Physician suicide letters

Physician suicide letters

I asked why physicians were dying by suicide. Here’s what they told me:

“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth it?” I wish I could change back but I realize that I will never be the same again and it isn’t in a good way. We had two suicides and one murder — skull crushed with a bat — and one serving life in prison for murder during a delusional episode after not sleeping for almost a month. Yes I went to a hard-core school (old school kind of place). PTSD isn’t benign; it truly affects you to the core — it changes your brain.”
- doctor in Philadelphia

“I’m in my first year of practice outside of residency and I can’t begin to tell you how often I think of death. Not because I hate my life — I have a wonderful husband and family. But the pressures of daily life as a doctor are overwhelming. I work constantly! Even on my days off, I’m working. When I take a day off, I pay for it later by double the amount of work waiting for me. I have patients yelling at me when all I wanted to do was help. They try to fool me and manipulate me. Insurance companies deny my patients help, leaving me with no resources to help. My boss is a douche — unethical and dangerous. I want to build a relationship and do what’s right for my patients — but the company pushes me to see more and more patients in less and less time. I cry at work, I cry myself to sleep sometimes. I don’t feel depressed, and I know my life has value, but sometimes the thought of suicide is just to escape the pressure of the profession. It’s not like I can realistically give up the job, my calling. I’m neck deep in debt and will never be able to pay it back if I leave the profession.”
- Michelle

“I didn’t realize that so many others in the field suffered as I do. I have tried to get help many times but it’s hard because I don’t think that anyone takes me seriously and I don’t think I can be completely honest with anyone without major repercussions. I don’t have any friends to socialize with and all my relationships have failed. I come from a background where I was the first to get a higher education so they think that I should be elated to just have MD behind my name and tell me to suck it up. I don’t want to possibly lose my license because honestly I love taking care of patients and sometimes that is the only time I get a few moments of happiness. But things have just been so bad for me that I have resorted to just doing locums [fill-in work] so I can isolate myself because sometimes I can’t stop the tears. I have tried a few times and the last time probably would have worked but at the time I was lying there looking at the dog I had then who was curled beside me nudging me to get up. Somehow I drove to the ER although severely hypotensive where I was hospitalized and they chalked it up to the fact that I had not really been eating or drinking for weeks. I no longer have that fur companion so I find myself alone and thinking about an escape a lot.”
- Dee

“My attending took great pleasure in bullying the students, and I saw real pathology among fellow students who felt like they couldn’t ‘take it’ anymore, and complained of ‘PTSD.’ I am not currently practicing medicine (for reasons quite possibly stemming from the fact that I never could find adequate mental health care).”
- anonymous

“I am a third-year medical student. I have done very well in both my coursework and national boards. I have publications, research. On paper, I am successful. Yet I find myself thinking about killing myself frequently. Walking into traffic, jumping through the window, just dying in the course of a normal day. Miserable thoughts. I went to the school psychologist to be fixed; I was referred to the school psychiatrist, who looked just as broken as I felt. He offered me antidepressants, if I ‘wanted to take them.’ It doesn’t make sense. I never felt this way before medical school. I loved, I thought, I reflected. I enjoyed being creative, yet now I’m chained by procedure, bureaucracy, and paperwork. There are no creative solutions to problems, there is no effective effort to improve the system except from big top-down initiatives of whatever hierarchy you’re subject to. It’s maddening. I used to watch the stars and smile. I volunteered. I ate well and exercised. I enjoyed playing with children. Now I’m finding a sort of perverse pleasure in patients’ pain; I recognize this as sadistic. I’m shocked. I’m revolted at how far my soul has degraded. It’s insane. I’m chronically sleep deprived. I can’t think or learn when I don’t sleep. I can’t smile without ulterior motive. I’ve confided in my family, who don’t understand the demands or the situation and have told me that ‘it’s my decision to feel sad.’ The [professors] don’t teach; half of them treat us as annoyances. Learning and healing both got lost somewhere. The good teachers leave or are ground down. I’m full of hate and sadness. I’m not sure why I’m still here, but I am. I feel like an echo of myself.”
- John

