My testimony in support of medical student mental health to the Missouri State Legislature for House Bill 867

I’m Dr. Pamela Wible, a family physician in Oregon. I’ve submitted my CV, witness form, and transcript of my testimony to Chairman Frederick. My schedule prevents me from traveling to Missouri for today’s hearing; however, I thank Vice Chairman Morris and the Committee for allowing me to testify remotely in support of House Bill 867, legislation that would require Missouri medical schools to screen students for depression and offer mental health referrals for those at risk.

Medical Student Stress *

Medical students face enormous stress. Their workload and debt load are immense. They witness incredible human suffering with no emotional support or debriefing. Routinely sleep deprived, they’re groomed in a medical culture that rewards self-neglect and often condones bullying.

Medical students are afraid to seek help for fear of retaliation or discrimination. Medical students are afraid to seek counseling because medical boards like the one in Missouri ask applicants if they’ve ever been treated for mental health issues. Checking the “yes” box can lead to a subpoena of one’s “confidential” medical records.

Medical students enter medical school with their mental health on par with or better than their peers. Up to 30% develop depression and 10% become suicidal during each year of medical school. Both men I dated in medical school died by suicide. Depression and suicide are known occupational hazards in medicine.

More than 400 U.S. doctors die by suicide annually. Widespread underreporting and miscoding of death certificates suggest the number is closer to 800. That’s like losing all 391 medical students enrolled at the University of Missouri Columbia School of Medicine plus the 433 students at the University of Missouri Kansas City School of Medicine— every year.


Please join me in support of House Bill 867

House Bill 867 benefits medical students. This bill will de-stigmatize mental illness and normalize medical students’ rights to request and receive confidential mental health care. Student participation is voluntary and student data remains anonymous unless students select otherwise.

HB 867 benefits families by making mental health data transparent across all 6 Missouri medical schools. In medicine, informed consent is the standard of care, yet medical students and their families have not been informed of the health risks of a medical education.

Last fall, I attended a funeral. Kaitlyn Elkins was a star third-year medical student described by her family as “one of the happiest people on this Earth.” She died by suicide, but the funeral wasn’t for Kaitlyn. It was for Rhonda Elkins, Kaitlyn’s mother. Unable to recuperate from her daughter’s suicide, Rhonda took her own life. I asked Rhonda’s husband, “If Kaitlyn worked at Walmart, would she and your wife still be alive?” He said, “Yes. Medical school has cost me half my family.”

HB 867 also benefits patients. The best way to care for patients is to first care for our doctors-in- training. Let’s practice what we teach. By truly caring for our medical students we demonstrate how we expect them to care for patients. The cost of not caring for our young doctors-in-training is more tragedy. Each year nearly 1 million Americans lose their doctors to suicide.

Finally, I support House Bill 867 because it benefits medical schools. We teach medical students the value of evidence-based medicine, but if our medical schools are exempt from collecting evidence on medical student depression, how can we evaluate student mental health? How will we know the impact of medical school wellness programs? The psychological well being of Missouri medical students is just as important as their academic performance. This bill finally gives us the data we need to properly care for and educate the future physicians of America.

On behalf of all medical students nationwide, I thank you for your support.

 Click here to read House Bill 867

UPDATE: On May 12, 2017, after 3 legislative sessions, the bill has now PASSED into law. Thanks to Keith Frederick for his tireless efforts!


HELP-2 copy

Pamela Wible, M.D., is a pioneer in the ideal medical care movement. When not treating patients, she dedicates her time to medical student and physician suicide prevention. Dr. Wible is the recipient of the 2015 Women Leader in Medicine Award.

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36 comments on “My testimony in support of medical student mental health to the Missouri State Legislature for House Bill 867
  1. Patricia Robinett says:

    Pamela, thank you for testifying at the Missouri State Legislature. I live in MO now.

