Attention all nurses, nurse practitioners, physician assistants, midwives, doctors and anyone else in health care: here are the top 10 warning signs that it is time to quit your job. The first three are mine. The rest are from colleagues. If you recognize anything on this list, please quit your job.
10. You feel nauseated when you see your clinic logo. You alter your commute to avoid streets with your clinic’s billboard.
9. Discouraged by the general despair among clinic staff, you try to be joyful. Then you’re reprimanded by the clinic manager for being “excessively happy.”
8. You dream of leaving medicine to work as a waitress.
7. You envy your sickest patients and/or you develop a perverse pleasure in your patients’ pain.
6. You pray you will be diagnosed with cancer so you can get some time to sleep.
5. You spend your nights trying to keep patients alive while you imagine ways to die by suicide.
4. You work 16-24 hour shifts and have not had sex with your spouse in months.
3. You are a top-rated doctor, yet you daydream about walking into traffic, jumping through the window, or just dying in the course of a normal day.
2. You are counting down the days until retirement during patient appointments.
1. You change your computer password to “fuck [name of hospital where you work]!!!”
Pamela Wible, M.D., is a practicing physician and founder of the ideal medical care movement. View her TEDMED talk Why doctors kill themselves. Attend our upcoming retreat and learn how you can stop suffering and start loving medicine again.
Let’s talk about cycles of abuse. Sexual abuse. Domestic violence. Human rights violations. Why does this stuff continue? Why does a woman end up dating a violent man and then another violent man over and over again. Why does incest pass on from generation to generation? Why are some countries plagued with human rights violations decade after decade? How can we stop the abuse? Oppressors won’t apologize spontaneously. Change depends on the victims. Here’s the problem: victims who don’t realize they’re victims are at high risk of becoming victimizers—thus perpetuating the cycle of abuse.
In the history of human rights abuse, I’m fascinated by what was once normal. Slavery and segregation. Women denied the vote. Only men could be doctors. All normal. How did we normalize what’s totally unacceptable today? Common practice. If everyone’s doing it then it must be okay. The younger generation inherits the beliefs of the older generation. Until one day someone disagrees.
People with new ideas are often ridiculed or vilified. Sometimes they’re killed. Until suddenly everyone supports the heretic-turned-hero.
Arthur Schopenhauer, a German philosopher, once stated: All truth passes through three stages. First, it’s ridiculed. Second, it’s violently opposed. Third, it’s accepted as being self-evident.
The United Nations Declaration of Human Rights guides us toward right behavior. Yet human rights violations continue. In poor countries with dictators and right down the street within our very own hospitals. Institutional bullying and abuse of doctors and nurses trickles right down onto patients. Health care human rights abuse—it’s an oxymoron. Yet every day in first-world hospitals our doctors are working 28+ hour shifts and 100+ hour work weeks, many times without adequate food or bathroom breaks. Some docs are so sleep deprived they start hallucinating and having seizures at work! Common practice. Normal. But it’s not really normal. Is it?
Why do human rights violations persist in our hospitals? Maybe it’s because victims don’t consider themselves victims. This is how we train doctors. Right? Sleep deprivation is a torture technique condemned by the United Nations, yet it’s also a medical tradition in American hospitals. I’ve been told tradition is just a bad idea held by a lot of people for a really long time. So why not change the tradition? What’s stopping us?
Stockholm syndrome maintains these cycles of abuse. It’s a condition in which victims develop empathy for their captors. Somehow, in a weird way, they support their oppressors. Call attention to their abuse and victims defend it. Docs with Stockholm syndrome fight to maintain antiquated medical traditions rampant with human rights violations. Why? To save us from future generations of lazy doctors, they warn:
Let’s not turn medicine into some coddling group hug where anyone with a brain can get through.
Physicians who complain about bullying are just spoiled brats and crybabies who are not cut out for a profession that has individual lives in the balance.
Younger docs living on trust funds just want to be treated like special snowflakes.
The newer generation of physicians is emotionally weaker and more likely to succumb to suicide.
I just hope when I have a problem that I’m lucky enough to have one of the cold-hearted, knowledgable, and tough physicians, not a crybaby taking care of me.
Is it possible that some petunias tap danced into medicine ignorant of the fact that life is hard?
In med school, I was called a flower child, I was ridiculed for crying with patients and was the brunt of many jokes for caring so deeply about my psych patients in particular. Years later after opening an ideal clinic (and helping hundreds of docs do the same), I was invited to deliver a keynote on how to create an ideal medical clinic. Check out the various comment cards after my speech:
She’s a nut. * Thoroughly enjoyed her talk and will start a similar practice. * Too ideal. * Excellent and extremely informative. * Complete waste of time. * Charming, sweet, encouraging, and completely impractical. * Realistic insightful, and quite revealing about human nature. Excellent and so simple. * Totally unreal.
