I had previously written you about the death of one of our residents in the anesthesia department [of a prominent US hospital]. I had mentioned another death [confirmed suicide] of a former internal medicine resident who had just started his fellowship.
I also want to let you know that our department is doing their best to continue the culture of shaming and secrecy around physician suicide. We are not allowed to talk about what happened. We have not had any sort of service to honor our own grief. We have been given various excuses for the lack thereof.
I had also purchased 6 copies of your book for my residents. I had not distributed them but had told a few about their presence. Please see the department wide email that I sent last week. The departmental administration should be ashamed of themselves. Please share this information as you see fit.
Sincerely,
Dr. J
Subject:Book on Physician Suicide
To all,
I have purchased a few books about physician suicide by Pamela Wible, M.D. I have had them for the better part of a month and have not sent a notice that I had them available for anyone. I was refused reimbursement from the department as this was considered to be a personal expense (for 6 books). I had previously purchased books on wellness and had been able to cover them through the department.
On Monday I was summoned to the office of the division chief. I had assumed that I was to be informed as to why the books were not eligible for funds. Instead I was informed by the executive vice chair that “the department did not want me to distribute these books to the residents.” At that time I also discovered that the division chief had stolen these books from the anesthesia workroom where I had placed them on the shelf. Since I have now recovered them I am making them available for anyone that is interested.
Dr. J
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If you are appalled by the behavior of those who wish to cover up the medical student/physician suicide crisis, please join our upcoming vigils across America to stand in solidarity with us, pledge your support of Do No Harm, the forthcoming documentary on physician suicide, and sign this petition. Thank you!
Here’s what happens when we don’t talk about physician suicide. More physician suicide:
Pamela Wible, M.D., is the author of the best selling book, Physician Suicide Letters—Answered. Photo courtesy of Yvonne Whitelaw, M.D., and quote by James Howe. Thank you all for reading banned books and for seeking the truth.
“Our incoming class at my medical school was just told by our Assistant Dean of Academic Affairs on our first day of orientation that he was there to crush our souls. His idea of welcome to medical school.”
Daily I receive messages from medical students like this one. I told this student to record all future lectures and to instruct classmates to do the same. Please contact Dr. Wible here to submit your recordings (your identity will be protected). Then a physician sent me a video of a junior doctor who did, in fact, record her abuse. Then she posted it online. To eradicate the culture of bullying and abuse in medicine, all medical students, residents, and physicians must begin recording the evidence. Then post your recordings online. Like Yumna.
Hi. My name is Yumna Moosa. I want to tell you why I don’t want to be a doctor anymore. Last year I worked under a man who sexually harassed me. It wasn’t only me. It wasn’t aways sexual. It was open and it was every day. Humiliating and degrading lower-ranking doctors is a big part of medical education. So he is an award-winning teacher.
I had to say something.
I had my phone with me while the hospital management explained that actually there was nothing wrong with my supervisor’s behavior. First, the racism.
Supervisor #1: “Are you defining yourself as Coloured? By race?”
Yumna: “Well, it’s tricky for me.”
Supervisor#1: “Pick one.”
Yumna: “I don’t want to.”
Supervisor#1: “No you’re saying that this is a racist problem so you must pick a race and then we work from there. . . In the last two years, as far as I can see, there’ve been 16 Whites, 43 Indians, 33 Blacks and 10 Coloureds, of which this one, I’m going to classify you as Coloured whether you like it or not. In this diverse group of people BEEP is in your group, he must have experienced the same process because he’s part of, he’s a Coloured and he is in the department of BLEEP.”
Yumna: “An example of something I mean is to say to a particular Black person, ‘You’re being stupid like a Black person.’ So it’s not to all the Black people, it’s to that person, but it is referring to their race in the insult. And that has happened.”
Supervisor #1: “Okay, so that’s individualizing.”
Supervisor #2: “It’s not racism then. Racism is against a particular race. If I’m racist I will be racist against every White man in the room.”
Yumna: “Otherwise it is not racism?”
Supervisor #1: “It’s not racism. No.”
