You’re not burned out. You’ve been abused.

Please stop using the word burnout. You’re 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 screwed 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? 

Victim blaming and shaming, bullying and hazing, all lead to increased suicides.

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? Abused medical students become abused doctors who may one day abuse patients. Human rights abuses are commonplace in our hospitals, clinics, and medical schools. This doctor worked 7 days in a row with almost no sleep! 

Think abuse is too strong? Read the UN Declaration of Human Rights. Countries get in big trouble for this sort of behavior. So why is it okay for our health care institutions to perpetrate human rights abuses on their own students and employees? It’s not. 

Think the doctor below is burned out? Nope. She has been ABUSED!!

Docs, stop playing nice. You are being abused.

Only you can stop this crap.

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.

Burnout blames the victim, not the perpetrator. It implies that YOU are to blame, not the system, not the perpetrators of the mistreatment.

To treat 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. Taking deep breaths will not end your abuse. 

WHAT YOU MUST DO: If you are being abused, YOU MUST LEAVE YOUR ABUSER. I know it’s scary. You are not alone. Need help with your escape? I’ll help you. Contact me

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

Grab your free guide to launching your ideal clinic here.

Please break the cycle of health care abuse that leads to suicide among doctors and poor care for patients.

Pamela Wible, M.D., founded the Ideal Medical Care Movement. She helps doctors open their ideal clinics through her popular teleseminars & retreats. When not caring for patients, she devotes her life to eradicating health care abuse. Videos by TEDMED and GeVe.

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40 comments on “You’re not burned out. You’ve been abused.
  1. LM says:

    Abused, this is correct- more like tortured. It seems to be in the medical field . I have yet to see the brothers in the fire dept treat their young the way medical and nursing schools do. Nope, you won’t see it because they go in the hot fire, they actually “go in” and need each other so they don’t burn any bridges–if that makes sense? It’s called working together for the best possible outcome of those they are trying to save. Be it fire, or a medical procedure, whatever–teamwork, respect for each other and the human body and mind. After all, the body is made up of tissue and fluid, (very fragile)

  2. Boilerrph87 says:

    This easily can be applied to any pharmacist working for any chain retail company!! Only we aren’t offered resiliency training, we’re just plain fired. The majority of pharmacists out there feel they can’t speak up because corporate chains can replace them at a moments notice with another warm body due to the glut of graduates they have helped to create by putting pressure on pharmacy schools and states to churn out more grads. Experienced pharmacists are being kicked to the curb and are now deemed nearly unemployable…yes ageism is widespread besides burnout, bullying, job intimidation, and blacklisting for future hiring. A sad state indeed.

    • Pamela Wible MD says:

      We all need to stand up for one another if we are truly healers. The abuse must stop. Silence will not save us. Thank you for your comment.

  3. yolanda valdez says:

    I was an LVN. My daughter became an RN. I was motivating my granddaughter to top her mother and become a doctor. After watching all these videos, I am not so sure anymore. I will let her decide on her own. I have however forwarded it to both my daughter and granddaughter so that they have a better understanding of the whole medical field. We all need to be more compassionate with our doctors.

    • Pamela Wible MD says:

      It is still a wonderful profession though we need to stand up and speak out against the abuse that has been so entrenched for centuries in our training. Mental health services for all would go a long way to heal our gaping wounds. We need to end the victim blaming and shaming culture for the good of all.

  4. mj says:

    After 20 years post residency if I could do it all over again I would.
    there’s a lot of traps out there that we walk into. Trap # 1 high debt load for college and then med school. Trap #2… listening to a real estate agent talk about how much house” you can afford.” Trap # 3.. buying a nice car and. nicely decorating your house putting yourself further into debt. trap # 4. Working too many hours to pay for the above mistakes. That leads to exhaustion , self neglect, spouse neglect. It’s very easy to abuse yourself or to get abused by others when we need to pay off debts.

  5. I have been rather amazed at the labels and reasons I have encountered since I began receiving updates from your ‘movement’ Dr. Wible. I began comparing attitudes of Physicians, Residents, and Medical Students today with those of these same groups at the time I went through Medical Training in the mid 1970’s. What a difference 40 years has made. Here is what I see. 1. Physician Suicide was even then approximately double that of the general population, and that ratio has not changed. What has changed is that suicide in both Physicians and the general population has increased 10 fold in the past 40 years. 2. Attitudes toward work, stress, substance abuse, and nearly every aspect of life have changed significantly in that period of time. Hours on duty and workload restrictions for Residents of nearly every Specialty have been restricted in the belief that this would reduce stress and burnout (or Abuse) as you are now calling it. Yet the incidence of suicide continues to increase…..hmmmm.