“I am in my final year of medical school and have had several classmates attempt suicide over the course of my degree. I love medicine and I love people, that’s why I chose this profession. Sometimes when awake studying at 3 am, or watching an autopsy, or witnessing highly emotional scenes at the hospital, I feel incredibly alone. Sort of like I’m not a part of humanity! It deeply saddens me that classmates and colleagues feel they are unable to seek help for their problems, and I hope there is more research in this in the future.”
- Julie

“I thank you for the website and the many comments by people. I qualified in the UK and things here appear to be the same. I have several colleagues who have committed suicide over the years, and I feel lucky to have survived myself, for all the reasons you describe. I am particularly taken by the PTSD image. Yes indeed I was traumatized in medical school and it continues to happen, but we get accustomed to it, to the point of becoming an abused class.”
-Christian

For every doctor who dies by suicide, friends, family, and patients are left to wonder why.

“I am still in a state of shock hearing that my brilliant, loving, compassionate, successful, well-respected, honest, hard-working physician committed suicide this past week. Pressure from the changing medical community/insurance/had forced him to close his 30-year practice and he went home and shot himself in the head. The letters keep coming in of how many people loved him, were healed by him, and admire him. What a tragic end to a successful career. Everyone is asking why. He was the best of the best, surgeon and specialist, nice home, nice family and now he is gone. Totally tragic.”
- Diana

Read more letters here.

Thank you for caring.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor.

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  • edwinleap

    Tragic and darkly fascinating. For year’s I’ve contended that we develop PTSD in medicine. I believe that much of what we call burnout is actually PTSD; even our ‘anger’ and ‘frustration’ may be what we consider acceptable ways to veil it. A 19-year-old soldier can develop those symptoms after one tour in a combat theater, and we believe him. A physician can see terrors for 30 years, and we still say ‘but don’t you want to keep going back? Don’t you want to help? Why waste your skills?’ Perhaps that’s why many consider suicide an option. Pamela, thanks for another excellent, engaging piece.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Please share widely. We can’t keep sweeping these fallen physicians under the carpet. One doc in town lost 7 colleagues to suicide in her career. What other profession allows this to continue???

      • edwinleap

        I can’t imagine what that person must feel to have lost so many. I think there must be parallels. Dentistry? They have a high rate. What do they do about it? And certainly, the military. It’s horrid. I’m definitely sharing this post.

        • http://www.idealmedicalcare.org PamelaWibleMD

          For ages we have suffered in silence. And we know how to end our pain very efficiently.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Do you realize that kids enter medical school on par with the general population in regards to mental health. Within a very, very short time medical training makes us ill. Why do we allow this?

          I am writing a solutions piece next so feel free to share your thoughts on how to prevent doc suicide – particularly if you have been a suicidal doc who chose not to die.

          • Gentle Spirit

            Great idea! I believe the missing link is using energy medicine, particularly chakra work/healing/balancing, to correct not only the imbalances in our doctors, but within our patients as well. My friend struggles with Crohn’s disease and after discussing it with my spiritual sister, we both agree that it is an idiopathic symptom that stems from an energy (chakra) imbalance. So I went to amazon and picked up many books to give to her which may help her find healing. Similarly, docs may find the fortitude they need by proactively meditating and aligning themselves with their higher selves. Regular sessions may help to create prophylactic barriers to resist the propensity for negative thought-forms to slip through and take hold. Soon western medicine must wed and become married to these eastern concepts of chakras, meridians, etc., to allow for a new paradigmatic tsunami of healing to inundate this hemisphere. Within every damaged area of our life, PTSD or otherwise, rejuvenation can be found.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes!!

          • SteveCaley

            That which heals and comforts the patient, heals and comforts the patient. The patient did not come to tell me that I would feel better with, say, ayurvedic medicine; the patient has come to tell me that ayurvedic medicine heals and comforts THEM (or doesn’t.) What heals, heals; and what sickens, sickens.

          • Geoffrey Koerner

            Sure! Let’s give it a go. Techniques from other parts of the planet are worth a try – especially for those in the medical profession who are being physically, emotionally, and mentally destroyed by the very system that was intended to bring healing.

