America's leading voice for ideal medical care

Frank H Netter MD School of Medicine Commencement 2019 →

Graduates selected Dr. Wible to deliver final inspiring words before becoming physicians. View speech, download MP3, or read full transcript below: (the audio podcast is BEST because you can hear all the laughter & audience reaction) . . .

In less than 30 minutes you will all finally be physicians! (cheering) And this summer you’ll be set loose on your very own patients. (laughter) How exciting is that? Maybe a little nerve-racking.

During your career (depending on specialty and work ethic) you may care for more than 100,000 patients—only a few will live in your heart forever. You will join them on a sacred journey for two. Trust them. They will guide you from nervous new doctor and teach you how to be a healer.

As a new intern, I was assigned to Emily. She had idiopathic bronchiectasis (a fatal lung disease) and refused to take her meds so the transplant team signed off on her case. They abandoned us. We were both 25. Sobbing uncontrollably with her oximiter alarm shrilling, she looked to me for help. I didn’t know how to help her die. So I snuck my dog, “Happy,” into her room for midnight excursions. With her portable oxygen tank rolling behind us, we’d hold hands and disappear across the hospital parking lot into a blanket of grass and gaze at the stars where she’d share her grief of never giving birth or finding her soul mate. Emily and I became soul sisters on an adventure of a lifetime. . . until the day, in her bedroom sitting beside her body wrapped in a Mickey Mouse blanket, I signed her over to the morgue.

Emily has never left my side.

Patients like Emily will hold your hand and lead you to places where there is no algorithm, no attending, where you have no earthly idea what you’re doing. All you’ve got is each other.

After Emily, Harold stumbled awkwardly into my heart. A loner who distrusted technology (and doctors), he lived in the woods caretaking a wildlife sanctuary with no electricity. No phone or car. But he had great health insurance (through his employer). His ex-girlfriend recommended me. So he’d hitchhike to my office—3 hours each way. One day he came in, his back covered in nodules. I excised one, sewed him up, gave him a kiss on the forehead, a slip for a chest X-ray, and an appointment to return next week. It was metastatic lung cancer. He chose chemo, moved to the city, got a cell phone, and quickly spiraled to his death. I got him back to his cabin. He died the next day. His ashes now food for the forest he so loved—where I visit him each fall.

I think Emily kind of helped me with Harold. You’re never really alone. Some patients follow you forever.

Protected: Doctor tries to shoot himself. He survived. I made this video for him (and all suicidal docs out there). →

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Hazardous work conditions kill doctors (and patients) →

I was invited on to this TV show to share why burnout and moral injury fail to address the underlying cause of physician distress—human rights violations in medicine. View full TV show here.

Doctors have the highest suicide rate of any profession. I run a doctor suicide hotline and I’ve investigated more than 1,300 doctor suicides. Root cause analysis reveals human rights violations as the culprit. Doctors who don’t succumb to suicide are victims too. Coping with abuse is not a solution. Ending abuse is. Injured morals offers no solution. Burnout is a smokescreen that distracts from human rights violations that are killing doctors—and patients. Let’s focus on facts and real solutions through institutional triage, definitive diagnoses, and targeted treatment.

1) Institutional Triage
As physicians, we address life-threatening emergencies first to save our patients’ lives. Stop the arterial bleed, the treat the acne. Institutional triage means prioritizing doctor suicide prevention by eradicating human rights violations in medicine that lead to suicides. When doctors are groomed to accept a culture of abuse, we perpetuate it on ourselves, our peers, and our patients. Eliminating hazardous working conditions will create a culture of wellness for us all.

3) Definitive Diagnoses
Students enter the medicine with their mental health on par with or better than their peers. We are then wounded by hazardous working conditions Illegal in all other industries that value safety. As a result, doctors may develop lifelong health sequelae such as new onset constipation, insomnia, anxiety, depression, PTSD, and suicidal ideation. Precise language is paramount. Burnout and moral injury distract and confuse victims while deflecting attention from abuse perpetrated by the medical system that labels victims as defective. By holding the system accountable for violating the specific rights of doctors (and patients), we can proceed with a targeted treatment plan.

4) Targeted Treatment
Unlike moral injury and burnout, human rights violations have proven medicolegal solutions that protect victims. Sleep deprivation is a known torture technique, yet new doctors are forced to work 28-hour shifts. The solution—a bed and a pillow. Food and water deprivation are common among sleep-deprived doctors who have no set breaks on marathon shifts. The solution—regular meals. Hazing and harassment is rampant in our hospitals. The solution—legal prosecution as is standard at other institutions that value human life. Doctors are collapsing from overwork, found dead in hospitals. The solution—comply with the same labor laws that protect pilots who fly 8-hour shifts (not 28-hours). All human rights violations in medicine are categorized here with simple, effective treatments.