    My Medical School Class was as diverse as any today, yet nearly everyone was Personality type AA. We all studied hard, worked long hours, and when the opportunity allowed, played just as hard. We were a cohesive group and supported one another in every way. This ethic was just as prevalent, if not more so during my Residency years. Here I must fast forward a bit or we will be here forever. What I am seeing at the end of my own career is Doctors coming out of training who want to begin at the top of everything without working for it, Residents who cannot show up in time to relieve those who are waiting to go home, and (this is not firsthand, since I do not practice in an Academic Setting) Students who do not show up on time for rounds, are not prepared, have no regard for dress codes, and expect to get off early. I’m sorry, I just do not get it!!

    This is no attempt to belittle the huge tragedy of the loss by so many Physicians and Physicians in Training. You have a huge task to tackle. I do, however, have to very seriously question this theory of Healthcare Abuse. Perhaps someone should look at the issue from the beginning as well as trying to fix it when it has already begun to break down.

    I have to believe that a great many of these losses are due to a lack of preparedness to work in Medicine. Perhaps some sort of psychological screening evaluation prior to even beginning a premedical program should be devised. Another concept would be to require a period of service either in the Military, or even a minimum of 2 years in the Peace Corps before being allowed to begin premedical training. This may be a more effective decision making tool for aspiring Physicians than anyone realizes.

    Anyway, I wish you the best in your endeavors. PLEASE stop referring to us (Physicians) as VICTIMS. There are already far too many groups claiming Victim Status already. Anyone can stop the Bus at any corner on any given day and get off. They only need to pull the cord. Jumping from the top of the Hospital is NOT necessary.

    • Pamela Wible MD says:

      Thanks Calvin for the insight from your perspective. There have been some changes in the last 40 years! A few items worth noting in response to your comments:

      1) Work hour restrictions are not enforced at many/most programs so in effect residents/students are still working 100+ hours week (they are just not allowed to write their true work hours down on their time cards).

      2) There is more isolation and less cohesion among many students today. The pressures are greater now (average debt load is insane – I graduated with 22K debt and med students now may have close to 400K). Also the nurse who worked with me in my family medicine clinic during residency reported that residents saw 8 pts/half day 30 years ago and that has steadily increased throughout the years. Now 14+ per half day. I think we could have some sympathy for those with unique stresses that did not exist in our day.

      3) Health care abuse has been so entrenched that it is hard for those to recognize as abuse. Yet when you watch the 2 videos in this article would you not agree that those doctors were placed in situations that were inhumane for them and their patients? Ideal medical care can not be delivered in 7-minute increments and on 168-hour shifts.

      4) I do think some psychological screening and transparency as to the risks involved in a medical education should be revealed to applicants before they find themselves suffering with suicidal thoughts and 300K+ debt. It’s called informed consent.

      5) What other term would be better than victim? Casualty? Martyr? I’m open to other ideas.

      • Pamela,

        You also make some good points that I did not take into account in my comments. I did get a chuckle over the ‘time card’ comment. We never heard of them. We just went home or to bed when everything was finished.

        The debt issue is very significant and I believe that most students without Family Fortunes or big Scholarships (which are few) are pretty much clueless about what they are going to have to pay back. Perhaps just showing them what the payback on a $20,000 car amounts to and have them do the math before committing might be a bit of a wake-up.

        The patients per hour issue certainly does not lend itself to good care, and I agree that the burden of increasing numbers of patients is not a healthy way to learn, nor is it a healthy way to practice, yet due to our entitled population and altruistic society and government, it is reality, is not going to go away, will only get worse, and your input into the lives of Residents and Doctors will be ever more necessary.

        I think that besides trying to inform those who are already have one foot ensnared in the trap, you must take your message to those who have not yet gotten on the merry go round. If they get on anyway, they will at least do so with the knowledge that the Gators are hungry and a 100 year drought is beginning. Not legally ‘informed consent’, but close.

        I am not certain what term would be proper, but I have a very difficult time with ‘victim’ in our current world. It has become too much of a status everyone wants bestowed on them.

