Doctor’s infertility cured by quitting assembly-line medicine, opening her dream clinic →

Today I checked up on a physician friend who just launched her solo family medicine clinic a few weeks ago. She writes:

It’s a slow start but it’s picking up. As more and more people get to know me it’s growing . . . like planting a garden for the first time . . . or growing a human.

Funniest thing is what happened with my fertility! So we had been unofficially “trying” for close to nine months with no success. I quit my assembly-line job and we moved to a new town at the same time. Not even a month later—I was pregnant! Just goes to show how much stress can impact fertility . . . and you know people were saying “Oh you shouldn’t leave, it will be too hard for you in a new place” or “moving is stressful” or “maybe you should just try harder.”

Well what’s the true price of NOT doing something about your situation? What’s the cost of staying in a the wrong place (personally and professionally) that isn’t serving you? Breaking inertia is so key. Even though on the outside it looks like we are paupers and we did take a loan to help us get through the move and start the practice, we are both wealthier in spirit, in knowledge (steep learning curve) and in opportunity. We just decided to go for it!!!! And you know even if the worst case scenario happens and it all crashes in a heap, we will still be happy because we followed our dreams and our passions and saw them come true—and no one can take that away from us—ever! 

There is no way you can fail now baby!

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Pamela Wible, M.D., has helped hundreds of physicians reclaim their happiness and their careers. She offers biannual retreats for medical students & physicians. Dr. Wible has been named the 2015 Women Leader in Medicine for her work on medical student and physician suicide prevention. Photo credit: Baby Weese :)

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Discouraged? Depressed? Suicidal? Watch this. →

“I know there’s a lot of you out there that are feeling disillusioned. You’re wondering why did I spend all those years in medical school and training, why am I hundreds of thousands of dollars in debt. I hate this. I hate this profession. I don’t feel like this is me. It’s because you’re in the wrong place. I have several friends (you know who you are) out there. You know that you are very unhappy. You are just racing to get to retirement as fast as you can so you can get out of medicine. What I say to you is dig down deep into your heart and reclaim that dream you had from when you were a little kid and all you wanted to do was help people and serve people, serve your community, and be part of the community in a respected way where you felt free. You can do it!” ~ Yami Lancaster, D.O.

“If you’re someone who has been wounded in such a deep way, I want to tell you the most important thing that I learned when I was in that exact position: you are not alone. There are people, many of us out there who are looking for you. We’re not waiting for you. We are looking for you. And if you just give us a slightest nod in our direction, we will come find you and we will help you heal.” ~ Gregory Mims, M.D.

“To those out there who are still in pain, there are options. The system is a lie. It’s fed you a false dichotomy that essentially you can be miserable, but successful or you can be destitute and happy. It’s not true. It’s not true. We are divided. We’re kept powerless, but there are those out there who want to help, help reform the system, help you heal to find something that is truly meaningful for you. It’s out there. There are options. You are not alone. And remember that the modern medical system’s unofficial motto right now is: the beatings will continue until morale improves.” ~ Bradley Michel, MS3

“It’s just that it is an abusive system, and you can quit and take time off. Find who you are. You can live your dream. And that’s all you need. Screw the system. It’s not meant to get people better. It’s meant to maintain chronic disease states and make a lot of money. So there ya go . . .” ~ Cammy Benton, M.D.

“What I would want to tell medical students or physicians that are suicidal or just want to quit medicine: I was there.” ~ Hawkins Mecham, MS4

“We as healers tend to isolate ourselves and ignore the fact that there’s a problem going on much, much wider than what we’re just experiencing personally. If you are someone who is struggling, I would encourage you to think about that fact that taking a little time away is very healing. When you have the time, don’t be afraid to take a break. Say, ‘You know what, this isn’t working for me right now,’ and take the time away from health care to evaluate because there are lots of options available to you once you take the time and stand back. But in that time, find who you are because you are an awesome person and there is so much more to you than just who you feel like when you are in this degrading system.” ~ Stephanie Whyte, M.D.

“If you need to take some time off, if you need to get rid of some of that PTSD that’s been part of this profession, our training, that’s completely fine. But don’t ignore that little voice inside you that still wants to do this, but in the way that serves your heart and is authentic to your self.”  ~ Yami Lancaster, D.O.

“The transition that I’ve experienced from feeling exhausted and depleted and trapped and sad at work to feeling exhausted, depleted, and angry at the system—that transition has really helped to give me the motivation I need to realize that there is a better way.” ~ Caroline Schier, M.D.

“I know you feel like you are entirely stuck. I know you think that there’s no way out. There is. There are other options and I really, really hope that you will look around and try to find them because I know when you’ve been told over and over that this is your only option that becomes reality to you. But it’s not. It’s not really real. There are other options. There are other ways and you’re not actually stuck. So please try to get yourself unstuck. Please. And ask for help.” ~ Lisa Kozinski, M.D.

“Ask for help. We’re a profession that doesn’t like to ask for help. When you’re reaching out you actually are stronger for doing that and I just want to let you know that by reaching out you’re empowering not only yourself, but you’re empowering your patients and you’re empowering your other colleagues.” ~ Hawkins Mecham MS4

“To anyone out there who is feeling trapped, depleted, exhausted, unhappy, my message to you is that there is a better way.” ~ Caroline Schier, M.D.

“We’re all working so hard. We’re such compassionate, intelligent people. There are plenty of ways to pay off our debt and make money. We don’t have to work for system that takes the majority off the top and works us until we’re burnt out, abusing ourselves. I know the stresses. I know the temptations or the necessity to turn to substances, to be depressed, to be anxious, and it doesn’t have to be that way. If you’re feeling that, please take the time to step back because suicide is the next step with that and it is just not worth it. And hearing from peoples’ families that have lost medical providers, it’s heartbreaking. It is such a tremendous loss to a society that needs healers.” ~ Michael Latteri, MS3

“What’s been the most amazing thing for me is the connection that I’ve felt with my peers here and the joy that I have leaving here, the excitement I have because I feel like being amongst these people that just want to serve from their heart has given me hope for my profession.” ~ Yami Lancaster, D.O.

“There are people out there practicing medicine that are more caring and compassionate and creative and amazing and beautiful than I could ever have imagined and that they love me and they love you and they love everybody and they just want to heal.” ~ Jenny Wheeler, M.D.

“If we can’t take care of ourselves and each other then we’re not doing it right so come join us. Pamela Wible and all these people are so awesome. We will always be here for you. All you have to do is contact us.” ~ Michael Latteri MS3

“I’m just joyful. I’m happy. I can’t wait to get out there and start building my dream and reclaiming my dream from when I was three years old and I feel like you can too. So have hope. You can get out of this. It doesn’t matter the debt. Just think about how you can help the world in the way that you wanted to since you were little kid. You can do this! I believe in you and so does Pamela Wible. That’s why I’m here and I’m so glad I found her and all these awesome, amazing people. I love you guys so much!” ~ Yami Lancaster, D.O.

