Doctor’s Fantasy: leave psychiatry to sell Tupperware →

Tupperware

Dear Pamela:

I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is exhausted and miserable and that the needs of our administration come first. And anyone who tries to say anything about it gets called lazy.

I hope the new generation of physicians will demand better treatment, but even this week I could sense how much young doctors just crave compassionate mentorship. They’re so grateful to be told simple things like: “It’s okay. I’ve been there too. I’ve stumbled in my career path ten thousand times. I know what it’s like to be lonely here, to feel like an imposter who can’t do things right. You don’t have to make up answers to insolvable problems. Patients just want you to be a human being, living and breathing with them, and respecting their voices.”

Medicine attracts perfectionists, and our training sharpens that quality into a dagger. The worst part—we become so diminished in our own self-worth that we no longer appreciate or even offer the healing that is the true legacy of doctoring.

I’m finishing my final year of psychiatry residency (thank god) and I’m just so tired. I used to think that things would improve after residency, but now I realize there’s no guarantee.

In my profession there’s an immense pressure to maintain “boundaries,” and they scoff at anything which is close to poorly defined. Many psychiatrists seem obsessed with proving that our field is “real” medicine, so they break patients into algorithms and charts, refer them to highly structured, easily quantifiable courses of psychotherapy that don’t allow deviation from “the treatment plan.” They measure illnesses with checkboxes and screeners rather than actually listening to any individual’s story.

But I doubt any medical specialty can actually heal patients this way, even for the most easily definable problems! How does a fool-proof algorithm for blood pressure control help if patients cannot get their prescriptions, or hate taking medicine, or can’t remember to take it, or quit due to side effects that they’re afraid to disclose, or any of the other millions of reasons that get in the way of good patient outcomes?! And those are things that you can never discuss in a ten-minute appointment.

Anyway, I’m glad that there are so many physicians who feel this same way, and even some who are brave enough to talk about it openly!!! How did we get so brainwashed that we actually believed that advocating for ourselves and for our patients meant we were lazy or inadequate? It’s so crazy. Nobody needed to oppress me by the time I graduated med school: I was the taskmaster and the criticizer.

When I talk about changing things, people says it’s not possible and we’re all doomed to misery and blah blah . . . Sometimes I say, “Well if that’s the case then I just won’t do it. I’ll pay off my loans and then go find something else.” My colleagues always look so shocked—as if they don’t have the same secret thoughts!!!

I’m about to have my last “performance review” with my abusive boss. My friends outside of medicine don’t believe me when I share the abuse I’ve experienced during my training. Lots of doctors try to pretend it’s normal, but it’s not. I go back and forth between trying to stand up for myself and thinking I should just put my head down and not cause myself any more problems. Most of the time I spend fantasizing about doing any other job—selling Tupperware, painting, working at a library—something normal, where nobody swears at me or treats me like I’m lazy after a 16-hour day. But really what I’d like to do is treat people with respect and provide therapy and run groups and teach mindfulness meditation. I just don’t know how to get from here to there.

I would write more but I have to fill out about 600 pointless electronic evaluations of my colleagues, in order for us to better wound each other anonymously. Yay!

Xoxoxo

Janelle

This letter was received and edited for clarity by Pamela Wible, M.D., a family physician and pioneer in the ideal medical care movement. Dr. Wible helps medical students and physicians recover from abuse and trains doctors to open ideal medical clinics at her biannual physician retreats. Photo by GeVe.

Tags: , , , , , , , , , ,
37 Comments

***

I love old people, but I will not accept Medicare →

Medicare

I love caring for patients—young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare on Independence Day 2006. Why don’t I accept Medicare? Let me fill you in.

I do not accept Medicare because:

Medicare treats physicians as criminals—guilty until proven innocent.

Medicare warns patients on their billing statements to turn their physicians in for suspected fraud.

Medicare demonstrates no transparency in the flow of taxpayer money through their program.

Medicare may reimburse physicians so little that we lose money with each appointment forcing doctors to go bankrupt (or run Medicare mills with ramped up volume and quickie visits to make ends meet).

Medicare claims are more complex than any other insurer with more billing codes and rules and regulations that require hiring a team of staff to remain compliant or else . . .

Medicare regulatory codes by which physicians must abide is 130,000 pages long! (US Tax code is only 75,000).

Medicare requires compliance with more unfunded mandates and administrative trivia than any other insurer.

Medicare penalizes physicians financially if we don’t use a Medicare-approved computer system and electronic health record.

Medicare penalizes physicians financially if we don’t electronically submit prescriptions the way Medicare demands.

Medicare threatens doctors every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Medicare audits may suddenly destroy a medical practice and a physician’s life as described by Dr. Karen Smith:

Medicare abuses and bullies doctors.

This is no way to treat people who have dedicated their lives to helping others.

How to opt-out of Medicare.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. And her TEDMED talk Why doctors die by suicide. Photo by GeVe.

Tags: , ,
57 Comments

***

I may not accept your insurance, but I will always accept you →

Accept Insurance:YOU

Just for the record: I am happy to see you—irrespective of your insurance.

I accept most insurance plans. And if I don’t accept your insurance, I have a very good reason.

I will not sign a contract with a health insurer that:

Abuses and bullies me and/or my patients.

Denies all my first claims.

Reimburses me so little that I may go out of business.

Leverages a $50 penalty against me when my patients accidentally go to out-of-network labs.

Charges me hundreds of dollars of “membership fees” before I’m allowed to see their patients.

Offers me a contract that dictates my responsibility for THEIR legal fees if they determine I did something wrong.