My favorite physician feedback: “Oh my! Love and peace! No help at all with reality.” Fact: patients come to us for love, peace, hope, and healing. That is the reality.
Truth passes through ridicule on its way to acceptance. So I accept that some doctors are on their way to embracing a more humane health care system amid their attacks on me, my patients, and those of us who are actually creating innovative medical models of the future. Remember: “Those who say it can’t be done should get out of the way of those doing it”
So tell the truth: Do you want a cold-hearted physician or a crybaby? If you think these are your only options, maybe you’re a victim too.
Are you at risk of dying at work? Know your Karōshi Line. Learn how to protect yourself from an early death in this podcast. Listen in . . .
“One of my best friends form medical school died a few years ago, 55 years old, excellent health, swam every day. Genius—musician, internist, bicycle designer. His name was Patrick Tekeli. His death affected me deeply. Mother found him dead. Suicide? Who knows; I call it Karōshi (過労死)—I’m sure you’re familiar with that, ‘excessive work death.’ But he made a great impression on me. I’ve already submitted my letter of resignation. In a few months I’ll be off the RVU treadmill. I may still work a few months a year, but I won’t be a slave anymore. Cheers, ~ Jack Foust MD”
In Japan working yourself to death is actually in the dictionary. Karōshi is a word that literally means overwork death. I’ve known many people who have died from overwork though I never knew there was a word for it. I’d further subdivide Karōshi into the acute and chronic varieties. After non-stop consecutive 32-hour shifts, this 30-year-old cardiologist Dr. Zhang nearly died from acute Karōshi. In this video he is seen coughing up more than 4 pints of blood.
Chronic overwork may be even more dangerous than acute Karōshi. Like a slow suicide, workers literally work themselves to their own graves. Most Karōshi deaths are due to strokes, heart attacks, or suicides. Karojishi is a suicide by depression or mental illness due to overwork.
In Japan, the “Karōshi line” is defined as a 60-hour work week (80 hours overtime per month based on the 40-hour work week). This line dictates the threshold over which a wrongful death lawsuit may be filed for government compensation.
As a reference resident physicians in US work 80+ hour work weeks (and some do 100 or more since the 80-hour work week cap remains unenforced by anything more than the honor system). In fact, the ACGME (accreditation body that oversees medical education in the US) is on the verge of lengthening shifts on new first year doctors to 28+ hours.
So I wonder how many hours a healthy human should actually work. What’s the optimal amount of time one can work and actually enjoy a normal lifespan with good health? I interviewed a random sampling of 14 people in the Pacific Northwest and the average response for a healthy workday: 5.8 hours.
Most folks felt 4-6 hours would give people enough time to exercise, eat well, care for their kids and enjoy their lives. On the high end, one guy said 10 hours if you’re job is great and 3 if your job sucks.
So what do you think? How many hours could you work each day without undermining your health or reducing your lifespan? Where’s your Karōshi line? Leave your response below.
Pamela Wible, M.D., is a family physician who reports on human rights violations in medicine. Most resident physicians work 28+ hour shifts. Many doctors die by Karojishi as discussed in this TEDMED talk Why doctors kill themselves. Dr. Wible is author of Physician Suicide Letters—Answered.
People pleasers are dangerous. They actually end up hurting people. Don’t be too nice anymore. Here’s how I recovered—and you can too! Listen in . . .
Check out the letter I just received:
Hi Pamela, I’m slowly making changes, but every day is a struggle. Part of my challenge is simply saying NO. I had a major breakthrough last week. My prior employer wants me to interview for another “job”…. I’m asking more questions before agreeing to go….like send me a job description/title and let me speak to someone about the current needs of the practice before making me drive over 3 hours on my vacation day!! Give me some specifics!! It’s been 7 days since I asked and I’ve yet to get a response. If you can’t answer simple questions then I don’t think I want to work for your organization! It sounds so dumb but it’s hard to say NO when I’ve been conditioned to be a YES person. It’s like they say jump and I say how high? It’s unfair and exhausting so I’m taking back control over my life NOW! ~ Erika
As doctors we’re used to being the straight-A valedictorian presidents of every club and organization. We’re people pleasers who submit to authority and we’re such do-gooder super-achievers that we tend to take on way more than we can handle. Saying no is a learned skill. Practice it now. In a mirror. With your kids, spouse, patients. To inspire you, here’s how I say no in my medical clinic: (feel free to steal these)
1) I say no to medication refills between appointments. More than 30% of calls to my clinic were related to prescription refills. No more! I say no to any patient or pharmacy requesting a refill outside of an office visit. I clearly state this in my office policy on my outgoing phone message. If a pharmacy still leaves a refill request on my phone line, I simply press delete (best feeling ever!).
