Doctors-in-training hit with knives, punched, left crying in hospitals →

So I started medical school in Germany. Germany has a very strange system. At that time it was relatively easy to get into medical school, but then they do everything to get you out of medical school. It’s the opposite of the United States. It has changed now. It’s very abusive from the get go. When I was a medical student, there was something wrong with the system that they over-calculated and there were 10,000 unemployed physicians in Germany. There were a lot of physician taxi drivers and so on. So the typical position you got at that time was a 3-month contract and usually a specialty that you didn’t want to be in. And it was highly abusive so your superiors could do anything with you: I mean hit you, I mean throw knives at you, and it was completely okay because you were happy you had a position as a doctor. And so I realized very quickly into medical school that that wasn’t really the thing that I wanted—being abused like that.  So I started orienting towards other possibilities. 

And then I got a scholarship to move to France, to medical school there for two years.  And it was the same thing. They had more of a physician shortage, but it was so highly abusive in medical school. I mean there was one surgical department where every single day all the professors had to say were mean things calling people words, yelling at students and residents in the OR. It was interesting.

Eventually I was invited to study in the states and I moved to California and it was a little bit similar there. I was only there for a short time and there was some protection from people there and it wasn’t that bad and then I got into residency in the States and there we go again. I mean I remember one ER doc he always hit me on the shoulder if I gave the wrong answer. There were 6 main faculty, 3 of which were completely burned out themselves, but they liked what they were doing but they couldn’t do it anymore . . . it seemed like they didn’t feel like they were doing a good job if the resident wasn’t crying . . . every day there was a resident crying, but we’re not talking about 3-year-old children not getting their chocolate. They were adult, mature people, very bright in the residency. They were all really bright people, but they were crying because they didn’t know the answer to some silly question. I don’t know what it was about or they missed something completely irrelevant. 

I realized how much abuse there was throughout. You had to be self-abusive in order to get your MCATs in order to get into medical school, go through medical school and get into residency, get a good residency, go through residency it is all abusive. You have to be completely self-neglectant and I realized I didn’t want that, yet I needed the board certification and it was only 3 years and I graduated from that and then around that time, at the end of residency, I met Pamela . . .

Dislike your job? Launch your own clinic—even without completing residency.

Have you been mistreated in your medical training? Contact Dr. Wible. 

Pamela Wible, M.D., reports on human rights violations in medicine. She helps health professionals heal from their trauma and open ideal clinics. Join our teleseminars and retreats. Stop suffering now.

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7 shaming words to stop saying now →

Shaming Words Pamela Wible

In medicine our motto is first do no harm. Words matter. Choose them wisely. Here are 7 words that shame, blame, and injure people who need our help.

1. Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark ages and use proper language to discuss the cause of death. It’s died OF pneumonia, heart attack, stroke, suicide. Say died OF suicide (or died BY suicide).

2. Don’t say she IS bipolar. People are people first. Some get physical and/or mental health conditions. The health condition is not their identity. She HAS pneumonia, heart disease, depression, not she IS pneumonia, heart disease, depression. Say she HAS bipolar disorder (or she is a person WITH bipolar disorder).

3. Don’t say he IS an addict. As in #2, people are people first. He is not a disease. He is not a behavior. Thus, he is not a substance abuser or an addict. He is a person who may have an addiction or a substance abuse disorder. Say he HAS an addiction.

4. Don’t say patient IS NON-COMPLIANT. Non-compliant blames the patient for not following a plan that she may have not understood or agreed to follow. Maybe she simply did not have money to buy the medication or the recommended treatment. Be precise and accurate with words, especially when placed in a permanent medical record. Don’t blame or shame. Be curious and engaging. Ask, “IS THE TREATMENT WORKING?” 

