I am a woman doctor, but I inherited a patriarchal medical model. A patriarchal medical model rewards male values.
MALE VALUES:
- Speed
- Volume
- Bigness
- Toughness
- Graphs
- Charts
- Algorithms
- Proof
- Strength
- Fighting
- War metaphors
But I am a woman doctor. I have female values.
FEMALE VALUES:
- Relationships
- Nurturing
- Hugging
- Joy
- Laughing
- Crying
- Feeling
- Spirituality
- Sharing
- Caring
- LOVE!
To be accepted in a man’s world, women adopt male values. A patriarchal medical model produces masculinized women doctors. I did not go into medicine to be a masculinized woman doctor. I went into medicine to be a healer—and a woman. And that’s what I am.
Pamela Wible, M.D. is a 100% woman doctor who practices family medicine in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind, a book that celebrates the love a woman doctor has for her patients.
I Love you for article ” Why Doctors Commit suicide”.
Each Bullet is true. I started Residency Program whose Director of Inpatient care welcomed the group new residents with a opening statement ” I can End your careers whenever I want”
I truly ended with a PTSD in that program
Sickening Anjali. So sorry you have had to endure the suffering. There is no reason for inflicting such intimidation and control on our future healers.
BRAVO!!! to you from a near miss!
MY RESPONSE:
I think the problem is less a trait of physicians than a trait of society. Physicians are trained to value healing above all else and are also trained that this can only come about through knowledge (in case of surgeons through practice). Always, science has outpaced medical education. In the past, physicians were perpetual students in order to keep up, very often provided with the intellectual tools– free books, journals and manuals from drug companies and hospital libraries. I often found physicians in the library eager to join our study groups. Alas, two thing in the last century happened at once that destroy physician morale:
(1) HMOs and health insurers forced incredible capitations on physicians while patients were bombarded with TV and media ads that made patients stuborn influence agents of Pharma and equipment companies. As a results, physicians have less and less time to spend with patients, though most of it was wasted explaining “why not” the garbage the patients picked up from TV bombardment with Pharma ads as well as bombardment with “off-label” bad advise from Pharma parrot-reps. This causes Dx to be made on the fly rather than through deep thought and reading…after wasting most valuable face to face time with patients explaining “WHY NOT” instead of why.
(2) Anyone graduated before 1995 missed out on the molecular biology revolution of today. As a result, physicians are some 40 years behind the science and the reimbursement bureaucracies another 20 years behind the 40 years out of date medical advances. Some MD/PhDs organized meetings( as for NIH, who can drop everything and travel to Bethesda, MD for a week of intense update?) to try and update colleagues locally. However, the researchers in these fields each developed his/her own vocabulary and code notions so molecular medicine requires that one first learns a totally new language; gone is the rational application of Greek and Latin and chemical terms. Kinases, proteins and DNA components have all sorts of odd numerical and verbal designations that must be memorized before going any further. However, after all the hype to justify the expense of the Human Genome Project– claiming to be getting “close to the address” of this and that disease, the 98%
“junk” DNA that is most of the cell’s DNA, as JAMA and NEW ENGLAD JOURNAL OF MEDICINE so well explained it, has been found not to be junk but rather critical regulatory machinery that we barely understand, very fragmentary at best.
So, physicians know that Mendel is not as rigidly relevant as we thought; furthermore, only Pharma plays around with genes in some dark proprietary fashion that no drug rep could ever explain. At the same time HOW and WHY– Rx and Dx– intervention is applied is, in the final analysis, totally based on such oversimplification as to be BS as a lot of the real reasons have to do with incomprehensible and often fraudulent statistics driven by the profit motive.
The physician faces the “new”-type patients who come with their “chief complaint” as a bag of manure they carted on their backs all the way to the office; they drop it on the physician’s desk and say: “Here, I carted this all the way to you, now you deal with it; that’s what you’re paid to do, so I can get back to my NORMAL (???) life [of self-abuse]!” And then there are those who see the doctor as a lottery ticket vs. the bureaucrats at the insurance for profit companies that see the doctor as a crook!
