NBC News: The Real Reason Doctors Burn Out →

View on NBC News. Full transcript below.

Medical Resident: Frustrating is way too benign of a word. It’s an infuriating system that we practice in.

Dr. Umut Sarpel: I don’t think most doctors get burnt out by doctoring, it’s everything else that comes along with it.

Dr. Pamela Wible: So we’re on the edge of life and death every day trying to save our patients’ lives, and for people to now start to understand that we have the highest suicide rate of any profession or that we are struggling en masse, this is not a popular thing to discuss. However, not to talk about it just perpetuates the problem.

Dr. Red Schiller: In many ways, we will look in this era as a dark age of medicine. As amazing as the advances are in technology, we’re failing in our ability to recognize our humanity.

Narrator: In today’s increasingly stressful, complicated world, we’re mentally, physically, and spiritually ill. And we turn to our doctors to heal us. But what most of us don’t realize is that many of them are more stressed and more burnt out than the rest of us. And it’s not because of the reasons you’d expect.

Dr. Umut Sarpel: A lot of medical students will ask, when they’re considering what field to go into, “How do you do surgical oncology? It would be so stressful.” That kind of stress, you sort of signed up for. I really love working with my hands. When I’ve done an operation, there’s something very concrete that you’ve accomplished, you know, technically challenging, but also really rewarding. Sometimes you just feel like the weight of the world is on your shoulders, especially when someone is optimistic you’ll remove the tumor. But, again, that’s the job that I signed up for, and people would be surprised that that’s not what wears you down at the end of the day. It’s everything else that comes along with it.

Narrator: There’s a silent pandemic that’s been spreading throughout the medical world. Doctoring is no longer just about doctoring. The amazing promises of technology have made for an exhaustive amount of bureaucratic tasks, like filling out electronic health records, or EHRs, which take doctors away from what they were trained to do, and put them, well, here. Today, for every hour a doctor spends with a patient, she spends at least double that charting it. So these EHRs, which lengthen already really long work hours, coupled with a lack of control and trying to diagnose and heal within a convoluted healthcare system, all contribute to doctors now having the highest burnout rate of any profession.

Dr. Red Schiller: In many ways, the healthcare system needs its own doctor. There’s this focus on quantitative performance that’s really altered the way in which doctors practice. And that’s not something that’s easy to do when people are receiving care with open-ended questions and complex concerns. People talk about a six-minute visit, a 15-minute visit, really sort of a helplessness that a lot of doctors feel that, “I spend all this time being educated, yet we’re really treated like, ‘Here’s the amount of time that you have, here’s the amount of people that you need to see, and here’s your quantitative goals that you need to meet at the end of the day, at the end of the quarter.'”

Dr. Red Schiller: Okay, thank you. Sounds fine.

Patient Bernice: I’m alive?

Dr. Red Schiller: More than alive. Vibrant.

Dr. Red Schiller: Medicine has lost its identity as a profession. So patients are really victims of the stress generated with people that they see.

Patient Bernice: I don’t know.

Dr. Red Schiller: So what would you like to talk about today?

Narrator: Bernice knew why I was filming, and so she went for it.

Patient Bernice: I really would like to talk about the medical profession.

Dr. Red Schiller: Oh boy.

Patient Bernice: No, not you. They don’t know who they’re talking to, and I’m constantly having to say, “Please look at me.” You look. You know who I am.

Dr. Umut Sarpel: I hear all the time people saying that they feel like their doctor never listens to them. And in the back of my mind, I want to say, “It’s because there’s all these other things going on that are wholly separate from taking care of the patient.” People would be surprised to know that when I’m seeing a patient and we’re doing surveillance to make sure that their cancer has not come back, oftentimes the insurance companies will deny a part of their scan. My office will have to discuss with the insurance company, I was going to say argue, but it’s not an argument, justifying that that scan is important. That takes time. That adds aggravation.

At some hospitals, the reimbursement scheme creates perverse incentives for physicians where you are rewarded by your productivity. And while productivity is a good thing, it doesn’t always equate with what’s best for the patient. We’ve been forced to shorten the amount of time that we allot for appointments, and we have a computer in the room, and there are some people who find the only way that they can make their day work is if they’re documenting at the same time that they’re talking to the patient.

Dr. Red Schiller: Yeah. Can you imagine other service industries where, a front desk at a hotel, where the person turned their back on you while you were trying to register? And these probably don’t always have simple solutions. But they’re crucial.

Dr. Umut Sarpel: I mean, there are doctors that would just rather completely leave the healthcare system than work within it.