        • Pamela Wible MD says:

          Agree. I prefer words that have not been overused. Need a good synonym. Let’s scour the thesaurus. Let me know if you find an alternative. While you’re at it, I need a new title for our documentary on physician suicide. “Do No Harm” is also overused. Prefer something more original and captivating. http://www.donoharmfilm.com View the film trailer if you’ve not seen it Calvin. Love to know your thoughts.

        • Sue milroy says:

          Thank you Calvin. You have informed comments regarding your own experience. Many expert doctors aren’t type AA, which provides help to patients who are not type AA either. Medicine is a wonderfully rich career. It’s just hard to appreciate that aspect after working 100 plus hours a week with little food or emotional sustenance sometimes. My experience aged 24 was that sometimes I didn’t have time to evacuate my bowels before being called to hold a ladies leg during hip surgery for 6 hours. I don’t think this is right or fair. We are not at war with our patients or our profession. Also, I don’t think the lady who’s hip I was holding for surgery would Have been too happy if I had flooded the area with a spray of E. coli.
          Kind regards,
          Sue

  6. I think you are absolutely right, Dr. Wible. And this applies to nurses too. Disrespect has many many forms and when attached to a power dynamic it IS abuse. It is pandemic in Healthcare! The work we do should be supported in our organizations and in society at large. It is a shame that people who work so hard to develop skills, expertise, and judgement would ever be treated so poorly. In nursing we see it show up in chronic understaffing, high incidence of workplace injuries and bullying behavior, turnover, and what is called ‘burnout’!

    Thank you for making point so clearly.

    • Pamela Wible MD says:

      The healthcare cycle of abuse must be stopped. Step one is to inform the victims of their abuse and abusers. Many in health care are clueless about this abuse. Some even defend it as a rite of passage. Time to get up to speed. This is 2016. Let’s break out of the dark ages in medical training and create a safe haven for all of us to heal. Please see this: http://www.idealmedicalcare.org/blog/how-to-grow-a-happy-doctor/ and specifically: “Advocate for humane treatment of attendings. So many docs have Stockholm syndrome, and see themselves as strong and capable, while seeing med students as whiny lazy kids who need to grow thicker skin. They need to be cared for and educated so that they see themselves as survivors of abuse—and empowered to break the cycle of abuse.”

    • Ema says:

      Beth, I was hoping an RN would comment on this. I came across Dr. Wibble’s article and found it so familiar. Number one bc my husband is a doctor, number two bc I’m a nurse and have felt the same way about the lack of empathy that is so common in this field. If you try to voice your concerns you are seem as a threat. You are intimidated and retaliated against. You are expected to practice in a very unsafe workflow. Patients are counting on you, families are counting on you. Everything needs to go by the nurse in order to happen. You are bulldozed by people who are just as tired and frustrated as you are. The tasks we are expected to accomplish just keep piling up and taking us further away from hands on patient care and teaching. Money wise nursing total up to slavery if you think of how much we make per patient for example. Electronic charting just turned against us because someone else is making a living on running reports and percentages and defining good nursing so far away from the hallways we stand on for 12 plus hous.

