Hazardous work conditions kill doctors (and patients) →

 

I was invited on to this TV show to share why burnout and moral injury fail to address the underlying cause of physician distress—human rights violations in medicine. View full TV show here.

Doctors have the highest suicide rate of any profession. I run a doctor suicide hotline and I’ve investigated more than 1,300 doctor suicides. Root cause analysis reveals human rights violations as the culprit. Doctors who don’t succumb to suicide are victims too. Coping with abuse is not a solution. Ending abuse is. Injured morals offers no solution. Burnout is a smokescreen that distracts from human rights violations that are killing doctors—and patients. Let’s focus on facts and real solutions through institutional triage, definitive diagnoses, and targeted treatment.

1) Institutional Triage
As physicians, we address life-threatening emergencies first to save our patients’ lives. Stop the arterial bleed, the treat the acne. Institutional triage means prioritizing doctor suicide prevention by eradicating human rights violations in medicine that lead to suicides. When doctors are groomed to accept a culture of abuse, we perpetuate it on ourselves, our peers, and our patients. Eliminating hazardous working conditions will create a culture of wellness for us all.

2) Definitive Diagnoses
Students enter the medicine with their mental health on par with or better than their peers. We are then wounded by hazardous working conditions Illegal in all other industries that value safety. As a result, doctors may develop lifelong health sequelae such as new onset constipation, insomnia, anxiety, depression, PTSD, and suicidal ideation. Precise language is paramount. Burnout and moral injury distract and confuse victims while deflecting attention from abuse perpetrated by the medical system that labels victims as defective. By holding the system accountable for violating the specific rights of doctors (and patients), we can proceed with a targeted treatment plan.

3) Targeted Treatment
Unlike moral injury and burnout, human rights violations have proven medicolegal solutions that protect victims. Sleep deprivation is a known torture technique, yet new doctors are forced to work 28-hour shifts. The solution—a bed and a pillow. Food and water deprivation are common among sleep-deprived doctors who have no set breaks on marathon shifts. The solution—regular meals. Hazing and harassment is rampant in our hospitals. The solution—legal prosecution as is standard at other institutions that value human life. Doctors are collapsing from overwork, found dead in hospitals. The solution—comply with the same labor laws that protect pilots who fly 8-hour shifts (not 28-hours). All human rights violations in medicine are categorized here with simple, effective treatments.

Read fascinating history of  burnout, moral injury, and human rights violations in medicine here.

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Text message prevents surgeon’s suicide →

 

A physician shares his suicide survival story with me. The 51 words that saved his life.

Hi Pamela, Here is the text that prevented my suicide:

“Hey I’m so sorry about your patient. That sucks. I’m very thankful that we have you as an excellent otolaryngologist to learn from. You take care of so many sick patients and do a marvelous job educating us how to do it safely, skillfully, and compassionately well. Thank you for that.”

It’s been a particularly hard year for me. But I’m surviving.
Thanks for all you do Pamela.

I shared his text as closing slide in my keynote last weekend on creating a culture of wellness among orthopaedic surgeons, anesthesiologists, and veterinarians. Concepts apply to all specialties and professions.

After interviewing male physicians who survived suicide attempts, I discovered the average time between their decision to die by suicide and the moment they grabbed their gun, pills, scalpel (or method of choice) was–3 to 5 minutes.

Average time it takes to type a text message—less than 1 minute.

Your best and fastest way to save a doctor’s life may be a text message.

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If you need more proof of the lifesaving impact of your words, read this:

RIPPLE EFFECT: Never underestimate the power of your words to travel 8,158 miles to inspire a random woman 991 days later. I just got this email today—nearly 3 years later!

“Hello Pamela, On 3rd November 2017, I was seeing an orthopaedic back surgeon, Dr. Gary Speck in Australia (where I live). While taking my history he discovered my daughter would commence Medicine the following February (2018). Instantly he told me of an article he had read that very morning and said it was a must read for my daughter. He kindly printed a copy for me to take home. The article is: Loyola Commencement Speech ‘Live Your Dream.’ My daughter is about to commence her 3rd year of a 6 yr medical degree at the University of Adelaide here in Australia. She has been home for the holidays and she still has the article. I asked if I could read it and she said yes but I’m taking it with me. I want to thank you for this article. Gary gave it to us because he thought it important to share your message. While she is still 4 yrs from being an intern, I love that she values your advice and that you inspire her. Keep being the amazing woman, doctor, mentor you so obviously are. Love from a very grateful mum/mom downunder in Australia xxxx”

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Creating a Culture of Wellness (Keynote) →

Note: Thomas Fishler, MD,  is correct spelling of his name.

