How Doctors Celebrate Independence Day—They Don’t →

Doctors4th

It’s July 4th! All across the country, Americans are celebrating freedom, liberty, and the pursuit of happiness. Families and friends are relishing potato salad, apple pie, barbecues and parades. 

Is your doctor decked out in red, white, and blue enjoying fireworks from his yacht? Probably not. 

Have you seen any medical students waving little flags? Unlikely. 

The truth is American medicine has little to do with liberation or independence. July 4th is just another day of captivity and confinement for most American doctors—and nearly all medical students.

Once upon a time all doctors were independent—until recently. My parents were both solo docs. Now most physicians are salaried factory workers practicing assembly-line medicine.

In fact, 9 out of 10 doctors wouldn’t recommend medicine as a profession.

Why? Here are a few factoids.

Pages in US tax code: 74,608

Pages of Medicare regulations by which physicians must abide: > 132,000 

Current number of diagnostic and procedure codes doctors must know: 17,000

Number of codes docs are responsible for with new guidelines in October: >140,000.

Percent of working hours doctors spend on non-patient-related paperwork: 22 %

Percent of working hours doctors spend on patient-related paperwork: > 60% 

Percent of time doctors spend looking at computers instead of patients: 40%

Percent of working hours new doctors spend face-to-face with patents: 12% 

Which is how many minutes per patient: 8 

Hourly income for solo psychiatrist (my mom) in 1970s: $120

Hourly income for employed family doc today: < $65

Current student loan debt load for many med students: > 300K

Number of Americans who will lose their doctors to suicide in 2015: > 1,000,000

In the land of live free or die, some chose death. 

I considered it.

Until I decided to live free as a solo doc.

Join me this July 4th to declare your independence.

Want to open an ideal clinic for your community?

Join our next teleseminar & retreat.

 

Pamela Wible, M.D., is a family physician and pioneer in the ideal medical care movement. She hosts physician retreats to help her colleagues reclaim their lives and careers. Dr Wible has been named 2015 Women Leader in Medicine.

Posted in Medical School, Physician Abuse & Bullying, Physician Suicide Tagged with: , , , , , , , , , ,
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Medical Student Suicide—Simple Solutions →

Michele and Kevin Dietl

Michele and Kevin Dietl

It’s medical school graduation season!

Here come the caps. The gowns. The smiles. And sighs of relief . . .

Time to celebrate our brand new doctors.

Except for the families that can’t celebrate their child’s graduation. Or their child’s marriage. Or their child’s birthday—ever again.

Like Michele and John Dietl.

They lost their son, Kevin, just weeks before graduation. Now they cling to online condolences and family photos. And to the never-ending question: Why?

I’ve become a sideline specialist in medical student and physician suicide. Why? Mostly because I can’t stop asking why. Why both classmates I dated in medical school died by suicide. Why we lost three doctors in town to suicide. Why my cell phone feels like a suicide hotline. Why I’ve received hundreds of letters from suicidal doctors and medical students. 

A distressed medical student writes:

“We have had two suicides within two years. Just months after starting first year, a male who was top of our class died by suicide. Another student found him after noticing he missed gross anatomy. The second was more public. An internal medicine intern who had just graduated jumped to his death in NYC. He was very charismatic, highly intelligent, and always willing to help out younger medical students.

The students mourned, including me, especially for the latter who I had just met. There have been no talks from the school regarding how to deal with suicide. I personally find it frustrating that my university does little about this. We have one counselor to all of our students and residents. As a community we are afraid to discuss the topic of mental health openly, and that two very excellent, compassionate people were lost to suicide.”

Since medical schools are doing “little about this,” I invited 176 medical students to share what should be done. In their own words, here are the top ten initiatives for immediate implementation:

1) Increase Awareness. Require all medical schools to establish a suicide-awareness campaign and program for early detection. There are marathons/fundraisers to bring awareness to just about everything. Talk about medical student suicide in public, out loud, and utilize every form of media. Alert students’ families to watch for warning signs. Let students know “you are not alone.” Practicing physicians must stop pretending this isn’t happening. To be accredited schools must meet a minimum level safety, requiring suicide prevention initiatives.

