Preventing Physician Suicide, Depression, Burnout

Turn off your cell phone. Get off the grid. Take a deep breath and say, “Ah . . .”

You are invited to Live Your Dream: Revolutionize Your Medical Practice, a healing retreat for physicians at Breitenbush Hot Springs. Take refuge with like-minded colleagues who realize that healing health care begins within.

Reclaim your vision, and then liberate yourself to practice medicine in alignment with your values—and the values of your community. Rest, replenish, and retreat with kindred spirits while learning to engage community, thrill patients and staff—even slash overhead and increase your income!

Learn effective practice models, cures for common office irritants, medical marketing, media and more. Soak, sauna, and soothe your soul while mastering the business, leadership, and community organizing skills you never learned in medical school so you can launch your own ideal clinic (or love your current practice).

Breitenbush Retreat and Conference Center is a worker-owned cooperative and intentional community on 154 acres of wildlife sanctuary in the Willamette National Forest of the Oregon Cascades. The Breitenbush mission is to provide a safe and potent environment where people can renew and evolve in ways they never imagined.

Enjoy snow-capped mountain vistas overlooking the Breitenbush River while soaking in the hot springs with your new physician friends from all over the country (and Canada!). Hike ancient forest trails and walk the labyrinth. Savor three bountiful, organic vegetarian meals daily with vegan and gluten-free options. Sleep peacefully (and uninterrupted) in cozy, geothermally heated cabins.  Breitenbush is a healing vortex and sanctuary that allows busy clinicians to take a break from technology and focus on personal goals and dreams.

Live Your Dream: Revolutionize Your Practice is offered biannually. The next retreat will be April 23-26, 2013. Mark your calendar!  Plan to stay an extra day or two before or after the workshop if you like. Optional massage and bodywork is available onsite for an additional fee. The event is open to doctors, medical students, nurse practitioners, and other health care professionals. Scholarships are available to medical students and others in financial need.

Live Your Dream is offered by Pamela Wible, M.D., a Eugene-based physician who pioneered the first community-designed ideal clinic in America. Her model is now taught in medical schools. She trains physicians nationwide, has been interviewed by CNN, ABC, CBS, and is a frequent guest on NPR.  She has expertise in preventing physician suicide, depression, and burnout. Co-facilitator is Kassy Daggett, a highly skilled coach and therapist. Learn more: www.IdealMedicalCare.org.

For rapid registration: Please email Dr. Wible through her website with your contact information. Space is limited. Register now to secure your spot.

4 Responses to Preventing Physician Suicide, Depression, Burnout

  1. r58black says:

    With regards to physician suicide, burnout and depression….the first step in dealing with the problem is to recognize there is a problem. The next step is to find the root of the problem, if discoverable. Even though the old concept of exogenous and endogenous depression has somehow magically fallen out of fashion nowadays…..it most likely is still quite applicable. It may, however, be of limited utility if an individual has essentially exogenous depression- i.e. depression due to circumstances external to the individual experiencing the depression- in a setting of a situation that the depressed individual has no real significant control over. In turn, that initiating event/condition may set off a series of internal events that essentially lead to endogenous depression….which….may even persists even after the conditions that initiated the exogenous depression are long gone much like a post traumatic depression syndrome (a.k.a. burnout). With regards to physicians, that profession in and of itself is noted to have up to five times the rate of depression, etc. when compared to the general population; however, of note that statistic was formulated based on physicians working in a socialistic medical system in the U.K. It has been my distinct observation that certain specialties have had a marked increase in dissatisfaction with their status especially over the last forty years. Many a retired previously happy family practitioner doc has confided to me as to why they quite early; most, if not all of these statements, distinctly correlate with the progressive invasion of third party control with the demand by that third party of increasing random access to the doctor’s time and with no reimbursement for the doctor’s time. It is disruptive of a busy schedule to say the least. After working under many settings, hospitals, large groups, solo practice, small practice, administrative medicine….I have found recurrent themes of rational, valid reasons for what are the conditions that have led to what I would term is exogenous depression that may/may not include physician suicide and/or physician burnout. These recurrent themes have been essentially an invasion into the doctor’s time, almost always on a non reimbursable basis as the disrupting individuals of the doctor’s time are often either paid by the hour to disrupt the doctor’s time or do not have to pay anything for disrupting the doctor’s time…..and I am not talking about emergency calls, etc. but even so, those events should be a reimbursable event and the affected doctor can chose to accept it as such or not. Patient’s and staff have not uncommonly contacted doctors in their so-called off time….which is really an invasion of personal time that one often shares with friends and/or family….the individuals that really ultimatley make life worth living for…..often for matters that are not really urgent/emergent….and if so, should not be handled over the phone anyway…as one should be calling 911 if emergent, etc. This flagrant disregard is most prominent with physicians that are salaried. A salaried physician has essentially agreed to be the employee of an employer on a 24/7 basis. So, with that unfettered, non reimbursed access one not uncommonly gets silly calls such as Ms. Jones in room 214 has constipation (even though there are standing orders in place to address such concerns) …or…one can even spend hours playing marriage counselor to a frustrated spouse of a patient….over the phone…non reimbursed. So, first and foremost is the distinctive disregard of the patient’s personal non reimbursable work time which when combined with a third party pay mentality, salaried (i.e. not paid by the hour) and all in a culture now steeped in entitlement….is the evil triad cluster flock that makes one finally realize that after all of these years of training, dedication, etc. that one has simply become a public serf. I know of many “great professionals” whose professional life is of utmost respect….but there personal life is marked by much tragedy….much more so than is commonly seen in households which treasure and protect their personal time. Second, is the fact that physicians often have become nothing more than a human shield in that they are often held liable for (not scientifically causative of) ….processes that are controlled by another individual…but the same individual controlling the process is not responsible for the process that they are controlling (i.e. a tyrant). Unfortunately, the misapplication of ERISA to health care by the thankfully now deceased President “I’m not a crook” tricky dick Nixon codified this tyranny into law. (However, even Dr. Martin Luther King wisely pointed out that “Everything Hitler did was legal”…..definitely immoral….but unfortunately legal in that jurisdiction). The civil court system, with regards to malpractice has little if any interest in seeking truth…i.e. scientific causality used to determine liability….and justice….i.e liability, if so then determined via scientific, not civil probability, ……….then judgement rendered is based on certified life care planning to determine the actual incurred cost of care, including counseling and/or chronic pain management, if applicable….as opposed to the open, ended subjective pain and suffering awards. (In early 2013, there was an actual award of 120 million dollars in a malpractice case in NYNY…incredible!). Add to all this the fact that physicians have different views on things as they have had more exposure to death and morbidity as compared to the general public. It is not an uncommon reason that people in the medical field often marry other people in the medical field as it is a unique subculture in and of itself. A provider’s anxious but appropriate response to a potential significant problem may not be equally appreciated by friends and/or family who are not of that distinctive subculture. Furthermore, as provider’s deal with morbidity and mortality….or for some just the fear of aging…..these are all matters than many in the general population would prefer “not to think of” until they have to. So, to a cheery inexperienced non medical person a casual conversation at a cafe can be a real downer for them. Even more so there is much envy in this society….which has become increasingly socialized as one hears the polite looter’s battle slogan of such things as “income equality” as though individuals who study long and hard, work hard, should somehow be paid equally to others whose demands of their profession are frankly far less than those of physicians; this legitimized tactic of envy is unfortunately even further accelerated by the mere fact that physicians are a voting minority. So, the crowd with the most votes wins….but not really…. ultimately. So, what’s a poor sod to do when one comes to the unavoidable realization of what one has allowed/tolerated what has been done to and/or become of….one’s profession? For starters, try saying “N-O”…practice it daily in front of a mirror if you have to. Avoid working under salaried conditions. You may have the allure of the promise of a “regular” income….but a reality check should honestly answer the questions…WHAT IS MY NET, AFTER TAX, NOT GROSS, TAKE HOME PAY AND HOW MANY HOURS DID I HAVE TO WORK TO GET THAT? I had an old professional friend in Canada….who as the progressive, socialistic taxation increased…..finally realized that by working five days a week…he was essentially a slave. He finally was able to pin down what I term is the “financial rape point”…i.e. the point at which out of every dollar one earns little is kept….and ultimately worked just two days a week. Rather than being a slave the remaining three days a week….he chose to pursue other events that he enjoyed with family and friends. Consider it. Do not be shamed by administrators or others. You should have no guilt for realizing that you actually have a right to your life. If you want to devote yourself 24/7 and that makes you happy…then go for it. But if it doesn’t that realization does not make you a bad person (even though you might be viewed as a disappointment to those who would knowingly/unknowingly prefer to enslave/indenture/loot from you. It simply means that you are not Mother Theresa (note that she had no family of her own) and that is quite OK not to be. The human shield exposure/demoralization upon realization that one is quite often simply a liability shield for a tyrant requires some additional, intelligent counter strategies to combat. Please note that some of these tyrants outwardly might appear and superficially act like very well mannered polite individuals……but their true nature will often be revealed when one has to work underneath them……they want control of a process…..but not responsibility for controlling that process….and worse…sometimes they want another individual to be responsible for the process the tyrant controls (a.k.a. patsy/fall guy). READ WHAT YOU SIGN INCLUDING THE FINE PRINT….IF STILL CONFUSING, AMBIGUOUS, CONTRADICTORY, NOT MEASURABLE AND/OR NOT ENFORCEABLE….THEN ASK FOR A REVISION TO MAKE IT SO…..IF NOT SO REVISED AND IF THREATENED IN ANY MANNER OR FORM…SIGN WITH THE NOTATION “WITH DURESS” BY YOUR SIGNATURE OR WALK AWAY. Consider, if you can requiring that your patients and/or potential patients sign an arbitration agreement with you as requirement to continue to see you or to become a patient of yours. The point is to think clearly of your options…use them…respond creatively…..say no if need be….guard your personal time if you want to…..do not become a serf willingly unless you want to (and make sure your motivation is not from some unresolved childhood issue or being raised in a guilt laden culture synonymous with the concept of original sin, etc.). So, reclaim your destiny as much as you can. Clearly delineate control responsibility loops (which clearly mark the boundaries of accountability). If you have feelings of guilt/shame try taking some assertiveness training if you need to….unless you enjoy feeling that way (and I am not referring to a sense of guilt for processes that you truly control and are, therefore, responsible for). Even if a physician has primarily what would classically be called endogenous depression….it can only help his/her primary condition if the factors causing the secondary exogenous depression are modified, preferably in a manner base upon reason and accountability.

