Doctor’s death an ‘inconvenience’ for patients

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An investigation is underway after a Chicago-area doctor is found dead—a suicide according to the medical examiner. What demands investigation is the callousness with which the this doctor’s death was reported by the media—and received by neighbors, many healthcare professionals themselves.

I’m alerted to the death initially by a Facebook friend: “Pamela, check this out!” Headline: Police: Doctor found dead near hospital in Berwyn. (Interesting side note: on 4/21 ABC news changed this headline to “Man found dead near hospital in Berwyn.”)

The facts:

On Thursday, April 16, a maintenance worker calls the police to request a well-being check on a tenant, Dr. Jon Azkue, a 54-year-old physician employed at MacNeal Hospital.

Police discover his decomposed body with suicide note surrounded by helium tanks. Mistaken as propane tanks, police call the bomb squad and evacuate the 4-story building which primarily houses healthcare professionals and medical businesses. How do his neighbors and colleagues respond?

“I was actually going to get some baby food,” says Jemin George. “My daughter is in one of the vehicles and it’s been almost three hours since she’s had something to eat.”

“It’s an inconvenience for the patients,” claims Riz Ahmed, an employee at Chicagoland Retinal Consultants, a clinic located in the building.

Anna Futya, clinic manager at the retinal clinic, is also frustrated by the inconvenience. “All the calls that are coming here—whether from patients or doctors—nobody is able to answer . . . ”

Wait, I thought this news story was about Dr. Jon Azkue. The headline clearly states: “Doctor found dead near hospital in Berwyn.” So why is the focus on inconvenience to patients? How did the dead doctor get scrubbed from the story?

Who is Dr. Jon Azkue? 

My online research reveals that Jon Azkue is a foreign medical graduate from Central University of Venezuela who was a senior internal medicine resident at MacNeal Hospital at the time of his death. He was just a few months away from graduating.

In this news report, Dr. Azkue is treated as if he is guilty of a crime. There is no expression of sadness for the loss of this doctor—presumably a man who spent his entire career caring for patients in at least two countries. In the comment section—amid jokes about terrorist plots and remarks about the selfishness of suicide—Doc T writes:

Wow. I’m appalled by the lack of sensitivity for the loss of life here. I myself am in residency and unless you live through it, you cannot begin to imagine the stress and sacrifices that we and our families endure—far greater than missed eye appointments. My condolences to his family and colleagues. The journalist and editor should be ashamed of the slant through which they allowed this ‘news’ to be delivered.

Facebook comments continue throughout the afternoon where Cailean Dakota MacColl, a premedical student, is equally appalled. “Hi Patient X, your doctor is selfish and committed suicide so they cannot do your eye exam today.”

Heather Springfield, another premedical student, chimes in:

I had the same line of thoughts. What a sad situation that a fellow human being who dedicated their life serving/helping others, is considered an inconvenience. It’s pretty damn ridiculous that society cries for its physicians to have an open doctor-patient relationship—to not be robots—but the moment a doctor shows their shared humanity, either they’re sued/abused/or commit suicide because they can’t take it anymore… etc. etc. What the hell is wrong with people? I wish, as a populous, we’d stop acting as if we live on separate planets when in fact, we share one planet. How hard is it to take a moment, and realize we lost a precious life to something preventable? It’s a damn shame, and my heart mourns such a loss…. This shouldn’t have happened. Shame on those residents, clinicians, and those who don’t take pause for what this is.

Physician suicide: more questions than answers

With his suicide confirmed, the real investigation must begin. Why did he die by suicide?

And why do we lose more than 400 U.S. physicians each year to suicide? Why are these suicides not investigated?

Like most suicided doctors, Dr. Jon Azkue left a note. Why are we not analyzing these suicide notes for common themes to prevent future physician deaths?

Sadly, we are unlikely to hear any more about Dr. Jon Azkue. We will not hear about the many patients he cared for, the lives that he saved. This is his 5 minutes of fame.

