Oklahoma doctor suicides—13 reasons why →

Dedicated to the lives of Oklahoma physicians we have lost to suicide 

On January 11, 2019, I delivered this talk to the medical students at Oklahoma State University Health Sciences to a surprise standing ovation and again the following day as the Oklahoma Osteopathic Association keynote address. Audio/transcript below. (Video will be posted when available).

Dr. Jonathan Bushman: Next, we’d like to welcome our keynote speaker. Dr. Pamela Wible, M.D., is a family physician born into a family of physicians, who warned her not to pursue medicine. She soon discovered why. To heal her patients, she first had to heal her profession. Fed up with assembly-line medicine, Dr. Wible held town hall meetings, where she invited citizens to design their own ideal clinic. Open since 2005, Dr. Wible’s community clinic has inspired Americans to create ideal clinics in hospitals nationwide. Her innovative model is now taught in medical schools and featured in Harvard School of Public Health’s newest edition of Renegotiating Healthcare, a textbook examining major trends with potential to change the dynamics of healthcare. Dr. Wible speaks widely on healthcare delivery and is the best selling author of Pet Goats & Pap Smears and Physician Suicide Letters—Answered.

When not treating patients, Dr. Wible devotes herself to medical student and physician suicide prevention. She’s investigated more than 1,100 doctor suicides, and her extensive database and suicide registry reveals highest risk specialties—and solutions. In between treating her own patients, Dr. Wible runs a free doctor suicide hotline and has helped countless medical students and physicians heal from anxiety, depression, PTSD, and suicidal thoughts—so they can enjoy practicing medicine. Please help me welcome Dr. Pamela Wible.

Dr. Pamela Wible: I’m so excited to be here. I loved the last talk. We have a new DPC patient over here, the AV guy Mike is so excited to sign up. He was really influenced by that talk by Kyle. And so today I’m going to talk about how I survived my own suicidal crisis, our opioid national crisis, and a gazillion patients begging me for marijuana—to finally love my life as a doctor.

I knew I was screwed when this hippie guy with dreadlocks came to my house while I was gardening. This guy accosted me in my own garden at my home looking for pot. And I was totally confused, out of context. Then he tells me, “I heard you’re the cool doctor in town.” So he thought that I was going to give him medical marijuana by coming to my house. And then I had another patient show up. This is in Eugene, Oregon. I don’t live in Oklahoma. Another patient brought this giant pot plant on the city bus coming to his appointment with me and was hoping to trade or barter or whatever like this is his payment. I had to explain, “No, I don’t take pot. Just cash or check.”

So this is a situation in Oregon. We have a state where we were the first to decriminalize marijuana in 1973. And in 1998 we legalized medical cannabis and then recreational cannabis in 2014. And of course you know, in Oklahoma, you legalized it in 2018. So I’m like 20 years ahead of you on the influx of patients demanding pot from me. By the way, I went to med school in Texas—UTMB/Galveston. And I did not go to medical school to be running a medical marijuana mill. 

 

Ever feel like this? In a situation where everyone is making demands on you to fill out paperwork and get people onto disability. And now they want pot from you. Is this really the best use of my education and my skills? It doesn’t make any sense. Assembly-line medicine—which is what I call this production-driven model that most docs are in—made me suicidal. My job sucked.

So this was my situation. You can see that’s me there screaming for help. This is art therapy for the captive physician in a big-box clinic. I felt trapped and unable to utilize the skill set that I had to help people in seven-minute increments with an embezzling clinic manager. It was insane, double-booked patients. My life sucked. I’m sure you can relate to what I’m saying. I had to do something different.

So I did something really crazy. I just decided, hey, if I’m not happy, and the patients aren’t happy, I’m just going to put the patients in charge. I don’t know how to run a clinic. I tried six jobs in 10 years. They all sucked. They were all assembly-line, big-box clinics. I’m just going to ask my patients. You guys design a clinic. Write my job decision. I’ll work for you. I’ve had enough. So I held a series of nine town hall meetings over a period of six weeks in Lane County, Oregon. And I collected 100 pages of written testimony. I pretty much told people, “Hey, I’m going to do whatever you want, as long as it’s basically legal.” And so I was able to adopt 90% of what people in my county needed for ideal healthcare and opened our clinic in less than one month with no outside funding.

Here’s a picture of going from big box to where the grass is greener. The grass is greener when you’re in your own clinic, and you own it, and you’re in charge.

I launched for $627.50 and I’ll explain how I did that because some people are concerned about startup costs for this sort of thing. They can be really low: quarterly insurance payments for malpractice were billed four times a year, so that was about 350 bucks upfront. And then my rent for my little one-room, cute, little office in a wellness center was $280 a month. This was 14 years ago. It’s gone up to about 400, but that’s not a big deal. And then I spent 40 bucks on some Goodwill chairs, and that was it. My exam table had not arrived yet by the time my first patient came, but he didn’t care if I examined him on the floor. We were having a great time, because we were back into the real patient relationship. And so I just want people to know, you can actually launch your clinic.

I have not set an alarm clock for work in 14 years, because I don’t want to be woken up by loud noises. After med school, I can’t stand loud noises jolting me out of sleep. I  believe in following my circadian rhythm, and I am my best around 3:00 PM in the afternoon. This is kind of early for me to be on stage. I don’t generally set an alarm because I usually go to sleep around 3:00 in the morning, wake up around noon, go to work around 3:00 PM. I’ll stay there as long my patients need. And I work Monday, Wednesday, Friday afternoons and evenings, because I don’t believe working two days in a row is healthy, not for me at least. So like to spend one day in between the days I work. And then I’m at my best with patients. It’s so fun, and I make more now than I made before, back when I gave 70% of my income away to the infrastructure that I didn’t need to run my clinic. All this infrastructure has grown up around you, and it’s a lot of people. You’re paying their salaries and everything. You don’t need them. If you’re doing lung transplants, you need a team, and you need a helipad, and you need all that stuff. If you’re doing primary care, outpatient specialty care, too many cooks in the kitchen, get rid of everyone. It’s called disintermediation, by the way, which is a term I learned in the self-publishing industry, which means removing the middlemen.

That’s the actual thing. That’s the cure for most of our ails. As physicians we need to disintermediate our lives—get rid of all the people that have no business between us and our patients. And I just want to forewarn you that some people, when they do this, they inadvertently recreate the big-box clinic in a smaller box. Don’t do that, because then that’s another nightmare. Now you own that big thing in a small box, and it’s going to drive you nuts. You’ve got to use a different business model. You’ve got to use a different kind of thinking to do this.

Medicine is an apprenticeship profession and sadly we’ve lost our mentors, which is why we’re all adrift together, wondering what to do. We’re getting our mentors back like Kyle and Jonathan and the wonderful people we have here launching new, innovative models (that are really just the old model coming back DPC and relationship-driven medicine). So when you do that, when you have the right mentors, you don’t replicate what’s not working. And since we’re creatures of habit, we inadvertently start replicating what we’re used to, even though we’re in a smaller box. So don’t do that. Follow a new model, and the grass is definitely greener. Now I’m doing house calls again! SO awesome!

Here’s a picture of me actually doing a house call in Oregon on the Pacific Coast for a patient of mine who used to drive 100 miles to see me. He has terrible arthritis. He can’t drive anymore, so whenever I go up the coast of Oregon, I always go visit him and do a almost unannounced house call and hang out with him for a while. Here we are.

He’s such a cool guy. Love this dude. Here we are doing an office visit over the Pacific Ocean. Is that awesome? Sitting on a little wicker loveseat. He’s adorable. I just love this dude. And by the way, he’s sort of a poor guy. He used to be the gardener for this particular property. And the woman who owns it is letting him live in that house for free for the rest of his life, which is awesome. And so he’s really got a good deal between me as his house call doctor, rent-free house over the Pacific Ocean, this guy has it made.


There I am filling out paperwork for his medical marijuana, because he feels better on medical marijuana for his terrible arthritis. So I have a few patients on it, but I’m not running a mill. And this is not what I want to be doing all day long. And I’m also filling out his paperwork for his disabled fishing permit. There’s a special series of pages you have to fill out if somebody is disabled, and they want to continue hunting and fishing. So you get a license for somebody to hunt and fish with you to help you, if you can’t hold the rod on your own and all that jazz. So that’s what I’m doing.

Here I am in my office. I threw a surprise party for my friend. Long story, she thought she was coming for a physical. She went in the back room to get undressed, and everyone jumped out of the bathroom. I live in a small town.

When you’re in a small town, you know everyone, and they’re your patients, because where else are they going to go? So I have a lot of fun at work. And by the way, I might seem kind of out to lunch, West Coast hippie type, yet I’m really a very conservative doctor. I’m totally by the book. I just like to have fun. Some people call me the female version of Patch Adams. I’m really fun, okay? So I just want to have fun at work. I believe you can accomplish just as much with a smile and a party hat, and you can put Mardi Gras beads on your patient during a physical. And you could laugh the whole time and have as much fun as you want and still deliver great medical care, and leave your patients laughing.

As a result, our community-designed clinic caught some national attention. Four months into it I had an article in the Journal of Family Practice on this new community design model. First one in the country where patients design their own medical clinic. I learned a lot from that, and now it was even in the Harvard Business Review. And then this is other article came out: “Who Will Heal the Healers?” Interesting title that was very prophetic.

Then my entire life changed on October 28th, 2012 at 3:00 PM, when I ended up in the second row of a memorial service for the third physician we lost in my town to suicide. And these aren’t fringe guys. They’re all male, top of their career and just suddenly gone. And so I’m sitting at his memorial service, and I’m noticing that of course everyone, small town, knows what happened. He shot himself in the head in a public park in he middle of the day, this pediatrician in my town. Everyone knows at the memorial how he died, but nobody will say it out loud. Everyone is whispering “Why?” in the bathroom. Everyone wants to know why he shot himself in the head in the middle of the day in a public park, which is a very pubic suicide. But nobody will ask the question out loud. How odd—especially for physicians. As scientists, we should be interested in this topic, because aren’t we here for healthcare? Isn’t it about decreasing pain and suffering? And these are our own brothers and sisters who are dying by suicide. Yet even physicians won’t say this out loud. They’re sweeping it away as if it didn’t happen—a perfect scenario for creating a situation in which there’s repeat occurrences, if you don’t identify what the problem is.