Medical Resident: This system is exploiting everyone inside of it. So you have pharmaceutical companies bent on making as much profit as they can off of meds, health insurance industries bent on making profit off of people and denying people’s claims to get healthcare, we have hospital systems, sometimes for-profit systems or sometimes systems that operate like for-profits even though they don’t have those titles. So we have physicians who are going into that medical industrial complex that are supposed to operate inside of that, and I think that a lot of people don’t really realize the amount of anxiety, depression, and suicide among physicians.

Residency Survival Guide

Dr. Pamela Wible: I’m a family physician in Eugene, Oregon, and I run a suicide hotline for physicians who are suicidal. When I was 36 years old and I became suicidal as a physician, I thought I was the only suicidal physician in the whole world. This is a common experience because this is not discussed. In the general public, 12.3 out of every 100,000 will die by suicide. Among veterans and military, it’s 30. And among doctors, it’s 40 per 100,000. We lose approximately 300 to 400 doctors per year in the US—the equivalent of losing an entire medical school of medical students to suicide.

Medical Resident: The more that you are told, “You’re such a great person, and doing such a great job,” it’s much harder for you to admit that, “Maybe I am suffering just like the person in front of me that I’m supposed to be caring for and working with.”

Dr. Red Schiller: We don’t really encourage a strong sense of community among the people who are learning medicine, teaching medicine, and providing medicine. We have more robust health services, but there is still, in our profession, and really in our society at large, this sense that if you can’t cut it, you’re weak.

Narrator: Burnout has become so pervasive that medical institutions across the country have installed chief wellness officers to deal with it. And this is Mount Sinai’s.

Dr. Jonathan Ripp: One of the reasons why this is gaining more attention is that it’s not just affecting members of a healthcare professional team, but the patients that are cared for by them. And so, if you . . .

Narrator: Everyone.

Dr. Jonathan Ripp: Right. There’s a large literature that shows that burnout correlates with medical errors.

Narrator: Medical error is the third leading cause of death in the United States.

Dr. Jonathan Ripp: Productivity of physicians, I think they’re already talking about a physician shortage. So in some regards, you can think of it as a public health issue.

Narrator: Or maybe it’s a public health issue in all regards.

Dr. Red Schiller: As part of the Mount Sinai community, I want to recognize their commitment to making this difference. I think the challenge is that this is a problem that’s not going to get solved by tweaking the edges. There’s wellness programs, health insurance plans have wellness programs, and what they all tend to focus on is self-care.

Dr. Red Schiller: The onus is on individuals to get well. The reality is a lot of the things that are making people unwell are things beyond people’s control. So you can’t breathe yourself or meditate through the challenges of having an EHR.

Medical Resident: You can cover me in as many essential oils as you want and give me as many granola bars as you want, but unless you actually restructure how the system functions, then don’t talk about caring about me or my peers or anybody else.

Dr. Jonathan Ripp: I think everyone recognizes that we’re likely to have the greatest impact looking at those system-level drivers. We really need to be smart about how we think about the efforts that are going to improve well-being, and look for those that are likely to have win-wins both on the bottom line and in well-being.

Dr. Umut Sarpel: Maternity leave I think is a perfect example of how wellness is sometimes at odds with the hospital’s bottom line. It’s pretty clear that the right thing to do is to not apply a financial penalty to women for having children, and yet at the end of the day, from the hospital’s perspective, there’s a side that has a hard time seeing that they should be paid for that time.

Dr. Jonathan Ripp: Obviously the healthcare system has a pressure to meet its bottom line and a budget.

Dr. Pamela Wible: We have not been dealing with this like you would expect a profession that’s based on human health and relieving suffering and death. We have not addressed our own internal problems.

Narrator: Nurses across the country have been protesting unsafe staffing levels. Residents and fellows are joining unions. Everyone is feeling the strain. Yet things have truly yet to change. And at the heart of all of this remains that core question of how to deliver good care and how to heal.

Dr. Red Schiller: Think about Paris.

Patient Bernice: I’m planning a trip with my niece.

Dr. Red Schiller: You can’t talk though. Now you can. Thank you.

Patient Bernice: Is it bad or good?

Dr. Red Schiller: Good. Better than mine.

Patient Bernice: Yeah.

Dr. Red Schiller: It’s 122 over 82.

Patient Bernice: That’s good.

Dr. Umut Sarpel: What is at risk the most is the relationship with the patient, which is heartbreaking because, at the end of the day, we went into this field because we really want to help people.

Dr. Red Schiller: What we forget is that being a doctor is really a calling, and it’s a gift. In some ways, the place to start is to just recognize that both the patient and the people providing care bring all this stress to the interaction, and possibly just taking a moment to acknowledge that. I suppose that to me is how I try to deal with this on a day-to-day basis is just focusing on being present. The early days of my training were in the midst of an AIDS epidemic, and I saw things that were just horrible about people with AIDS being turned away. But it was certain people who are able to rise to the occasion and show others how not to be afraid, and I think each generation really needs to do that. You can’t do it alone.