“We know what it’s like and we don’t want to lose any more of our brothers and sisters in health care and it’s making us angry because this world needs us.” ~ Gregory Mims, M.D.

“You are not alone. You are loved.” ~ Pamela Wible, M.D.

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Pamela Wible, M.D., has helped hundreds of physicians reclaim their happiness and their careers. She offers biannual retreats for medical students & physicians. Dr. Wible has been named the 2015 Women Leader in Medicine for her work on medical student and physician suicide prevention. Video by GeVe.

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How To Be The Doctor You Always Wanted To Be (Explicit Language) →

Interview with Pamela Wible, M.D., on The Doctor Paradox with Dr. Paddy Barrett. Warning: EXPLICIT language. Listen to interview here. (Paddy is an Irish guy and it kind of sounds like we’re in a bar.)

PB: Hello. Paddy Barrett here and you are very welcome to another episode of The Doctor Paradox. The Doctor Paradox is about rediscovering passion in medicine. It’s about investigating why physicians are so often unhappy in their work but more importantly what we can do about it. To address this issue we interview a range of guests, from psychologists to authors but mostly physicians themselves who have gone through this journey and found fulfillment in their work. 

Today we have a very special guest because after too long of a delay we have our first female guest but more importantly she is someone who truly inspires you to be the doctor that you always knew that you wanted to be. She is a practicing physician in Eugene, Oregon, and she is the founder of the Ideal Medical Care Movement, whereby she flipped conventional medicine on its head and defined a medical clinic in a family practice setting—for patients, designed by patients. She also host retreats for physicians who have somewhat lost their way in medicine and has spoken extensively including TEDMED, TEDx and those talks of been incredibly well received. Ladies and gentlemen, Dr. Pamela Wible. Pamela welcome to The Doctor Paradox.

DoctorParadox

PW: Thank you! Good to be here.

PB: Pamela, it is really fantastic to have you on. I think you are very unique personality within the field of medicine and I think you really practice the type of patient care that most physicians would aspire to or had originally thought that that is the way that they would be practicing clinical medicine. Both you and your patients seem incredibly happy within the health care ecosystem. I know it didn’t immediately begin that way for you and I was hoping you could take us through that journey that got you here and really explain what your early days in training were like and take us through that story. 

PW: Well I was fortunate because both my parents are physicians and I went to work with them as a child so I saw medicine in it’s heyday and is was really, really fun. My mom’s a psychiatrist. My dad’s a pathologist and, although he had many other jobs (like working at the methadone clinic) he worked with live patient’s too. It was really fun to just be in the thick of it you know as a four-year-old going to work with my parents seeing how they interface with people during critical times in their life, whether it be death or drug addiction or psychiatric admission to the state hospital. 

I just saw that you could make such a huge difference in people’s lives and really be there for them and it was just absolutely captivating to me. It’s a beautiful mix of science and human drama (laughs) and psychology! and I just love all of it and so I went into family medicine because I thought it had the breadth and depth of all of, you know, being able to just literally be there womb to tomb for an entire community. I just fell in love with family medicine. I graduated from the University of Arizona Department of Family and Community Medicine wanting to be a doctor for a town and just deliver that those house calls and be there for people. 

But I found that all my job options were literally assembly-line medicine jobs. You know, putting me into like a Toyota-manufacturing-plant style of medicine. And the reason I mention Toyota is I ended up at the hospital library one night (you know I am one of those people who likes hanging out in the medical library). I’m a lifetime learner sort of person and I found a whole section of books on Toyota manufacturing!! And I was like “What are these doing in here?” There are people out there literally modeling health care off of assembly-line manufacturing plants and it makes no sense! We’re people. We’re not cars. We’re not, oh my gosh I could go on forever about this, but there are people who are just so stuck in this reductionist medical mindset of looking at people as machines. They’ve absolutely undermined our entire profession and and dehumanized everything from medical education to actual health care delivery. It makes no sense. 

I found my way out of this when I started looking around and noticing physicians don’t look happy, patients don’t look happy. We’re not supposed to be on an assembly line and I went and did a series of town hall meetings and asked my community to design their ideal clinic and I told them I would work for them. Write my job description. I want to be your doctor. I wanna work for you and it’s been beautiful ever since. 

PB: Now I mean the idea of these town hall meeting (and I’ve heard you speak about this before) but I was wondering if you could explain a little bit more about this in detail for our listeners because it is such a unique concept and I think if you could explain that in more detail that would be fantastic. 

PW: Many people are familiar with the town hall meetings were politicians come in and give you the latest on what they’re gonna do for us and we listen to them and I guess ask questions at the end and hope they listen to us. As opposed to that type of town hall meeting, I really wanted to put the town in charge of the meeting so it was more like a listening session. I came in and was quite vulnerable in explaining that I was really depressed and having recently experienced suicidal thinking and it was all occupationally induced! Thinking that I couldn’t be this doctor that I really wanted to be for them. All the jobs that existed were pretty much assembly-line medicine jobs and it wasn’t making me happy and it certainly wasn’t making my patients or community happy. 

Essentially after just a five-minute intro of explaining kind of my state of despair over health care which I think resonated with the group I asked them to dream it up. Tell me your wildest ideas. Nothing is too off-the-wall. I gave them all sheets of paper and some time to write down their just craziest ideas. If you could have anything!  If you could design an ideal clinic and an ideal doctor you know what does this look like, taste like, feel like? What would you like the experience to be like when you see your ideal doctor, your ideal clinic? They completely mapped it out for me and it was just fabulous! 

Could be a little bit scary I would guess for some people [other doctors to lead town halls]. First of all public speaking is scary for people. Second of all the idea that you would ask the community to tell you what they want and that you would promise to deliver it and you don’t even know what they’re gonna tell you is a little bit like going out on a limb there but for whatever reason I have faith in this process. All the feedback I got back (which was 100 pages of written testimony) I was able to adopt 90% of what these people wanted and we were open in one month with no outside funding!

PB: Wow, that’s incredible I think ya know we often unfortunately look at our patients in terms of what our patients need and it’s rather prescriptive but you’ve entirely flipped that on its head and I’m curious to hear some of the consistent themes, what patients asked for that we often don’t provide or what is that they were really desire since we really are not meeting their needs. 

PW: The number one theme is a humanized experience, a human scale as in I want to walk into a living room and feel like I’m sitting with my friend who happens to be my doctor. So people want to feel like they are connected with you. Eye contact, you know honest vulnerable communication and not feeling rushed. Appointments start on time. All the kind of human skills that you would need to sustain any relationship like a marriage. You wouldn’t leave your husband or wife sitting in a restaurant for an hour two waiting for you to show up, I mean you wouldn’t. Sitting and typing on the computer and not looking at your spouse in the eyes? I mean you know it’s a sacred relationship and it needs to be on a human level! 

