Medicine’s dirty secret—an interview with Dr. Wible


Medicine’s dirty secret. Dr. Pamela Wible interviewed by Dr. LaKeisha W. McMillan. Fully transcribed below. Listen on iTunes or download MP3 here.  Episode 68: “Shhh . . they want us to keep it a secret” with Dr. Pamela Wible.  (Note: Interview with Dr. Wible starts at 5:30)

LM: I talked about us stepping outside of the box here at House Calls with Dr. Mac and this week is really one of those moments. I was introduced to our guest through a mutual friend. I became aware of Dr. Pamela Wible through Facebook and started following her and I really connected with one of her soapbox issues some people would say, but really one of her passions. It’s an issue that she is championing and I was able to connect with her and the community that she is basically a tribal leader of and I was able to connect because she has been unearthing one of medicine’s dirty little secrets.

Dr. Wible is a family physician and she was born into a family of physicians who warned her not to go into medicine. She soon discovered why: in order to heal her patients she first had to heal her ailing profession. Fed up with assembly-line medicine, she held town hall meetings where she invited citizens to design their own ideal clinic. Open since 2005, Wible’s community clinic has inspired Americans to create ideal clinics and hospitals nationwide. 

Now what has she been championing? What does she need to heal within her ailing profession? One of those little tiny dark areas in medicine is physician suicide. 

She is the author of Physician Suicide Letters —Answered. In it she begins to talk about the culture of medical school and medicine and she begins to explain to us why it is that hurt and abused physicians can barely take care of themselves and thus they really can’t take care of their patients. And so she is starting a campaign to change the way healers are taught.

For years I tried to put into words my experience with medical school, residency and even my first practice and I just couldn’t formulate the words and put it into any type of coherent thought for someone who had not been through residency to understand. Reading her book and sitting down and talking with her, she’s put it all into words. So I invite you today to sit down and look at medicine through the physicians’ eyes.

This episodes has some explicit language so for those of you that have small listeners with you I ask that you use discretion. So let’s get started. Let’s sit down. Let’s have some conversations. Let’s connect these dots. Let’s get some straight talk.

LM: Welcome to House Call with Dr. Mac where you get a real doc with straight talk for the whole you. We are in downtown Washington DC with Dr. Pamela Wible and I have to say that this conversation is going to take me to places that I probably haven’t visited in a very, very long time because it takes me back to medical school, it takes me back to residency, it even takes me back to my first practice and going back to those places aren’t always so nice and bright and fun. Dr. Wible, we want to welcome you to the House Call community. Thank you for consenting in your busy schedule while you’re here from Oregon to sit down and talk to us today.

PW: Thank you for having me. I love, love this topic. I love talking to doctors. I love helping patients understand why they’re not getting the care they deserve and it all tracks back to our training and the way we’ve been treated in our medical practices. So I just want to talk the truth and I know you are somebody that’s really into that as well.

LM: Yes! Absolutely. We talk about connecting our health dots here in the house call community. We want for as a person allows us to come into their homes or on their walks, in the cars, or taking care of their daily activities and they’re listening to us and we’re allowed to come and make a house call with them that they’re able to hear individual’s health stories, health care provider’s and other expert’s perspectives on a topic and they are able to connect their own health dots and begin to experience whole person care. And what I like to do is connect the dots of how a guest came to this community.

I was introduced to you through social media and I was introduced through a dear friend of mine who I found out is actually chapter 52 of your book, Physician Suicide Letters —Answered. And as I followed you more and understood your passion and your platform and I just happened to see that you were going to be in my backyard, I said, “Oh my goodness, I don’t know, this is really a shot in the dark, but I’d really like to sit down with her.” And that’s how we’re sitting down today. So we’ve given a little bit of what we’re going to talk about today, but we’re going to talk about a subject that is a big hush-hush in the medical community, in our every day communities. We’re going to talk about death by suicide and we’re going to talk about physicians’ death by suicide. And can you tell me how did you become passionate about this subject matter? How did you even become passionate about physician death by suicide?

PW: Well it all started on October 28. It was 2012 and I was sitting in the memorial service for the third physician that we had lost in our small town in just over a year. And I was sitting behind his young children in the front row. He was a pediatrician who shot himself in the head in a public park in the middle of the day in my town, a top-rated doctor, and I am sitting behind his children. Just listening to everyone whispering “why?” and mourning. The whole community had come together to try to celebrate this man’s life and our loss. And I just kept hearing “why?” whispered in the bathrooms and as people we’re checking in and signing the little book. Of course, I was walking in with the why question too. But to hear all the whispering why, why, why around me I just started to really get deeply involved with that question during the entire time I was sitting there and then I started counting the number of suspicious death that I knew about in young doctors and I had filled up all 5 fingers on each hand and so then I thought oh wow the why for this is way bigger than this one man’s death. I think we have a coverup going on here. I think this requires a huge investigation. And I don’t think these people in this room have any clue as to what’s really going on here and so it just blew me away.

The other interesting thing is just 2 days before [his suicide] I had published my first book, Pet Goats & Pap Smears, which is just kind of like a “chicken soup for the soul” book for doctors with all fun stories of healing from my patients and my practice and all my house calls and fun things I do with patients giving them balloons and kissing people . . .

LM: Wow!

PW: . . . bringing them soup to their house and all the crazy things I like to do. Ya know, they call me the female version of Patch Adams only it’s a business model you can really make money with and it’s replicable because it seems people could really get into having a doctor like me. 

LM: Yep! we’re going to talk about that later.

PW: And so I came out with this book that was really supposed to revitalize my profession and help physicians find their joy and help patients find their joyful physicians and to have less than 2 days later another doctor kill himself on my town. I thought I guess a chicken soup for the soul style book isn’t really going to solve this problem. This problem within my profession is so far gone you can’t just hand people a book of fun medical stories. As a group we have PTSD. We have depression and a lot of us are walking around trying to plot our suicides during our workdays at our clinics and hospitals. 