5. Don’t say PROVIDER. A provider is a person who provides something. How nebulous. In medicine, a provider is an economic term used to lump all the revenue-generators together into one pile (often to see how much more money can be squeezed out of them). It’s a dehumanizing word that lacks precision and, honestly, it’s offensive to the people who have spent so many years of their lives to achieve mastery in their chosen profession. Use proper terminology. Say NURSE PRACTITIONER, MIDWIFE, PHYSICIAN. If you must use a collective term, say HEALTH PROFESSIONALS. Sometimes, I say HEALERS.

6. Don’t say MIDLEVEL. What is that? Maybe it’s when an elevator gets stuck between two floors? Again (see #5) this is a word used by health care administrators to describe revenue generators who are somewhere halfway between a nurse and a doctor (I think). Use proper terminology. Say PHYSICIAN ASSISTANT or NURSE PRACTITIONER. 

7. Don’t say BURNOUT. Physician burnout is a term of oppression that blames the doctor for not keeping up with an inhumane schedule (30-hour shifts, 120-hour work weeks) in a toxic workplace that may include hazing, bullying, and no time to eat or take bathroom breaks. Even on their so-called time off, doctors may still be working on chart notes at home in bed on the weekends. Burnout blames the victim and deflects attention from the perpetrator. Speak the truth. Say HUMAN RIGHTS VIOLATION or HUMAN RIGHTS ABUSE. Don’t say burnout, say ABUSE.

Know of any other shaming words that should be lost from our lexicon? Add your comment below.

Shaming Words To Stop Saying Now

Pamela Wible, M.D., is a practicing physician who reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered and leads popular retreats for health professionals. Come join us! Image: Shutterstock.


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“Burnout” ~ a smokescreen for human rights abuse →

Physician burnout is human rights abuse

“Burnout” is a smokescreen for rampant human rights violations in medicine. Am I losing anyone here? Let me break it down.

“Burnout” is a complete mental and physical collapse from overwork. Psychiatrists define it as a job-related dysphoria in an individual without major psychopathy. Which means—your job sucks. You’re normal

Smokescreen is an artificial cloud of smoke that hides the perpetrator’s true intentions. This cloud of smoke may take the form of a statement or word used to obscure the truth so victims don’t understand what the heck is really going on. For example, apply the victim-blaming term “burnout” to deflect attention from oppressors who are guilty of human rights violations.

Human rights violation is the violation of a basic right to which all humans are entitled, including the right to life, liberty, equality, a fair trial, freedom from slavery and torture, and freedom of thought and expression. Common human rights violations in medicine include: 1) Sleep deprivation (24+hour shifts, 80+hour work weeks) as described by this physician whistleblower who was forced to work 168-hour shifts.  2) Not being allowed to eat, poop, pee when one needs to 3) Bullying and hazing 4) Being terminated, harassed, or threatened rather than receiving accommodations under the ADA for mental or physical health issues as described by this physician whistleblower who nearly died when her hospital obstructed her medical care.

Physician whistleblower is a physician who reveals health care’s human rights violations to the public. If you’re a physician with a whistleblower story, contact me. Doctors must stop being complicit with abuse or they will become the perpetrators (see below). Physician whistleblowers protect themselves, other health professionals, and patients from continued abuse. Silence and secrets protect the perpetrators.

Victim is a person harmed, injured, or subjected to oppression or mistreatment (may include being sacrificed or killed due to an action/inaction). Those who don’t know they are victims are at high risk of becoming perpetrators.

Perpetrator is an individual (acting alone or within a system such as a medical school, residency or hospital) who harms, injures, or subjects another to oppression or mistreatment (may include sacrificing or killing someone else due to perpetrator’s action/inaction).

Burnout is a smokescreen for rampant human rights violations in medicine. One way to end a cycle of abuse is to stop blaming the victims. Tell the truth: it’s not burnout, it’s abuse. 

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Pamela Wible, M.D., is a physician who reports on human rights violations in medicine. Have you been abused in medical training or beyond? Contact Dr. Wible. 