Pamela Pappas, MD, a psychiatrist writes:

Rest in Peace, Dr. Azkue. Being a resident at age 54 is not easy, and I’m wondering about his life and what led to this kind of end. No mention of family being notified before releasing this news to public, etc. Our culture (both medical and non-medical) apparently regards doctors as dispensable. Yes, of course patients are ‘inconvenienced’ when a doctor dies! Houston, we have a PROBLEM here, and we need serious remediation.

Why is this news story so unsympathetic to this deceased doctor?

And why are clinics, hospitals, and medical schools so willing to sweep these deaths away—often with no debriefing for survivors. Why are physicians not receiving routine on-the-job mental health support for such a high-risk profession?

Georgia Jones, a Facebook friend, shares:

This is so sad. They [doctors] deserve to have therapy without being judged or the worry of losing their job. Schools need to start preparing students for what is to come, and have help in place if they become emotionally overwhelmed. It’s so sad that this is still happening. Doctors are human beings, like us. Start treating them as such. They’re not machines! They have emotions, and believe it or not, the death of their patients DOES affect them!! Give them a break! R.I.P. Dr. Azkue. I’m sorry it came to this.

Here’s the truth: until we investigate why this doctor died by suicide, we will continue to lose more doctors. Maybe if we took a sincere interest in Dr. Azkue’s death, we could prevent the next one.

Incidentally, Kim Aaronson, a chiropractor in Chicago, adds:

Here’s another note of interest, a local chef here in Chicago committed suicide on Tuesday of this week. It has remained in the news every day. (even covered in this NYT article) The doctor’s suicide has not even been mentioned. There is clearly uneven coverage going on here…. The FB comments show the kind of empathy the press should have shown…. You are so right on, a doctor dies and it seems that no one cares at all….

Pamela Wible, M.D., is a pioneer in the ideal medical care movement. When not treating patients, she dedicates her time to medical student and physician suicide prevention. Dr. Wible is the recipient of the 2015 Women Leader in Medicine Award.
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It’s March 30th. Have you hugged your doctor?

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I’m in a room full of doctors at a my mom’s 50th medical school reunion when I announce, “It’s almost March 30th!” I Pause. “Doesn’t anyone know what March 30th is?” Nobody has a clue.

March 30th is National Doctors’ Day! Who knew? I never heard of it—until a friend told me last week.

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Veterans know about Veterans Day. Mothers know about Mother’s Day. Lovers know about Valentine’s Day. Why don’t doctors know about Doctors’ Day? Maybe because nobody celebrates it.

But a quick search leads me to a site that proclaims “National Doctors’ Day Gift Ideas for 2015 Are Here!” According to this official gift-giving site of The National Doctors’ Day Organization:

National Doctors’ Day is held every year on March 30th in the United States. It is a day to celebrate the contribution of physicians who serve our country by caring for its citizens. The first Doctors’ Day observance was March 30, 1933 in Winder, Georgia. Eudora Brown Almond, wife of Dr. Charles B. Almond, decided to set aside a day to honor physicians. This first observance included mailing of greeting cards and placing of flowers on graves of deceased doctors. On March 30, 1958, a resolution commemorating Doctors’ Day was adopted by the United States House of Representatives. In 1990, legislation was introduced in the House and Senate to establish a National Doctors’ Day. Following overwhelming approval by the United States Senate and the House of Representatives, on October 30, 1990, President George Bush signed S.J. RES. #366 (which became Public Law 101-473) designating March 30th as National Doctors’ Day.

Each year we lose over 400 doctors to suicide—the equivalent of an entire medical school. Doctors struggle. Doctors suffer. Doctors grieve. But doctors usually keep their feelings inside.

My recent essay on the viral photo of the ER doctor grieving the loss of his patient opened a physician floodgate of feelings. Many physicians came forward to share their stories of grief. Diane Lyn writes:

The truth is—You don’t have TIME to grieve. Because there are people inside waiting to be seen. I clearly remember in residency having to sit with my attending and tell 3 adult children that both of their healthy parents were dead. Car accident. Fifteen minutes later I was making faces at a 2-year-old so I could look in his infected ears [and I was] thinking these parents have NO idea what I’ve just been through.