  7. Anonymous hell says:

    First , I want to thank you for speaking up for all doctor’s and providers being abused. My story was so horrific, I thought only I could have endured this. I like many in healthcare wanted to provide great care to my patients and people. Having grown up with a single mom in NYC , I knew very well the public hospital system. I promised myself when I grow up I wanted to serve the underserved communities I had grown up in. I graduated from college with Honors ,got married and found the dream job I had wanted all my life. My patients loved me and I loved medicine so much so that I thought it was unfair to get paid for what I loved. My story took a sudden unexpected turn when i got a new supervisor who would make hiddenly disgusting racist, unethical comments about the mostly minority uneducated patients we took care of. They were disgusting remarks made daily in the on-call room about minority patients, residents, and even attendings. In the beginning, I didn’t know what to say other than step out of the room in disgust. I even tried to ignore her by justifying her as just ignorant but it got worse more physicians joining her and ridiculing the patients I had sworn to protect. I was soon outcasted for not belonging to her group. I felt so alone. I had just bought an apartment in NYC by myself so I needed the financial security. It got so bad with my supervisor picking on me daily, I went from eager to work to barely wanting to go to work became very depressed even considered suicide it was torture. Finally, I got advice from an Employement Empowerment Association and was told to get help and how to report it to administrators in a more professional way. Yes, I made mistakes in my handling this but out of the things I thought I had to learn in school, how to handle this with a supervisor was not one of them. I finally went to administrators but she denied all she was saying and to my surprise after 7 years of great service they protected and believed her. She took pleasure in her denial and even torturing me more but I was alone little by little my group left and the people hired did anything to ingratiate their boss. I asked for a transfer and still couldn’t prove my allegations so got nowhere. Then I was called a liar and sensitive by the administration. I couldn’t even complain about the short staffing I was being given and just wanted help to do the right thing for patients. Nothing I said mattered at this point even if covering too many patients was easily identifiable. In the end, I complained and the hospital administrators just said it was my word versus hers and no one else was speaking up except a social worker who had reported her comments but gotten transferred out of the department. I ended recording her comments to prove my story and end this nightmare. In NYS it is permissible to record as long as you are present and I made sure not to record patient information just her comments. Even with her voice administration chose to do nothing just chastise me and even more strongly ignore the obvious. Maybe they were afraid of a lawsuit but in the end so much more could have been done by them. I was attacked and threatened for having dared to bring administrators the proof I needed to make my case,all just failed. I called the Dept of health and was told as long as no patient was physically hurt nothing could be done, it was a legal or employment issue. I even sent my hundred of hours of recording to attorney’s general’s office so someone could do something but there wasn’t money or menace obviously involved, she got away this just wasn’t important enough to anyone except my friends and family. Patients being called pieces of shit, losers. worthless was not bad enough to put an end to this individual. I tried everything even took my recordings to the dept of human rights to be told her comments about AA patients I couldn’t do anything because I wasn’t African and there were too many comments about gays , seniors, mentally handicapped , Mexican patients which made her an equal opportunity racist, therefore, not illegal just disgusting. I was left disappointed with medicine, left my job and never want to work in healthcare ever again after experiencing such a failure of administration and the organizations that are supposed to have stopped this. I was majorly disappointed in the lack of care for me a good provider who really cared and just wanted this to be acknowledged and stopped. My supervisor got a raise and is still there. I was told by administration never to release to the public the recordings or risk being sued for breaking the laws that are supposed to protect patient privacy, not racists. Sad it’s been years and I will never forget what I heard or endured and the lack of kindness anyone had for me trying to stand up alone against a smart but disturbed individual.

  8. JYP says:

    I graduated from psychiatry residency 1.5 years ago, and working in community mental health clinic. I feel bad but feel very overwhelmed because we only get 20min med checks, stacked back to back without any break (unpaid lunch hour which is only relief!) and we get berated from the admin for not seeing enough patients, and get quarterly letter from the CEO just to let us know what our efficiency score is, and that we get ‘zero’ bonus. I am seeing very ill and impoverished patients for serious psychiatric disorders and also providing MAT services (suboxone/methadone). I don’t know if I am being unreasonable but 20 min is not enough to see the patients for all these issues. My fellow providers here have approached the admin to get us more time – I had been enticed to come join this group with “30 min” med checks when I first started. The admin is frequently stating that we are under constraint from the higher ups etc etc.
    I have 1.5 years remaining on my contract here (I am a foreigner on a work visa)and have an app which is counting down the days till I can find a job possibly in some sort of M.D. related paper desk job. I am fearful that I am becoming a jaded, cynical doctor – no! I am normally very bubbly and hopeful indeed! thanks all for listening.

  9. JYP says:

    I am really sad and overwhelmed all the time. I am seeing very indigent patients in community psychiatric clinic for significant psychiatric illness and also for MAT services(suboxone/methadone). I brought up these concerns to the admin and they simply told me “well, some providers can do an excellent job in 20 min and other providers do a poor job in 60 min”. sheesh.

    • Pamela Wible MD says:

      What was your response? Some administrators do a crappy job their entire careers. What would be the proper response to that cop out?

