Doctor suicide: where are the vigils, cards & flowers? →

How-We-Honor-Our-Doctors-Wible

Two days ago a beautiful young doctor jumped to her death beside her NYC hospital. A resident in the victim’s building writes:

“I first heard of this tragedy from your Facebook page. I am so disgusted by the silence. I am having a hard time understanding why there are not flowers by where she passed. I don’t understand why there wasn’t a candlelight vigil marking the tragedy.”

I’ve spent 5 years studying 757 doctor suicides. I’ve yet to see any doctors piling up flowers in front of the hospital for their dead colleagues. Or any patients leaving cards of appreciation and love for their dead doctors. Or any hospital CEO or staff holding candles while crying and hugging each other at midnight vigils. Why?

How should we respond on a medical campus when a doctor who has dedicated her life to public service dies by suicide? Surely there should be a public memorial on the sidewalk or fence where hospital staff and patients can leave balloons, handwritten notes, candles, and photos.

Grieving among community is how we heal from unexpected tragedies.

At the residency hospital where I trained, here’s the grassroots memorial for Congresswoman Gabrielle Giffords after an assassination attempt:

Gabby Gifford UMC

Seems every week communities are publicly grieving shootings. Since 1980, we’ve lost 379 people in the US to school shootings. That’s less than the number of doctors and medical students we lose to suicide in one year. Look what we do for school shootings. We shut down the schools. We let everyone go home. We put flowers on the doorstep of the school. We put teddy bears in the fence. We call in counselors from all over the place to come and help our students. We go to the local church and hold candles. On national news we are crying and hugging. We don’t do anything for medical students. Or doctors.

Seems we live in a word full of public memorials for everyone. Except doctors.

Here’s a ongoing memorial for a Swedish teen who took her life in the ocean in 2013.

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For 10 years, I pass by this ghost bike for Oregon cyclist David Minor every time I go downtown.

David Matthew Minor Ghost Bike

Here’s an Oregon roadside memorial to fallen policeman Kelly James Fredinburg.

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And a memorial for actor Robin Williams who died by suicide.

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Last Tuesday Washington State University quarterback Tyler Hilinski died by suicide. Here’s his memorial near the football stadium.

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Two days after Tyler died, a Mount Sinai doctor jumped to her death next to her hospital. I know who she is though her name still has not been publicly released. There’s no memorial. No cards. No flowers. No candlelight vigil for the woman who devoted her entire life to healing others. Here’s how we treat doctors who die by suicide.

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I have one request: If you live near W. 59th St. at 10th Ave. in NYC and you pass by this spot, please leave a note, a card, or a flower for this forgotten physician. Thank you.

If you’re a physician or med student in NYC who is distressed by this suicide, please call me at 541-345-2437 or contact me here. I wish to gift you a 100% confidential off-the-grid (no EMR!) Skype or phone session with a resident physician mental health expert. Plus I’d love to talk to you too.

UPDATE: As of Sunday afternoon one woman has left a bouquet for our fallen physician.

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Sunday (3 days after her death) now 4 bouquets:

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Monday 1/22 afternoon:

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Tuesday afternoon bouquets arriving from all over the USA. Call Flowers by Richard 212-582-3505 to order a bouquet of flowers to honor this brilliant and beautiful young doctor.

4Flowers4Doctor

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Suicided doctor: covered up with a tarp—and silence. →

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Yesterday afternoon another young doctor jumped to her death in NYC. She landed at the entrance of the building where she lived.

Within less than an hour, I received the following emails about her. All published with permission.

“Hello Pamela, I am not a doctor, but a mother of 3 and a wife of an resident physician. Tonight I watched AGAIN the police taking the body of another female doctor—lifeless—into a body bag. Two doctors died from jumping off our 33-story building in 2 years and no one seems to care. The hospital and everyone is so silent. They cover it up. No one talks about. Someone dies and everyone puts their heads down and ignores it and are told by the hospital to keep quiet—especially to reporters.

Thank you so much for your blog, public speaking, and advocacy. Since I’m not a doctor, there’s only so much I can understand about what my husband is going through. Discovering your blog has helped me know how to help my husband in so many ways. I worry so much about him. When we’ve tried to seek mental health care, we’ve had to be top secret about it. It’s insane. I’m tired of seeing dead bodies out my window. I’m tired of being on the sidelines. I’m feeling so angry and upset. I feel so powerless. What actions can I take to make sure I never see something like this happen again? Words can never describe how it feels to see a dead body outside your window. A beautiful lifeless body of a beautiful doctor.

This is what I saw when I came home tonight—a dead doctor lying under that tarp—lifeless in the freezing cold. What I am suppose to tell my daughter when she asks, ‘Mommy what’s that?’” 

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Email #2

“I’m a physician. I have a career ahead of me, which I’m too scared to speak out against. I came home again to another suicide. Another doctor dead from Mt. Sinai in NY. I think NY is a horrible place to work. Conditions are deplorable for doctors and you should investigate. Both suicides were horrible—jumped from our high rise. I’m convinced it’s the exhaustion, the demands to perform at 100% 24/7 to meet ridiculous administrative and FINANCIAL demands. We need to change healthcare. In NY doctors are blamed for everything the nurses, techs, janitors, staff don’t do. We have to do every job AND document and be nice 100% of the time. Everyone is protected by unions—except doctors. We’re criticized and destroyed with unbelievable debt. I don’t know why anyone would willingly go into this field. I love what I do, but I have grown to hate this system. I have lived in a culture of shame for too long. Would you please expose these Manhattan hospitals? They lack compassion. They are all obsessed with finances, prestige and scores. This suicide today was horrific. I came into my building—a crime scene. Don’t let another doctor’s life go unspoken for. They will likely say she was troubled, but why was she troubled!?? Because she wasn’t efficient enough? Sad and overworked? Our hospital will make it about her. Like the girl that died last year, she was too sad.”