    If I was to add anything to your points it would be that doctors are forced by the system to do things that go against their high, ethical standards and human nature… such as circumcising healthy skin off baby boys; such as withholding food and water from the elderly who have become “too much trouble”, like my friend Gert; such as recommending drugs and procedures that carry tremendous risks and can harm, like Gardasil. Those types of things can’t help but contribute greatly to their stress levels because they go against their innate inner wisdom and wreak havoc with their hearts and heads.

    • Patricia Robinett says:

      p.s. This just came into my inbox and is an example of how doctors are faced with a huge dilemma – the cancer issue. If med schools taught students how to help people find radiant health rather than simply diagnose and treat the symptoms of disease, MDs would surely rally and be very enthusiastic about their study and work rather than depressed about it.

  2. Pamela Pappas says:

    I’m very happy to see you speaking out for the mental health and well-being of medical students. Having personally run a very well-utilized Medical Student and Resident Mental Health Service at a medical school, I agree that such services are essential in ALL medical schools.

    While this is being reviews, I’d also suggest a close look at the KIND of “mental health services” to be provided. I hope that these will extend beyond pharmaceutical interventions, and include counseling and psychotherapy that does not treat students like sick specimens to be inspected. I would hope that health-promoting integrative interventions would be available as well. Actually I wish to be available for physicians in practice also — without retribution.

    Thanks again for drawing attention to this issue.

  3. Pamela Pappas says:

    I’m very happy to see you speaking out for the mental health and well-being of medical students. Having personally run a very well-utilized Medical Student and Resident Mental Health Service at a medical school, I agree that such services are essential in ALL medical schools.

    While this is being reviewed, I’d also suggest a close look at the KIND of “mental health services” to be provided. I hope that these will extend beyond pharmaceutical interventions, and include counseling and psychotherapy that does not treat students like sick specimens to be inspected. I would hope that health-promoting integrative interventions would be available as well. Actually I wish such services to be available for physicians in practice also — without retribution.

    Thanks again for drawing attention to this issue.

    • Pamela Wible MD says:

      Yes, Pamela, I agree that this should not just turn into a mother funnel for medicating students. A healthy environment and a progressive humane curriculum would prevent the need for many mental health issues in students. Debriefing after a traumatic case should be mandatory. Geez. Common sense stuff.

  4. Kate says:

    Dear Pamela

    Thank you for your amazing testimony. As you may know, veterinary students face the same negative culture at school, combined with very high student debt, and salaries well below that of physicians. Our suicide rate is the highest of any medical profession – at least 4 times the national average. Most, if not all states, ask mental health questions on licensure applications and renewal applications. Some, e.g. Alaska, ask specifically what conditions the applicant has been diagnosed with. We are forced to either not seek treatment, seek treatment, report it, and be forced to have our medical records turned over to the board (which can require examination by a physician of their choosing at the applicant’s expense, and can limit/revoke/deny licensure), or lie on the application and renewal forms.

    Recently, a survey, conducted in part by the Auburn University Psychology department, the CDC, and the National Association of Public Health Veterinarians, was sent to most of the 80,000 or so practitioners in the country, to assess the mental health state of U.S. veterinarians. I will share the results to you when they are tabulated.

    It is unacceptable for professional schools to teach in an environment that causes or exacerbates mental health conditions, interrogates students about these illnesses on application/renewal forms, sanctions them by forcing them to release their medical records and pay for board mandated diagnostics, treatment, and monitoring, and in some cases limits, denies or revokes licensure.

    Take care

    • Pamela Wible MD says:

      Agree Kate. Totally inhumane and barbaric way to train healers of humans and/or pets. Love to know your thoughts on the source of this pathology? How did this culture of bullying, abuse, and mental & physical health neglect ever get started in veterinary medicine? Thoughts?