      • JYP says:

        My reponse to the admin was ‘why don’t we look at overall outcomes i.e. lesser patient mortality/morbidity/hospitalizations/ER visits instead of just numbers of patients seen?” The admin (including the physician administrator) scoffed at me and told me that there is *no* evidence that spending more time with the patient leads to better outcomes. I was also told that there is such a high need for patients mental health and if we don’t get more efficient then their needs are not being met. We often get berated during monthly staff meetings that we are not doing good enough (numbers) and that we need to do more paperwork(non billable things). sometimes they will praise and applaud certain providers(i.e. NPs/PAs) who tend to just give patients often very high addictable Rx meds and are therefore popular and well liked and can see patients in 5 minutes – so easy! often these patients are in the hospital or overdose, but the admin doesn’t really care about this. Also our medical director has ‘replied all’ to the entire provider email list to berate a certain NP who had expressed concern for patient safety when the entire EMR was broken and she was not able to get any information about the patient and did not feel safe/comfortable going in there blind. there are just so many things which I cannot even convey through words, I feel sad all the time here – the culture seems to be pitting us providers against each other – no one wants to help one another …seems that there is a lot of bitterness in general 🙁 anyways, sorry for the rambling….

        • Pamela Wible MD says:

          Often the folks who “run” medical clinics have very divergent ethics than those who are caring for patients. By continuing to work for these clinics you perpetuate the cycle of abuse and the “pill mill” degradation of our profession.

          • JYP says:

            even the medical director of our MAT team is a major cause for polypharmacy, and very ‘liberal’ Rxing of benzos/sedatives to patients who are on methadone or suboxone and have problems with alcohol! often these patients end up very ill/unstable and then they are just dumped onto me to clean up the mess. I have been trying to do what I believe is the best thing for the patient – reduce suffering but not harm the patient and utilize other therapies instead of placing the patient in a helpless detached mental fog like a chemical lobotomy. I am seen as ‘the mean doctor’ here nonetheless and patients complain when I set safe/firm limits with them. I am here on a work visa and have 2 more years left, I have discussed with my immigration lawyer and it will be extremely difficult/unlikely that I will be released from my contract — the only way is if I get fired 🙁 it is my fault for signing on for 3 years.

          • Pamela Wible MD says:

            Like the “mean parent” who gives kids healthy foods instead of gummy bears all day. Oh no. You are J1-Visa. Even more abuse doled out to J1-Visas! Please extricate yourself ASAP. Don’t lose your precious life over unethical administrators.

          • Pamela Wible MD says:

            I think there are many in Chicago and other urban areas. Lots of residency positions filled with J1 Visas and they really take advantage of those folks. SAD.

        • JYP says:

          I’ve also asked about a 5 min bathroom break in the morning between patients, and the admin replied with “your break is when a patient no-shows” – sheesh.

  10. JYP says:

    Just wondering, is anyone else a non-US on a work visa here as a physician? just wanted to reach out and see if others are in similar feelings with immigration issues….

  11. Lynn Shepler MD JD says:

    As a psychiatrist, glad to see you are calling it was it is — ABUSE. I am fed up reading about “burnout”! It’s not burnout — it’s abuse?

    • Pamela Wible MD says:

      One correction Lynn (not a question mark at the end. This calls for an exclamation mark.)

      “As a psychiatrist, glad to see you are calling it was it is — ABUSE. I am fed up reading about “burnout”! It’s not burnout — it’s abuse!!!”

  12. Anne Odgers, MFT says:

    I take offense to Dr. Schuler’s previous comments. To quote him on who should apply for the practice of medicine “I have to believe that a great many of these losses are due to a lack of preparedness to work in Medicine. Perhaps some sort of psychological screening evaluation prior to even beginning a premedical program should be devised. Another concept would be to require a period of service either in the Military, or even a minimum of 2 years in the Peace Corps before being allowed to begin premedical training. This may be a more effective decision making tool for aspiring Physicians than anyone realizes.”

    Does this mean we should have people who already have PTSD from the wars in Afganistan and Iraq coming into the rigors of medical school? He seems to have no understanding of that the abuse in medical school results in PTSD. Dr. Schuler practices at Sage Memorial Hospital which is in a small town in Arizona with only 25 beds. I would not want to be a patient in that hospital ER considering his attitude toward his colleagues. I assume this attitude would be evident in the way he treats his patients.

    • Anonymous OB/GYN says:

      I completely agree with Ms. Odgers. I think that Dr. Schuler is out of touch with the reality of most of today’s physicians/care providers.

      He is probably an old white male. I’m not being racist, just a realist. He was part of the “good old boys’ club.” Everything probably WAS peachy for him. He wasn’t different. He fit along right in the mold of the patriarchy. He was “liked” probably just for being a white male. I’m not saying that there aren’t really compassionate, smart, kind, and competent white male doctors, but they do not have any idea what everyone else has been through.