Then I got an email that truly shocked me.

I do not have permission to publish this one so I won’t. I will say that it came from a man who I deeply admire, a man who is a health system executive in NYC. He wrote me in distress about the loss of this young doctor. He explained that hospitals investigate why things go wrong in patient care and lessons learned are shared to improve processes and prevent future deaths. When a doctor dies by suicide, how are we to learn from this tragedy if we don’t study what went wrong? Police don’t investigate suicides. Investigation is left to grieving family and friends. Don’t we have an obligation as a society and as medical professionals to understand why these suicides occur? He concludes, “If this were a patient, we’d be all over it and so would the regulators.”

A few hours before this flurry of emails, I was on the phone with a doctor who reported that her own family physician shot herself in her clinic. The doctor who called me disclosed the she had never been suicidal herself—except once, during residency for about 15 minutes. In an impulsive move she went up to the roof of her 5-story hospital. Standing on the ledge, she recalled a lecture in which she was instructed that to assure death one must jump from at least 6 stories. So she paused. Then turned around and went back to work.

Now to answer the questions posed to me by the doctor’s wife, the physician, and the hospital executive. First, I believe we all have a common goal—to end these suicides.

To the wife of the resident physician who asks, “What actions can I take to make sure I never see something like this happen again?” I say talk about these suicides. Secrets will not save us. Organize a support group for physicians and their spouses. Don’t wait for another fallen physician. Channel your passion into action. Reach out to others in your building in a way that inspires and fuels you.

To the doctor who asks, “Would you please expose these Manhattan hospitals?” I say that as doctors we must all speak up about injustice, human rights violations in medical education, and deplorable working conditions in our first-world hospitals. It’s not just Manhattan hospitals. Doctors and medical students are dying by suicide throughout the United States and the world. This is a global epidemic.

To the executive who asks, “Don’t we have an obligation as a society and as medical professionals to understand why these suicides occur?” I say yes. I hold our medical system to the highest standard when it comes to protecting human life—and that includes the lives of our doctors. As a society we must understand that this is a public health crisis. More than one million Americans lose their doctors to suicide each year. We can no longer cover up these deaths with tarps and silence. We can no longer walk away from the very people who have dedicated their lives to serving others. It’s just wrong.

“How are we to learn from this tragedy if we don’t investigate?” Without an investigation, history will repeat itself. More doctors will plunge to their deaths from hospitals and resident housing complexes in NYC. If we don’t investigate this death, we are each complicit in the loss of future physicians to suicide. Now is the time for fearless leadership, for the heroes among us to reveal themselves and take a stand for our doctors—for the men and women who walk into our hospitals everyday to so selflessly serve others.

My question to you is “What will you do to prevent the next doctor suicide?

Need help?

Physician Suicide 101: Secrets, Lies & Solutions

What I’ve learned from 757 doctor suicides

Contact me anytime. I’m happy to speak to you. Plus I’m gifting a confidential therapy session with an expert on resident mental health to anyone impacted by this tragedy.

Addendum: Doctors were working in the hospital right next to this building and could see there was a woman preparing to jump. They witnessed her fall. They knew she could be one of their friends (since the building houses primarily doctors). Yet these doctors had to continue to care for patients amid their tears and screams at the window. Many have flashbacks to colleagues that jumped from same building in previous years. “It is always the same thing,” says one resident. The hospital sends the usual ‘we’ve had a tragic death’ email. They tell us to meditate, sleep, and hydrate.” Then it happens again.

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“Unprofessional”—how one word is used to censor, harass, and intimidate doctors →

Unprofessional Doctors

Pamela Wible: I just got this letter I want to discuss with my friend and colleague, Sydney Ashland, who’s helping me answer all the letters I receive from medical students and doctors needing help.

So Jamie, an anesthesiologist, writes:

“Today I came across a blog post you wrote entitled, ‘Words that Blame Doctors.’ I saw this comment (see screenshot) about the use of the word, ‘Unprofessional.’ I too have been shamed for actions considered to be unprofessional and threatened with probation, which never happened, but you get the idea. Could you send me the advice you sent out in the email reply to this commenter?”

 

 

Unprofessional Doc

Pamela Wible: Sydney, what’s your gut reaction to this letter?

Sydney Ashland: We often pathologize each other in medicine, because we are focused on diagnosing patients, finding the label for what’s wrong with someone. In this highly stressed, unbelievably pressure-filled environment, when we are confronted with the truth or something that makes us pause, something that is unexpected, we have this knee-jerk reaction of pathologizing each other, trying to put a label on the other person, to quickly dismiss it, move on with our stress-filled lives.

Pamela Wible: Here’s the actual definition of professionalism—exhibiting a courteous, conscientious or generally businesslike manner in the workplace. And for doctors and med students sometimes that extends to outside the workplace because they want to see what you’re doing online and what you’re posting on Facebook and all of that. So it is very invasive the way that professionalism is used with health professionals.

Unprofessional would therefore be not exhibiting a courteous, conscientious or general businesslike manner in the workplace. For example unprofessional attire. I think we can all agree you don’t want to show up in smelly unlaundered clothes; unprofessional comments or behavior like cursing and screaming. We can agree on that.