Dr. Umut Sarpel: I think 10 years ago, there was no discussion of wellness. Maybe we were expected to be the bastions of wellness, and that’s obviously not true. So I think this added attention is important, and hopefully something will come of it. I hope there’s hope.

Narrator: Our society still thinks of doctors as these all-knowing, always correct people on a pedestal. But the truth is they are people too, and stress tremendously affects them. And this is why being conscious of what’s happening outside of the exam room is so important for our own health. And it’s also why the big changes that have to be made to this system are vital for the well-being of clinicians everywhere—and for us all.

Not burnout, not moral injury—human rights violations

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Physician Self-Care vs. Self-Abuse →

Self-Care vs. Self-Abuse

Yesterday I posted this on Facebook and was overwhelmed by comments . . .

Today I’m celebrating 30 days of weight lifting (with a personal trainer) & back on 100% plant-based nutrition that makes me feel awesome. YESSSSS! I (finally) made the decision one month ago to start taking care of myself!!!! More than 3 decades ago (in high school) my mom asked me, “When are you going to stop taking care of everyone else and start taking care of YOURSELF?” I had no idea what she was talking about. Her question didn’t even make sense to me. I thought it was normal to caretake & nurture others. I thought my gift of opening my heart & soul to care for special needs animals & people & anyone who needed my help was what I was born to do. Only last month did her question FINALLY make sense to me. AFTER 24 years of school (& 11 years of medical training). AFTER 26 years of being a family doc and taking care of everyone who needed me regardless of ability to pay. (Oh, and I chose family medicine over pediatrics or nephrology because I wanted to take care of EVERY organ system of EVERYONE in the whole world!). “When are you going to stop taking care of everyone else and start taking care of YOURSELF?” only made sense AFTER becoming so disillusioned with big-box assembly-line medicine, I nearly ended my life by suicide. AFTER losing so many med students & doctors to suicide that I’ve been running a free physician suicide helpline on my own since 2012. AFTER being determined to find out WHY my brothers & sisters in medicine were killing themselves. AFTER investigating the suicides of 1,300 doctors & med students. AFTER seven years of running myself ragged flying across the country to help suicidal med students & residents in crisis, leading free retreats for surviving family members, vigils for deceased doctors, and organizing & facilitating a giant free retreat for 500 docs in NYC last fall to prevent doctor suicides that ALMOST KILLED ME (yes, I had pneumonia & I kept working even when several docs surrounded me and tried to force me into going to the hospital, I would NOT go. Why? I HAD WORK TO DO to help save everyone else who was suffering—and yes, I was so sick & febrile that I was probably delirious and I did hear the angel of death whispering to me in the middle of the night, “Pamela . . . Come here Pamela . . .” ).

What kind of person does something like this? There IS a word for this behavior. *** THIS IS CALLED WORKAHOLISM *** One month ago I decided to STOP BEING A WORKAHOLIC the day after publishing Human Rights Violations in Medicine: A-to-Z Action Guide, a guide that gives actionable instructions for victims to SAVE THEMSELVES. Yes, I finally cracked the code on WHY my brothers & sisters in medicine are dying by suicide. Yes, I have a solution that will prevent 99% of future suicides among doctors. Yes, I have given those instructions to victims who can now save their own lives. SO I AM FREE!! I’m here. I’m happy to guide you. I’m still running my doctor suicide helpline. However, I’m no longer going to do the work FOR YOU. I’m no longer going to do the work of 100+ people. Yep. >>> I AM NO LONGER A WORKAHOLIC. I AM NO LONGER A WORKAHOLIC. I AM NO LONGER A WORKAHOLIC. This is what SELF-CARE looks like. (& it’s not a weekend retreat. it’s not a massage, it’s not a green drink). SELF-CARE IS A PERMANENT LIFESTYLE. Have you suffered from workaholism that has almost killed you? Guess what. YOU CAN STOP THE CYCLE OF SELF-ABUSE NOW. TODAY. Who’s with me?

PamelaWibleMDSelf-Care

Above: This is me now—as a true role model for self-care (after nearly killing myself from workaholism = self-abuse).

Below: This is me last fall pointing up to the 33-story rooftop of a Mount Sinai building where a beloved colleague died by suicide. I was so determined to prevent the suicides of my brothers & sisters in medicine that I almost died by self-abuse in the process. Self-harm is not always as dramatic as suicide. Like our patients who die slowly by self-harm (no exercise, crappy diet), doctors can also die a slow suicide from self-abuse. Don’t be a victim of your own abuse. I don’t want you to land on this sidewalk with all our fallen physicians. Your FIRST JOB is to save yourself. Then save your patients.