I was fascinated by people’s reaction to the suicide and the hush-up nature of it. And I couldn’t stop thinking about it, because I’m a scientist, and I’m a curious human being on the planet, plus my job is being a doctor. My job is solving medical problems, so I wanted to know just to answer the question for myself why this guy died. And not just this guy, I want to know why the other two guys died in my town in just over a year. Three guys died in my town of suicide, all doctors. And sitting at the memorial, I started counting how many people that I knew had died by suicide as physicians. I was in my early 40s and I knew 10. Can you believe that? I was shocked, including the fact that, by the way, two of those guys were men that I dated in medical school that died by suicide—not while they were dating me. This is when they decided to marry other women. That’s just the truth of the matter.

Okay, so I started tracking these. I started a little list in my little diary. I kept a doctor suicide diary, and kept writing down names. Then I wrote a little blog about it. Five years later, I end up with 547 names on this registry. This was just a hobby of mine I was doing outside of clinic. But it took over my life, because six years later, just the end of last year, I had over 1,100 names on this list. I’m just a private citizen interested in answering a question. And I end up with this massive registry of physicians from all over the country and world.

So I had a blog, by the way, for about a year before I was at that memorial service. And I don’t think anyone was reading it. I don’t think anyone cared how happy I was as a doctor. I had little photo essays of my house calls. It was cute and all that, but nobody really cared. But I started writing about suicide, and all of a sudden that blog there on the bottom got 231 comments. You think nobody is reading your stuff, and all of a sudden you get hundreds of comments. And some of the comments were people writing, “My son died in residency to suicide, and here’s his name. And here’s his situation.” They’re not only commenting. They’re telling me the entire case histories of their own children that died in medical school. They have classmates that died in residency, and patients are writing in about their doctors who died, but nobody did anything about helping them grieve from losing their doctors.


And then some of my blogs, kind of cool, started getting picked up by the Washington Post. The editor  wrote me and said, “Do you mind if we republish your very well-written blog?” And I’m like wow. I didn’t really do that well in English in high school, but if I’m getting my blogs picked up by major newspapers, then go for it. So my physician suicide blogs have been picked up and run on the front page of the health science section in the print version of the Washington Post and online. Is that cool or what? And it just kept going from there. I ended up on Dr. Oz last year. So I think this is a topic that people are finally ready to discuss.

This is an actual wall in my house (in my home business office) covered with pictures of doctors and medical students who died by suicide. Many of them, I’m very close to their families, because—let’s just face it—in the aftermath of a suicide, often the person who’s died by suicide is shunned. So they almost get buried twice. They’re shunned in the aftermath of their death. And then the family, nobody wants to really talk about this with the family for too long. So a lot of times when I contact the families, they’re relieved that finally somebody is calling and wanting to talk about their loved one. Family members feel shunned and isolated, they lose friends. So much pressure to keep it quiet. And so hard to  grieve in isolation. It’s just a nightmare.

So I started running these retreats for physicians. And last year in December, there were two women who lost their husbands to suicide as physicians. And one of them, by the way, shot both of his children on his way out. And so I’m recognizing the extent of this problem. By the way, I truly believe if that guy was a real estate agent, those kids would still be alive, and so would he. And they’d be rolling Easter eggs at Easter and doing family things. It’s our profession that has killed these people. And we cannot allow this to continue. And so I just was like, who’s helping these families that are left behind? And so I just out of the blue, because I was so good at these retreats with physicians, I decided to offer an all-expense paid trip for these widows. Where are they going to go? To the emergency room and cry? She lost her whole family. So I flew both of these women out. They both lost their husbands to suicide within a few weeks of each other. And they were high-profile cases that were in the news, and people kept contacting me, saying, “You should talk to them. You should talk to them.” Well I think they’re going to need more than a phone call and prayers for recovery and Bible quotes. I think they actually need more intervention than that, when their whole family is gone.

So they arrived in Oregon for a retreat, put them in a room together, so they could heal with each other, and did therapy with them with a therapist for three days in a row, helped them grieve the loss. One of them still had two kids, and the other one didn’t have anything. And they became friends. They were of course having nightmares, unable to sleep, so you want to put them in a room together, because they were afraid to sleep alone. Just some of the stuff that I’m doing, that really I had no idea I was going to end up doing this when I moved to my cute, little clinic and discovered this doctor suicide crisis.

But the joy of all this is when you’re in your own clinic, and you’re not paying 74% overhead, is what I was paying … Would you move to a state with 74% income tax? Because that’s what you’re doing when you work in those big-box clinics. You are giving it away to all these people. You know what? They could care less whether you live or die. They may not even care if your patients live or die. All they care about is how much revenue you can generate per millisecond. And I’m not embellishing this. Just the facts. You know what I mean? So I think the sooner we can recognize the reality of what’s going on, because we’re nice guys, we’re a little naive, do-gooders. But we’ve had people that are not such do-gooders bossing us around. When the A students are being bossed around by C students, that’s not a good scenario, got to break out of that.

So I just personally can’t stand the idea of losing any more of these people. That’s the situation I’m in, and so I just want to catch you up to speed. I’ve been running a suicide hotline for six years with doctors. I think I have gathered more information about this than probably anyone on the planet, including the ACGME and other people that think they’re protecting us with all their things they are doing (while they take weekends off and work 9:00 to 5:00).

So anyway, the high rate of suicide among doctors has been reported as far back as 1858. In England was the first time it was recognized. Is that depressing, that 160 years later, we’ve done nothing about it? And this is our own problem of our own profession. And we’re talking to patients about seat belts and don’t smoke and don’t eat high-fructose corn syrup. We’re worried about everyone else, but meanwhile our partner just hung himself in the other room, and we’re like, can’t talk about that. That’s a taboo topic.

If we treated diabetes like this, whispering in the bathrooms about blood sugars we wouldn’t get very far with our diabetics. And so we have to talk about this, and I’ll make it fun and inspiring to talk about it because I’m going to give you some hope and answers.

Physician suicide is a public health crisis. It needs to be dealt with like a public health crisis, because more than a million Americans are losing their doctors to suicide every year. Do the math. Researchers believe that about 400 docs are being lost per year, but it’s probably more, because guess who fills out the death certificates. Unlike other professions, we’re covering for our colleagues even in the aftermath of their suicides. We’re writing it as an accident to preserve their reputation, even though it was … the gun went off. They think it was an accident, whatever we like to say, try to sweep it under the rug, so they get their life insurance payout, and we don’t piss off their wife or husband. So it’s like dancing around this in circles isn’t really helping.

When we have a public health crisis, we have to treat it like a public health crisis. Bird flu, Ebola, and other crises—people in hazmat suits, exact body counts, collecting the data. It isn’t up to what the family wants to do in the aftermath of a suicide when it’s a public health crisis. That’s when you’re counting the bodies, whether the family wants you to count them or not. They can’t say it’s a car accident or a heart attack when it was really a suicide, because we have a million Americans losing their doctors to suicide every year. So though I do believe, of course, being sensitive to the family in the aftermath is important, they don’t get to dictate how we deal with a public health crisis.

The suicide crisis will continue until we address it like scientists. I’m just passionate. I hope I’m not offending anyone. I have a lot of passion for this topic. And so this is every year—here’s the math: there’s about 400 doctors. That’s not even including medical students that die, because patients consider medical students their doctors. They don’t sometimes know the difference between short, medium and long coats, so they just think that’s the doctor. And so basically when you do the math, you’ve got … Let’s just say 500, if you include the medical students. So that’s 500 times the average, and maybe it’s different with medical students. They have less of a patient panel, but for family medicine, it’s 2,300 patients per panel in this sick system. Most of these doctors are probably dying in the assembly-line system and not in DPC clinics (where they’re jumping for joy and have time to attend their children’s ballerina recitals). And so that’s a million people losing their doctors. Okay, that’s a problem.

And this is by specialty. I did a little data analysis to get the linear thinkers excited so you don’t just think I’m drifting around on anecdotes. Here we go. This is raw data. There’s a lot of surgeons coming in, anesthesiologists. You can see this is the list of the raw numbers by specialty. Out of the 1,103 suicides that I’ve got on this list, 969 are physicians. 134 are medical students. 920 come from the US, and 183 are international. I’d like to clarify that I didn’t go out looking for any of these. These cases are submitted by people who contacted me to make sure their friend or family member was on the registry (and please note that nearly 100 of these suicide victims are honored in the new documentary—Do No Harm: Exposing the Hippocratic Hoax).

Sometimes after one of these suicides, I’ll get five or six emails within hours to days of the death. Even more important than this slide above is the next slide where I compare the numbers per active doctors in each specialty to determine risk per specialty, you can see anesthesiologists are through the roof.  Based on these 1,103 cases, anesthesiologists are dying 2.3 times the number of surgeons and 5.5 times the suicide rate of general internal medicine.


Okay, so this is a problem, and I’m going to discuss now the 13 reasons why this is happening with case studies of actual people, who I am close to their families. Most of them I feel like I’ve been adopted to their family, because I’m the one of the few who is still talking about their dead loved one. Like five years later I’m still calling and checking on the mom and still into it. I guess it’s taken over my life. I gave up mosaic artwork. I gave up knitting. I used to crochet. I just feel like this is going to be a better hobby for me and better potential benefit to the planet. So that’s why I’m doing this.

But before I start I’d like for us to give up the stigmatizing language around suicide. Because suicide is still a taboo topic, we don’t even know the right language to use. So we’re running in circles. We don’t know the right words to say. I’m just going to make it really easy. Don’t say committed suicide. That sounds like a crime, like burglary, murder and rape. These people were suffering a mental health condition, hopelessness generated by our profession. And so what you call it is like anything else, die by or die of pneumonia, heart attack, suicide. Let’s stick to the facts, and let’s not stigmatize the people with our language after they die. And so a failed suicide, this is totally perverted here. That means that you survived your suicide. That’s ridiculous. Why is that a failure? It’s attempted suicide, and then a successful suicide, how is that success? That’s not success. We just lost another doctor. Completed suicide, if we could just stick with the facts, I think we’d be able to collect the data with less emotional overlay and trouble communicating with each other. And so just a plea to de-stigmatize suicide. And so I’m going to share some actual case studies.

Now this guy is awesome. I love him. His name is Dr. Benjamin Shafffer, and he is the totally coolest orthopedic surgeon. In seventh grade, middle school or whatever, he was voted most school spirit. He’s charismatic and loving. If you can’t tell this guy is frigging awesome, he was the top DC sports surgeon. And I don’t know how people do it. I never was into OB and stuff like that. My attending told me it’s “hours of boredom for minutes of terror.”  This guy is on the sidelines of NFL games, things where people make their livelihood from their shoulder and have an injury. He’s jumping in there and fixing it. This guy can handle pressure, right? So it’s like why does somebody like this, such a cool guy die? Well chronic, lifelong anxiety, behind that smile, there’s a lot of smiley physicians out there. Maybe not in the room right now, but I know you see them. They’re cracking jokes all day. That might be a risk factor for somebody covering up their real anxiety and depression.