          • Sharon

            Geoffrey: Well put.

  • http://www.idealmedicalcare.org PamelaWibleMD

    What mental health services do they offer at your school?
    What were the top 3 contributing factors to your depression/sadness?

  • http://www.idealmedicalcare.org PamelaWibleMD

    1) Has it always been like this? Not as bad as it is now in my opinion.

    2) Would it help if student debt was not a factor? YES! Docs keep jobs they hate because they think it is the only way they can pay for their student loans. Economic noose.

    3) Is there a medical specialty that is “happy and satisfied?” I think there are docs in every specialty who are happy and satisfied, They are by no means the majority. Most of them have figured out a way to practice medicine on their own terms. The happiest docs I’ve met are self-employed.

  • buzzkillersmith

    1. Michelle is not depressed? She is 4+ depressed. Someone ought to give her a PHQ-9.

    2. The practice of medicine will not get better. It will get worse. These folks need to pull the plug, need to ignore the sunk costs. No shame in that. You have to know yourself. Curious how folks so intelligent on conventional measures can have such poor judgement on more important things.

    3. If you want to be a doc, you must be pretty tough, able to get the crap kicked out you for 35 years or so. They need to give prospective students a hard-ass test of some sort before letting them into med schools. Many folks in medicine are squashed into paste. It’s been that way ever since I started back in the dinosaur days.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Are we like the masters of denial or what?

  • http://www.idealmedicalcare.org PamelaWibleMD

    Anna ~

    1) What do you think specifically caused you to contemplate suicide?

    2) What could have been done differently to support you in your education, training, employment, to prevent suicidal thoughts (assuming your suicide contemplation was work related)?

    • Anna

      I was subject a lot of workplace bullying, mostly from other physicians who were meant to be mentors and colleagues. I was miserable at work, and I think the patients knew it. At the end of each day, I always wondered whether it would be better if I walked in front of the bus instead of onto the bus. When it comes to workplace bullying from your peers, there really isn’t much to prepare you for it. I’m lucky to have found another, more supportive, place to work, but at the back of my mind, I always fear that they will turn on me and I’ll be back in that same dark place.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Actually in some more progressive medical schools they allow students to grade their professors and tell all – anonymously. Bullying is not acceptable. If you were not subject dot bullying do you feel you would have still suffered from suicidal thoughts?

  • Dave Mittman, PA, DFAAPA

    Wow, Pamela. I am really moved by these. I am so sorry for these people. I also let all my PA and NP friends know of your post. I do not have enough contact to know if younger NPs and PAs feel the same way but the same pressures hit them, with less power in the system. Very much as competitive to get into PA school and also significant debt.
    This really needs to be addressed. It seems that these people have thrown all their marbles into being “a physician” and see no other recourse. A class in med school in how one can use their clinical training in non-clnical professions might at least provide an escape to a few. Also more team and less individual might help-at least you will have friends to share with. Or are a sub-set of really bright but less capable of sharing feelings even to friends?
    Please keep the ideas coming.
    Dave

    • http://www.idealmedicalcare.org PamelaWibleMD

      Offer a medical school course called, “How to escape your miserable job as a doctor” may be an interesting idea. Not sure if med schools would go for it . . .

      Though some may want to “escape” into another career–or death–what we really need is to salvage our once beloved profession. We love people. We love medicine. Healing is our spiritual calling.

      I’m working on a practical solution piece. Coming soon . . .

      • Dave Mittman, PA, DFAAPA

        Agree. Read my “!0 Question” Interview up now. http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/45340

        No-but a lecture that one can use clinical skills in non-clinical areas. Research, writing, medical web sites, advocacy for diseases, medical directors for charities, medical editors, etc.
        Just saying give them permission to go out of the clinical box IF NEEDED.
        Dave

        • http://www.idealmedicalcare.org PamelaWibleMD

          Great interview Dave. I like your elevator pitch! Yes, out-of-the-box thinking of any variety would be fabulous!!