Patients have no idea what doctors have been through because doctors don’t usually tell anyone what they’ve been through. When we tell our stories, we allow others to empathize with us. Amy, a psychiatrist, shares her sorrow—and a solution:

I am a physician and my husband is an ER doctor. He rarely talks about work. It is too hard for him emotionally, particularly when children die as we have two young sons of our own. The last time I went to visit him at the ER, a young child had passed away from drowning. I can’t imagine how the doctor working with that family was able to move on with her day and see other patients after such a tragedy. She was crying in the hallway when I walked into the emergency department. All I knew to do was give her a big hug. I am a psychiatrist and it is not rare for me to be brought to tears by stories I hear from my patients. It is an emotionally taxing job, one that does not allow for having a bad day of my own. I take my phone with me everywhere, answering calls, text messages, and emails on vacations and weekends. It eats away at the time I have with my own children but I do it because I care and because of the pure joy that I feel when someone returns with a good report or does something positive they never imagined that they would accomplish. I have an envelope in my office that contains thank-you notes and letters from previous clients. I encourage anyone who has had a good experience with their doctor to be proactive in sharing their gratitude. I can’t even begin to express how meaningful those moments of joy and positivity are in a career that can be so intensely heartbreaking.

How do patients react when physicians reveal their feelings? The oupouring of public support for the ER doctor crying in the viral photo speaks volumes. On my Facebook page, Carla Sallee responds, “This really touched me. I want to hug every healthcare worker I know right now. I don’t know that I ever, ever empathized with my healthcare professionals as much as I now feel I should.”

On March 30—our national day of thanksgiving for doctors—you can officially celebrate your doctor. But how? Drop off a box of chocolates? Bring a bouquet of flowers? It’s really the simple things that matter most. Here’s what my friend Butch does for his docs:

I have sent quite a few thank-you cards to doctors over the years. I quit because I thought they may be taken wrong or just too much and adding to their junk mail. Thank you for letting me know it is OK to do, Will be sending more now that I know they do help. Helping them to feel appreciated was the whole purpose anyway. Thank you for everything you do.

A few words of appreciation can help your doctor survive amid sometimes unbearable suffering. More than once, my colleagues have shared that a kind gesture by a patient made life worth living again. So give your doctor a card, a flower, a hug. The life you save may save you.

Thank you!

~ Pamela

P. S. While you’re at it, thank your nurse, dentist, and veterinarian too! Looks like they have national holidays that nobody seems to celebrate either.

Pamela Wible, M.D., is a family physician and pioneer in the ideal medical care movement. She is active in medical student and physician suicide prevention and leads biannual retreats to help her colleagues heal from grief and trauma.

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Heart-wrenching photo of doctor crying goes viral. Here’s why.

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Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”

Thousands of people have commented on the web. In their own words, here is why the photo went viral:

1) Humans crave raw empathy. The photographer captures a poignant moment in a stoic profession that trains doctors to remain professionally distant. The voyeuristic photo reveals the emotional reality of doctoring—and a side of physicians that people don’t usually see—while uniting us all in our common humanity.

2) Unexpected death is universally heartbreaking. An ER doc, Smeee, writes:

When it comes to our work, nothing is harder—and I mean nothing—than telling a loved one that their family member is dead. Give me a bloody airway to intubate. Give me the heroin addict who needed IV access yesterday, but no one can get an IV. Give me the child with anaphylaxis. But don’t give me the unexpected death. . . . We can only do so much, and we can only hope to do our best. But it’s that moment, when you stop resuscitation, and you look around, you look down at your shoes to make sure there’s no blood on them before talking with family, you put your coat back on and you take a deep breath, because you know that you have to tell a family that literally the worst thing imaginable has happened. And it’s in that moment that I feel. And I feel like the guy in this picture.