Supervisor #2: “It’s individualizing. Or say let’s use sexual harassment. Because sexual harassment the definition is something that you personally feel uncomfortable with. So if he makes the remark and I’m comfortable with that remark, then it’s not sexism.”
Supervisor #1: “Friendly banter.”
Yumna: “But does it have to make every woman that has ever spoken to him uncomfortable?”
Supervisor #1: “Yes. That’s the definition of sexism.”
Yumna: “If a single woman doesn’t mind being told that women are stupid and irrational and incompetent, then it is not sexisim?”
Supervisor #1: “Then it’s not sexism. No.”
An essential skill for doctors is speaking with absolute authority. But saying that we did take that nonsense seriously, how do you count how many people are uncomfortable?
Yumna: “The first time I came to you to speak about Dr. BLEEP, one of the things you said to me was that I wasn’t the first person who complained. What was that?”
Head of Department: “That was what I heard from a previous consultant.”
Yumna: “Okay.”
Head of Department: “But that’s, you know, there’s no, there was no formal hearing or anything about that, you know, so . . .”
Yumna: “Okay so if it’s not formal, then it didn’t happen.”
Head of Department: “No, It didn’t happen if there was no formal hearing.”
Yumna: “Sure, um . . .”
Since then I’ve found five junior doctors who have submitted written complaints about the behavior of seniors at this hospital. Silence will not save us. Please submit your recordings. In one case as part of a large group. Nevermind verbal complaints. But these cries for help never became formal. Strange? Here’s why.
[In this recording the head of another department who recently qualified in medical mediation with the University of Cape Town was brought in as a neutral third party.]
Physician mediator: “You know you never when you’re young want to do something that’s going to impact upon you for the next fifteen or twenty years. It will. This will. You’ll never get another job! When I say, ‘Never get another job,’ you’re unlikely once this gets out, this is what you, this is your conduct.”
Yumna: “But, Dr. BLEEP my conduct is explaining that I felt uncomfortable with the behavior of my senior.”
Physician mediator: “You’re welcome to. You’re welcome to. But what I’m trying to get across to you: you’re one out of 360. If 359 have agreed with it you’re stok, steen, aleen [ Afrikaans: stok, steen, aleen = English stick, stone, alone = completely alone] and the departments, no department wants a person who is the loner. So if everybody is happy with a certain setup, we all drink beer at lunch time and you wanna come say, ‘I don’t drink beer’ then ‘No. Fuck off. This department drinks beer at lunch time. We don’t want you.’ You know, whatever the decision, whatever the processes are, if you want to be the loner, people will not want you in the department.”
Yumna: “It’s confusing because a lot of these things that happen are problematic. It is problematic.”
Physician meditator: “Only to you.”
Yumna: “The fact that there’s a workplace that is sexist is problematic.”
Physician mediator: “Only to you. Only to you.”
Yumna: “That’s not true, Dr. BLEEP, it’s not.”
Physician mediator: “Yumna. I’m an old man in this game. Only to you under these, this circumstance. And nobody is 100% happy at work. I’ve been in this game a long time. I’m telling you, grow up.”
Yumna: “Okay.”
Physician mediator: “Act like a doctor and you’ll be treated like one. Act like you’re a little spoiled brat and you’ll be treated like one. Grow up. My advice to you.”
Yumna: “I appreciate the conversation.”
[Yumna shows him her Medical Internship Logbook that contains feedback about harassment.]
Physician mediator: “Chuck that book away. Stand up and say, ‘An Act of God has occurred’ and God works in mysterious and wonderful ways and that your book has been lost. You’re applying for a new one and having thought about it and that you had a long chat and you realize that maybe what you said was inappropriate. Whether you do or whether you don’t, it’s not my problem.”
Yumna: “You just think that’s the main solution.”
Physician mediator: “Well I’m telling you it’s the solution.”
The book contains the only full record of my two years of supervised medical work as an intern. I didn’t throw it away. And then I heard that I couldn’t continue with my career. The head of the department wrote that after two years of notoriously grueling work as a doctor in South African hospitals I still have worse clinical skills than a university student and need to be retrained because I’m unsafe.