        • http://www.idealmedicalcare.org PamelaWibleMD

          Incidentally, I am speaking at the PAEA (Physicians Assistants Educator Conference) in Philly this fall. I am really curious about depression, suicide, burnout rates in PAs and NPs. Data anywhere? Anyone tracking this?

          • Dave Mittman, PA, DFAAPA

            PAEA……
            Not sure anyone is tracking or even speaking about this in either profession. I know thousands of PAs and NPs; PAs greater and we don’t really hear of it. I am not in touch with the younger PAs who are very academically gifted and more competitive than us older PAs. I’ll ask a friend who might know. A PA who is a PTSD expert from Viet-Nam days. Dave

  • EmilyAnon

    This post is so depressing. As a patient I want to do something, or say something, but the sadness is beyond words.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Please say something. Share this with your friends and family. Doctors are human. We can not take on everyone’s suffering and all the abuse we receive from this dysfunctional health care system without a release valve.

      So next time you are with a doctor, juts ask, “how are you doing? really. . . I want to know . . .”

      • Patient Kit

        My next doc appointment is May 2. When he asks me how I am, I always tell him and then ask how he is — and mean it. It’s true of all docs, I know, but I imagine that oncologists can have some really rough times.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Hold his hand, look into his eyes. Don’t take a knee-jerk “I am fine” answer. A local peds doc was always jovial at work. Had his great one-liner responses. Then he was found dead in a park – self-inflected gunshot wound to the head.

          • Patient Kit

            I dunno. Eye contact and human interaction is a given. But I don’t think I’m going to hold his hand. LOL! Don’t want to flip the GYN out. :-o How about if I just make an effort to make him laugh or smile?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Ok. “Always play to the room,” is what my ex-husband (a musician) used to say!

          • DoubtfulGuest

            Dr. Wible…a patient is not a performer…nor is s/he the professional in the doctor-patient relationship…

            Figuring out what doctors want is pretty complicated, actually. For some of the same reasons highlighted in this post. I’m all for patients showing their doctors some caring and support.

          • http://www.idealmedicalcare.org PamelaWibleMD

            “Play to the room” means dong what is appropriate for the situation.

          • DoubtfulGuest

            I looked it up when you said it to me last time.

            Patients rarely have any way to find out what’s appropriate for each individual doctor, until a lot of time has passed. So that statement is not very applicable to the doctor-patient relationship.

            Lots of folks here want to help their doctors. The particulars are a bit more of a mystery. I wonder what would help doctors to be clear about their needs and preferences?

          • http://www.idealmedicalcare.org PamelaWibleMD

            It’s not easy to know the right thing to do. But DO something. Express concern, appreciation. Write a letter. I had a patient write me a note that simply said:”Breathe.” I carried that with me for a long time.

            Don’t underestimate your ability to heal your doctor with simple human kindness.

          • DoubtfulGuest

            Okay, I’m glad to try to help.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Thank you. It really IS the simple things that make such a HUGE difference. Ideas:

            1) Make a handmade card that says, “I appreciate you.”

            2) Drop off a carnation with a note: “Our appointment meant a lot to me. Thank you.”

            3) Drop off some homemade cookies and milk with a notes: “I thought you may need a mid-aftrenoon snack.”

            One kind gesture could save a life.

          • SteveCaley

            “Thanks for doing what you do.” Simple, one size fits all. Never in bad taste.

      • Suzi Q 38

        My next doctor appointment is in late April.
        I will do exactly what you suggest.
        My doctor is so busy with medicare and medical patients that he doesn’t have much time for chatting.

        • http://www.idealmedicalcare.org PamelaWibleMD

          But he will really appreciate your cookies and milk with that little handmade card you will drop off. :)

          • Suzi Q 38

            I definitely will bring the doctor and staff some good foods to eat. As far as the card, I will have to think about it. Our relationship has been rather rough and direct, yet we appreciate where each other is coming from. Maybe I can find a nice thank you card.
            Thank you for your story.

            I understand how the doctor can be overwhelmed with all of us patients.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Thanks Suzi Q 38 ~ It must be odd to look at things from the doctor’s perspective for the first time.

          • Suzi Q 38

            Yes.