3) Doctors are not allowed to grieve. A surgeon, TheGreatGator, shares, “We are never formally trained to deal with loss and/or with giving the worst news of a families life to them.” Another doctor, boldwhite, writes:

I know what that person is feeling. Yesterday one of my 17-month-old patients died. I was in the bathroom crying in private between patients several times yesterday. I’ve cried in stairwells and hallways. It eats at you. Life is very fragile and the pain of losing those we are trying to help becomes a scar that doesn’t go away. It has shaped who I am as a person.

4) In medicine, crying is unprofessional. That needs to change—now. A premedical student volunteering in the local ER tells me about a female physician who cried after losing a child. He thought her behavior was unprofessional. I asked him to consider, “Who did she harm by crying?” Meanwhile, a physician tells me she’s been cited for unprofessional conduct for crying at work. Her boss told her, “Unless you are dying, crying is unprofessional behavior and not to be tolerated.” Some physicians and young doctors-in-training are uncomfortable with tears. Grieving is a healthy reaction to sadness. Humans bond through shared pain. Please do not punish your colleagues for their willingness to be vulnerable with grief-stricken families. Real doctors cry.

5) Patients want doctors who cry. Patients are comforted when doctors grieve with them. Vicki Allemand Scott, a mother on Facebook, concurs, “When my daughter passed away the doctors and nurses formed a wall in front of us until she was gone. ALL of these wonderful people were crying just as much as we were. I will never forget the kindness and compassion we were shown by these special people.”

6) Real men cry. Men are socialized not to cry. This photo honors a man for having the courage to cry. A son, livinbandit, shares:

My dad is an ER doctor, and has been for as long as I’ve been alive, always working nights. He doesn’t usually talk about patients, but he would talk about the gross things he’s had to deal with around the dinner table with the family. The times that I do remember though, however rare they were, were the times he would come home, and cry in my mother’s arms because there was someone that he couldn’t save no matter how hard he tried . . . He didn’t think any of us kids were watching, but I seemed to always see. I’ve never had more respect for my dad then when I would see him cry because he felt like he could have done more . . . Even if he couldn’t have.

7) More than anything—doctors need your empathy. What happens when the physician in the photo pulls himself together and gets back to work? One commenter on Reddit, PM_YOUR_PANTY_DRAWER, suggests the sad reality:

The part most people fail to realize, is that this man now has to compose himself, walk into another person’s room, and introduce himself with a smile and handshake to the next person. Sometimes healthcare workers walk in to see someone new and before even introducing themselves, out comes; ‘We’ve been sitting here for 45 minutes and . . .’ or ‘That guy next door has been moaning forever and nobody is helping him.’ You literally had to direct yourself 100% at someone grappling with death, and the rest of the show goes on around you.

There’s times where you run, and rush, and hurry, and skip eating, and go 12 hours without urinating, and you’d give your firstborn for a cup of water, and through it all, you lose, you get complained to, and you get zero sympathy from your coworkers or management. I’ve been covered in phlegm, urine, feces, blood, infectious drainage, sweat, and tears. I’ve had to go from ensuring a person continues to breathe, to a room full of angry people because grandma wanted a Tylenol and the call light has been on for 10 minutes, and we’re going to another hospital, and we want another doctor, and this place is getting a call to the administration, and I’m going to call a lawyer, and I’m calling channel 6 news, and we know so-and-so and he’s going to hear about this.

Healthcare is a life of fighting, defending yourself, sacrificing yourself, working weekends, missing holidays, and sometimes things like losing a patient makes you want to throw up your hands and say ‘fuck it, I’m out.’ But you can’t. You do it because you love it. You do this thankless and unappreciated job because you want to. I can’t believe I’m in 6-figure debt and gave up the nights and weekends of my 20s so I could voluntarily do it. But I couldn’t see myself doing anything else.

One doctor, jimbomac, has a simple request: “Let me tell you those ‘thank-you’ cards probably mean more to us than you think . . . we do hugely appreciate when people like yourselves take the time to say thanks.”

