On February 23, 2018, Dr. Pamela Wible delivered this LSUHSC keynote address fully transcribed below.
Katy Wagner: All right, if everyone could just take their seats, we’re going to get started. My name is Katy and I have been working on the Mental Health Awareness Week planning committee. We’d just like to thank you so much for coming out to all of our event. Now I’m going to invite Dr. Ghali up here. He’s going to introduce our keynote speaker for the week.
Dr. Ghali: Good afternoon. It’s my pleasure and honor to be here in this very important occasion. I’m here because I view mental health as a very important subject matter. Throughout this week, you’ve been seeing and hearing about the sobering statistics on depression and suicide amongst medical students and physicians. I want you to know that we at LSU are concerned about the mental health for all students and healthcare providers. Just in the two years that I’ve been in this position, in the interim role and a permanent role, we’ve had three to four students and residents that (again, it’s always hard to figure out the exact situation) but I would put them in the exact category of concerns that Dr. Wible has and why she’s here, and what we’re talking about related to this mental health awareness.
Some of you may see the statistics indicating depression and suicide being higher with medical students and physicians as a deterrent to our chosen career path. I do not. I see them as facts that each of us must address. This is why I want to strongly commend the students who created this educational platform on mental health awareness, so thank you very much.
Rather than just standby and watch, these student leaders have chosen to take action, which I am certain will result in many taking needed action to address their depression, feelings of being overwhelmed—or possibly even suicide. I hope each of us will join these concerned students, in being cognizant at your fellow students or colleagues who are having a tough time.
Don’t assume someone else will ask, “Is there anything I can do to help?” Just as compassion and attentiveness to our patients is vital to being a successful physician, it is also essential to being a good friend, mentor, and colleague. Bullying and abusive authority is unacceptable. As a chancellor, I’m constantly on the lookout for this. I will tell you as I tell my faculty, I will kick you out of this institution if you bully, and I find bullying as a really unacceptable way and an abuse of authority. That, I believe, causes undue stress on students and residents and fellows, and it is unacceptable in my mind.
I’d like now to introduce our keynote speaker, Dr. Pamela Wible. I had an opportunity to meet her for the first time, and I came on purpose a few minute early just so I would have the opportunity to talk with Pamela. She’s clearly a visionary who has made it her life’s work to improve community medicine and to become a national mentor for the mental health of medical students and physicians. I’m happy to share that she has some Southern roots, and she received her MD from UT Galveston before pursuing her residency in family medicine at the University of Arizona. I like Galveston, but I’ll also tell you that she resides in Eugene, Oregon. I love Eugene. It was the very first place when I moved to the U.S. at the age of three from Iraq.
I was born in Iraq, and I came to the U.S. The first place that we went to is Eugene, Oregon. It’s where my mom ended up enrolling and getting her Master’s degree before we came to Texas. Just like you went to Wellesley, it was an all girl school. Basically, Eugene, Oregon, University of Oregon at that time, she was the only woman in her class in her Masters of Business Administration class. They actually wondered whether she was in the right class or not when she showed up the first day, she goes, “No, this is where I belong.” She was the only girl.
If I fast forward about 30 years later, so I was doing a fellowship in Portland, Oregon, and my mom came up to visit me, and she said, “Hey, can we go and visit Eugene?” I said, “Sure.” We hadn’t been there in 25 to 30 years, so we went down and drove down to Eugene. As we got into the town, my mom looked around and says, “Gosh, this place hasn’t changed a bit. It hasn’t changed a bit since we were.” I pulled in to the gas station to get some gas, and I asked the guy, and my mom was in the car, I said, “Let me ask you something. Is there something going on here, because there’s just a bunch of hippies walking around and everything?” The guy is like, “Oh dude, man, there’s a Grateful Dead concert this morning.” There you go.
Anyway, Pamela was named one of the 2015 women leaders in medicine, and as the “Physician’s Guardian Angel” by TEDMED, her book entitled Physician Suicide Letters Answered was Amazon’s number one bestselling book in 2016 (in medicine & psychology).
Dr. Wible’s popular blog and articles have been picked up by major media outlets such as the Washington Post and Time Magazine. Her TEDMED talks resonated with our particular students resulting in their decision to bring her here to our campus. Without further delay, let’s give a warm LSU welcome to Dr. Pamela Wible. Thank you.
Dr. Wible: That was a warm welcome, and I’ve got a funny story about Eugene I got to tell, now that you’ve introduced that story, right? I mean, man, what goes on in Eugene, you’d never believe it. I’m just going to go out on the limb and say this one thing too. When I first moved to Eugene from Texas, where people are pretty friendly in the South, I was just not used to so many people hugging you all the time. I was 29 years old. I just finished residency. I was walking down the street, and literally, people are walking up to you smiling like they just had sex with you. I have no idea who these people are, and they’re all wanting to hug you and see how you’re doing. They’re legitimately interested. They’re not fake.
