Doctor explains insurance from bubble bath →

Hi! This is Dr. Pamela Wible and welcome to “Insurance 101” where I’m going to explain my philosophy about health insurance. So let’s just use the rubber duckies as kind of a teaching tool here. So this is you, the doctor, and here’s the patient. And so you all are sitting in the room doing your office visit. Maybe the patient came in with an ingrown toenail or bronchitis or something. And so you’re having your little session and everything’s hunky-dory.

But you might kind of wonder why you feel like there’s so many other people in the room—other little ducks quacking at you. And here’s a group of little quacking ducks that might be passing by because in the average assembly-line medical clinic there’s five FTE staff per physician so, you know, here’s the coder, the biller, and all the people that you need to run that big assembly-line office. And you might feel like they’re kind of like traveling into your exam room with you. So now it’s no longer you and the patient. You’ve got like a bunch of quacking ducks in here.

And then you’ve got insurance companies, like these guys here are basically, look at this, like spitting on you, ya know. This one is spitting on your patient. And so the thing is if you feel like somebody is spitting and shitting on you it could be that you’ve got people in the room that really shouldn’t be there like maybe possibly insurance companies. Here’s another—maybe this is workers’ comp or something. There are some pretty massive insurance companies that could come right on through and disrupt what’s going on between you and your patient and have you filling out all sorts of the extra forms and paperwork that take like two, three, four times the amount of time that your office visit took.

And so I just want to encourage you to think clearly about what is best for you and for the patient. Is insurance serving you? I think for catastrophes, ya know, like lung transplants or things that are high ticket items obviously insurance may be necessary. But, ya know, for little ducky toenails and little ducky bronchitis is insurance necessary? So just give that some thought and in the next few videos I’ll share more about my philosophy on medical insurance.

Want to see more videos? Contact Dr. Wible here.

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Pamela Wible, M.D., is a family physician and founder of the Ideal Medical Care Movement. She hosts physician retreats where she helps doctors and patients design ideal clinics and get back to healing. She is the author of Amazon’s #1 best selling Physician Suicide Letters—Answered and Pet Goats & Pap Smears. Please Contact Dr. Wible anytime. She returns calls from her bathtub perch above the Pacific Ocean. 🙂

Tags: burnout, direct primary care, doctors, happy doctor, health insurance, ideal medical care, medical school, patient abuse, patient bullying, patient depression, patient profiling, Physician abuse, physician bullying, physician burnout, physician depression, Physician entrepreneur, physician suicide

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I’m Dr. Wible and I speak for the victims →

DoNoHarm

On February 4, 2016, I delivered this speech to 250 citizens of Missouri at a fundraiser for a documentary on physician suicide.

I’m here to speak for the victims—medical students and physicians who’ve died by suicide and others on the edge now who have written to me. I simply ask that you open your heart to their words . . .

Dear Pamela ~ I definitely graduated from med school with PTSD. It has changed me forever. I will never be the same again. We had two suicides and one murder, skull crushed with a bat, and one serving life in prison for murdering a classmate during a delusional episode after not sleeping for a month. Please change medical education. We were so beaten down. It takes a lot for me to cry, but I cried all the time along with everyone else. But we hid it from each other, of course. ~ Maria

Dear Dr. Wible ~ I’m not sure you read your [Facebook] messages but feel compelled to thank you. I was finishing term two of med school and had a bottle of Xanax in my hand. I was ready, as so many of us are. I took three then three more and came across your talk, “How to graduate medical school without killing yourself ” which I believe may have saved my life and a couple of close friends who are also suffering. [He was in the process of a suicide attempt and my lecture popped up on his Facebook feed] I’m near the top of my class and praying for death to escape the trap I’m locked into. I was in true delirium from lack of sleep and fear of failure. Studying in my sleep and waking up every hour in panic. Med school is doable but why must it be taught in this format? I read your stories and I’m just in shock how many others feel like I do or I feel like they do. Please keep sharing. You are saving lives, friend. ~ Chris

For each person I help, there are thousands more on the edge.

Each year more than one million Americans lose their doctors to suicide.

Across the country, our doctors are jumping from hospital rooftops, overdosing in call rooms, found hanging in hospital chapels.

It’s medicine’s dirty secret. And it’s covered up by our hospitals, clinics, and medical schools. No medical school wants to be known as the suicide school. No hospital wants to be #1 for interns jumping from rooftops. No one wants to become a doctor—to kill themselves.