2) I say no to angry men who yell during office visits. After divorcing my ex who had anger management issues, I’ve decided that anyone with an anger problem should seek help from a specialist in anger (not me). Don’t project your anger at your boss, wife, or mother onto me. I will not tolerate any loud, hostile men in my life.
3) I say no to charity care (yet I’ve never turned any patient away for lack of money in 12+ years). Medical care is not a passive experience. I expect patients to be actively engaged emotionally, physically, and financially. I give 110% to my patients and I expect an equal energy exchange in return. In the rare case that someone is truly unable to pay, I require that they donate their time to the community (soup kitchen, animal shelter, etc) just as I’ve donated my time to them.
4) I say no to assembly-line medicine. I didn’t invest decades of my life to become a caring and competent physician only to be held hostage in a big-box clinic seeing patients every 7-10 minutes. So I quit and opened my own ideal clinic where I see patients for 30-60 minutes (plus now I earn more too!).
Saying no has made my life awesome! Imagine if we all learned to say no. When large groups of people say no, governments, employers, and organizations respond. Plus the media loves it too!
Anytime you withdraw your participation or relationship with an organization or refuse to cooperate with a policy or job description, you are boycotting something. Boycotts create culture change—quickly. Think about the far-reaching impact of the bus boycott (when Rosa Parks said no she would not give up her seat). Withdrawing revenue (or revenue-generating employees) from a business in a capitalist culture is a sure way to get action.
When employees refuse to work as a form of organized protest, a boycott becomes a strike. In the UK this past year junior doctors were on strike due to unsafe/unfair working conditions. The senior doctors supported them and so did 54% of the general public. No patients died as a result. A well-planned strike creates culture change—even in medicine—and without harming patients. In the US, I don’t predict an all-out physician strike; however, each doctor who says no and refuses to participate in for-profit insurance, corrupt organizations, or medical institutions that violate the human rights of their workers is essentially a microstrike. In large numbers, microstrikes take down entire industries. Just watch.
People pleasers actually hurt people
By saying YES to corrupt organizations or employers that violate human rights of their employees, you are actually harming yourselves and others. The cycle of abuse in medicine is perpetuated by people pleasers who won’t say no. So congratulations! By saying no you are healing not only yourself. You are healing our wounded profession, your patients, and your community. Thank you!
Jon Azkue, a Chicago-area doctor, died by suicide just before completing his training. I first reported his death a few years ago. This is a follow-up story on his suicide. What really happened to Dr. Azkue? And why? In this podcast I break the silence on one doctor’s suicide.
Two years ago, on April 20, 2015, I first read the headline: Police: Doctor found dead near hospital in Berwyn. Immediately, I published an article on Dr. Azkue’s suicide. The next day, ABC news changed the title of the story to “Man found dead near hospital in Berwyn.” How does a dead doctor get demoted to a “man” found dead?
Here are the facts: On April 16, a maintenance worker calls police for a well-being check on a tenant, Dr. Jon Azkue, a 54-year-old physician employed at MacNeal Hospital. Police discover a suicide note and his decomposed body surrounded by helium tanks. Thinking they were propane tanks, police call the bomb squad and evacuate the four-story building which houses health professionals and medical businesses. Here’s how his neighbors and colleagues respond:
“I was actually going to get some baby food,” says Jemin George who evacuated the building with his family. “My daughter is in one of the vehicles and it’s been almost three hours since she’s had something to eat.”
“It’s an inconvenience for the patients,” claims Riz Ahmed, an employee at Chicagoland Retinal Consultants, a clinic located in the building. Clinic manager Anna Futya, is also frustrated by the inconvenience. “All the calls that are coming here—whether from patients or doctors—nobody is able to answer . . .
Wait, I thought this news story was about the doctor. The original headline clearly states: “Doctor found dead near hospital.” So why is the focus now on patient inconvenience? How did Dr. Azkue get scrubbed from his own story?
Dr. Azkue’s death is not only reported as an inconvenience to patients, he is treated as if he is guilty of a crime. There’s no sympathy, no sadness for the loss of a man who spent his life helping others. In the comments—amid jokes about terrorist plots and remarks about the selfishness of suicide—one doctor writes:
Wow. I’m appalled by the lack of sensitivity for the loss of life here. I myself am in residency and unless you live through it, you cannot begin to imagine the stress and sacrifices that we and our families endure—far greater than missed eye appointments. My condolences to his family and colleagues. The journalist and editor should be ashamed of the slant through which they allowed this ‘news’ to be delivered.
I’m compelled to discover the truth. Turns out Jon Azkue is a 1994 foreign medical graduate from Central University of Venezuela who was just a few months from completing his final year of internal medicine residency at MacNeal Hospital. Though he was a physician in Venezuela, his dream was to practice medicine in the Unites States. So what happened? Why would he kill himself just months before fulfilling his dream?
