Dr. Wible Keynote: Finding Your Bliss – SPECIAL GIFT For You :) →

Join Dr. Wible in Las Vegas December 14th for her keynote, Beating Physician Burnout: Finding Your Bliss and get two special gifts so you can live your dream in 2019!

TWO GIFTS FOR ATTENDEES

#1) Download your FREE audiobook of Physician Suicide Letters—Answered here:

PhysicianSuicideLettersAudiobook

#2) FREE one-on-one coaching for 30 days with Dr. Wible who will personally help step-by-step launch your DREAM CLINIC when you register for our Fast-Track Program.

I’ll call you as soon as I’m back from Vegas!

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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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Love letters prevent suicides →

Could a few sentences on an index card save a life? Yes.

A once-suicidal teenager saved eight lives by attaching these love notes to a bridge.

Could a loving note save a suicidal veteran with PTSD? Yep.

Sending caring letters is one of the only interventions proven in randomized controlled trials to reduce suicide among military. (With no adverse effects)

Doctors are the people veterans, teenagers, and others turn to when suicidal; however, physicians have the highest suicide rate of any profession. If we help suicidal doctors, they’ll be in better shape to help the rest of us. Right?

So how can a patient save a doctor’s life?

Could sending a thank you note to your doctor prevent suicide? Yes, it sure can!

I’ve spent the last six years running a suicide helpline for doctors. Physicians have actually told me that patient thank you cards have prevented their suicides. Some keep a stash of patient thank you notes in their desks to read in times of despair.

Turns out old-fashioned letter writing can save not only veterans and doctors. Caring letters prevent suicides in the general population all across the world.

To help prevent suicides among our healers, one amazing medical student I know has launched a compassion project in which doctors-in-training are writing anonymous love letters to each other then leaving them in medical schools and hospitals. Here are a few of their letters:

I’ve studied more than 1100 doctor suicides. I’ve interviewed families, friends, colleagues. I’ve read autopsy reports on doctors, their last texts and suicide letters.

What if your letter really could prevent a physician suicide? Would you write one? (Please know that compassionate letters are therapeutic for both the writer and receiver)

This holiday please join our doctor love letter campaign

Patients: After you open your presents, consider writing a few quick thank you notes to the wonderful emergency doctors (nurses, EMTs, veterinarians) who couldn’t be home for the holidays. Then drop off your cards at the local hospital.  Some folks in my town are doing this as a Christmas church project!

Medical students & doctors: Write about your struggles with advice on how you made it through a challenging time in your training or practice. Share a few uplifting words of wisdom for someone who may be in trouble now. Don’t be fooled—even “happy” doctors die by suicide. Give letters of appreciation to specific people or leave anonymously in special locations.

Surviving families: If you’ve lost someone to suicide in medicine, please know that there are many more struggling in medicine with similar suicidal thoughts and feelings. I encourage you to write the kind of letter that you wish your loved one would have received from a secret admirer—someone who understood his/her struggles and could offer insight, hope, and love. The kind of letter that might have changed the course of his or her life and prevented that fatal decision.

Daily I’m in contact with medical students and doctors who are in pain and struggling. If you’d like me to distribute your letters to those who need your words most, please mail them to:

Pamela Wible, MD
Doctor Love Letters
P.O. Box 5225
Eugene, OR 97405 

Note: If you mail me letters to distribute, either seal and indicate on envelope that it is for a medical student of doctor. Or you can leave letters open and then I can read and sort them to people who need your specific words most.

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America: 393,300,000 guns & 28,000 psychiatrists →

(Update to 2012 America: 350,000,000 guns & 47,000 psychiatrists)

 

Untreated mental illness + guns = predictable catastrophes.

America in 2018 = 307 mass shootings in 311 days.

This week a veteran with presumed PTSD shot up Borderline Bar & Grill. His Facebook declaration:

“I hope people call me insane… (laughing emojis).. wouldn’t that just be a big ball of irony? Yeah.. I’m insane, but the only thing you people do after these shootings is ‘hopes and prayers’.. or ‘keep you in my thoughts’… every time… and wonder why these keep happening…”

Shall we do what the shooter seems to be asking for—help those with insanity—or just hope and pray?