8) Doctors who don’t grieve get sick.  Unprocessed grief is dangerous for human health. My Facebook friend, Joe Jacobs, writes:

I had a friend who was consuming heavy amounts of cocaine in the 80s trying to deal with a doctor’s life. He was a Cedars doctor making big bucks and living a prestigious life so I asked him why and he responded with. Paraphrase: I’m an oncologist who thought I would be able to help using the latest cure methods. I find myself head of the ward of incurables and it is my job to ease their pain and watch them die and then watch the response of family members to the outcomes.

9) If you don’t cry, you die. In my recent article, Physician Bullying: ‘Not Allowed to Cry’ I discuss unprocessed grief as a root cause of physician bullying, abuse, depression—even suicide. Both men I dated in med school died by suicide. Brilliant physicians. One overdosed at a medical conference. The other overdosed after work. In just over a year, we lost three physicians in my town to suicide. Gunshot wounds, mostly. One local doc lost seven colleagues to suicide—so far. Our profession punishes doctors for grieving and restricts the medical licenses of those seeking mental health care. So rather than process our grief, many docs turn to alcohol, drugs, firearms.

10) The physician in this photo is a modern day hero.

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Pamela Wible, M.D., is a family physician and pioneer in the ideal medical care movement. She hosts physician retreats to help her colleagues heal from grief and reclaim their lives and careers.

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My testimony in support of medical student mental health to the Missouri State Legislature for House Bill 867

I’m Dr. Pamela Wible, a family physician in Oregon. I’ve submitted my CV, witness form, and transcript of my testimony to Chairman Frederick. My schedule prevents me from traveling to Missouri for today’s hearing; however, I thank Vice Chairman Morris and the Committee for allowing me to testify remotely in support of House Bill 867, legislation that would require Missouri medical schools to screen students for depression and offer mental health referrals for those at risk.

Medical Student Stress *

Medical students face enormous stress. Their workload and debt load are immense. They witness incredible human suffering with no emotional support or debriefing. Routinely sleep deprived, they’re groomed in a medical culture that rewards self-neglect and often condones bullying.

Medical students are afraid to seek help for fear of retaliation or discrimination. Medical students are afraid to seek counseling because medical boards like the one in Missouri ask applicants if they’ve ever been treated for mental health issues. Checking the “yes” box can lead to a subpoena of one’s “confidential” medical records.

Medical students enter medical school with their mental health on par with or better than their peers. Up to 30% develop depression and 10% become suicidal during each year of medical school. Both men I dated in medical school died by suicide. Depression and suicide are known occupational hazards in medicine.

More than 400 U.S. doctors die by suicide annually. Widespread underreporting and miscoding of death certificates suggest the number is closer to 800. That’s like losing all 391 medical students enrolled at the University of Missouri Columbia School of Medicine plus the 433 students at the University of Missouri Kansas City School of Medicine— every year.

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Please join me in support of House Bill 867

House Bill 867 benefits medical students. This bill will de-stigmatize mental illness and normalize medical students’ rights to request and receive confidential mental health care. Student participation is voluntary and student data remains anonymous unless students select otherwise.

HB 867 benefits families by making mental health data transparent across all 6 Missouri medical schools. In medicine, informed consent is the standard of care, yet medical students and their families have not been informed of the health risks of a medical education.

Last fall, I attended a funeral. Kaitlyn Elkins was a star third-year medical student described by her family as “one of the happiest people on this Earth.” She died by suicide, but the funeral wasn’t for Kaitlyn. It was for Rhonda Elkins, Kaitlyn’s mother. Unable to recuperate from her daughter’s suicide, Rhonda took her own life. I asked Rhonda’s husband, “If Kaitlyn worked at Walmart, would she and your wife still be alive?” He said, “Yes. Medical school has cost me half my family.”

HB 867 also benefits patients. The best way to care for patients is to first care for our doctors-in- training. Let’s practice what we teach. By truly caring for our medical students we demonstrate how we expect them to care for patients. The cost of not caring for our young doctors-in-training is more tragedy. Each year nearly 1 million Americans lose their doctors to suicide.