The other thing that’s unique about Eugene, I think, it has to do with just people are stoned there a lot, so everyone is like really happy. It’s legal, medical marijuana and all that, and now recreational marijuana. I actually had a patient come to my appointment with a giant pot plant that he was going to try to trade with me, because he didn’t have insurance. So funny. I was like, “I don’t really need it. I’m already high on life.” Eugene is a different universe I think.
Here’s something I posted on my Facebook and Twitter.
I legitimately feel this way. The people I met here are so warm and welcoming. I know there’s people who are struggling with various mental health issues, but the fact that you all have come together and are so willing to discuss this and support one another, I think just says a lot about your school. I’m really proud to be here, so thank you for inviting me.
I want to share with you two questions that were recently asked by medical students that have changed my life in the last few weeks. The first one: “What was your proudest moment?” This was at a medical student retreat that I was leading in February. I was with a group of 10 medical students that I sat with four days in a little retreat overlooking the Pacific Ocean. That was the question asked to me. I immediately knew the answer. Just happened a few weeks before and it was the actual proudest moment of my life.
I’m going to just give you a little bit of the backstory, because it’s started on January 18th when … Her name is Deelshad Joomun, the first female interventional nephrologist. Three days into her first job as an attending at Mount Sinai, she went up to the 33rd floor, the roof of a building, and stepped off. Within an hour or so after she died, I received three emails.
This is the first one, “Hello Pamela, I’m not a doctor, but a mother of three and a wife of a resident physician. Tonight, I watched AGAIN the police taking the body of another female doctor, lifeless, into a body bag. Two doctors died from jumping off our 33-story building in two years, and no one seems to care. The hospital and everyone is so silent. They cover it up. No one talks about it. Someone dies, and everyone puts their heads down and ignores it and are told by the hospital to keep quiet, especially to reporters.” Later on in her email, she had, this is just an excerpt, “Words can never describe how it feels to see a dead body outside your window, a beautiful lifeless body of a beautiful doctor.”
Then, I got this email, “I’m a physician. I have a career ahead of me, which I’m too scared to speak out against. I came home again to another suicide, another doctor dead from Mt. Sinai in New York. I think New York is a horrible place to work. Conditions are deplorable for doctors, and you should investigate. Both suicides were horrible, jumped from our high rise. I’m convinced it’s the exhaustion, the demands to perform at 100% 24/7 to meet ridiculous administrative and financial demands.” He goes on . . .
Then I received, “I’m a health system executive in New York City, and one of our physicians jumped off a building this afternoon. Don’t we have an obligation as a society to understand why each and every suicide occurs? How do we learn from them? If this were a patient who had just been discharged, we’d be all over it and so would the regulators.”
These emails go on. These are just excerpts. I have permission from the first two to share them. I’m not revealing the identity of the third one, though I really admire that this man in a moment of emotional accessibility reached out to me. I think he was then overpowered by the other people in his institution to probably not engage with me thereafter, but I do admire that he reached out to me. It did help that five days before, I had an article in the Washington Post on the front page of their health science section on physician suicide and the results of five years of my research, so I think I was top of mind when this happened.
I did publish an article with a picture that was shot from the building from the wife of the resident physician. That is Dr. Deelshad Joomun under a brown tarp.
This happened at 3:30 in the afternoon. Many hours passed, and now it’s night, and she (the wife of the resident physician) saw the police come and throw her body in the most disrespectful way into a body bag, and drive off. That would have been the end of the story, because the hospital is not keen on talking about this. Her family is Muslim, and they don’t want to talk about it either. In fact, they told everyone that she died in a car accident, so you have censorship on both ends, and I’m in the middle.
For a variety of reasons, I couldn’t let this go, probably because the number of people asking me to help was accelerating, and I’m in a unique position where I have a skill set where I can actually help, and so I couldn’t walk away from this. I started staring at this picture. It’s very intense. I started to just think about how we honor our dead. I started to think, “Gee, like, other people don’t just get covered in brown tarps, and left on the side of the road. Why is this happening to doctors?” I realized like, “Wow, everyone else gets honored except doctors.” The one on the bottom right is a teenager in Sweden who died by suicide 10 years ago. They still maintain that site. People come and visit it.