Then there’s the ‘showing disrespect’ to anyone, including attendings, patients, and staff. So the problem with disrespect is it’s a little bit subjective. Hurting somebody’s feelings. That whole ‘disrespectful’ category of unprofessionalism—that’s the gray area where we get into trouble where medical students and doctors get thrown under the bus. Is it not pretty subjective?

Sydney Ashland: It is subjective. Any time we use labels in medicine to hurt each other, dismiss each other, we’re at risk of losing our humanity and no longer being healers but perpetuating a toxic system. We need to be careful. One of the responses that people should have when they’re accused, in this case, of being delusional is, “Can you give me an example of what you would consider delusional behavior? And what is your definition of delusional?” When you ask the question, the other person then has the responsibility to clarify for you exactly what they’re talking about.

Pamela Wible: Yeah. I think a lot of the problem is our lack of precision with terminology and throwing people into these trashcan diagnoses like ‘unprofessionalism.’ I want to give some obvious examples because there are times when people do have lapses of professionalism such as dishonesty, lying, cheating, plagiarism. I think we can all agree on that. But with disrespectful behavior that has a negative effect on others—there’s a gray area.

Sydney Ashland: Would you consider truth-telling disrespectful?

Pamela Wible: Absolutely not though there are more effective ways to truth-tell that will lead ultimately to much more success. People risk feeling blown off when talking to the wrong person at the wrong time.

Sydney Ashland: Sometimes what trips people up is when they feel like, “I am just trying to get to the truth, I’m just trying to ask a question,” and they’re confused because instead of having that question answered, this label—this projection or pathologizing happens. If you’re looking for fairness, if you’re looking to be respected then ask yourself the question, “How can I better communicate what I’m trying to in this moment, so that I can have a sense of fairness?”

Pamela Wible: Here are some examples of unprofessionalism’ that medical institutions claim negatively impact others. The one that always disturbs me is the phone call that I had one day from a resident at a hospital who was written up for unprofessionalism because she actually cried in response to a difficult case. She was calling me to ask if I had any scientific literature to support her right to cry, or that it was okay to cry. Is that not strange?

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Sydney Ashland: I think we’re very uncomfortable with strong emotions in the sterile environment like hospital or clinical settings. We want to feel like we can just intellectually process whatever is at hand and we really don’t need to access those deep feelings because those deep feelings scare us.

Pamela Wible: Another example is from Physician Suicide Letters—Answered. A med student with migraines wrote me, “I was dismissed from medical school in the beginning of my fourth year because I had a medical condition that didn’t help the school’s technical standards. I suffered abuse my entire third year from residents and physicians telling me that I wasn’t fit to be in medicine, that if I knew what was good for me I would just drop out. My school told me that being sick was akin to being unprofessional, and that I should give up my dreams of wanting to become a physician.”

Sydney Ashland: And it’s so ironic that this is happening in an environment where the whole industry is focused on health.

Pamela Wible: Another one. Extremely disturbing. A third-year peds resident died by suicide, actually shot himself after being fired by a residency problem, just a few months before graduation. This guy was an excellent doctor, didn’t do anything to harm a patient. yet when his co-resident questioned what happened she was sent to the program director and written up as unprofessional and threatened to be sent to a psychiatrist for asking about her colleague’s death.

Sydney Ashland: Wow. That’s unbelievable.

Pamela Wible: Punishing doctors in training for having normal emotions, for having physical ailments, for not controlling their physiologic response to sadness. How is an illness a lack of professionalism? The last case is just direct censorship when asking about a colleague’s termination leading to suicide.

Sydney Ashland: I think that sometimes those in authority have a hard time filtering what is appropriate and inappropriate. Some of what impedes this relationship between the superior and the resident or medical student is that the person in authority isn’t sure how far they should take things. They weren’t treated with dignity and respect and they feel like they’re treating their medical students and residents so much better than they were treated. There’s an inability to really trust that people can filter their emotions, that they can express their emotion and ask for a time out or a little space, that they can have a chronic health condition and still be professional and show up for work and carry their own weight. So I think that’s part of the problem.

Unprofessional FB

Pamela Wible: I posted on Facebook last night, “Have you ever been reprimanded for being unprofessional in medicine and why?” Lots of responses which I categorized into three areas. One is forced hierarchy and professional distance, another is human rights abuse and censorship and the third is natural physiologic responses. One woman writes, “I got written up for sitting on the edge of a patient’s bed holding his hand and laughing at his jokes. I was told I was being inappropriate.”

Sydney Ashland: That’s breaking professional distance. When the person was really just being compassionate.

Pamela Wible: “I prayed with a patient.” When the patient initiates and is going to be feeling more hope and help by attaching to a doctor and praying with them, what is the problem?

Sydney Ashland: There’s no problem. That’s a patient being vulnerable. It doesn’t even have to coincide with your own religious or spiritual beliefs. You’re there for the patient and you’re supporting that patient and what they need.

Pamela Wible: Again, it’s breaking through professional distance which I call professional closeness. Let’s get with modern times and connect with each other without fear. Another one. “I was told that I was too friendly and that it was unprofessional because I tried to make small talk with my surgery attending as a medical student, was humiliated in the hospital hallway and told I was not going to be successful because of this.”

Sydney Ashland: Wow. Reminded to stay in your place, and that’s the forced hierarchy.

Pamela Wible: “Yes, in medical school, for suggesting I should keep my promise to help at a flu shot clinic for the homeless instead of attending a floof lecture by a big name they had visiting, which was made mandatory with only a few days notice because they wanted impressive turnout. When I told them I wouldn’t go because of the prior patient care commitment, I was told I was unprofessional and would be written up in my file for it if I didn’t go to this lecture.”