    • Pamela Wible MD says:

      Nice summary!

      Good point:
      These recurrent themes have been essentially an invasion into the doctor’s time, almost always on a non reimbursable basis as the disrupting individuals of the doctor’s time are often either paid by the hour to disrupt the doctor’s time or do not have to pay anything for disrupting the doctor’s time

      In regards to working as a slave: At my favorite factory job, I had 74% overhead which meant that I worked 143 days per year for free and saw 4004 patients per year for free (NO PAY) just to pay overhead.

      Pamela

  2. bursztynMD says:

    Why physicians get burned out? They are HUMAN. One day, whatever it is that causes their suffering suddenly exceeds their ability to cope. That feeling that you have had enough may start small and then slowly grow, or just hit you like a rock wall one day. Everybody is different, and we all have our own, unique resiliency; but there is a limit for every human on how much one can take. Whatever it is that hurts you, being either assembly line medicine, lack of respect, relentless pace or stress of not being able to meet patient/administrator/society mislead expectations, it will eventually hunt you down and get you, given enough time. Some of us are long time survivors, and it takes years before we lose this race. To add to insanity, physician are taught to “tough it out” and push aside their pain, fatigue, depression etc. and be “do it all”, never fail superhumans. Just like the notion that physicians somehow may be trained to get used to chronic sleep deprivation (I tried many times, but my body keeps winning each time and somehow my endurance in this game shrinks as I get older). The problem is, I had never met superhuman, physician or not in person in this life and I suspect it is because they do not exist except on TV. Yet people do expect physicians never be sick, never feel the effects of sleep deprivation, never make mistake and so the list of craziness goes on. Physicians have exactly the same physiology as everybody else and no amount of training will change it. It is possible to develop personality traits and mental toughness to be able tolerate exposure to pain/suffering, relentless pace etc. better, but there is always a limit when both flesh and spirit get run down and exhausted. I cannot count how many times I got burned out, then got myself together, like Phoenix from ashes, only to jump into well of craziness again and loose, recover and … get back again. Why did I do this over and over without even second thought of how crazy this is? For honor and glory? (Not money for sure, given the hours and difficulty of the job it is a joke). I was born with such personality that it is in my very nature to heal others; the need to do so is just as strong as the need to breathe every day.
    Many others practicing medicine were born this way. Such gift makes a person prone to give away to others more that it can be safely given away. I was taught over the years that it is my responsibility to survive whatever comes my way because I am the physician and the only important thing in my life is taking care of patients. So I became “the survivor”, with long hours of full time practice, frequent calls, heavy patient load, drenched in forms and phone calls every day, only to rush to to pick up my children from school by 5 pm and then have patients calling me at home in evenings when I was desperately attempting to take care of my kids and answer phone calls from patients at the same time. It was not a life, and I cannot call it hell, but it was at least purgatory.
    One day, however, suddenly as lightning strike, things changed. It took 3rd, this time unplanned pregnancy. I remember one day I was alone at home, and, looking at my pregnant belly I sat down and the though hit me like a stone wall: “I cannot do this anymore”. It was one of this moments of perfect clarity that it occurred to me that I am running a crazy, insane, idiotic race I cannot ever win or benefit from, followed by instant second thought: “what a bunch of c…p this is!”. Why do I continue this martyrdom getting myself burnout, then trying to recover on vacation just to get burned out again? Regardless of the expectations society has for physicians, I could not “tough it out”, my body did not get used to sleep deprivation and each burn out left me feel like I lost piece of myself and it never came back to me. This very moment, I simply did not care anymore about expectations of others . Let them try my job for 1 month; they will be running away seeking the earliest available appointment for PTSD counseling.
    Later, I quit my position and switched to part time, and it helped immensely. My joy came back, my health improved. Now I am back to full time job, but with limited hours and no calls and much smaller patient load; there is a balance in my life. I no longer think I should be cooking pizza instead of treating my patients. Bottom line is this: this it is my life and it belongs to me and people I love. It is the same for you.

    • Pamela Wible MD says:

      Yes. It is true. Physicians can NOT be victims and healers at the same time. We must first do not harm to ourselves. Thank you for being courageous enough to stop the insanity and practice in alignment with your values.

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