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Telemedicine Tips & Tricks →

Start your telemedicine clinic—today. Whether you’re a med student, resident, physician, or nurse—you can use telehealth to share your expertise now—and get paid. No need to sit through another committee meeting or ask for permission. View video or download MP3 for details.

In today’s podcast/video you will learn how to:

* Practice telemedicine without any special platform—just your cell phone (or landline).

* Collect credit card payments or insurance reimbursement.

* Decrease your overhead to < 10%—(even 2 or 3%).

* Launch your clinic for just $627. Here’s how I did it.

* Save 86% on your malpractice premium. Instructions here.

* Host interactive group visits—and get paid.

* Work from home naked—or while breastfeeding!

* Determine your special niche and target your ideal patients.

* Discover cheapest ways to market to patients. Download 147 ways to grow your practice.

* Learn sneaky ways to do physical exams virtually.

* Leverage staff in telehealth visits (& get reimbursed by insurance)

* Practice telemedicine from anywhere in the world!

* Sing the “happy doctor” song 🙂

If you are stressed out, anxious, depressed, or even suicidal, contact Dr. Wible for free 100% confidential help 24/7.

Thanks Kendra Campbell, MD & Kerry Traugott, DNP for your wisdom.

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Physician trauma during a pandemic →

Video, audio, and downloadable MP3 above. Very brief, highly-edited text below:

I’ve heard firsthand the suffering of physicians during the past 8 years while running a free suicide helpline for doctors. Some experience trauma predating medical training. All experience trauma during medical education or in our daily lives as physicians. Few have emotional resources to cope with trauma. This podcast & video offer specific skills to prevent retraumautization during a pandemic.

A brief summary of how we respond to trauma:

RETRAUMATIZATION DURING A PANDEMIC

Negative effects of trauma:
Hypervigilance
Flashbacks/flooding/intrusive thoughts (PTSD)/dissociation
Insecurity
Emotional instability
Distorted beliefs

Positive effects of trauma:
Heightened intuition
High emotional IQ
Processing and integration of past events
Increased belief in self
Improved self-confidence & independence

TYPES OF TRIGGERS & PTSD DISRUPTORS

Triggers can be physical, emotional, sensory (sights, sounds, smell), relational emotional response, an activated memory. You might feel that you are revisiting a familiar place (dimly-lit narrow hallway) or may smell a perfume that transports you back to a traumatic scene.

Disruptors allow you to remain present in your body and avoid dissociation. Be self-protective. Avoid catastrophizing. Physically move so you can feel your body in its present state. Choose an empowering action. Don’t stay silent. Tell the truth even in a pandemic

VICARIOUS TRAUMA

Vicarious trauma is traumatization through hearing of trauma, suffering, death of patients (or participating in the care of suffering patients). Our empathic connection and visceral exposure allows our senses to fully participate in a traumatic encounter—even if we resist or think we can “handle it.”

Physicians often ask how I can deal with the suffering of so many colleagues who struggle with depression or suicidal thoughts. Here’s what has helped me. Utilize similar strategies for yourself.

1. Support groups – I’ve started several support groups for doctors and a loss survivors group for families who have lost physicians to suicide. By having a group, individuals do not feel alone and do not face the burden of caring for others alone. Avoid generic support groups. Bigger is not necessarily better. Targeted, intimate, smaller groups (<100) may be best for sharing authentic personal thoughts.

2. Pair up – Have a mastermind partner—someone with aligned vision and purpose who shares in your struggle. Create a ritual in which you contact each other daily, weekly, by text, email, dinner dates. The more you engage, the better. Though physical isolation may be necessary in a pandemic, emotional isolation is deadly (especially for physicians).