So that was fantastic because that’s all I wanted to do. I mean literally theses people echoing back my own personal dream. The second thing that came up is an integrative approach meaning they don’t want any pills and interventions. They want to know what they can do with their diet and their lifestyle with massage, you know maybe an acupuncturist. They want no drug therapies which Western medicine has not trained us in and so that’s an educational deficit, unfortunately, that we have. So I was I was happy to move in that direction because it makes a lot more sense. There’s better outcomes and that’s what people want. Other themes came up like you know to see everyone regardless of their ability to pay and to have mutual respect. The top two that really stand out were a humanized experience and an integrative approach. And what was amazing that stood out to me is that nobody in like 100 pages of written testimony nobody asked for high-tech equipment or any sort!  No technical gadgets or anything that people focus on so much when you read articles like in the New York Times and things like that about what “experts” think patients want. They don’t want any of that shit! (Host laughs) They don’t! 

PB: I think so much of what you’re speaking to harkens back to the idea of you describing you couldn’t be the doctor that you wanted to be and so many of us end up in positions of practicing in such a way that does not reflect those original ideals of what is it is that you wanted to do and why you wanted to do it. And it also reflects as you said the idea of the human experience. That is why we we got into this profession in the first place. It wasn’t to learn specific technical skills. It was those technical skills could work alongside and augment our human experience of dealing with people and I think it also speaks to the idea of the integrative approaches is so critical it is a huge shortfall in our training and partly to do with the idea that you can’t measure it in objective. In many ways you can but you know if if you can’t measure it doesn’t exist and therefore you can’t improve it and you can’t bill for it. I think those patient needs are equally reflecting the needs of the physicians out there and I personally think that the idea of not being the doctor that you want to be is is one of the most fundamental underlying themes of why so many physicians are dissatisfied with their work today. 

PW: Yeah, correct and then the major shortfall just starts in medical education which is still a very fear-based training modeling. Reductionist medicine does have a fatal flaw in that it’s basically the opposite of holistic medicine which is mind-body-spirit integration. Reductionist medicine looks at peopla as machines—it’s a mind-body-spirit DISintegration model of training which, of course, would be very damaging to the students. They come out and they’re a shell of the person they once were, the beautiful person that wrote their personal statement as they entered medical school with their hopes and dreams alive. They leave with them shattered by a medical education system that literally should teach three skill sets and only gives half of one skill set. 

These three skill sets that should be taught in all medical schools are the technical skills, the human skills and the business skills of being a doctor. We receive no business training which leaves us completely open prey for third parties to just financially (you know) destroy us. Not to mention the high debt during medical school. The human skills you know like how you tell a family their child died in a car accident, like what you do with your grief. You love these people in your community and they’re dying and you have tell them that they have cancer and how do you handle the human side of the doctor? How do you set boundaries with people? How do you cry? You are not allowed to cry you know these are all things that are never addressed and we are only given the technical skills and the very narrow Western technical skills. We’re certainly not taught the value of acupressure, acupuncture, nutrition. When I was in med school (I was vegan at the time) a surgeon at a lecture was making fun of people going to health food stores buying fiber! I mean it’s just like crazy I mean really? You guys are gonna make fun of people who want to be healthy? Anyway it’s a very odd, it’s an odd situation. 

PB: It certainly doesn’t align to the model of what actually patients want—an integrative overall approach. I think much of the advancements we have made in medicine have been obviously very specific areas and we have niched down and become hyper-specialists but we lose that sight of as you described it that womb-to-tomb journey. When you are interacting with a patient in a very narrow portion of their experience in life you begin to lose the overall journey and that’s why I think it’s so critical that you do try and develop as you have that that womb-to-tomb experience. Your parents advised you not to do medicine. You described them working in the heyday of medicine. Why do you think they they told you that? 

PW: Because they could see government intrusion and all sorts of third parties coming to take their piece. They just saw less and less autonomy for physicians and of course they knew how brutal the medical education training model was. Being an idealistic young teenager I didn’t have any idea what I was stepping into. I just knew the end results that I wanted to be this great neighborhood doctor but they I guess were trying to protect me from from the injury that I would sustain. 

PB: You know there is kind of this brutal training environment. I think of all that I’ve gone through those very difficult phases and they have been difficult but they have been incredibly formative. But there are boundaries that are often exceeded and a recurring theme that’s just becoming more and more apparent but certainly was always present was this issue with physician suicide. You have had quite a troubling exposure to physician suicide. Why do you think so many doctors are killing themselves? 

PW: Well they’re trapped in a mind-body-spirit disintegration model called reductionist medicine which devalues the heart and soul—and that’s the only reason to be alive. The things that we can’t measure are the things that were living for—hope, love, joy, all the beautiful parts of being a spiritual being having a finite human experience. To just niche that down into like all sorts of medical minutiae that just focuses on the mechanics of being human without allowing us to have our humanity and our hearts and souls in our bodies is very damaging to the human psyche and spirit. 

PB: I couldn’t agree more. It’s that disconnect between our expectations and the realities of what we’re currently practicing in that ecosystem that exists now. You mentioned the term burnout. For me personally I will say that I didn’t understand what burnout actually was. I thought that when you burnt out you just physically gave up collapsed on the ground and the world passed you but what was surprising to me was that you could be burnt out and still practicing your day today work and maybe not even realize that you had burnout. Can you explain to us what burnout actually is and how it manifests? 

PW: Well I actually can’t stand the term burnout because it’s a victim-blaming term that’s used by our oppressors to label us and make us feel personally defective. If you made it to medical school or your residency or you’re practicing physician in this country, you’re already in the top 1% of resilience compassion and intelligence. The fact that you can take these high-functioning people who are like valedictorians in their high schools and such and after just a very short period of time in medical school or in practice turn them into like the majority of them having a condition called “burnout” that means that it’s a system problem and not an individual problem. The system doesn’t spend a lot of time focusing on what they’re doing that they could change instead what they do is send us to resilience training courses! As if we are resiliency deficient! Couldn’t be further from the truth! You know what I mean? We are high-functioning people in an abusive system so I don’t choose to use the term “burnout” that much. I really have a problem using terms of oppression that are victim-blaming terms. 

I think it’s much more accurate to say we have a highly abusive and toxic medical system that is destroying the humanity in our idealistic, beautiful healers. I think it’s so important to point that out because often the solutions that are are offered are Band-Aid, temporary solutions and they are obviously not going to affect any meaningful change if they’re simply within the environment of a very toxic environment. You’re just gonna continually feeling the way that you do now—abused. 