      He didn’t have to deal with having to have a period, be pregnant, breastfeed, cook, take care of a house/husband/kids, & work 100+ hours in a week. He probably had a girlfriend/wife doing all of those other things for him! He didn’t deal with sexual harassment or punishment for refusing to date his senior residents/attendings. How about being called a “nurse” by the patients because of his gender? He doesn’t get it.

      I think a lot of older physicians have completely forgotten/blocked out how hard their residencies were. Time tends to make you forget and minimize things. Trauma also tends to help you forget – coping mechanism!!!!

      And considering how little these older physicians had to spend to pay for med school, they have NO concept of the kind of debt that physicians who are recent graduates have had to take on. In addition, the regulatory burdens and terrible reimbursement have not helped the situation.

      I don’t care that they had “unlimited” work hours. I was in residency just after the 80 hour work week rule started, but I also started residency 1 year before the rule limiting interns/1st year residents to 16 hr days instead of 24+ like the rest of us. It was still hell to have to work 24 hours some days with no breaks. I was literally dead on my feet. I would suffer terrible migraines from sleep deprivation and hypoglycemia from not being given any breaks to eat. I would have loved to have tested my creatinine after not drinking for 16+ hours. Don’t worry about bathroom breaks – you don’t get to drink anything, so there isn’t anything to urinate.

      When the old timers got out of med school, they had very little debt, little regulatory oversight, were paid VERY well, well-respected in the community, and had very good quality of life off the bat. It isn’t like that anymore. Physicians have been completely devalued.

      There were few administrators breathing down your neck telling you how poor your “efficiency” is that you can’t see 4+ patients in 1 hour. Not to mention the documentation burdens. I have SEEN the charts of those “old school” docs. It is woefully inadequate charting. You are lucky if you have more than 3 lines of (illegible) words on the page. And they bill for a full visit for that. Sure, I could see 6+ patients/hour if I didn’t document anything either!!!! You can’t get away with that anymore.

      The poor nurses are stuck after a 12 hour shift charting for an additional 1-3 hours because it was too busy to complete all of the ridiculous charting requirements they have to do while ACTUALLY caring for patients! It would be too dangerous!

      It is unfair to compare that time in history with today’s day & age.

      Anyways, yes, I do think that the medical profession is brutal and inhumane. I think healthcare providers are extremely brave and altruistic people who don’t want to complain. They are trying to solve problems, not become one. They do not want to burden others with their problems.

      No one is looking out for the providers. Everyone assumes “He/she is a professional….they should take care of it on their own.” No. No one can take care of everything on one’s own. It is UNFAIR to dehumanize healthcare providers like that. No one would ever shame a patient complaining of chest pain for coming to the hospital for help. Why should we shame healthcare providers for feeling overwhelmed/depressed/exhausted? It is a dangerous double-standard.

      Also, I’ve witnessed belittling, bullying, gossiping, and generally abusive behavior among healthcare providers from the attendings to the nurses to the administrators. The abusive behavior causes so much shame & isolation that the victims turn their blame inward. Their moods suffer. Depression/anxiety/PTSD ensue. Empathy tanks. They can’t relate to patients anymore. Some of these providers are suffering more than the patients they are treating!!!!

      These “walking wounded” can’t ask for help. They will be singled out, stigmatized, and punished. Their “competency” is questioned. God forbid they have actual human emotions & feelings. They suffer in silence. It is terrible. As for just “quitting” as Dr. Schuler alludes to – that is extremely naive. How are these doctors going to afford to repay their debts once they quit? My student loan repayment is a $2000/mo (and I only had $200k in debt). Where are these doctors supposed to live? Rent is expensive! Are these docs not supposed to eat? How about affording health insurance? What are these docs qualified to do if not practice medicine?

      I’ve experienced it firsthand. I gave up my 20s to a profession that is dying by attrition & self-sabotage. I truly don’t want to practice medicine anymore. It isn’t worth losing my humanity.