3. Share resources – Conserve your energy (so you don’t have to repeat yourself over and over again) by sharing a resource like a book or PDF that can help many people at once. For example, I wrote Physician Suicide Letters—Answered to support passively suicidal doctors (and made it a FREE audiobook here). After so many phone calls with doctors facing abuse from hazardous working conditions, I wrote Human Rights Violations in Medicine to give all my best advice in one place (rather than one-off phone calls that were less comprehensive). Predating the pandemic, many doctors were experiencing violations of their human rights—bullying, hazing, sleep deprivation—now many lack of PPE (personal protective equipment) making their working conditions more dangerous. A resident just contacted me and reports no PPE provided despite dealing with patients in isolation and leading codes on exposed patients. Resident went to Lowe’s and was given the last respirator and N95 before shift.

4. Unite – Now is the time for camaraderie. Be assertive and diplomatic when petitioning as a group for your rights as this will prevent retaliation against any one person. Now is also a great time for health professionals to use telemedicine in low-overhead practices during a pandemic. Grow your practice and serve your community by embracing innovative new models to prevent patients from clogging overwhelmed hospitals.

Need help? Have a questions? Contact Sydney Ashland or Dr. Pamela Wible. To learn more about traumatized physicians, check out Sydney’s new trauma video series.

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Physician Suicide & Resilience Gaslighting →

An open letter published with permission from a resident physician in the aftermath of a doctor suicide:

“A resident at U of M [Manitoba] has committed suicide. The school circulated and email stating that he died as if it were an accident. If I hear one more person utter the words ‘physician resiliency’ I’m going to lose it. Making this an issue about ‘resiliency’ is a pretty clever way to shift onus on the individual. In the face of this mental health crisis we hear again and again that we need to ‘bolster resiliency.’ What does that mean? Toughen up? Take time for yoga? I think the language is becoming toxic. Please tell me how one can be ‘resilient’ working 110 hours a week in an ultra-stressful environment. By using your 30 minutes of free time every week for mindfulness meditation? Organic food? Free coffee in the lounge? Let’s cut the crap and talk about real issues facing residents: the exhausting workload, the hours, the toxic working environment. access to mental health services, the inability to take personal days. So please do not insult us with talk of resiliency. We’re all resilient. We all fought hard to get here. It’s one thing to ignore a problem, and another to deliberately misdirect and mislead. Show some damn respect.”

I was asked for advice so I share the impact of gaslighting and blaming victims for lack of resiliency when they are subjected to hazardous working conditions that violate their human rights.

Gaslighting is psychological manipulation of a medical student or physician leading the victim to question their own sanity.

The goal of a gaslighter is to make a medical student or physician doubt themselves, lose their sense of identity, perception of reality, and self-worth. Article 26 of the Universal Declaration of Human Rights proclaims: “Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms.” Yet gaslighting is a common form of manipulation and mind control in medicine—often through words and phrases that are repeated over and over again until victims are so worn down that they accept (and even defend these words) as their new reality. Gaslighting is psychological warfare.

Physician “burnout” is the most popular victim-blaming buzzword used to make medical professionals question their self-worth while distracting attention from the medical system that has perpetuated human rights violations on physicians. A slang word for end-stage drug addiction first used on the streets of inner city America in the early 1970s, “burnout” is now weirdly accepted as a real condition for doctors. Despite medicine’s obsession with measuring physician “burnout” for nearly four decades, the epidemic of physician cynicism, exhaustion, and despair is worsening. Psychiatrists define “burnout” as a job-related dysphoria in an individual without major psychopathy—meaning you’re normal; your job is killing you. You are not at fault. Stop accepting blame.

The proposed solution for physician “burnout” is physician resilience. The word resilience is used to blame doctors who are truly among the most resilient human beings on the planet and simply need to be treated with respect and supported in their work. If you made it into medical school you’re already in the top one percent of compassion, intelligence, and resilience. You have no resilience deficiency. You are not defective. You are responding normally to an abusive medical system as this doctor explains:

“After a forced increase in work hours to maintain productivity, my chief publicly blew up at me unprovoked in the OR like something out of a horror movie as he morphed into a monster before my eyes and triggered my PTSD. Then the male physician administrator pats my hand, oozes sympathy, and honestly said, ‘You are clearly the most burned out of our anesthesia group. Tell me how I can help you be more resilient.’ I am a 61-year-old woman who has practiced anesthesiology for nearly 30 years: I am as bloody resilient as I can be! Why does the system create an untenable set of working conditions, causing stress and exhaustion, and when the predicted outcomes occur—I am the problem!”