Head of department: “The reason why she’s not been signed off is regards some serious clinical performances and mismanagement of patients. As HOD of the department I cannot sign off an intern who I feel whose training has not been sufficient for her to learn the basic principles.”
In order to assist my career they were deliberately sabotaging it so I would learn a lesson about what it means to be a good doctor and more importantly so would my colleagues. Very long story short the Health Professionals Council of South Africa overturned the HOD’s decision. They finally said I’m allowed to work as a doctor. Why am I posting this video about how I don’t want to?
I’m doing this publicly because I want attention. Every day other junior doctors in South Africa and around the world are subject to the same kind of institutional coercion that I was. STOP PUTTING UP WITH THIS.
As a former doctor I have nothing left to lose. I can take some risks and hopefully show how the law will provide support. Meanwhile those with influence must deal with the systemic culture of abuse in medicine. It is tricky. One sympathetic health official is now considering removing the feedback section from internship logbooks so other junior doctors can’t get themselves into trouble by complaining.
It comes up over and over again. The harms I’ve suffered are my own fault. I brought them upon myself by not just keeping my head down. Medicine is a military hierarchy. Juniors are constantly told this is what your seniors went through and we must just do our time and get it over with. Some think this “just obey orders approach” is the best way to deal with emergencies or an overwhelming war against poverty and disease.
Me? I genuinely believe in the healing power of kindness and mutual respect and the importance of honest communication for avoiding deadly mistakes or learning from them. I’m a young educated person who is committed to making a contribution to my society so I am doing everything I can to prevent anyone else having my experience and I am looking elsewhere for my true calling.
___
Yumna Moosa is currently a research fellow preparing to register for a PhD in bioinformatics. Two of the senior doctors are facing charges of professional misconduct for what they did to her.
Here’s what happens if we don’t address the culture of abuse in medicine:
Pamela Wible, M.D., is a family physician who has dedicated her career to eradicating bullying and abuse from medical education and to preventing medical student/physician suicide. Contact Dr. Wible.
Illustration by Jorge Muniz, PA-C. Image credit Medcomic.com
We enter medicine with our hearts and souls on fire ready to serve humanity. By the time we complete medical training many of us have anxiety, PTSD, depression—even suicidal thoughts. Why? Medicine is stressful. Many of us work 100 hour weeks surrounded by suffering and death. We may deliver a stillborn, try to save a teenager with a gunshot wound, and then rush into the next room to help a lady having a heart attack—all within an hour. With no debriefing or emotional support. Medical training glorifies physical and emotional self-neglect and endorses teaching by intimidation and public humiliation. Bullying, hazing, and sleep deprivation is the norm in many of our finest hospitals and clinics. And if we seek psychological support, we’re mandated to report it on all job applications.
Doctors who complain about inhumane working conditions are often labeled with “burnout,” a “resilience deficiency” or even “disruptive.” They’re mandated to resiliency classes so they can learn mindfulness, deep breathing, or yoga. Victims get instructed in work-life balance, boundaries, and other ways to conform to their workplace abuse.
Anger, grief, and depression are normal responses to a sick medical system that forces us to submit to inhumane working conditions. “Burnout” blames the individual. Physicians may then feel unfit for the profession they once loved. The most vulnerable among us may leave medicine. Some may consider suicide.
“Burnout” and similar labels are dangerous to the individual and also distract from the real diagnosis—human rights abuse. (FYI: Meditation, yoga, and taking deep breaths are not treatments for human rights violations.)
The United Nations Declaration of Human Rights Article 5: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24: Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
Doctors, if you on a 36-hour shift in the ICU and have not eaten or pooped all day, you are experiencing multiple human rights violations. Patients, if you’re in the hospital and your doctor is bullied, abused, hypoglycemic, and sleep deprived, you should be very, very concerned. Human rights violations will adversely impact your care.
