The *Surprise* Birthday Party Physical :)

I love my patients. And I love surprises. Most patients fear unexpected medical events, but medical surprises don’t always have to be bad news.

I’m a neighborhood family doc. My patients are friends. They celebrate my milestones and I celebrate theirs. A few like to surprise me for my birthday. So when Rachel scheduled her physical a few days before her birthday, I didn’t miss the opportunity.

I called her friends and family (most are patients) and told them to arrive with gifts by 3:30 and hide in the exam room.  At 4:00 pm Rachel sat unsuspecting in the waiting room. I brought her back for the usual pre-physical interval history and girlfriend chat (yes, I DO need to know everyone she’s been dating in the last year!). Before she revealed all her romantic escapades, I guided her back to the exam room where everyone jumped up from behind the exam table, screamed, blew bubbles and party horns, and basically scared the crap out of her!

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And if you still don’t believe it’s possible for a doctor to throw a surprise birthday during a physical exam -> WATCH THIS!

So did she allow all of us in on her physical? Nope. She cut her appointment short and asked us to take her out for drinks.

Just another day in the life of a family doctor. :)

Pamela Wible, M.D., is a family physician in Oregon. She pioneered the first medical clinic designed by patients. Watch her TEDx talk “How to get naked with your doctor.” Photos and video by GeVe.

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Doctors not allowed to ask patients, “How are you?”

Medical Insanity

Another indication that health care is sick—doctors are being told to stop asking patients open-ended questions like:

“How are you feeling?”

“What worries you?”

“What’s on your mind?”

Today a physician just e-mailed me:

“I am really, really overwhelmed right now.  What happened to me at work this week was grim, even before our dreaded production meeting.  I can feel tears welling up. Reason:  Many times I have tried to incorporate friendly pick-me-ups like a smile, a handshake, a ‘thank you for coming in to see me today,’ an ‘it was wonderful to see you today’ at the end of patient visits. My standard opening line has always been some version of ‘What brings you in today?’ I’ve always felt a source of pride that I can ask open-ended questions and still get to the bottom of most issues in a short visit. My production meeting yesterday pretty much squashed all those niceties out the door.

We are now to be double-booked [two patients per appointment slot] to ‘make our production quotas.’ Our regional director (not a doctor) reinforced the decision by our medical director (an MD under the thumb of the regional director) that we are NOT to ask open-ended questions in our visits but to let the medical assistants who room the patients identify the SINGLE issue that they are coming in for and THAT’S IT.  So we basically need to shut down to whisk them through the door.

You know as well as I do how ridiculous and futile that is and how fast care like this destroys what’s left of the therapeutic relationship. I now have to figure out a way to work even faster while still being caring and compassionate.  I am in a really shitty position.”

My plea to doctors: please stop taking this shit.

Pamela Wible, M.D., is a family physician and founder of the ideal medical care movement. Watch her TEDx talk on ideal care. If you’re a doctor, join the physician teleseminar and learn how you can stop suffering and start practicing real medicine. Photo by GeVe.

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Top 10 ways to know it’s time to quit your job

QUIT

Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you try to be joyful. Then you’re reprimanded by the clinic manager for being “excessively happy.”

8. You dream of leaving medicine to work as a waitress.

7. You envy your sickest patients and/or you develop a perverse pleasure in your patients’ pain.

6. You pray you will be diagnosed with cancer so you can get some time to sleep.

5. You spend your nights trying to keep patients alive while you imagine ways to die by suicide.

4. You work 16-24-hour shifts and have not had sex with your spouse in months.

3. You’re a top-rated doctor, yet you daydream about walking into traffic, jumping through the window, or just dying in the course of a normal day.

2. You are counting down the days until retirement during patient appointments.

1. You change your computer password to “fuck [name of hospital where you work]!!!”

Pamela Wible, M.D., is a family physician and founder of the ideal medical care movement. Watch her TEDx talk on ideal care. If you’re a doctor, join the physician teleseminar and learn how you can stop suffering and start practicing real medicine. Photo by GeVe.

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Drop doctorspeak & get real with patients

If you’re a doctor, I bet you speak doctorly. You act doctorly. And dress doctorly. And spend your days in clinic with other doctorly doctors.

But life is what happens while you’re busy staring at computerized flow sheets, algorithms, and billing codes.

Real life happens outside of man-made medical institutions. Patients live in the real world. And I always wanted be a real doctor—a doctor who specializes in being real with real people meeting them where they really live and work and play.

So last week, I left my office to treat people on the streets. Over 6000 patients. For free.

Beside a row of port-o-potties, I volunteered my services to those in need. Some required medical care. Others just psychological support. All received a smile. Many left laughing.

I live in Eugene, Oregon—The birthplace of running. TrackTown USA. America’s premier summer marathon runs right in front of my house.

Unfortunately being too healthy can be hazardous to your health. There are medical ailments unique to long-distance runners. Chiefly: chafing. Thighs, armpits, and yes, nipples. After miles of shirt friction, even the toughest nipples get torn up. Bras protect women. But look at these bloody nipples on men.

The proper medical term: marathoners thelorrhagia. But medical jargon often creates fear and confusion, so I use normal words anyone can understand. Plus I made a sign:

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How should guys protect their nips?  Some use duct tape or bandaids. Others go topless. A few wear sports bras. Here’s another solution:

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I got out on the streets at 5:00 am.  Even brought my boyfriend’s daughter—an avid athletic supporter:

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And recruited a man on the sidelines to cheer with me:

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I know what you’re thinking: “Did anyone really take her up on this?”

