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.
Awesome stuff. Thank you Pamela, for writing this book, and for making my world a better, brighter place by your presence in it! With gratitude, with appreciation, with love, ~B ???
LOVE YOU Bodhi!!! The best is yet to come 🙂
Was #1 in LAW as bestseller on Amazon when I woke up this morning!
God bless you Pamela
A doctor that was bullied. Pimped. Made to fail a pediatric anesthesia fellowship. Rumors were spread about me bad things, I am incapable , I was sued , it was not me who was sued , it was my attending. The same chairwoman was trying to make me lose another job 4 years later ; I fought n got me fellowship. I did not lose my current job. My current job has all the things you wrote about: Age discrimination. We the attending have no time to eat pee poop, my family has to read your book because they have no idea why I am miserable every morning as I go to work. I have to take my water, food, snacks .. coffee tea everything. And of course god forbid you are sick , you d rather go to work n leave in your coffin than call in sick. Dehydration hypoglycemia occur with all doctors in training and post training. Sleep deprivation. Same story. Bullying age discrimination on the job. Favoritism.
“you’d rather go to work and leave in your coffin than call in sick.” That sums it up for so many of us. Sad.
Dr. Wible, I completely understand your message. When I was working 72 hour work weeks, (I was working the equivalence of two full time jobs every week for many years) I was denied a vacation day off to see my oldest son graduate from high school. And I was specifically informed by my direct supervisor that “if I called in sick that day I would be terminated from my job”
I could not afford to be terminated from my job, where I earned my wages and had health insurance coverage for myself and children as a single working mother. So, I worked that day to continue to be able to provide for my family.
Sadly, my son has at times reminded me I was not in attendance, it not only hurt me, it also hurt him.
An immediate family member of mine suddenly died while I was at work. I told my supervisor of the event and that I had to leave. Her FIRST response to me was……”don’t you have patients there?” and “well, I can’t cover you” I independently found someone to cover for me and I left work.
Another time I was on my way driving to my Uncle’s funeral. My supervisor knew about the funeral but still called me and told me I HAD to go back to work to help out with an unexpected influx of admissions. I reminded her I was on my way to the funeral, which she already knew about. Her reply was that she was too “busy picking up her son from college” and couldn’t go in herself. P.S….her son’s college was only a 45 minute drive away. I went to the funeral.
Thinking about it again today still hurts.
Unreal that we are held to standards that limit our ability to be human, attend funerals of our loved ones, see our own children grow up, attend family functions.
Pamela, your book sounds vital, to sit next to The House Of God and Kill As Few Patients As Possible. About 36 years later I remember my longest day with a 10 minute sit-down was 46 hours, and I was hallucinating while charting towards the end as evidenced by what I could manage to read the following day. Yet I considered that just part of internship . . .
I remember being trained by an ob/gyn resident who was hallucinating and drifting off into a dreamland while interviewing a pregnant lady about to deliver.
Amazing way to look at Medical life! Thanks Pamela.
Labor of love for my brothers & sisters in medicine——and ALL their patients.
Thank you Pamela for speaking up. When I started my first rotation as a 3rd year medical student, I could not believe what I was witnessing. There was an OB/GYN resident who had just given birth. The senior residents on the service were up in arms because she took time off after the delivery (not a lot, mind you) and were making their plans to make life awfully difficult for her…and these were FEMALE senior residents. Well, that was just a taste of what was to come. When I started residency, my assistant program director would have us do skits for him (imagine that, 80+ hours working and this on top of all that) for his entertainment. It’s total bullshit behavior which has no purpose whatsoever and absolutely no place in a professional environment. Not only that, but surgical residents were and still are told all over the country that if they are married, then the aim of their surgical residency program is to insure divorce. WTF is that? It’s BS held over from a time when medicine was run by privileged – and almost exclusively white male – assholes. Until now, Pamela, no one has told them that it’s wrong and tried to make it right. Please don’t stop what you’re doing and make it right. God bless you, Pamela.
The female-on-female physician aggression has been so shocking for me to witness as well. I personally have been attacked primarily by female physicians (even recently) related to my suicide prevention efforts. No issues with male physicians who have been not only respectful but so appreciative. Not generalizing here. Just my recent experience in the last year with certain groups of female physicians. I find it alarming how willing doctors are to tear each other down. Physician infighting just plays into the divide-and-conquer mentality that keeps us all victimized. Sad state of affairs.
Dr. Wible, I passed out to sleep late last night and missed this morning’s session for orientation week, so the school wanted to meet with me. (Ps. They almost sent a welfare check on me at 8am cause my phone was out of battery). I came in really disappointed, embarrassed, and was very anxious, but they asked about what was going on. When I told them about the my medical student mental health project, they asked more, and soon flipped a 180 full of disbelief and excitement. Our family med director was so supportive and knew about you, and as we talked students that had seen the trailer kept interrupting our conversation. It was such a joyful transpiration that I was simply blown out of my mind on the support, and it is really encouraging to see the new people running the school prioritize and treat students as individuals. They’ve incorporated new workshops for the very first time this year on straight up bullying and mistreatment that goes on during rotations, and it was run by our head dean (the really nice one I told you about that replaced the old one last summer).