So why? What the hell is going on? And why is this such a secret? And why am I piecing this together between patients? I’m a solo family doc, yet somehow I’ve become an investigative reporter, a specialist in physician suicide. Why? Mostly because I can’t stop asking why. Why both doctors I dated in med school died by suicide. Why 8 doctors killed themselves—just in my sweet little town. So I keep talking and writing—and listening for the truth. And because I’m listening with my heart and soul 24/7, my cell phone has turned into a suicide hotline and I’ve received hundreds of letters from suicidal physicians.

Like this letter I just received from an intern: “While in the ICU I joked about jumping from the helipad and a nurse said ‘well it’s about time, we’re due for another one. It’s been a few years’ I worked 118 hours last week and was told I’m not committed enough. And being the only woman if I show any feeling or compassion or pain I’m ‘over emotional’ and when families hug me I’m told I should have been a social worker.”

Suicide is never a joke. Students and doctors are crying out for help. And they are met with callousness—and even encouraged to kill themselves. These letters that I’ve published in my newest book, Physician Suicide Letters—Answered, reveal the pervasive and largely hidden medical culture of bullying, hazing, and abuse that claims the lives of countless medical students, doctors, and patients. Students who ask for help are often labeled (in evaluations and transcripts) as unprofessional, not a team player, inefficient, too sensitive, lazy, angry, idealistic. They are even told they have “inappropriate feelings.” Victim blaming and shaming creates desperate people and desperate people take desperate actions to end their pain.

So how does the system respond?

1) Doctors who dissent to working conditions are diagnosed as DISRUPTIVE (and are mandated to attend disruptive doctor classes). Well behaved doctors rarely make history. We need disruptive doctors.

2) Doctors who complain about 100+-hour work weeks are told they lack RESILIENCE (and are sent to resiliency training). We don’t need more resilience. We need more resistance to abuse.

3) And the catch-all diagnosis of the day—BURNOUT. Doctors aren’t burned out, they’ve been snuffed out.

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Like Dr. Greg Miday who sought help from the Missouri Physicians Health Program—an agency with no physician oversight that controlled his medical license. They told him NOT to follow his psychiatrist’s safety plan. Hours later he died after slicing the arteries in his wrists and ankles.

Like Dr. Kevin Dietl who couldn’t get the help he needed for occupationally induced depression. He killed himself just weeks before his graduation from a Missouri medical school. Michele and John Dietl were to be celebrating their son’s graduation, instead they attended his funeral.

Like the 3 medical students who died last week—a triple suicide. Three female medical students in India threw themselves into a well. In their suicide note they cite excessive fees, bullying, and abuse. This is a global phenomenon. And suicide pacts happen in the US too. Two female family medicine residents in Oklahoma died by overdose together (with a gun as backup).

Thankfully, MISSOURI is shining a spotlight on this crisis and blazing a trail for us all. Yes, the Show Me State is showing us what can be done.

Why Missouri ? 1) State Rep Dr. Keith Frederick is spearheading legislation to help depressed and suicidal medical students and 2) Dr. Stuart Slavin at St. Louis University is humanizing the medical school curriculum with excellent results for student mental health and 3) Families like the Dietls and Midays are speaking up about their physician children who have died in St. Louis for lack of the care they needed.

How can you support our efforts?

1) Read Physician Suicide Letters—Answered to grasp the current conditions of medical training. We can’t solve a problem nobody knows exists. **All book proceeds will be used to humanize our medical education system and help save the lives of suicidal medical students and doctors.**

2) Support the documentary Do No Harm so that the world can see the truth behind the white coat.

3) Keep talking and shining your light on this topic. “When we all shine our lights together, there is no darkness to fear.”

Pamela Wible, M.D. is the founder of the Ideal Medical Care Movement and an activist in medical student and physician suicide prevention. She has been named one of the 2015 Women Leader in Medicine for her pioneering contributions to medicine.

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Why are mental health questions still allowed on physician job applications? →

DearPamela

Dear Pamela,

Question for you in regards to disclosure about mental illness. In every job that I have applied for, as part of the credentialing process, there are questions about felonies, treatment for drug/alcohol abuse and mental illness. Why are mental health questions still allowed to be on there? I have had postpartum anxiety/depression three times now and I feel like it is none of their damn business. So I have lied about it on my applications. Also, I feel like these question could contribute to doctors not seeking help, especially for problems that could require a mental health hospitalization. I would be so interested if there were a survey out there or a study looking at whether these questions have an adverse effect on doctors and medical students presenting (or not) for care they may desperately need. If somebody answers that question as a no, but lies, are these places able to access medical records to find out if somebody is truthful? How much weight does that question even have? Do we as docs worry too much about mental health questions unnecessarily?

