yeah, yeah. There’s a lot of guardian angels. I personally believe that we should be able to have a world where people don’t have to leave a suicide note in their 20s and 30s because of a cruel medical system. It should be a never event in our hospitals and medical schools that anyone should die by suicide, and see, that’s the thing, when parents send their kids to medical school, they think that their kids are in the safest place if anything were to ever happen to them. Like, if they fell and broke their ankle, they’re surrounded by a hundred doctors. They would get the best care. Or if they had a panic attack. But the parents have no idea it’s walking into a Afghanistan-like situation for their mental health. That’s why it also takes the parents who are not physicians by surprise.
All I’m saying is the simple solution is having a culture of kindness where people really are expressing love to one another. Even if everything stayed the same, all the stresses, but if we were just nice to each other, the stress wouldn’t matter as much, because we know that we are loved, appreciated. The medical student knows that the attending really loves them and is looking out for them. I think it’s just the stress plus isolation and loneliness that causes the suicides.
Monica Goldstein: Thank you, Dr. Wible.
Dr. Pamela Wible: Thank you. And, by the way, if anyone wants to reach me, I’m at idealmedicalcare.org, and I return every single email and every single phone call. So if anyone’s suffering with depression or panic attacks or suicidal in healthcare, please reach out to me here. I talk to people for free all day long who are suffering.
Monica Goldstein: Thank you for sharing that.
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Doctor revived after suicide. Here's what he says.