Or fall into our usual anti/pro-gun divide?

Let’s analyze the irony identified by the gunman before the devastating slaughter of 13 Americans.

Let’s dive into the uncharted territory of human psychology—the mind of a straight shooter before a calamity. His prophetic post may reveal the answer we’ve been seeking.

Because we the people are responding exactly as he predicted.

Vilifying the shooter as insane.

Offering victims our hopes and prayers.

Is this the best we can do?

They say insanity is doing the same thing over and over again and expecting a different result.

Yet we keep going round and round the same post-carnage questions: Where did he get the gun? Did he acquire it legally? What was his motive?

Rather than interrogate the shooter postmortem, let’s do a psychological autopsy on the living—analyze our response for clues as to why the killings continue.

I’ve got a unique vantage point on mental health care in America.

I was once a suicidal physician. Now I run a physician suicide hotline. I’ve spoken to thousands of suicidal physicians and investigated more than 1100 doctor suicides (some homicide-suicides). Doctors have the highest suicide rate of any professions. Even higher than veterans.

If doctors can’t get proper mental health care, will patients fare any better? Unlikely. Here’s why.

America has 393,300,000 guns and only 28,000 psychiatrists (that’s 14,046 civilian-owned guns per U.S. psychiatrist—up from 7447 guns per U.S. psychiatrist in 2012).

That means we’ve doubled the number of guns per psychiatrist in just 6 years.

Increasing firearms while decreasing mental health access is not a winning strategy.

Why do we have so many guns and so few psychiatrists?

We have a constitutional right to bear arms. We have no constitutional right to health care.

America is a world leader in mental illness. Most Americans will develop at least one mental illness. More than half begin during childhood. Yet more than half of our psychiatrists are on the verge of retirement.

Meanwhile America remains the most heavily armed nation in the world with 120 guns per 100 U.S. citizens—that’s more than one gun per person. Nearly half of all Americans have at least one gun at home.

The human brain controls the gun.

People will find a way to end their pain. A civilized society offers civilized solutions. A violent society offers violent solutions.

In America it’s easier to find a gun than a psychiatrist. Ammunition costs less than medication. No prescription necessary.

So who’s insane? The shooter? Or us?

(I’m not inherently against guns. I’m against untreated mental illness. And I’m against untreated mental illness + guns, pipe bombs, machetes or anything else that can damage life on Earth).

Pamela Wible, M.D., reports on human rights violations in medicine. Dr. Wible attends therapy weekly to maintain her sanity and wishes all Americans enjoyed the same luxury.

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1103 doctor suicides & 13 reasons why →

(Listen in above to a rerecorded keynote—due to a fire alarm during event—or read transcript of Dr. Wible’s presentation below)

Michael Phillips MD: Good morning everybody. I want to introduce the lectureship and remind everybody who Gil was. Gil was originally from Philadelphia and then moved to Oregon where he joined The Gastroenterology Clinic, which at the time was the only GI-specialty clinic in Oregon. He became one of the preeminent gastroenterologists well-loved by patients and staff alike and known for his outstanding humor, his clinical skills, and patients who absolutely adored him. I continue to take care of patients that he took care of 20 to 25 years ago and they still think of him as their gastroenterologist. I’m just kind of standing in. That’s the kind of guy Gil was. Gil really dedicated himself to education. He was Outstanding Teacher of the Year twice—a testimony to who he was. He died unexpectedly at the age of 50 [on a ski trip, not a suicide]. In response to his untimely passing, we established this lectureship 20 years ago. We’re here today to commemorate him and to continue to use his legacy to help facilitate our practice and humanity in taking care of patients.

It’s really with a great pleasure that I get to introduce our speaker today, Dr. Pamela Wible. Pamela is family physician born into a family of physicians. Her parents actually warned her not to become a physician. Shortly into her first year of medical school, she experienced the adverse effects of medical education on her own mental health. It wasn’t until 2012 after losing three colleague physicians to suicide that she began to investigate the mental health crisis among medical students and fellow physicians.

