Human Rights Violations in Medicine: A-to-Z Action Guide (Sneak Peek) →

Excerpt from Human Rights Violations in Medicine released June 19, 2019.  Dedicated to my brothers & sisters in medicine who have lost their lives in pursuit of healing others.

From sex trafficking to censorship, the range of human rights violations is immense, some more heinous than others. Abuse may be perpetrated by dictators in war-torn countries and administrators in first-world hospitals. Inside this action guide are the top 40 human rights violations present in our most prestigious medical institutions. In isolation, many seem minor. In totality, these violations lead to thousands of American medical student, physician, and patient deaths—each year.

Suicide is an occupational hazard for physicians and medical students. Yet students enter medical school with their mental health on par with or better than their peers. So why do so many medical trainees kill themselves before graduation?

Walking into medical school is like entering a war zone. A medical student in the Army Reserve told me she was less stressed in Afghanistan during active sniper fire than in medical school! Here’s why: She had total trust in her military comrades. She knew if killed by enemy fire, she would be brought home, covered in an American flag, and honored with a proper burial. They had her back. In medical school, she never knew who would stab her in the back.

I suffered major depression in medical school and almost took my life by suicide as a physician. I thought I was the only one. Then both men I dated in medical school died by suicide—as successful practicing physicians. They left behind wives and young children.

I had to find out why my friends were dying.

In 2012, I began running a suicide helpline for doctors. Since then I’ve spoken to thousands of suicidal physicians (and families that have lost doctors to suicide). I’ve now compiled a registry with nearly 1,300 doctor suicides that I’ve personally investigated.

I know why doctors die by suicide. I know highest-risk specialties. I know what leads doctors and medical students to make the decision to kill themselves during medical training and beyond. Now I feel compelled to share what I’ve discovered with you.

Our doctors are suffering from human rights violations in medicine.

Human rights are universal moral principles that apply to the treatment of all human beings no matter sex, ethnicity, religion, culture, or profession. These basic freedoms are standards of human behavior protected by law from birth until death.

In 1948 the Universal Declaration of Human Rights set the international standards for human rights so we might have freedom, justice, and peace in our world. Individual nations have also drafted documents to safeguard the rights of their citizens. Since I am a practicing physician in the United States, I reference not only the Universal Declaration of Human Rights, but also the United States Constitution, the United States Civil Rights Act, and the Americans with Disabilities Act as guidelines for human behavior.

As physicians, our professional code of conduct further dictates that we uphold the rights of the most vulnerable. Despite being held to the highest standards of behavior when safeguarding the rights of patients, physicians and medical students experience human rights violations endangering their own lives.

Physicians-in-training are now legally forced to work 28-hour shifts and 80-hour work weeks. They suffer extreme sleep deprivation at levels incompatible with life leading to hallucinations, psychosis, seizures—and death. During these inhumane shifts, doctors experience food and water deprivation. Hypoglycemia and dehydration lead to fatigue, confusion, dizziness, and fainting. Physicians are not immune to the basic laws of human physiology.

Bullying and hazing persist in medical education despite being outlawed from elementary schools through universities. I receive ongoing reports of racial and sexual harassment inside our most prestigious teaching hospitals. Most shocking, our nation’s hospitals and medical schools continue to discriminate against physicians and medical students with mental illness and physical disabilities—contrary to their stated mission to provide compassionate care for all.

Medical students and physicians develop high rates of occupationally induced anxiety, depression, PTSD, and suicidal ideation. Yet we’re offered no debriefing or on-the-job support after witnessing trauma and death. Instead we risk interrogation and punishment by medical boards, hospitals, and insurance companies when seeking mental health care. As physicians, we comply with laws protecting our patients’ medical information; however, our confidentiality is often breached by hospitals and medical boards when we receive care. As a result, doctors either don’t receive needed care or drive hundreds of miles out of town, use fake names, and pay cash for psychiatric treatment.

