This week TEDMED announced, Pamela Wible, M.D., Physicians’ Guardian Angel, as a speaker at this year’s event in Palm Springs, California. She will speak on physician suicide.
Dr. Pamela Wible was interviewed on NPR station KPLU in Seattle on physician suicide and her interview won a national award! Second place, Division A, for Best Interview from PRNDI (Public Radio News Directors, Inc.) Listen in here. Full transcript of her interview below:
GS: You’re listening to Sound Effect from KPLU. I’m Gabriel Spitzer and this is the kind of letter that Pamela Wible gets.
PW: “Dear Pamela, An anatomy professor did in fact inform us that we would commit suicide at a higher than average rate and informed us from the lectern how to accomplish it successfully. Considered following the instructions on 3 occasions—most recently when a 4 year old I had in the hospital died.”
GS: Okay, so this is a letter from a fellow doctor—a doctor who’s grappling with thoughts of suicide. Physicians are in the business of saving lives, but they have one of the highest suicide rates of any profession. An estimated 400 doctors a year take their own lives. Pamela Wible is a physician in Eugene, Oregon, and she’s devoted a big part of her career to helping doctors cope with thoughts of suicide. As you can probably tell this is a tough subject that’s not going to be appropriate for all listeners. And this interview in particular gets pretty heavy. It’s about 10 minutes long. When I talked with Wible, she told me about the moment she realized how big a problem physician suicide is.
PW: I was sitting at the memorial service for the third physician that we lost in our small town in just over a year. And I sat there in the second row of his memorial service, and I just started counting the suspicious deaths of doctors and I realized I had quite a number of them, including both men that I dated in medical school.
GS: What is it about the profession that makes suicide a particular risk?
PW: Well, we have kind of an antiquated medical education model that’s based on the, I would say, tough-it-up, suck-it-up, don’t cry, feelings aren’t welcomed here, do your job, do it efficiently—almost a militaristic model of medical training and that’s very dehumanizing to the students. And a lot of medical students actually graduate with PTSD. So it’s a traumatic educational process and I think that’s the root cause of much of this.
GS: Oh, that’s interesting. So it’s really about the paradigm that’s kind of drummed into them in med school and in training?
PW: Right. Because when you compare the mental health of medical students at the beginning of training, they come in with their mental health on par with or greater than their peers. And something happens during medical training that disables them essentially.
GS: Can you think of an example from your own training that demonstrates that way in which you feel it dehumanized.
PW: Well, besides the obvious sleep deprivation and the massive amount of material that we’re supposed to learn, in my particular program we had to do dog labs which meant that every 4 students were assigned to one dog that used to be a pet and we were supposed to kill it to learn very simple physiologic techniques that could have been learned in other ways. This is absolutely a dehumanizing process that I protested and was able to get exempted from. In fact, they didn’t even refer to this as an experiment. The physiology professor referred to this as an experience—in which there was no alternative. And they actually made fun of me. The dean told me I had, “Bambi Syndrome.”
GS: Do doctors get care when they need it? I mean mental health care. Considering that doctors are dispensing care and counseling patients all the time, you’d think that they would know exactly what they need and how to get it.
PW: No. Absolutely not. In fact, we are not “allowed” to seek mental health care for fear of losing our license. On our licensing applications there is a question that is actually in the same area as the questions about criminality, and DUIs, and felonies. In there, in that section, there’s a question about if you have ever sought mental health care. And if you check yes, you will have to probably meet with the Board in person to describe why you did that. I’ve known a physician, in my town actually in Oregon, who was delayed in getting her license by 6 months because she checked that box being completely honest and why she checked it is she sought counseling during a divorce. Ya know, everyone is depressed during a divorce. She had to pull her records which that counselor had since retired. They made her go get evaluated by another counselor for her mental health before they would allow her an Oregon medical license.
GB: So that has a chilling effect, huh?
PW: It has a chilling effect because, ya know, honestly I have a friend who is a psychiatrist—she’s an excellent psychiatrist—and she actually drives 200 miles out of town, uses a fake name, and pays cash to get mental health care. How would you like that? In order to be off-the-grid and not be tracked by the medical boards.
GS: Oh, wow.
PW: The other thing I hear from medical students and physicians all they time is that they actually are jealous of their dying patients in hospice and they wish that they could jump in bed and be the one with cancer so they could get some down time and some rest.
GS: That is so shocking and it’s so different than they lay public perception of doctors. That doctors are either heroic, mission-driven, ya know, saintly people or, ya know, that doctors are businesspeople or whatever. What you’re describing is really alien to folks who aren’t close to the profession, I think.