PB: What would you say to somebody who was struggling right now with where they are, say in their training. They know they have to go through certain steps but they just know intrinsically that there’s something off and and they’re struggling with their career. What would you say to them to enlighten them or get them back on path? 

PW: Well it would be good for them to reach out for help. I think that medicine is an apprenticeship profession so it’s very important to have mentors who you look up to that you want to emulate because that’s how we learn how to be doctors—we study other doctors. What’s troubling is many medical students they tell me that medical school is more like an anti-mentorship program meaning they meet a lot of doctors they never want to become. So you’re just exposed to the cynical jaded doctors out there who have been successfully dehumanized by their medical education and traumatized. 

Many of them have PTSD and don’t recognize it—which I think is probably a more widespread situation even then this oppressive term “burnout.” It’s just not recognized because it has not been discussed so you know the issue really is when you get right down to it we need a proper diagnosis to come up with the proper treatment plan. I think all physicians would agree with that if you are calling something pneumonia and it’s really sepsis or something completely different you’re unlikely to save the patient. So to use the term “burnout” which is a victim-blaming term and not the correct diagnosis, we reinforce in an individual that they’re defective in some way. And we are not at all getting to the root of the problem which is a system that has taken high-functioning people and destroyed them! So what I recommend is that anyone who is suffering talk to other physicians who seem to have figured it out, you know what I mean? If you’re a family doctor and you don’t like your job, try to find another family doctor who looks like they’re loving their practice and loving their patients and then just hang out with them. I think you need to have great mentors. In med school we are certainly not being exposed to enough happy doctors from the community who are successfully practicing solo medicine for example.

They are not teaching this in these tertiary care medical centers medical and students have a lack of exposure to what’s really working out in the field. So ask for help. That’s the main thing—ask for help—but ask somebody who’s figured it out because if you go and ask another cynical doctor what to do you’re gonna get cynical advice. See what I’m saying? 

PB: Absolutely I think that is so important. The theme of mentorship is something that runs consistently throughout this show but I also believe in the idea of peer pressure. Peer pressure gets this negative connotation but you will develop the mean attitudes of the people that you’re surrounding yourself with and as as you described if people that you’re looking to for guidance and direction are people who have become incredibly cynical within the system you will get led in the wrong direction. I think it’s important to look further out and find those people who resonate with you in terms of an ideal philosophy of how you practice. Many people feel trapped in terms of how they will actually step out of this system that is very difficult to work with and often leads to feeling very disengaged as you have described. You have a concept called an ideal clinic and I am hoping that you could explore and explain a little bit more detail what the ideal clinic is? 

PW: I believe the most evolved way of looking at the definition of an ideal clinic is that it’s a clinic that is designed by the community and the patient’s. Meaning it’s really patient-centered not all this kind of lip service like the patient centered medical home that does not put the patient in the center of designing the practice. The patient is still held hostage to a physician or administration-designed clinic. What I’m talking about is actually having the faith and trust in your patients—the end users—and asking them what they want and allowing them to design their own ideal clinic because who would know better than the person (the recipient) what would be ideal. Of course, we understand you know how to treat various diseases from a western medical standpoint and I’m not asking the patient to come up with algorithms for diseases but as far as designing a clinic, you know, where should it be located, the colors, the overhead. What time do you want the clinic to be open, how do you want to access your doctor, all those sorts of health care delivery questions—the patient should absolutely be in charge of that and you’ve got to remove these $400 per hour consultants who are not on the frontline of health care delivery. I know what patients are talking about [and what they want] and in every community they may be a little different in what they want. What works in the middle of Nebraska might be totally different then whats going to work in the middle of Manhattan. I live in a small little hippie town. People have a certain concept of what type of doctor they would like to have here and its definitely not a conservative Western doctor who is just gonna be narrow. They want a broad approach so listening to people being respectful and delivering healthcare in a way that they feel like they’re part of the community clinic and they have a sense of ownership in these clinics because they created them. 

PB: I would imagine it seems almost foreign to us now to actually put the patient—the ultimate user of our healthcare system in the middle. It seems like that the purpose of clinics is to have the clinic rather than to serve the needs of our patients. So can you explain how each ideal clinic may be different, will serve the individual needs of its population. What does your clinic look like and maybe some ways it might be different to the classic and conventional structures? 

PW: Just probably harkens back to the original pre-1965 model before we had Medicare and third parties inserting themselves and codebooks and all this other stuff that’s really unnecessary in primary care. I really want to preface this by saying primary care and tertiary care are two different animals completely. If you need a lung transplant you do need a five-story hospital, a helipad, and the whole team, and lungs on ice, and a high staffing ratio, and overhead is higher and all that. What I do in my clinic is Pap smears, ingrown toenails, bronchitis and things like that. I don’t need a hospital and, in fact, the more stuff you have as far as square footage, staff, overhead and third parties, the worse the care. You know what? I just need to be left alone with my patients. My 280-square-foot office that they designed—a nice little clinic with a shaggy carpet on floor, beanbags, lots of comfy pillows. Feels like a little living room in a studio apartment with a bathroom attached. I have an exam room but I don’t put people on the exam table unless they’re actually gonna get an exam. Most of the time they are sitting on the couch and I’m in the wicker chair. 

It’s an amazing experience in that it’s just normal. I’m looking at them and I have my laptop and I do keep notes but I’m not like tied to the computer. I’m not using electronic medical record that was created for me by somebody who has no idea what I do, you know. I created my own electronic medical record with software that came with my Apple laptop and so it makes sense to me I don’t have to spend inordinate amounts of time just staring at the computer. I’m looking at my patient. We’re connecting as human beings and it’s absolutely beautiful, The appointments start on time all the time for 30 to 60 minutes. I still accept insurance but I streamline everything. Easy!

PB: There’s a lot of jealous physicians out there listening to your ideal model who only hope that they could someday achieve that. Your parents were physicians so you got an insight into the life of the physician. But for most people it was what their family doctor was to them when they were young. Ideally what would harken back to the the model that you’re describing and it’s amazing to see happy doctors and happy patients engaging in that. 

PW: This is the only model that really works for primary care. You cannot use a tertiary care payment model and delivery structure and overhead to deliver primary care or you’ll destroy primary care. What is basically happening now is that we’re dealing with ingrown toenails with the same coding book, the same staffing ratio, the same infrastructure as we are for a lung transplant. Come on! This stuff is simple. You wouldn’t call your car insurance company for the rock chip in your window or every time you pull into a gas station. Would you ask their permission to get an oil change or to fill up your car? I mean it’s at the level of ridiculous right now that we’ve involved so many people in such a simple interaction. Most people’s problems can be solved just much easier if everyone else would get out the way. Too many cooks in the kitchen sort of thing. 