For the past six years, Dr. Wible has reported on doctor suicides and human rights violations in medicine. Her articles have been picked up by major media including The Washington Post and Time Magazine. She’s the author of the bestselling book, Physician Suicide Letters—Answered (free copies available today). Dr. Wible has two TED Talks on doctor suicide. She’s been interviewed on primetime investigative television and featured in a new award-winning film Do No Harm that’s currently being screening at hospitals and medical conferences internationally.

In between treating patients as a solo family physician in Eugene, Oregon, Dr. Pamela Wible continues to run a free doctor suicide hotline that’s been in operation since 2012. Today, she’ll share the results of her investigation into more than 1100 physician suicides and reveal simple truths and solutions to prevent the loss of our healers. Please welcome Dr. Pamela Wible. Thank you.

Pamela Wible, MD: Thank you all so much for being here. I want to thank Providence for hosting this event and taking on this topic of doctor suicide. Though I never met Gil in Oregon, our paths did sort of cross in Philadelphia. Turns out my dad and Gil attended the same high school where Gil was actually the vice president of his graduating class.

There he is. Teacher of the Year at Providence as a young guy before he had the mustache. Gil knew from early on that he was headed for a career in medicine. He declared that right away at Central High.

Unlike Gil, my father assured his classmates as the president of his class that his future occupation would be in the motion pictures.

Like a good Jewish boy he relented to parental pressure and became a doctor. Both Gil and my dad did some of their training at Hahnemann in Philadelphia. Both pursued internal medicine. How odd is it that I’m invited to do this lectureship and my father and Gil have such parallel paths in medicine.

Unlike Gil who died at the height of his career, my father practiced medicine for 62 years and retired at 87. He died four years ago this morning at 91. My dad ignited my interest in medicine. Here I am following him around in the hospital. With physician parents I grew up in the hospital hallways back when they didn’t care if your kids crawled through the morgue with you. I don’t see many physicians’ toddlers wandering the hospital hallways today. Too bad. I had so much fun playing with the paraffin in the pathology department and looking at this huge glass jar with all the bullets and foreign bodies he found in patients (that I thankfully inherited after he died).

Dad’s a pathologist. I think the human drama of running a small neighborhood internal medicine practice was a little bit too much for him, so he chose a more predictable patient population in the morgue. My mom is a psychiatrist so I tagged along as a child at the state hospital. So I spent my time with mom hanging out with the seriously mentally ill and with my dad I got to hang out with dead people. Neither of my parents needed stethoscopes so I inherited all their equipment from med school too. I developed this love for medicine and a fearlessness about mental illness and death because of the unusual experiences I had with my parents—amazing for a blossoming young doctor, but for my siblings morgue visits were horrifying and traumatic.

Unlike my father, I’m much more of a rebel. Since I was warned not to pursue medicine, here I am graduating from medical school and becoming a solo family physician (who still doing house calls and practices medicine the old-fashioned way—which is kind of a rebellious thing to do in 2018!).

I was living the happily-ever-after life of an old-fashioned family doc in the sweet town of Eugene, Oregon until October 28th, 2012 at 3:00 p.m. when my entire life got turned upside-down. I found myself sitting in the second row of a memorial service for our third physician suicide in our small, idyllic little town full of farmer’s markets, organic food, and friendly hippies. Sitting at this memorial service, I started to count on my fingers the number of doctors that I had personally lost to suicide in my life and/or who died under suspicious circumstances that I thought maybe were suicides covered up with the classic euphemisms.

Within a few minutes, I had counted 10. Startling for me in my early 40s—the prime of my career. So I did what I needed to do to get a handle on this epidemic—I gave up knitting and mosaic mural artwork and began tracking doctor suicides as a hobby. I became completely obsessed with why so many doctors were dying by suicide. Two of the doctors on that list of 10 were men that I dated in medical school who died by suicide (not while I was dating them I want to make that clear) but later on when they were married. They died at 39 and 44 leaving wives and young children behind.