Robin Williams, of course. Even suicides are honored because the teenager and Robin Williams and the quarterback were suicides. The quarterback actually was a Washington State University quarterback who died by suicide two days before Dr. Joomun died, and just spontaneously, his jersey was hanging by the stadium. “We love you, Tyler.” Flowers, balloons, all these things. Then the policeman that dies, I don’t know if that was a suicide, but that’s in Oregon near my house, gets lots of flags. All the other policemen come out. They do a special ceremony. They honor each other. They give the surviving widow his badge. I mean, they have a whole routine. They blow a bugle. They wave flags.
The bicyclist.Oh, throughout my town, lots of people commute by bike, so there is some fatalities. I don’t know if you have this here, but they paint the bicycles white. They’re called ghost bikes. This one’s been there in downtown Eugene for probably 10 years. This site is still maintained with fresh flowers. I was thinking like, “So, why don’t we do this for doctors?” Maybe because it’s at a hospital, but then at my University of Arizona in Tucson, Gabrielle Giffords was shot, and they filled the front of the hospital with a huge a mound of teddy bears after that shooting. Hospitals do allow people to create spontaneous memorials, so I was like, “Why is this not happening?”
I now have close to 800 doctors that I’ve and medical students who died by suicide on my list. I’ve been on this for five years. I have never seen a spontaneous memorial for a medical student or a physician. It’s just nothing happens. I think this is dramatic, and so I felt like I had to do something since people were egging me on to do something. I actually just showed up, and led a vigil. This is the proudest moment of my life, okay? It happened at 6:00 p.m. on January 26th, 2018. I just decided to show up, and post on Facebook that I’m leading a vigil for a woman I don’t even know, because I can’t bear the fact that she would just disappear from the face of this earth.
She put so much energy into her career. She had finally arrived at the pinnacle of success, and to just disappear, just seems cruel, and also is terrible for, by the way the people that witnessed this. There were doctors in the hospital that were looking out the window that saw another doctor jump off the roof. Doctors who were doing procedures on patients, because this high rise. You see it, and there’s 450 doctors that live in that building that are wondering. There are children asking their parents, “What’s under the tarp.” We have to address this, okay? I eulogized her, so I did the vigil on the night of the 26th. On the 27th, I rented a room at the hotel that I was in, conference room, whatever, renaissance room. For 10 hours, I received people. For 10 hours, we came and told stories about her, and I led a memorial service for her. I just feel like we should all be doing this. I shouldn’t have to necessarily fly … I mean, I’m happy to do it, but I shouldn’t have to fly from Oregon to New York to lead something that in the immediate aftermath needs to be done by the institution to help their own people who are grieving. The people came to the vigil by the way that had witnessed this walking down the sidewalk, and they were whispering in my ear, “Thank you for doing this,” and they now have closure. I didn’t know who she was. We have to do something.
That was one question. “What was your proudest moment?” I guess, I just want to say to you, your proudest moment can happen today. It can happen any day. When you step forward, and you do it fearlessly, and you behave in an ethical way, and you are honorable in your intentions, even if other people are mad at you, or you’re going against the grain, that could be the proudest moment of your life. I want to encourage you to always be looking for, “Could this be the proudest moment of my life where I can step forward amid silence and do something that is actually lifesaving?”
You don’t have to wait until you get your diploma in medical school to save lives. You could save lives now. I would just give you all honorary doctorate degrees now. Just consider yourselves doctors today, and start doing the beautiful work that doctors do to save lives. Don’t wait, because I’m now getting emails from medical students who write (the second question), “What can I do so I’m not the next one under the tarp?” What can you do? Well, this is a really good time. Prevention should happen early. When you try to talk somebody off a ledge is not the best time to try to deal with suicide. To deal with suicide, it takes everyone. It takes a village, and it takes a way of relating to each other like family members, like you really do care about one another.
I’m sure none of you wants to be in a situation where one of your classmate’s parents gets a phone call from the police at 3:00 in the morning that their child has died. It’s up to us to be on the watch tower, and pay attention to subtle things, and to create an environment so that nobody’s parents in here have to get a terrible phone call one night. It’s terrible to get those phone calls.
It was August 2016 when I got an email from a medical student who told me, “I was less stressed in Afghanistan than medical school.” This isn’t the first time that somebody has told me that they were less stressed in active war zones than medical school, which is a pretty dramatic statement.
I’m a very curious person, so of course, I want to know more. “Can you tell me more, or what is this all about?” What it comes down to is that, “The stress was incredible, but I have their back, and they have mine. In an unsafe country and a future filled with uncertainty, I felt secure because we supported each other.” What this is all about is it almost doesn’t matter you can survive almost anything if you know that people next to you love you, and are there for you, and are not going to back stab you, and you can trust them, and they really have your back. Even if you die on battlefield, they were drag your body home. You will have a burial. They’ll get the flags. They’ll put the thing over your coffin. You’re not left alone to die under a tarp and be left with nobody that cares.