It’s really interesting when you say a lot of doctors are jealous or would like to do this. I would just encourage them to do this but the problem that’s holding them back is not the lack of business skill because I teach these retreats for physicians in which I’ve been giving them business skills for a decade now.  What really is the bottleneck here is the physicians with PTSD and their self-esteem has decreased and their self-confidence has decreased through their medical training and they have had psychological damage from an abusive medical education and medical workplace. That’s exactly what they need to have restored so that they can open these clinics. It feels a little bit to me like talking to somebody in a domestic abuse relationship. You could talk to them till you’re blue in the face and try to convince them that prince charming exists. They just don’t see it because they’re in an abusive relationship and so all they know is that they’re afraid and they don’t know how to get out of it. It’s so easy to start a clinic and I love my patients and my life is wonderful. It’s really hard to help people who are so wounded psychologically.

PB: I totally understand. It must be amazing to to see that evolution of physicians going from such a place of difficulty to being so much happier and content with their work and that kind of brings us back to the idea of what you mentioned about specific retreats directed at this very problem. Can you tell us what what does the retreat actually involve and what is it that the people do get out of it? 

PW: It starts with a teleseminar and weekly 60 to 90-minute phone calls over at a 10 week period in which people (including medical students and anyone in health care) are actually invited to participate. They get the business skills and human skills they need to be a doctor, meaning to get what their medical education did not give them. I give that to them. And they get the camaraderie of being with a bunch of like-minded doctors who our ready to break free of their abusive workplace and really be the doctors that they had originally described other personal statements when they entered medical school. So it’s an amazing experience for people who for the first time feel supported and feel like there’s a family atmosphere of like-minded healers. Then they’ll get all these incredible skills which they can put to use. Then at the very end of the 10 week, we have a 4-5 day retreat in the woods of Oregon on 150 acres at the hot springs which is incredible where they are off the grid and are not on call and just with each other! I limited it to less than 60 people and I keep it very intimate and these people are able to finally heal from the PTSD the trauma the abuse that they have sustained from medical school.

The beautiful thing about it is that I almost don’t even need to be there to facilitate this because when you get a group of healers in a room together and you don’t distract them with ICD-10 codes and a bunch of bullshit, they naturally (check it out) want to heal each other! 

PB: We see this in the social environments that we’re in that we naturally trend towards those discussions and conversations but putting it in that environment is just so much more I would imagine. Now over the course of the show, I’ve had several in female listeners contact me in terms of looking more at the female perspective of medicine. Do you think that there are unique challenges for females in medicine today?

PW: Yes there are unique challenges. I’ll preface this with I love men. I do not have any problem with men, but I do have a problem with a patriarchal medical system that devalues female traits. So that’s what we’re in. We are in a medical education model that values, speed, and graphs, and charts, and things that you can “prove,” and all that jazz. Yet the most meaningful things in life are things that you can’t measure like love, affection, joy, hope. These are the things that keep people alive and wanting to live on planet earth. This is what women are naturally good at. 

Women are more relational than men. It’s how we are built. We like to hug and kiss and we cry easier. The medical system devalues that difference. And when (by the way) you ask patients what they’re lacking in medical care, they want all these female traits. When they say they want a humanized experience they are talking about wanting their doctor to look at me, and cry with me, and laugh with me, and hug me, and all those things. Those are things hat women naturally do all day long with their kids and their relatives and they would do it if it were okay at work, but they are freaked out that they’re going to get written up for unprofessional behavior! So this is horrible that we are not allowing women to be women. In fact, medicine really masculinizes women which I find so disgusting. I’m listening to these women speak and they sound like detached men. They even start to dress and behave in masculine ways. They are just not feeling safe to be women. I would like women to be welcomed to medicine as women, to be paid equally with men, to be respected for the complementary skill set that we are born with. Come on guys! We’re not gonna bite! 

And the thing is for every woman we lose to suicide in medicine we lose seven men! Is that not screaming out for female values? I want men to reach out and ask us to help them. Our solutions might actually save your life. 

PB: It’s so true. Many of those traits are repressed in men and also devalued and not asked to be augmented in females. Many females are just better at certain things. There’s a great book, Why Men Don’t Listen and Women Don’t Read Maps, about evolutionary life when men came home after hunting and they were just vaguely aware that there were small people living in the house that actually happened to be their children and the female mind was more set up to picking up the nuances of social behavior and it certainly feeds into how they would deliver more compassionate health care. It’s not to say that it’s unique to females, but it just seems to be maybe more developed. Now say if there were females listening who are finding themselves in that position, what would you say to them in terms of how they navigate that process?

PW: If you are with a malignant instructor in medical school or residency sometimes you just have to bear with it until you get out of it. Once you are free and you are a physician, please be yourself. There is no shame in being a woman—100% female. That’s how I am. I am the same at work as I am at home as I am with my dog. I am always the same. I do not put on a facade as a physician to go to work. I speak the same way. I have the same intonations. I put glitter on (I hate wearing makeup) and it’s just easy because you just put it on your face. I dress the same way. I wear jeans. I wear wrap shirts and maybe some of my cleavage shows. This is just me. I am not trying to cross anyone else’s boundaries. I am comfortable in my own skin and I am dressing and speaking and acting and behaving in a way that is 100% Pamela Wible. I think that is why my patients trust me and why people are attracted to me because here’s the magic formula—I’m not afraid to be myself! Anyone can do it.

PB: It’s so important to point out those key issues, Sometimes we just have to endure and get through a particular point, but when you do have that flexibility to go back to what your core values are, to do what you are doing. It is so amazing to see someone who is so comfortable in what they are doing and who has gone through that process of difficulty and challenge to finding a place of true fulfillment is a spectacular process to witness. I think it is really encouraging to see that.

PW: One thing that’s really funny is that I was speaking at a medical school once and, of course, people will tend to have a lot of questions for me after my talks and I’ll stay there for hours answering questions—everything from mental health to how to run your ideal clinic. One woman came up and her question was, well, she didn’t actually have a question. She says she just wanted to see if I was really wearing glitter! She just couldn’t believe it that a doc could take off the white coat and be a real person—just blows people away. I want to encourage everyone to be themselves. There is no shame in being your true self.

PB: That has certainly been one of the key themes on this show in terms of when people trusted their own internal compass that is when they found themselves where they had wanted to be. So it so important to trust yourself in that respect. We don’t do this alone and the questions that I like to ask people is the question of advice. What’s the best piece of advice you’ve ever received?

PW: I think it’s from my mother because she was always telling me that I could do whatever I want to do in my life and that I could be whatever I wanted to be in the world and nobody could stop me. That is a great piece of advice and I would like more people to believe in themselves. One person living authentically is more powerful than any amount of legislation top-down from Washington DC. 

PB: That’s so true and speaks to the concept of following your own internal motivations that truly drives you. Now is there any book that you think everyone in health care should read?