  5. Kate says:


    What a great and obvious question! I am surprised at myself that I have not thought about the cause of this toxic culture. It is time for me to try to find out. I think defining the cause is the first step toward finding a solution. As a group we like to tie a case up with a nice, tidy etiology, so teaching the cause of the problem is a good place to start if you want to convince doctors to change. I think Arrogance and fear drive the behavior, but I don’t know what causes the arrogance and fear. Do you understand why it happens in human medicine?

    • Pamela Wible MD says:

      Why it happens in human medicine:

      1) Flawed reductionist medical model = opposite of holistic = mind-body-spirit DISINTEGRATION
      2) Abuse cycle. Victims of previous bullying and abuse are now teaching next generation of docs
      3) Rampant cynicism (read House of God) and objectification of patients as diseases
      4) No debriefing or ANY mental health services routinely given to medical students
      5) Punish those that are vulnerable and ask for help.

      Medical training is often not conducive to health.

  6. Robert G Wilkie MD says:

    I want to thank you so much for the most incredible testimony you gave to the Missouri Legislature . I am a physician who practiced 32 years having suffered threw medical school , as well as along career in medicine , with untreated and mistreated depression . Not only is the issue of compassion for understanding for depression and related disorders a problem in training programs ; it is a huge problem in practice . To this day it is is a problem for the practicing physician to get the help they need , without being stigmatized by both other physicians as well as the State Board . In my case , I was labeled as a drug addict instead of my situation being recognized as a case of improperly diagnosed depression . To make a very long story short I was forced into a drug rehab program when I should have been sent to a up to date psychiatric center . I then got into a catch 22 situation with , leaving the rehab center ,the Missouri Physicians Health Program as well as the Missouri State Board For The Healing Arts . I had my license suspended and now revoked because I was unable to afford their agreements . I would like to recommend to all your students as well as practicing physicians to get legal protection when they declare or are told they need to go for mental health treatment . These bodies I have mentioned have little understanding of these problems . They view addiction issues as forms of moral failure . Likewise mental health issues , even in todays medical climate , are often treated ,by these bodies, in a similar manner . You are often told that your illness makes you a doctor unfit to practice . Up front legal assistance will prevent these bodies ,from abusing you when you do declare the need for help . It saddens me to have to give this warning to those who read my comments . These bodies have enormous power because they have the ability to make decision about you behind closed doors . One would think that in the year 2015 , consequences of declaring a need for mental health care , would not be treated by these bodies like they are . In my opinion depression should not be looked upon any differently than diabetes is . Psychiatry is just now catching up with other medical disciplines . Many of the most compassionate and intelligent doctors suffer , as do I , from depressive disorders . Please have your readers get the help they need while being under legal protection . These controlling bodies need education . This is another piece of the problem that , in time , must be dealt with . In Missouri , Dr Fredericks is taking a brave stand on this very serious issue . In closing , get the help you need , while being protected with legal counsel . My not having done so has cost me a career in medicine having cared for patients for 32 years . In 32 years I never had one complaint about my care .

    • Pamela Wible MD says:

      Tragic and physicians MUST be protected and given the mental health care that any human being deserves. Without fear. Without punishment.

  7. karuna Chapman says:

    I am applauding loudly in front of my computer screen! Thank you Pamela, with a hug. Karuna

  8. Robert G Wilkie MD says:

    Pam – I is true . They will by abusing their power screw up the ones who need care . This is only a warning that I feel your readers should be aware of . If the Board or the MPHP gets involved in your life you must confront their power tactics . If possible have those needing care seek it in a discrete manner . Even if you do , however , I strongly recommend legal back up , just in case . I hope Deans of medical schools have more class , in understanding the great need you so beautifully expressed in you testimony to the committee . It was both moving and shocking ! I suppose I can be of more help with post graduate situations .
    I will be sending you a detailed summary of my long sad story .It does contain survival techniques I learned along time ago . If you think things are bad now you should have been with me in medical school in the late 60,s .
    I recommend that the students seeking care , get to psychiatrist that are up to date . For example , the psychiatrist I see does genetic screening and sometimes special scans .
    Again it was a great step forward in dealing with and exposing these unnecessary tragedies . All the best — Robert