2) Decrease Stigma. Minimize stigma by addressing mental health throughout the curriculum. We need physician role models who admit to struggling academically and psychologically and are willing to share how they’ve overcome these struggles. Create a culture where it’s not just okay, but ENCOURAGED to seek mental health help. Never threaten a student. Never say that divulged information will be documented and used against students academically. This shuts down communication. Do not force medical leave for mental health issues. Some of us just need guidance, and high stress brings out our maladaptive coping mechanisms. Forcing us to leave school penalizes us for voicing our mental health concerns.

3) Share Resources. Students must know what is available and how to get help. Offer social/financial/academic resources. Students have real-life milestones during school, like death of loved ones and the end of long-term relationships. The message should be: if you find yourself in trouble, you have options and we’re here to help. We want you to graduate! Give students step-by-step instructions, easy to follow—even when at their lowest low—of what to do if students are contemplating killing themselves. 

4) Institute a Hotline (Online & Offline). Establish suicide hotlines everywhere there are medical students. Offer a website messaging service answered anonymously by students who have survived depression and suicide. People who actually relate to our perspective and can offer hope. Online site would be overseen by licensed mental health professionals and would allow students to access help without time constraints, travel, or treatment costs. The support group atmosphere would allow anonymity, but also rapid intervention via Skype or video chat.

5) Start Annual Screening. Because most suicides come as a total shock, require meetings with a counselor. A mental health check might catch symptoms that others miss. Plus if everyone has to go then no one is being singled out. Let it be okay for students to ask for help with anxiety, depression, suicidal thoughts. 

6) Provide Mentorship & Therapy. Match mentors with med students to give them a reality check and make sure that they’re okay psychologically. Ask students about their hopes and dreams! Send reminder emails every few months with ports of call for help and make it very obvious at a glance that the services will be confidential. Create intentional safe spaces in which students can work through feelings or grief and guilt that arise inevitably during rotations. Many feel traumatized in school. Trauma therapy can really help heal the wounded. 

7) Humanize Medical Education. Avoid curriculums that dehumanize and completely molecularize the human body. Improve academic support for struggling students. Offer the opportunity to retake tests. Learn clinically relevant material rather than stupid factoids. Reform the board exam system so students don’t feel they have to study every hour of every day memorizing minutiae that is completely irrelevant. Integrate clinical work during first two years. Give students time to take care of basic needs like eating good food, sleeping at least seven hours per night, exercising, and caring for relationships. Mental health starts with self-care. 

8) Offer Peer Support. Peer-run support groups at least weekly between classes where students can have heart-to-heart conversations about their day. Start a mental health advocacy group on campus and create a dialogue centered around openness and mutual understanding.

9) Require Physical Education. It sounds really trite, but so many students talk about how they’d love to go for a run if they could just . . . Group exercise or class outings into nature. P.E. Yeah. Physical education. We have all kinds of required science classes that build stress and keep us sitting, but we need a reason to get up and get moving. Depression builds when we sit all day. Helping medical students be physically active would reduce depression and hopefully, suicide. 

10) Stop Bullying. The #1 recommendation: a learning environment free of bullying, with harsh consequences for negative or mean instructors. If we disagree with something the school does, we should not be worried about being in a hostile work environment. Let students know it’s okay to make mistakes and stumble and fall along the way. That is how we grow. Instead of bullying, it’s going to sound silly, but dole out hugs. Like the “Free Hug” movement (where people stand around town, holding a sign: “Free hugs”). Such a basal connection, free from malice. When our loved ones hug us, the release of endorphins and feeling of security is unmatched. Tell medical students it is 100% acceptable to feel what they feel, and to be anything other than honest with themselves is not okay – that the best physicians remember their shared humanity. 

A few weeks ago I got to hug Michele and John Dietl. They were so gracious and kind to me. Honestly, I haven’t had a man open a door for me in decades. They treated me to lunch at a wonderful Italian restaurant in St. Louis. And they told me all about their sweet, beautiful son. Because Kevin was only three weeks from graduation when he died, they told me the school went ahead and printed his diploma.

So Michele and John have their son’s white coat. They have their son’s diploma. They just don’t have their son.

This doesn’t have to happen again.

But today I was just told about another one in San Diego.

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Pamela Wible, M.D., is a pioneer in the ideal medical care movement. When not treating patients, she devotes her time to medical student suicide prevention and leads medical student and physician retreats. Dr. Wible is the recipient of the 2015 Women Leader in Medicine Award. Photo credit: Dietl family.