Censorship—loss of freedom of speech—is common during medical training and practice. Physicians and medical students are scrutinized on personal social media accounts and often fear sharing divergent views due to retaliation from superiors.

In the aftermath of medical student and physician suicides, surviving colleagues have been threatened with termination, intimidated to keep quiet, and obstructed from peaceably assembling to grieve the loss of their own friends. Doctors and medical students have also been prohibited from attending funerals for their immediate family members.

Overworked the equivalent of two to three full-time jobs, trainees have no time to build healthy relationships, date, and procreate during their fertile years. If they do conceive, they may face harassment when pregnant, breastfeeding, or requiring time to care for their kids. Medical training places severe physiologic stress on the mother, leading to life-threatening complications of pregnancy and fetal death.

Doctors are routinely exposed to unethical and criminal behavior in clinics and hospitals, including insurance fraud. Some are forced to do procedures without proper supervision or patient consent. Resident physicians are coerced to lie on their time logs if they work more than 80 hours weekly or be punished for duty-hour violations and labeled as “inefficient,” then forced to see psychiatrists where they are diagnosed with ADD and prescribed stimulants to pick up their pace.

United States hospitals and clinics routinely violate the human rights of medical students and physicians, endangering their lives—and the lives of their patients. Physician-induced medical mistakes are the third leading cause of death in the United States. Physicians who attempt to protect their patients by complaining about human rights violations risk retaliation and destruction of their careers.

Please note that for every medical student and doctor suicide, there are thousands of physicians still suffering the non-fatal wounds of their medical education. To physician parents like mine (who warn their children not to pursue medicine) these are the wounds you don’t want inflicted upon your loved ones. To everyone who doesn’t feel quite right after medical training, here are the words that describe your injuries.

So why am I writing a book on human rights violations in medicine? Not to bash my profession. I’m writing this action guide to empower my brothers and sisters in medicine, to save the lives of future generations of physicians—and to salvage my beloved profession.

Please join me in speaking up against abuse.

Human Rights Violations in Medicine—A-to-Z Action Guide available here. All proceeds dedicated to physician suicide prevention.

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Frank H Netter MD School of Medicine Commencement 2019 ~ Dr. Wible →

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.

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Susan lost her doctor to suicide. She wants to know why. →

Susan Kreischer is one in a million.

One of a million Americans to lose their doctor to suicide—each year.

She is still devastated years later.

“I had awful back pain—was barely walking when I met Dr. Ortiz and right away we bonded. Every time I went in, he’d give me a huge bear hug, lifting me off the floor (and I’m a heavy woman). He always had a big smile on his face. He was it. He was the man. He didn’t just hand me another pill. He actually got in there and solved my problems.”

Dr. Ortiz was a man who never gave up on his patients.

“Later when I had more back problems, he said I’d need my hip fused and he’d look for another surgeon since that wasn’t a procedure he was familiar with. Next time I saw him he told me that he didn’t find anyone he could trust so he was going to do it himself—and that’s exactly what he did. He learned that procedure for me! I was in awe that he did that for me.”

Staff in the operating room were in awe as well. Nobody could believe how perfectly Dr. Ortiz performed her fusion.

“I saw that man five times in a day and a half in the hospital, plus he went to see me another four or five times when I was in recovery. He called me every night at home to make sure I was okay—and I was.”

Susan wonders how she’ll ever replace him.

“I don’t trust other orthopedic doctors around here. I had some very bad experiences. I had so much faith in Dr. Ortiz because I knew he was being truthful—giving me his honest opinion. I adored him. He was a saint to me. He took so much of my pain away. He changed my life.”

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How my patients prevented my suicide (& started a medical revolution) →

Today is the anniversary of my suicide survival story—a happy ending to six weeks of unrelenting thoughts of dying when forced to see patients every ten minutes in big-box assembly-line clinics. My lifelong dream of being a trusted, loving family doc doing housecalls was gone. I saw no way out.