            It has taken me a long, long, time to even begin to see their side of the professional relationship which is somewhat personal because our lives are so important to us.

            I still think some are jerks, but I realize that I don’t have to go to the ones that are.

            So many other doctors do care, and I need to appreciate them. I should thank them whenever appropriate.

            I have come to realize that doctors are humans who are educated and highly intelligent in their given specialties. They are not perfect, and at times make unforeseen errors. Most are not able to admit that they are imperfect or missed a diagnosis entirely.

            I still think he is an idiot and would not go back to him, but I can move on now, understanding that he definitely was not at his best when he was my doctor. This doesn’t mean that he can’t be a better doctor for someone else. I was quite vocal, so I am sure he has had to time to think and reflect. He can learn to listen to his patients after making his huge mistake with me.

            It happens…time to forgive and move on.

            I was lucky that I found others who were interested in helping me.

            I know he feels bad about what happened, because occasionally his nurse still calls to ask me how I am. His nurse and I are not friends, but he knew we were cordial to each other. My surgery was in 2011 and my mistreatment was in 2012.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Good to have a balanced perspective. To hold no grudges, To forgive. Our most challenging patients are our best teachers. You may have been that for him. He may be thankful for what you taught him.

          • Suzi Q 38

            Thank you.

          • Guest

            Thank you, Pamela!

          • DoubtfulGuest

            She has been here for quite a while, listening to lots of doctors.

          • http://www.idealmedicalcare.org PamelaWibleMD

            But from the perspective of suicidal thoughts . . . that is new for most (even docs) to read. . .

          • DoubtfulGuest

            I think she’s participated on other threads about the topic? I want to see this get much more attention, to solve the problem and help all the suffering docs. I’m just concerned that Suzi Q 38 might feel pressure to “suck it up” when she was horribly injured and treated unkindly by more than one doc. She has high empathy for others…let’s remember to extend the same to her?

            I can’t agree with shifting the ethical bar so physicians don’t have to apologize like any other normal grown ups. It’s bad for you guys, psychologically and spiritually. Not to mention that other people matter, too. I will always take issue with the notion that patients are inherently selfish or unwilling to put themselves in others’ shoes. Just wanted to make sure that wasn’t an issue here…:)

          • http://www.idealmedicalcare.org PamelaWibleMD

            Suzi Q 38 – your docs job is to care for you. Not your (paid) job to care for your doctor. But any care you extend to your doc will be much appreciated.

            Just clarifying.

            Random acts of kindness really help make life worth living.

            :) Pamela

          • Suzi Q 38

            Yes.
            My doctor does his best.
            At times he is distracted and tries to move on to the next patient too quickly.
            Once, I got in his “face,” LOL.
            I told him that I had been really sick lately with my cancer scares and my cervical neck injury that he needed to “slow down” when seeing me.
            He agreed.
            Like I said, I have had him as a GP for 12 years.
            He also was the one that facilitated my paperwork for my treatment and subsequent surgery at the teaching hospital. He also processed the request for the MRI of my knee. Recently he filled out paperwork to get me some long term care insurance. This was not easy to do as, I have already had neck surgery, and there are problems with my spine.
            I got word that my insurance was approved. This was the second time around. The first time, my insurance was denied.

            Today I talked to him about my high cholesterol and the fact that I no longer want to be on a statin.
            I feel so much better without it, and since I already had pain from my spine, I didn’t need the statins making things worse. My blood sugars went down when I discontinued my statin.

            He agreed that I was not a good candidate for stain use.

            Anyway, I brought him, his receptionist, and his nurse each a tray of a dozen huge apples. My favorite apples are from Costco. The nurse and receptionist liked the gift. They are the ones who mail me my lab results before I see the doctor, or deal with my insurance company of various levels.
            The also call me to let me know when any request is denied, because they know that I call the insurance company directly myself, and ultimately change the outcome.

            The doctor was happy, too. His eyes lit up when I informed him that the whole tray of apples were for him to take home or leave in his office. He said thank you.