So docs, how do you know if you’re experiencing human rights violations at work? 1) You don’t get lunch or bathroom breaks. 2) You are forced to work multiple-day shifts. 3) You are not allowed to sleep. 4) You are forced to see unsafe numbers of patients. 5) You can never seem to find “work-life balance.” 6) You are threatened verbally, financially—even physically. 7) You are bullied. 8) And if you ask for help, you’re called a slacker or worse.
If any of this seems familiar, it’s not your fault. You are a victim of abuse. So what should you do? Your goal should not be to cope with abuse. Your goal should be to stop it. Taking deep breaths will not end your abuse. If you’re being abused, speak up. If you’re complicit with abuse, you perpetuate the cycle on the next generation.
Other countries get in big trouble for human rights abuse. Why should US health care get a pass?
Here’s what happens when we are complicit with medicine’s human rights violations:
Doctors who complain about inhumane working conditions are often labeled as “burned out” or “lacking resilience” or even “disruptive.”
Their employers respond by mandating resiliency classes so they can learn mindfulness, deep breathing, or yoga. Victims get instructed in work-life balance, boundaries, and other ways to conform to their workplace abuse.
Here’s the problem: Meditation, yoga, and taking deep breaths are not treatments for human rights violations.
Doctors, if you are running an ICU on a 36-hour shift and have not eaten or pooped all day, you are experiencing multiple human rights violations.
Patients, if you are in the hospital and your doctor has been bullied, abused and is suffering from constipation, hypoglycemia, and sleep deprivation, you should be very, very concerned.
I’m not making this stuff up. This is health care in America:
The UN Declaration of Human Rights: Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
Other countries get in big trouble for violating human rights. Why does first world health care get a pass?
Doctors need to eat, poop, and sleep just like everyone else. It’s true.
The deadly end result of not addressing these human rights violations:
Pamela Wible, M.D., is a family physician, an advocate for human rights in medicine, and an activist in medical student and physician suicide prevention. Please support our documentary to expose the truth.
So I just walked out of clinic today and I have to tell you I feel awful. Just awful. I was so excited to work at this particular clinic and now having seen how we went through patients like they were scraps to be tossed out, it is so disheartening.
The doc I was working with was lovely. She was very nice. But she kept telling me that I was making the “classic mistake of trying to ask patients about their problems” (!!!) apparently we don’t have time for that.
Another doctor told me, ”you only get sued if you are an asshole, so always pretend to be interested.” My mentors are kind, but they’re also so disconnected. They were clicking through visit logs to point out the “slacker” docs with 25 patients in an afternoon because we saw 30.
I just can’t. Holy crap.
I can’t imagine practicing like that, celebrating the fact that we went in told someone they had diabetes to go “lose weight” and walk out 5 minutes later and we’re supposed to be proud of ourselves for efficiency?Completely brush off the trauma a patient is telling us about her rape and PTSD because whatever we don’t have time.
It just kept going and going.
I felt like breaking down and crying every time I walked out of a room. How could I possibly be okay with turning my back on these people so grateful to see us?? But honestly now I’m just terrified. Of residency. I always knew it would be like that, and I do want to do it and get board certified, but holy crap. How could I ever survive that?
Eventually I’ll open my own clinic, you’ve inspired me too, but I always felt like I want to “work” for a bit, get comfortable with being a full-fledged doctor, and have a steady salary and savings before plunging into opening my own clinic. That I could just “survive” residency the way I’ve been surviving med school, but now it sounds awful. Is there really a residency that won’t crush my soul??
Sorry for ranting. I just needed to vent, but I’m alone in California on this internal medicine rotation and I know you will understand. They’re just training us to abuse patients in assembly-line clinics.
Thank you for being a shining light, and a great example. Without the hope of my own ideal clinic someday, there’s no way I could do this.
~ Jonathan
* * *
Hey Jonathan,
My best advice is to open your ideal clinic as soon as possible. Do not delay. Every day you wait, you continue to support this sick system that abuses you—and your patients. If you are a true healer, you can no longer be a victim. You must stand up for human rights. Yours. And your patients.