LM: That is the truth! That is the truth! I took your book and devoured it in about 3 hours and I just kept turning the pages and turning the pages and there’s one story in there about an anesthesiologist and the reason that this came to mind is you’re talking about how we’re planning our suicides as we’re going through our workday. He was in a surgery and had just helped perform surgery as an anesthesiologist and then went and hung himself. And people are wondering what happened, what happened? And you made such a point in that story that physicians are high functioning people. We are functioning until our last breath.

PW: Right. We are doing complex surgeries, brains surgeries, orthopedic surgeries, and a two hours later we are in the back room shooting ourselves in the head. The whole topic of suicide is overwhelming for anyone. Even just one suicide is overwhelming. When you think of how many suicides there are just during our interview here happening around the world, it’s just incredible. I think the way to handle it is you pick out a subset—a demographic that you can deal with—like I totally understand now medical student and physician suicide. I understand why it happens. I understand how we can prevent it. I think 99% of these are preventable—and easily preventable. And so once you can focus on one target demographic and really solve it then you can extrapolate to veterans and transgendered and everyone else can benefit. I know a lot of people may think why should I care about physician suicide. I’m not a physician. Well let me tell you. You are going to need health care in your life and you don’t want the person controlling your ventilator to be sleepy, bullied, and plotting their suicide while they are trying to take care of you.

LM: Absolutely.

PW: Furthermore, I think we can all get behind the idea that why should we create a world with so much misery that people feel their only more comfortable and safest choice is to kill themselves. That’s quite a world we’ve created.

LM: Absolutely.

PW: The other thing that I had mentioned yesterday during my keynote to these medical educators is we’ve created a medical education system in which some people feel so out of their comfort zone in what we’re making them do and how we are training them that they feel like it is more comfortable to shoot themselves in the head than to finish medical school. 

LM: Yes.

PW: In residency too. I was asking these people in the audience to please get out of their comfort zone and help me solve this so we can finally talk about this and people resist coming to the stage and sharing from their hearts. I’m telling you it is much easier for you to get out of your comfort zones and help me solve this than to allow these residents to continue to be so far out of their comfort zones that they feel more comfortable jumping off a hospital rooftop in Manhattan to their death than going back to work tomorrow as an OB/gyn in their residency.

LM: Absolutely. I want us to go back a little bit. You were talking about how we’ve created an atmosphere, I have tried so many times to put into words residency, medical school, and the first time you get out there on your own that can house all of it. I used to say residency is just a pathological state of affairs.

PW: It’s like being in a cult.

LM: Yes.

PW: Like you’ve got sucked into a cult and you can’t relate to the rest of the world like everyone else does. You are not real normal anymore. It’s going to take years to recover from it. 

LM: Yes! And in your book you talked about the atmosphere of bullying. That we have created an atmosphere of bullying. A hierarchy in which we’re sleep deprived and we’re asking people to and I had totally forgotten about it until I read it in your book the pimping sessions that we have. Oh my goodness. I totally forgot about that. That is what we used to call them. People are like what, what do you mean, what are you talking about. So can you give us a little bit and explain the atmosphere and culture of medical school and residency that starts fostering this PTSD we suffer?

PW: We have fear-based training programs. And that is just not going to fly in 2016. I know there used to be a time when people thought it was okay to spank their kids and be violent with other people as a way to teach people. It’s 2016. The fatal flaw here in Western medicine is that we are following . . . I went to a really progressive all-women’s college, Wellesley College, and I was used to being treated well, being respected and told I could be anything I want to be in the world. Come on, Hillary Clinton went there, Diane Sawyer, Madeleine Albright. I was following in the footsteps of people who can accomplish things. We were told on day 1 we were women and not to let anyone call us girls. You can do whatever you want. Don’t let anyone hold you back. All the sudden I graduate from there and head to medical school in Texas to this good-old-boy’s backwoods anything goes, womanizers, hunters, racists, anything goes craziness. I felt like I went back 300 years into the past and I had because medical schools are training us based on a 17th century philosophy of reductionist medicine which basically just sees us all as a bunch of really interesting organs in a sack of skin. That is how they train us to look at people.

LM: Yes. Yes.

PW: So if you just start feeling like you are a machine, it’s because we are trained in a 17th century philosophy that we don’t have hearts and souls, feelings. That’s how they were able to do vivisection, take live animals and carve on them and they thought that was okay because they don’t have feelings! We’re just like really interesting machines so we can understand how the machinery works. We’ve gotten so micro. micro, micro one of the things I said during my talk yesterday “Humanizing medical education: How to grow a happy doctor” I said, “Isn’t it fascinating that we know how to do a lung transplant, that we’ve mapped the human genome, that we can grow human organs in a laboratory, but we don’t know how to grow a happy doctor?” Isn’t that amazing? It’s like that Martin Luther King quote: “Our scientific power has outrun our spiritual power. We have guided missiles and misguided men.” Our spirituality has atrophied. We have a fatally flawed Western medical education system that somebody needs to call out so I guess that will be me. We’re in 2016 teaching medical school as if we are in 1647.

LM: Have mercy.

PW: What was life like in 1647? Is that how we want to be dealing with people now? That is one problem. Then mix that with capitalism gone mad and patriarchy trying to keep hold of the power. It’s time to respect women, minorities who are really the majority, ya know. 

LM: Right, Right.

PW: It’s time to respect people in our hearts and souls. We all have souls and we are just spiritual beings having a finite human experience. They need to get that in medical training. It does not matter if you can map the humane genome if you don’t have humanity. Actually it’s pretty dangerous for people to have all this technology without any heart and soul. Look at Hitler. You can have a lot of interesting ideas for the human genome, but if you don’t have heart and soul you’ll create major havoc. And that’s what we have.