That’s SO awesome! It was amazing to meet up with you this past month! So very excited about your project 🙂 Way to go!!
What it sounds like is a job!! Everyone goes through this. We can’t do whatever we want on our jobs. What should we do? Create a country club atmosphere for doctors?
Everyone goes through working 28+ hour shifts without access to food/water and wearing adult diapers because they can’t take bathroom breaks? Read the book. . . .
At my old residency, one resident went into diabetic ketoacidosis and required hospitalization for several days because of our irregular access to food and water,” reports a physician. Labor laws guarantee that employees get bathroom breaks and regular meals during their shifts. At my local PetSmart, my dog groomer gets two 15-minute paid breaks and one 30-minute unpaid break during her 8-hour shift. At my local Starbucks, baristas get two 10-minute paid breaks and one 30-minute unpaid break per 8-hour shift. Both work 40-hour work weeks. Even my pilot gets breaks and can’t fly more than nine hours straight. Yet new doctors-in-training work 28 (or more) hours per shift without breaks, meals, or sleep and are expected to work 80 (or more) hours per week.Labor laws don’t apply to medical students, residents, or physicians. No bathroom breaks. No time for meals or snacks.
Here’s what happens when doctors work 168-hour shifts.
Please have some empathy.
Bob, I am going to give you the benefit of the doubt. It seems as if you have a point of view which is coming from a legitimate place. I can think of many situations in which it might be helpful and wise to gently suggest someone (or perhaps a whole group) “stop whining.” ORDINARY college, perhaps. Teenagers on ORDINARY part-time jobs. Young persons in ORDINARY military boot camp. If we ourselves have gone through any of these experiences and survived, we may develop a categorical “toughen up” stance. The first thing you might consider is whether you actually did survive. I am presuming you are a doctor. I fear (yes, actually fear) you may have lost something very important to your humanity, and in this, your ability to endorse and contribute toward greater humanity in the world. This may be the case with many working doctors and doctors-come-bureaucrat who contribute to abuse of persons, to injustice, and to the systematic corruption of government and enterprise in healthcare. If you will refrain from being angry or reactive toward me for a moment, you may wish to take a moment to feel sad. You have my empathy. If you “went through this” – if you went through the abuses Dr. Wible describes, I can only say that I wish we had been there, pushing back against abuses in YOUR time of need. This is not to say you should not be proud of accomplishing things which have been hard to accomplish. Enduring formidable challenges, however, is not the same as enduring preventable abuses. There is a lot of space between standing up to inexcusable abuses and demanding a country club atmosphere. We MUST not, NEED not and WILL not normalize abuse, injustice, and corruption by resigning ourselves to the frozen comfort that “Everyone goes through this.” There are two types of abuse survivors out there. There are those who normalize their abuse so as to reconcile or neutralize it, and there are those who say, “The buck stops here. What happened to me was WRONG, and thus, I WILL NOT pass on to others that abuse which was passed on to me.” No one is saying that “workers” should be able to do whatever they want, willy-nilly. No one is suggesting medical practice or medical school should be so easy that trained monkeys could make the grade. Bob, contact us at HARBR-USA.org. We may be able to help you find things you may have lost. Dr. Wible, thank you for your work.
Labor of love and I think it’s time we all extend our empathy to include medical students and physicians—-those who dedicate their lives to caring for others.
Maybe having been subjected to such abuse is part of the reason residents and doctors both (not to mention nurses) are not infrequently abusive towards patients, as well as those who believe they can rightfully over-ride consent law.
Bob, You sound absolutely clueless and insensitive. Not only is getting the degree a struggle, but after you are working on your own the boards who over see the licensee are out of control . No over sight , talk about bullies on steroids . You would fit right in with those sociopaths. Because you are not capable of empathizing with someone who has gone as far as taking their own lives.
I am interested in your work. At present I am a single mother and PhD Med student, and work about 90hrs a week. As I have no childcare I do this while my 10yo daughter sleeps. I lecture in applied ethics while she is at school one day a week to make ends meet, as my scholarship is for one person really. I feel my own health being ruined but what to do? I have 7 months to completion. Ironically I am doing a PhD in medical education for future mental health professionals!
Please contact me here and I’d love to speak to you –> (email me via my webform & I’ll call you back) –> https://www.idealmedicalcare.org/contact/
Great work, Pamela. I’m happy to distribute to interns at Roanoke Carilion, Duke, MCV, UVA, and any other medical school I might be visiting, if you want to send me some.
I’ve also put a picture of the book with a link to this page on the DoC members site.
Awesome! 🙂 Happy to come speak if needed.
Veterans Administration Physicians are extreme patient profilers.