Finally, I support House Bill 867 because it benefits medical schools. We teach medical students the value of evidence-based medicine, but if our medical schools are exempt from collecting evidence on medical student depression, how can we evaluate student mental health? How will we know the impact of medical school wellness programs? The psychological well being of Missouri medical students is just as important as their academic performance. This bill finally gives us the data we need to properly care for and educate the future physicians of America.

On behalf of all medical students nationwide, I thank you for your support.

 Click here to read House Bill 867

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

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Pamela Wible, M.D. named 2015 Women Leader in Medicine (acceptance speech)

On February, 26, 2015, Pamela Wible, M.D., was named the 2015 Women Leader in Medicine by the American Medical Student Association in Washington D.C. Dr. Wible was nominated by American premedical and medical students as one of the most inspiring women educators in medicine today. Her acceptance speech is filmed and fully transcribed below.

INTRODUCTION: Pamela Wible, M.D., is a family physician born into a family of physicians. In 2004, fed up with left assembly-line medicine, Dr. Wible held town hall meetings where she invited citizens to design their very own ideal clinic. Open since 2005, Wible’s innovative model has sparked a populist movement that has inspired Americans to create ideal clinics and hospitals nationwide.

Pamela Wible’s model is now taught in medical schools and undergraduate medical humanities courses and is featured in the Harvard School of Public Health’s newest edition of Renegotiating Health Care: Resolving Conflict to Build Collaboration, a textbook examining major trends with the potential to change the dynamics of health care. Dr. Wible is also the author of Amazon’s top-rated Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind—a book that I had the pleasure of reading and being inspired by a year ago.

When not treating patients in her community clinic, Dr. Wible devotes her time to medical student and physician suicide prevention. Dr. Wible’s work in this area was a huge component of why I nominated her for this award. I truly believe that the conversation that Dr. Wible is beginning about suicide prevention is turning the light toward medical students to reexamine their own wellness as well as the wellness that we provide our peers.

A graduate of Wellesley College, University of Texas Medical Branch at Galveston, and the University of Arizona Department of Family & Community Medicine, Dr. Wible is now called to help students and  physicians deliver ideal care to their communities. It is such an honor to introduce Dr. Pamela Wible, an inspiring leader and educator of the next generation of physicians as the 2015 Women Leaders in Medicine Award winner.

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Well, I like to start with my favorite quote. A zen poet once said, “A person who is a master in the art of living makes little distinction between their work and their play, their labor and their leisure, their mind and their body, their education and their recreation,  their love and their religion. They hardly know which is which and simply pursue their vision of excellence and grace, whatever they do, leaving others to decide whether they are working or playing. To them, they are always doing both.”

Medicine is an apprenticeship profession. We learn to be doctors—by studying doctors. And patients learn by studying us. The word doctor means teacher. But what are we teaching? If doctors are victims, patients (and medical students) learn to be victims. If doctors are discouraged, patients (and medical students) learn to be discouraged.  If we want happy, healthy patients, we must fill our clinics & hospitals with happy, healthy doctors. 

But when I look around, I really don’t see many happy doctors. So my mentors are—medical students. I love your youthful joy and exuberance and I’m inspired by your endless curiosity and conviction and compassion. I want to grow up to be just like YOU.

I want to be like Becky, she’s a medical student in Oklahoma. She has a dream of providing care to the poorest of the poor of Oklahoma City. And I want to be like Julia, a med student I met in New Jersey. She wants to open her clinic on an organic farm. And I want to be like Sasha, a premedical student from Pennsylvania who wants to “cry with and love on” her patients. I am inspired to be the best version of myself when I think of these people and when I think of medical students and the joy and love that they have and the desire that they have to serve people when they enter medical school. And so I want to keep that joy alive for the rest of your medical career. And I want to bring that joy back to my colleagues who have lost this.

I’m a family physician in Oregon and I love my patients. I hug them and kiss them, and I do housecalls. And they all have my home phone number. I’m on call 24/7. That would seem like a hardship, but it’s not. I never really feel like I’m working. I think that’s because I’m self-employed—which is how most doctors worked until very recently. For centuries physicians have been self-employed.