LM: My goodness. You have started championing this message. You are out there in the forefront. You’ve given some pretty shocking statistics when it comes to death by medical students and physicians. Can you give us some of those statistics? How many physicians we lose in a year and how many millions of Americans will lose their doctor?

PW: Well, for your listeners who haven’t gone to medical school let me just tell you over one million Americans will lose their physicians to suicide this year, and again next year, and again next year, and if we don’t do something the next year too. We’ve got to do something because we can’t have all these patients call in for appointments and their doctor isn’t at the clinic and they can’t figure out why, because they don’t even tell them. They just assumed they moved, but really they might have just jumped off a building last weekend. This is just completely hidden, covered up. These people who’ve seen their doctors for 20 years, they’ve saved their lives. They can never find out what happened to them. All they know is they have to pick a new doctor. That’s totally unfair for multiple people. Just for your listeners who are patients, I want to fill them in on what this means for you. 

What it means for physicians is that we lose over 400 physicians per year to suicide, which is the equivalent of entire medical school of medical students just disappearing every year, and we already have a physician shortage. So how can we allow that to happen? That’s not even counting the number of medical students we lose to suicide, which is like maybe 75 to 150 a year, but we don’t really know. Why don’t we know? It’s not like we can’t figure out that they didn’t show up to class. Like I told them yesterday it’s like, “You do know when they don’t pay their tuition that they’re not there anymore, right?” Like where did they go? Why aren’t they there? They’re not migrant farm workers, they all have social security numbers. We should be able to track these people. Look, you track every move they make while they’re alive. You track every grade point that they aren’t up into the zone that you want them in. You track their step one and step two scores until you drive them literally nuts, making them want to jump off a building. But the minute they jump it’s like they never existed. Same thing with physicians now, some of these big-box assembly-line medical clinics are putting ankle monitors on the doctors to time them how much time they’re in the room. They’re scrutinizing every move they make. You might as well be a prison inmate. And the minute they die it’s like they never existed. They only exist as long as they’re a revenue generator for you, right, as a medical school or a big-box clinic. That’s when they exist and as soon as they stop generating revenue you have nothing else to say. Let’s just call it what it is.

LM: Wow. So have you gotten a lot of resistance from the medical establishment?

PW: No, I haven’t had any resistance.

LM: Really?

PW: I have people that are afraid for my life. I have people that tell me like, “Watch where you walk,” but I don’t feel resistance. People come up to me and they thank me all the time. Doctors come and tell me that, “You’ve saved my life, I read that article, I finally understand.” Mothers who’ve lost their children to suicide in medical school or residency, they read this book for example or read something I write and they finally understand why they lost their child 20 years ago. They didn’t understand, they thought maybe it was something wrong with their child. No, this was done to your child.

The other thing I want to say that’s pissing me off more than anything is this term “burnout.” I am so sick of this term “burnout” being used, because that is a victim-blaming and shaming term that then fuels the problem that we have [see You’re not burned out, You’ve been abused].These doctors are walking around getting labeled with “burnout”, which makes them feel defective. The reason why this upsets me is a lot of people that have been suicidal have told me that they were first labeled with this term “burnout.” which made them feel like, “Oh, there’s something wrong with me. I can’t keep up with the group.”

That fuels their decision to jump off buildings and buy guns and kill themselves, because they were labeled with a term that was created by our oppressors, okay. This was not a term that was created by anyone for any sort of nice reason. This was a term that is created and propagated by our professors and kind of well-meaning but clueless physicians who use this term that basically makes us feel like there’s something wrong with us.

Let me tell you, we were valedictorians, top of our class shining stars before we started medical school. There is nothing wrong with us. We were high functioning people. We were the kind of kids that like any parent would want to have. We didn’t curse, a lot of these kids are like, they don’t curse, they don’t drink, they study all the time. They’re really good, good people. That should be encouraged and they should be celebrated. They are the winners. Why would you take a group of such high functioning people and suddenly over 50% of them have “burnout?” These people have been frigging abused! We need to use the real term, which is “abuse,” and I don’t use that lightly. I didn’t just make this up. Read the United Nations Declaration of Human Rights and you can point out multiple articles in there that are broken in our American hospitals and clinics every day on their own employees.

How does this fare for patients? Not very good, because the doctors who are taking care of you have been abused to the point of plotting their own suicides during their work hours. I mean this is serious. This is why people aren’t getting the care they deserve in this country, and elsewhere.

LM: Exactly. I was reading your book, and you’re like, these letters are not just from the United States, they’re from South Africa, they’re from India. They’re from all over the world, because this is something that’s being propagated in the medical profession across the board.

PW: Yeah, we have exported our 17th century supposed modern medical system to the rest of the world. They have their own stressors of poverty and other issues in India compiled on top of this complete disaster. Let’s just call it what it is.  A treatment plan will make any sense if you don’t have the right diagnosis. What is the right diagnosis? Well, it’s not “burnout.” It’s not “burnout.” In fact, these people have been snuffed out. It’s not “burnout.” Their souls have been methodically removed from their bodies by a medical education system based on a 1647 philosophy of reductionism, which is a dehumanizing philosophy that literally believes we have no souls in our bodies. When you look at doctors, like nobody’s home. Their soul has left their body, which is why they’re a tough crowd to talk to and less animated, because they’re not home. They’re not home.

LM:  Can you tell us why you came to DC?

PW: They invited me here, can you believe that?

LM: I love it, I love it. What organization?

PW: AACOM, it’s American Association of Colleges of Osteopathic Medicine. They’re basically an organization that represents the 44 medical school campuses across the country that train over 26,000 of our medical students every year in the United States. I have to say osteopathic medical schools are, at least on their websites and their mission is to be, holistic. Mind, body, spirit integration, which is the opposite of reductionism, which is mind, body, spirit disintegration. That’s the basis of allopathic medicine, which is the MD programs. Osteopathic doctors are already kind of like shining stars in the solution to what’s gone wrong here. Not all of them kind of understand the ins and outs of a lot of things I’ve discovered, so they wanted me to come and shed light on this. They’ve been really, really highly receptive to the things that I’m saying. 

