Pamela Wible MD http://www.idealmedicalcare.org/blog America's leading voice for ideal medical care Sat, 01 Oct 2016 17:58:13 +0000 en-US hourly 1 http://www.idealmedicalcare.org/blog/wp-content/uploads/2015/09/cropped-favicon.512x512-32x32.png Pamela Wible MD http://www.idealmedicalcare.org/blog 32 32 Hospital saves doctor’s life, then bullies her and threatens termination for disability http://www.idealmedicalcare.org/blog/hospital-saves-doctors-life-then-bullies-her-and-threatens-termination-for-disability/ http://www.idealmedicalcare.org/blog/hospital-saves-doctors-life-then-bullies-her-and-threatens-termination-for-disability/#comments Sat, 17 Sep 2016 17:32:03 +0000 http://www.idealmedicalcare.org/blog/?p=3557 ]]> erinkalan750

Dear Dr. Wible,

I am writing to you with great sadness, but with relentless determination to ignite change. I am a doctor with a disability. Two years ago I began residency training in pediatrics. The privilege was overwhelming as I stood a doctor in the very halls where I had been wheeled in as a patient with a brain tumor. I couldn’t believe that I had actually made it, that I was alive, and that I would be given the great gift of caring for others. I fulfilled my dream and my promise to my neurosurgeons—that one day I would walk through the doors of this hospital as a doctor. 

But my dream has slowly been taken away from me. I fought to complete my pediatric training, but my program fought harder to discriminate, retaliate, and punish me for my differences. Early on I began experiencing significant difficulty with sleep deprivation. I was threatened with termination for requesting formal ADA accommodations and told I would be fired if I proved unable to endure 80-90 hour work weeks, 28 hours of continuous work without sleep, and up to 14 days without a break. My body was resilient as I had survived 2 brain tumors and 3 brain surgeries, but was left with permanent (yet mild) physical challenges. My residency program was well aware of my needs but chose to label me as weak. I was humiliated and criticized as unfit to practice medicine. I tried to tough it out and power through the grueling schedule I was forced to work. I would be fired if I didn’t. 

I recall arriving home one day after a 28-hour shift and being unable to walk up the stairs to my house. My body was shutting down, my morale was nearly gone, and I needed someone to understand. My oncologist became increasingly alarmed that I was being bullied for my disability, yet it was one of the graduate medical education administrators who took my situation into her own hands as she went over the heads of my program. After being denied formal ADA accommodations for 2 years, I was finally granted a work-hour adjustment. 

Then all of the sudden I experienced an abrupt shift in my evaluations. Suddenly, my performance was well below average with a knowledge base of “sand, not stone.” I was warned that I was too polite, too nice, and that I needed to become more arrogant if I was going to make it as a doctor. My program director explained to me that she “didn’t care how residents conducted themselves as long as they didn’t kill anyone.” I was told to “turn off my moral compass” and that “you do not have to be a good person to be a good doctor.” My program was searching for any way to push me out through completely absurd claims regarding my performance. All of these complaints began when I started working a “humane” 60-hour work week. The constant shaming and harassment was unbearable. No longer willing or able to tolerate discrimination, I resigned at the beginning of my third year. 

Residency programs are not interested in training physicians to be humanists. They are interested in creating machines. I am not a machine. I am a human being who wants nothing more than to devote my life to this University as my doctors at this hospital are the reason I am alive. I want to be the kind of doctor that could tell a child in pain that I understand because I have felt this pain. Being a patient has made me a better doctor. I want to be a walking example of the amazing work of my pediatrician, neurosurgeons, and oncologists. My program has taken all of this from me. The irony of my story is palpable: I pursued pediatrics—to care for those who are vulnerable and suffering—and my program has not been able to care for their own doctors.

It is indescribably crushing that the same system that gave me my physical life back has now taken away my life’s purpose. My superiors have belittled me for the very deficits that inspired me to become a doctor—my compassion, love, and dedication to my patients. In trying with all that I have to give back to the institution that has saved my life and to devote myself to making the lives of children better, my dream has been destroyed, my time as a patient has been devalued, and my heart has been broken.

Sincerely,

Erin S. Kalan, DO

Erin agreed to have her letter published. She joins the long list of doctors who are daily subjected to the same bullying and discrimination tactics by US hospitals that put profit over people and fail to comply with ADA laws. Recent cases include Stephanie Waggel who was fired by her hospital for having cancer and Svetlana Kleyman who was not allowed to complete her surgical training after a spinal infection.

Outraged? Please share this article. Add your story as a comment below. Silence will not save us.

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An ingrown toenail is not a lung transplant (how primary care is being held hostage to tertiary care) http://www.idealmedicalcare.org/blog/an-ingrown-toenail-is-not-a-lung-transplant-how-primary-care-is-being-held-hostage-to-tertiary-care/ http://www.idealmedicalcare.org/blog/an-ingrown-toenail-is-not-a-lung-transplant-how-primary-care-is-being-held-hostage-to-tertiary-care/#comments Mon, 12 Sep 2016 10:27:59 +0000 http://www.idealmedicalcare.org/blog/?p=3531 ]]> an-ingrown-toenail-is-not-a-lung-transplant

Here’s a quick review of health care delivery basics:

Primary care – Stuff you can get handled with your primary care doctor in your neighborhood. Example: ingrown toenail.

Secondary care – Stuff your primary care doctor refers to a secondary specialist down the road. Example: colonoscopy.

Tertiary care – Complex stuff you need to deal with at a big-city hospital. Example: lung transplant.

Simple. Right?

Here’s the problem: In modern medicine we’re holding primary care hostage to a tertiary care delivery model. 

