How to Smoke a Cigarette with Your Doctor →

Joe has smoked two packs per day since his teens. He knows better. I don’t need to lecture him on the dangers of smoking.

“I was a respiratory therapist back in Brooklyn,” Joe says in his thick New York accent.

“And you smoked?”

“Yep. All the respiratory therapists smoked, Doc.”

“Reminds me of cardiologists who order bacon and eggs in the hospital cafeteria, but then tell patients to eat low-cholesterol diets.”

Joe continues, “It’s my anxiety. That’s why I smoke. I moved to Oregon a few years ago for the quiet life. I’m gonna turn my life around. You’ll see, Doc.”

Today we’re celebrating. Joe hasn’t had a cigarette since he went into the hospital last month with pneumonia.

“I feel terrific!” he says. “I’ve turned the corner, Doc.”

The next day I’m bicycling through town. I turn at the corner of Sixth Avenue. To my right, I see a man smoking a cigarette. I have a feeling it’s Joe. He’s standing next to an apartment complex. I get closer. Oblivious, he has headphones on and he’s tapping his left hand on his thigh. So I speed up and then stop suddenly right in front of his face. The high-pitched squeal from my brake pads startles him.

He does a tough guy pose and tries to stare me down. “What’s your problem?” he says.

I lean my bicycle against the door to his apartment.

“Who are you?” he demands as he closes in on me.

We’re in a standoff. He takes off his headphones. I take off my bike helmet. He removes the cigarette from his mouth. I remove the sunglasses from my face.

Then he slinks back against the building and almost cries, “Oh my God. Oh no. Oh no. Oh my God. I can’t believe it. I promise this is the first cigarette. I just picked it up just now. It’s the first one. I mean the last one. I promise I’m going to quit, Doc. I’ll quit now, tonight, as soon as you leave. It’s the last one. I promise. I can’t believe it’s you. What is this? Why are you here? What are you, an angel?”

I put my hand on top of Joe’s balding head, look straight into his eyes, and I bless him: “Your life has been spared one more day.”

Then I ride off into the sunset.

This is PART 1. Read PART 2.

Chapter 78 from Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. ** R.I.P. Joe 12/10/13 **

Tags: cigarettes, ideal medical care, pamela wible, Pet Goats and Pap Smears, smoking

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Why I Kiss My Patients →

I started kissing patients in med school. And I haven’t stopped.

During my third year pediatric rotation, I used to stay up late at night in the hospital, holding sick and dying children. I’d lift them from their cribs, kiss them, and sing to them, rocking them back and forth until they fell asleep. One day the head of the department pulled me aside. He said that I was a doctor when my patients needed a doctor and a mother when they needed a mother.

Twenty years later, I’m still mothering my patients.

I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. They worried that big government would kill the small-town physician. But I love being a family doctor. And I love my patients. I hug them and kiss them, and I do housecalls. And most patients call me Pamela or sweetie, or honey. They all have my home phone number. I’m on call 24/7, but I never feel like I’m working.

I’m not good with boundaries. I’m never sure when work ends and play begins. It all feels the same to me. Many of my patients are friends. I do their physicals and eat over at their homes for dinner.

I’m not a fan of professional distance. But I’ve been trained to maintain distance from patients. How can I remain distant when I’m looking deep inside people in places nobody has been before? How can I remain detached when delivering a mother’s first baby, saving a brother’s sister, or helping a child’s grandfather die?

Apparently, maintaining a safe distance from patients will help my objectivity, limit favoritism, maintain clear sexual boundaries, and prevent exploitation. But patients today don’t want professional distance; they want professional closeness with a doctor who has a big heart and a great love for people and service in a clinic where people feel warm, nurtured, loved and important.

And I want to be that kind of doctor.

The truth is: I can’t always stop patients with heart attacks from eating bacon double cheeseburgers. I can’t always stop smokers from smoking. I can’t always stop little kids from dying.

I can’t always cure, but I can always care—and kiss my patients.