LM: Good, because I was wondering if you were getting any push back from medical schools, from residency directors or programs. 

PW: I have not received any push back. Can you believe that? The thing is, I’m a strong person obviously. I’ve got a thick skin and you can’t really offend me that easily. Even if you don’t like me it’s okay, I’m going to keep moving a hundred miles an hour right past you. So join me, I’m a fun person just speaking the truth with love. I think people realize that. I’m not in this to make money, not for an ego thing. It’s so funny, every once in a while like, “Oh, you’re making, you’re just doing this for your . . . Look, I didn’t get into this to make a lot of money off of suicide victims. When’s the right time to ask somebody for their credit card when they’re calling you and they’re suicidal? I’ve never done that! It’s so funny because some physicians will be like, “Oh wow, this is a really great revenue stream,” and it’s like, “Really?” It’s incredible.

As far as push back, I would say it’s funny because my dad asked me once, he thought I was getting a lot of hate mail. I haven’t had any hate mail, but all the time I often get told mostly by men or people older than me, they’ll say, “Well, keep up the good fight.” I have to say, “This isn’t a fight, this is a labor of love.” I just love what I do, you can tell by seeing what I do at my office. I don’t feel like I’m fighting anyone. I am celebrating the truth and inviting people to join me. There are people who, I’m sure, are repelled by me. The people who are repelled by me can keep doing the same thing they’re doing, which is, if it’s the status quo, it’s killing doctors and killing medical students. That’s your choice, but I don’t consider this a fight. I don’t consider this really very difficult, even. I’m just noticing the truth and speaking out loud.

LM: Wow. Can you tell us what is ideal medical clinics? Am I saying that correctly?

PW: Yeah, ideal medical clinics or ideal medical care. It’s essentially what happened is I was very frustrated working in an assembly-line big-box clinic. I actually became suicidal myself after 6 jobs in 10 years, because I’m not (if you can imagine) probably not a good employee. If I don’t like the way your rules are set up I’m probably going to bring it to your attention and you might want to probably fire me, maybe. Even though I’m a really agreeable, pleasant person, I will point out what’s not working. I won’t stay in a place that continues to do things that make no sense. I basically couldn’t figure out how I was going to work in alignment with the values that I had that I had written on my personal statement when I started medical school. I wanted to be a real healer, do house calls, have 30 to 60 minute visits. Really hang out with people and help them.

That wasn’t part of my job description at all these big-box clinics. They just wanted you in there 7 minutes in and out, upcode it, lie on the medical record. “Do whatever you have to do so we can get more money. We just need a warm body in the room and we don’t really care about patient outcomes. We’ll say it if we have to to get our JACHO, whatever accreditation. As long as we don’t get sued and we get the money we just want you on a treadmill. We’ll control the volume and the pace and you just keep walking.” Anyway, we’d been in paper chains for a long time in the dungeon, and doctors don’t understand they can just crawl right out at any time. You’re your employers only competitor, isn’t that cool? Just go across the street and open your own clinic. That’s what I did, is I have basically this idea that I didn’t have to be in chains in an organization that I have no respect for, so I left.  But I did get into the state of feeling really depressed. I felt like, “Is there any way to be a doctor the way I really want to be in this country?” I felt like it just wasn’t possible in the United States to be a real healer.

I looked around and I noticed the patients weren’t happy, and doctors aren’t happy. I got this amazing idea, “Why don’t I just put the end user in charge? I’m exhausted, I’m suicidal right now. I don’t think I can figure out how to run a clinic because I feel like I’m ready to kill myself. Why don’t I ask my patients and my community to design their ideal clinic and I’ll work for them. You all write my job description, I’ll do whatever you want.” And that’s what I did.

I led 9 town hall meetings in 6 weeks. Literally for 6 weeks I did not move and I was in a self-induced coma in bed because I was really depressed. Which my sister-in-law, who’s an orthopedic surgeon, told me, “Depressed just means you need a deep rest.” That’s what it felt like, I did need a deep rest. I literally didn’t get out of bed for 6 weeks except to go to the bathroom and let my dog out. The backyard was full of crap by the time I finally . . . Anyway, the point is I had this dream, like an epiphany, like a message from God almost. It wasn’t really a dream but I wasn’t really awake. I can’t explain this, it’s never happened to me at any other time in my life, where I felt like this pull, like I saw all these people coming together and designing their ideal clinics and hospitals, and people just as a grassroots sort of thing. Brick by brick, police officers holding hands with nurses and doctors and patients all kind of doing it together. It was this beautiful vision that I had, and I jumped out of bed, called the newspaper and told them, “I’m going to open a clinic designed completely by the patients in our community.” I was just literally on a roll for years after that, that’s all I was doing. I had those town hall meetings. That was December 7th, 2004 when I had that vision. January through March of the next year I had 9 town hall meetings, collected a hundred pages of written testimony which I have with me actually. I bring it often with me everywhere. I’ve got a hundred pages of written testimony here of what my people in my town want for ideal health care. I read it all. I pretty much told them I would do whatever they wanted as long as it was basically legal. I said, “Just write your wildest ideas and most crazy things that you want to do at the doctor’s office.” They wrote it all down and I read it and I could do 90% of what they wrote. We were open one month later without any external funding. Isn’t that amazing?

LM: That is awesome!

PW: That’s what I’m saying.

LM: That is awesome! You are able to duplicate this for other physicians that want to do this?