Posted in Medical School, Physician Abuse & Bullying, Physician Suicide Tagged with: , , , , , , , , , ,
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How to be a happy doctor →

How to be a happy doctor

I was a physician employee, many times for many hospitals and clinics. I’d stay a year or two, but eventually I’d quit. Then, in 2005, I opened an ideal clinic designed by my patients. Ten years later, I still love private practice. Why? I’m finally practicing medicine the way I had always imagined.

When I decided to open a private practice, I was determined to do things differently. I needed to know what my patients really wanted from me. So I led a series of town hall meetings where I invited my community to design an ideal medical clinic. I collected 100 pages of written testimony, adopted 90 percent of the feedback, and opened one month later. Now my job description is written by patients, not administrators. I’m finally the doctor my patients had always imagined.

I work collaboratively with my patients in a neighborhood family medicine clinic where nobody is turned away for lack of money. It is ideal. There are so many things I love about private practice. Here are a few:

• Autonomy. No more committee meetings. If I want to change an office policy, I just do it. I don’t ask permission for time off. I just take off. Fortunately, I rarely feel the need for a vacation since I work a humane, part-time schedule (20 hours per week, including administrative work). By the way, I’m in control of my schedule. I never double-book. I’m never rushed or frazzled.

• Disintermediation. By “removing the middle men” and no-value-added intermediaries, I now have more direct relationships with my patients. They requested a simplified, small office with less staff running around. So now I’m a solo doc with no staff. I don’t miss the layers of bureaucracy and administration. Nor do my 500 patients who get uninterrupted 30-minute to 60-minute appointments. I do accept most insurance plans; the ones that don’t require hoop jumping through a gazillion unfunded administrative mandates.

• Finances. Because I’m no longer supporting a bloated bureaucracy that does not support me or my patients, I have extremely low overhead. As a result, I’m taking home three times as much income from each patient visit than I had taken home per visit in my high-overhead employed positions. Yep. I make more money seeing fewer patients and I do this without charging patients any extra fees.

• Authenticity.  I dress casual, not corporate. I’m usually in Levis and clogs at work; so no white-coat hypertension. My patients appreciate that I dress like a real person. One woman exclaimed, “It’s so refreshing to meet a doctor who is a real person with a real personality.” I like being me. Why hide from my patients? I’ve never practiced professional distance. I believe professional closeness is most therapeutic.

• Fun. I have a gift basket in the exam room with prizes for patients who have lost weight, quit smoking, or achieved other health goals. Patients also receive gifts if they bicycle or walk to the office. I host random “Patient Appreciation Days” with balloons and dark-chocolate treats. I even throw clinic holiday parties — all patients are invited!

• Inspiration. What I love most about my practice is that I’ve stopped complaining about medicine. After all, if doctors are victims, patients learn to be victims. If doctors are discouraged, patients learn to be discouraged. If we want happy, healthy patients, why not start by filling our clinics with happy, healthy doctors? By enjoying private practice, I’ve inspired my colleagues to start enjoying their own careers again. Some have opened ideal clinics. Some docs have told me that I’ve saved more than their careers — I’ve saved their lives.

Want to open your own ideal clinic?

Join Dr. Wible’s teleseminar and find out how! 

 

Pamela Wible, MD, is a family physician in Oregon. She hosts biannual physician retreats to help medical students and physicians overcome burnout, depression—even suicide—so they can be happy too!  Contact Dr. Wible for a free initial consultation on how you can be a happy doctor :) Photo by Geve.

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Texas Doctor’s Craziest Text Messages →

So yesterday I get this email from a physician friend. . . 

Subject: On Call 24/7 :-)

Some on-call text messages from my patients:

“I fell better just hearing from you”

“Good deal thanks!”

“Enjoy your family this week!”

“Well, it’s official! My husband has become a true Redneck!!!! Ayyyyye! Sorry I meant to send that to my friend!!!”

“Ok, thank you! Yay no needles for two weeks! Woohoo!!!”

Video of my patient’s pot-bellied pig :-)

“So happy you got free!!!!”

“That’s because you’re awesome! Seriously, from both a patient and RN standpoint I can honestly say there just aren’t any doctors these days who actually take the time and care about their patients the way you do.  I’m excited to be a patient at your new practice! :)”

“Thank you. Needed a little good news.”

“Thanks so much. You are a jewel”

“That is such great news! I’m so glad to hear that. Thank you so much for letting me know. I’ve been worrying about it.”