Kick-off keynote delivered on February 7, 2020 at AO North America, an international organization serving veterinarians, craniomaxillofacial, hand, spine, and trauma surgeons.

Introduction: It gives me great honor and privilege to introduce our first keynote speaker for the day, Dr. Pamela Wible. Dr. Wible is a family physician born into a family of physicians. Her parents warned her not to pursue medicine, but she followed her heart only to discover to heal her patients, she had to first heal her profession. So she held town hall meetings and invited her community to design their own ideal clinic. Open since 2005, Dr. Wible’s community clinic has sparked a movement in which patients and physicians are designing ideal clinics nationwide.

When not treating patients, Dr. Wible devotes her life to medical student and physician-suicide prevention. She runs a suicide hotline and hosts retreats with discouraged medical students and physicians, for which TEDMED has named her “The Physicians’ Guardian Angel.” Dr. Wible has personally compiled and investigated more than 1300 doctor suicides, and had analyzed the data for high-risk specialties and actionable solutions to prevent future deaths. Dr. Wible is the author of Physician Suicide Letters-Answered. Her blogs have been picked up by major media, such as The Washington Post and Time Magazine. She has been interviewed by most major TV networks, and is a frequent guest on NPR. She is featured on the documentary Do No Harm, that exposes our hidden physician suicide epidemic. So put your hands together to welcome Dr. Wible to the stage.

Pamela Wible, MD: Thank you so much for having me. I’m really excited to be here. Originally I was on the schedule the last day of your event, and then they moved me up to the middle day and now, with the late-night phone call I got in my hotel room last night, I’m your first speaker, how about that? I got promoted.

So, we’re going to talk about the culture of wellness through a really interesting lens that I feel is not discussed, because it’s a bit of a taboo topic; but it’s going to give you a lot of insight in how to move forward with an actual strategy that will be effective at creating a culture of wellness. So take the journey with me. We’re going to start with physician mental health.

This is a quote that I gave during an interview that got a lot of traction online. Now, in this quote there are two tactics that have been used to deal with the obvious despair that exists within our profession. Meditation/yoga on one side, let’s just kind of sweep this away here and maybe if we just took a nap and a green drink. Then on the other side is early retirement, I’ve got to get out of here. Right? Because I talk to a lot of surgeons and their spouses who tell me that their partner is counting down the days to retirement, trying to make an early exit.

So somewhere between the early exit and meditation is an actual solution—a real strategy. And so we’re going to discuss that today. And I think you’ll find some relief in the fact that I am a truthspeaker, so I don’t hold anything back, but I am delivering this with great love for my profession and to save lives of my colleagues.

So the learning objectives today are to learn a targeted, high-yield set of actions you can implement to promote wellness among physicians today. And this does not require you to sit in committee meetings or get any approval from anyone. You can actually leave this lecture and do it right away, right now, because I’m a very action-oriented person for those of you who have read any of my blogs and know me. Also, we’re going to understand how to create a culture of wellness utilizing a concept I call, “institutional triage,” which I coined just for your conference. And I think you’ll be able to relate to it. And then discover the highest-risk specialties for suicide, and what you can do to stop the crisis. Read more ›

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Death Row Health Care (Stand-Up Comedy) →

I just moved to NYC (part-time two weeks each month) on January 1, 2020 to help physician residents who are struggling there and to continue to address the doctor suicide crisis and empower physicians and medical students nationwide. Thought I’d try a little stand-up comedy (just for a fun hobby—work-life balance, ya know!).

I still practice medicine in Eugene, Oregon, in an ideal clinic that was designed entirely by my patients. I offer 24/7 telemedicine, house calls, plus office visits in my new downtown office and, of course, I’ll see patients when and where it is most comfortable for them. I also continue to run a suicide helpline for doctors and spend much of my time addressing hazardous working conditions in medical institutions. I speak widely on the physician suicide crisis and love mentoring and inspiring the next generation of doctors.

I continue to be committed—through keynote addresses, commencement speeches, white papers, journal articles, TV news interviews, and now a little stand-up—to reaching a wider audience with the message of compassionate health care transformation.

Here’s a little peek into my personal experience during medical training on death row. . .

I went to med school in Texas. And Texas is #1 in executions! I attended a world-famous school. It’s the only med school in the world—inside a prison hospital. (I think they should’ve mentioned that when I applied). I show up. I’m 21 years old and my patients are rapists and serial killers. But here’s the upside, when it came to appointments all of them were there—on time

Another perk. My tuition was subsidized by the Texas Department of Criminal Justice, so my death row criminals, they paid for their crimes—and my education.