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Is your doctor worth more than a plumber? →

plumberdoctor-hourly-wage-pamela-wible

I asked a group of docs I’m coaching how much they’re worth per hour. Interesting question given docs have 11+ years of specialized training beyond high school. Surgeons spend most of their 20s and 30s in school. By the time these folks graduate, they’ve got 200K+ med school debt—before kids, spouse or house. Many docs just don’t have time to develop a social life, fall in love, have children—until their 30s or later!

What’s it worth to have all that training? Where does all that delayed gratification and self-sacrifice lead? Some urgent care jobs pay docs $75/hour. Of course, patients want to see doctors for a $20 copay. Is that all we’re worth?

When I asked docs to tell me what they’re worth, many refused to respond. Why? Confusion, overwhelm, low self-worth? Maybe most doctors have been devalued for so long, they just have no idea what they’re worth. 

Those who responded were all over the map. DC Psychiatrists charge $600 per hour. A Colorado family doc is $200/hr. One in Louisiana charges $100. As a reference, a family nurse practitioner in Alaska bills at $466/hr and a med student in California claims he’s worth $600. So what’s the truth? How much are you worth per hour? (This is not an optional question. You really do need to know.)

Reality check: let’s compare doctors to plumbers. Much shorter training and tuition costs. Just a year at a community college post GED/high school. Then (depending on location) 2-5 years of paid apprenticeship before getting licensed. And what do plumbers charge? I just had a guy fix my toilet tank. Took 15 minutes. I paid $125. A gynecologist in Washington state pays her 26 year-old plumber $350/hr for emergencies.

Plumber liability insurance is usually less than $1K annually. Compare that to a family doctor at 10K+ or neurosurgeon 100-200K+ yearly. Just for professional liability insurance. Before a patient even walks in the door.

So is plumber in Washington worth 3.5 times as much as a family doc in Louisiana?

What do you think?

What would you pay for an hour with a doctor?

Addendum: As I’m publishing this (no joke), my landlord calls to tell me my office bathroom is flooding. I rush down to assess the damage. Not bad. Maybe all pricing is relative to need and urgency.

 Click here to find out how dog walkers are earning more than doctors.

Pamela Wible, M.D., is a practicing family doc in Oregon. She pioneered the first ideal clinic designed by patients. Now she helps others open ideal clinics too. Join our upcoming retreat and learn how.

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Hospital obstructs medical care, nearly kills doctor →

I recently reported on Stephanie Waggel, the doctor fired by a prestigious U.S. hospital for getting cancer (story also picked up by Medscape and The Washington Post).  In her whistleblower video, Stephanie describes how she nearly died due to obstruction of medical care. 

It started during my intern year of residency.  Which, bizarrely, was the happiest year of my life. And all my friends are like, “You’re an intern, you’re not supposed to be happy, something is clearly wrong with you.” But, I’m like, “I’m out! I’m doing psychiatry. This is what I’ve always wanted to do.” I absolutely loved it. I had so much energy and I planned my outfits weeks in advance and had themes. And I had all these lectures for the medical students and it was just everything that I always wanted and it was completely delightful. I started having this pain, and it was waking me up from my sleep. And I really didn’t have time (because I was an intern) to get it worked up. But it was getting really, really bad. I was feeling really sick a lot and something had to be wrong so I really had to push to go to these appointments. 

For example, one time I went to get an MRI, but the MRI machine broke and then I had to go again the next day. And then when I told my team and my attending the MRI machine broke, they made some joke about my weight. And I was like, “No it’s actually cause there’s some helium tank in it that broke.” They were not letting me go. It was awful, and I’m like, “No, I need to find out what’s wrong with me.” So I pushed and pushed and pushed and after wrong diagnosis, and everything, they finally found out that I had renal cell carcinoma. And I said, “Well, that’s going to be a lot more doctors appointments.” 