Pamela Wible, M.D. is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.

Tags: compassion, ideal medical care, pamela wible, Pet Goats and Pap Smears

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The Life of a Miscarriage →

Last week a woman told me that she had a miscarriage in her bathroom. She was terrified. She didn’t know what to do. So she flushed it down the toilet.

A miscarriage is the spontaneous expulsion of a fetus from the womb before it is able to survive on its own. One in five pregnancies ends in miscarriage. Many women don’t know they are miscarrying. Those who know usually suffer grief and sadness, mourning the loss of what could have been . . .

One moment a young mom-to-be is decorating the baby’s room, preparing to welcome a new son or daughter. The next moment, she is giving birth to death.

For some women every period is a failure. The disappointment, the longing, the despair is overwhelming. One woman describes “years and years of monthly miscarriages—a constant cycle of anticipation, devastation, acceptance, and surrender.”

How much is a human life worth? Women spend tens of thousands of dollars on fertility treatments that may still end in miscarriage.

What happens to all these miscarriages?

I asked Mom, a retired psychiatrist. She told me that during her pediatric rotation in medical school, she was called to a premature delivery. When she arrived, the obstetrician had already tossed the miscarriage in the trash. Mom looked down. The tiny body was still moving. Mom tried to save it, but it died.

It seems odd that someone so valuable could be flushed down the toilet or thrown in the trash. But not all miscarriages are discarded. Some are sent to my father.

As a teenager, I worked alongside Dad, a hospital pathologist. We received miscarriage specimens in plastic containers. Each miscarriage was carefully placed on a fine metal strainer in the sink. We turned on the water and rinsed away the membranes, clots, and blood until all that was left was a tiny little rib cage and a couple of femurs. Dad could date and age the little body by the size of the bones. I thought it was amazing.

While most fathers were accompanying their daughters to ballet recitals or soccer matches, I was privileged to participate in an archeological dig with Dad through the remnants of human life. And for me it was all normal—and beautiful.

Raised in a morgue, I spent my childhood accompanying Dad to work. I peeked in on autopsies and examined body parts. But as a young girl I was most intrigued by the babies. They looked like Buddhas. From largest to smallest, they sat cross-legged along one shelf. Floating in jars, they leaned toward me and stared straight through me. And they never blinked. They seemed to know something I didn’t. But who were they? And why were they trapped in jars? And how come I wasn’t inside a jar, too? Dad’s inner-city miscarriage collection still intrigues me. All Philadelphia natives, they were probably Irish Catholic, Puerto Rican, and mostly African American. But none were black, or brown, or white. All blue babies. All race-neutral. Chromosomal defects were the likely cause of demise. Maybe their tender souls weren’t ready for a rough, urban life. God may have had a better destiny for them.

This is the United States of America. In God we trust. So what happens to all these miscarriages? Seems the souls leave the bodies. And the bodies become medical waste.

But not all are lost and forgotten. When Dad retired, he offered me his miscarriage collection. I was honored to be asked to watch over their little bodies rather than have them incinerated as medical waste. But I could not see stuffing all the jars into my carry-on bag and holding up the line at the airport while trying to explain myself. So I kept only one. I made it through airport security with that tiny person in my pocket—a six-week-old calcified embryo about the size of a penny.

Sometimes when I lose sight of the big picture, I hold that tiny person in my hand and I see the whole world.

Pamela Wible Pamela L. Wible, M.D. is a family physician and bestselling author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. A portion of this essay excerpted from chapter 95, “Buddha Babies.”

Tags: ideal medical care, miscarriage, pamela wible, Pet Goats and Pap Smears

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The Ideal Medical Care Movement Sweeps America →

More and more doctors are leaving jobs they hate and opening ideal clinics.

It’s a national trend.

Now there are hundreds of ideal clinics nationwide. Find one near you on this map. Meet some of the most innovative doctors in the country in these news stories. Discover how they’ve created the cutting-edge clinics of the future.