          • http://www.idealmedicalcare.org PamelaWibleMD

            How sweet to bring a tray of apples. . . . :)

          • Suzi Q 38

            ” I’m just concerned that Suzi Q 38 might feel pressure to “suck it up” when she was horribly injured and treated unkindly by more than one doc. She has high empathy for others…let’s remember to extend the same to her?”

            Yes. Thanks for your concern. “I have “been there, done that” as far as doctors that do not care.

            I got rid of them.

            As far as doctors behaving…most of my doctors do. The majority of them care. I just was fixated on two who did not. I decided that it was a “free country,” so if the two doctors were not listening or helping me, it was time to move on. I made sure to let them know how dangerous their actions or non actions were to me. They were called in to get a talk from the CEO. I could have reported them further, to the joint commission and/or medical board, but they would have done nothing.

            My other doctors know why I go to them (My medical condition) so they have been diligent in getting me the proper treatment.

            For example: My new neurologist of 1 1/2 years told me that I needed to go back to the teaching hospital where I had my cervical neck surgery at to take another MRI of both my cervical spine and brain, so that she could compare the MRI’s from a year prior to now.
            I called the MS neurologist department at the teaching hospital and he gave no argument to that request. In fact, he ordered both plus a thoracic MRI.
            My neurologist is hoping that the images have not changed much. She wants to rule out MS, so that I can quit worrying about it for now.

            I have learned.
            If my doctors are not doing what needs to be done, I no longer will just let it go.
            I will push for whatever care the experts have told me that I need. If I don’t get it, I will have to ask for the assistance of the nurse navigator.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Wow. Impressive.

          • SteveCaley

            That reminded me of a fellow who was retiring at the place I was at, and I picked up some of his patients. Some of them had had him for THIRTY-FIVE YEARS, and of course they hated me, and of course I expected it. Nobody wants a new doctor. In the old days, you had a doctor for fifteen years, and they lived in your town, and you knew what was behind the mask. One of the cruelest things that reform has done, is taken away long-term patients. I estimate it takes FIVE YEARS of care before you get truly in rhythm with a primary care patient. Anyone who’s been seeing you for twelve years, wow! You already got the doctor-patient relationship, a lot of time and trust down. You know, you might already be a bright light keeping him going in the trenches – I’ll bet you are. Thanks.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I had 6 jobs in 10 years before I opened my own clinic. never kept a job more than 1 or 2 years. I spent more time saying goodbye to patients I’d just met than developing relationships. Another tragedy of big-box medicine.

          • Suzi Q 38

            Thank you.
            This is the longest I have retained any doctor, except my husband’s cousin, who is our dentist.
            I have been seeing my dentist for as long as our marriage, which is 31 years.

            My husbands aunt lived to be 100.5 years, and kept the first doctor for over 40 years until the doctor died. She then went to my husband’s family GP until he died. Then his son took over his practice, and she went to him until she died in January 2014.

            We like to keep doctors around who are doing a good job.

          • Suzi Q 38

            I brought a gift of a dozen apples in a gift tray.
            He appreciated the gift.
            Our relationship is rather direct, so I am not sure that he would like a card.
            He is the doctor who called me “fat,”LOL.
            In retaliation, I lost 40 pounds.
            He is “old school Asian,” so telling a patient this in such a direct manner is the norm for him.
            At first, I was offended, but decided to see what would happen if I lost the weight.

    • Anna

      Today, 2 separate patients gave me chocolates. Small things, but they meant the world for me. One patient gives me chocolates regularly, and just leaves it on my desk. She doesn’t say anything, and she gets really embarrassed when I thank her. The other patient was a bigger surprise, she pulled out a chocolate bar from her purse and gave it to me to thank me for the care I had provided in the last few weeks. It very nearly made me tear up. It’s small gestures like that that make my day :) You don’t need to ask me how I am, just show me you appreciate what I do.

      • Suzi Q 38

        Thanks for the tip.

        • http://www.idealmedicalcare.org PamelaWibleMD

          And speaking of tips, I’ve actually received tips from patients. I guess if your care is exceptional leave a tip! Will help pay off those outrageous student loans. :))

          • Suzi Q 38

            I am guessing my doctor doesn’t need the money for loans. He looks to be about 65.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Some graduating from school now won’t be able to pay off loans until their 80s.