Be aware, physicians are masters of disguise. That’s why, with so many of these cases, nobody ever sees it coming, because he was just cracking jokes two hours ago, and the OR had just finished the surgery. And now he’s hanging in the surgical closet. How did that happen? You just don’t know, because doctors have been covering up their emotions for so long, especially guys, socialized in the country to be the fix-it man, not show anyone your true emotions. Well then all of a sudden your master of disguise compartment hyper-compartmentalized life breaks down in a moment in time, and then you’re hanging from a rope, or around here a gun shot. It just depends on the country. In India they’re hanging from ceiling fans by their saris. It just depends where you are. In a moment of desperation, you grab what you have, and if it’s your sari or your gun or whatever it is, you just get it. And you pick the closest thing, and that’s why … I don’t know, I’m sure I’m in a group where you’re not into super gun control or anything, but the point is, they’re going to find some way to die. If you take away their gun, they’re going to fill their car with whatever, with fumes. They’re going to jump from a bridge. They’ll figure something out.

Okay, and so he had marital and work distress. As you age, of course, your body needs more medical care. He had a medical condition. The thing that really drove him over the edge, his psychiatrist retired, passed him onto a new psychiatrist in the middle of all these things going on and gave them new meds, which did not work, and then basically just whatever, doubled the dose as I understand. And so this guy died by suicide at home, hanging himself because of shame and stigma. He didn’t want anyone else in Washington DC to know that he was anxiety ridden. He couldn’t risk to let the team know, the people that run all these special … He just didn’t want anyone to know. He didn’t want his colleagues to know, so he would rather hang himself on a book case at home. This is insane that we’ve created an environment where men can’t ask for help, and physicians can’t ask for help.

Just a quick story is one of the guys that I dated in med school, who died by suicide, when we were in a car before the GPS days, we were lost in the car. And I wanted to ask where we were. I just wanted to ask the gas station. He let me have it. “How dare you ask? I’ll just figure this out.” And he would not ask for help. We were lost in a car. What’s the likelihood he’s going to ask for mental health help once he has a white coat on on top of that? Not much, because he died by, as they say “accidental overdose” which I don’t believe for one minute with the methadone next to his bed. Doctors dose drugs for a living. We know the lethal dose.

So here’s Kaitlyn Elkins, third-year medical student, star student, valedictorian, brilliant, gifted and incredible woman. Why did she die? Well, from loneliness, because in medical school it’s divide and conquer. Your success depends on your partner’s failure. If the guy fails next to you, maybe you have a better chance of getting a residency than he does. And it’s all about stepping all over each other for your own success, which is ridiculous. And by the way, that setup continues for the rest of our lives, much to the devolution of our whole profession, because that creates a lack of unity in which your attitude towards your classmate in first year of medical school persists your whole life. And you’re going to just step all over each other until our whole career is destroyed, and we lose our profession. That’s allowed many physicians predators to sneak in and profiteer off of us, making nice, passive income off of 74% of our hard work, which is what they made off of me in the big-box clinic.
So do people need to be dying of loneliness? Does that need to be happening? These are all preventable.

Here’s Kevin Dietl. He basically, you can tell, such a sweet guy, would’ve been a great doctor. Why did he die? Well, he minimized his depression. His mom knew something was wrong, but he said, “Everyone in my class is depressed. I’m just like everyone else.” Well that’s not normal. A whole class of medical students shouldn’t be depressed. We should start asking, “Why is that happening?”

And I don’t favor the term, burnout, by the way. Burnout in my mind is a victim-blaming term that blames us for situations that are out of our control. I think if we had time off and a normal life, we would naturally go on hikes and naturally enjoy ourselves and wouldn’t have to go to lectures on the importance of sleep after a 24-hour shift. In the military you have a forced wellness lecture now quarterly, and they allow the doctors to sign up for time doing adult coloring books. Well that’s kind of ridiculous. I think if you’re a doctor that wants to color, you would normally do that, if you have time to color, but not while you have 17 patients waiting, and they force you in a room with a coloring book in the military. It makes no sense. Forced wellness on the overworked, it’s ridiculous.

And so anyway, Kevin feared losing his career. He wouldn’t seek mental healthcare, so he died from untreated mental health issues. His untreated depression spun into psychosis. And then it was really a mess. He should’ve got help earlier on, but he was scared that it was going to ruin his chance of getting a residency. So of course there’s a lot of these people who shoot themselves right before their original graduation date.

Another case of a beautiful, young man, awesome person. This guy had some traumatic childhood, which again, you’re going to get re-traumatized in medicine, when you see all this death and suffering. And so this guy was just basically completely exhausted, emotionally, spiritually and physically spent, and so he just died from exhaustion. Should people be dying from exhaustion?

Should physicians be dying from overwork. Which, by the way, in Japan, is illegal to work over 60 hours. If you die by suicide in a job where you’re working more than 60 hours, the cutoff is 65 for suicide, and for cardiovascular and others, threshold is 60. Your employer is then held financially liable. Okay, so why does the ACGME have residents working 80 hours a week? That’s two full-time jobs. Would you get on an airplane with a pilot working 80 hours a week? Nobody would do that.

And this beautiful man, Sean Petro, another caring, beautiful, would have been a great doctor. His mother was infertile for 10 years, finally got pregnant. This is her only child. He died by suicide. We’ve allowed this to happen in our profession. I hold us responsible for allowing this to continue for 160 years and not doing anything about it. And of course when I talk to the mother, and they realize this has been going on for 160 years, and it’s not just their “defective” child, they’re outraged that we’ve allowed this to continue. He died by sleep deprivation.

And Dr. Vincent Uybarreta, great guy, again would’ve been a great doctor. Look at the difference between him from graduating high school and graduating medical school. He died by suicide a few months after. Can you see the energy, and the life in his body has just been sucked right out? It seems obvious to me. I don’t know if you can pick that up. But anyway, why did he die? Surgery intern says it all in a program where there’s a lot of bullying. And so he basically succumbed to sleep deprivation and bullying, which is a very toxic combination.


I love this man, Steven Ortiz, who grew up down the street from me, became an orthopedic surgeon. I never knew him. I only knew him in the aftermath of his death, because I’m close to his mom, incredible guy. These people are primo doctors. These are the doctors you’d want to go to. We’re not losing fringe characters that shouldn’t be doctors. We’re losing the compassionate, loving ones who are really smart. And orthopedic surgeon, I just have to tell you, such a cool guy. He’s done things that I’ve never even done, and I thought I was the Mother Teresa of medicine. He came home from a vacation to see a patient, who was sick. Who does that? An orthopedic surgeon who really loves his patients. There were potholes outside of the hospital, bad hospital admins, and he asked them to please fix them, because he’s a spine surgeon. And having your patients bounce up and down with spine surgery before and after on potholes isn’t good. They wouldn’t fix it, so this guy, previous career in construction, second career as an orthopedist, just went out before work one day with cement and gravel, and he just fixed the potholes in the parking lot himself, since the hospital wouldn’t do it, and then went to surgery.

His mom was like, “19 years of medical training and my son is out there fixing potholes in the parking lot of the hospital.” Now why did he die? Well, he refused to do surgery when conservative treatment would work for his patients. And that cut into the bottom line of the hospital. Like many people in specialties where there’s a lot of money to be generated from procedures, there’s pressure to do more, and that friction point didn’t go well. His income decreased, and he left a letter documenting what he witnessed. And by the way, your work ethic is the last thing to go so he’s checking on his patients, checking on critical labs, leaving goodbye letters to the nurse. Then leaves the hospital, sits in his truck over the new pothole that he fixed and shoots himself in the heart. So this is a guy that we lost as a whistleblower. Okay, this is happening over and over again across America. It’s not often in the news. We’re too busy working, getting 75% of our revenue stolen to understand what’s going on here. But I’m just trying to get everyone up to speed.


So here’s another beautiful man. Second-year internal medicine resident—Dr. James Evan Astin. Like many people, he was first suicidal in medical school, did not have preexisting issues, as the slides have shown earlier today, is that we came into medical school (as Lynn showed in her first slide set this morning) with mental health better than the general population and our peers in college. But students soon realize they’re being basically funneled into assembly-line clinics to be factory workers the rest of their lives, and they’re not really so tolerant of that. Evan told his mother before he died, “I just wanted to be a scientist who helped people, and this is not at all what I do.” So he died because of misery in medicine and shot himself in Texas, at his dad’s farm.


And this is Dr. Greg Miday. I love this dude. He is brilliant. So he’s one of those people that we all hate, because he never had to study in medical school. I was not like that. He never studied and he made straight As, spent all of his time helping other people trying to understand basic concepts that I’m probably still having trouble with. And you know he’s a great guy when years after he died, his patients are still writing on his online legacy page. “Thank you for not calling off the code on my husband. We had him for another five years.” Sorry you didn’t make it, but we had my husband for another five years. And people from high school thank you for being nice to even the unpopular kids. May your soul rest in peace. Here he is helping homeless women, my god. He had so much free time, because he didn’t have to study in medical school. He was out on the streets helping homeless people. I mean this guy is amazing. Why did he die? Well he had chronic anxiety, probably from being brilliant in a world that felt like special ed to him. He probably felt different, right? And so he self treated with alcohol, which in a way is his own business. If he’s never impaired at work, he should be able to relax the way he wants to at home. Well he chose to use alcohol, ended up in a PHP, which put him on a one-size-fits all track and bullied him 300 miles out of state, so he didn’t graduate on time as I recall. And he basically was sober for many years, complied within a program but then broke up with a girlfriend right before starting his oncology fellowship and started binge drinking just at that moment. Well part of his treatment plan is he had to turn himself back in. You turn yourself back in, they’re going to force you to go 300 miles out of state again, one size fits all. No special treatment for you. And he had a psychiatrist in town he was seeing that came up with a safety plan for him, so he could start his fellowship on time. He’s never endangered a patient. He’s the one that you want for your care in the ICU, even if he drinks at home, because he’s better than probably everyone else in the hospital. Okay, but instead they’re going to send him 300 miles away.

Anyway, they (non-physicians!) overrode his treatment plan. No doctors oversight in his physician health program and they overrode his personal psychiatrist’s treatment plan. And so he went home and slit his wrists in the bathtub because of the PHP. There’s a lot of suicides that involve PHPs. They are not uniform throughout the country. Some of them are terrible. Others are pretty good. We don’t really have a uniform and secure safety net for physicians who are suffering. Doctors are often ignored and enabled by their colleagues or harshly punishment, and there’s not much in between.