PW: Yeah, I basically help them understand that their patients are their greatest allies. When we work together we could create so much more beauty and healing then we ever could by ourselves. You certainly don’t want to work for an organization that’s out of alignment with your basic values. Let’s just do this together. What ideal medical care is, is, ideally, it is care that is designed by the end user where the patient (and I even told these medical school administrators yesterday the ideal medical school would be designed by medical students). They are high functioning, high achieving. They don’t want to sit and just jack around all day. They want to learn how to do neurosurgery. They want to learn anatomy. They want to learn medicine. They’re not slackers, okay? Stop treating them like babies. Let’s stop treating patients like juveniles and have them so dependent on us and annoying. Treat them like adults. Let’s start treating patients, as long as you’re not a pediatrician, right? And let’s treat medical students like adults. Respect them and put them in charge of their own destiny and their own medical education system and creating their own clinics and creating their own hospitals.

LM: I love this.

PW: That’s ideal medical care.

LM: I love it.

PW: It works, it’s not just like a little pipe dream I’m sitting here in the hills of Oregon just dreaming. I am serious. I invited people to do this. Literally was no effort on my part, I just read what they wanted and did what the people said. This is like the community mandate. All it is is honoring people for their potential and following them. A good leader follows the people. What do the people want? What do medical students want? What do patients really want? Have we ever asked them? Isn’t it strange that we’ve never asked them what do they want? We just hold all these people hostage to a 17th century philosophy of you’re just an interesting bunch of organs in a bag of skin.

LM: Yeah, we’re going to dismember you and figure out all the little pieces. 

PW: Yeah, and that’s how people feel. They feel like they’re trapped on an assembly line, they feel like they’re treated like a machine. Another thing I want to tell you, that I went to the medical library. I’m one of those people who stays up late at night and likes to read books and go to the medical library. When I was on call I would go to the medical library at my hospital, be the only one in there at midnight just reading all the books and finding all sorts of interesting stuff.

I found a whole row of books on Toyota manufacturing. What is that doing in my hospital in my town? I open up these books and it talks about lean something business. Basically what I got from that is they are designing hospitals based on Toyota lean manufacturing principles. It’s not just that it’s a 17th century philosophy that we’re following that’s so antiquated, we are also using out-of-control modern capitalism and applying Toyota manufacturing techniques to human services, which makes no sense. That’s why people feel like crap after they go to a doctor, because they’ve just been treated like they’re a Toyota and a machine who has really interesting defective organs. See what I’m saying?

LM: Pamela, I could sit here and talk to you all day because I am so relating to every single thing you are saying. It is just, it’s helping me because now I know I wasn’t crazy. What I was feeling was real, and what I experienced was real. It wasn’t something that was made up in my head. Now I have somebody else to help corroborate that story so that others can understand what this side goes through. 

PW: The thing is, it’s like we’re just having the normal reaction that anyone would have to a sick system. Patients, if you’re not feeling well after your appointment you’re having a normal reaction to a sick medical system. Medical students, if you’re not feeling well in medical school you are having the normal reaction to a sick medical education system. Physicians are having the normal reaction to a sick job that they’ve been stuck in, that they can get out at any moment including today. So quit!

LM: Absolutely, absolutely. 

PW: It’s not going to change without physicians standing up. Patients literally are held hostage by the fact that their physicians don’t have enough courage to leave their jobs that are not working out for them. Basically what’s going to lead this revolution and humanization of medical care and medical practice is that physicians need to, en masse, boycott these sick medical systems and be true healers. That’s what you wanted to be when you signed up for medical school. You cannot be a victim and a healer at the same time. Choose one.

LM: Wow. Wow. I’m looking at our time and we’ve got to wrap this up and round the corner.

PW: Really? 

LM: Yeah, I know. 

PW: We can’t just do a second segment and then you could put two out? 

LM: We sure can. It’s your time. 

PW: It’s fine, yeah. 

LM: Okay, wow. Yes, so we’re going to conclude this segment right here but we’re going to continue talking and we’re going to put out the second episode. I thank you for giving us more of your time. I want to talk about- so should I give a pause here maybe? Okay, I’ll just give a pause. 

PW: Thank you for having me, and I’m glad to come back for another episode. 

LM: Okay, we are back with Dr. Wible here in DC. She has consented to give us more of her time. I’m so excited about this. I wanted to talk to you about your TEDMED talk. How did you arrive on the TEDMED stage?  

PW: Well, apparently they had 10,000 nominations to do a TEDMED talk. It’s a real honor to be asked to deliver one. They picked 50 people and they had me on opening night. How I arrived is that, it was like an internal nomination. They were reading some of the things I was producing, the blogs on physician suicide. (I needed to get a cough drop, getting over a cold)

LM: Yes, we’ll get a moment. Let’s take a moment.

PW: Okay.  

LM: Okay, we are back with Dr. Pamela Wible here in Washington, DC and we’ve been talking about the subject of death by suicide with physicians and medical students. At this point, we were talking about how you arrived at the TEDMED stage. I know people are probably familiar with TED talks, they are talks about technology, innovation, and design. This was TEDMED though. This is the first time I was even introduced to TEDMED. I didn’t know there was a separate type of under the big umbrella of TED talks. You were able to be on the TED stage, and you were telling us a little bit about that. Your talk was about your passion; the subject matter that you champion, which is physician suicide. That TED talk can be found on YouTube online, can it not? 

PW: Mm-hmm (affirmative), yeah and they have a TEDMED site. You just have to google “Why doctors kill themselves” and you’ll find it there. You’ll find it on YouTube, TEDMED. 

LM: The letter that you have on the cover of your book, you integrated that story in your TEDMED talk. Could you give us a little bit about that story? 

PW: Yeah, that was about a physician, Greg Miday, who was this amazing nocturnist, which is a hospitalist that works night shifts at the hospital. He admitted the mosy number of patients ever at Barnes Jewish Hospital in St. Louis. He was this hard-working, super-smart guy. I mean, on his obituary legacy page there are patients still writing in thanking him for saving their lives, and he’s been dead for 2 and a half years. Is that amazing? It’s amazing that this guy dedicated his life to saving others and yet they let him fall and mistreated him in a way that lead to his own demise. 