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Well, one guy yelled, “Too early. It’s only mile 3.”

“I got bandaids,” another dude announced as he pounded his chest.

A husband said, “No thanks,” until his wife interjected, “Yes, we’ll take some!” I squirted a glop on her palm; she applied the goo to his nips as he ran away from me.

When I posted these pics on Facebook, a friend replied, “You’ve out-weirded me, Pamela.”

“Hey, I didn’t make this nipple thing up just to be rubbing runners’ nipples.”

Doctor means teacher. The best teachers make learning fun. Mission accomplished.

Watch how one doctor can prevent 12,000 bloody nipples from 17 countries in one hour:

Pamela Wible, M.D., is a family physician in Oregon. She pioneered the first medical clinic designed by patients. Watch her TEDx talk “How to get naked with your doctor.” Photos and video by GeVe.

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Wow! Man discovers simple way to prevent suicide

While I struggle to prevent physician suicide. I discover a man who didn’t seem to struggle at all. With no training in suicide prevention, no training in mental heath, and no medical background, one man saved hundreds of souls from suicide.

Meet Don Ritchie.

He lived beside a popular suicide spot. A life insurance salesman by day, Don sold life to the suffering by night. For 50 years, he coaxed 100s from the cliff’s edge.

How?

He gently asked: “Can I help you in some way?” With a warm smile, he’d offer a cup of hot tea. And invite them over for a chat. Before he died, Don urged others: “Never be afraid to speak to those in most need.”

I have a huge collection of teas. If anyone wants to hang out, call me: 541-345-2437.

A cup of hot tea = the solution to suicide.

Thanks to this man:

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Watch video of Don Ritchie. Watch another video of Don Ritchie. Photo credit by Salute to Don Ritchie.

Pamela Wible, M.D., is a family physician obsessed with preventing despair, depression, and suicide among medical students and physicians. She’s so inspired by Don Ritchie!

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How one TED talk is changing the world of medicine

I’ve never been a small-talk doc. My therapist calls me “the Dr. Kevorkian of medical taboos.” I’m most comfortable discussing the uncomfortable—topics that scare most physicians. In my TED talk, I bust through three taboos: human sexuality, physician-patient intimacy, and doctor suicides.

Taboo #1: Sexuality. Americans are oversexualized and sexually repressed. And that’s not healthy. Because I’m at ease with my sexuality, patients are free to express theirs. I care for polyamorous couples, sex workers—even married virgins. Why would patients disclose such intimate details they’ve never shared with other doctors? I’m nonjudgmental and accepting, so patients allow me to see who they really are. That’s healthy. And fun. Yes, I even offer Pap parties (find out why in my TED talk):

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Taboo #2: Intimacy. So why aren’t more doctors and patients having fun? Frankly, they’re scared. Intimacy means in-to-me-see. When doctors fear patients, patients fear doctors. Fear begets fear. So let’s face it: our fear-driven disease management billing system is ill equipped to deliver health or care. Maybe that’s why our doctors feel so, well . . . unwell.

Taboo #3: Suicide. Doctors are beyond frightened. Many docs (and med students) are burned out, depressed—even suicidal. The fact is: nearly one million Americans will lose their doctors to suicide in 2014. When would be a good time to discuss the hundreds of doctors and medical students who die each year by suicide? With more than 100,000 views, my TED talk would suggest the time is now.

In many cultures, those who travel into forbidden territory are ostracized. But sometimes, the public demands—even craves—the truth. My TED talk is more than a truth-telling sermon. When I was invited to deliver a TED talk, I was instructed to change the world in less than 18 minutes with one, new, big idea. So I introduced the world to America’s ideal medical care movement—a grassroots revolution in which citizens are opening ideal clinics where patients and doctors can be comfortable, connected, and happy. The public excitement is palpable. And the media is abuzz.

The Washington Post asked to publish my physician suicide blog in their print newspaper and online with my TED talk embedded. When doctors commit suicide, it’s often hushed up was the third most read national news story that day. Due to high readership, The Washington Post asked me to write another article. Huffington Post invited me to contribute Why I Kiss My Patients. The Daily Beast showcased the ideal medical care movement and my TED talk. A Reader’s Digest article is coming in November. And Time Magazine just interviewed me for a feature.

The reaction in medical circles is equally inspiring. After reposting my blog, Physician Suicide Letters , the editor responded: “We have never had comments of that magnitude and it is utterly eye-opening for me.” I am now the #1 top-trending author on KevinMD and my talk is listed the #1 TED talk that all medical students should watch.

Can a big idea get any bigger? Yes.

The producer of America Tonight discovered my TED talk and sent a crew from DC to film me for two days. An excellent 11-minute program on ideal medical care as the solution to the physician suicide crisis aired on prime time national TV with portions of my TED talk replayed! Though not accessible online, here’s a much abbreviated print version of that story.

I thought my idea was just for Americans until I was featured in the UK and then named New Zealand’s Compassion Hero. I’ve been contacted by citizens from Nigeria to Singapore, Kenya to Iceland. Suicidal physicians, medical students and their family members from all over the world have reached out for help after viewing my talk. Doctors have thanked me saving their lives. Patients have thanked me for helping them develop healing relationships with their doctors.

TED - Larry quote

I’m a small-town doc with a big idea. People think I have a PR team. I do not. My TED talk has spread one inspired person at a time. In less than six months since my talk was uploaded, it has gone global. And this proves to me that one TED talk can change the world of medicine.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Photos by Wind Home and GeVe.

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