PW: Oh gosh, I would love them to read my book, Pet Goats & Pap Smears, and I’m not about making money. This is not about selling my book. I’m happy to send it free to anyone who wants it. The thing is I wrote it for medical students because they are in such a state of despair and it’s like a “chicken soup for the soul book” for medical students and physicians that allows them to feel like they are following me around for the day. It’s perfect bathroom reading. The subtitle is 101 Medical Adventures To Open Your Heart & Mind. The chapters are 1 to 3 pages each with cartoons. When patients read it they say, “This is exactly he kind of doctor I want.!” When medical students read it they’re like, “This is what I wrote on my personal statement, the kind of doctor I want to be.” When physicians read it they say, “I wish I could do this!” Embedded in the stories are practice management tips which would be irrelevant for a truck driver from Dallas who read it and loved it and hadn’t read a book since high school. The point is you get the depth of the material based on where you are in your life cycle and what profession you are in. I wrote it at a fourth-grade level so anyone could enjoy it. If physicians could see that they have this opportunity to practice in a real way where they can be in a relationship-driven practice with their patients, it would give them an immense amount of hope so that they would know that their dreams can come true. This is not just a theoretical book of one day some day. This is actually following me around with my patients. And I just wish more doctors would recognize that they have the same possibility to live their dreams.

PB: Wow! Pamela, I just want to say this has been a really fantastic conversation and so enlightening and encouraging. What you are doing is possible and you are giving people the framework to actually do that. And I just want to say thank you for taking the time to be in the show to let us know your insights and perspectives that will be so incredibly valuable to all the listeners. And finally where can our listeners find out more about you?

PW: IdealMedicalCare.org is my website and I return every single email and phone call. I am very much accessible to anyone who needs me, whether it’s a patient, medical student, a physician. I find that it is really important to be accessible and to have open lines of communication so anyone anywhere in the world feel free to contact me.

PB: Wow. You heard it here. Pamela, thank you again for being on the show. It’s been a fantastic insight.

Posted in Ideal Medical Care, Patient Relationships Tagged with: , , , , , , , , , , , , ,
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Burnout Is Bullshit →

Bullshit

Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f@*d up so fast? ATTENTION medical students and doctors: It’s NOT your fault. 

Burnout is physical and mental collapse caused by overwork. 

So why blame the victims? 

The fact is medical students and physicians are collapsing because they are suffering from acute on chronic abuse. At some medical schools, 100% of students report abuse

Do you think this gets better? Physicians are overworked and overwhelmed with bureaucratic bullshit during most of their careers. They are trapped in assembly-line big-box clinics where they are treated like factory workers and berated for not seeing enough patients per day. These are human rights abuses in our nation’s hospitals. This doctor worked 7 days in a row with almost no sleep! 

And the doctor below. Think she’s burned out? Nope. She has been ABUSED!!

Docs, stop playing nice in the sandbox. You are being abused.

You can’t be a victim and healer at the same time.

Only you can stop this shit.

 How do you know if you’re being abused at work? 1) You don’t get lunch or bathroom breaks. 2) You are forced to work multiple-day shifts. 3) You are not allowed to sleep. 4) You are forced to see unsafe numbers of patients. 5) You can never seem to find “work-life balance.” 6) You are threatened verbally, financially—even physically. 7) You are bullied. 8) And if you ask for help, you’re called a slacker or worse. 

If any of this sounds familiar, it’s NOT YOUR FAULT.

YOU ARE A VICTIM OF ABUSE.

So what should you do?  Sign up for a resiliency training? Meditate? Take deep breaths?  Your goal should NOT be to cope with abuse. Your goal should be to STOP it.

Physician burnout is a diagnosis that blames the victim, not the perpetrator. The term physician burnout IS physician abuse. It implies that YOU are to blame, not the system, not perpetrators of the mistreatment.

To prevent burnout, health care institutions may offer resiliency classes to train doctors to prioritize self-care and manage their emotions. WARNING: You can not meditate your way out of abuse. You can not take enough deep breaths in a year to end your abuse.

WHAT YOU MUST DO: If you are being abused, YOU MUST LEAVE YOUR ABUSER. I know it’s scary. But you are not alone. Need help with your escape route? Call me! I escaped. You can too.

End The Abuse! Stop Being Victimized. Download Instructions: Your FREE No B.S. Guide To Launching Your Ideal Clinic & Telling Your Employer To Take A Hike.

Want an ideal clinic? Join the Physician Teleseminar & Retreat.

YOU were born to be a healer, not a victim.

Pamela Wible, M.D., founded the Ideal Medical Care Movement. When not treating patients, she devotes her life to helping her colleagues be doctors not slaves.  Image by Pamela Wible. Videos by GeVe.

Posted in Ideal Medical Care, Physician "Burnout", Physician Abuse & Bullying Tagged with: , , , , , ,
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Thanksgiving message of hope for doctors & medical students →

“I know there’s a lot of you out there that are feeling disillusioned. You’re wondering why did I spend all those years in medical school and training, why am I hundreds of thousands of dollars in debt. I hate this. I hate this profession. I don’t feel like this is me. It’s because you’re in the wrong place. I have several friends (you know who you are) out there. You know that you are very unhappy. You are just racing to get to retirement as fast as you can so you can get out of medicine. What I say to you is dig down deep into your heart and reclaim that dream you had from when you were a little kid and all you wanted to do was help people and serve people, serve your community, and be part of the community in a respected way where you felt free. You can do it!” ~ Yami Lancaster, D.O.

“If you’re someone who has been wounded in such a deep way, I want to tell you the most important thing that I learned when I was in that exact position: you are not alone. There are people, many of us out there who are looking for you. We’re not waiting for you. We are looking for you. And if you just give us a slightest nod in our direction, we will come find you and we will help you heal.” ~ Gregory Mims, M.D.

“To those out there who are still in pain, there are options. The system is a lie. It’s fed you a false dichotomy that essentially you can be miserable, but successful or you can be destitute and happy. It’s not true. It’s not true. We are divided. We’re kept powerless, but there are those out there who want to help, help reform the system, help you heal to find something that is truly meaningful for you. It’s out there. There are options. You are not alone. And remember that the modern medical system’s unofficial motto right now is: the beatings will continue until morale improves.” ~ Bradley Michel, MS3

“It’s just that it is an abusive system, and you can quit and take time off. Find who you are. You can live your dream. And that’s all you need. Screw the system. It’s not meant to get people better. It’s meant to maintain chronic disease states and make a lot of money. So there ya go . . .” ~ Cammy Benton, M.D.

