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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Assisted Physician Suicide: Are Doctors Killing Doctors?

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Standing on the edge of his hotel balcony, a doctor describes the rolling hills. He tells me, “It’s a beautiful place to die.” Ten minutes later, he agrees not to injure himself—for now.

I’m not running a physician suicide hotline. But doctors keep calling me.

It’s midnight and I’m speaking to a psychiatry intern. Bullied by residents and her attending, she cries, “I’ve lost my self-confidence. I’m depressed. On psych meds now. But I don’t feel better.”

Then a fourth-year medical student shares a similar story. “I was normal before med school. Now I’m so afraid. I can’t go on,” she sobs.

I counsel each woman for nearly an hour: “You are not defective, the system is defective. We enter medicine with our mental health on par with or better than our peers. Depression and suicide are occupational hazards of our profession.” Thankfully neither are actively suicidal. Both women just needed to talk—to cry—and to hear the truth.

The truth is doctors are suffering. Surrounded by sickness and death, we watch families wail, shriek, cry while we stand silently—sacred witness to their sorrow—until we’re called to the next room for a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. And when do we grieve? Never.

Doctors are not allowed to grieve.

Today a physician tells me she’s been cited for unprofessional conduct. Why?  She was seen crying. Her boss told her, “Unless you are dying, crying is unprofessional behavior and not to be tolerated.”

Then a retired doc tears up as she tells me about a miscarriage she witnessed 30 years ago. She thanks me. Why? She hasn’t been able to cry in 5 years.

Doctors are not allowed to cry.

So what do we do with our sadness? We injure ourselves—and each other.

When I speak to victims of physician bullying, I explain, “Your instructors are suffering from unprocessed grief—probably victims of bullying themselves. Medicine is an apprenticeship profession. Trained by wounded doctors, they’re now wounding you. Your bright eyes, your enthusiasm, your idealism remind them of their loss. Rather than feel their own grief, they lash out at you.”

Individual psychiatric therapy can’t solve institutional trauma. Collective wounds demand collective healing. Doctors are not defective. Our profession is.

And hiding our pain ain’t working. Recently the janitor at a medical conference asked, “What’s with all the grim faces and sad eyes?” To the average person, medical conventions look like funerals. Maybe that’s because doctors are dying by suicide at twice the rate of their patients.

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 3 physicians in my town to suicide. Gunshot wounds mostly. One local doc lost 7 colleagues to suicide—so far.

Too often physicians turn to alcohol, drugs, firearms. But why don’t doctors seek professional help? Some do.

Some doctors drive hundreds of miles out of town for therapy. They pay cash for visits with no paper trail. They use fake names. Physicians who seek mental health care know they may face board investigation and license restriction—and those with licensing issues have even higher rates of suicide.

If we want real health care, we must first do no harm to our healers. Imagine if we allowed doctors to grieve.

I once attended an African grief ritual. Villagers wail around a fire for 3 days in a highly emotive ceremony. Attendance is mandatory. Why? Those who don’t grieve become the village troublemakers next year.

Physician bullies are medicine’s troublemakers. And they need our help—and compassion. Not threats. Not license restrictions. Not public shaming. They need psychological support. And so do the rest of us.

Anna, a retired surgeon, still carries the wounds from her medical school professor:

I was happy, secure, and mostly unafraid until the age of thirty. Until med school. I do not know what happened precisely, but I do recall in vivid detail that on the first (orientation) day of med school the MD who was our anatomy professor, and therefore largely controlled our lives for the next many months, stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers and said these words: ‘If you decide to commit suicide, do it right so you do not become just a burden to society.’ He then described in anatomical detail how to commit suicide.

Anna’s experience is not unique. Physicians-in-training are given explicit instructions from their instructors in proper techniques for overdosing on lethal medications too.

Anna concludes:

Through the many years of training and through what would appear to the observer a successful career in a surgical subspecialty and now into retirement, I have carried the anxiety, and the depression, and the fear. . . . I still remember how to successfully commit suicide because someone who had power over me at a vulnerable time described the details. And we wonder why . . .

Pamela Wible, M.D., was once a suicidal physician. An expert in medical student and physician suicide prevention, She hosts physician retreats to help her colleagues heal from grief and reclaim their careers.

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Are you receiving health care or abuse?

Abuse ScheduleA physician in Texas posts this photo on Facebook. Caption: “My schedule one morning in January 2014. Never again . . .”

Yay! Another physician breaks free from assembly-line medicine.

High-overhead, high-volume offices sacrifice the sacred physicians-patient relationship and perpetuate a disease-billing management system. This is NOT health care. It’s abuse.

Patients: avoid clinics with 10-minute slots. Go for docs who offer 30-60 minute appointments. Physicians: stop following the same old practice management advice. Follow you Facebook friends. They offer the best support and business tips:

This is so sad!!!!