Because I am so vocal and such a prolific writer on doctor suicides, I ended up well-known among my peers for my investigation into doctor suicide and soon people began telling me about more and more doctor suicides. Five years later, I ended up with 547 cases submitted to me by physician colleagues and family members. I never went looking for these suicides. They were submitted from people calling me saying, “Hey, I want you to know my neighbor shot himself in the head a year ago. I was in my backyard. I heard the shot, I saw the police come. The family’s not really talking about it, but here’s the backstory and I want you to know what really happened to this cardiologist.”

So I end up with this list—an informal suicide registry where I’m tracking by name, specialty, date, method, and location of suicide, plus any extenuating circumstances. Now I have a very deep understanding of why my peers chose to die. And cases keep coming to me almost daily. Now I have 1103 doctor suicides that I’ve personally investigated by talking to family members, friends, the last boyfriend, and medical school classmates.

With so much content, I’m discovering themes. Here is my blog where I began to share results of my investigations. Full disclosure: Personally I’m so obsessed with this topic because I was a suicidal physician myself in 2004. I thought I was the only one. I had no indication that other doctors were suffering. I felt like the oddball, the sensitive one. Maybe I was too idealistic. I just had no idea physician suicide was such an epidemic.

Professionally, I feel called to be a healer. As a scientist and physician, it is my obligation to research why my peers are dying. So I started blogging about suicide and my blog (that nobody really read up until then) suddenly on December 12, 2012 when I published Why Physicians Commit Suicide ended up with 80 comments right away and now 231 comments. So the public response kind of egged me on to continue talking and writing about it.

Then my blogs started to get picked up by The Washington Post, like this one, What I’ve learned from my tally of 757 doctor suicides. That was how many cases I had on my registry as of January 13th this year. Here’s a screenshot of the top of my blog a month ago back when I had just over 1000 cases and reported on my latest data at my keynote at this orthopedic surgery conference. I was the only female physician speaker during this four-day orthopedic surgery symposium. I consider that a huge accomplishment. All the orthopedists only got 10 minutes to deliver their content and they gave me an hour on doctor suicide! There’s an indication that we’re making progress as a profession addressing doctor suicide.

So here’s a wall in my house covered with physicians and medical students who have died by suicide. Again, I’m taking this very personally and I’m in touch with many of their family members.

Now a bit about the scope of the doctor suicide crisis. We’ve known about the high rates of doctor suicide since 1858 when first reported in the UK. Now, 160 years later, the root causes of these suicides remain unaddressed. That’s because we don’t really understand the root causes of a taboo topic—hidden for more than a century. Because as a culture we’re scared to say suicide out loud in and we’re definitely scared to say doctor suicide out loud.

Doctor suicide is a triple taboo. Death is not a topic anyone wants to discuss over dinner. Suicide is death suddenly in your face. Now doctor suicide—the people that are supposed to be helping us are dying by suicide too. This strikes terror in the hearts of patients and makes doctors feel vulnerable. It’s just a scary topic for most people so I’m taking this on because lives on the line that can be saved today by the way we behave with each other and our willingness to tell the truth about physician suicide.

Physician suicide is a public health crisis. More than one million Americans lose their doctors to suicide each year—just in the United States. Researchers say we lose 400 physicians per year to suicide (they believe this is an underestimate), yet 400 is the size of an entire medical school. The average medical school has 126 students in each class, and so that’s an entire medical school equivalent of physicians per year. Due to all the secrecy and underreporting—even death certificates that are completed as accidents when they are self-inflicted—doctor suicides are often well hidden. A physician in family medicine has a patient panel of 2,300 patients. The average emergency medicine doctor probably sees even more per year. Simple math on 400+ times 2,300+ and you’ve got a million patients who’ve lost their doctors to suicide (and that’s not including student doctors).

