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.

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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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When your health insurer pays for breakfast, here’s what happens . . .

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Health insurance is complex. Eating out is easy—unless you were to involve your health insurance company.

If you hired a third party to pay your restaurant bill, you’d pay twice as much, wait 2 weeks for a table, and have 7 minutes to eat.

I shared my restaurant analogy on a LinkedIn discussion with health care executives, and got this response: “I’d like to ask the Doc if she pays cash for dining out or does she use a third party like MasterCard or Visa to pay the bill?”

I may use plastic, but a credit card is not an insurance plan that requires prior authorization for my burrito, checking a formulary to see if I can get a side of noodles, and—worst case scenario: a policy may have an exclusion for desserts in excess of 200 calories.

Don’t like the restaurant analogy? Here’s what happens when you use health insurance to cover your automobile.

Need an oil change? Jiffy Lube has a 10-day backlog until their administrative office can fax State Farm for approval. Flat tire? Soonest appointment at your in-network tire facility is next month. Out of fuel? You can’t stop at Shell or Exxon because Chevron is your preferred provider.

If this seems ludicrous, it is.

Insurance is for catastrophes, not daily care and maintenance. Car totaled? Call Geico. Fractured femur? Call Aetna. Or maybe Kaiser has the best deal. In the meantime, want to save 40% on routine care? Stop using health insurance for your hangnail.

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Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. Photos by Dr. Wible.

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Doctor’s Fantasy: leave psychiatry to sell Tupperware

Tupperware

Dear Pamela:

I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is exhausted and miserable and that the needs of our administration come first. And anyone who tries to say anything about it gets called lazy.

I hope the new generation of physicians will demand better treatment, but even this week I could sense how much young doctors just crave compassionate mentorship. They’re so grateful to be told simple things like: “It’s okay. I’ve been there too. I’ve stumbled in my career path ten thousand times. I know what it’s like to be lonely here, to feel like an imposter who can’t do things right. You don’t have to make up answers to insolvable problems. Patients just want you to be a human being, living and breathing with them, and respecting their voices.”

Medicine attracts perfectionists, and our training sharpens that quality into a dagger. The worst part—we become so diminished in our own self-worth that we no longer appreciate or even offer the healing that is the true legacy of doctoring.

I’m finishing my final year of psychiatry residency (thank god) and I’m just so tired. I used to think that things would improve after residency, but now I realize there’s no guarantee.

In my profession there’s an immense pressure to maintain “boundaries,” and they scoff at anything which is close to poorly defined. Many psychiatrists seem obsessed with proving that our field is “real” medicine, so they break patients into algorithms and charts, refer them to highly structured, easily quantifiable courses of psychotherapy that don’t allow deviation from “the treatment plan.” They measure illnesses with checkboxes and screeners rather than actually listening to any individual’s story.

But I doubt any medical specialty can actually heal patients this way, even for the most easily definable problems! How does a fool-proof algorithm for blood pressure control help if patients cannot get their prescriptions, or hate taking medicine, or can’t remember to take it, or quit due to side effects that they’re afraid to disclose, or any of the other millions of reasons that get in the way of good patient outcomes?! And those are things that you can never discuss in a ten-minute appointment.

Anyway, I’m glad that there are so many physicians who feel this same way, and even some who are brave enough to talk about it openly!!! How did we get so brainwashed that we actually believed that advocating for ourselves and for our patients meant we were lazy or inadequate? It’s so crazy. Nobody needed to oppress me by the time I graduated med school: I was the taskmaster and the criticizer.

When I talk about changing things, people says it’s not possible and we’re all doomed to misery and blah blah . . . Sometimes I say, “Well if that’s the case then I just won’t do it. I’ll pay off my loans and then go find something else.” My colleagues always look so shocked—as if they don’t have the same secret thoughts!!!

I’m about to have my last “performance review” with my abusive boss. My friends outside of medicine don’t believe me when I share the abuse I’ve experienced during my training. Lots of doctors try to pretend it’s normal, but it’s not. I go back and forth between trying to stand up for myself and thinking I should just put my head down and not cause myself any more problems. Most of the time I spend fantasizing about doing any other job—selling Tupperware, painting, working at a library—something normal, where nobody swears at me or treats me like I’m lazy after a 16-hour day. But really what I’d like to do is treat people with respect and provide therapy and run groups and teach mindfulness meditation. I just don’t know how to get from here to there.

I would write more but I have to fill out about 600 pointless electronic evaluations of my colleagues, in order for us to better wound each other anonymously. Yay!

Xoxoxo

Janelle

This letter was received and edited for clarity by Pamela Wible, M.D., a family physician and pioneer in the ideal medical care movement. Dr. Wible helps medical students and physicians recover from abuse and trains doctors to open ideal medical clinics at her biannual physician retreats. Photo by GeVe.

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I love old people, but I will not accept Medicare

Medicare

I love caring for patients—young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare in 2006. Why don’t I accept Medicare? Let me fill you in.

I do not accept Medicare because:

Medicare treats physicians as criminals—guilty until proven innocent.

Medicare warns patients on their billing statements to turn their physicians in for suspected fraud.

Medicare demonstrates no transparency in the flow of taxpayer money through their program.

Medicare may reimburse physicians so little that we lose money with each appointment forcing doctors to go bankrupt (or run Medicare mills with ramped up volume and quickie visits to make ends meet).

Medicare claims are more complex than any other insurer with more billing codes and rules and regulations that require hiring a team of staff to remain compliant or else . . .

Medicare regulatory codes by which physicians must abide is 130,000 pages long! (US Tax code is only 75,000).

Medicare requires compliance with more unfunded mandates and administrative trivia than any other insurer.

Medicare penalizes physicians financially if we don’t use a Medicare-approved computer system and electronic health record.

Medicare penalizes physicians financially if we don’t electronically submit prescriptions the way Medicare demands.

Medicare threatens doctors every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Medicare audits may suddenly destroy a medical practice and a physician’s life as described by Dr. Karen Smith:

Medicare abuses and bullies doctors.

This is no way to treat people who have dedicated their lives to helping others.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. Photo by GeVe.

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