Keeps me on hold and rotating through multiple phone lines while never addressing my concerns.

Treats me like a criminal.

Assigns me patients who have not selected me as their doctor.

Pays me through a complex formula that even a mathematical prodigy can’t understand.

Penalizes me financially if I don’t use the type of computer system that they think I should use.

Penalizes me financially if I don’t electronically submit my prescriptions the way they think I should.

Threatens me and my colleagues every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Insurance companies have done all of these things to me. My choice to end my relationships with abusive insurance companies will never impact the quality of medical care that you’ll receive from me. I will always care for you even if I do not care for your insurance company.

Just saying.

Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. Photo by GeVe.

Tags: , , , ,
28 Comments

***

Why You Should Love Your Doctor →

shutterstock_98641478

Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.

Doctors may amass up to 500K debt for the honor of one day caring for you and your family.

Doctors delay childbearing and starting their own families so they can care for your family.

Doctors miss their own kids’ ballet recitals and baseball games so they can care for your kids and family.

Doctors get out of bed and leave their husbands and wives in the middle of the night to care for your sick husband or wife.

Doctors—while “off-duty” and “on vacation”–may save your life on an airplane, in a swimming pool, shopping mall, or car accident.

Doctors suffer with you. They carry your pain home with them.

Doctors may be hazed, bullied, and abused by professors, patients, employers, insurance companies, politicians, and the media, but they keep caring for you and your family.

Doctors are commonly sleep deprived and exhausted. They skip meals and bathroom breaks so they can keep caring for all the people like you and your family who need them.

Doctoring is not a 9 to 5 job. Your doctor may still be thinking about you and your illness while trying to fall asleep at night.

Doctors have PTSD from decades of witnessing trauma. Doctors have the highest rate of suicide of any profession.

Today, tell your doctor, “I love you.” The life you save may save you.

Sadly, our doctors are dying. Here’s why:

Pamela Wible, M.D., is a family physician in Oregon. She offers physician retreats where she helps doctors recover from their abuse so they can get back to caring for their patients. Image by Shutterstock.

Tags: , , ,
22 Comments

***

Why I Really Kiss My Patients →

_GVE5008

I started kissing patients in med school. And I haven’t stopped.

During my third-year pediatric rotation, I would stay up late at night in the hospital, holding sick and dying children. I’d lift them from their cribs, kiss them, and sing to them, rocking them back and forth until they fell asleep. One day the head of the department pulled me aside. He told me that I was a doctor when my patients needed a doctor and a mother when they needed a mother.

Twenty years later, I’m still mothering my patients.

I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. They thought big government would kill America’s small-town neighborhood doctor. But I love being a family doctor. And I love my patients. I hug them and kiss them, and I do house calls. And most patients call me Pamela or sweetie or honey. They all have my home phone number. I’m on call 24/7, but I never feel like I’m working.

I guess I’m never really sure when work ends and play begins. It all feels the same to me. Many of my patients are friends. I do their physicals and go to their homes for dinner.

Doctors are warned to maintain a professional distance from patients. But how can I remain distant when I’m looking deep inside people in places nobody has been before? How can I remain detached when delivering a mother’s first baby, saving a sister’s only brother, or helping a child’s favorite grandfather die?

I’ve been told that maintaining a safe distance from patients will help my objectivity, limit favoritism, maintain clear sexual boundaries, and prevent exploitation. But patients today don’t want professional distance; they want professional closeness with a doctor who has a big heart and a great love for people and service.

And I strive to be that kind of doctor.

I’m the kind of doctor who once hired a patient—a massage therapy student—to work on low-income, high-needs psychiatric clients during their medical appointments. All enjoyed free foot baths and hand rubs. Not one had ever received massage; most had never experienced safe, loving touch in their lives. Now they require less medication.

I’m the kind of doctor who believes in favoritism. I want every patient to feel like they’re my favorite. So I celebrate random “Patient Appreciation Days.” Yes, I shower unsuspecting visitors with dark-chocolate hearts and Mylar smiley-faced balloons as they enter the office. This is in addition to the gifts many receive for meeting their health goals. Sitting on the couch next to her balloon, treats piled high in her lap, a woman bursts out, “This is like going to Grandma’s!”

Kids and adults alike enjoy the unexpected attention and gifts. It’s especially exciting for new patients who choose me from a preferred provider list given to them by their health insurance company. After receiving a door prize and an initial hour-long appointment, one gal exclaims, “I feel like I hit the lottery!”

That’s exactly how I feel being a family doctor. Best. Job. Ever.

Doctoring, like mothering, is a subjective experience. Good doctors are interested, friendly, and intuitive. Patients don’t seem to want objective doctors who are impersonal, unemotional, and strictly business.

Doctors, like mothers, should be emotionally intimate. And they should maintain clear sexual boundaries like any good mother does with her child. Maybe doctors should be more motherly.

A few years ago I visited the foster home where my nephew lived before he moved in with me. I spent the weekend with a dozen teenage boys, all on psychiatric medications. An autistic child had moved into the home that day. At nightfall, he begged me to tuck him into bed. That evening I tucked all 12 boys into bed and kissed them goodnight. When the foster mom found out she said, “You crazy. Them boys hasn’t been kissed in years!”

Maybe some patients don’t need a pill. They need a kiss.

_GVE5002

Pamela Wible, M.D., is a family physician in Eugene, Oregon. This essay first published in Huffington Post. Photos by Geve.


19 Comments

***

ARCHIVES

WIBLE’S NPR AWARD

Copyright © 2011-2025 Pamela Wible MD     All rights reserved worldwide     site design by Pamela Wible MD and afinerweb.com