Sydney Ashland: Ugh. You know. And the problem with that is then you force someone to come to a lecture like that, and you really fuel resentment and a lack of engagement in whatever’s going on at the lecture.

Pamela Wible: And, “For being too nice to staff who they considered below me, basically admin didn’t want docs to have good working relationships with those they considered easily replaceable.”

Sydney Ashland: It’s really sad to keep people in their bubbles, in their boxes, so that there isn’t a sharing of information, a sharing of support for each other, and then people feel isolated and in that isolation, trouble begins.

Pamela Wible: The last one on forced hierarchy is, “Being my first year of practice in Colorado for allowing my staff to call me Karen.”

Sydney Ashland: Some areas of the United States we’re definitely breaking down those barriers where we are more comfortable identifying by our first name, but there are still areas where they’re really resistant.

Pamela Wible: We’re going through a culture change. We are breaking down barriers. People are having more direct relationships. It’s actually okay to break down hierarchy and have more of a partnership with your patients, not be a dictator, have more of a partnership with your professors, and I think that is the modern way that we should be relating to each other. The danger in continuing to be in our own little cubicles is that divide and conquer is at play. We remain alienated. It’s easier for power structures to take advantage of us and control us.

Sydney Ashland: And more mistakes are made in that model because people aren’t talking to each other. People are afraid of each other. People resent each other. So, you know, it’s so much more effective to have a wonderful working relationship with the unit secretary, to be able to talk to the lab tech in a way that is respectful and human, and then you will have people who will leave no stone unturned in helping you find that elusive diagnosis or get that stat test done in the midst of a really busy crunch.

Pamela Wible: So two examples under the next category—human rights and censorship. The first one. “Six months ago, I sent an email labeled ‘feedback’ to my manager at my part-time job. I work at a medical school part time as a community mentor. I explained that the contract didn’t account for the hours spent working. This apparently was unprofessional.” And I think a lot of times when students and residents are forced to work excessive hours and correctly identify the hours worked they are thrown under the bus with the term ‘unprofessional’ and punished for work-hour violations. Another one:

“During my internal medicine residency continuity clinic I had a patient turn around, block me in by putting his arms around my waist, and kiss me on the lips in the exam room. Understandably alarmed, I immediately went to my attending and told him. I made it clear that I did not feel comfortable reentering the room alone. He told me that I needed to work on my professionalism and boundaries. After that, I always grabbed a male medical student to shadow me when I saw a patient.”

Sydney Ashland: It’s so discouraging to hear these stories. I can’t believe that the liability of lying on your time card is more important than actually having your physical space and your body be intruded upon and invaded by someone. That’s where the disconnect between what is truly unprofessional behavior, which was the behavior of the attending or the supervisor who didn’t help the student who had been treated like that with the kiss and the unwanted physical contact, I mean, that’s the unprofessional behavior.

Pamela Wible: And why should you be written up as unprofessional for involuntary natural physiologic responses? Three examples:

“I nearly vomited while holding a cup for a patient to expectorate into when I was a med student. I was told this was unprofessional.”

“When one of my pediatric oncology patients died, I openly cried on the ward. Written up, unprofessional.”

“I cried when a baby died. Again, they didn’t use the word unprofessional, but it was heavily insinuated. I wasn’t sobbing, but just a couple of tears sneaked out.”

Sydney Ashland: I hear these types of stories all the time, and natural physiological response can include fainting in the ED when witnessing terrible pain and you’re putting in a chest tube and it gets really trauma-filled experience, and somebody faints, or somebody throws up. And instead of us just dealing with each other with compassion, like they do in the war zone when a soldier throws up or a soldier faints, his buddies or her buddies help restore her to her feet and life goes on, and that’s what we need to do in these really stress-filled environments.

Pamela Wible: My purpose for discussing this unprofessionalism topic is not to demonize anyone. I don’t want to create more obstacles. I want people to feel comfortable to really develop sincere relationships with their attendings and the staff and patients. Let’s be in an honest, caring environment. Stop with counterproductive labels.

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There are, however, legitimate lapses in professionalism, and this was something that was shared on Facebook by an attending.

“I’ve seen students Snapchat sensitive pictures that are on the screen in lectures and then also ask to go home around 2 PM on a seven-to-seven internal medicine inpatient shift to feed their parents’ cats, and the list really goes on. Being compassionate is not unprofessional, but the term is still appropriate to use in certain circumstances in medicine. In my experience students are coddled too much these days and get away with almost everything. I think the pendulum has swung from malignant to apathetic. Just my two cents.”

What would you say to this attending?

Sydney Ashland: This seems like very isolated incidents because that is not my experience when working with people. I think certainly there are the times where there’s some black humor if you’re working in a hospice or you’re working in a morgue and there’s a certain level of survival, coping strategies that can kick in. It’s a fine line between that and truly unprofessional behavior.

Most of the people that I talk to are afraid to go to the bathroom. They’re afraid to call in sick when they have fevers and horrible viruses. They don’t want to pass it onto their patients, but they know that if they don’t come in they will be told that they’re not a team player. So I really do not experience these people as being coddled or apathetic. Actually just the opposite.

Pamela Wible: Two more comments from Facebook. From a doctor in training, “Professionalism is the weapon of a malignant regime in a residency.” And from a medical student, “Our school uses ‘unprofessional’ practically anytime anyone speaks up against something the school is doing. Honestly the word has lost any significance for me at this point.”

In summary, the truth really is in the details. We need to be very specific about why something is unprofessional. You need to ask, “What specifically did I do that was unprofessional?”