Read fascinating history of burnout, moral injury, and human rights violations in medicine here.

Tags: doctor moral injury, moral injury, Wendy Dean

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Text message prevents surgeon’s suicide →

A physician shares his suicide survival story with me. The 51 words that saved his life.

Hi Pamela, Here is the text that prevented my suicide:

“Hey I’m so sorry about your patient. That sucks. I’m very thankful that we have you as an excellent otolaryngologist to learn from. You take care of so many sick patients and do a marvelous job educating us how to do it safely, skillfully, and compassionately well. Thank you for that.”

It’s been a particularly hard year for me. But I’m surviving.
Thanks for all you do Pamela.

I shared his text as closing slide in my keynote last weekend on creating a culture of wellness among orthopaedic surgeons, anesthesiologists, and veterinarians. Concepts apply to all specialties and professions.

After interviewing male physicians who survived suicide attempts, I discovered the average time between their decision to die by suicide and the moment they grabbed their gun, pills, scalpel (or method of choice) was–3 to 5 minutes.

Average time it takes to type a text message—less than 1 minute.

Your best and fastest way to save a doctor’s life may be a text message.

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If you need more proof of the lifesaving impact of your words, read this:

RIPPLE EFFECT: Never underestimate the power of your words to travel 8,158 miles to inspire a random woman 991 days later. I just got this email today—nearly 3 years later!

“Hello Pamela, On 3rd November 2017, I was seeing an orthopaedic back surgeon, Dr. Gary Speck in Australia (where I live). While taking my history he discovered my daughter would commence Medicine the following February (2018). Instantly he told me of an article he had read that very morning and said it was a must read for my daughter. He kindly printed a copy for me to take home. The article is: Loyola Commencement Speech ‘Live Your Dream.’ My daughter is about to commence her 3rd year of a 6 yr medical degree at the University of Adelaide here in Australia. She has been home for the holidays and she still has the article. I asked if I could read it and she said yes but I’m taking it with me. I want to thank you for this article. Gary gave it to us because he thought it important to share your message. While she is still 4 yrs from being an intern, I love that she values your advice and that you inspire her. Keep being the amazing woman, doctor, mentor you so obviously are. Love from a very grateful mum/mom downunder in Australia xxxx”

Tags: doctor suicide, ENT suicide, surgeon suicide, text message prevents suicide

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Creating a Culture of Wellness (Keynote) →

Note: Thomas Fishler, MD, is correct spelling of his name.

Kick-off keynote delivered on February 7, 2020 at AO North America, an international organization serving veterinarians, craniomaxillofacial, hand, spine, and trauma surgeons.

Introduction: It gives me great honor and privilege to introduce our first keynote speaker for the day, Dr. Pamela Wible. Dr. Wible is a family physician born into a family of physicians. Her parents warned her not to pursue medicine, but she followed her heart only to discover to heal her patients, she had to first heal her profession. So she held town hall meetings and invited her community to design their own ideal clinic. Open since 2005, Dr. Wible’s community clinic has sparked a movement in which patients and physicians are designing ideal clinics nationwide.

When not treating patients, Dr. Wible devotes her life to medical student and physician-suicide prevention. She runs a suicide hotline and hosts retreats with discouraged medical students and physicians, for which TEDMED has named her “The Physicians’ Guardian Angel.” Dr. Wible has personally compiled and investigated more than 1300 doctor suicides, and had analyzed the data for high-risk specialties and actionable solutions to prevent future deaths. Dr. Wible is the author of Physician Suicide Letters-Answered. Her blogs have been picked up by major media, such as The Washington Post and Time Magazine. She has been interviewed by most major TV networks, and is a frequent guest on NPR. She is featured on the documentary Do No Harm, that exposes our hidden physician suicide epidemic. So put your hands together to welcome Dr. Wible to the stage.

Pamela Wible, MD: Thank you so much for having me. I’m really excited to be here. Originally I was on the schedule the last day of your event, and then they moved me up to the middle day and now, with the late-night phone call I got in my hotel room last night, I’m your first speaker, how about that? I got promoted.

So, we’re going to talk about the culture of wellness through a really interesting lens that I feel is not discussed, because it’s a bit of a taboo topic; but it’s going to give you a lot of insight in how to move forward with an actual strategy that will be effective at creating a culture of wellness. So take the journey with me. We’re going to start with physician mental health.

This is a quote that I gave during an interview that got a lot of traction online. Now, in this quote there are two tactics that have been used to deal with the obvious despair that exists within our profession. Meditation/yoga on one side, let’s just kind of sweep this away here and maybe if we just took a nap and a green drink. Then on the other side is early retirement, I’ve got to get out of here. Right? Because I talk to a lot of surgeons and their spouses who tell me that their partner is counting down the days to retirement, trying to make an early exit.