    • Kelly says:

      I absolutely 100% agree with you, Dr. Wilkie. If you get near the Missouri PHP, as I did, ask for legal representation first. If you don’t, you will find yourself out your self-esteem, your right to due process and quite a chunk of money. Sad that what was supposed to be a helping organization has devolved to what this is — financial and emotional extortion with your license and ability to practice dangled in front of you as bait. My only hope is that this bill will not become an excuse to identify and then stigmatize those medical students who are the most vulnerable, as so many legal issues surrounding mental health and confidentiality are fragile. Helping solutions can be misused. That being said, I think your testimony was wonderful, Pamela.

      • Pamela Wible MD says:

        Goal is that information collected is de-identified and anonymous. Only the aggregate data is shared with the public for transparency and informed consent. Students should be permitted to select a school not only for its academic track record but also for their track record on mental health of their students.

  9. Mariona Vasquez says:

    I support house bill 867.

  10. Debra Fant says:

    Thank you Dr. Wible – I am a nurse who was passionately ranting about this to Dr. Bill Fisher who was head of the Family Practice Residency at OHSU years ago when my husband and friends were in the meat grinder of internship, losing their altruistic humanitarian values as their own needs were so ill met. He let me finish and said calmly “I agree with you.”
    There have been small improvements along the way but never enough, and I am thrilled to feel that tidal shift happening now. I thank you for standing up and being a voice for reason, for speaking of the atrocities in the system, for advocating for people supposedly cared for “well” in our current system. For being an advocate of holistic healing practice where all parts of the equation are respected, where quantum principles are recognized that support the notion that it takes healthy well people to hold space for healing to happen, that it is each one’s “job” to heal within their own being.
    THANK YOU. BLESS YOU. I am so very grateful. Debra, Waldport, OR

  11. MichaelL says:

    Are we not being trained for further abuse in the life of small town surgeons (in my case)? I remember being bullied by the one of the Family Practice teachers, even having the gall to suggest I drop out of medical school. It was the only clerkship I had “problems” in. I guess he did not like surgeons!

    The abuse and bullying, I went through for being one that preferred more compassion and caring for the patients, ended in my eventually being driven out of medicine. My memory of doctors reporting me to administrators for excising brown recluse bites (learned in articles presented in residency that was the best treatment), refusing to write antibiotics for people who appeared to have a virus (in a doc-in-a-box, pre-treatment era with antivirals, Symmetrel or the newer, Relenza and Tamiflu), or fired for not seeing more than thirty patients/day, are just a few examples. There were plenty of threats going around.

    I think there needs to be something done to investigate the reasons some of us were reported to the data bank as “disruptive”! Opening your mouth about the deficiencies, all around us, can result in our practices being destroyed! I don’t miss practicing medicine and swimming with those sharks. I do resent seeing poor patient care , (I think cost my mother her life), in these meccas of medical care. Those people, in small towns, are being sent to “regional centers” because doctors in small hospitals are scared about taking care of really sick patients. God forbid they should not have stellar reputations because a person who has an operation would die at their hospital.

    I feel if I had been allowed to stay with my mother in her hospital room, (bullied out of her room, by a nurse) I could have better seen what deficiencies in her care I could have improved, making sure she did things, like using her incentive spirometer. (She died, allegedly, from pneumonia that was not responsive to antibiotics!) She was found “unresponsive” on the fourth day post-op. She looked fine the second post-op day! Add to that the fact that they had her on Propofol the night we were supposed to turn her respirator off, it makes me even less trusting of the medical establishment. Is is normal to give patients Fentanyl when you remove the respirator? They did that, too!

    Well I think there are plenty of bullies, out there, that run the inner workings of hospitals, as well. Medical politics can result in doctor suicides, as well! I am happy I was strong enough no to be one of those statistics! The medical bullies are everywhere!