Unprofessional-BW

Sydney Ashland: There are cases, just as you said, where there are unprofessional behaviors, with someone who may just lack the filter that they need to understand the difference, or who are so overworked and under rested that they aren’t able to really discern what’s appropriate or inappropriate. But the more specific you can get, the more questions you can ask about what is perceived as the inappropriate behavior, and what you could have done differently, that’s key, because if you know what you could do differently. And if there’s no response that probably means it was a manipulation or a bullying technique. But if there is a specific response, then rather than be defensive, take it to heart, go talk to a friend, to a mentor, and get some feedback.

Pamela Wible: There’s just immense pressure to conform and accept the current culture of medicine and medical training, but my message to anyone out there who is in medicine (especially if you’re new to the field) is that medical culture needs to change. We actually need more disruptive medical students and physicians who are not afraid to ask, “Why?” Think independently. Ask questions.

This is supposed to be a learning environment where we all work together for the good of the patient and we all become healers, and more well-adjusted, not tormented by our training.

So I’m very curious what you think. Contact me or Sydney. I’ll give Sydney a chance to share how you can reach her.

Sydney Ashland: My website is SydneyAshland.com. I have very flexible hours and segmented periods of time that I’m available, with 15 minutes, 30 minutes, an hour, whatever people need. And I’m very reasonably priced so even a medical student can afford $30 for 15 minutes to get sage advice and a mini action plan.

Pamela Wible: Sydney, I’m just curious if you could share with everyone what sort of categories of things that you handle on these calls?

Sydney Ashland: I deal a lot with people who are wanting to exit their current job situation and begin to create an independent practice for themselves. I work with students who are struggling with passing various step tests or who are having a hard time with an attending or within their school system. I work with residents in helping them to be a team player and also set healthy boundaries for themselves, and communicate in a way that isn’t offensive or doesn’t create defensiveness. I help people with PTSD, anxiety, because even if you’ve gone to a really great medical school, some of what you see in a hospital setting, some of what you are asked to do can be quite traumatic. So I help people to move beyond that, quickly integrate the experience, so that they don’t spend years with a sleep disorder or with some dissociative issue.

Pamela Wible: I do want to be there for all the people reaching out to me. I answer every single email. I really do appreciate the time that you’ve taken to help those with emotional issues so that I can focus on the higher-level business strategy which is my true gift for the world.

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Top 10 lies doctors tell themselves →

LiesDoctorsTell

Pamela Wible: Today I’m sitting here with Sydney Ashland, an expert in physician mental health, who has worked with doctors for decades helping them overcome negative thinking patterns. And we’re going to dive into the top 10 lies that physician’s tell themselves. The number one thing that I hear over and over again from doctors is, “I’m stuck in assembly line medicine.”

Sydney Ashland: Yes. I hear that all the time, too. I’ve worked with hundreds of physicians, and it doesn’t matter if they’re a general practitioner, if they’re a family medicine doctor, if they’re a specialist, they all believe they’re stuck. I’m here to tell you, and I’m going to use an example of a specialist who thought she was stuck in middle America, a child psychiatrist, and she discovered that this was not true. Even though she had had a challenging fellowship and then ended up in a very big hospital, where she was told, “There’s absolutely no way as a child psychiatrist, as a pediatric psychiatrist, that you can work outside of the system.” Yet she was so over burdened, and in such a compromised position with the demands that were placed on her, that she felt like she had to explore other options. When she decided that she was going to go out on her own, she was pleasantly surprised to discover that she wasn’t stuck. Not only was she not stuck, she could thrive. And she has a thriving practice where she sees many, many, many children each and every week. And has a waiting list.

Pamela Wible: And never even put up a website, right?

Sydney Ashland: Never put up a website. And doesn’t even take credit cards.

Pamela Wible: They have to bring cash and a check, right?

Sydney Ashland: Right.

Pamela Wible: And the other thing about her, is that these CEOs at the hospital system—the administrators that were hassling her so much about how she was gonna fail and this would never work—they actually bring their kids to see her. How about that!

Sydney Ashland: That’s a wonderful ending to that story.

Pamela Wible: Number two is: “I’m not smart enough.” I hear this all the time. Don’t you?

Sydney Ashland: Yes.

Pamela Wible: And I just tell these medical students, these physicians, “Are you kidding? You’re in the top 1% of intelligence, compassion, and resilience on the planet. You’ve been valedictorian, president of all these clubs. The smartest one in the room. Why don’t they feel smart enough Sydney?

Sydney Ashland: I think they lose their confidence. In fact physicians report that their number one issue is self confidence that gets eroded through the process of being trained as a physician. Often we embrace perfectionism in order to make up for that which we feel insecure about, and perfectionism does not help us feel smarter. It just helps us become controlling. Then we feel insecure and not smart enough. You’re absolutely right. You are in the top 1%. You’re not only intelligent. You are brilliant.

Pamela Wible: Number three. “I have no power.” You’ve got a mortgage to pay, you’ve got administrators down your throat. Family, spouse, kids. You have a lot of obligations. You start to think that your life is not your own, but you do have power. I felt the same way. My contract was up, I was the only breadwinner. I finally decided, “I don’t have to put up with this shit.” And I took my life, and my career into my own hands, and opened my own practice. This was 12 years ago, or 13 years ago now, and it was a simple change in overhead. I changed the structure, I cut out the middlemen, and I literally got my power back by removing all the people in my business life that were sucking my power from me. They’re like little parasites and you’re supporting them with the revenue you’re generating per minute. Sometimes upwards of 85% is going to them. Why not cut them out of the formula? Which is what I did. My overhead went from 74%, to about 10%. I was suddenly making as much as I was earning at my full-time job, working part-time on my own and having the time of my life. What do you think about this power issue?