I can’t believe people practice like this! Every 10 minutes??? We’re doctors, not robots!

And this is what people have to spend their hard earned money on insurance for. Pretty sad, but mostly sad for the exhausted doctor who can’t possible be making a difference in someone’s life with 10 minutes.

Throw in a cumbersome EMR and that’s a recipe for surefire burnout by 10 am!

I was a medical assistant back in the day for a physician who kept a schedule like this. This is an impossible schedule to maintain and just sets up a system where the individuals involved with providing care constantly feel like they are failing. Very demoralizing. Very depressing. Definitely not a practical approach for the patient or the physician (and his/her minions). I used to get chastised for taking “too long” to collect a patient history (even five minutes was considered “too long”) and the physician told me I had to “stop talking to the patients so much.” I told the physician that there was no way to get an accurate history without talking to the patients for more than five minutes… the physician told me I would “eventually grow out of my need to talk to people.” Ha. Wrong.

This makes me want to cry.

This has been normal for the state NHS GPs here in the UK for over a decade! Only now are they burning out as the state wants them to do surveys, audits, med reviews, etc as well as consult with the pt in the same 10 mins!

Obscene.

This is crazy, not only does this burnout the physician but how on earth can any true healing happen with type of schedule, no time to even talk to them no wonder the country’s health sucks and we spend so much money because there is no healing in the business of medicine.

Welcome to my world. Friday, like too many days, I did not get to pee or have a sip of water…eating almost never happens and a “lunch” doesn’t exist… I felt like I was in solitary confinement. Thank God I still love what I do and love my patients—these are the only two things that keep me going.

That’s nuts!

Yes, and the amount of documentation required to be reimbursed adequately for that 10-15 min visit takes about 25 mins each patient unless you can stomach being a fraud (which I cannot) so then you’re perpetually behind on that, so…the cycle is very dissatisfying and makes a lot of us wish we had chosen another career option, but then we realize that our medical school debt is so deep that there is no other option for us, so we carry on…  :(

When did this great country become a country of wimps and sickly people?

Dear physicians, NPs & PAs: PLEASE rebel when the bean counters try to do this to you.

We write our own stories through the choices we make.

You have the power to say NO!

Pamela Wible, M.D., is the founder of the ideal medical care movement. She teaches physician retreats where she helps physicians reclaim their lives and their careers—so patients can finally get the care they deserve.

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The #1 thing patients want from doctors

Ever wonder what patients really want from doctors?

Is it the fancy buildings with marble fountains?

Is it the board certifications and diplomas on the wall?

Is it the expert medical jargon and starched white coats?

Nope. None of the above.

Listen up, docs: Patients just want the real you. Ya know—YOU. The competent and caring you who really listens with compassion. The real you that talks like a real person and answers people with the honest truth in words they understand. The you that treats patients like family.

Does it matter if you’ve got glitter on your eyelids? Or if you come in after hours in sweatpants? Or if your kid tags along with you to work? Actually patients think those things are kinda cool.

So how do I know what patients want? I ask them. And what they want more than anything else is a doctor who is courageous enough to be real.

Doctors don’t seem to know this.

I’ve attended lots of medical meetings and sat around conference tables with physicians trying to figure out how to gain market share, how to get great patient satisfaction scores, how to bring in more revenue.

At one such meeting I sat with 12 physicians and a frazzled secretary frantically taking notes. The docs decided that we should all take a special test so we could become “experts” in diabetes and put our diabetes certificates on the wall to impress patients. As I raised my hand, all eyes turned to me and I shared, “Patients don’t really care how many certificates you have on your walls. What people want is 5 more minutes of your time. They really just want you.”

The room went silent. Blank stares. The secretary even put down her pen. Then the conversation picked up right where they left off in pursuit of their special diabetes certificates.

Meanwhile I had recently opened a clinic designed entirely by patients. I was making more money. And working less. Plus I was in such high demand that I had a waiting list—a really, really long waiting list.

My waiting list quickly exceeded the number of patients in my care. Folks even tried to bribe me to get to the top of my list. I told one gal it would probably take 5 years before I could see her. She said, “No problem. I’m not moving. I want YOU to be my doctor. Put me on the list!”

I have no diplomas on my walls.

No special certificates.

No white coat.

Just jeans,

glitter

and

a

smile.

The magic formula is YOU.

pAM_star_WEB_CROP

Pamela Wible, M.D., is a family physician and pioneer of the ideal medical care movement. Attend her physician retreat and learn how you can have an ideal clinic too. Medical students are welcomed.

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7 steps to get what you need from your doctor—fast!

7 steps to get what you need from your doctor

Sick of phone trees, endless refill requests, packed waiting rooms, out-of-control bills, and other medical misadventures?  Follow these 7 simple steps to get your doctor to do what you want.