What’s an ideal clinic?

Ideal care is relationship-driven rather than production-driven. Most ideal clinics offer 24/7 access to the doctor by cellphone, as well as e-mail access, home visits, same-day appointments, and more . . .

Ideal clinics deliver ideal care for patients in sustainable neighborhood offices. Patients have excellent access to their doctors and develop strong relationships over time while receiving comprehensive health care services close to home.

Ideal care is defined by patients. They often say, “I can get care when and how I need it with a doctor who knows me as a person.” Doctors who provide ideal care say, “I am free to do what is best for my patient and I have all the time, tools, and technology I need.”

Many physicians have led town hall meetings and have allowed their patients to design the entire clinic, from homemade gowns to the office decor and more.

Don’t like the health care you are receiving? Stop complaining. Find a doctor you love.

Meet two of the newest ideal doctors in America in these video clips: Lara Knudsen, M.D. and Nila Jones, M.D.

Keep your eyes open for the next ideal clinic coming to a neighborhood near you.

Pamela Wible, M.D., pioneered the first community-designed ideal medical clinic in America. She can be reached at idealmedicalcare.org.

Tags: ideal medical care, Lara Knudsen, Nila Jones, pamela wible

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Interview with Dr. Pamela Wible: Pioneer of Community-Designed Health Care →

Dr Pamela Wible has been described as medicine’s Martin Luther King. Born into a family of physicians, her parents warned her not to pursue medicine. She followed her heart only to discover that to heal her patients she had to first heal her profession. So she led a series of town hall meetings inviting citizens to design the clinic of their dreams. Celebrated since 2005, Wible’s pioneering model has sparked a populist movement that has inspired Americans to create ideal clinics and hospitals nationwide. Dr. Wible is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind and is co-author of the award-winning anthology Goddess Shift: Women Leading for a Change with Michelle Obama and Oprah Winfrey. Dr. Wible has been interviewed by CNN, ABC, CBS, and is a frequent guest on NPR.

Could you tell us about your background and what made you decide to become a doctor?

I was born to be a doctor. My parents are physicians, so it’s in my blood. In utero, I accompanied my mom, a psychiatrist, on rounds at the state hospital. Raised in a morgue, I worked alongside my dad, a pathologist. I peeked in on autopsies and examined body parts, even miscarriage specimens. Dad and I examined itty-bitty rib cages and femurs. He could age the body by the size of the bones. I thought he was amazing.

From the morgue, I followed Dad to three part-time jobs. At the Philadelphia jail during pre-breathalyzer days, on-site doctors examined drunk drivers. Bored coloring the policeman coloring book week after week, I got clearance to interview the inmates. At the methadone clinic, Dad told clients to show me their track marks. On call for the Philadelphia Fire Department, Dad would lift me from bed for late night drives to industrial warehouses engulfed in flames. I’d sip hot chocolate with Dad and the crew in the lead fire truck. Introduced as a doctor-in-training. My parents set me loose on schizophrenics, inmates, addicts, and cadavers while most girls my age were playing with Barbies. How could I not be a doctor?

You wrote the book Pet Goats & Pap Smears which has received astounding reviews. Could you tell us a bit more about the book and if you have any other books planned for the future.

This book offers what medical school doesn’t. Medical training teaches technical skills, but not the art of medicine. Doctors are taught to order blood tests and CAT scans, to diagnose and drug, to perform surgery. But we have no courses on how to serve patients with joy. We have no textbooks on love and compassion. We aren’t tested on creativity. Intuition is rarely recognized as a diagnostic tool. And all too often, we view death as our own failure. Trained to detach emotionally and spiritually from patients, medical students eventually lose connection with the meaning of life and the mystery of death.