Here’s some raw data on more than 1100 cases I’ve received. Of 1103 suicides. 969 are physicians and 134 are medical students on the registry and 920 of these happened in the U.S. while 183 are international. People are contacting me from all around the world. Last week I was on a Skype call with a doctor form Israel telling me about the head of the department who died by suicide, as usual “happiest” guy and totally unexpected. When looking at raw registry numbers per specialty (and not accounting for size of specialty), surgeons are in the lead, then anesthesiologists, family medicine, internal medicine, emergency medicine, psych, ob/gyn, pediatrics, and radiology. However when evaluating these numbers based on active physicians per specialty we can see the real impact of suicide per specialty below:

These are numbers based on active physicians in the largest specialties. Now we start to see some really interesting trends. Anesthesiologists are really off the charts. Of the largest specialties, general internal medicine has the lowest number of suicides according to my 1100+ cases. Anesthesiologists actually have 2.3 times the rate of suicide of all surgeons (general surgeons plus all surgical subspecialties). Anesthesiologists have 5.5 times the rate of suicide of general internal medicine doctors.

Medical students with preexisting mental health conditions deserve informed consent about mental health risks per specialty. I have premed students calling me who’ve had previous suicide attempts or panic attacks that are poorly controlled right now and they want to go to medical school. They deserve to know this information just for their own sanity and survival.

To fill in the gaps of this underreported epidemic,  I’ll review 13 reasons why doctors die by suicide through case studies by introducing you to 13 our best and brightest colleagues who have died by suicide.

First, a quick recap on the language of suicide. Because this is such a taboo topic, people have been afraid to even say suicide aloud. By the way, at that memorial service that I went to they never said suicide out loud. Everyone knew that he shot himself in the middle of the day at Mount Pisgah in Eugene, so it wasn’t hidden. He’d had a public death in a public park, but nobody at the memorial service said suicide out loud. In the bathrooms and milling around, everyone kept whispering, “Why?” Everyone wants to know why and nobody will say suicide out loud. Imagine if we we were afraid to say diabetes out loud but we had to sneak into the bathroom to whisper about our diabetic patients. How far we would be with treating diabetics? Imagine if patients had to sneak out of town and pay cash and use paper charts to keep diabetes off the EMR. Insane. Right?

My plea here is let’s destigmatize suicide so we can actually discuss this crisis factually with data—and without such terror and shame. We can actually solve this problem. Because we don’t often know how to talk about suicide I’d like to encourage correct terminology.

“Committed” suicide is actually a very antiquated, stigmatizing way to discuss suicide because it makes it sound like a crime (like committed burglary or rape). Really suicide is a medical condition in which people are dying prematurely and should be discussed like every other medical condition—died by diabetes, died by heart failure, died by or of suicide. I know it’s hard because it’s like a knee-jerk reaction to say “committed” suicide. Even newscasters are still saying “committed” suicide, but I’ve been schooled on this through a psychiatrist who is the parent of a 29-year-old internal medicine physician who died by suicide. She was one of the first who commented on my blog Why Physicians Commit Suicide and she wanted me to know the title of my blog was stigmatizing. I didn’t know any better. I was just starting to discuss this myself and it was a great teachable moment for me, and so I’d like to pass that on to you.

Next, the idea of a “failed” suicide. How weird is it that when a physician attempts suicide and actually survives that should never be framed as a failure? Call that an attempted suicide in which we now have salvaged the person’s life by the grace of God. “Successful” suicide. To die as a 29-year-old internal medicine resident is not success. That’s a completed suicide which shouldn’t have happened in the first place. To prevent the next 29-year-old internal medicine resident from dying by suicide, I would ask you all to please destigmatize the suicide conversation.

Now I’ll share 13 case studies and 13 reasons why we’ve lost some very beautiful and brilliant people to suicide. I could talk about each of these amazing people for hours. Due to time constraints I’ll give just a thumbnail sketch of each case (some have been discussed in far greater detail in my other articles and keynotes).

First meet Dr. Ben Shaffer. Ben’s sister just sent this newspaper clipping to me. Ben was voted Most Likely to Succeed in high school. That has a new meaning for her now. He was also voted Most School Spirit in junior high. You can see this guy is awesome, charismatic, loving. He was the top DC sports surgeon at the time of his death. They called him Dr. Smiles. Nobody had any idea he was suffering. Such a smiley guy cracking jokes up and down the hospital hallways.

Why is he now suddenly dead by suicide? Read more ›

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