One reason why I like being self-employed is that I haven’t had to set an alarm clock in 10 years for work. Because I work afternoons and evenings 3 half-days per week and it’s AWESOME! I highly recommend it. And I like being self-employed because I’ve never turned anyone away for lack of money. Because I’m the boss and I can do that. And I like the boss. Being self-employed I have a lot of fun. I can break the rules that don’t make sense because I’m self-employed. And here are 3 rules that don’t make sense and I would encourage you all not to follow these 3 “rules” in our profession:

1)  I refuse to practice professional distance. Because what patients really want is professional closeness.

2)  I refuse to practice cookbook medicine. Because patients aren’t chocolate chip cookies. I’m not a cookie cutter doctor—and neither are you.

3)  I refuse to practice assembly-line medicine. Because I didn’t go to medical school for all these years to be a turned into a factory worker—and neither did you. Patients aren’t looking for a factory worker or a zombie robot. They are looking for a real human being so I would encourage you to stay real during your training. You’re going to be a lot happier that way.

The other thing about breaking away from assembly-line medicine as was discussed during my introduction is that I was able to create a new model with the help of my community. I basically had a town hall meeting where I told everyone that my job sucked and that I was suicidal and that if they didn’t come up with a better way [for me to practice medicine] I was just going to be a waitress or something. I just could not see continuing practicing medicine in this insane corporate assembly-line 7-minute-visit practice style so I collected 100 pages of written testimony. I pretty much told them I would do whatever they wanted as long as it was basically legal. So if you could just tell me what’s your dream. Write my job description for me if you wouldn’t mind because it’s not really working for administrators to write my job description. I’d rather work for the people themselves. And I got 100 pages of testimony and was able to adopt 90% of what patients needed in my town and we were open one month later! It’s not rocket science. You don’t really need to wait for the government to do this for you.

Buckminster Fuller has a quote I really like. “You never change things by fighting the existing reality. To change something, build a new model [ideal medical care] that makes the existing model [assembly-line medicine] obsolete.” I hope you’ll join the movement for ideal medical care and that YOU will be the change you want to see in medicine.

“A dysfunctional medical system can only exist on the backs of a disempowered physician population—the precursor of which is an abused medical student population.”   

So I hope during medical school you will break the rules when need be and that you won’t be too well-behaved. And that you will stand up against intimidation, bullying, and abuse because it doesn’t get better. You might as well stand up at the beginning.

We need to take our profession back. And if you need any help feel free to Facebook me, be my friend, email me, call me anytime. My home phone number is 541-345-2437. Put it on speed dial in case you are bullied or abused. I am accessible. In case you want to know sooner than later what to do, come to my talk on Saturday. I’m giving a talk on some strategies that you can use to confront unethical behavior in medical school with grace and success.

“The truth is: it’s impossible to be a victim and a healer at the same time. So I hope you’ll choose being a healer rather than a victim.”                                

And I thought I’d read this most beautiful chapter that came out of a series of interviews with doctors called The Raw Truth. This is the reason why I became a doctor and I think it is why many of us became doctors.

I often wonder: Why am I a doctor?

I want to live in the real world, a world without pretense, a world where people can’t hide behind money or status. Illness uncovers our authenticity. Doctoring satiates my need to be witnessed and to witness the raw, uncensored human experience. I crave intensity.

Like an emotional bungee jumper, I live to inhale the last words of a dying man, to hear the first cry of a newborn baby, to feel the slippery soft skin in my hands, to cut the cord and watch a drop of blood fall on my shoe, to wipe a new mother’s tears, to introduce a father to his son, to hold a daughter’s hand as she kisses her father good-bye one last time.

I am a doctor because I refuse to be numb. I want to live on the precipice of the underworld, the afterworld, to look into patients’ eyes, to free-fall into an abyss of love, despair, death and then wake up tomorrow and do it all again.

Maybe doctoring fills a hole, a void. I doctor for connection, to be needed—to be loved.