  13. anon says:

    Nurses are treated the same way as the docs in these videos. Back-to-back doubles, no sleep, no food, no bathroom breaks, never sit down. Once an RN goes onto a unit she can’t leave unless there is someone to relieve her. That is ‘patient abandonment.’ It is a good law, intended to protect pts but administrators use it to abuse staff. No need to staff the next shift when you have a captive nurse who can’t leave! There is no reason for it except administrators want to save money by short-staffing and abusing anyone who speaks out. They get bonuses for not spending on necessary supplies and staff. I have seen so many horrendous things it would take 10 thick books to tell half of it. I mostly worked in nursing homes and psych facilities as I was older when I got my RN, and those were the jobs open to me. I think it is no secret those are not good places to work or be a patient but neither are hospitals. Two of the more horrible pt events I saw were both related to pts being denied pain meds. The drug war is really a war on patients. In the first instance, I received a middle-aged lady dying of bowel CA on Saturday afternoon (I worked 3-11) Her recent abdominal surgery wound had dehisced and was squirting volumes of fluids all over every time she moved–she moved a lot because she was screaming and squirming and we had to change her soaked sheets constantly, until we ran out of linens, ABD pads and towels. Her family was there, weeping, begging me to get her morphine. I had some Roxanol on my cart for another patient but recent rules prevented me from borrowing another pt’s pain meds even if I had an order for this pt, which I didn’t. We tried to call the house doctor (the only doc in nursing homes, no attendings, etc) but it was a weekend. He was never in his office on a weekend, and a junior doctor was in charge who was afraid to prescribe. The supervisor finally gave up and said ‘we’ll have to wait until Monday when Dr. so&so comes back.’ Of course, you can guess the ending to this tale. That poor lady died before Monday. Next case and the one that drove me out of nursing. I made the mistake of moving down South where healthcare gets worse for every mile south of the Mason-Dixon Line. This was a state where gay people were really despised. It was my first day on the job. After caring for 40 pts I had never seen before, the lone nurse at the other end of the unit, informed me he felt too sick to stay, had pneumonia and was going to the hospital. So, I started on his 40 pts at 11 pm, after working 3-11. The state had been investigating this place for a month and the institution tried to cover up their short staffing by making the nurses work until they all had pneumonia. The aides would do no work. They sat and laughed, so nurses were doing their work too. On the schedule, the administrators had written in staff names of people who didn’t exist to make it appear they were appropriately staffed. So…I started out on my rounds, and almost immediately found a young man begging for pain medicine and help. I went in to see what his problem was. He was dying of HIV and looked like a skeleton. He was too weak to get up to go to the bathroom and every container he could reach, coffee cups, waste can, etc. was filled with stale urine, as were his linens which were glued to him. He had morphine shots ordered but none had been given in days. I had not seen an HIV pt in that condition in years–this was 2006, long after most people were getting meds but they didn’t get them in that state if they were poor. Well, I could go on and on. I tried to report that to the state, and met with nothing but trouble. Any nurse who reports pt abuse will lose her license and that is used as a big stick to keep nurses quiet. I never saw a pt intentionally injured. It was all neglect of this sort. Nurses have no say in anything and I worked in venues where doctors rarely showed up, indeed, were only required to appear once a month to sign forms. Even if I led them by the hand–which I have done-they would not see a patient. I know they see thousands of pts in nursing homes, at around .25 a head, (Medicaid) in a lump sum–a young doctor told me that, so it’s no surprise. But what is the solution to all this? One big reason nothing is done is that it is kept secret.

    • Pamela Wible MD says:

      Thank YOU for sharing this. We should all be documenting these human rights abuses. It’s beyond cruel. Almost unbelievable. Yet so commonplace.