Sydney Ashland: I think that you absolutely nailed it. It’s responsibility that we tell ourselves that we bear, that makes it impossible for us to have power. And the truth is  your responsibilities are lessened when you take your power back.

Pamela Wible: And remove the disempowering people from your lives and also the disempowering thoughts that you have of constantly have to serve all these other people.

Sydney Ashland: Whether it’s the administration, whether it’s your family, whether it’s your community. Take your power back.

Pamela Wible: Number four. The thing that gets under my skin more than anything in the world. The thing that I hear more frequently than anything else is, “I’m burned out.” You are not burned out. You have been abused, manipulated, and you have experienced human rights violations in your medical education and training.

Sydney Ashland: That’s right. We are so conditioned to blame the victim because if I tell you, “You’re burned out. It is your problem,” then I am victim blaming, and I refuse to participate in that. I agree. You are not burned out.

Pamela Wible: The problem with this, the reason why this gets under my skin, is that people start to think that they’re defective when they hear the word, burnout, right? And that defectiveness leads to additional negative patterns of thinking in which you feel like you don’t belong. You’ll never make it as a physician. You don’t even belong on the Earth. You’re not even helping your family. You might as well kill yourself. This leads to—it’s like a gateway diagnosis to suicide. So please, I am begging you all to use proper terminology. To stop calling yourself burned out, when you’ve been abused, neglected, manipulated, and have literally survived years of human rights violations.

Sydney Ashland: Hear. Hear.

Pamela Wible: Number five.

Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.

Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.

Stop overworking! Join our upcoming physician retreat & relax . . .

Sydney Ashland: Exactly. Exactly. That’s craziness.

Pamela Wible: And number six. “I can’t get confidential mental health help.” Yes you can. There are so many off-the-grid options. Even locally. Many psychologists and counselors do not even use an electronic medical record. They keep paper charts, and they’re 100% confidential. You can always talk to your pastor, your massage therapist, your friends without worrying about anything going into an EMR. Plus there are therapists, even psychiatrists, who do phone and Skype sessions. I’m here. I’ve been running a suicide hotline for five years, and Sydney, you have same-day emergency sessions for anyone in the world, right?

Sydney Ashland: Right. Skype or phone.

Pamela Wible: And how do people get a hold of you?

Sydney Ashland: All they need to do is type in SydneyAshland.com and right there is my schedule, right there are my types of sessions, and what the fee is, which is incredibly reasonable.

Pamela Wible: I think your 15-minute sessions, which people can have between patients, right, and same-day Skype and phone sessions, I think they start at like 30 bucks?

Sydney Ashland: Exactly. Because I don’t want financial restrictions. I don’t want financial barriers to hold anyone back. I want anyone to be able to reach out for help.

Pamela Wible: Including premed and medical students?

Sydney Ashland: Absolutely.

Pamela Wible: They are often wondering, should they even go into this field, right? You have a lot of information that would help them avoid a whole lot of hassle later on in life.

Sydney Ashland: Yes. Which takes us into the next . . .

Pamela Wible: Because you cannot afford not to get help, right?

Sydney Ashland: Exactly. “I’ll go broke.”

Pamela Wible: Number seven.

Sydney Ashland: Believing that in order to pay off debt, maintain your medical license, you have to stay in assembly-line medicine or your big box. I visited, several times recently, with an OB/Gyn who believed this, thought she couldn’t leave her practice because of the tail insurance on her malpractice insurance. She had loans to pay off. She was the breadwinner. Didn’t think she could support her kids and spouse. And guess what? She discovered when she started exploring what it might take to get a small space, to get rid of all of the administrative, middlemen that you talk about, Pamela, in her office, and just provide simple health care for women that her overhead dropped dramatically. From 70% down to 15%, that she got a very reasonably priced space, that actually her risk for malpractice went down because there were fewer people interacting with these patients Fewer people taking call. In fact, I don’t think she has anyone taking call. You don’t have to go broke to go out on your own, or at least to change the way you’re practicing medicine.

Pamela Wible: And number eight. “It’s the system.” We spend so much time vilifying and demonizing insurance companies, pharmaceutical companies, clinic managers, hospital CEOs, that we don’t take our own lives back. Once you realize that you have the power to practice medicine on your own terms, you end up way more successful and financially secure. You sometimes realize, along the way, that you are the problem. You have been the main obstacle to your success.

Sydney Ashland: Yes. And you know what? Some people end up embarrassed when they realize that the way they chart, that they have for years been chastised at work about how much time charting is taking. Then they go out on their own and think, “Oh my word. I’m free.” They realize that they are spending an inordinate amount of time. They’re writing books. Or that there are other systems that they aren’t utilizing that could so help them.

Pamela Wible: They end up just making things more difficult for themselves. It is not the system. We can blame the system, and stay captured, and captive, and disempowered by the system, but frigging take your own life back. It is not anyone else’s fault if you’re not happy.

Sydney Ashland: Or another thing that I hear a lot is, “It’s the system that promotes the types of patients that I get.” I have these needy patients, or these patients that keep exhibiting behaviors that I am not fond of, and it’s the system that attracts that.” Then we go out on our own, and we find out that the same needy, entitled patient show up. Guess what? That means that we’re trying to overdeliver, that we’re over-accommodating, we’re enabling, and when we look at ourselves, we no longer have to blame our patients, or the systems. We can change ourselves and then our practice changes.