Sincerely,

Concerned Physician

Dear Concerned Physician,

Mental health questions on job applications are more than just an invasion of privacy. These questions are against the law. According to the Americans with Disabilities Act—a law enacted by the U.S. Congress in 1990—employers are prevented from discrimination based on mental or physical health. It’s illegal to ask applicants disability-related questions. Furthermore, accommodations must be provided for employees with medical conditions. Case closed.

Yet on physician insurance credentialing, state board licensing, and employment applications, mental health questions persist. In addition, these personal health questions are grouped with questions on criminality (such as felonies and DUIs) which would suggest that a doctor who seeks mental health support is committing a crime, further stigmatizing those who need support—not punishment.

Why are there no questions about diabetes, stroke, or other physical conditions that could potentially impair a physician’s ability to care for patients? Why is the singular focus on mental health? And why are these questions allowed to be on there at all when they are against the law? Medical boards exist to protect the public. Employment applications protect the needs of employers. Insurance credentialing applications protect the needs of insurance companies. So who’s protecting doctors? Nobody.

These illegal questions have remained unchallenged by medical students and physicians for far too long. Do we really need a survey to prove these questions have a detrimental effect on doctors and medical students who may delay/avoid care?

It’s none of their damn business if you’ve had postpartum depression. I agree. If you are not impaired and your physician has released you to work then you shouldn’t need anyone else’s permission or approval to do your job.

Those who tell the truth about seeking mental health care have suffered delays in licensure and ridiculous levels of added scrutiny. A physician friend of mine had a 6-month delay in obtaining her state license when she revealed that she had sought counseling during a divorce ages ago. The board mandated that she provide her counseling records. But her counselor had retired. So they forced her to get a psychiatric evaluation before declaring her safe to practice in the state. Doesn’t everyone need therapy during a divorce? Why the hell is it anyone else’s business?

This is exactly why a friend of mine, an excellent psychiatrist, drives 200 miles out of town, pay cash, and use a fake name to receive mental health care.

Some doctors do lie on applications. Can the board, insurance companies, and employers gain access to your medical records? Not unless your records are easily accessible on an electronic medical record system and they can find out who provided your care. Though I’m no legal expert, I believe they can still subpoena your records. So do docs worry too much about these questions? I believe concerns are justified. Physicians have faced discrimination and major career ramifications by revealing the truth.

Fear of seeking treatment due to these antiquated, punitive, and illegal questions leads to increased physician depression, anxiety, substance abuse—and ultimately may result in suicide. I know of several medical students who have died by suicide for fear of seeking mental health care that would be disclosed on their official school records and in future applications for residencies, hospital privileges, state licensure, and insurance credentialing.

We enter medicine with our mental health on par with or better than our peers, yet anxiety, depression, substance abuse, and suicide are all occupational hazards of our profession. Here’s why. We’re steeped in a profession full of human drama, suffering, and death. Yet we have no on-the-job emotional support then we’re punished if we seek mental health care. How can we care for others if we can’t get the care we need as human beings—without fear, stigma, and discrimination?

Seeking mental health care is the responsible thing to do for one’s own health and I believe regular mental health support makes one a better doctor. In fact, I believe all medical students and doctors require mental health care to be well-adjusted human beings. We should be far more concerned about physicians who don’t receive mental health care.

Pamela Wible, M.D., is the author of Physician Suicide Letters—Answered. She enjoys answering questions from doctors and medical students. Dr. Wible is the founder of the Ideal Medical Care Movement and teaches popular biannual retreats to help other docs open their ideal clinics too.

Tags: credentialing, hospital privileges, medical board applications, medical student burnout, medical student depression, medical student suicide, Physician abuse, physician bullying, physician burnout, physician depression

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Physician Suicide Letters—Answered by Pamela Wible, M.D. →

PhysicianSuicideLetters

When is a taboo topic no longer taboo? When is it okay to stop hiding behind euphemisms? When is it safe to tell the truth? The answer is now.