  12. Chagai Dubrawsky says:

    All the problems and issues in the world will be solved immediately.once we overcome Stress. can it be done? YES!!!, How? SLEEP RIGHT.This is the answer. We can get World Peace through the correct sleep. What do we know about SLEEP RIGHT?

    • Pamela Wible MD says:

      That would help us all get above the lowest rung of Maslow’s Hierarchy of Needs. Adequate sleep does help one approach life with energy, hope, and compassion vs. torment and fatigue.

  13. Pamela Wible MD says:

    “We heard House Bill 867 in committee today, and you were a rock star!
    You were the cornerstone of the entire hearing. People broke down in
    tears during your testimony. There were no objections and the committee
    voted unanimously in favor of the bill.” ~ Dr. Keith Frederick, Chair of
    the Health Care Policy Committee, Missouri House of Representatives

  14. LEANN COOMER says:

    You’re AWESOME!!

  15. Patricia Ritchie says:

    As a Missouri resident, I have contacted my state representative Caleb Jones and state senator Kurt Schaefer to further House Bill 867 in becoming Missouri law.

    I was briefly a medical student at the University of Missouri-Columbia in the fall of 1985. Both my grade point average and Medical College Aptitude Test scores were higher than the average student admitted. I had, however, developed chronic fatigue following mononucleosis my sophomore year of college. (Yes, I now have the ME/CFS/SEID diagnosis. I actually consider it fair that someone wanting to be a physician had to run that gauntlet.)

    Before attempting medical school in the fall of 1985, I went the associate dean of students, Dr. Nancy Soloman, MD and requested their decelerated program of spreading the first two years of medical school over a three-year period. She suggested I start the regular curriculum and then decelerate if I needed to. After several weeks of the regular schedule, I returned to her office again requesting the deceleration program that had already been in place for years. At that point she stated, “If you can’t take it, you should get out now.” And, “This [medical school] is for people who don’t have problems.”

    Out of a first year class of about 100 students, I was the second to withdraw from medical school. Later, I was told 1 in 4 students in that class withdrew. That’s a terrible waste!

    I think the attitude that medical school is for people who don’t have problems is at the core of the problem of medical students not being able to access good mental heath services. (I must say as an undergraduate at the University of Missouri-Columbia I received excellent mental health services from PhDs in the Department of Counseling Psychology.)

    While I was not able to pursue a career in medicine, with my undergraduate background I was able to keep meaningful employment and promote public health until I was fired in 2012 from my job of 19 years as public notice coordinator in the Missouri Department of Natural Resources’ Public Drinking Water Branch. I was fired in whistle-blower retaliation and also in retaliation for seeking disability accommodation.
    Dr. Wible, thank you for testifying before the Missouri legislature and letting my tell my story.

    All the best!
    Patty Ritchie
    Hartsburg, Missouri

  16. Dr. Mary Jo Bulbrook says:

    Thank you for giving voice to an imperative need in our society. Working alongside MD’s as a colleague has taught me the power of support can keep those over stressed and in despair from giving up and giving in. This bill will help alleviate the problem that has gone unsolved for many years. It is time to step up and offer support to this at risk population. While in Newfoundland at one of the hospitals there was a large sign that invited the medical students to beer bash on the weekend – guess what is one of the problems in the state – alcoholism… guess who supported the “resources to the medical students to let go of their stress this way” the beer companies. It bothered me then and still does that we do not offer “healthy” alternatives to medical students to manage their intense stressors in the workplace. Bravo for speaking out to this critical need and may we move forward with alternatives that are healthy and empowering rather than addicting and superficial stress relievers.

    • Pamela Wible MD says:

      WOW!!! That is disturbing! Then when doctors use this legal method for quelling their pain they are turned in for substance abuse.