“What I would want to tell medical students or physicians that are suicidal or just want to quit medicine: I was there.” ~ Hawkins Mecham, MS4

“We as healers tend to isolate ourselves and ignore the fact that there’s a problem going on much, much wider than what we’re just experiencing personally. If you are someone who is struggling, I would encourage you to think about that fact that taking a little time away is very healing. When you have the time, don’t be afraid to take a break. Say, ‘You know what, this isn’t working for me right now,’ and take the time away from health care to evaluate because there are lots of options available to you once you take the time and stand back. But in that time, find who you are because you are an awesome person and there is so much more to you than just who you feel like when you are in this degrading system.” ~ Stephanie Whyte, M.D.

“If you need to take some time off, if you need to get rid of some of that PTSD that’s been part of this profession, our training, that’s completely fine. But don’t ignore that little voice inside you that still wants to do this, but in the way that serves your heart and is authentic to your self.”  ~ Yami Lancaster, D.O.

“The transition that I’ve experienced from feeling exhausted and depleted and trapped and sad at work to feeling exhausted, depleted, and angry at the system—that transition has really helped to give me the motivation I need to realize that there is a better way.” ~ Caroline Schier, M.D.

“I know you feel like you are entirely stuck. I know you think that there’s no way out. There is. There are other options and I really, really hope that you will look around and try to find them because I know when you’ve been told over and over that this is your only option that becomes reality to you. But it’s not. It’s not really real. There are other options. There are other ways and you’re not actually stuck. So please try to get yourself unstuck. Please. And ask for help.” ~ Lisa Kozinski, M.D.

“Ask for help. We’re a profession that doesn’t like to ask for help. When you’re reaching out you actually are stronger for doing that and I just want to let you know that by reaching out you’re empowering not only yourself, but you’re empowering your patients and you’re empowering your other colleagues.” ~ Hawkins Mecham MS4

“To anyone out there who is feeling trapped, depleted, exhausted, unhappy, my message to you is that there is a better way.” ~ Caroline Schier, M.D.

“We’re all working so hard. We’re such compassionate, intelligent people. There are plenty of ways to pay off our debt and make money. We don’t have to work for system that takes the majority off the top and works us until we’re burnt out, abusing ourselves. I know the stresses. I know the temptations or the necessity to turn to substances, to be depressed, to be anxious, and it doesn’t have to be that way. If you’re feeling that, please take the time to step back because suicide is the next step with that and it is just not worth it. And hearing from peoples’ families that have lost medical providers, it’s heartbreaking. It is such a tremendous loss to a society that needs healers.” ~ Michael Latteri, MS3

“What’s been the most amazing thing for me is the connection that I’ve felt with my peers here and the joy that I have leaving here, the excitement I have because I feel like being amongst these people that just want to serve from their heart has given me hope for my profession.” ~ Yami Lancaster, D.O.

“There are people out there practicing medicine that are more caring and compassionate and creative and amazing and beautiful than I could ever have imagined and that they love me and they love you and they love everybody and they just want to heal.”  ~ Jenny Wheeler, M.D.

“If we can’t take care of ourselves and each other then we’re not doing it right so come join us. Pamela Wible and all these people are so awesome. We will always be here for you. All you have to do is contact us.” ~ Michael Latteri MS3

“I’m just joyful. I’m happy. I can’t wait to get out there and start building my dream and reclaiming my dream from when I was three years old and I feel like you can too. So have hope. You can get out of this. It doesn’t matter the debt. Just think about how you can help the world in the way that you wanted to since you were little kid. You can do this! I believe in you and so does Pamela Wible. That’s why I’m here and I’m so glad I found her and all these awesome, amazing people. I love you guys so much!” ~ Yami Lancaster, D.O.

“We know what it’s like and we don’t want to lose any more of our brothers and sisters in health care and it’s making us angry because this world needs us.” ~ Gregory Mims, M.D.

“You are not alone. You are loved.” ~ Pamela Wible, M.D.

PamelaWibleRetreat

Come to our next retreat!

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Pamela Wible, M.D., has helped hundreds of physicians reclaim their happiness and their careers. She offers biannual retreats for medical students & physicians. Dr. Wible has been named the 2015 Women Leader in Medicine for her work on medical student and physician suicide prevention. Video by GeVe.

Posted in Medical Student Suicide, Physician "Burnout", Physician Abuse & Bullying, Physician Retreat, Physician Suicide Tagged with: , , , , , , , , , , , ,
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AMA interview with Dr. Wible at TEDMED →

Christine Sinsky, M.D., from the American Medical Association interviews Pamela Wible, M.D., after her TEDMED talk. Watch periscope video here. Fully transcribed below:

Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the Vice President of Professional Satisfaction at the AMA, and we’re here at TEDMED because it’s an important gathering of deep thinkers, of innovators, of practicing physicians. The AMA believes in bringing those key constituencies together. So Pamela, you really knocked it out of the park last night with your talk. It was really just terrific.

Dr. Wible: Thank you so much. It was really fun, amazingly fun to present a topic that’s so challenging.

TEDMED-WIBLE-PHOTO-shrink

Dr. Sinsky: I wanted to start out by telling you one of the things that is meaningful to me. That care of the patient requires care of the provider, and I could feel your passion last night around our need to be better as a medical community at caring for each other, at caring for our colleagues. I wonder if you’d like to start from there and move forward.

Dr. Wible: I think we really need more of a culture that is collegial and like a family, instead of a culture of competition. And that starts during premed and day one of medical school we could set the stage for more of a family atmosphere where we’re looking after each other like you would family members. I think that’s how it works in other high-stress professions like fire departments and police departments. People are really there for one another as supports.

Dr. Sinsky: So shoulder to shoulder, together. Picture for me, you are the Dean of a medical school. You have the ability to help change that culture. What would you do?

Dr. Wible: Day one of medical school I would introduce the students to the campus and welcome them home. This is where you will be with your family for the next four years. You’ve jumped through enough hoops to get here and we are here to support you. I would give my personal cell phone number to the students. I would have a panel discussion with some of our top leaders at the medical school who would share their personal struggles with despair and then triumph from professional liability cases, from deaths of their patients, from divorce, suicidal thinking and all of this so that we normalize the conversation of our human needs. And we can start to bond with each other beyond just the supratentorial lectures and multiple-choice tests. 

Dr. Sinsky: You know, I was talking after your talk with one of my physician colleagues and we were thinking about how we each felt in medical school and some of that impostor syndrome that I think all physicians feel—that we are isolated and alone and no one else is feeling that way. Tell me more how this approach when you are the Dean can help to address that issue. 

Dr. Wible: Right now students feel extremely isolated and that just continues through our entire profession. We are in a culture that glorifies self neglect. And so we end up working on our little islands and we don’t ask for help because, of course, we are supposed to be the helpers. We are not supposed to be receiving help. And so if we can just break through this and really look after one another. Create a situation in which people do not feel individually defective. Once we can communicate that you cried yourself to sleep after the stillborn and so did I and we had the same reaction to that case, it just normalizes our human experience. And that’s what we need to do is start to have conversations like real people, like we are now without the stiff starched white coat.