This week I uploaded 53 chapters of physician suicide letters in a book that became a #1 Amazon bestseller in less than 24 hours. No publicity stunts. No PR team. No prelaunch marketing. How does a book become a bestseller in a day? When the public is ready for the truth.

Here’s a sneak peek inside:

December 3, 2015

Dear Dr. Wible,

I’m not sure you read your [Facebook] messages but feel compelled to thank you. I was finishing term two of med school and had a bottle of Xanax in my hand. I was ready, as so many of us are. I took three then three more and came across this link, “How to graduate medical school without killing yourself,” which I believe may have saved my life and a couple of close friends who are also suffering. I’m near the top of my class and praying for death to escape the trap I’m locked into. I was in true delirium from lack of sleep and fear of failure. Studying in my sleep and waking up every hour in panic. Med school is doable but why must it be taught in this format? I read your stories and I’m just in shock how many others feel like I do or I feel like they do. Please keep sharing. You are saving lives, friend.

Chris

I’ve been receiving letters like this for three years. Not all have happy endings. I also receive letters from families who have lost their brilliant, compassionate children—during medical school. And the suicides are not isolated to student doctors.

March 23, 2015

Pamela,

I am not surprised at the number of suicides among medical practitioners. I was a nurse for years and went back to school to be a physician assistant. There is so much abuse handed out in training. At the time I was in school, we still had some thirty-six hour shifts. It was difficult. At least at the university that I attended they had a buddy program. All of the first-year students were given a third-year student to help show us around and be a mentor. The problem was that before we even started our first classes, my mentor committed suicide. She was in her car on her way home still close to the hospital when she stopped at a red light then picked up a gun and shot herself in the head. The person behind her was a physician at the hospital. These things are not that unusual. It’s a sad state of affairs.

Patricia

These suicides are not isolated to students of medicine, to physicians, to physician assistants. The health care cycle of abuse impacts everyone in our hospitals, clinics, and medical schools. Including patients.

February 12, 2015

Pamela,

When I share what happens in our academic medical center with my non-medical friends, they are astonished and disbelieving. The level of bullying in my institution is amazing, including a faculty member seriously suggesting that a resident’s mistake was so heinous that he should “off ” himself. When I speak about changing the culture of medicine, my colleagues think it is impossible to support financially. In our institution, money is a deal breaker. We have a patient wellness program with financial/insurance premium incentives, but as far as I know, no physician wellness program with incentives. I will watch what happens with you with interest. Keep doing it.

Vicky

So what are the answers? How do we stop the cycle of institutional abuse? Physician suicide hotlines inside our hospitals? Resilience training for our wiped-out doctors? Meditation classes for medical students? Advocacy centers for mistreated patients?

February 13, 2015

Vicky,

It’s not costly or complicated to end bullying and hazing. It’s been outlawed at elementary schools, fraternities, and pretty much everywhere—except health care. How much does it really cost to be kind and compassionate? How much does it cost to replace hundreds of doctors who off themselves?

Pamela

Finally an answer.

In Physician Suicide Letters—Answered, Dr. Wible exposes the pervasive and largely hidden medical culture of bullying, hazing, and abuse that claims the lives of countless medical students, doctors, and patients. Now—for the first time released to the public—here are private letters and last words from our doctors who could no longer bear the pain of an abusive medical system. What you don’t know about medical training and culture can kill you. Dr. Wible takes you behind the white coat and into the mind, heart, and soul of our doctors—and provides answers.

This cycle of health care abuse is a global phenomenon. Letters in this book are from Canada, Egypt, India, South Africa, UK, and the USA. There is no country in which medical students are immune from the effects of a traumatic medical education. There is no perfect health system in which doctors do not struggle to preserve their humanity and patients do not die for lack of care. There is no amount of money, no high-priced health plan that will guarantee that the doctor controlling your ventilator is not sleep-deprived or suicidal. We are all at risk.

The solutions are simple.

The time to act is now.

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Pamela Wible, M.D., is a family physician in Oregon. She is author of Physician Suicide Letters—Answered and Pet Goats & Pap Smears.

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Physician Suicide Letters—Answered (a sneak peek inside my new book) →

On January 11, 2016, just before midnight, I uploaded a game-changing book to Amazon. I’m now awaiting my proof before releasing the book to the world. (As of January 15th it’s now available on Amazon here). Medical education and practice will never be the same. Mark my words.