So I went and I had a partial nephrectomy [kidney removal] and I thought that everything could be set up because there are people having babies and things like that. So I would send my schedule, like when my appointments were, and say, “Oh I have this appointment, like, three Tuesdays from now.” That Tuesday would come and everybody would be like, “Oh, we’re slammed today. You’re going to have to reschedule that appointment.” And I’d be like, “Okay.” And then, I’d reschedule it and then that day would come and they’d be like, “Oh, we’re really busy.” I would never be able to get to go to my appointments. So, eventually, I was just like, “I’m going, I need to go.” And my oncologist said that had I not gone, I would have died within at least a year or two. And, when he said that to me, I was like, “Well, I’m really glad that I went, because had I listened to everyone around me, I would be dead in a year or two.”

And I distinctly remember this attending that I had, on the day that I was diagnosed with cancer, told me to pick between being a doctor and being a patient. And up until that point, I never really thought about, “What if I’m a patient and a doctor?” But then, the entire year was just a struggle to be both. 

So I went to my chief for help, I’m like, “I need to go to these appointments, like follow-up,” cause I needed genetic testing because what twenty-eight-year-old female gets kidney cancer? And he was just saying, “Ugh, we’re going to have to re-do the call schedule.” And I’m like, “I’m so sorry to inconvenience you, but I have cancer.” Then I went to governing bodies (that I won’t mention) and they were telling me, “This really isn’t our problem, it sounds like an institutional kind of thing.” So then I went to people in my program, I went to attendings, I went to the dean, I went to the hospital ombudsperson (who cried when I told her what was going on). She seemed to care a lot, but she basically said there is nothing I can do for you.

After that, I saw her in the hallway at work and she had this look like, “I’m so sorry that I can’t help you.” And she came over and handed me a piece of paper and hugged me and walked away. And I looked at the paper and it was the telephone number to a lawyer, and I’m like, “This is all just so bizarre.” So then, I really didn’t want to get the legal system involved, but there’s got to be somebody that can help me. So then I started writing to the university president and he didn’t reply to me either. 

So I just got to this place where I decided to just fix everything on my own. So I made it a QI [Quality Improvement] project to create a system that I call PWP (which is physician wellness program). So that if anybody else has a chronic illness, or even needs to go to therapy every week or something, that they don’t go through all these hurdles that I was going through. And I spent a lot of time and research and effort into this and that’s how I found out about the National Day of Solidarity to Prevent Physician Suicide, which I worked on with Pamela. Once my department found out that I was doing this, they’re like, “You need to stop.” And I said, “But, you told me to do research and I’m doing research.” And they said, “You can’t have days about suicide.” And I’m like, “Why not?” 

So then, I did finally get a lawyer and I filed a claim to the EEOC and then when they found out I filed the claim to the EEOC, they voted to terminate my residency. And, I appealed that cause my evaluations from my attendings, I had maybe two average and the rest were above average.  And it just didn’t make sense so I figured that maybe they’d look my appeal and wonder, “Why are we firing her?” But then, when Care 2 published a little paragraph about why I got involved in the Day of Solidarity, and I spoke about how I had cancer and was having a really tough time getting off work to go. That is the day that they chose to send me a letter stating they’re terminating my salary and my health insurance, knowing that I still had more follow-up. So I just thought this is definite retaliation, the vote to fire me was after I filed with the EEOC and then the letter I got terminating all my benefits was the same day as my paragraph for the Care 2 page came up. 

So, now I am unemployed, so I am full-time working on PWP. So if anybody has any connections to residency programs that they’d like to implement a wellness program into, I’m your gal. 

 

Stephanie Waggel fired for cancer

Leave Stephanie a comment below or contact her at ImproveMedicalCulture.com.

Got a whistleblower story? Been abused in training? Contact Dr. Wible.

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Pamela Wible, M.D., reports on human right violations in medicine and offers physician retreats to help her colleagues heal from the trauma of their training. Are you a wounded healer? Come join us! Video by Geve. 

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