And so here’s a great guy—Dr. Charles Christopher—who would’ve been amazing geriatrician. Why did he die? Well he died of a broken heart and soul. According to his mom, he didn’t want to be an assembly-line worker. That’s all he saw in residency. How are you doing to do seven-minute visits for geriatrics. He didn’t see what future he had, so that’s it.

Dr. Alexander Reading was in Britain. I get cases from all over the country, Britain’s top trauma orthopedic surgeon. This guy basically couldn’t handle the guilt of a minor clinical error that did not kill the patient. He couldn’t handle it, so he died by perfectionism. These are very physician-unique situations.


And another very wonderful physician Dr. Lara Barnett we lost to untreated suicide and OCD, personal, tormenting herself from a perfectionism and OCD.

And then here’s another second year medical student, Neil Grover died. We don’t know why, suicide due to unknown reason. I think many of them are in this unknown reason category. Why are they there? I don’t know. We’ve never had a morbidity & mortality conferences to figure out why they died. So they just keep dying by suicide, and we keep pretending it’s not happening and sending prayers to the family and prayers for speedy healing. We need to actually address this as scientists. And so here are the 13 reasons why listed here.

I think you have copies of these. I think you have a PDF copy of my slideshow, if you want to look through this later. I divided these into three categories, which basically we have a lack of mental healthcare category, and inhumane medical training category, which has a lot to do with why these people are dying. And they would’ve been okay as real estate agents and other professions. But because our medical training is warped and unethical medical practice is a problem, that’s killing doctors.


And so I’m going to just review with you 13 Oklahoma suicides. These are people you know, and I’m putting them up by names, case number and everything. I was originally maybe not going to do this, but out of the blue, weirdly, I was contacted by a Tulsa Police officer through some bizarre series of events, which I’m happy to describe later. And she told me all of these are public record, so you shouldn’t hold back. Share them all. And I think, yeah, that’s what we need to do, is just approach this like any other medical condition. These are people that we lost. This is exactly how it looks on my registry. They’re all by case number based on the organic sequence, that they came to me from people reporting them. Okay, so then there’s name, age, gender, date of suicide, location of suicide, specialty and the reason why, the backstory. And I have a whole other document where I saved all the millions of emails I’ve gotten from people giving me the really detailed backstory. I’m not airing people’s dirty laundry. I’m just giving you a thumbnail of what the situation is.


Case number 196 is Gina Madole, DO, 35 years old. She died in 2010 in Durant, Oklahoma. She was a third-year family medicine resident who died of a gunshot wound because of mental health issues.

Then we have Darius Noble, DO, who died a few months after that in Ada, Oklahoma. He was 46. I think he’s family medicine (every so often you see a question mark because I don’t always know if I’m quite right on a few details). It’s the information that comes to me from others, and sometimes it’s confirmed by their obituary. Sometimes they’re just missing a few little pieces. I’m not sure if his specialty was family medicine, but he did die of a gunshot wound, and he had personal issues, which I will not air publicly. By the way, in medicine, when you spend so much of your time with working 100 hours a week for professional success, you will have personal life atrophy. And so when you have that happen, you could lose your marriage, get divorced and have all sorts of other issues that you wouldn’t have if you were a real estate agent or worked at Starbucks.

Jerome Block, MD, 77 year-old gentleman, a physician, integrative medicine, internal medicine doctor in Tulsa jumped out of a building. I believe it was the 20th floor of the building, and this was due to fraud. He was caught in Medicare fraud, which is another problem that DPC will solve, because you won’t be coaxed into, I don’t know, putting a nurse practitioner in the room without you while billing under your Medicare number, or you won’t be inflating codes and doing all these weird coding and billing dances that could make you go to prison or be fined. Do you really want to do that? Do you know the Medicare codes or guidelines for legality and staying within the rules of Medicare is larger than the US Tax Code? Who’s going to make it through? I think the US Tax Code is like 75,000 pages, but the Medicare guidelines are like 150,000. Add that to the DPC slideshow, because who’s going to be able to follow 150,000 pages of guidelines? And the thing is, when you call up Medicare to ask a question, they don’t often know the answer. They send you to somebody else, and they might give you an answer that’s completely different. I mean you can never get to the bottom of what’s really going on with Medicare. Huge lack of transparency and yet your butt is on the line. If you under code, because you think it’s safer, you can get in trouble for under coding your visits. It’s unreal.

Alan Rowlan, MD,  is a surgeon who died in Oklahoma City in 2019 of loneliness and isolation. Then we have Susan Hill, MD, from 1990, female general surgery senior resident who (like a lot of these surgeons and anesthesiologist especially) are dying in the hospital of IV overdose. She was just found in the hospital dead due to total exhaustion. And then we’ve got Kim David Floyd, DO, a 50-year-old gentleman who died in Norman, Oklahoma recently, in 2017, I think from an overdose. But he had an addiction issue.

And then we’ve got Adam Steele, very interesting. I just got an email an hour and a half ago giving me more information on his situation. I’ve had several of his classmates email me recently. He went to OSU, and I think now he died in 2009. He was in his 20s. It was in Tulsa. That was confirmed in an email I got an hour and a half ago that I didn’t ask for. This information just comes flowing to me synchronicity I guess right before my talks. So there’s two cases in here from OSU, and they’re both students who had to remediate. And they felt alone and isolated, like they didn’t get the help they needed to survive the despair and hopelessness of their situation.

Where’s the off ramp for if medical school doesn’t go well? Is there an off ramp? Or is it just your gun? Is that the off ramp? Because that’s not a good off ramp. These are young people who need help trying to figure out what they do with $100,000 in student loans, and they didn’t pass step one. They need help, and they shouldn’t just be hauled off and discarded because they don’t look good for the school or whatever. Sometimes we just don’t do anything to help them, and they’re little kids. They need help. I guess I can say that, since I’m 51, but they’re sweet people who had the best of intentions. And so we had untreated mental health issues and maybe substance abuse issues. I don’t have the full story. These are just things that have flown in to me by classmates. I do know these are legitimate suicides.

This is the one that I think you were referencing Kyle. Neal Clemenson, MD, was the program director in family medicine from Edmond, Oklahoma. He recently died, last year, May 1st, by a gunshot wound, I believe, due to isolation, is what we think based on the information that I have. He’s nodding, so probably on track there.

Then Anna Randall, DO, some of these are in the news. She was in the news, because they were looking for her, because she was missing. She’s a pathologist. They found her with a gunshot wound by, I don’t know, her riverfront home or something in Muskogee, if there’s a river there, the lakefront. Anyway, she died, as it was declared in the article, exhaustion. She was just exhausted. She had to sell her practice. This is an exhausting profession. You could die from just being exhausted and having no time for your family or fun or eating or sleeping and stuff like that.

Brent Cambron, MD, was in the news a lot. He was the star child from Sperry, Oklahoma, which I guess is a small town, ended up in Boston as the star anesthesiologist there until he was found dead of an IV overdose in the hospital closet, addiction.

Okay and then Matt Song just is the most recent one who died in Oklahoma in September, 2018, Oklahoma City, first-year psychiatry intern of, I think, an overdose, mental health issues, I think. I don’t have confirmation on some of this. It’s just the best guess based on what I have. (I was also forwarded the announcement of his suicide by his program thankfully being very open about his suicide).

Jonathan Holmes is a student who died a few weeks before he was to graduate with his class at OSU. But because of remediation issues, he was just sitting at home, looking at all his student loan paperwork, wondering probably what he was going to do. So he said I better just end this pain for my family. Now he has a tight-knit family from around here I’m told. His best guess for what to do was using a handgun. We’re leaving our best and brightest students alone with handguns and no help and no off ramp, and they don’t need punishment, and they don’t need people to ignore this. They need actual help (especially around the time of their original graduation date).

Here are the 13-plus reasons why. I’ve highlighted the ones that are significant for the 13 Oklahoma suicides.


And the reason why I have 13 twice in here, it was really odd. I thought I might as well include some suicides from this local region to try to pull people in. Maybe they’ll know some of these people, and it will impact them and want to do something. And so I went on my list of close to 1,200 now, and there happen to be exactly 13 from Oklahoma. So who knew? Just worked for the talk.

And here are some solutions. Obviously we need a humane and safe medical education experience and medical institutions. We do not need to be putting out best and brightest in unsafe situations and unethical environments where they’re learning to be doctors by watching other doctors lie on the computer in the hospital about the review of systems and all sorts of other things that teaches, you, because it’s an apprenticeship profession, that it’s okay to lie on the hospital computer, including if they put more than 80 hours, and they work for a week. The hospital computer locks up and makes them lie in a lot of residency programs. And so what is that teaching? That’s teaching our future physicians to lie on the computer, not good, unsafe, unethical, not good for patients, not good for fraud. You get caught up in fraud that way and want to kill yourself before you get called into the medical board.

We need to honor and respect the human rights of our students and doctors. I think we’re out of touch talking about burnout. I personally don’t even believe in the word. I think it’s a victim blaming, shaming term that has been distorted. Originally a term used for drug addicts in 1972, it’s a slang word. Somehow it’s now applied to all doctors in 2019. Makes no sense to me, because really what’s happening is we have chronic human rights violations in medical education and training. When I say I don’t use the word, burnout, people ask, “Well what word would you use? What would you replace it with?” Let’s replace it with the truth. “Try these three words—human rights violations. Those are the words to use, because we’ve been talking about burnout for 40 years. And we still don’t have a solution, and everyone’s eyes glaze over when you talk about it over and over again. Meditation and  yoga is not the treatment for human rights violations.

I don’t know how many of you guys in here got in your yoga pants this morning, but I don’t think that’s the solution. I really don’t. (Yoga is awesome but not the treatment for human rights abuse). I think we need to talk about the truth. We’re scientists. Let’s talk abut the facts. The facts are sleep deprivation, exhaustion, work hours that are illegal in other industries and illegal—punishable criminally in Japan. Okay, and we’re letting this happen to our own people in our own profession. It’s unreal. So I want to stop the bullying. It should be a safe zone like in elementary schools, no bullying. Maybe we could do that in medical schools too.

And require on-site, accessible mental healthcare, because let’s just face it. We work in the ER. If you don’t have mental health problems doing that job, you might be a sociopath. People are dying in front of you, and you have to tell people, “Sorry, you have a stillborn.” If you’re not crying from that, something might be wrong with you. I really think we need to have on-the-job mental healthcare, so we don’t have so much PTSD in our emergency workers. And that’s why I think the surgeons, the trauma surgeons and emergency and OB/GYN are highest on the list. They’re traumatized by their daily work, and they need help. And we need to prevent chemical dependency in students and doctors. We need to talk about doctor suicide crisis.