Pamela Wible: And number nine: “Nobody cares.”

Sydney Ashland: This is another lie. Because there are so many people who want to share your vision. They just need the invitation. So much of the time when we isolate and we don’t communicate, we tell ourselves that nobody cares, because we’re in our little isolated bubble. Once we start to poke our head out, and we start to talk a little bit about our vision, and we get brave enough to invite others to join us, we discover that there’s power in collaboration. That more people cared than we’ve recognized. Those are the small communities where people start taking up donations in order to help someone who is really sincere and honest build their practice. We build alliances. We build a network. And we discover that not only is that a lie, but there are a lot of people that care.

Pamela Wible: I just sent a $10,000.00 check to a woman who inspires me in North Carolina. She’s opening up a clinic in her farmhouse this July when she finishes residency. There are so many people that want to help you. Mary Ellen got $100,000.00 check from a philanthropist in upstate New York to open her clinic.

Sydney Ashland: I know.

Pamela Wible: People will jump out of the woodwork to help you. You have to believe in yourself first and realize that people care. And what I want to say that is truly important for me to say right now is you do not have to wait until the next physician suicide to care. I want you to take the doctor in the next cubicle out to lunch. Do not wait to care until you’re at his funeral, standing next to his children. You can care now. You are a health professional. You know how to care. It’s in your title. Why are people not doing this?

Sydney Ashland: Because they’re afraid. Because they’re isolated. Because they’ve started to believe the lie that nobody cares.

Pamela Wible: And number ten.

Sydney Ashland: “Nothing will ever get better.” I’m here to tell you, you are not terrible. You have not screwed it all up. It doesn’t matter if you’ve lost your license, made unethical or illegal mistakes, or missteps. It can and will get better. You just need help in strategic planning. You need to be willing to embrace change, instead of resisting it. And when you do that, through acts of courage and bravery, usually that start by telling yourself the truth. Not participating in the lies that we tell ourselves, you begin to personally and professionally experience what it’s like to have things get better, not worse. You absolutely can create for yourself, what you want your practice to look like.

Pamela Wible: Absolutely! You can have whatever you want in medicine. We are totally living in a time when huge disruption and innovation in medical practice delivery is happening right now. Don’t miss out. You can get involved in this. People are launching medical clinics in yoga studios, with juice bars, and teaching patients how to garden from their farmhouse clinics. You can literally break free and design whatever your heart desires, whatever you want, and engage your community to help you. So please stop isolating. Ask for help. You are not alone. Your community cares. Your loved ones care. I care. You can call me 24/7. You are a brilliant, capable, amazing person and stop selling your soul. You went into medicine with high hopes and dreams and you can absolutely be the doctor you described in your personal statement when you entered this professions. Please stop waiting for the system to change. A system is just made up of people like you. Now is the time.

10LiesList

Do you recognize any of these lies? Let’s go through these one more time. What are these lies? I’m stuck in assembly line medicine. I’m not smart enough. I have no power. I’m burned out. I must overwork and overextend myself. I can’t get confidential mental health help. I’ll go broke. It’s the system. Nobody cares. Nothing will ever get better. If any of these sound like things that are circulating through your mind every day, you may be lying to yourself. If you recognize these lies, I am inviting you, and Sydney is inviting you, and encouraging you, to stop lying to yourself today and become the person you were truly born to be.

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The most honest obituary →

Sometimes there are no words.

Not even a eulogy.

Then one courageous family writes this obituary. [This obituary was written by Rachel Dawson, his wife, with the blessing of his parents] In it they share how their son lost his battle with severe depression. How he adored his children. How he sacrificed fun, free time, and relaxation to receive his medical degree. How he took on the challenge of surgical residency. How he was so very damaged by his untreated anxiety, long work hours, and intense stress. How he attempted to self-medicate his hurt. How despite being an intelligent surgeon and a loving father, he did the unimaginable.

I first heard of Dr. Chris Dawson just hours after his suicide in a Facebook private message:

“My friend who is also a doctor’s wife is going through a nightmare at this very moment. Her husband graduated residency this summer along with my husband and he killed his two small kids and himself this morning. Her husband suffered from depression due to the difficulty of residency season and never recovered from it. I know residency is hard, I always said it’s a real b#%^*, but if you know your partner is having a rough time, suffers from mental illness or is going through a depression get him some help. At all cost! My heart is broken for my friend who no longer has her babies. This med journey can be very hard and can take you through a darkness if you don’t get the help needed. It was so close to home that I had to share. Mental illness is nothing to be ashamed of.”

Chris-Aubrey-Luke-Dawson

I’m a doctor, a problem solver. I study human suffering so I can help people. That’s my job.

In 2012, I became alarmed by how many doctors were dying by suicide. So I started counting dead doctors. I began with a list of 10. Today I have 699.

Now I run a suicide hotline for doctors.

During the last 5 years, I’ve spoken to thousands of suicidal doctors; interviewed surviving physicians, families, and friends; and published a book of their suicide letters, I’ve spent nearly every waking moment since 2012 on a personal quest for the truth of why we lose so many doctors to suicide. Here’s what I’ve discovered.

Of the 699 doctor suicides I’ve compiled, only 2% (15) involve a homicide. Half of those (7) are male physicians who killed a female spouse/girlfriend (all in health care—4 nurses, a nursing student, pharmacy tech, and dentist). Three male physicians killed their young children. Another strangled his disabled adult daughter before killing himself. Less than 1% of all doctor suicides involve homicide of their children. Of the 3 cases involving young children, all suicide victims were having marital/relationship problems with the mother. One also killed the mother.