PW: Physicians are not allowed to really be vulnerable—and to share what’s really going on. So they put on the white starched coat, and smile, and have their bow tie—and nobody really knows what’s going on under that coat.
GS: So you have chosen to tackle this in some very particular ways including these retreats that you bring health care professionals on. Can you talk about those? What happens on them?
PW: These whole things began as just business strategy retreats to try to help physicians who want to open independent practices. But interestingly, on that day that I went to this gentleman’s memorial, that evening I had a retreat. And I showed up and I had fallen into this physician suicide topic in such a bizarre way and I just thought I would check in with the people attending the retreat and I opened the retreat by asking, “How many of you have lost a colleague to suicide?” And everyone’s hand was raised. And then I asked, “Well, how many of you have considered suicide? And every single hand remained up, including mine, except for the one female nurse practitioner.
GS: Did that change the nature of those retreats then?
PW: Well, I started to realize that a lot of people came to the retreats for emotional healing and that was really was in the way of them starting their independent practices. Emotional healing is required before we can really be the doctors that we dreamed of being.
GS: So when you’re together in those settings, how to set out about trying to help people?
PW: Well, I think a lot of it is just having these healers off-the-grid. There’s no cell phone, no Internet service. I’ve got 40 to 50 doctors in a lodge room on 150 acres in the mountains of Oregon. And they literally are just finally willing to share the truth about their experiences in medicine and so there’s a lot of crying, there’s a lot of hugging and a lot of validation. And I think people for the first time feel that they’re not defective. The system is defective and they’ve been abused. The other thing that’s so beautiful is actually because we were wounded collectively, I do feel like the treatment for physicians is collective. Meaning pulling off the “weak ones” on the periphery and throwing them into a psychiatrist’s office isn’t the best way to deal with our collective wounds. So I think when you can get healers together they naturally heal one another. It’s a really beautiful thing to witness.
GS: So you said that when you asked that question about how many people in the room had considered suicide and everyone’s hand went up including yours. What do you want to say about your own struggles with suicidal thoughts?
PW: I want to say that I came into medicine like most people as an idealistic humanitarian that just wanted to help people and the reason why I developed these suicidal thoughts . . . I mean I did get into some major depression in my first year of medical school completely related to those dog labs and watching the dehumanization process of my classmates which was just brutal. But then once I got into [practicing] medicine, ya know you’re always thinking it’s going to be better on the other side, wait until you graduate. But I was much like everyone else in the country funneled into these assembly-line medical jobs which are not the definition of healing, Seven-minute office visits where you’re just feeling that you smacked Band-Aides all over people is not at all health care and so I got depressed and suicidal because I felt that I could not believe I invested 24 years of education, all this time and energy, into a profession that I love, and when you are stuck in a system that does not allow you to be a healer, it’s a absolute assault on your soul. And so that’s where I was—the dark night of the soul.
GS: What helped you emerge from that?
PW: I had an epiphany that if the patients are miserable and I’m miserable and I’m looking at my colleagues and they look miserable, even though, ya know, they’re faking it sometimes and putting on these smiles. I just decided, you know what, I’m going to turn this over to my community. I’m going to lead a town hall meeting and I’m going to ask the end-user—the patient—to design their ideal practice and to write my job description and I’m going to work for them. And I’ve been so happy doing this now for 10 years in what I call, an Ideal Medical Clinic designed by the patient.
GS: Do you see any signs that this is getting any better? Is the training . . .?
PW: Yes! Definitely. Because we’re talking about it. They fear of speaking about the trauma that we experience as medical students and physicians is dissipating so that we’re more able to have this open and with the Internet kind of conversation. And the fact that we are no longer hiding all these bodies and all the data is the big first step. If you think about it, to use a medical analogy, there’s no way you’re going to solve someone’s medical problem until you have the correct diagnosis. Where would we be if we were afraid to say Ebola out loud or HIV? We would be nowhere. And so we’ve got to be able to say physician suicide out loud. And the next question after people recognize that this is a crisis is “why?” And when people start asking why, then we start solving it.
GS: Well, Dr. Pamela Wible is a family physician in Eugene, Oregon and she joined us from the studios of KLCC. She works with doctors in the Northwest and all over the place on suicide prevention. Thank you so much for being on Sound Effect.
PW: Yeah, thank you!
Follow-up interview 5 years later: The doctor who helps save doctors found herself in greater demand during the pandemic.