And by the way, the good news is we really don’t have a suicide problem. What we have is a secrecy problem. If we didn’t have secrecy, we would’ve solved this 100 years ago. But because everyone is hushing it up and quoting Bible verses (I have nothing against the Bible, but I don’t think the Bible is the treatment for diabetes and other serious medical conditions) There are certain conditions that require meds and a different sort of algorithm. And I’m all into prayer and helping everyone heal, but unless you’re … What’s that thing? The Christian Scientists, and some people think you can heal from everything from praying. Maybe you can, maybe in some cases, but I’m not against anything. I’m just for the facts and not hiding things.

Okay, and so this is our 13th gentleman that we lost to suicide, and I’m just going to share his story, because I’m very close to his daughter. He died in 1977. His name is Jerry King, he died in Kentucky, but he’s an Oklahoma native, and he was a male anesthesiologists, of course there. I love the picture, very old school with the little radio and his phone. And he did have an overdose in the hospital, like all of the anesthesiologists here, died by an addiction.

And I have a letter from his daughter I’m going to read, because here’s his daughter in his arms after her birth, his daughter hugging him as a toddler. And there we’ve got her at 14 years old. This is a letter from her. She’s in her 50s now. She wants me to read this to you.

“My father was from a poor family in Oklahoma and the first to go to college. He father didn’t even make it to high school. Dad graduated from the University of Oklahoma Medical School and became and anesthesiologist in 1964. He was on the first team to successfully reattach an amputated arm. The surgery went so well that the patient became a pottery artist. I have one of the pieces in my home. Unfortunately, during that time that he went through residency, it was not uncommon [as I know many of you recall] for drug companies to send samples to med students, residents and doctors. It was at that time that my father became addicted to uppers and downers in order to make it through the long hours. In his mind, the drugs helped him accomplish his dream. But in the end, they also took it away. Many times over his career, he was caught using drugs, and his fellow doctors and the administrators would hush it up and move him to another town in another hospital out of some twisted combination of loyalty and shame.

Thing was, my father was excellent at what he did, a gifted physician, wonderful teacher. Hospitals and universities were glad to have him at first. And then the meds would start missing, and patients that needn’t had died, did. After he got caught in Lexington at Saint Joseph’s hospital, while he taught at the University of Kentucky, they took away his drug license. He then found a job in Harlan Country, Kentucky at the Harlan Appalachian Hospital, where somehow he was able to not only teach but once again be in surgery. Don’t ask me how they allowed an anesthesiologist without a drug license to be involved in surgeries, but they did for a year. But this time when he got caught after meds were missing, and a woman died, he was told that they would have his medical license pulled. He went into work that Sunday morning and, according to the coroner, went into the surgical dressing room and shot himself up with enough medication to kill 20 men his size. One of his students found him. I still remember them coming to my house.

[She was 14 at the time. See the picture of her? That’s how old she was when this all took place, okay? So just listen to what this child went through. And we’ve set this situation up this way, so that she had to go through this. They came to us. I was talking in detail. She said she can’t, she’ll never forget this moment, of course. They lived up on a hill. It’s impossible to get there. When there’s cars in the driveway, you know when there’s five cars in the driveway, only two fit in the driveway, and three are on the lawn. And there’s all male doctors in the house and administrators surrounding her mom when she walked in the house. And the first thing her mother said, “Well at least we have the memories.”]

I still remember them coming to my house. My mother, who had been an active alcoholic for a number of years, was incapacitated and had no memory for six months. At 14 I had to notify my grandmother in Oklahoma of her son’s death and arrange my father’s funeral. I still have the canceled checks, where the local banker, who knew the situation, allowed me to sign in my childish scrawl the check for my father’s casket. Chemical dependency among medical personnel has to be addressed, whether it is the stress of the addiction or the repercussions of the addiction, patient deaths, loss of family, loss of license, law suits. Chemical dependency plays a serious part in physician suicide. If we don’t better communicate the issues of chemical dependency with premed students and rid the profession of the enabling of fellow staff and administrators and eradicate the shame of dealing with addiction, we will continue to lose patients and medical personnel. I know all too well how deadly that silence can be.

So I am here to please beg of you to help me stop the censorship around suicide and especially medical student and physician suicide. If we’re going to be of any use to veterans and everyone else that’s dying of suicide, we have to set the gold standard for how you handle mental health and how you deal with suicide.

Doctor suicides are hidden by other doctors and by families and medical institutions and the media . . . Here’s why they’re hidden. Well, the families are overwhelmed, confused. They’re blaming themselves. They have all sorts of regret and pain. You cannot leave it to a family in deep grieving, who just lost their star child or their husband in the prime of their career to deal with this. How are they going to deal with this? They’re crying in bed. They’re incapacitated for six months with alcoholism. They can’t deal with this.

Medical institutions that could deal with this are too worried about CYA for risk, copycats, litigation. They’re worried about being blamed, so they don’t want to do anything about it, because it’s like bad PR. You don’t want to be known as the hospital with the highest number of doctors and residents jumping from the rooftops. Now if the family doesn’t want to deal with it, because they can’t, and the hospital won’t deal with it, but that’s what they should be doing, if they really are, like the billboard says in town, providing the most compassionate care, then what?

Religions don’t want to deal with it and suggest that you’re burning in hell. That’s not popular either, cultures, people trying to preserve their reputations in the aftermath. And then we’ve got the final nail in the coffin, is suicide media guidelines, which I can’t stand, because they handle suicide differently than beheadings, kidnapping. Everything else is on the front page of the news. There are murders, rapes, everything else—except suicide. We’re adults, and we’re reading about the true facts of what’s going on in the world. But suicide is not reported like everything else, because you’re not allowed, because you’re not allowed.

But we’re adults, and we’re scientists. And isn’t it time to be allowed to talk about suicide? As medical professionals when will we be able to review these cases? We’re not going to solve this epidemic if we don’t talk about it.

So I’m asking you today to understand that these beautiful people that we lost—who saved countless lives while they were alive, but nobody came to save their life before they died—have suffered so much in life. Physician suicide victims are dis-remembered in death, left to perpetual isolation, which is what killed them in the first place. As scientists, we must investigate the suicides of our brothers and sisters in medicine. We have so much to learn from them, for the benefit of ourselves and our beloved profession.

And in parting, I want to thank you for caring. I assume that you care, because you’re here. I would like you to care as much as I care, and I’m going to take questions in a minute. I do want to mention that I have a book that’s free, called Physician Suicide Letters—Answered. I know it sounds depressing, but it’s actually really uplifting, and it’s a free audio book that you can download and listen whenever you want. It’s on my website at IdealMedicalCare.org. Just click on books, and there’s a link for a free download. If you like my voice, and you want to hear me for three hours, it’s even better for three hours. And you know what? This is like being a fly on the wall during my suicide hotline that I run for doctors. So you’ll hear some of the things I actually say to doctors, that maybe you want to use some of these lines yourself. As long as we can save lives, that’s all that matters.

How-We-Honor-Our-Doctors-Wible

As a profession it is very important, how we honor our dead. Every profession, all sorts of people that die, there’s often some sort of a public display that pops up. Even drunk drivers on the side of the road who killed entire families going the wrong way on the highway, they still get a little white cross with teddy bears. Everyone gets something, public display. Robin Williams there, the actor, he has a whole sidewalk display. He killed himself by suicide. And then right before a doctor who’s covered in a tarp there, you might notice the doctor gets nothing. But the football player, the middle, top there, quarterback died by suicide at the University of Washington, and within hours everyone had, “We love you, Tyler,” balloons, and the students were crying, holding candles.

Public display of grief is normal. That’s normal, that police officers that are killed, suicide and homicide, whatever, they actually will name a whole highway after you. You’ll be traveling down the highway with the name. I don’t know any highways named after doctors. I don’t think we’re handling these very well in the aftermath. We’re ignoring them. We’re not naming highways after them. And the teenager there, this is 10 years after she died. They’re still coming to visit the area where she walked into the sea there. And this middle one at the bottom is a bicyclist in Eugene. We have a lot more bikes probably and bike lanes than you do in Oklahoma. But the point is, there are people who are killed by motor vehicles on bikes all the time. And I don’t know if you have these here, but they’re ghost bikes. They’ll paint a bike white and keep putting flowers and everything this is 10 years after this guy died, downtown Eugene, Oregon, still a ghost bike is there. Everyone passes by and remembers this guy now.

A year ago on the 18th of this month, Dr. Deelshad Joomun stepped off Mount Sinai, one of the buildings there. The houses 450 doctors. She was the third one there that died within two years, and they covered her in a tarp. There she is, hand hanging out of the tarp and left her there for hours. And then finally the police came and threw her in a body bag, and that was it. Her family lives overseas. She was a J-1 visa, so nothing was going to happen.

I got three emails within an hour of Deelshad’s suicide, and they were imploring me—commanding me—to do something. So I wrote a blog called “Where are the Candles, Vigils and Flowers?” Because I was kind of upset that it was just a tarp. The minute we stop generating revenue, especially if you’re bloody on the sidewalk, then you’re a problem for the big-box clinic. Then they want to sweep it away, get the blood off. They don’t care if you live or die, as long as there’s people in line to replace you. Warm body, billing and coding, that’s what they’re interested in. And so I’m just telling the truth. I’m not trying to be a downer. This is just the truth. You’re replaceable, and when you’re on the sidewalk, you’re not only replaceable, but you’re like a stain on your image.

So I flew to New York City, and I don’t even know this woman, led a 10-hour funeral for her in which people came in from her students that went to school with her in Dubai showed up. I didn’t even know this woman. I just put it on social media. People came all day long to honor her and grieve. I led a candlelight vigil. I was told by the school, by the way, that if any media show up, they’ll be arrested. Can you believe that? I was like, I’m not the person you want to provoke. Did you just say that if media show up they’re going to arrest them? So I told the filmmaker, who’s doing the film on this topic of physician suicide. She said, “Hold on a minute. Let me get a camera crew there. Just pause.” So I put it on pause, camera crew came, filmed this event. And now it’s the first scene in a documentary coming out on physician suicide prevention. View Do No Harm film trailer here.

And so I’m imploring us to stand up for our brothers and sisters and remember these beautiful people. These are Oklahoma physicians we’ve lost to suicide. You might know some of these people. We’ve lost these people. They should still be here. Why are they not here? I’m asking you please to stand with me in not allowing any more of our beautiful physicians in Oklahoma to die before their natural death and to look out for your brothers and sisters. Thank you. We’re going to do Q and A at 1:30, so if any thoughts have come to your mind through this conversation, feel free to come back at 1:30. I will answer any of your questions, and I’m available whenever you want to pull me aside in the hallway. If I’ve got any details wrong on any of these suicides, I’m happy to update them for you. Thank you.