  14. NeuroMD94 says:

    I went through medical school and then training in the 1990’s. We worked 100 hour weeks and often on call every other night. I also was able to have 2 children and breastfeed both through the experience thanks to my fantastic colleagues, including nurses, who gave me the few minutes throughout my shift to go pump. I was at a huge academic center and we were extremely busy. All in all, I loved most of it. But I think several factors contributed to that. Good friends in my school and training programs, a husband who went through the same process 4 years ahead of me (yes, I lived through that too), minimal debt and the idea that we weren’t working for the sole reason of having tons of money. All of those factors have made our lives as a two doctor family possible.
    I learned a lot just from absorbing knowledge from my husband and his friends, talking cases. This prepared me for how to think like a doctor. The staff supervising our residency were surprisingly progressive, not in limiting hours, but in allowing me to have my children and supporting me through any decisions I made in this regard. Residency is hard. But we worked together, as a team and got the work done. We also learned fast that nurses are your best friend, if you treat them right! Respect for your ancillary staff, whether it’s nurses who are most like you or the secretaries or the folks cleaning the rooms goes a long way towards making your life easier.
    And now, we are both able to have physician jobs that allow us reasonable hours so we can be off with children or together. We have more than enough to be safe and happy but aren’t tied to working for the money.
    I think, based on the doctors and nurses I have known who have committed suicide, that it often is because of something else in their life. With one doc, it was because he was the classic overachiever that had never failed at anything and was suddenly in an Ivy League Hospital residency and up against the best and brightest and met people as smart as he was. The most recent nurse I knew had many outside issues and work facilitated his suicide in that he had access to meds but he ultimately would have done it anyway.
    Medicine is mostly high pressure and little care for those in it (whether their problem is mental health or physical health). We expect to just deal with it, and others put that pressure on us as well. How many of us has gone to a doctor for a physical ailment and been given minimal instructions because they assume we already know it.
    I think the medical field is fraught with examples of this sort of thing. And once you are out in practice, there are insurance companies to fight with. Or lawyers if you blink the wrong way. So, it is demanding. For instance, I can see (as more and more regulations pass) things like the issue of prescribing or not prescribing pain meds to a dying patient being a legal issue. The current recommendations from the CDC are clear about how they are to be prescribed, but I bet that lawyers are chomping at the bit to go after the doc that prescribes too much or the one that prescribes too little.
    That’s the issue with medicine, at least once you are out. You are often caught between a rock and a hard place. You might want to do the best for the patient but there are 50 roadblocks in your way.
    As much as I love the mystery of each individual I have the benefit of seeing, it is becoming a more and more frustrating career choice for our best and brightest.

  15. Judith Vance says:

    My managing VP was hostile, abusing and a bully. I paid her salary and overhead with 5level visits. Worked 60 hrs, paid for 30. Burned out me and my RD partner. Both of us left. Neither wants to practice again. Now I’m found my niche and have a mission to prevent unnecessary surgeries. Have to take boards again as they ran our while I’ve been on disability related to MVA, fatigue and pain med use related to that position.

    • Pamela Wible MD says:

      Glad you pulled yourself out of that shenanigan.Too many docs being abused by their employers. Then patients get the crappiest service from the most distressed docs. And we call that “health care” in the USA. What a joke.

  16. Anonymous says:

    Thank you for your very informative and on-point article. I am a medical social worker employed by a large healthcare organization and many of the issues you touched-upon also apply to us. We are also abused on a regular basis. Impossibly large caseloads, no bathroom/lunch breaks (meetings often scheduled during lunch), verbally abusive managers, corporate robots whose only concern is lowering the length of stay. Nurses in my department are paid more and treated better than we are. We now work shifts (but are salaried), holidays, weekends, and are on-call at night. There is no pay differential provided to us for this work. And, if we are called-in at night, we still must report to work @ 8AM in the morning. If we dare to complain, we are written-up and targeted by management. Many of our more experienced social workers have quit and we are left with new grads who stay for 1-2 yrs and then move-on. Those of us who cannot afford to quit have to stay quiet and take the abuse, or risk being either bullied or fired. Administration simply does not care about their employees, only their bottom line – getting patients out of the hospital, keeping the LOS down, and receiving their year-end bonuses for a job well-done. I have been in healthcare for 30 yrs and cannot wrap my head around the changes that have occurred since I started in the field. I did start-out as an intelligent, inspired, compassionate individual, but have become quite cynical, unhappy, and just try to get-through each day as best I can and practice self-care whenever possible. I am grateful to our hospitalists who seem to be cognizant of our situation and are very respectful and kind to the social workers!

    • Pamela Wible MD says:

      The very predictable result of allowing people with very divergent ethics from us in leadership positions. Human rights abuses in our hospitals and clinics are serious. Perpetrators need to be punished. Stand up. Speak out. Silence will not save us. By being complicit as a victim you support the infrastructure that injures so many including yourself.

  17. Pamela Wible MD says:

    Just got this email:”I married my husband his first year of residency, and the difficult time I watched him and his fellow residents go through was heartbreaking. There were 17 residents, 13 of them married or engaged; not one lasted including our marriage. We divorced and after three years, reconnected and have been remarried for six years. We were one of the lucky ones.”

  18. Great post Pamela. Abuse is certainly a commonality and not unique to any one industry. The more people stand up to it, the better it will be heard.

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