If you’re getting a lung transplant you need a 5-story hospital with helipad, medical team, insurance coding/billing software (you actually need insurance to cover the $500,000+ bill) and all sorts of special machines and complicated equipment. If you’re getting a colonoscopy, you need one person to shove a tube up your butt in a simple office with a few staff. If you’ve got an ingrown toenail you need one primary care doc in one tiny exam room with a pair of scissors. 

When we force ingrown toenails and buttholes to subsidize 5-story hospitals, helipads, medical teams, and insurance systems, we create incredible inefficiency and expense. In fact, all that crap is not only unnecessary, it just gets in the way and makes your $100 toenail or $1000 colonoscopy cost hundreds and thousands more! 

When we force primary care to pay for the infrastructure of tertiary care medicine, we end up with  assembly-line medicine in which patients are forced through 7-minute visits. Both high volume and price gouging are required to pay for the unnecessary helipads and hospitals for your ingrown toenail.

I’m a family doctor and I’ve been delivering primary care to my community for decades. I’ve removed ingrown toenails and metastatic lung cancer. I’ve cared for psychiatric patients and complex neurologic conditions. In fact, I can deliver care for 99% of what ails my patients right in the comfort of my 280-square-foot office. Just two chairs. One exam table. And no staff.

All I really need is my brain. And my brain tells me we must stop allowing buttholes to design primary care delivery in America.

Contact me for a free guide on how to launch your ideal clinic

___

Pamela Wible, M.D., is founder of the Ideal Medical Care Movement and author of Physician Suicide Letters—Answered.  Jorge Muniz, PA-C, is an internal medicine physician assistant, illustrator, and author of Medcomic: The Most Entertaining Way to Study Medicine. Image credit: Medcomic.com.

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Want to hang out with diabetic truckers with erectile dysfunction? Or hippie women with chronic yeast infections? Who’s your ideal patient? http://www.idealmedicalcare.org/blog/want-to-hang-out-with-diabetic-truckers-with-erectile-dysfunction-or-hippie-women-with-chronic-yeast-infections-whos-your-ideal-patient/ http://www.idealmedicalcare.org/blog/want-to-hang-out-with-diabetic-truckers-with-erectile-dysfunction-or-hippie-women-with-chronic-yeast-infections-whos-your-ideal-patient/#respond Sat, 10 Sep 2016 06:58:26 +0000 http://www.idealmedicalcare.org/blog/?p=3516 ]]> shutterstock_trucker

Attention doctors: If you’re not attracting your ideal patients, don’t blame them. They probably have no idea how to find you. That’s your job.

So who do you really want to see? What patient population makes you excited to jump out of bed every morning? Seriously. Who the heck do you want to spend 40+ hours per week hanging around? 

Are you interested in seeing parents of kids with ADHD in Washington who are curious about vegetarian diets but feel confused in the grocery store surrounded by tofu? What about hippie women with chronic yeast imbalances intrigued by homeopathy in Oregon? Attracted to diabetic divorced long-haul truckers with erectile dysfunction passing through Interstate 81 in Virgina?

Anyone getting excited yet? Then keep thinking . . .

Do you love obese republican women in Missouri with fibromyalgia? Or would you rather spend your days with runaway teens in Memphis? Or retired gluten-free wealthy women in Dallas? It’s your choice. Remember there IS someone for everyone. 

So who’s YOUR ideal patient? If you don’t know, they won’t know either.

Here are three doctors who have figured it out. And three patients who—against all odds—have found their ideal doctors. These are doctor-patient matches made in heaven! And all these folks couldn’t be happier.

Parents of kids with ADHD in Yakima, Washington, who want to try vegetarian diets love Dr. Yami Lancaster, a pediatrician who does house calls where she even dives into the family pantry, refrigerator, and freezer to remove hidden culprits that sabotage health. She accompanies overwhelmed parents food shopping, guides them to healthy foods and may even cut the family grocery bill in half! Then she’ll lead a private cooking lesson at their home that will keep the kids busy in the kitchen so parents can finally relax. 

Hippie women with chronic yeast imbalances who want to try homeopathy in Happy Valley, Oregon, adore Dr. Kat Lopez, who believes in the body’s innate ability to heal. No more phone trees, cafeteria-style waiting rooms and five-minute quickie visits with doctors who look sicker than patients. Dr. Lopez spends a full hour with clients who leave with a comprehensive plan to restore health using nutrition and lifestyle so they can wean off drugs. Naturopathic doctors, an acupuncturist, and massage therapists are on site as well as a holistic dental hygienist, and a hyperbaric oxygen chamber. 

Diabetic divorced long-haul truck drivers with erectile dysfunction passing through Raphine, Virgina, now have their prayers answered with Dr. Rob Marsh. The big truck stop off Interstate 81 offers diesel, a hot shower, a good dinner, and now a doctor. This small-town family doc needed more patients to keep his solo practice afloat. With a underserved patient population of 20,000 long-haul truckers who are never home long enough to have their own family doc, Dr. Marsh took the job! He treats everyone who walks in and even does U.S. Department of Transportation physicals. He gets paid mostly in cash (win-win!) and now the truck stop owner plans to open an pharmacy.

So who’s your ideal patient? Don’t wait. Need help? Contact Dr. Wible.

Grab your free guide to launching an ideal clinic full of ideal patients

Pamela Wible, M.D., is a family physician who pioneered the first ideal clinic designed entirely by patients. She loves helping others find joy in medicine and live happily ever after in their ideal clinics too. (Photo credit: Shutterstock). For a free teleclass on how to attract your ideal patient, please contact Dr.Wible.

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