Addendum: Doctors at this event submitted 12 more Oklahoma physician suicides that were not on the registry. Sadly, doctors will continue dying by suicide until we bring this topic out of secrecy and discuss these cases honestly so that we can learn how to prevent future suicides. If anyone needs to speak with me, you can contact me here.

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How a 14-year-old girl handles her physician father’s suicide—and what we can learn from her words. →

Meet René. She gave me a letter to read to physicians when I spoke last week at the Oklahoma Osteopathic Association. (Listen to keynote here). Here’s what I shared from this courageous woman with a wise message for us all. My talk was dedicated to her father, Jerry E, King, MD, and all the medical students and physicians who lost their lives to suicide in the pursuit of helping and healing others. See Oklahoma doctor suicides—13 reasons why.

I have a letter from Jerry’s daughter I’m going to read. Here’s his daughter in his arms after her birth, his daughter hugging him as a toddler. And there we’ve got her at 14 years old. This is a letter from her. She’s in her 50s now. She wants me to read this to you.

“My father was from a poor family in Oklahoma and the first to go to college. He father didn’t even make it to high school. Dad graduated from the University of Oklahoma Medical School and became an anesthesiologist in 1964. He was on the first team to successfully reattach an amputated arm. The surgery went so well that the patient became a pottery artist. I have one of the pieces in my home. Unfortunately, during that time that he went through residency, it was not uncommon [as I know many of you recall] for drug companies to send samples to med students, residents and doctors. It was at that time that my father became addicted to uppers and downers in order to make it through the long hours. In his mind, the drugs helped him accomplish his dream. But in the end, they also took it away. Many times over his career, he was caught using drugs, and his fellow doctors and the administrators would hush it up and move him to another town in another hospital out of some twisted combination of loyalty and shame.

Thing was, my father was excellent at what he did, a gifted physician, wonderful teacher. Hospitals and universities were glad to have him at first. And then the meds would start missing, and patients that needn’t had died, did. After he got caught in Lexington at Saint Joseph’s hospital, while he taught at the University of Kentucky, they took away his drug license. He then found a job in Harlan Country, Kentucky at the Harlan Appalachian Hospital, where somehow he was able to not only teach but once again be in surgery. Don’t ask me how they allowed an anesthesiologist without a drug license to be involved in surgeries, but they did for a year. But this time when he got caught after meds were missing, and a woman died, he was told that they would have his medical license pulled. He went into work that Sunday morning and, according to the coroner, went into the surgical dressing room and shot himself up with enough medication to kill 20 men his size. One of his students found him. I still remember them coming to my house.”

She was 14 at the time. See the picture of her? That’s how old she was when this all took place, okay? So just listen to what this child went through. And we (the medical profession) have set this situation up this way so that she had to go through this. René explains that they came to her house. She said she can’t ever forget this moment. They lived up on a hill. It’s impossible to get there. When there are five cars in the driveway (only two fit in the driveway and three are on the lawn) and there’s all male doctors in the house and administrators surrounding her mom when René walked into her house. The first thing her mother said, “Well at least we have the memories.”

“My mother, who had been an active alcoholic for a number of years, was incapacitated and had no memory for six months. At 14 I had to notify my grandmother in Oklahoma of her son’s death and arrange my father’s funeral. I still have the canceled checks, where the local banker, who knew the situation, allowed me to sign in my childish scrawl the check for my father’s casket. Chemical dependency among medical personnel has to be addressed, whether it is the stress of the addiction or the repercussions of the addiction, patient deaths, loss of family, loss of license, law suits. Chemical dependency plays a serious part in physician suicide. If we don’t better communicate the issues of chemical dependency with premed students and rid the profession of the enabling of fellow staff and administrators and eradicate the shame of dealing with addiction, we will continue to lose patients and medical personnel. I know all too well how deadly that silence can be.”

So I am here to please beg you to help me stop the censorship around suicide and especially medical student and physician suicide. If we’re going to be of any use to veterans and everyone else that’s dying of suicide (including all the patients who need us to be in our right mind when caring for them), we—the medical profession—must set the gold standard for how to handle mental health and deal with suicide.

Doctor suicides are hidden by other doctors and by families and medical institutions and the media . . . Here’s why they’re hidden. Well, the families are overwhelmed, confused. They’re blaming themselves. They have all sorts of regret and pain. You cannot leave it to a family in deep grieving, who just lost their star child or their husband in the prime of their career to deal with this. How are they going to deal with this? They’re crying in bed. They’re incapacitated for six months with alcoholism. They can’t deal with this.

Medical institutions that could deal with this are too worried about CYA for risk, copycats, litigation. They’re worried about being blamed, so they don’t want to do anything about it, because it’s like bad PR. You don’t want to be known as the hospital with the highest number of doctors and residents jumping from the rooftops. Now if the family doesn’t want to deal with it, because they can’t, and the hospital won’t deal with it, but that’s what they should be doing, if they really are, like the billboard says in town, providing the most compassionate care, then what?

Religions don’t want to deal with it and suggest that you’re burning in hell. That’s not popular either, cultures, people trying to preserve their reputations in the aftermath. And then we’ve got the final nail in the coffin—suicide media guidelines, which I can’t stand, because they handle suicide differently than beheadings, kidnapping. Everything else is on the front page of the news. There are murders, rapes, everything else—except suicide. We’re adults, and we’re reading about the true facts of what’s going on in the world. But suicide is not reported like everything else, because you’re not allowed, because you’re not allowed.

We’re adults. We’re scientists. Isn’t it time to be allowed to talk about suicide? As medical professionals when will we be able to review these cases? We’re not going to solve this epidemic if we don’t talk about it and continue to allow all this censorship.

Please help break the silence, secrecy, and shame the allows others to lie and censor the cause of death of our doctors. Doctor suicide is an epidemic—a public health crisis. One million American are losing their doctors to suicide annually. We require a public health response. We must stop hiding the truth. Stop lying on death certificates. Stop turning our heads away and allowing doctors to suffer in silence. Stop ignoring and enabling the sickness and the pain carried by our doctors daily. We carry a huge burden. We’re surrounded by death and suffering every day. Let’s get real.

As adults—scientists and—we must protect each other and the public by not allowing one more doctor suicide to be buried in shame—left to a grieving child to make sense of adults who censor the truth.

Censorship has never solved a public health crisis.

Thank you.

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43 seconds to your dream job. Just answer YES to these 3 questions: →

HAPPY NEW YEAR! Want to make this year the best year ever? Here’s a simple strategy to get high-yield returns in this 43-second clip from my Vegas keynote. What would you say to these three simple questions I pose to the audience?

Can you answer YES to any (or all) of these questions?

1) Are you super excited to go to work Monday morning?

2) Are you having so much fun you’d work for free?

3) Do you hope you never have to retire?

I’m looking for people who have found their dream jobs—especially doctors who can honestly respond YES to all 3 of these questions. Please leave a comment on this blog to help us understand how in the heck you are so friggin’ excited about your job. Curious minds want to know how to replicate what you’ve done and CONGRATULATIONS!

If you CAN’T answer yes to these questions:

1) Why not?

2) When will you?

3) What’s your plan of action this year to improve your career?

I want to know what’s holding you back. Taking no action to improve your situation will pretty much guarantee that you have a similar (or worse) year. Your life is supposed to be fun. Really.

Comment below and contact me here if you want help making your dream job come true. Oh, and if you’re still in med school or residency NOW is the perfect time to plan your dream job so you can launch as soon as you graduate—even before completing residency if you want! Seriously.

Plus, if you’re premed and didn’t get accepted to med school (or if you are in med school and want to quit) you CAN still be a healer and get paid to treat patients without completing medical school (as long as you’re not planning to be a transplant surgeon or something super specialized).

Do not just sit on the couch and be sad or keep a job you despise. There is hope. Trust me.

Above all, do not end your precious life. We can’t afford to lose one more beautiful brilliant humanitarian to physician suicide. YOU ARE LOVED! The world needs you to be the amazing healer you were born to be.

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How to inspire 4000 doctors with one backpack (in 4 minutes) →

One-backpack keynote. How I inspired 4000 doctors in 4 minutes. True story.

Dr. Wible: 4 outfits for Las Vegas that I fit into my one backpack. This is it. And it’s showtime! With my PowerPoint on my Wonder Woman USB and magic backpack outfit #2. (Clapping) This is a medical system that needs to be disrupted. Backpack disruption! Into this one little backpack with 7 shirts, 2 vests 3 pairs of jeans, 2 trench coats, one coat, my bra, all these accessories and makeup. 2 pairs of shoes, electronic stuff, water bottle. 3 pairs of glasses, 2 pens into one backpack and getting on the plane in a few hours. How? Raise your hand if you’d like to know (clapping). Alright. Hey, I’m in the car with Jason who can’t believe this is the only luggage I have.

Jason: “I can’t believe it! I’ve never known a woman to pack 4 days in just a backpack. Amazing! You ought to give lessons.”

Dr. Wible: Jason, the reason why I have my backpack here is because I have some beautiful handmade designer clothing that I had to check at one point and I got it back after my last keynote. I got it out of the plane and it smelled like airline fuel.

Jason: “That happens more often than you think. I deal with a lot of people who fly and the horror stories of luggage ruined, pieces of clothing and such, you’d be surprised.”

Dr. Wible: You can’t risk it. Thank you for the ride!

Jason: Nice talking with you!

Dr. Wible: I don’t have to check any bags. No bags to check. Putting my bag through. I’m at United Airlines counter.

Flight Attendant: Please stow your larger carry-on luggage in the overhead bin and place smaller items under the seat in front of you. Stowing your rollerboards in the overhead compartments wheels first. Let a flight attendant know if you need any help.

Dr. Wible: Hey, I just got home and here is everything that I pulled out of my backpack: two trench coats, two vests, seven shirts, three beautiful necklaces, one bra, two pairs of socks, two pairs of shoes, four pairs of pants, a menstrual pad, some BandAids, some meds, my toothbrush, a bunch of little toiletries, here is my glitter, cases for three pairs of glasses, cords for cellphone, my favorite pencil, handmade wood pen, earplugs, some instructions for where to be so I don’t miss my keynote, seven packages of dried fruit, an apple, a tiny little thing of Tabasco, two Christmas gifts that I received, PowerPak little fizzy, two tea bags, money and receipts, two USB drives, a book that I highly recommend everyone read—An Inflammation Nation, that I got from my great friend, Dr. Sunil Pai, my watch, my lipstick, and two hair ties, my favorite coat that I just made. All this stuff (except for the cat) fit into this one backpack with three areas that you can store things in. Reaction Kenneth Cole is the brand so if anyone really wants to get a really good backpack that can fit a lot in. The side pockets basically there for the dried fruits and there’s a little pocket for your water bottle.