LM: My goodness, oh my goodness. We wanted to start talking about how can the community get involved or how can people help. I saw on there there was a story, a mother. You were talking to a mother. A mother wrote to you and she started talking about House Bill 867. Can you tell us about House Bill 867? 

PW: It’s a bill in Missouri in the state legislature that basically is going to start screening for depression at all the 6 Missouri medical schools and making that data transparent and accessible to the public. Parents have no idea when they send their children to medical school that they’re sending them into harms way, that they have an increased rate of suicide, depression, and other mental health issues. You would certainly interact with them differently during their training and check in on them more, and send them care packages. It’s your right to know if you’re walking into harms way. This data needs to be informed consent. The public needs to know, medical students need to know. Medical students might choose a different medical school that has a lower suicide rate if this data was made available.

LM: This is data about the schools letting out data about how many students have either had or have mental illness or are suicidal. 

PW: It’s not to identify students. It’s an anonymous de-identified screening process. The data in aggregate is going to be made available to the public so that you can make a judgement.

LM: Is this a good environment for me to go into?

PW: Yeah, and the same thing with like infection rates in hospitals and other sorts of things. The public deserves to know what they’re walking into. You might choose a different hospital that has less suicide among the doctors, less infection rates. You know what I mean?

LM:  Right, right. Part of the data points. Part of the data points. Now as of right now, is there any type of support for physicians that are feeling that they need some mental help, or they need that help that they’re not, they’re feeling that they’re starting to slip away. They’re walking down that path, that, “I’m becoming suicidal.” Is there anything that we have in place today?

PW: No, there’s nothing we have in place today. There are little pockets of people trying to do things but there’s nothing on a national scale that’s available [specifically for doctors]. That’s why I sort of became the suicide hotline for physicians, not just in the US but around the world. Medical students keep writing me. Why would they write me? They have nowhere else to go so, of course, they reach out to me.

LM: That’s what I wanted people to understand. There’s really no place for us to go, even for us to receive psychiatric help or saying if somebody’s bold enough to say, “I need some help. I’m having anxiety, I’m having depression, I need some help.” You wrote about a doctor that would go 200 miles away, pay cash, and use a fake name in order to get help. We shouldn’t have to jump through those hoops. The reasons we do that is because when we’re going for licensure, when we’re going for privileges, we’re asked to check off “have you ever been under psychiatric care?” “have you ever had to deal with XY and Z when it comes to mental health?” If we check yes, what happens? 

PW: You have to go in front of the state board, explain yourself. Usually there’s a whole blank page at the end that you need to fill out explaining exactly what happened. It’s really none of their business, in a way, that you had a divorce and had to go to marriage counseling. But they want to know, they want to dig up everything that you’ve ever done that had to deal with your mental health care. You have to defend yourself in front of a group of people that you don’t know that are at your hospital or the state medical board. 

Sadly, some people end up getting turned over to the Physician Health Program, which is actually like a program that preys upon physicians financially to support itself, and has them in a, they send everyone into an AA style 12-step program whether you have substance abuse or bipolar or anxiety or bullying. No matter what it is, it’s like this weird one-size-fits-all. It’s kind of terrifying. That’s what lead to the letter on the front cover of my book, is that Greg Miday was sent into a Physicians Health Program. He did have a drinking issue, right, but he was never impaired at work. He liked to drink because it made him feel better with his anxiety that he dealt with in his free time. He never was impaired at work, yet they were on his butt constantly and wanting him to go 300 miles out of town and do treatment programs that were really demeaning. The way they spoke to these people was very 17th century. Belittling. At one point he called his mother from the treatment center. His mother’s a psychiatrist. When he got off the phone his little counselor there said, “Oh, what’s wrong, you had to call your mommy?” You know, you don’t talk to adults like that who are suffering. This guy is highly intelligent. He saved hundreds of peoples lives, and by your bad attitude and speaking to him like he’s some sort of a child or imbecile, it just shows that you have a problem. This, as far as where physicians can go for help, well the Physicians Health Program on the surface sounds like a place you might be able to go and get physicians health. However they terrorize people there. Letters from physicians who’ve been terrorized there that you’ve read in the book. I’m sure some people have been helped by certain programs, especially if they believe in the AA style treatment and they actually have alcoholism or something like that. But for the majority of people, I’m not sure that this is a helpful situation. That’s where we’re at. We’re in the dark ages, we’re back in the 17th century. We’re at the Renaissance Hotel so . . . 

LM: Yay! We can have our Renaissance!

PW: It’s time for a Renaissance!

LM: Suicide, death by suicide, is not just an event that happens to the individual. It effects the family, it effects the coworkers, it effects the patients that they were taking care of. It’s a ripple effect. Can you give us a little insight on the story about Kaitlyn and her mom Rhonda?

PW: Kaitlyn was, at the time of her death, a 23-year-old medical student, her third year at Wake Forest. She was like a star child. Straight A, valedictorian. One of those people, never cursed, so good. From a rural town in North Carolina where, gosh, she probably had the highest IQ for a hundred mile radius. She’s just a brilliant, smart person who was dedicated to helping people and wanted to become an anesthesiologist. She went to medical school. I didn’t, obviously, know her. I never spoke to her before she died on April 11th, 2013. But she, in my mind, just from hanging out, her mom reached out to me and was so happy that I was working on this. Her mom then wrote a book after her daughter died on suicide of gifted people and how it’s different than just people in the general community who you might see that they’re suicidal before they do a school shooting. You might sort of notice they’re not acting right, they’re not doing brain surgeries 2 hours before they shoot themselves in the head. The average person is decompensating.

