Doctors keep screaming and throwing scalpels. What can I do? →

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Dear Dr. Wible,

Thank you for the work that you do. I have been following your push for humane medical education for several months now. I finally decided to contact you after reading your article about how “burnout” is actually abuse. I am a med student entering my third year. I have been consistently hearing horror stories from other students about the treatment we will receive on our clinical rotations—doctors belittling us, calling us names, screaming and yelling everyday, throwing scalpels in the operating room, not giving bathroom or lunch/dinner breaks, manhandling patients under anesthesia, and many other things that students are too scared to even describe. When I have brought these concerns up, I have been told by peers and even administration that the best way to handle this behavior is to “keep my mouth shut and my head down.” The school is very aware of the problem. We’ve asked the administration to establish a formal student mistreatment policy (we currently do not have one) but I sincerely doubt that any changes will come as they claim that they don’t have less abusive clinicians to teach us.

I came to medical school specifically to work with underserved populations and to further social justice in health. I am very concerned about being broken by this abusive system in my third year. I am already exhausted, experiencing depression and anxiety, having panic attacks and insomnia. I am torn between my intrinsic desire to fight against abuse and what everyone is telling me—to stay quiet to survive. I know that it will kill a part of me to “just take it,” but I don’t know how I can get through this training any other way. I honestly don’t know what writing you will accomplish, but you seem to be one of the few people willing to acknowledge the rampant and ingrained culture of abuse in medical school.

Thanks again,

Matt

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Dear Matt,

Silence will not save us. The health care cycle of abuse is perpetuated by those who do nothing to stop it. Victim blaming and shaming with labels such as “burnout” actually perpetuate the mistreatment by deflecting attention from institutional abuse and making individuals feel defective. You are having the normal reaction anyone would have to an inhumane health care system. Here’s what I recommend (in no particular order):

1) Keep a daily journal. List all incidents of abuse and mistreatment of students and patients. Writing has been the best therapy for me. Helps you process and get the pain out of your system.

2) Publish your experiences in training. You can do this (even anonymously) through popular blogs such as mine or KevinMD. Submit an op-ed to local, regional, even national newspapers (under a psuedonym if you must). I called my med school and residency out on their cruel vivisection experiments in the local newspaper—and still graduated! (Some of my superiors even thanked me for being courageous).

3) Start a petition with your classmates to present to your dean demanding that your human rights be respected during training. There’s power in numbers. They can’t scapegoat the entire class. I petitioned for my rights successfully in med school. Read how I did it here.

4) Advocate for humane treatment of attendings. They are injured and need help too. So many docs have Stockholm syndrome, and see themselves as strong and capable, while seeing med students as whiny lazy kids who need to grow thicker skin. They need to be cared for and educated so that they see themselves as survivors of abuse—and empowered to break the cycle of abuse.

5) Remember that you are not defective. Don’t take threats and abusive comments personally. Most of what they say has nothing to do with you. Theses folks need therapy.

6) Invest in your health so you can help others. Get routine counseling and massage. Sleep and eat well. Do what you can to stay resourced and strong so you can think clearly.

7) Report unsafe and inhumane working conditions to OSHA and other oversight agencies that are involved in accreditation of our medical institutions.

8) Give positive reinforcement when abusive instructors actually behave. Your feedback may help them to be better teachers. These folks are seriously wounded. As weird as it seems, they need your help.

9) Start a Balint group, peer counseling, or other support system among your classmates. Maintain cohesion. Intimidation and public humiliation work best when students are divided and conquered. Stick up for your peers. Speak out as a group if a student or patient is mistreated. Here’s how one med school class got rid of their bullying professor.

10) Most importantly—do something.

Hope that helps!

🙂 Pamela

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Pamela Wible, M.D., is the founder of the Ideal Medical Care Movement. Dr. Wible is the author of Physician Suicide Letters—Answered. Need a letter answered? Contact Dr. Wible.

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Doctors found unsafe to drive home after work →

Some employers are now providing cab rides for physicians because they’re too fatigued to drive safely after their hospital shifts.

Just got this email from a resident [physician-in-training]: “OMG. See below. The violations and consequences pretty much deter you from ever bothering to want to use this service.”

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My response: “If doctors are so tired they can’t drive, why are they being allowed to care for hospitalized patients? If they can’t safely drive a car, why are they being allowed to run ventilators in the ICU?”

His response: “Exactly. And then let’s offer residents a ride in the most threatening way possible so that there is no chance they will take it. It’s all so stupid that it’s painful. I think you need to publish volume two of Physician Suicide Letters—Answered and just publish documents like this. They speak for themselves just like the letters.”

I reply: “Sleep deprivation is a torture technique and a form of hazing common in medical training. Did you see my TEDMED talk where I discussed this?”

He responds: “The funny part is, how often does a doctor ever not work 12 hours and not feel exhausted. I think any physician would have difficulty abusing this. However my bet is, if you were to use this too often—whatever that is—(even within their stated criteria of 12 hours and exhaustion) you would be called in for a chat to ask why it is that you are so tired so often, and more absurd, humiliating questions. Kind of like our work hours reporting now. [Residents are limited to an 80-hour work week]. We have learned not to report working beyond 80 hours/week. If you do you are called in to discuss the “hour violations” and a chat about how inefficient you are. So everyone lies, everyone works way over what they report, and yes everyone is still exhausted. Round and round we go . . .”