WibleNYCMarch-Roof_2

Doctors & med students—to learn how to take care of yourself so you don’t die by your own hands, view this keynote: Physician Suicide–Prevention & Intervention.

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Free Residency Survival Guide (& Self-Help Book for Wounded Healers) →

ALL NEW INTERNS: Here’s YOUR FREE COPY of Amazon’s #1 New Release in Medical Law & Medical Ethics! Your guide to SURVIVING RESIDENCY with your heart, soul, and dream alive! No need to struggle, isolate, feel like an imposter, or accept abuse as part of medical education. If you ever feel anxious or stressed, exhausted or depressed by residency, this is for you! Here’s how to free yourself from the abuse cycle within medicine. You don’t need to suffer for one more minute. ** You have LEGAL PROTECTION & THE RIGHT TO A SAFE WORKPLACE ** You can be the doctor you always dreamed of becoming. TO GET YOUR FREE COPY: Send a paragraph sharing your #1 anxiety about residency & your mailing address via IdealMedicalCare.org/contact & your care package will arrive this week by USPS media mail. If you’re not an intern, get the book with 1-day Prime shipping here.

IF YOU ARE A PRACTICING PHYSICIAN (or any medical professional), there is no need to struggle, isolate, feel like an imposter, or accept abuse as part of medical practice. Many of us are still suffering from having been victimized by the abuse cycle within medicine. You don’t need to suffer for one more minute. This action guide will help you heal from decades of trauma.

 

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It’s July 1st ~ WELCOME New Doctors! (Here’s your hospital survival guide) →

Today is July 1—the day new doctors begin working in our nation’s hospitals. Do you realize new doctors work 28-hour shifts? Here’s what you need to know: My dog groomer works 8-hour shifts. Over 8 hours, groomers are less attentive to panting—and pets die. My pilot can fly 9 hours. Over 9 hours, pilots are less attentive—and planes crash. Yet new doctors are forced to work 28-hour shifts. Ya see, labor laws protect pilots and passengers, pet groomers and pets. Not doctors or patients. Working more than 24 hours is like having a blood alcohol level beyond the legal limit to drive a car. Would you take your poodle to a drunk pet groomer? Board a plane with a drunk pilot? Why go to hospitals forcing doctors to work more than 24 hours? You deserve a well-rested doctor—and your doctor deserves sleep. Medical mistakes are reported to be the third leading cause of death. Sleep deprivation has led to patient deaths and physician suicides. Always ask your doctors how long they’ve been at work and boycott hospitals that abuse doctors and patients.

TAKE ACTION NOW:

1) Always ask your doctors how long they’ve been on shift. You have the right to request a doctor who is alert and well-rested. Your doctor has a human right to sleep. Boycott hospitals that abuse doctors and patients.

2) Document all episodes of sleep deprivation endangering the lives of medical professionals and patients depending on their care. Reference Human Rights Violations in Medicine: A-to-Z Action Guide. Medical mistakes escalate when doctors work beyond 24 hours as these sleep-deprived doctors reveal.

3) Never drive yourself home after a > 24-hour shift. Call Uber or Lyft. Doctors have been in fatal car crashes after long shifts.

4) If your workplace is unsafe, unhealthful, or hazardous due to sleep deprivation, contact OSHA and NIOSH. File a confidential OSHA (Occupational Safety and Health Administration) complaint to trigger an on-site inspection by a compliance officer trained to protect workers and their rights. Then request a health hazard evaluation through NIOSH (National Institute for Occupational Safety and Health). They will perform an assessment of physician work conditions and file a report with recommendations. Three employees are required to request a NIOSH evaluation. Your identity will remain confidential.

5) File a confidential complaint with the Joint Commission and ACGME to have your workplace inspected when sleep deprivation is a hazard to human health. Seek legal counsel for further help.

6) File a complaint with the New York State Department of Health under the 405 Regulations if you have suffered work-hour violations in New York, where medical trainees sustain greater assaults yet have greater protections than physicians in the rest of the United States. ACGME policies may be in conflict with your state laws. If you feel your rights have been breached in New York, seek legal counsel.

7) Let ACGME CEO Dr. Thomas Nasca know how you feel about his decision to allow doctors to work 28+ hours without sleep: Accreditation Council for Graduate Medical Education 401 North Michigan Avenue, Suite 2000, Chicago, IL 60611 or call 312.755.5000. Email Dr. Nasca: tnasca@acgme.org

Want to learn medical self-defense?

Here’s how to protect yourself as a medical student, doctor & patient.

 

Need confidential help? Read Action Guide above, then contact Dr. Wible.

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

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

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

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

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

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

I had to find out why my friends were dying.

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

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

Our doctors are suffering from human rights violations in medicine.

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

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

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

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

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

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

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

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

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

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

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

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

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

Please join me in speaking up against abuse.

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

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