Physicians are unique in that they have been so good at disguising their problems for so long that they can put on a show until the very end and be high functioning, which was her case. She’s a high functioning person.I feel like that maybe, this is me kind of feeling into her situation, being such a bright person can be like a curse. It’s like if you’re smarter than everyone else you could feel like you’re in a special ed class everywhere you go and nobody can relate to you. Not that you want to be judgmental on other people, it’s just that who’s your tribe if you’re super smart like that? Who can you hang out with that really gets you? I think she felt like when she got to medical school she’d finally be with her tribe of people who are as high functioning and smart as she was. But what happens in medical school is they keep these people so terrified and isolated they don’t have time to bond with one another and become friends. They end up just these terrified, lonely, very smart people, which is like a death sentence because loneliness, we’re social animals. Being really smart and lonely is like a double whammy. You can’t relate to a lot of people and what goes on in the world with the common man because you feel a little different because you’re gifted. You take these gifted lonely people and you torment them. They’re smart, they see that you’re tormenting them. They understand that they have now signed up for a profession that’s going to be a lifelong torment. They’re not going to tolerate that. They’re going to see suicide as the more comfortable option than continuing to be tormented financially with $300,000 of student loans in a profession where what’s the end goal? They finally get out of all this and they work at like an assembly-line clinic and are forced for 7-minute visits with OB/gyn patients and so your fingers are going in and out of all these women all day long. That’s really like joy, joy, that’s what you’re going to be doing?

LM: You don’t get to connect with anybody.

PW: Your soul’s purpose, which is the reason why you went into medicine, is basically shit on. What happened is that Rhonda reached out to me and I became really close to hear. On social media we were in connection. I was on the phone with her quite a lot. One day after I delivered a talk where I was actually quoting her from the book that she wrote about her daughter and I Facebooked her. I was so happy because we got a standing ovation. She never liked my post and she didn’t respond. Then I found out the next day when I went on her site, there were all these “Rest in peace, Rhonda.” She had died by suicide actually during my talk. 

This impacts, when you lose a family member to suicide it increases your risk of dying by suicide. This family has lost 2 out of their 4 members of their nuclear family to suicide. I asked the father. I went to her funeral. I’m sitting there with my hand on Rhonda’s casket and looking ahead at Kaitlyn’s gravestone with her beautiful 23-year-old smiley face picture on there with her little blonde hair. Perfect, didn’t harm anyone on the planet sort of sweetness. Now here’s her mother’s casket with all the earth torn up with the little fake green thing that they put for grass. This is very surreal, that now we’re going to have this mother be buried next to her daughter. I asked the father at the after party where you’re all hanging out with the relatives. He’s such a sweet man, and he’s not vengeful. He’s not the type of person to blame others for his problems. I asked him, “If your daughter worked at Walmart, do you think she and your wife would still be alive?” And he said, “Yes. Medical school has cost me half my family.”

LM: Wow. This has so many layers. This has so many layers, there’s such a ripple effect. You’re doing so much to help bring awareness to this and bring it to light. You’re also not just bringing it to light and you’ve developed these ideal medical clinics, but you’re also reaching out to medical students and physicians through a retreat. Can you tell us about that?

PW: Oh yeah. I actually just started. That’s actually (what happened to me is, this is very funny) is that I’ve been to a lot of therapists in my life. I was seeing this one therapist years ago. I wanted to make a follow-up appointment with her and she said she couldn’t see me the next week and I was like, “Why? I really need to come back and see you.” She said, ” I’ll be at a retreat,” and I said, “What retreat are you going to?” She said, “I’m going to Self Care for the Healthcare Professional.” I was like, “Oh my God! That sounds great! I should go with you!” And she was like, “Oh my God.” I think she just wanted to get away, I’m kind of a high-needs client at the time. I needed a lot of help. When I was messed up in medicine, I needed a lot of help. She called the retreat leader and asked her, she said, “Do you still have space?” The retreat leader who’s now my friend said that she could tell by Jeannie’s voice that she wanted her to say, “No, I don’t have space,” but she said, “Oh sure, bring her on.” She got off the phone, she’s like, here’s this woman who’s my therapist, who basically was trying to leave for a week and go teach a retreat, and now suddenly I’m going with her.

Instead of making a follow-up appointment, I’m following her into the woods for 4 days on a retreat. At that time, I have to say I didn’t own a car. I was doing house calls on my bike and I was just living the small-town cutesy lifestyle that you can live when you’re not in Washington, DC. The next question from my mouth is, “Can I get a ride with you?” Here’s a woman that just didn’t want to see me next week and now she’s going on a trip with me, driving me 2 hours and a half each way in her car and spending 4 days with me. I ended up in the woods at this retreat and it was really interesting, because it was mostly massage therapists. I think there was a nurse practitioner there, and they were just really loving. It was just a very therapeutic, I’ve never been in a situation with other people in medicine or healing arts where I felt loved and embraced, so it was just really interesting to have that feeling. I think that had a lot to do with me after, it was like 6 weeks or so after the retreat when I had my vision of the community coming together and supporting you. I think that was my first time, at that retreat, that I felt supported by my peers. I know they’re not medical doctors, but they were massage therapists and people in the healing arts.

LM: But they were people in the healing, yes.

PW: It was my first actual on earth experience of being with other people in my field and feeling nurtured and loved by them, and supported. That’s what gave me this idea that people actually, a community could support you and help you heal. We should put the community in charge! It lead to a lot of epiphanies that I had. When I finally was able to find my joy and my healing, I wanted to give back to physicians who certainly need a retreat experience like this. I went right back to Breitenbush Hot Springs, which is where that retreat was located, and I started running retreats there for physicians. I’ve been doing it, this is my 11th one coming up next month.

LM: Wow!

PW: It’s great, we have anywhere from like 20 to 50 doctors there and they hang out in the hot springs, which is clothing optional. Our first night everyone disrobes and we all sit together naked in the hot springs. That’s what doctors really need to do, they need to get real with each other and don’t act like you can’t see a naked human body. That’s what you do all day long, so stop acting like you’ve never seen anything like that. 