There ya go! You can be a keynote speaker on tour in the most amazing outfits ever—all without losing anything, ever having to check a bag. The crazy thing about this is that overpacked. Several items I never wore. I didn’t need half the toiletries. I brought everything I needed to bring down the house with 4000 doctors as the keynote speaker in Las Vegas.

Dr. Shaun McKee: This is the one lecture you should have seen! Pamela nailed it!

Dr. Wible: Keeping the theme of simplicity which was the theme of my speech, you don’t really need much. You actually can open your own medical clinic with two chairs, a piece of paper, and a stethoscope and if you’re a psychiatrist you can throw that out the door. With my life of voluntary simplicity, maximal joy and bliss through the roof. Launch your own practice! Live your dream! Don’t let anyone stop you!

I highly recommend that all doctors out there, don’t escape into side gigs. Stop running away. Stop using the bullshit term of burnout and get back to the reality of being a real healer. You can do it. On a few hundred bucks you can open your clinic like I did. You don’t need a whole bunch of stuff. You can friggin do all of this with your medical degree and a backpack. Don’t overcomplicate your life.

Need help packing for your next keynote, launching your dream clinic, or leaving assembly-line medicine? Contact me at IdealMedicalCare.org

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Maintaining your sense of self during medical training & beyond . . . →

Listen in to a clip from our med student Dream Team with Dr. Pamela Wible & Sydney Ashland. (fully transcribed below). To join our next Dream Team call, contact Dr. Wible.

Sydney Ashland: Tonight we’ll cover the top five attributes that you need to cultivate in order to maintain your sense of self.

1) Number one is to refuse to engage fear messages. One of the common threads that I hear all the time from medical students and residents is that they are often controlled by fear. The first fear that often starts is the fear of not knowing. You leave high school feeling really, really smart. You get an undergraduate degree and you feel like you’re competent, and then you start med school and even premed sometimes, if you have already declared your major and you have those helpful, or not so helpful professors who start to try and train you early. The message that is all-consuming is now feeling like you don’t know, now feeling like (excuse some of the labels I’m going to use, but just to make the point) you feel like an idiot.

You feel like you’re the dunce in the class, that everybody is smarter than you are, that you’re absolutely terrified of what you don’t know not only because it’s embarrassing and you feel a sense of shame. For, you know how to study, you know how to buckle down and be serious. You have a vision, a passion, and to suddenly feel as if you’re dropping in the ranks, and somehow it might appear that you’re not really serious, that you are needing to learn how to study and how to apply yourself is just disheartening and jolting. It jolts your whole sense of self. Then it’s reinforced by professors who talk about in attendings, that you don’t know anything. The fear of not knowing. What if I don’t know what’s wrong with the patient? If you don’t know what’s wrong with a patient, you could kill somebody. If you don’t know what is wrong with a patient, they could end up suffering. You’re holding the class back. You’re embarrassing yourself on grand rounds, or when you’re explaining to your attending when handing off a case.

You start to worry. What if I’m not smart enough to figure it out? The answer is, you are. You are enough. Don’t buy into the messages of fear around not knowing. You do know. You know how to study, you know how to protect yourself, and do what’s in your own best interest. To really cultivate self-talk that has to do with, “I’m enough. I am smart. I’m up to this.” Keep track of your wins. Keep track of what you know. Keep track of your study groups where somebody says to you, “How do you always come up with the answer? How can you always figure this out? I’m just starting to get jumbled, and rummy headed, and can’t even think clearly.” Write those things down. Reinforce all your moments of clarity rather than focusing on the times you’re confused, or unclear. This is the number one, most critical piece about not engaging the fear messages.

When somebody knows how to study, when they’ve been top in their class in high school, or done well in premed, and then you get into medical school, and you start to feel like you’re not knowing enough, that you’re falling behind. The good thing about smart people is, smart people know how to ask for help. They know how to engage others on their own behalf. They know how to resource themselves, to look up resources and find what might be available to help them get over whatever struggles they’re having. If it’s a topic that you don’t enjoy, a class that has a teacher that is less than stellar, then to be able to do those extra things that will help you again, feel like you’re yourself. You are the brilliant self you have always been, and will always be. I want you to hear that phrase, and record it perhaps. “I am my brilliant self, the brilliant self I have always been, and will always be.” Reinforce those messages so that you can walk with your head held high. You feel like yourself. Because that’s some of what starts to happen.

We start to feel as if we’re an imposter. As if we don’t recognize ourselves in the mirror. We look haggard, we’re sleep deprived, we’re exhausted, but if you are reinforcing that you are your most brilliant self, and will always be that, and that you are a smart cookie. You know who to ask, and where to go to get the information you need. Then you’ll be able to keep that piece of yourself intact, and not engage that fear message. The second part of the fear message is fear of mistakes. Perfectionism is a major issue in the medical field for physicians. I would say at least 90 percent of physicians that I’m engaged with are perfectionists. That means that they can’t abide a mistake. The very idea of doing something incorrectly, of not being prepared, of putting somebody at risk, just is untenable.

Taking the job too seriously, taking your studies too seriously, it’s one of the big reasons that people develop test anxiety is they’re so afraid of making mistakes. They’re so afraid of getting it wrong that they immobilize themselves or they second guess themselves. They put down an initial answer, and then they sit with it for a few seconds and go, “I don’t know, maybe that’s not right. Let me read it again.” Then they change their answer, and the next thing you know, I’m getting a phone call, or Pamela is getting a phone call from somebody who says, “You know, the truth is, I missed it by three points, and part of that is because I was second guessing myself the whole time.” Or, “I totally crashed and burned because I had no confidence going in. I was so afraid of making mistakes.” We learn from our mistakes.

Every time somebody calls you on a mistake you make when you’re in training, you need to have the attitude of, “Thank you so much because you know, I learn from my mistakes, and every time you correct me, every time you point me in a different direction, or you nudge me, or you encourage me to pivot, that is a time where I can really learn something. Where I can become even a better clinician, a better student.” Look forward to the mistakes. Have some Post It notes on your mirror in the bathroom, or on your dashboard in your car that are humorous, about how making mistakes is actually what your goal is because every time you make a mistake, you become better. Surgeons learn that early on, that every time they don’t know something, every time they make a mistake, they say, “Well, I’ve learned it today. I will never make that mistake again. Now I know, and I’m better than I was yesterday.”

For everything you don’t know, for every mistake that you make, and you recognize it, you then have an opportunity in the next moment, to be a better, more qualified expert than you were two minutes ago. To feel that evolution of change, that transformation. Accept your humanity with vigor because in accepting your humanity, and refusing to engage the fear messages, you are going to absolutely go through medical school with confidence. You are not going to succumb to bullying, or gas lighting, or pimping, because you are confident. You refuse to let fear be your motivator. Instead, you’re motivated to be your best by holding onto your vision of who you are in the present, and who you can be in the future. Is there anything you want to add to the section on fear, Pamela?

Pamela Wible: What’s really important is to make sure that you’re not making fear-based decisions in your life. Most people in the world, if they break down their motivations from why they’re getting married to who they’re marrying to what they do or don’t spend money on to what job they take, they’re often making fear-based decisions.

It is so essential for you to make decisions based on desire. Which is why I title the retreats and seminars Live Your Dream and the Dream Team. Keeping the full-color version of your dream in front of you (or at least the bits and pieces that you have depending on where you are in your training) will propel you forward so that you start to make desire-based decisions, instead of fear-based decisions.

Medicine reinforces fear-based decision making. You’re afraid of a lawsuit. You’re afraid of making a mistake. You’re afraid of failing a test, that sort of thing. Do you see that Sydney?

Sydney Ashland: Yes, absolutely. Yes. Begin to make decisions out of what I want verses what I’m afraid of because the more you obsess on something, the more profoundly active it will be in your life. If you’re obsessing about your anxiety, the more anxious you will be. If you are obsessing about what you shouldn’t do, if you’re making your decisions out of fear, then the more likely you will make decisions that are not as sound because you’re engaging fear to such a degree that fear is fueling the decision. Fear is present to such a degree that it will remain. It’s really hard to make a fear-based decision, and not have fear remain.

2) Secondly keep your sense of purpose. I know for many of you listening, you might just sort of shrug that off, and say, “Well of course,” but Pamela and I can both attest that we talk to residents and physicians who have been in the field for years, and are experienced, mature physicians who have long, long, long ago lost their sense of purpose.

Even when we ask third or fourth year medical students or residents,”So, what got you into medical school in the first place?” There’s a long pause. That pause always concerns me because the closer you are to your sense of purpose, the closer it is to the tip of your tongue. When somebody asks me a question, “Are you thirsty?” I can say yes, or no in a nanosecond because I know. It’s right there. When you keep your sense of purpose on the tip of your tongue, in front of mind, then you will continue to fuel your training experience with your sense of purpose. It’s not something, “Well, when I graduate medical school, then I’ll be a resident. Well, when I complete my residency training, then I’ll be a true physician. Well, when I’ve been a true physician for five years, then.” All of those “Well, when’s,” are a journey away from your sense of purpose. You need to stay present. You are as dedicated a would-be physician today, almost physician today, as a mature physician who has been in practice for a long, long time.

You may even be more connected to your expertise because you’re fueling everyday with your sense of purpose, and your dream. Keep very handy, maybe in the front of one of your notebooks, or on the wallpaper of your phone, what your vision and passion is, so that you are constantly reminding yourself, “This is why I’m here.” This isn’t about how much school costs, and how deep in debt I’m getting. This isn’t about people-pleasing, and trying to go for that A in every class. This isn’t about competing with my peers. This is about truly keeping my sense of purpose, my original dream so close at hand that every decision I make is fueled by that inspiration. When you live a life feeling inspired, then you live a life that is purpose driven, that is filled with right decision making, it is connecting you to your authentic self, so you’re not going to lose yourself in the process. You will have a happier, healthier time through training. You will maintain relationships. You will just feel connected to your highest self if you keep that sense of purpose handy. Stay connected, keep your dream alive, remind yourself your reason for being here.

3) Number three is cultivate and maintain positive beliefs. One of the things that people often brush aside is the fact that there is innately some negative energy connected to medicine because you are learning about all the things that can go wrong in the human body. You’re learning about all the disease processes. You’re learning about all the things that could happen that you want to guard against, or you want to treat, and intervene once things have gone wrong. That’s a negative energy. It’s necessary, but it can begin to erode your positive beliefs.