Dr. Sinsky: Right. And the isolation behind the strong man kind of front. So last night you really spoke very much from the heart, about the extreme when we don’t care for each other. The stresses and lack of support can manifest in the most severe outcome—death by suicide. Can you talk a little bit about why that’s important and the extent of it, and move to solutions, things that we as a medical community can do to help our colleagues in pain.

Dr. Wible: It’s important because we are losing an entire medical school full of physicians every year to suicide, so hundreds of doctors. Both men I dated in medical school died by suicide. In my small town we lost 8 physicians to suicide, 3 within 18 months. So it’s a huge public health issue. More than one million Americans lose their physicians to suicide every year so we must take this seriously. If not for the individual, the public health implications of losing that many physicians when we already have a physician shortage. Right? So that’s one thing. What was the second part of the question?

Dr. Sinsky: I just want to clarify that a full medical school every year.

Dr. Wible: Yes. And that’s not even counting the medical students that die by suicide. And what disturbs me is we are not tracking any of this and we could be tracking it because we know all the names of currently enrolled medical students and physicians in this country, so it shouldn’t be a mystery. We should have firm numbers. Some of this is not being tracked properly. 

Dr. Sinsky:  So who is doing it well? Who is addressing suicide prevention at the medical school level well? Or at the practicing physician level well? And if no one is what should we be doing? 

Dr. Wible: Some schools like Saint Louis University and others are doing a pass-fail grading system so there is not the tension about grades that creates that competitive environment. So if we just take the pressure off of these amazing people. Medical students are already in the top 1% of compassion, intelligence, and resilience in the country. How much more pressure do we need to put on these high-achieving people? Take the pressure off and let them enjoy the love of learning instead of just shoving all these multiple-choice tests that never end with medical minutiae that they are not going to use in the future. So take the pressure off and create an environment where there is peer networking and peer support groups. Schools should have a suicide helpline that the students man themselves. We learn to take blood pressure on each other. We are using each others’ bodies to learn how to do the physical exam. Why not let these medical students in their first and second year learn some of these skills to help each other emotionally? Have them on call from first and second year so they feel like they are doing something other than just reading their books. Actually helping each other. 

Dr. Sinsky:  So you are getting at one of those issues that makes physician suicide such a challenging problem and that is for physicians there are barriers to getting mental health care and that probably starts in medical school. Getting mental health care from your boss or supervisors might be an issue and once we’re in practice. So what else can we do to reduce the barriers to getting help when we need professional help for depression that’s extreme, for example.

Dr. Wible: Well, one thing that I discovered when people call me is that medical students and physicians who do have extreme depression, anxiety, panic attacks that are occupationally induced were normal before medical school. Just listening to them on the phone helps. I am not giving them drugs. I am not their doctor. I’m just a friendly colleague on the phone. They feel so much better afterwards. I continue to drive home the point that you’re not individually defective. This is a system defect. If more than 50% of a group of people develop a condition we call “burnout”—which is really a victim-blaming term—then it is really a system’s issue, not an individual issue. Once they realize that they are not individually defective, they feel so liberated and they feel so understood. We should not wait until people are so far gone into psychotic depression that they need to go to a psychiatrist. The first day of medical school and as an ongoing continuum of care we can really listen to each other and be human with one another.

Dr. Sinsky: I want to make sure I caught this because I think this is a hugely important point. We need to think about the locus of responsibility for physician distress, for physician suicide, for burnout (if we use that term) in the external environment much more so that in the internal environment as a defect in the strength or the ability of that person. Did I understand you?

AMA-Tweet

Dr. Wible: Yes. It is a bigger issue. It is not that the an individual was born with a resilience deficiency. You’re in the top 1% of resilience if you are in medical school so let’s honor your strength and capacity for learning and providing care for people. And one thing that I wanted to say since I think this is about creating your ideal clinic is that we should really teach to the personal statement, not just to all these multiple choice tests. People come in with a clear indication of what their soul’s purpose is and what their intention is and what they’d like to receive for their $300,000 of tuition and schools need to be teaching to these personal statements and digging them out of the file drawers and asking the students, “How are we doing getting you to your goals here? Are we doing well as a school?” There’s really only 2 types of practices that have emerged: relationship-driven or production-driven practices. What medical school seem to be doing now is driving everyone into assembly-line, production-driven practices which do not match what most people have written on their personal statements. So we need to go back and ask the students, “How are we doing? How can we do better?” and really help people live their dreams—because that IS the ultimate solution to suicide. When you are living your soul’s purpose, there’s no way that you want to take your life. It’s when you feel that’s been stolen from you [that life loses meaning].

Dr. Sinsky: So I want to ask the last question. What do you think organizations like your organization, the American Academy of Family Physicians, or the America College of Physicians, or the AMA can do to help reduce physician stress, reduce the risk of burnout, reduce the risk of suicide, and increase the likelihood that we’re practicing in an ideal practice? 

Dr. Wible: I like to reference Maslow’s Hierarchies of Needs. During medical school you are thrown down to the lowest rung of physiologic instability (not getting to eat, sleep, and all that stuff). What Maslow did is he studied people who were high achievers who were self-actualized and that’s what we should do in medicine. Instead of talking about all the doom and gloom, start showcasing that doctors who have figured it out. Let’s have a panel of the happiest doctors in America so we can hear what they are doing and why they are so happy. Doctor means teacher. Medicine is an apprenticeship profession. We learn by modeling other people. So let’s start showcasing the people who are really having a good time, who’s patients love them, who are just really rocking it in medicine and that would be a really great way to learn how to do it right. 

Dr. Sinsky: So this is not a set-up Pamela. You may not know, but part of the work we’re doing at the AMA is exactly that. 

Dr. Wible: I really didn’t know that.

Dr. Sinsky: You didn’t know that. I guess we’ll close with this. We have put online a series of practice transformation resources to help to get back to our calling of relationship-based care. So that our physicians can spend the majority of their time on work that only physicians can do, relationship-building, and medical decision making. And they are all about creating an ideal work environment.

Dr. Wible: That’s lovely. That’s really great. I’m looking forward to seeing that.

Dr. Sinsky: Maybe we will call you in to be one of our authors. We also highlight places where people are doing a very good job. So, Pamela, I’d like to thank you so much. You’ve really inspired many, many people across the country with the work that you’ve been doing and the message you’ve been articulating.

Dr. Wible: Thank you so much. It is a joy to be here.

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Dr. Wible’s TEDMED talk was featured in the Palm Springs newspaper the following morning. Article here with great photo! When her TEDMED talk is released online, it will be posted here. Hopefully soon :)

Posted in Medical School, Medical Student Suicide, Physician Suicide
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