To prevent physician “burnout,” health care institutions may offer physician resilience workshops to train doctors to prioritize self-care and manage their emotions so they don’t become disruptive—another term that blames doctors who express feelings of despair from gaslighting. Disruptive physicians who stand up and say no to abuse are then labeled as unprofessional. The list of gaslighting terms used to manipulate and confuse doctors are too numerous to compile (though I encourage you to keep your own list at the end of this chapter).

“Despite seeing a physician on a regular basis, I had to seek psychiatric evaluation at an emergency department,” reports a trainee. “Rather than going to a facility covered by my insurance, my program insisted I come to my own hospital—what followed was an egregious violation of my health records that were modified and used against me. I was blamed for my mental health: my ‘burnout’ and my lack of ‘resilience.’ I was coerced into resignation, and I would later discover I was not the first nor the last resident in my program to experience this. I am still on the road to recovery from this harrowing situation.”

The end result of using gaslighting words that blame doctors for the abuses committed by the medical-industrial complex is physician disempowerment, hopelessness, anxiety, depression—and suicide.

Appointing chief wellness officers to help physicians with “burnout” by mandating wellness modules for the abused can be part of the problem as illustrated in the video below.

TAKE ACTION NOW

Always ask for precise definitions of all words used to blame doctors at your medical institution. If there is no definition or the meaning is so convoluted that you are confused, then there is a high probability the word is being used to gaslight you.
Ask, “What could I have done differently. What is the proposed solution?”
Talk to a trusted mentor to get feedback before accepting any label and definition as helpful to you.
Stop using gaslighting phrases like “physician burnout.” Physicians are not the problem. Victims perpetuate the cycle of abuse by using the words of their oppressors.
Document, document, document. Save every email and record every conversation. If you are being blamed, manipulated, and confused at work, document everything. Reference Human Rights Violations Documentation Guidelines in this book.
Keep a list of words used to blame doctors at your medical institution.

To learn more about gaslighting and how to protect yourself from toxic working conditions, reference Human Rights Violations in Medicine: A-to-Z Action Guide.

Tags: human rights violations, physician burnout, physician resiliency, physician resiliency training

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Brief history of why doctors work 28-hour shifts →

Doctors all worked unlimited hours—unchallenged until Libby Zion’s death on March, 5, 1984. Her dad found her care was left to sleep-deprived residents with no supervision. Legal battles ended in New York’s 1989 Libby Zion Law—requiring doctors-in-training be supervised and limited to 24-hour shifts and 80-hour weeks. In 2003 these caps were applied to all US residents and in 2011 new doctors were capped at 16-hour shifts. Yet caps remain unenforced so residents may still work unlimited hours. In 2016, we delivered a 75,000 signature petition to Dr. Nasca at the ACGME, demanding the agency charged with resident training address sleep deprivation and doctor suicides. In response, they nearly doubled new doctor shifts from 16 to 28 hours in 2017 and now permit unlimited hours without justifying why. If this bothers you, tell the ACGME (and your hospital)—that your doctor has a right to sleep or you have a right to see another doctor.

Protect yourself & your loved ones. Always ask, “How long have you been on your shift, Doc?”

Let the ACGME and Dr. Thomas Nasca know how you feel about their decision to allow doctors to work 28+ hours without sleep: Accreditation Council for Graduate Medical Education 401 North Michigan Avenue, Suite 2000, Chicago, IL 60611 or call 312.755.5000. Email Dr. Nasca: tnasca@acgme.org

Hazardous work hours in our hospitals lead to deadly medical mistakes, doctor suicides & fatal car accidents.

Your legal defense strategy: Human Rights Violations in Medicine: A-to-Z Action Guide

Tags: 28-hour shifts, ACGME, Libby Zion, Libby Zion Law, sleep deprived residents, Thomas Nasca MD

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