  17. Julie Greene says:

    I can see, looking back, that some of my doctors seemed stressed out. One even admitted she was getting pressured from her “hospital.” Know what for? She was instructed to cover up patient abuse. The hospital, MGH, Massachusetts General Hospital, became aware of my blogging about abuse that happened to me in their facility. I refused to stop writing about it. MGH knew I was right, but lied to my doctor, justifying their abuse. My doctor then threatened me, tried to forcibly drug me, telling me, “I am giving you this drug to stop you from writing.” She also said, “Human rights are trivial.” A few times, she appeared completely out of control, raising her voice in a venomous manner right in her office. Had I acted that exact same way in her presence, she would have called Security and had me locked up. I’ve since had verified by healthcare personnel that I was exactly right. I wasn’t delusional that the abuse had occurred and my doctor’s claims that I was “delusional” were completely wrong. I knew this all along but it was great to be verified by a professional, since no one would believe little ole me.

    I agree with the above poster that abusing medical students and then trying to patch up what’s been done with mental health “care” won’t solve the problem. In fact, it’ll make it worse since the students will be subject to labeling, coerced onto drugs that do more harm than good, and possibly institutionalized as well. Current mental health care isn’t humane at all. Why subject medical students to further abuse in the name of “care”? We don’t need more Big Pharma sponsored abuse, nor packaged “therapy” which does little but to reinforce labeling and the “disease” model. We need compassion, flexibility, and a direct way for students to address the abuse, not an instant patching up of horrible mistakes, which only serves to silence these students.


    • Pamela Wible MD says:

      Thank you Julie for speaking out as a patient for the mental health rights of us all. The ripple effect of one injured medical student is immense. Patients need to know that their doctors have the resources they need to provide mental health care to others. Honoring and respecting our young doctors is the best way we can demonstrate the care we expect them to provide to their patients.

  18. Mindy Elias says:

    It is not just depression in medical students. The health care industry, hospitals particularly, promotes the opposite of health for all employees! Rotating shifts, no time for meals or often even urination, unhealthful processed foodstuff, and accountability while not on the premises are just a few of the inherent issues.

  19. Chris says:

    I applaud your efforts and agree with everything you had to say. My only comment is that the mental health care professionals need to be competent and compassionate. I am very fortunate to have worked with mostly competent mental health professionals. However some are what I would label “quacks.” Especially if you are unfortunate enough to deal with the criminal justice system. Many of their therapists are incompetent and work for the “system” rather than the best interest of the patient. In my case the physician health programs have been supportive and I feel quite fortunate. For any medical students or health professionals involved please be proactive and involved in one’s mental health care. Ask questions and even feel free to challenge mental health professionals if there is a question of quality of care. Legal representation may be worth considering according to one of the earlier comments.

  20. Kelly says:

    My only fear is that this leads to the kind of self-reporting that leads to interventions like the Missouri PHP, which is a farce, and in my opinion borderline unethical. I’d be happy to talk to you about my experiences with them after my suicide attempt, in which an organization that I thought was there to help me only contributed further to my spiral.

  21. Pamela Wible MD says:

    The Dissection of House Bill 867: – Missouri Leads States on Medical Student Well Being and Advocacy

  22. Pamela Wible MD says:

    GREAT NEWS!!!!! On May 12, 2017 the bill FINALLY PASSED!!! A big thank you to Dr. Keith Frederick who kept re-introducing the bill each time it was killed. He started in 2015, tried again in 2016, and now in 2017 SUCCESS!!

  23. Sarah says:

    I think what you’re doing is great. My husband is a medical resident now and while some days are good, many days he comes home overworked, under rested, and so stressed out or just down about the stresses of being a medical resident and sometimes even dealing with patient loss. It has taken its toll on him and I wish I knew how to help or what to say to him. These people are worked so hard and so many people don’t see or understand what they must go through for their careers. I would really appreciate any advice you have on any way I could help him get through this time in our lives.

    Thank you,


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