Brief history of why doctors work 28-hour shifts →

Doctors all worked unlimited hours—unchallenged until Libby Zion’s death on March, 5, 1984. Her dad found her care was left to sleep-deprived residents with no supervision. Legal battles ended in New York’s 1989 Libby Zion Law—requiring doctors-in-training be supervised and limited to 24-hour shifts and 80-hour weeks. In 2003 these caps were applied to all US residents and in 2011 new doctors were capped at 16-hour shifts. Yet caps remain unenforced so residents may still work unlimited hours. In 2016, we delivered a 75,000 signature petition to Dr. Nasca at the ACGME, demanding the agency charged with resident training address sleep deprivation and doctor suicides. In response, they nearly doubled new doctor shifts from 16 to 28 hours in 2017 and now permit unlimited hours without justifying why. If this bothers you, tell the ACGME (and your hospital)—that your doctor has a right to sleep or you have a right to see another doctor.

Protect yourself & your loved ones. Always ask, “How long have you been on your shift, Doc?” 

Let the ACGME and Dr. Thomas Nasca know how you feel about their 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

Hazardous work hours in our hospitals lead to deadly medical mistakes, doctor suicides & fatal car accidents.

Your legal defense strategy: Human Rights Violations in Medicine: A-to-Z Action Guide

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Protected: Doctor tries to shoot himself. He survived. I made this video for him (and all suicidal docs out there). →

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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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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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