Chapter 90, The Raw Truth, Pet Goats & Pap Smears. 

And in summary, at its core, doctoring is intimacy and intimacy means “in-to-me-see.” It’s when we see so deeply into another, that we find our own reflections and discover ourselves. So I’d like to ask you to be a healer and not a factory worker.  And I’d like to ask you to take your eyes off your computer and look into your patients. Because it’s there [in your patients’ eyes] that you will find the truth and discover yourself and your path in medicine. Thank you.

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Dr. Wible’s Q & A went on for 2 hours after her acceptance speech. Here are some of the medical students and physicians who hung out with her until nearly midnight:

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Need a speaker at your next event? Contact Dr. Pamela Wible to speak at your grand rounds, medical conferences, and medical school commencement ceremonies.

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A physician quits assembly-line medicine. Here’s what happens next . . .

A few months ago a physician friend Facebooks me:

I only have 7 days of clinic left. Just finished two weekends back to back so it will be something like 20 days in a row that I worked before I get a chance to breathe. One weekend was “punishment” for my subpar production due to attending your retreat. Just have call on Christmas and I’ll be done. I’m already getting calls for the new clinic, so things are looking up!

She writes back today:

Man, there is so much I wanna tell you! So much has happened! First it seemed like nothing was happening and then everything happened at once. We opened our doors last Friday and have seen 22 patients so far. We are trying to start slow, but our phone is blowing up!

I thought I would maybe be seeing one patient a day, but it’s been 4 to 6 AND I AM NOT EVEN TRYING! We haven’t even told people we are open! I haven’t even said anything on Facebook. It is fucking surreal! And get this—we had a 100% show rate, everyone arrived early, and they all paid without me asking for money. We paid our monthly overhead within the first few days.

So first day of clinic last Friday, we decided to do a “soft open.” We basically only scheduled 2 patients—both who have seen me for over 2 years and wouldn’t mind any hiccups. The visits are amazing. I don’t feel like I’m a doctor at all. It feels like hanging out with friends. It’s comfortable—like coming home and being able to just be yourself, but I am helping people and it feels—like me—like the me that I knew before I got lost in the insanity of assembly-line medicine. It feels like destiny—like I am doing exactly what I am supposed to be doing at this very minute—what I was born to do! Everything goes smoothly, and both my husband and I are beaming.

I had told him that morning I hadn’t felt so hot, but I chocked it up to excitement and nerves. I’m trying to finish my charts up when it hits me. First diarrhea. Then vomiting. Ugh.

So here I am trying to knock out this last chart while puking into the trash can and making furious diarrhea runs to the bathroom (no pun intended). And I start laughing—laughing so hard I am crying and can’t breathe. He thought I’d lost my mind. To answer his quizzical look, I said between gasps:

“I just realized that working in our own clinic—even though I am simultaneously puking and trying not to shit my pants—trumps the best day I ever had in assembly-line medicine.”

And that’s no lie!

Pamela:

YAY!!!!! TOLD YOU SOOOOO!!!!!!!! I’d love to talk to ya this weekend after you are done puking and PLEASE send me your website so I can promote you (not sure you even need more patients). Are you doing cash only or insurance or a mix? Let’s talk soon.

She explains:

Doing all cash. I seriously can’t believe that people pay cash to see me! It kinda blows my mind. Puking is over. So yeah, let me know when is good for you!

Website—not up yet and I’m kind of glad for now. Will wait until I feel like we can handle more people—it was a little overwhelming when we were getting all these calls and unable to see people. I will let you know when we get one though!

Pamela:

You TOTALLY have the market cornered because you are the ONLY ideal psychiatrist in the state I would bet!!!!! SO PROUD OF YOU!! SEEE!!! I TOLD YOU SOO!!!!!!!!!

PamVDClinic

She replies:

Annnnnnd, you’ll love my fortune cookie from tonight!

FC

Pamela Wible, M.D., pioneered the first ideal clinic designed entirely by patients. Now she hosts physician retreats to help her colleagues off the assembly line and into their ideal clinics. 

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