There’s 450 people in that building, and 33 people showed up for a vigil. The next day when I did a memorial service, only 13 people were there, but two people were my cousins that came on Greyhound from Philadelphia, and then me. That means only 10 people showed up. Now, just think about the population density of New York with how many medical professionals were there who knew her, and only 10 people came to that memorial service, but there were people streaming in all night long at the room that I rented. It says a lot for the fact that people in the building were scared to come because their school threatened them with termination if they spoke to reporters or had anything to do with this.
They got emails that said that it is a breach of your contract to speak to reporters. I can go into more detail about minute by minute how this was handled in the wrong way by a medical institution. I don’t want LSU to be one of those institutions that just sends an automated email responder template when suicides happen. We can actually do this in a more personal way that’s very healing for the survivors who are still suffering. I think what the LSU secret is (so this was after I posted that happy thing on my Twitter and Facebook) is that it is a family atmosphere here. I’m very glad to be here because I had to fly to New York twice in two weeks. The second time was because Dr. Oz wanted me to come on his show to talk about what’s going on with all these doctor suicides in New York City.
It is a very intense place, New York city. And the medical system and healthcare environment in New York is a very stressful environment. It’s so nice to be in Louisiana. I really like it here. Everyone’s friendly, the cost of living is reasonable. I mean, I think you guys have a lot going for you here, and I just think we could do even better. There’s nothing that should be stopping you all in Louisiana from being the number one school in the country for taking on medical student mental health.
You could create a situation here that is replicated at medical schools all across the country, because I think by the fact that you even have me here, when some other programs tell their residents to take down my posts off their Facebook page and not to friend me or to unfriend me. There are some places that they’re not a fan of me. You guys brought me here. You’re open to this. I commend you for being a leader in med student mental health, and for having a faculty that is taking this seriously and so you have a lot to be proud of. Let’s build on that.
And so Randy, at the bottom there, he actually went to one of my retreats and he graduated from this school, medical school and residency, and he was here last night. He had to go back to Baton Rouge, but he came to see the film trailer. And he did mention that he loves this school and he has nothing but positive things to say. Very interestingly, when he walked in to this room, which I guess is the same room he trained in. He went to lectures here, 20 or 30 years ago or whatever. He said he had sort of a reaction being in here, that was a little startling for him. Like he felt a little PTSD. He still felt in his body the tension of nervousness about getting an exam or failing something or whatever. And he said that he actually does, every once in a while, have dreams about sort of the fear of being in medical school. And he said he’s never had recurring dreams about anything else, but every once in a while he’ll have a dream about something that happened here, that’s a little startling.
So I think we can improve our teaching methods, so people don’t have dreams later on and have sort of PTSD responses to how we are teaching. When he told me that I recalled that I hadn’t gone back to Galveston in 22 years, since I graduated. My mom (she graduated from UTMB Galveston and is an MD psychiatrist) and I went back for her 50th year reunion, it was my 22nd, and it was so cool. Like a mother/daughter team, getting to go back to their medical school reunion. But I didn’t go back for 22 years for the same reason that Randy probably didn’t want to come sit in this room, because it was just the memory of the trauma that I sustained (that I think is unnecessary in medical training) prevented me from wanting to even go back to Galveston. When I went back there, I realized what a nice place it is, but I didn’t quite really appreciate it when I was there because I was so distressed.
I met another woman at that reunion (it was her 35th reunion) and she said when she walked in to the medical library, she just started crying and she had no idea why. So I think people are having visceral memories of experiences at medical school that are not ultimately helpful to carry in to their future.
So let’s do this differently.
I want to share a survey that the students did before I arrived. The outcome of these few questions are that about 56.3% of students here claim the state of their mental health is good to excellent. However about 55% claim that mental health issues are a problem here. So we have work to do.
And 36.5% are uncomfortable speaking to faculty, and 42% are uncomfortable seeking help, despite help being available. And a third are comfortable with faculty and the help that’s available, however one in 10 students don’t know who to ask for help. And over half the students here are unsure what resources are available. So even though you have resources, we’re not really getting it out to students in a way that they understand. More than 20% don’t want their school to know, or hospital to know anything about their mental health. Okay, so we still have secrecy, some barriers to break through, some education to do here, to make it even more accessible for people here and 60% want peer support groups.
The overall message that I would like to get across today is, the thing that’s going to save our lives, that’s gonna prevent you from being under the tarp or the person sitting next to you from landing under a tarp and their parents getting a bad phone call—is relationships with one another. We need each other, and we need each other from day one of medical school.