It was so bizarre that I was learning how to give rectal exams on murderers. Shocking actually. Prostate feels good. Cholesterol’s up. Wait, that could kill ya. It was crazy ordering heart-healthy meals for guys on death row. To graduate on time I had to keep them alive till we killed them.

To give you some perspective, I had just spent the last four years at Wellesley—an elite all women’s college, so I hadn’t been with men in like forever. Now I’m on the front line dealing with America’s most wanted—rectums. And I had the most wanted—finger. Imagine: I’m this idealistic, caring young lady—with my finger up the ass of a serial killer. Two big guards behind me. Kinda hot. Right? I’m thinking, “Isn’t this every woman’s fantasy?” Truly I was the most wanted by the most wanted.

So I was vegan at the time and very determined to help all my patients eat healthy. As you can imagine, it was really difficult to convince these guys to eat less meat and more vegetables. I mean these guys were real carnivores. A couple were cannibals. I’m talking kale smoothies. And they’re thinking I’d love to eat her elbow.

Death row health care—that’s an oxymoron. I deal with a lot of oxymorons and morons on Oxy.

In Oregon I’m licensed to perform physician-assisted suicides. In Texas physicians are able to perform physician-assisted homicides (Yes, they actually have physicians in the execution chambers in Texas! Crazy right?). So I feel really comfortable practicing in both Oregon & Texas because in both states I can legally kill you. (Unreal!)

I have so much more to share about my experience growing up as the child of two physician parents and so many other events that have shaped who I am and allowed me to be so innovative in my care of patients and my suffering colleagues. Many of those stories (including my ethical dilemmas practicing medicine as a student doctor on death row) can be found in my first book: Pet Goats & Pap Smears.

Stay tuned. More to come . . .

Want to talk? Contact Dr. Wible here.

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Beloved doctor dies in physician health program. Her husband wants to know why. →

Shawn C. Kelley, M.D., died by suicide under the care of Washington State Physicians Health Program. She was referred to the WPHP based on one unsubstantiated allegation unrelated to patient care. Her husband shares his thoughts and experiences about the program tasked with protecting his wife—and he appeals for a more objective and transparent process for helping vulnerable physicians. (interviewed on date 9/20/19)

I’m Vince Nethery, professor of clinical physiology, and my wife Shawn passed away six years and 55 days ago. I received a phone call at midnight on a Saturday night, and that’s never a good time to receive a phone call. It was from a law enforcement group in Seattle informing me that she had passed away. I got in the car and drove to Seattle. The circumstances that led to this are complicated, multifactorial, and questions come up all the time. We will probably never get answers to many of the questions, even today, six years later.

Shawn was a loving wife, tremendous mother of two children, 1,000 patients or more lost their physician, the medical community of North Central Washington lost one of their longtime members, and how this all came about, as I mentioned, we’ll never know. What we do know is that there are circumstances that led to some level of discontent in the workplace with one particular individual. That individual filed a complaint to the medical director of the hospital. Later we learned the complaint had something to do with an out-of-work experience. It was a private function that had nothing to do with the workplace. The complaint expanded to the workplace with the individual saying they would never work with Shawn again. We asked for an investigation to say, “Well, what’s the basis of this? Give us a root cause analysis of the situation. See how many others were affected by some allegations of . . . I don’t really know what they were, but whatever those allegations were.

Ultimately, Shawn was directed to go to the Washington Physicians Health Program. She wasn’t exactly sure why, but she was directed to go there and based on that directive she had no choice but to go. She met with two individuals in a conference room and those individuals discussed or asked or interrogated her, I don’t know, I wasn’t there, for about 45 or 50 minutes. At the end of that time period, the medical director of WPHP came into the room and within five minutes indicated that she was to go to an inpatient facility within a few days [Note: she was to pack her bags, leave her family, and travel to Georgia to enter their “preferred” inpatient facility at her own expense for four days. She was not given a diagnosis or a clear reason for their decision].

She walked out of there. She called me. I remember it as clear today as it was then. She was incredibly upset, as anybody would have been I would think.

We communicated about how it went and I asked her what was the basis for the directive that came from the psychiatrist at WPHP. She indicated that he was in the room for maybe five or 10 minutes and when he made the directive to her that she needed to go, she asked why, and he indicated to her that her speech was pressured or pursed and that was the basis for his evaluation. I wasn’t exactly sure what that meant so I asked Shawn and she indicated that, “Well, that’s usually a sign of stress, that you have pursed or pressured speech, and it’s a sign of stress.” And she said, “Well, how do you think I would be? I just spent 50 minutes in this meeting having these fairly one-sided conversations with two individuals and I was stressed out. It would be unusual for somebody not to be stressed.”