So somewhere between the early exit and meditation is an actual solution—a real strategy. And so we’re going to discuss that today. And I think you’ll find some relief in the fact that I am a truthspeaker, so I don’t hold anything back, but I am delivering this with great love for my profession and to save lives of my colleagues.

So the learning objectives today are to learn a targeted, high-yield set of actions you can implement to promote wellness among physicians today. And this does not require you to sit in committee meetings or get any approval from anyone. You can actually leave this lecture and do it right away, right now, because I’m a very action-oriented person for those of you who have read any of my blogs and know me. Also, we’re going to understand how to create a culture of wellness utilizing a concept I call, “institutional triage,” which I coined just for your conference. And I think you’ll be able to relate to it. And then discover the highest-risk specialties for suicide, and what you can do to stop the crisis. Read more ›

Tags: AO North America, burnout, chief wellness officer, craniomaxillofacial physician suicide, hand surgeon suicide, hospital wellness programs, MD, military medicine, moral injury, Orthopaedic surgeon suicide, Orthopedic surgeon suicide, spine surgeon suicide, Steven Ortiz MD, suicidal surgery reesident, Thomas Fishler, trauma surgeon suicide, Vet Confessional Project, veterinarian suicide, Vicarious trauma in physicians

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Death Row Health Care (Stand-Up Comedy) →

I just moved to NYC (part-time two weeks each month) on January 1, 2020 to help physician residents who are struggling there and to continue to address the doctor suicide crisis and empower physicians and medical students nationwide. Thought I’d try a little stand-up comedy (just for a fun hobby—work-life balance, ya know!).

I still practice medicine in Eugene, Oregon, in an ideal clinic that was designed entirely by my patients. I offer 24/7 telemedicine, house calls, plus office visits in my new downtown office and, of course, I’ll see patients when and where it is most comfortable for them. I also continue to run a suicide helpline for doctors and spend much of my time addressing hazardous working conditions in medical institutions. I speak widely on the physician suicide crisis and love mentoring and inspiring the next generation of doctors.

I continue to be committed—through keynote addresses, commencement speeches, white papers, journal articles, TV news interviews, and now a little stand-up—to reaching a wider audience with the message of compassionate health care transformation.

Here’s a little peek into my personal experience during medical training on death row. . .

I went to med school in Texas. And Texas is #1 in executions! I attended a world-famous school. It’s the only med school in the world—inside a prison hospital. (I think they should’ve mentioned that when I applied). I show up. I’m 21 years old and my patients are rapists and serial killers. But here’s the upside, when it came to appointments all of them were there—on time

Another perk. My tuition was subsidized by the Texas Department of Criminal Justice, so my death row criminals, they paid for their crimes—and my education.

It was so bizarre that I was learning how to give rectal exams on murderers. Shocking actually. Prostate feels good. Cholesterol’s up. Wait, that could kill ya. It was crazy ordering heart-healthy meals for guys on death row. To graduate on time I had to keep them alive till we killed them.

To give you some perspective, I had just spent the last four years at Wellesley—an elite all women’s college, so I hadn’t been with men in like forever. Now I’m on the front line dealing with America’s most wanted—rectums. And I had the most wanted—finger. Imagine: I’m this idealistic, caring young lady—with my finger up the ass of a serial killer. Two big guards behind me. Kinda hot. Right? I’m thinking, “Isn’t this every woman’s fantasy?” Truly I was the most wanted by the most wanted.

So I was vegan at the time and very determined to help all my patients eat healthy. As you can imagine, it was really difficult to convince these guys to eat less meat and more vegetables. I mean these guys were real carnivores. A couple were cannibals. I’m talking kale smoothies. And they’re thinking I’d love to eat her elbow.

Death row health care—that’s an oxymoron. I deal with a lot of oxymorons and morons on Oxy.

In Oregon I’m licensed to perform physician-assisted suicides. In Texas physicians are able to perform physician-assisted homicides (Yes, they actually have physicians in the execution chambers in Texas! Crazy right?). So I feel really comfortable practicing in both Oregon & Texas because in both states I can legally kill you. (Unreal!)

I have so much more to share about my experience growing up as the child of two physician parents and so many other events that have shaped who I am and allowed me to be so innovative in my care of patients and my suffering colleagues. Many of those stories (including my ethical dilemmas practicing medicine as a student doctor on death row) can be found in my first book: Pet Goats & Pap Smears.

Stay tuned. More to come . . .

Want to talk? Contact Dr. Wible here.