We’ve already proven ourselves as amazing, capable, intelligent, compassionate people, to have been accepted to this institution, so by the time you get here, I would like to promote the idea that everyone be fully embraced, and not tormented in any way. Because you’re not a slacker, you wouldn’t have made it here. You’re highly intelligent, and I would like for us to treat each other not like bad kindergartners, which I think a lot of doctors feel like they’re treated that way by administration, but like highly intelligent, beautiful, loving people that you are, with pure, noble, humanitarian intentions, even the ones that seem like they’re not like the gunners. Somewhere down inside, I think even those people have pure, noble, humanitarian intentions. They just haven’t been promoted. We can create an atmosphere that encourages humanitarian gunners. You could turn all this around.
So let’s incentivize what we want to create here, because social isolation of otherwise healthy, well functioning individuals, eventually results in psychological and physical disintegration, and even death. So the solution to this is—each other. We don’t need a big NIH grant. Suicide isn’t actually really the problem. The problem is secrecy. Once we break through the secrecy. Once we have relationships with each other, the suicides naturally stop happening on their own.
Just this morning I got a Google alert that I had an article, in Medical Economics, which I didn’t even know was coming out. It’s kind of fun. It’s a slide show, which I thought, “Oh, I’ll just add this to my slide show.”
So basically, here are nine ways to combat physician suicide. Most of these have to do with relationships, so it just reinforces the theme that I had in my talk anyway.
Number nine: is to talk about suicide and stop the secrecy.
Number eight: Remove mental health questions from licensing applications, or alter the wording from have you ever had a mental health condition, to do you currently have a medical condition that would limit your ability to practice medicine safely? I think if any of you are in touch with the stat medical board, and can start advocating. I don’t know what the language is in Louisiana, but if you can start advocating for this change. And then of course, let the students know (who most of them want to practice in Louisiana), here’s the wording of the question so you can now feel relaxed to seek help and even go on medication, if necessary, because you will be able to practice medicine in Louisiana after you graduate. Here’s the wording of the question. Here is the wording of the question in our hospitals for privileges. Make it all very transparent, so people aren’t in the mystery of, “Will I ever? I heard there’s a question I might have to fill out.” Just make it clear that they’re safe.
Number seven: provide on-the-job support, especially for emergency department physicians, surgeons, and medical students in these specialties on rotations, are seeing horrible things and they need on-the-job support when they have to tell a family their three year old child died or they lose a patient. And so, the Chaplin, listeners, we’ve talked about having professional listeners just available. There are things that you can have available, so that there’s debriefing after difficult cases. Don’t let people sit with this for decades. I have doctors coming to my retreats, a woman that came who was like close to retirement, who started crying about a miscarriage the she witnessed like 20 years before. Just out of the blue with no provocation. I think she was just sitting in a comfortable space with people who she felt she could, I guess experience, finally, her first tears about something that she’s been containing for 20 years. That can’t be helpful. To contain these tears for decades. Afterwards, she said, “I’m just happy that I was able to cry, I haven’t been able to cry for 10 years.” So this is, humans are supposed to cry, you shouldn’t be written up as unprofessional, you should should cry frequently in medical school, that’s how I got through with my soul intact. There’s a lot of things to cry about, and I think you shouldn’t hold back. The more crying, the better. I think you should be concerned if you stop crying in medical school, something’s gone wrong. Okay, so that’s my best advice. Keep Kleenex close by.
Number six: help doctors off the assembly line and out of big-box clinics, if they’re not happy. Help them open independent clinics where they can practice and align it with their values and original intent when they entered medical school, I really do think we should be teaching to the personal statement of the person who’s entered here. We should be at intervals, how are we doing at LSU, getting you to your goal of being a rural family doctor at home in Louisiana? How are we doing? Do you feel like you’re on track? Is there anything else we could be doing for you? Don’t let it go where they deliver this beautiful personal statement, it goes in a file, gathers dust, by the time they graduate they forgot whats on there, nobody ever brought it up again. Teach to their personal statement, teach to their dream. Ask them at intervals, “What is your dream?” Like, “Gee, what do you want to do when you get this amazing degree here? You’re going to be able to do whatever you want.” And so take an interest, inspire them.
Number five: Befriend one another, focus on collaboration not competition.
Number four: Mentor other physicians.
Number three: Spend time together outside of the office, take a colleague out to lunch. You can see the theme here.
Number two: Hand out thank you cards and notes of appreciation, random acts of kindness would go a really long way to improve the environment that you already have which is already pretty good compared to many places.
Number one: Change the culture from isolation to one of community.