When premedical and medical students shadow me in my office, they often tell me that I’m the first happy doctor they’ve ever met. And the only solo doctor they’ve ever known. Students tell me they have no mentors. In this book, I offer myself as a mentor to students who will never have the opportunity to hang out with me at our community clinic. Though I’ve written this book for medical students, doctors and patients love it too! This book is now taught in medical schools and undergraduate medical humanities courses. And yes! I have Pet Goats & Pap Smears sequels coming. But first I need to complete the Kindle conversion of this book . . . coming soon!

What made you decide to start a physician retreat and what did you learn from that experience?

I published Pet Goats & Pap Smears to celebrate the joy of doctoring. Two days later, a local pediatrician shot himself in the head in a public park. In just 18 months we lost three physicians in our small town to suicide. At the pediatrician’s funeral, I realized that both men I had dated in med school were dead. Brilliant physicians. Loved by their families and patients. Both died young—by suicide.Physicians have the highest suicide rate of any profession. In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. I was suicidal once. Assembly-line medicine was killing me. Rather than kill myself, I invited my patients to help me design an ‘ideal clinic.’ It is possible to love medicine again. I wanted to do something to help other doctors love medicine too.

I learned that doctors lack the basic skills to run a successful solo community clinic. They lack camaraderie. They lack joy. In the retreats, I teach community organizing and business strategies that doctors need to succeed. Doctors deserve to be happy, to live their dreams fearlessly.

In your opinion why have so many physicians, at one point in their life, considered suicide?

Doctors are wounded healers. Many docs tell me that they graduate medical school with PTSD. We carry the trauma from every life-and-death experience we witness in our training. We carry the pain and suffering of our patients’ lives. Yet we don’t receive mandatory mental health services to help us cope. In fact, physicians are afraid to seek mental health care due to licensing repercussions. I have compiled a list of reasons why doctors die by suicide here.

How do you personally deal with stress on a day-to-day basis?

I do not compartmentalize. I love my work. I work a humane schedule. I allow my patients to help me. I invited my patients and community to design an ‘ideal clinic.’ So many people volunteered to help open the clinic. They saved my life and my career. My patients give so much energy and love back to me. And I feel very, very supported. I have no stress.

The majority of readers of this blog are medical students. What advice would you give to any of them who may be considering suicide or who are suffering from depression?

Remember your personal statement. Honor yourself and your dreams. Ask for help. Remember that you are paying tuition to learn a skill set so that you may be the doctor you described on your personal statement. Do not settle for less. Allow classmates, patients, other doctors to help you. See a therapist or counselor. Do not isolate. Do not suffer in silence. Do not give up on your dreams. Contact me anytime. Seriously!

Are there are any clinical predictors of physician suicide? And if we are worried about a colleague, what is the best approach?

Clinical predictors are history of suicidal ideation, depression, substance abuse, isolation, pessimism, cynicism, and hopelessness. We have easy access to lethal drugs and firearms. Not a great mix. If you know a colleague who is suffering, reach out to him or her. Realize that men often have a harder time asking for help. Keep your heart open for others who may be having a hard time. Invite them to lunch. Listen to them. Sometimes just having someone to talk to is enough.

Has becoming a doctor impacted on your social life, relationships and family life?

Yes! Doctoring is my life. I love it. The key for me is working part time so I can love my personal life too.

Could you explain what an ‘ideal clinic’ is?

An ideal clinic is defined and designed by the patients and community the clinic serves. In 2005, I held town hall meetings and invited citizens to design their own ideal clinic. I collected 100 pages of written testimony, adopted 90% of feedback, and we were open just one month later. For the first time my job description had been written by patients, not administrators. My patients are my heroes. I discovered that patients and doctors want the same things. By bringing my patients’ ideal clinic to life, I was suddenly practicing medicine in the clinic of my dreams. Here’s how any community can design an ideal clinic.

If you had 1 billion dollars to improve one aspect of healthcare, what would you spend it on?

Humanizing medical education. We need happy doctors, not reductionist robots. I’d start by giving free copies of Pet Goats & Pap Smears to every premedical and medical student in the world.

Reposted from Meddebate. Interview by Jamal Ross, London, UK.