1. Get Organized. Be clear about what you need from your appointment. Make a comprehensive list of all the issues you want to discuss—and your ideal outcomes for each. Patients who are proactive and organized can cover twice as much in an appointment compared with patients who are passive and unprepared.

2. Prioritize. Organize your list. Assign numbers to each problem in order of significance to you. Now scrutinize your list for conditions that may be life threatening. Move those to the top. This is the order of significance for your doctor. Highlight the top 3 and handle remaining items as time permits.

3. Start early. The best time to see a doctor is early in the day. Twenty percent more polyps are found on colonoscopies before 11:00 am. Why? Physician fatigue. Need your physician’s full attention?  Mondays and Fridays are the busiest days so schedule your appointments on midweek mornings before 11:00 am.

4. Be human. You need a physician, not an automaton. But many docs feel more like factory workers practicing assembly-line medicine. Jolt your doctor out of the robotic technician role by making a human connection in the first 30-60 seconds of your visit. Start with a joke, a poem. Bring a smiley-face balloon or homemade chocolate chip cookies. Humans bond over food and fun. Try it.

5. Be direct. Now that you’ve got rapport, share the top 3 items on your list—and your desired outcomes—in as few words as possible. If you prefer not to take drugs, state that immediately so your doctor doesn’t go on a detour discussing medications. If you want a referral to a physical therapist, say so upfront. Just want reassurance, ask for it. You’re more likely to get your needs met quickly by stating your intentions directly.

6. Plan ahead. To avoid multiple visits, consider your medical needs over the next 6 – 12 months. Ask for refills at your visit rather than calling later. Are you likely to have a flare-up of a chronic condition in the next year? A bad back? A panic attack? Prevent midnight trips to the ER by getting emergency medications now.

7. Say thank you. End appointments with this sentence: “Thank you. I really appreciate ____________.”  (Fill in the blank). If you can’t say anything nice, find another doctor.

And if your doctor looks terribly distressed, hand your doc my phone number: 541.345.2437. I help physicians off the assembly line so they can enjoy seeing patients again. You just might save your doctor’s life!

Pamela Wible, M.D., is a family physician and pioneer of the ideal medical care movement. Join the movement to deliver ideal care to all Americans!

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7 Secrets to Loyal Patients for Life

LoyalPatiets

Loyal patients are the lifeblood of a medical clinic. And devoted patients are worth their weight in gold. It’s a lot easier to care for an established patient that lots of one-timers who never return. Beyond ease of workflow, the economic benefits are fabulous. A loyal patient panel will stay with you (and pay you) through sickness and in health even if you don’t take their insurance—even if you choose to go cash only. Loyalty is earned. So what should you do? Follow me:

1. Solve problems. Physicians must solve their patients’ chief complaints. Don’t get distracted by one-size-fits-all algorithms and computer prompts. Treat the patient, not the computer, not the insurance company.

2. Return calls. If a patient calls, call them back ASAP. Return emails, labs, and test results the same day. Sooner is better. Patients get anxious when left waiting.

3. Start on time. Respect your patients’ time by staying on schedule. If you run late, apologize. Better yet, offer a $5 gift card for a cup of coffee. When I run late, my patients choose handmade soap from a giant wicker basket. What will you do?

4. Stay put. If you want patients to stop doctor shopping, then doctors should stop job hopping. Jumping from one clinic to another isn’t a winning strategy for a loyal following. Find or create an ideal clinic and stay there.

5. Have fun. Nobody wants to see a doctor who is stressed and depressed. Smile. Laugh. Tell a joke. Lighten up. Host a patient appreciation day every once in a while and hand out balloons and chocolates—just because!

6. Research & refer. If you can’t solve a problem, research and refer to someone who can. Reach beyond allopathic medicine when needed. Refer to acupuncturists, massage therapists, and other health professionals. Replace, “We have nothing left to offer you” with “I’d like you to see my colleague who has had some incredible success treating your condition.” Never abandon your patients to Dr. Google.

7. Do house calls. You’ll basically stand out as the town hero when you treat a patient in their home. Try it weekly—even monthly. I bet you’ll love it!

Patients are routinely held hostage on phone trees and in packed waiting rooms, in paper gowns and cold stirrups. Believe me. It doesn’t take much to wow your patients. In fact, now I even get tips! Yesterday, I  got an $80 tip on a $95 bill. Follow my strategies and you’ll get tips too! And you won’t even have to put out a tip jar :)

Pamela Wible, M.D., is a physician entrepreneur and pioneer of the ideal medical care movement. She teaches physicians cutting-edge business strategies at her biannual physician teleseminars & retreats. Join us anytime! Medical students are welcomed.

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