I want to help you do all of this, and so for anyone who’s here today, I have a teleseminar that’s starting on Sunday—a 10-week course where I walk you step by step how to open your own clinic, how to live your dream in medicine. It’s usually $1,800, but I’m gonna give it to everyone here for free. And all you have to do is go contact me on my website. And you can look at the teleseminar and read all about it, see if you want to do it. But it’s a good deal. So that’s one thing that I’d like to put myself out there, to help you.
And so what can your school do for you? Here’s where I think administration can take the lead in helping what students have started. We had a town hall meeting yesterday where I got amazing information from students. Things they were able to share with me, that they don’t necessarily want their name attached and handed straight over to administration. But I think I’ll hand it over to one of you, who can keep it anonymous. Please mine this for information. Here are some things that came out of our session that I think are really important.
First of all, we have to enhance the relationships between students, so that they’re solidly on a foundation when they start their academics. “Instead of a super-quick callous, stressful, two-day orientation (that’s all canned) before starting med school, offer a weeklong retreat sort of thing. To get prepared for the journey and meet classmates, create a study plan, learn what exercises you like, get nutrition tips, find out where Whole Foods is”. Whatever you want to do, right? And really support this. And some of the things you could do during this orientation, which by the way I am volunteering to come lead it, if you want me to do, ’cause I’m really good at leading retreats. And we could do these in between first and second year, maybe a two day event, or between second and third year. Like there should be a time where you kind of can get together and revamp, start remembering why you’re here to begin with, think about your dream.
And during this time, you can help students find their best learning styles, so that before they fail their first test, they can figure out, “Oh, I’m an auditory learner” and they can find the other auditory learners. Give them a survey, so they can figure out what type of learner they are, then they can pack up together with the 10 other people that learn the same way, and be in their own little study group. They already know who’s in their study group before they start, not trying to kind of wing it. Get a nutrition plan ahead of time, try to figure out what’s the best thing to eat. Non-medical interest groups, somebody said they went to your organizational fair for interest groups, where everything was medical. What about bonding with people over non-medical sorts of issues? I think it helps to not be thinking about biochemistry the whole time, and just do something like play tennis . . .
Continuing with student relationships, add “student think tanks for updating the curriculum.” They have so many great ideas that are like zero cost to the institution, that could be implemented immediately and would really improve the moral. And when you improve the moral, you improve the grades. When you improve the grades, everyone passes the boards. It all works in concert, right? Just fun things, puzzles, games, a scavenger hunt, you could make this fun, you could make it medical. Incentivize working out.
Community relationships. Okay, people are here because they love Louisiana, they want to stay in Louisiana. They want to love the people in Shreveport and they want an opportunity to reach out to people. These are some volunteer things that people want to do, like community projects, going in to neighborhoods, just allowing people to get out of the library and out of the lecture hall once in a while, to actually do something that would reinvigorate them. Relationships with health professionals, in allied health professional departments. These are all pretty simple things, just kinda lightening the load on the academic requirements a bit. Because people can learn on their own, and you can condense some of these lectures, maybe more in to sort of a cliff notes version, that they can have standardized. You need a little free time to breathe, because it’s in free time that you build relationships, and it’s the relationships that are gonna save your life and improve your GPA. So carve out some time in the schedule for relationships, so they’re not busy all the time, and actually I guess give yourself and give the students permission. Say, “Hey, between three and six today, you’re not allowed to study. No studying, we’re gonna do this other thing.” Some people need to be told, “Stop studying.” Okay?
Physician relationships. They would really love to bond with clinicians and maybe not have as much contact with so many PhD teachers, that are teaching sort of minutia, that might not, they can’t see the relevancy to what they’re going to be doing in the future. They’d really like to get in with, if they’ve come to become an ophthalmologist, can they meet another ophthalmologist in their first year, that they can bond with and maybe volunteer in their office, or start following patients, so that this seems relevant to their personal statement and why they’re here. I won’t read all of these.
Add a business course from physicians that are in successful independent practices. Wouldn’t it be cool if they could come and teach at LSU so that students can get an idea that, “Oh wow, it is still possible to be in practice as a solo physician.”
Patient relationships. So this is actually what saved my life. I could have ended up under the tarp because I was suicidal. Instead I asked my patients for help. I just did not feel like the profession that wounded me would have the help that I needed. So I thought, “Let me bypass, sadly, my profession and just ask my patients and my community for help.” So I did these town hall meetings and I won’t go in to everything that I did, but my patients basically designed my own practice, they wrote my job description. I’ve been really happy. And one of the things that I think is one of the most beautiful things that we can all do, that you should sometimes in your medical school experience try, is doing a house call.