I asked her who the two individuals were who were in the majority of the conference meeting with her and she wasn’t sure. She knew the names because they introduced themselves, but she didn’t know what their role was, what their qualifications were.

A subsequent meeting with the medical director of WPHP many months later where I accompanied Shawn to that meeting, I asked the medical director who the two individuals were.

His first response was, “They are professionals in WPHP.”

I said, “Okay, are they trained psychiatrists?”

He said, “No.”

I said, “Well, perhaps they’re psychologists, right, they’re certified through psychology?”

He said, “No.”

I said, “Well, do they have a bachelor’s degree?”

He said, “They have a substance abuse certification.”

I said, “Okay, how do they get that? What level of education do they need to get that?”

He said, “They received that through a program at a local community college.”

I said, “So we’re making a decision that’s going to have a significant impact on somebody’s life here on the basis of 45 minutes of questioning discussion with two individuals who have a community college certification. That doesn’t seem right, does it?”

He said, “They’re professionals in our organization.”

I then followed up with the medical director and I asked him, that given the heavy emphasis in medicine today and for the last decade or more, on evidence-based being the base for making critical decisions, I asked him to explain what the evidence base was for the medical decision that he made. He got up and left. Came back five minutes later and said, “Our meeting is finished.”

We had spent about 90 minutes in this meeting with him to try to get to the bottom of a basis for his decision. He would not provide a rationale for it, none whatsoever. He provided no evidence to support it beyond the hearsay or the allegations made by a single person that were unsubstantiated in a following followup investigation of the setting in which this individual worked.

I was flabbergasted, actually, that an individual who had so much quote unquote “power over” the functioning of a physician could make those types of decisions and make them without being able to provide a justification, especially to the person to who that decision was being rendered. I’ll take a break.

Of course with 20/20 hindsight there are probably some things that might have been done in a different way that may have averted the outcome that did exist. One area I personally think would have benefited this particular situation would have been the development of a clear pathway to the resolution. That is, what are the specific areas that need to be addressed and completed in order to have a return to normalcy of the workplace? It seemed like we were forever chasing a moving target. One thing was asked to be done, it was complied with. At the end of that, there was another thing, and that was done. Then there was something else. And at the end of the day there was no clear pathway to resolving the matter and allowing individuals to return back to a professional environment that they were trained to be in.

In addition, the establishment of an ombudsman type of person within the setting to provide an objective evaluation of it without the workplace evaluations being conducted by essentially some of the individuals who were inherently at the root cause of some of it. And that didn’t exist. There wasn’t an objective individual who was doing a root cause analysis to find out at a very basic level the underlying factors and the veracity or lack thereof of the allegations that were made.

There was really no support provided from a physician perspective. Shawn felt like she was out there like a shag on a rock. Just at the whim of whatever direction the wind was blowing. To put a more defined mechanism in place and to have a clear set of directives that need to be addressed, to find out whether they need to be addressed, and then determine the pathway to follow for addressing them, if there is validity to them, would have been extraordinarily helpful in this case.

Questions that remain unanswered:

1) Why is it that one disgruntled individual in a social setting can leverage a complaint (unrelated to patient care) against a competent physician and undermine a doctor’s entire profession?

2) Why are two individuals with 10-month community college certificates in charge of determining the fate of a doctor’s career in 45 minutes?

3) Why are physician health programs not using evidence-based medicine?

4) Why is there a lack of transparency in physician health programs so that the physician and family and not given a diagnosis and treatment plan with a clear pathway to resolving the unsubstantiated allegations against the doctor?

5) Why are physician health programs unwilling to answer questions about physicians who have died by suicide under their care?

If you have answers to these five questions, please share your insight below as Dr. Shawn Kelley’s family deserves to know what happened to her.

Questions raised about physician health program safety:

Doctors fear PHPs—why physicians won’t ask for help (TV report)

Physician Health Programs: More Harm Than Good

Physician health programs: ‘Diagnosing for dollars’?

Top 10 things you need to know about PHPs

After investigating more than 1,300 doctor suicides during the last seven years, I’ve noticed a disturbing trend in which physicians have been dying by suicide under the care of physician health programs. Victims are sent to PHPs for unclear reasons, mandated to one-size-fits-all “preferred” substance abuse treatment centers for up to five years at great personal expense—even though many had no substance use issues. If you have been harmed (or helped) by a PHP, please share your story below.

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