Here’s a sneak peek for those who are curious. The description from the back cover:

This book includes real suicide letters—the last words of medical students and doctors. Also included are letters from surviving family members, colleagues, and patients. Most letters are from actively suicidal physicians seeking my help. All have been published with permission. A few have been edited for clarity. Some names have been changed upon request to safeguard the careers of those who have written to me. Meet six of the physicians we lost to suicide below:

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Bobby Bowling, M.D., Philip Henderson, M.D., III, Kevin Dietl, D.O., Kailtyn Elkins, MS3, Vincent Uybarreta, M.D., Greg Miday, M.D.

Introduction

Despite it all, I remain an optimist.

Medical school knocked me to my knees. I haven’t been the same since. Even though I still have a sparkle in my eyes and joy in my heart, a piece of me is missing. I can never get it back. I’ve tried. My innocence is gone.

Like most students, I just wanted to help people. I wanted to heal the broken world, the injured hearts and souls of patients who would one day entrust me with their lives. Instead, I nearly lost my own life. The memo-rization-regurgitation method of medical education disturbed my creative, non-linear mind. I studied constantly—spitting back medical minutiae for multiple-choice tests. I’m an average test-taker, though I excel with patients. I’m happiest helping people.

But it’s difficult to be happy (or to help people) in a medical culture that condones hazing, bullying, sexual harassment, and teaching by public humiliation. In my school, there seemed to be no end to the filthy jokes that demeaned female patients and classmates. In lectures, my instructors actually made fun of vegetarians for eating “health food.” When I protested the dog labs (as first-year medical students we had to kill dogs), the dean diagnosed me with “Bambi Syndrome.” I was belittled because I cared—about animals, about people, about my own health, and about this planet we call home.

I cried my way through the first year of medical school. As long as my tears kept flowing, I knew I would be okay. Crying meant that I could still feel pain. If I stopped crying, I thought I would go numb. One night I cried so much that I awoke the next day with my eyelids swollen shut. I could no longer bear to see the brutality.

I survived by clinging to my dream of being a caring family physician, of making house calls, of being a trusted and loving neighborhood doctor. I graduated from med school, completed residency, and got a job. I hated it. So I moved to another clinic. Then another. And another. After a decade of seven-minute visits at assembly-line clinics, I was nothing more than a factory worker. I felt like my dream was dead.

I wanted to die.

And, I thought I was the only doctor who felt this way.

Then I got a crazy idea. What if I asked for help? Not from the profession that wounded me. Instead I asked patients: “What is ideal health care? What kind of doctor do you want?”

They told me that an ideal doctor is happy, has a big heart and a great love for people and service. They described an ideal clinic as a sanctuary, a safe place, a place of wisdom with fun flannel gowns and complimentary massage while waiting, where nobody is turned away for lack of money.

I followed their instructions and opened their ideal clinic—the first clinic designed entirely by patients!

I started writing and speaking about my dream-come-true clinic, how I survived med school, and how I recovered from my occupationally induced depression and suicidal thoughts.

Then something weird and unexpected happened. I started getting letters from suicidal medical students and doctors. I wasn’t the only one who had felt this way!

Each year more than one million Americans lose their doctors to suicide, and nobody ever tells patients the truth—the real reason they can’t see their doctors ever again.

Nobody talks about our doctors jumping from hospital rooftops, overdosing in call rooms, hanging themselves in hospital chapels. It’s medicine’s dirty secret—and it’s covered up by our hospitals, clinics, and medical schools.

No medical school wants to be known as the “Suicide School.” No hospital wants to be #1 for interns jumping from rooftops. No student wants to become a doctor in order to kill themselves. It’s the ultimate oxymoron: the barefoot shoemaker, the starving chef, the suicidal doctor.

So what the hell is going on? Why is the plague of physician and medical student suicide such a secret? Why am I the one piecing this together? I’m a solo family doc, yet somehow I’ve become an investigative reporter, a specialist in physician suicide. Why? Mostly because I can’t stop asking why. Why did both doctors I dated in med school die by suicide? Why did eight doctors kill themselves—just in my sweet little Oregon town?

There are answers. Finding them requires being willing to look at some very disturbing facts. It also requires the willingness to engage with people who have experienced and who continue to experience a great deal of pain. So I keep talking and writing—and listening for the truth. And because I’m listening with my heart and soul 24/7, my cell phone has turned into a suicide hotline and I’ve received hundreds of letters from suicidal physicians all over the world.

You may be wondering why so many people who want to help people end up killing themselves. That’s why I wrote this book.

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