Doing house calls brings everything together. It’s medical, it’s going out in to the community. It’s being with a patient. If you could somehow, I think a cool idea is get assigned to a family in Shreveport and be their medical student/advocate/eventual doctor, and follow them for the four years that you’re here, and do house calls every six months with them, to check in with them and see how their children are growing up, and check in with the parents. That would make you feel like a part of the community, a part of their family. Maybe they even invite you to Thanksgiving dinner. You just never know, ’cause you can’t always get home. And so I just think we should sort of start adopting one another like that.
And I want to share a house call that I did with one of my patients. By the way, patients are not as smart in biochemistry, they don’t have the book smarts, but they have the common-sense knowledge that you need, and they have the love and support that they want to give you. Medical institutions are under financial pressure, but there’s so many untapped human resources—people who want to help you. Yet you haven’t asked for help and we haven’t created the environment where people feel okay to do this. So I want to share a house call. If you ever get a chance to go on my blog, just look up House Call on a Hundred Foot Cliff. This is a guy who drives 100 miles to come see me. He’s out in Newport, Oregon. His name’s Johnny. He’s just the sweetest guy, I love this guy so much.
He can’t stop talking. He talks way more than me. I can hardly get a word in edgewise. And this is us doing a house call on a cliff, overlooking the Pacific Ocean. I actually do my retreats in Newport and what’s really funny is . . . I just got the idea in February, “Oh, I should have Johnny come talk to the medical students.” So he teaches my retreats now. He comes, he puts on his little jacket, he gets all dressed up, he comes with notes and he is so inspiring that at the end of my retreat, the medical students, they didn’t want a picture with me, they wanted a picture with him. And they even put him in their cell phone as “Johnny, my life cheerleader.” And he gave his phone number to all the medical students. They’re all gonna call him if they need any help. And I want you, this is sort of like my last slide, so I want you to meet Johnny in this video.
So it’s called Can House Calls Prevent Physician Suicide? It’s just kind of this weird thing that I thought of two years ago when I made this. It’s kind of a weird entry sorry. It’s kind of gruesome, but whatever.
Dr. Wible: Now why do you think more doctors aren’t doing house calls?
John Lesiak: Well, I really think a lot of them are kind of afraid to. I think they’re afraid to be real people, like a patient would expect a doctor to be. And I think they’re just afraid to open up and kinda go to somebody’s house. They want to be safe in their environment. And I really think that’s something that maybe they should kinda look different at, and change their attitude about how they want to approach their patients. They just want to feel safe, and they’re afraid to open up sometimes I think. They’ve kinda lost that doctor/patient touch. And they need to get back in touch with their patients and that. I think they would really enjoy it more. They would enjoy being a doctor again, instead of just being somebody that wants to write a script out.
Dr. Wible: And you think this’ll actually help the doctors, huh?
John Lesiak: Oh, very much so.
Dr. Wible: You know doctors have a high suicide rate. Why do you think they have such a high suicide rate?
John Lesiak: Well because they don’t open up. They don’t open up and be people. They close themselves in, they create blocks. And that’s part of the problem of not being out to go visit a patient at their house, and things like that. They need to open up and be more friendly. Be people. They’re people too, just like we are. It’s like, we’re all people. And to have a doctor be personal, it’s very important. It’s almost like they’ve forgotten why they wanted to be a doctor.
Dr. Wible: Now what do you think about doctors and patients who hug at the end of the visit?
John Lesiak: The hugs are the best part.
Dr. Wible: And you walked out of there with some balloons, huh?
John Lesiak: Oh yes, walked out with balloons, walked out with hugs. And more than once, I’ve walked out of your office, when I went back to go to my car, and there’d be somebody else in the parking lot and everything, and they’d say to me, “Johnny, you …” Or they’d just come up to me, wouldn’t even know who I am and they’d come up to me and say, “You sure look like you’re happy.” And I said, “I just went and saw my doctor.” And then they automatically say, “Well, who’s your doctor?” And I them who you are and that, and they say, “Well, you just look like you’ve had a good time.” And I say, “I always do when I go see my doctor.”
Dr. Wible: That’s great.
John Lesiak: And that’s happened. That’s happened more and more. Even when I go to the bank, or I talk to people after I’ve gone and done my visit. They’ll just say, “You know, you really … You just feel like you’re a whole different person. You feel really uplifted.” And I tell them I am. I’ve had people that have driven me back and forth for my visit, because I haven’t been able to do my drive all the way, do the 100 mile drive. And when I come back out of there, they said, “Are you sure you went and saw your doctor? You’re just too happy to go to the doctor’s office.” “Oh no, I saw my doctor. And I just had a great time.” It always is a great time. Never left your office, even when you’ve told me something that I may not have known what was gonna happen or something like that.