I went with my college roommate there once, by the way, it was so funny. We were getting out of the hot springs and she was really like freaked out. She started whispering to me because there was a 70-year-old guy that was naked in there with us. I’ve seen naked 70-year-old guys, haven’t you? Being a physician, the average person hasn’t. She was freaking out. She’s looking at how things are hanging, and she was freaking out. I was like, “That’s how 70-year-old men look.” 

All I’m trying to say is doctors need to stop being so uptight. They already know how everything looks, so just take your clothes off and sit in this thing. It’s full of lithium, it’s going to help you. This water is therapeutic. It’s really funny to see their little white coats hanging on the branches of the fir trees and all these doctors sitting there. We do it at night the first night. It’s not, they don’t have to, but I highly recommend it because it’s therapeutic just to sit in the water. It’s therapeutic to sit with your peers who are so shielded and have built up protections to be in such a competitive medical school environment. What we’re trying to do is have you be for real, at least this next 4 days where you’re off the grid, no cell service, no Internet. You literally are not on call for anyone except your own body for the next 4 days. We want you to be for real. I think everyone needs something like this every year, but doctors need it more than anyone. What happens there is we do educational sessions. Doctors who previously graduated from the retreat lead sessions on how they went from despair to bliss and how they’re running their practices. Basically, again, people who have healed themselves are teaching each other how to heal. It’s not like they’re coming just to hear me talk, though I can certainly talk. I just loved bringing these together.

LM: But it’s the healers teaching . . .

PW: Each other. Healing the healers.

LM: That is nice. 

PW: Yeah.

LM: That is nice.

PW: It’s great.

LM: Wow. I have thoroughly enjoyed my time sitting here with you and going through the book [community testimony] that you’ve allowed me to look through. I’ve just started looking at the front of the page where you were talking about, you’re asking the end user, “How do you want things set up?” One thing that jumped out at me, you asked a medical student. “What are 3 things that you would like to tell your dean that you’re afraid to say, that I’ll say for you?” One of them named Sam said that, “Medical school was the worst thing I could have done for my mind, body, and soul.”

PW: Yep, yep. He said that, “Medical school is the single most unhealthy thing I have ever done for my body, mind, and spirit,” is the first thing he wanted me to say. The second thing is, “I was on zero psychiatric medications and now I am on more than one and it’s just my second year of medical school,” and three is, “The only communication that the school has with us is through fear mongering and the upperclassmen just tell us to get through it and it’ll be over soon.” That’s our modern medical education.

LM: That’s it. That last one, in your book you talk about that physicians are told to just suck it up. Suck it up. That’s just the way it is. You chose it, you knew. You knew it was going to be hard, just suck it up. I remember being on call around the Christmas holiday season because we really technically didn’t have the time off. The residents got together to see how we could help each other have a week off. You take Christmas and I’ll take the week of New Years or however we work it. What’s happening is you’re on call every other night. There’s half of us that are there that’s running a full service, and the other half comes back. I remember at the end of my week that I was there I literally just slid down the wall. We’re doing our sign out at the board in labor and delivery and I just slid on the floor and I just sat there. I couldn’t move, and all I said was, “Nobody died. Nobody died this week.” That’s my sign out.

PW: Yep, that’s crazy.

LM: It’s one of those things where people look at you and they’re just like, “You knew it was going to be hard. You knew you weren’t going to get sleep. You chose OB, so you knew the babies were going to come at any time.” It’s not that I knew it was going to be hard and suck it up, but I wanted to be a part of a persons life at a very important time in their lives, and be able to walk them through that. We don’t have that support. I love what you’re doing because you’re not just saying, “Hey look, we have this problem over here,” but you’re also giving some solutions and giving an atmosphere where people can heal and can move on and be better, and be better healers.

PW: The bottom line is we’re all on a continuum between living our dreams and dying by suicide. You’re on that road somewhere. Every day if you make self destructive choices you’re moving closer to the suicide end, or if you make choices to live your dream, your souls purpose, you’re moving more toward living your dream. Unfortunately our medical training pushes us right down to suicide because it steals our dreams, our hopes and dreams. When people say, “It’s always been this way,” and, “Buck up,” and, “Suck it up,” it’s like, “Well, you know what? Tradition is just a bad idea held by a lot of people for a really long time and it needs to change.”

LM: That’s a great point. Before we leave the community and wrap this up, we usually have our guests give our community a tip of the day. It can be on the topic we’re talking about, or it can be anything that’s now in your heart, your mind, your soul, that you want to share with the community. Could you give our community a tip of the day?

PW: Yeah, the tip of the day, which is what I always write in my books when I was signing them, is “May you always live your dreams fearlessly,” because that’s what it takes, is a fearless attitude to be who you really are in the world, to be who you were born to be in this world and don’t let anyone tell you that you can’t. Living your dreams is the key to energy, to success. Let me tell you a little story about a doctor who opened her own clinic. After my retreat she went home, she has her amazing little clinic in Ft. Worth, near DFW Dallas, Texas area. She was so excited doing house calls, really spending time with people, that she called me one day and she was really concerned that she needed to go to a psychiatrist because she felt manic. She felt so excited about her life that she thought something was wrong. I had to tell her, “That’s normally how you’re supposed to feel. Remember when you were 3 years old and you jump out of bed every day and just run through the house and be so excited for breakfast and so excited about the next thing that’s going to happen. Adults are supposed to feel that way too! But we have given it up because we got indoctrinated and socialized and all sort of systems about how you’re supposed to dress and act and feel as an adult. That’s not the case. If you live your souls purpose, if you are a doctor in a clinic that you love and you love your patients, you literally will jump out of bed at 3 in the morning, can’t wait to get there. Everyone should be able to feel that joy for today and for the rest of their lives. Nobody can give you the instruction sheet on how to do that, it’s all about going back inside yourself and getting to know your soul and your heart, and really figuring out why you were born and why you’re here, and then fearlessly living in alignment with your soul. That’s my tip of the day.

LM: Love it. I love it. With that, we’ll see you guys here next time in the community. Bye now.

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