An open letter published with permission from a resident physician in the aftermath of a doctor suicide:
“A resident at U of M [Manitoba] has committed suicide. The school circulated and email stating that he died as if it were an accident. If I hear one more person utter the words ‘physician resiliency’ I’m going to lose it. Making this an issue about ‘resiliency’ is a pretty clever way to shift onus on the individual. In the face of this mental health crisis we hear again and again that we need to ‘bolster resiliency.’ What does that mean? Toughen up? Take time for yoga? I think the language is becoming toxic. Please tell me how one can be ‘resilient’ working 110 hours a week in an ultra-stressful environment. By using your 30 minutes of free time every week for mindfulness meditation? Organic food? Free coffee in the lounge? Let’s cut the crap and talk about real issues facing residents: the exhausting workload, the hours, the toxic working environment. access to mental health services, the inability to take personal days. So please do not insult us with talk of resiliency. We’re all resilient. We all fought hard to get here. It’s one thing to ignore a problem, and another to deliberately misdirect and mislead. Show some damn respect.”
I was asked for advice so I share the impact of gaslighting and blaming victims for lack of resiliency when they are subjected to hazardous working conditions that violate their human rights.
Gaslighting is psychological manipulation of a medical student or physician leading the victim to question their own sanity.
The goal of a gaslighter is to make a medical student or physician doubt themselves, lose their sense of identity, perception of reality, and self-worth. Article 26 of the Universal Declaration of Human Rights proclaims: “Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms.” Yet gaslighting is a common form of manipulation and mind control in medicine—often through words and phrases that are repeated over and over again until victims are so worn down that they accept (and even defend these words) as their new reality. Gaslighting is psychological warfare.
Physician “burnout” is the most popular victim-blaming buzzword used to make medical professionals question their self-worth while distracting attention from the medical system that has perpetuated human rights violations on physicians. A slang word for end-stage drug addiction first used on the streets of inner city America in the early 1970s, “burnout” is now weirdly accepted as a real condition for doctors. Despite medicine’s obsession with measuring physician “burnout” for nearly four decades, the epidemic of physician cynicism, exhaustion, and despair is worsening. Psychiatrists define “burnout” as a job-related dysphoria in an individual without major psychopathy—meaning you’re normal; your job is killing you. You are not at fault. Stop accepting blame.
The proposed solution for physician “burnout” is physician resilience. The word resilience is used to blame doctors who are truly among the most resilient human beings on the planet and simply need to be treated with respect and supported in their work. If you made it into medical school you’re already in the top one percent of compassion, intelligence, and resilience. You have no resilience deficiency. You are not defective. You are responding normally to an abusive medical system as this doctor explains:
“After a forced increase in work hours to maintain productivity, my chief publicly blew up at me unprovoked in the OR like something out of a horror movie as he morphed into a monster before my eyes and triggered my PTSD. Then the male physician administrator pats my hand, oozes sympathy, and honestly said, ‘You are clearly the most burned out of our anesthesia group. Tell me how I can help you be more resilient.’ I am a 61-year-old woman who has practiced anesthesiology for nearly 30 years: I am as bloody resilient as I can be! Why does the system create an untenable set of working conditions, causing stress and exhaustion, and when the predicted outcomes occur—I am the problem!”
To prevent physician “burnout,” health care institutions may offer physician resilience workshops to train doctors to prioritize self-care and manage their emotions so they don’t become disruptive—another term that blames doctors who express feelings of despair from gaslighting. Disruptive physicians who stand up and say no to abuse are then labeled as unprofessional. The list of gaslighting terms used to manipulate and confuse doctors are too numerous to compile (though I encourage you to keep your own list at the end of this chapter).
“Despite seeing a physician on a regular basis, I had to seek psychiatric evaluation at an emergency department,” reports a trainee. “Rather than going to a facility covered by my insurance, my program insisted I come to my own hospital—what followed was an egregious violation of my health records that were modified and used against me. I was blamed for my mental health: my ‘burnout’ and my lack of ‘resilience.’ I was coerced into resignation, and I would later discover I was not the first nor the last resident in my program to experience this. I am still on the road to recovery from this harrowing situation.”