After you’ve talked to me about it, I can leave and I feel good. I know that you’ve set me on a path to make things better. If I’ve had something that’s discouraged me. And you know, that’s something that’s really missing in a lot of doctors. They don’t take time to talk to their patients, they don’t take time to actually treat them like a person. They’re just an account number to them and they in and out real quick. You’ve always taken time to talk to me, as long as I want to sit and talk, and you may have somebody sitting outside, waiting for their appointment, but then again, you go out there and you tell them, “Well, it’ll just be a little bit longer.” And they’re happy, because they know that when they get their turn, they’ll be able to sit and talk to you and talk to you about things for as long as they need to, to be able to feel good about where they’re at too.
Dr. Wible: Don’t you think this is the best job ever?
John Lesiak: Oh yeah, I think you got a good job. I wish, maybe way back when, if I was gonna be something, if I could’ve been a doctor or something like what you’ve done. It was always before, when I saw a doctor, it wasn’t-
Dr. Wible: It didn’t make you want to be a doctor.
John Lesiak: I always kinda thought, “That isn’t what I want to be.” And I always felt like I wanted to be a good person. And you ended up being a doctor who’s a good person. And that really means a lot. That just means a lot. ‘Cause I know it comes from the heart, instead of coming from the pocketbook.
Dr. Wible: Making me cry.
John Lesiak: But it’s the truth. It is. You’ve done a lot of good for a lot of people. And hopefully you can do good for doctors too.
Dr. Wible: Yeah, I think they all want to be doing this.
John Lesiak: Hopefully they can sit down and talk to you and kinda see that they don’t have to be under all the stress that they’re under. That sometimes they create their own stress. And if they were just to kinda change their attitude, how they go about things, they would have fun. They would enjoy going to the doctor’s office. That’s where they work, and they would enjoy it. They’d wake up every day and go, “I’m ready to go to work. I’m happy. I know I’m gonna feel good about going to work today.” And feel good about what they do. That’s important. They need to feel good too. Besides having a patient feel good, the doctor’s gotta feel good. Because if the doctor’s not feeling good, for any reason, that’s gonna carry over to their patient. They won’t be able to really treat their patient the way they should be.
Dr. Wible: Yeah, if they feel depressed or suicidal, what kind of healthcare is that?
John Lesiak: Right. How can they help somebody else, when they need some help themselves, to be able to get through things? When if they just looked at things in a different way, they would be able to say, “Hey, I can change this. I don’t have to be this way. I can be happy. I can be excited abut seeing my next patient.”
Dr. Wible: So you have a lot of patients who want to help you, and I think we’re not asking them. They’re really smart and they’ve been watching you, especially if you’ve been their doctor. They know that you’re stressed out. They want to help you. Anyway. I’ll stop now, ’cause I could talk forever and so could he, but if you have any questions, I’m happy to answer anything that you want to ask me. I hope that gave you some easy things that you could do today differently . . .
Question: What kind of success have you seen with peer support groups, if you’ve seen any?
Pamela Wible: I haven’t seen it with my own eyes, but I’ve heard from people in other institutions, that it’s really working well. It kinda depends on the buy in of the faculty. I think once they can get together in these peer support groups, it’s very, very helpful for them. Yes.
Question: What about a personality assessment before medical school? Do you think that would be useful for undergrads to figure out if they should go to medical school via assessment or psychological evaluation?
Dr. Wible: Yeah, I think it would be helpful to have a psychological evaluation before you pursue the career, just to see if you have the stamina. But it shouldn’t be used in a punitive way. I don’t want medical school to be like, “Okay, everyone has to go through this. If you show any signs of anxiety, you’re out.” Because honestly, a lot of us pursue this profession because we have had wounds that we want to heal, and help others with. So many of us are motivated to come here because we’re sensitive people who have seen things that are traumatic in our personal lives, and we can be supported, so that we can become truly the compassionate, loving doctors that we had intended to be. But I do think it’s like informed consent. When you pick up cigarettes, and it reads, “Warning, lung cancer.” Like it’s your choice then, whether you want to do it or not. You need to know, okay here’s the risk to my mental health, of this type of a profession. And here’s my score on this. Do I have the stamina to make it through? Leave it to the individual, fully informed, to decide.
Katy Wagner: Thank you so much Dr. Wible for coming. She’s available until two, if you want to hang out afterwards and ask her some more questions. But I wanted to thank you all for joining us for mental health awareness week. And if you haven’t gotten the chance, check out our displays that are right outside the library. It’s a lot of really powerful stuff, from our students, faculty and staff. And give it up for Dr. Wible one more time.
Thanks to all the amazing students at LSUHSC who made this event happen!
They did such a fantastic job with all the decor and arranging all the speakers 🙂
And pulled off this weeklong event while studying & attending class!
All I had to do was show up and speak 🙂