So, unable to be thorough in examination because of visit time constraints, with no time to think– but worst of all not allowed to go back to school to learn MECHANISMS of physiology/pathology at the molecular level instead of dumb pseudo-statistics as if all patients were some randomized homogeneity– physicians are losing morale and burning out. They understand that: (a) with so little control of causes of disease, (b) so little patient collaboration in a “we fighting your illness together” sense because patients only want an end to symptoms so they can go back to their “normal” symptoms-causing lives, and (c) the process of Dx, Rx and Tx (not even enough time to get a responsible history) out of their control by totally their responsibility, physicians know enough statistics to know that the more patients they see, the more likely that they will find themselves in court, making them in the final analysis devoid of authority but buried in liability!
Inevitably, insecure, physicians get defensive and, looking in the mirror, they are disgusted with the defensiveness they see. “I am an MD to GIVE, not to take FOR myself or to constantly have to defend myself, not to deal with BS and frivolous insulting charges from patients unhappy with their condition and insurers unhappy with the complaints of their stockholders….And now the hospitals want to OWN us MDs as indentured clinic employees!!!
Sure, it you’re an MD only to own a big house and a Cadillac, you find a way. But if you’re a caring humane physician who feels the patient’s pain– though TOTALLY UNAPPRECIATED and suspected (Primary care MDs are paid per hour of patient contact that your plumber per hour of contact with your pipes according to MEDICAL ECONOMICS going back to the 1980s!!!)– you begin to dread waking up in the morning. Unlike other people who can call in sick, you can’t because it is a rule of our society that physicians DO NOT get sick, so if they FEEL SICK, they must be malingering!!!!!
In the Stalin Era of the USSR, it was a common statistic that the group of people who most often committed suicide where the wage earners who were accused of sabotaging the State by “malingering.” Like our physicians today, they felt defenseless against the punishment imposed on accused malingerers. So, as an MD today, when knowing that if you stay home with a fever you will be accused of sabotaging your patients’ health by “malingering,” you cannot miss grasping the reason why eventually so many physicians commit suicide. After all, if as a physician, you do manage to get to a party, the guests invariably think nothing of designating the left bank of the punch bowl as your makeshift office…so, “the doctor is in” and they line up for free medical advice (with you totally liable for erroneous advise). You know what happens if you say: “please see your own PMD as I’m only here to loosen up drinking this punch like the rest of you and have a good time
AWAY from the office!”
No physician commits suicide on day #1 post-residency. It takes time of caustic practice as enemy #1, guilty until proven innocent. We all judiciously damn Stalin’s “DOCTORS’ PLOT” terror campaign blaming doctors for whatever Stalin’s paranoia could conger-up. We can understand why so many Soviet doctors committed suicide rather than face persecution. Yet, we just can’t grasp how America is persecuting as “Stakhanovites” its own physicians. Americans can’t understand that physicians need PAID time to re-educate themselves periodically– educational “sabbaticals” every few years like ALL academics are provided. They need more TIME with patients to INDIVIDUALIZE patients by getting to know them BOTH when sick as well as when well to individualize that difference. Physicians also need time to decompress with quality family time.
Hospitals are snake pits of over-paid administrators, underpaid medical staff and overworked residents and nurses. Less teaching and more pecking order priming goes on in these snake pits. Also too much institutional healthcare is for outrageous profits as executive salaries if “non-profit” and stock-holders’ dividends if for-profit. The cost of that is physicians who kill themselves because they blame themselves for feeling “SICKENED” by medicine while judge THEMSELVES psycho-pathologically as “malingerers.” It’s when all the pain medications they take so they can go on no longer work that they resort to ending the feeling of guilt and self-disdain through suicide. Look at the real crooks, the administrators with an MD to their names or an MPH who see patients as a “commodity.” Those MDs who are administrators are few….FAR LESS THAN THE MDs WHO COMMIT SUICIDE so concentrate FIRST on saving the caregivers before going after the bureaucrats. Give
doctors:
1) AUTHORITY
2) RESPECT
3) A STABLE LIVING WAGE
4) TIME TO REST
5) AN END TO FASCICLE SCAPEGOATING…
….and most importantly, give them SABBATICALS WHERE THEY CAN CONTINUE THEIR EDUCATION (which, by the way, should not leave them crippled with debt after residency as does their initial medical education).