You start to begin to focus on what’s wrong with people, rather than what’s right with people. You begin to perhaps engage the energy of worry because you’re concerned, you’re loving, you’re compassionate, you’re empathic. It’s sometimes hard to maintain your positivity when you’re faced with tragic stories of cancer, and system wide infections, and death, and premature birth.

Just the very topics that I just listed, impacted you just hearing the words. Just hearing the words, premature birth, we all go to a vision, a sound, a memory that we have associated with a preemie, a baby that comes early. Maybe it’s somebody in our family who lost a baby who was premature, maybe it was a sibling who was in an incubator. Maybe it’s something you read about in the news, but it puts your whole system on high alert, and you feel the negative energy of fear, and concern, and what can go wrong in the world.

When you connect that to the energy of stress that is inherent in the practice of medicine, and in the training of medical students, it’s really hard to be focusing on all these diseases, all these things that could go wrong. You’re stressed out. Stress is almost embraced as a lifestyle in medicine. You’re told to expect that you’re going to work long hours, that you’re going to be underappreciated, and overworked. That it’s a thankless job.

How many times have we heard that? That you’re sacrificing parts of yourself in order to be of service. Those are very negative messages, and even martyrdom is a negative message that makes it impossible to cultivate, and maintain positive beliefs. You have to refuse to succumb to the distorted and destructive thinking of medical training. You just have to. You really need to, as much as possible, be glass half full instead of glass half empty people because that’s the way that you’re going to protect and maintain your sense of self. If you came from a family that has a lot of fear based thinking, if you come from a family where there’s a fair amount of stress just in your family system, you could already be at risk of succumbing to more negative thinking, and negativity. You get to choose. You don’t have to just be victim to your thoughts, victim to the self-talk in your head. You can choose what you want to believe.

I would suggest that sooner, rather than later, you make a list of some of your beliefs around health, around work, around how people are valued, how you value yourself. Just those core beliefs that have to do with, I believe that basically, the world is a loving, and nurturing place. Or, no, actually I believe that it’s a dog-eat-dog world. It’s each man for himself. You’re lucky if you make it through alive people. If that’s the energy that you grew up with, or that somebody close to you has inundated you with, you are going to be at risk in a stressful training environment, of actually reinforcing and increasing your negative beliefs. You can stop that today by taking an inventory of what your world view is, what your internal beliefs are about yourself, and about the training process that you’re going through.

Then decide which beliefs need to go, which you’re going to say goodbye to, and erase off the sheet, or black out with a sharpie, and which beliefs you’re going to increase and validate everyday through affirmations, through having your mentor remind you that it’s all about positivity, and reinforcing that which is positive in your life. Maintain balance, and choose your beliefs carefully. Would you like to say anything about positive beliefs, Pamela? You are the queen of positivity.

Pamela Wible: How did you know I was aching to say something? Okay, I’ve been posting these actually, sharing them on our Dream Team chat. Some of them with comments. Regarding cultivating and maintaining positive beliefs, we are obviously in a medical system that is steeped in human suffering, pain and death. We go in with the notion that we’re going to help and heal others, but the fact is there are others that we can’t help. There are others that have sort of self-imploded by the time they arrived in full-blown MI’s and strokes, stillborn babies.

You are going to see things that are very disturbing for sensitive healers to see. Especially without mental health support on the job. We’re doing our best to support you here, but often when you see these things is the time when it would really be helpful to get some debriefing, or emotional support. That doesn’t always exist in a hospital setting where they tell you, “Time to see your next patient.”

I find for me that spirituality, and keeping a sense of the big picture of the world, and the universe is very comforting and helpful. Now, whether that is for you a religious sort of thing, like, leave it to God or Jesus, Allah, whatever you believe in that is the grand, spiritual force with some power over what’s going on with human destiny here, that can help you not feel like a personal failure if a patient dies.

Remember: “Do your best, and let God do the rest.” I really love that because it’s just something that makes me feel like, “It’s not really all up to me. I can just do the best within my human skills, and it will be okay.” I want you to understand, the western medical model, with it’s reductionist philosophy is really set up with the notion of success verses failure. Success being the patient survived. You cured all their chronic diseases. Or failure: like their cholesterol is still high, they died. You somehow feel like you failed. That is not your failure. That’s a patient’s failure—their life’s destiny—for a complex range of reasons that I don’t even pretend to understand. You’re just somebody who intersects with their life at one part of their journey, so please do not hold yourself responsible, and feel the guilt that some perfectionist medical students and physicians end up feeling.

A resident physician in Israel actually told me after a patient died, he took that patient’s chart home because he felt somewhat responsible because of maybe a dosing error. His interpretation was that he could have saved the person. He kept that patient’s chart in his closet for four years in his bedroom to remind himself constantly that he doesn’t know as much as he thinks he knows. Now, is that helpful to sleep in your room with a dead patient’s chart in your closet, or under your pillow?

I want to prevent you from going down that route of feeling personally responsible for other people’s outcomes when it is out of your control. Please do not succumb to that limited world view of reductionist medicine that you’re steeped in right now. That is just one little way of looking at the world, and of helping and healing others. Any thoughts on that, Sydney?

Sydney Ashland: You have power and control over your thoughts and your actions. Just because you may have a strong internal reaction, we all have reactions internally to things that we observe. In your training, you’re going to have big reactions internally, but you get to choose what your thoughts are about that later. You get to choose how you’re going to relate to what you just observed. You don’t have to just fall victim to the circumstances. I think it’s all about staying really, really present and intentional, where you say to yourself, “Wow, I just saw a stillbirth. I just witnessed this. In fact, I did more than witness it. I was a part of it.”

Even in studying, some people have talked to me who are extremely sensitive, that even some of the pictures that they are exposed to are traumatizing. “I just saw this horrific picture of someone who was in a motorcycle accident, and had horrible injuries. That’s sticking with me, and I’m obsessing about it. I’m afraid if I were to ever confront that.” You get to choose what your thoughts are. You get to choose to have responses verses reactions. What Pamela just described was absolutely right on, and it really leads into the next . . .

4) Number four is trauma and PTSD. We see a high, high rate of trauma and PTSD in physicians. This is two-fold. I want to say this, and I want everyone to really take it in. Many of you have experienced some trauma in your past. In school, in your family of origin, maybe with strangers in some traveling experience. Life is complicated and complex. Very few people make it from birth to death without having experienced some type of trauma in their life. Untreated trauma becomes PTSD, and even if it’s an isolated event in childhood where you say, “Yes, well, that was only that one time where I was thrown off the horse, and this injury occurred.” If you don’t deal with it fully in the moment that trauma stays with you.

Working in the field of medicine often triggers old trauma and PTSD. We hear it all the time. We’re witness all the time to the effects of this early trauma in your life. It’s important to acknowledge and heal your trauma as soon as you’re aware of it. In medical training, my recommendation, and these resources are listed here, it’s okay, and even encouraged on my part for you to be in therapy. To have a place where you can talk to people, to someone, and maybe it’s with Pamela and I, or maybe it’s with a therapist, to be able to deal with your trauma.

Also keep your connection to nature, to exercise, to music, to self-help books, classes, activities, because those are all interventions that will help you stay present with the trauma, and work with it to heal it, so that it’s a distant memory. It will always be with you, but it doesn’t have to be an activating event that reactivates PTSD in your current clinical situation. That’s an important piece. Often times, people don’t really want to hear it. They don’t want to deal with it. We minimize the trauma we had as a child. “Oh, well yes, my stepdad was abusive, but he left after four years.” Well, those four years were important years.

The first time you’re going to deal with an inebriated patient, you could really get activated, or when you’re doing your psychiatric rotations, or when you’re studying about psychiatric conditions. It’s really, really important for you to deal with your trauma.

5) Lastly it’s really, really important (mandatory not optional) is to have a mentor. If you don’t have a mentor, you are going to be at risk of isolating. That’s something that really, really happens very, very frequently in medical training is people start to isolate. It happens. It’s insidious. You just are a good student, you’re studying, you’re working, you’re doing so much that you don’t take the time to really cultivate a mentor relationship, and when you don’t have a mentor in your life, you are at risk of going offline more, and more, and more where you’re compartmentalizing your mental health, your professional and personal needs.

You can’t do that with a mentor relationship. The whole point is to share honestly, to be vulnerable, to ask questions, to share the truth of who you are without apology, and receive all the amazing support that the person who is mentoring can possibly give you. When you can receive that, and you’re in gratitude, and they begin to see how profoundly this mentoring relationship affects your life, they are rewarded by being engaged in that relationship with you.

There will be times when you’re the mentor and there will be times where you’re the mentee. It’s absolutely critical when you’re getting your medical training that you identify a mentor. Maybe even two or three individuals, depending upon who you feel you most need support from. It could be someone who is in the field, and an expert, and that you’ve had a connection with for a long time. It could be someone that’s a coach, someone who is a peer that’s in a different state in a different medical training program who is a little bit ahead of you. There are lots of options for mentors that you can choose, but choose a mentor. You really, really need to.

Those are my five ways that I suggest everybody cultivate to maintain your sense of self right from the beginning, so that you can be confident, assertive, walk through this intense time. It doesn’t have to be hard. It can just be intense. Intensity isn’t a bad thing. Pamela and I are both intense personalities, and we love that about ourselves, but it doesn’t mean that we have to make it hard for ourselves. We can be intense and have a sense of ease, a sense of confidence, a sense of being in the flow, and being present. That’s the gift that I want each of you to have during your training, your rotations, your experience in the medical field.

Pamela Wible:  I just posted all of your points as you went through them on our Dream Team chat. Regarding choosing a mentor, we’ll have a separate call just on how you do that. How you select a mentor, how to ask them, and how to set the relationship for success, so it’s not just something that you’re winging.  So many medical students, and physicians, and I’m talking about physicians in their fifties and sixties have told me, they have never had a mentor in medicine. I just think that is so sad to go through your whole career, and not have somebody that you could look up to, and have mentoring you. This is one of those things that you don’t want to miss out on, and it’s so easy to do.

Again, the mentor by teaching and taking you under their wing even receives more than you get from them because the process of teaching and helping somebody else keeps your mind alive and open. The relationship is beautiful for both people, so don’t feel guilty as if you’re taking time from somebody. You’re actually bringing honor and beauty and love into their life as well by even asking them to be your mentor and that’s an honor.

If you need a mentor or would like to join our medical student/resident Dream Team, contact Dr. Wible.

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