And what does my friend think of being on call 24/7/365 as a solo doc for her patients? Here’s how she ends her email: “Doctors just don’t get this kind of feedback on the treadmill (when their staff do all the communicating with the patients!)  I love my patients!!  I love my job!!!”

How would YOU like a doctor like that?

Meet the happiest doctor in Texas: Jennifer Zomnir, M.D.

HappiestDoctor

Want an appointment?

For a good time call 972-218-0020

Are you a patient dreaming of an ideal doctor?  Join the ideal medical care movementAre you a doctor dreaming of your ideal clinic? Contact Dr. Wible for a free consultation on how you can have this much fun at work!

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Pamela Wible, M.D., pioneered the first ideal medical clinic designed entirely by patients. Stop suffering and follow the health care model that works for patients and docs.

Posted in Ideal Medical Care, Patient Relationships Tagged with: , , , , , , , ,
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The Pap Party—The Definition of Patient-Centered Care →

There’s a gazillion scholarly articles on patient-centered care. You can even attend conferences on how to deliver patient-centered care. Or you can stop all the academic masturbation and just do it.

The Pap Party is a perfect example of patient-centered care. 

The History of the Pap Party

My patient Sandra, an uninsured woman in her fifties, calls for a physical. As I’m scheduling her, she asks if she can bring her friend Teresa who’s uninsured and needs a physical too. I reply, “Sure! Bring all your friends.” We decide to turn her appointment into a party.

One week later, bursts of laughter echo down the hall as Sandra and Teresa enter my office and sit together on the sofa. I pass around a tray of chocolate-covered strawberries as we review their medical histories. I perform both their physicals and Pap smears and an hour later we’re still cracking up. They leave with door prizes and balloons tied to their Pap specimens which they drop off at the lab. 

I celebrate the joy of Pap parties in chapter 26 of my book, Pet Goats & Pap Smears, and after reading my book a physician friend invites me to her house for a Pap party! WOW!! Since I’m late on my Pap smear, I definitely take her up on it.

In case you’ve never been to a Pap party, here’s how ya do it:

1. Cross over the railroad tracks and footbridge into the Pap Palace.

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2. Make sure you’re in the right house. Look for evidence of the Pap party.

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3. Pass out party favors, Pap smear books, and answer Pap questions.

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4. Perform Pap smears while feeding each other truffles & sipping on wine!

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5. Wish you were there? Listen to what the ladies had to say:

What do you think?

Is this patient-centered health care or what?

** P.S. My Pap smear is NORMAL!  Yay!!! **

Pamela Wible, M.D., is a pioneer in the ideal medical care movement. She helps communities design patient-centered ideal clinics. Click here to > join the movement for ideal medical care.

Posted in Ideal Medical Care, Pet Goats & Pap Smears Tagged with: , , , ,
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Ideal Clinics: The Health Care Model That Works! →

Ideal Clinic Model

There’s a lot of complaining in health care. Here’s just a sampling of quotes from letters I’ve received this week:

Physicians:

“I’ve become so disillusioned with medicine. I don’t know who to talk to anymore or what to do with my life. I’ve lost my joy and my soul is sad.”

“I’m a specialist who is bored and sick of angry patients. What can I do?”

“If it weren’t for my faith, I would have been one of your [suicide] statistics.”

“I’m so frustrated, I want to walk away, but where does one go? It’s the same everywhere. EHR’s and conveyer-belt medicine. I feel trapped and betrayed. I want to scream when I come to work everyday. This is a nightmare.”

Health Care Professionals:

“We see patients when we ourselves need treatment. We need someone to normalize the emotion of burnout and give hope to those of us feeling vicariously traumatized by the work we perform day in and day out.”

“I am a CRNA. I lost 2 colleagues last year to suicide. I am continuously amazed that in our ‘helping’ fields people are looked down upon for needing help.”

“Idealistic me, graduated at the top of my class, but have found that working in health care seems to be one of the most corrupted and conflicting professions to be in.”

Patients:

“I really would like to find a doctor who doesn’t judge me and think I am crazy.”

“I would be happy to find a doctor who for once actually listens to me and my story.”

“I just got home from another insulting, degrading appointment and I can’t take one more visit. I am literally crying as I write to you.”

Here’s the 53-second solution:

Want to open an ideal clinic?

Contact Dr. Wible for your FREE consultation!

 

Pamela Wible, M.D., pioneered the first clinic designed entirely by patients and was just voted the 2015 Women Leader in Medicine. Inspired? Click to > join the movement for ideal medical care.

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