Physician suicide often leads to more questions than answers. In the U.S. we lose more than 400 physicians each year to suicide. Like most docs, Jon Azkue left a note. Why aren’t we analyzing these suicide notes for common themes to prevent more suicides? Why aren’t these suicides fully investigated? Why does it seem like nobody cares when a doctor dies by suicide?
Since the bomb squad left his apartment, we’ve heard nothing more about Dr. Azkue. We’ve heard nothing about lives he saved. This was his five minutes of fame. Nearly two years later and we still have no answers as to why, no investigation of his residency program (where I’ve been told other doctors have attempted and died by suicide). Sadly, my prediction that this doctor would be forgotten by the media and medical profession has come true. Are his years of dedication not even worth a plaque on a wall? Are doctors so disposable?
Since Dr. Azkue’s suicide, I’ve amassed hundreds of cases of doctor suicides. Plus a collection of “suspicious” deaths like the anesthesiologist found on the side of an interstate. “No foul play.” Docs found dead inside hospital call rooms. “No foul play.” Really? That’s it. No follow-up stories. Healthy docs dead. Prime of life. Top of their game. Chief of departments. Case closed. How can we solve a public health crisis by ignoring it?
Here’s the truth: One million Americans lose their doctors to suicide each year. Until we investigate why so many doctors are dying by suicide, we’ll continue to lose more doctors to suicide. Maybe if we took a sincere interest in Dr. Azkue’s death, we could prevent the next one.
Meanwhile the only public honoring of Dr. Azkue appears to be on my blog where co-workers share: I knew Dr Azkue and worked with him. Shame on the public for their insensitivity to this situation. Unless you know the whole story, people, think before you speak! You never know what someone else has gone through! Who are we to judge? May he rest in peace. I worked with him also and found him to be a kind doctor. He was very nice and very intelligent and it breaks my heart to see that he passed away.
Even Dr. Azkue’s son, Jon Mikel, reached out from Mexico to search for answers about the unusual circumstances surrounding his father’s death.
He was in fact fired on his third year of the residency (just a few months before graduating). The hospital didn´t tell us why exactly. He lost his visa status as a result and would have had to leave the country. We are from Venezuela, and its bad over there, really bad. That must have devastated him, as his dream, since I have memory, was to live and practice medicine in the states specially because he did his first two years of med school in Boston. He could not finish back then for financial reasons, so he went on to finish med school in Venezuela and was a doctor over there several years. After Chavez though, he committed himself to his dream of practicing medicine in the states. It took him years. We thought he had finally made it… By the way, my family went through his stuff, they found two job offers for when he finished in August as well as few good letters of recommendation. A relative spoke to the program director. We still don’t understand why he was fired. They told us it was a decision taken by a board, nothing that could be done there. But wouldn’t give us the why.
Now it’s 2017 and we still don’t know why. I do know of several residency programs that have a habit of firing final year residents just months form graduation. I’ve seen the victims vilified and careers destroyed. Any investigation into these programs? Not that I’m aware of.
In summary, a physician is sacrificed by his profession and the media chooses a patient inconvenience angle. Why? Wendy Eidman explains the unusual and callous reporting of this story:
So I used to be in television news (both an anchor and reporter); I can tell you exactly why this story was written the way it was. When the reporter got to the scene, she was not doing a human interest piece, which is the kind of story that you want to listen to. She covered a breaking news story, a situation that was unfolding — a possible explosive device in the building, the disruption of the residents’ lives, the consequences to the businesses involved, and the discovery of a victim in an apartment that had been rented to a physician, cause of death undetermined at the time of broadcast. It was appropriately done with the information that the reporter had at the time she had to go live. When I was in TV, it was station policy to not cover suicides in general unless the suicide had some consequence to the public — a person stepping in front of a train, causing the system to shut down for a time during rush hour, for example; in those cases, the story itself was the disruption of service to customers during rush hour. Management for my station felt that if they did allow coverage for suicides, the publicity might encourage suicidal people to go through with their plans. Since the reporter in this particular story had already gone live, it would have been good to follow up with the kind of story that you are envisioning once the coroner released the report that the doctor had indeed completed suicide. It would have been an awesome opportunity to do a series on the issue of physician suicide and the general state of medical care in America. I am going to hashtag the TV station so that they can read this comment and perhaps follow through during May ratings.
Physician suicide is a public health crisis, yet there has still been no follow-up story. No major media investigation. So I’ll continue to report on these suicides myself—and I will continue to honor our fallen physicians.
If you are a doctor, medical student, or health professional who is suffering, click here for help. If you want to know why so many doctors are dying by suicide, listen to this award-winning NPR interview.