Why would a doctor dedicated to saving lives take his own? And the lives of his loved ones?

Many doctors write suicide notes explaining their motives. A few leave extensive documentation—even videos (often they are whistleblowers exposing fraudulent hospital systems). Still questions remain.

Motives for murders perpetrated by doctors often involve ending perceived suffering of others. Four of the 15 physicians were attempting to end distress in dependent family members prior to taking their own lives. They wanted to protect siblings from an abusive parent; to stop an aging mother’s misery; to prevent institutionalization of a severely disabled adult daughter for whom the physician was full-time caregiver; to end the suffering of a child tormented with the same anxiety disorder as the dad. None of these four physicians seem to have been acting with malicious intent when they took the lives of others before killing themselves.

So how do we respond as a society to these suicides? Often with an outpouring of love for the surviving family amid condemnation of the suicide victim mixed with lots of confusion.

And then comes silence.

Until it happens again. In the house next door. The one with the Christmas lights and candy canes. And the soccer ball in the yard.

Our collective rage resurfaces. We pray for the family to find peace. Then the story falls to the bottom of the news cycle.

Until it happens again.

And again.

‘Round and ’round and ’round we go.

I’ve read hundreds of doctor suicide obituaries. One common theme: euphemisms obscure the cause of death and prevent discovery of answers we so desperately seek.

Secrecy, shame, and silence are 100% ineffective as problem-solving strategies. They also prevent us from healing.

Full disclosure: I do not know Chris Dawson, but I feel like I do. Maybe it’s because I grew up in Dallas down the street from where he died. Maybe it’s because we both graduated from medical school in Texas and completed our residencies in Arizona. More likely it’s because we both fell into a suicidal depression at age 36. Since he can’t share his story, I’ll share mine.

From October 22 through December 7, 2004, I couldn’t get out of bed. For 6 weeks. I wanted to die. I prayed that I’d go peacefully in my sleep. Despite my pleas with God and the universe, I woke up each day horrified that I was still breathing. I could not figure out how to release myself from my unbearable pain. I was fed up with being forced to practice assembly-line medicine like a factory worker. I had just been let go from a job (contract nonrenewal “not a good fit”). I could not face one more day. My bills were piling up. My marriage was on the rocks. I felt like I was in a suicidal coma. If I had a loaded shotgun, I may have pulled the trigger too—and this story would be mine.

The fact is we all have a breaking point—a threshold over which we would consider killing ourselves. And even our loved ones (in our disordered thinking) as a mercy killing.

So what shall we do now?

Here are 5 ways we can prevent the next physician suicide

1) Increase awareness of our physician suicide crisis. Be alert to mental health risks of medical training and practice, including high-risk specialties for suicide. We can’t solve a problem nobody knows exists. Talk about it. See the forthcoming film, Do No Harm. View trailer here. To arrange a screening at your medical school, hospital, or conference, email info@donoharmfilm.com.

2) Avoid a medical career if you have pre-existing anxiety or depression. Medical training will worsen your mental health—and may be life-threatening to those who are not resourced to cope with chronic high pressure and ongoing exposure to suffering and death. In fact, 75% of med students are on psych drugs just to survive med school.

3) Allow access to nonpunitive mental health care. Physicians have unique occupationally induced mental health needs and currently risk punishment for help-seeking by state medical boards, hospitals, and insurance companies that may prevent a doctor from practicing medicine. If you are suffering, I’m available to speak with you and I can refer you to confidential care by phone or Skype 24/7. If you are in imminent danger please call 911.

4) Allow access to nonpunitive marital counseling. A physician friend had her state license delayed for 6 months because the medical board demanded to review her marriage counseling records because she was depressed during a divorce. Doesn’t everyone need help during a divorce? Why should physicians fear seeking counseling for their marriage? (Note: a lot of physician relationships fail because there’s no time to spend with your spouse when working 100+ hours per week!). One request: Please support Rachel Dawson who has lost her entire family.

5) Humanize medical training. Residency is brutal with chronic sleep deprivation and human rights violations (plus lack of legal protection). Surgeons used to brag about 100% divorce rates! (as if toughing you up and destroying your family would make you a better doctor). Let physician trainees sleep, eat, and see their loved ones. Doctors are human.

Doctors are extremely gifted, complex individuals. Most people attracted to medicine have brilliant minds and are able to tackle immense complexity. Yet the culmination of such intense personal and professional pressure contributed to this surgeon’s complexity becoming confusion and such horrific torture that he just had to end it all.

So how do we preserve our humanity? That was the one thing Chris was unable to do at that moment—preserve his humanity. He most assuredly loved his children and as a surgeon saved many lives. Though he saved lives, he may have been unable to feel fulfillment. Medicine conditions physicians to be withdrawn and professionally distant. For somebody like Chris who suffers with anxiety to be groomed for emotional distance and discouraged from seeking help is deadly.

We are all born into this world with our own eccentricities, quirkiness, and a certain predisposition to anxiety and depression. Nobody is immune.

Did Chris have pre-existing anxiety before medical school? Seems so. If he were a realtor or an auto mechanic would he have been able to access confidential nonpunitive care for his anxiety? Yes. Would he have been more resourced to assist his children with anxiety? Yes. Would he have had more time to spend with his wife and invest in his marriage had he not been a surgeon? Yes. Would he and his children be alive now? I think they would.

My hope is that this honest obituary allows us to begin an honest (and long overdue) conversation about mental health.

Because our silence nearly guarantees our suffering will continue.

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