Until I told my patients I was suicidal.

I begged for their help. I asked them to create an ideal clinic, even write my job description. I promised to do whatever they wanted. My life sucked. I had nothing to lose. I figured we could all escape corporate medicine together. They were game.

Soon more than 100 patients delivered written testimony. I was SO excited to read it all. We adopted 90% of their amazing ideas and just one month later (with no outside funding) we opened the first ideal clinic—designed entirely by patients. Today is our 14-year anniversary of the most beautiful gift a community could ever give me—the ability to be a real doctor.

Now I do housecalls. I absolutely adore my patients. And I’ve never turned anyone away for lack of money.

Read all about how we did it here.

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Not “burnout,” not moral injury—human rights violations →

Burnout is a slang word for end-stage drug addiction first used on the streets of inner city America in the early 1970s. During that time, psychologist Herbert Freudenberger volunteered at a New York City free clinic treating addiction. He overheard the term and used it to describe himself and clinic staff in a 1974 article on staff burnout detailing long-term physical and psychological job stress.

He then authored a book on burnout in overachievers and another on burnout in women further popularizing the slang word which seeped into common lexicon. Burnout was no longer limited to Americans overdosing in back alleys. Now housewives and high achievers and anyone stressed at work suffered from burnout too.

“Physician burnout” first appears on my PubMed literature review in American Medical News in July, 1981. It is unclear to me who first applied the term to doctors. What is clear to me—is that despite medicine’s obsession with burnout for nearly four decades—the epidemic of physician cynicism, exhaustion, and despair is worsening.

So why are physicians experiencing physical and mental collapse from overwork? Psychiatrists define burnout as a job-related dysphoria in an individual without major psychopathy—meaning you’re normal; your job is killing you.

Meanwhile physician burnout books and breathing exercises are offered by burnout coaches on every corner. Curious why physician burnout is on the rise amid the plethora of burnout programs, I asked a physician burnout coach, “Don’t you think all your ‘burnout’ breathing exercises and EMR workarounds just prolong the agony for physicians in toxic working conditions?”

He replied, “Yes.”

Since that 2015 conversation, I’ve been debunking burnout as a victim-blaming buzzword that prolongs physician agony by avoiding the real issue leading to physician despair. So what’s the real issue? Enter Drs. Wendy Dean and Simon Talbot with their landmark 2018 article, Physicians aren’t ‘burning out.’ They’re suffering from moral injury. In it they explain:

The concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work. . . Physicians are the canaries in the health care coal mine, and they are killing themselves at alarming rates (twice that of active duty military members) signaling something is desperately wrong with the system. . .The simple solution of establishing physician wellness programs or hiring corporate wellness officers won’t solve the problem. Nor will pushing the solution onto [physicians] by switching them to team-based care; creating flexible schedules and float pools for [physician] emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques or participate in cognitive-behavior therapy and resilience training.

Yes. Thank you. Exactly.

Last week the anti-burnout buzz accelerated when ZDogg quoted my 2015 blog—Burnout is BS—in his viral video “It’s not burnout, it’s moral injury” echoing my advice that we stop saying the victim-blaming term.

Now we’re getting somewhere. But is it really moral injury?

Moral Injury is a term applied to combat veterans in 1998 by psychiatrist Dr. Jonathan Shay. Moral injury is damage to one’s conscience when perpetuating, witnessing, or failing to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct (often resulting in profound shame). Moral injury is a normal human response to an abnormal traumatic event—a deep soul wound shattering one’s identity and morality. Dr. Shay’s original definition was based upon his patients’ war narratives and Homer’s Iliad (762 B.C.) and required three components: (i) betrayal of what’s right by (ii) someone who holds legitimate authority in a (iii) high-stakes situation. Individuals with moral injury may see themselves and the world as immoral and irreparable. Read more ›

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