The end result of using gaslighting words that blame doctors for the abuses committed by the medical-industrial complex is physician disempowerment, hopelessness, anxiety, depression—and suicide.
Appointing chief wellness officers to help physicians with “burnout” by mandating wellness modules for the abused can be part of the problem as illustrated in the video below.
TAKE ACTION NOW
Always ask for precise definitions of all words used to blame doctors at your medical institution. If there is no definition or the meaning is so convoluted that you are confused, then there is a high probability the word is being used to gaslight you.
Ask, “What could I have done differently. What is the proposed solution?”
Talk to a trusted mentor to get feedback before accepting any label and definition as helpful to you.
Stop using gaslighting phrases like “physician burnout.” Physicians are not the problem. Victims perpetuate the cycle of abuse by using the words of their oppressors.
Document, document, document. Save every email and record every conversation. If you are being blamed, manipulated, and confused at work, document everything. Reference Human Rights Violations Documentation Guidelines in this book.
Keep a list of words used to blame doctors at your medical institution.
To learn more about gaslighting and how to protect yourself from toxic working conditions, reference Human Rights Violations in Medicine: A-to-Z Action Guide.
Dear Doctor Pamela,
I wanted to thank you for your contributions in vocalizing the experiences and tragedies that occur in the medical field that go unheard. Doctors are held to a standard that undermines their own health and well being, and that affects everyone. I wanted to know your personal opinion on how residency and call hours changed after Libby Zion, and what can physicians and non-physicians do to assure the health and happiness of everyone? There have been a few other sources criticizing the current limits, and studies showing more limits on hours do not negatively impact one’s training and performance.
Thank you again, I love this website.
Wishing you and all doctors well!
I’ve addressed the lack of uniform and enforced changes after Libby Zion’s death here: Brief history of why doctors work 28-hour shifts
Please read the book for behind-the-scenes story of work hour violations (and ongoing human rights violations in medicine):
Human Rights Violations in Medicine: A-to-Z Action Guide
Hi Dr. Wible,
I have followed your work for quite some time now, and I want to just say thank you for all you do.
The abuses I’ve suffered as a medical student, to this day, shatter my heart and remain the greatest insult ever made to the naïveté and innocence of my conscience, and I’m not sure the scars will ever fully be healed, though I stand strong in spite of them. I often think, “If this is how little they care about their students, is any patient really safe under their medical care?” I am extremely glad that I have not fallen seriously ill during my medical education, for I fear I would have died, given the untrustworthy characters of the physicians evaluating me, regardless of the quality of their care. They are often no better, and arguably worse, than wolves in sheep’s clothing — Because literally, they’re criminals in white coats.
Please keep doing what you do. I’m a medical student who hopes to join your efforts one day as a medical educator who treats people very differently than his abusers did and similarly exposes these criminals for who they are. It hurts me to think of the number of perfectly good and useful physicians (and medical students) that might have been practicing (or working towards their licenses) and able to help in this COVID-19 pandemic, had they not been purposelessly cut off at the knees, or pushed into a corner where they felt they had to take their own lives.
Or perhaps those who are still alive are blessed because they can no longer work on the frontlines, being better protected from exposure to the virus; I don’t know….
God bless your work, Dr. Wible. Stay the course.
Thank you SO much for your message below. I’d love to speak to you. Just sent you an email 🙂
I can personally attest to the absolute disregard of residents well being at UM. I was fired from there for speaking up about work hour and human rights violations. Damn near took my own life but decided that medicine wasn’t worth it. Still, they have and continue to ruin my career.
Have you ever wondered why a CEO or a Program Director or the 80 year old Dept Chair never seem to be complaining of gas lighting/bullying or burnout. That is so because they re the sociopaths who have perfected the art of work place toxicity. They have climbed the greasy pole by sheer natural selection. Medicine is taught and sold as a godly vocation, but is in fact just as dog eat dog, brutal and exploitative as any other corporate work place. Most of us learn by getting hurt ( sometimes irreparably) that ‘rent’is extracted by the ‘rent seekers’ who enjoy different perks e.g. remaining relevant professionally despite being an octogenarian, earning 7 figure salaries with a magazine life style while extolling others to do 80 hours week. The fish rots from the head and in order to dissect out the cause, I insist we start taking the tops off!