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Pamela Wible, M.D., is a physician who is outraged by the health care cycle of abuse that wounds physicians and patients alike. She helps physicians break free of the cycle of abuse at biannual retreats. Need help? Contact Dr. Wible.

Tags: residency work hours, resident physician abuse

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You’re not burned out. You’ve been abused. →

Please stop using the word burnout. You’re not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? ATTENTION medical students and doctors: It’s NOT your fault.

“Burnout” is physical and mental collapse caused by overwork.

So why blame the victims?

Victim blaming and shaming, bullying and hazing, all lead to increased suicides.

The fact is medical students and physicians are collapsing because they are suffering from acute on chronic abuse. At some medical schools, 100% of students report abuse. Do you think this gets better? Abused medical students become abused doctors who may one day abuse patients. Human rights abuses are commonplace in our hospitals, clinics, and medical schools. This doctor worked 7 days in a row with almost no sleep!

Think abuse is too strong? Read the UN Declaration of Human Rights. Countries get in big trouble for this sort of behavior. So why is it okay for our health care institutions to perpetrate human rights abuses on their own students and employees? It’s not.

Think the doctor below is burned out? Nope. She has been ABUSED!!

Docs, stop playing nice. You are being abused.

Only you can stop this crap.

How do you know if you’re being abused 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 sounds familiar, it’s NOT YOUR FAULT.

YOU ARE A VICTIM OF ABUSE.

So what should you do? Sign up for a resiliency training? Meditate? Take deep breaths? Your goal should NOT be to cope with abuse. Your goal should be to STOP it.

Burnout blames the victim, not the perpetrator. It implies that YOU are to blame, not the system, not the perpetrators of the mistreatment.

To treat burnout, health care institutions may offer resiliency classes to train doctors to prioritize self-care and manage their emotions. WARNING: You can not meditate your way out of abuse. Taking deep breaths will not end your abuse.

WHAT YOU MUST DO: If you are being abused, YOU MUST LEAVE YOUR ABUSER. I know it’s scary. You are not alone. Need help with your escape? I’ll help you. Contact me.

Remember: YOU were born to be a healer, not a victim.

Grab your free guide to launching your ideal clinic here.

Please break the cycle of health care abuse that leads to suicide among doctors and poor care for patients.

Pamela Wible, M.D., founded the Ideal Medical Care Movement. She helps doctors open their ideal clinics through her popular teleseminars & retreats. When not caring for patients, she devotes her life to eradicating health care abuse. Videos by TEDMED and GeVe.

Tags: burned out doctor, burned out medical student, medical student burnout, physician burnout

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How to grow a happy doctor →

Yesterday I spoke with 500 medical educators who are responsible for educating more than 26,000 medical students across 44 medical school campuses in the United States. Before my presentation, I asked 500 medical students: What are 3 things you’d like to tell your dean (but are afraid to say)? I’ll do it for you.

Here’s the basic message I delivered to a room full of medical school deans, provosts, presidents, and administrators in my keynote, Humanizing Medical Education: How To grow A Happy Doctor.

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Isn’t it amazing that we know how to perform lung transplants, map the humane genome, grow organs in laboratories, but we don’t know how to grow a happy doctor? We do know how to grow unhappy doctors. Here’s what a medical student named Sam wants you to know:

1) Med school is the single most unhealthy thing I have ever done for my body, mind, and spirit.

2) I was on zero psychiatric medications and now I am on more than one, and it’s my second year of med school.

3) The only communication the administration has with us is through fear mongering and the upperclassmen just tell us to get through it and it’ll be over soon.

I’ve heard from lots of medical students like Sam. So I synthesized all the responses I received from students into the top 10 commandments for medical school educators. Yes, this is what medical students want to tell you but are afraid to say.

The 10 Commandments for Medical Educators

1) Teach leadership, transformation and empowerment in the curriculum. Empower me so I can empower patients.

2) Stop creating an environment that encourages competition among students.

3) Tell me that it’s okay to cry in front of patients if it’s on their behalf.

4) Ask what inspires me and ask how you can help me achieve my goals.

5) Respect us as adult learners. Avoid condescension. Don’t revel in our ignorance. We want to learn. Try not to kill our curiosity.

6) Advocate for humane treatment of attendings. So many docs have Stockholm syndrome, and see themselves as strong and capable, while seeing med students as whiny lazy kids who need to grow thicker skin. They need to be cared for and educated so that they see themselves as survivors of abuse—and empowered to break the cycle of abuse.

7) Be more concerned about your students wellbeing than damn Step 1 scores.

8) Provide emotional support for doctors and med students. Our wellbeing benefits the whole system. We are not the enemies here.

9) Please don’t train me to forsake my humanity to be a better doctor. My humanity should be celebrated, enhanced, and matured, not demeaned, degraded, or insulted.

10) Show me empathy.

What happens when medical training fails to follow the sage advice of these students? More of this:

Pamela Wible, M.D., is a family physician who is determined to stop the medical culture of bullying, hazing, and abuse that has injured countless medical students, physicians, and patients. Want to help? Contact Dr. Wible.

Tags: medical school, medical student abuse, medical student bullying, medical student burnout, medical student depression, medical student suicide

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Why doctors kill themselves →

TEDMED talk by Pamela Wible, M.D. Read fully transcribed TEDMED talk. For more information on how you can help stop the loss of our brilliant and compassionate healers, see Dr. Wible’s TEDMED page.