MDs that are still alive should work to cure their symptomless or repressed symptoms of PTSD that so many suffer from– especially primary care MDs– as a result of our society “Stakhanovite” capitation system that for profit insurers and allegedly not-for-profit hospitals impose on them.
DE Teodoru
Excellent summary of issues facing physicians today. Thank you so much for posting. Let’s keep the conversation going. Fist step to healing is RECOGNIZING and CLAIMING the problem. First we must make the diagnosis that physician suicide IS a problem. Many docs are willing to just sweep it under the carpet because the issues are so immense to take on straightaway. Thanks for your words.
There is a power in words. Thank you for validating ME by listing all the female values here. I as a female physican, this is how I function every day; and how I treat patients. Hovewer, since male values were dominating medicine during the course of my entire education, I did make a mistake of trying to live by those. The problem is, it did not work for me, I had to fake it; in the end I got tired anyhow and reverted back to my genuine ME with all the nurturing, bringing hope, relationships and the rest. In reality, how can I pretend to be a male??? Just like faked loyalty or love, it is just an illusion.
But there was always a shadow of doubt that I may not be right with this; (afterall I know so many smart people in academia who tell me otherwise). So thank you Dr. Pamela for validating who I am and “killing” this shadow of doubt after all those years. Sometimes all a physician needs are just right words from another…
Yes. The lists are simple. It took my nearly 20 years as a doctor to figure this one out myself. Glad I can be of some help. I think you’ll find even more insight in my book. Happy to send you a copy, but the e-reader is the best so if you can download that I think you’ll be in heaven.
Hi Pamela, I am a nurse. I am male and was born left handed and have always had more of the intuitive side right brain dominance. I understand your thinking about Male/Female values. Ultimately both polarities of yin/yang or masculine feminine principles are necessary and exist on a continuum. Of course each personality has a constellation of traits/values that they develop. Some of these values are artificial societal values and create useful/benign persona, yet some are repressive and restrictive and create a mask of a false self and ego. One must breaking free of stereotypes and develop true self-awareness and find authentic self expression and actualization to be free from this matrix of artificiality and false values. There are both masculine and feminine false/artificial values. There has been an overall shift of deeper awareness of feminine values in society, there needs to be a newer understanding of authentic masculinity as well. Spirituality has always been a huge part of my life. I see the taoist principle of firmness and flexibility to be mutual and complimentary. These two principles are necessary to transcend the category of either/or thinking and to see beyond the surface of our societies’ constructs of gender and division (fragmented thinking) and to learn to dance to the rhythm of our true authentic nature. This true nature is the unconditioned mind or spirit or mind of Tao, in the Christian Spirituality it is the mind of Christ. Whatever we use to describe it, it is the consciousness by which we live, move and have our being and the ground by which we can blossom into the fulness of our greater selves in love. The western patriarchal left brained medical values are not holistic or spiritual and fail to instill healing, hope or meaning. The Caring Science of Jean Watson is holistic and is something I implement in my practice and life. In my own studies of Spirituality, Chinese Medicine, Western Medicine/Science and Nursing a broader viewpoint has emerged of openness to learning from many viewpoints and perspectives. Saint Irenaeus stated that “the glory of God is a human being fully alive; and to be alive consists in beholding God.” This spiritual mystery of God is beyond words. To see men and women become fully alive and be all that they can be also goes beyond words. Dr. Pamela, who you are goes beyond words, it is amazing what you have done in bringing authentic womanhood into the profession of Medicine. May more people be awakened by your message.