          • Suzi Q 38

            I don’t mean to be rude, but whose fault is that?
            Couldn’t the loans be paid off faster if the doctors live frugally until they are? Most of the doctors I know live beyond their means. My physician friend and her husband unfortunately bought a new house worth about $950K when the market was very high and houses were expensive. If they tried to sell, they would have to take a substantial loss.
            This came about when her husband lost one job after another, during the recession.
            We figured out that our incomes were similar…their house was much more costly than ours, we did not owe student loans, and our modest cars were paid with huge downs or cash.
            Our teenage kids shared a beat-up pickup truck.
            We sent them to state schools for college.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Most docs I know live on the cheap. I’m in a 900 square foot house. Prius. Bicycle. Cat. Lentils for dinner most nights. Voluntary simplicity. For 10 years I lived without a refrigerator. Vegan.

            Most docs live like normal regular people – especially primary care docs.

          • Suzi Q 38

            Good for you.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes! Exactly. Voluntary simplicity works well in my clinic. 280 square foot office. $370 per month rent. Part-time malpractice insurance $3900 per year (they give me 50% off bc I’m part time) No staff costs bc I’m truly solo. Supplies are cheap. It is a very simple work life and patients really appreciate it. I’ve removed all the stress that is so common in other clinics. No bullying. No cynics. No abuse.

          • Suzi Q 38

            I like your style.
            It is nice that you can do that.
            Also, you do not have any dependents other than your cat at home.
            Your frugal lifestyle affords you freedom at work.

            I know that is not the case with some doctors, as they have a family to support. Others are married to other physicians/specialists, so their combined income is probably quite high.

            I think though, that some doctors are more mindful of the fact that those loans won’t magically go away. They have to be aggressively paid down, as soon as there is more income to do so.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yep. Paid mine off i a few years. Only 22K in 1993 when I graduated. University of Texas schools are very cheap coma red to others. My tuition was 5K yearly and I think now is is 17K. A real deal!

          • SteveCaley

            Thanks for the tip! I’m proud to say that I put 400,000 miles on my car that’s still running, but “out to pasture.” I use it once in a while. The paint had all flaked off, and everyone was trying to convince me that it wasn’t a doctor’s car. But it was! I’m a doctor! There’s a lot of hi-life salesmen out there who will inflate your ego and sell you the world – on a payment plan.

          • http://www.idealmedicalcare.org PamelaWibleMD

            The guard tried to kick me out of the doctors’ parking lot on my first day of work at my first job. He thought I was a hippie. He said, “This is the doctors’ arming lot.” I replied, “Yep! I’m a doctor.”

            Ok. Ok. Here’s the car:

          • http://www.idealmedicalcare.org PamelaWibleMD

            And here are all the family medicine residents and me in the back of my pickup:

          • Suzi Q 38

            Dr. Wimble,
            You made me laugh today.
            Your antics inspire me to become a child at heart again.

          • Suzi Q 38

            Good for you not to “fall” for it.
            No one needs a Mercedes if you can’t pay for it in full.
            My son is a computer engineer.
            He told me he wanted to buy an Audi.
            I told him that he didn’t need one unless he could pay cash.

            He paid cash. His choice.
            I would have used the money as a down on a piece of property, but it’s a free country when you are over 18.

          • DoubtfulGuest

            The doctor I had the most trouble with, I had a fleeting thought to mail him one of those doctor coats that are sparkly like a disco ball, so he would feel conspicuous. Not the best use of limited funds. But I have a giving frame of mind. I can definitely do thank you/appreciation cards.

          • http://www.idealmedicalcare.org PamelaWibleMD

            How fun!!

          • DoubtfulGuest

            I’m sure I can’t post the link here. But a search for “triangle mirror ball” fabric would take you right to it. They have gold lamé as well.

            A be-sequined greeting card would be a nice option for the budget-minded.

      • DoubtfulGuest

        I’m glad to know this. For some reason I thought it wasn’t allowed in most places. Awkwardly, I seem to know a lot of people who don’t like chocolate, so I wonder if that applies to my docs. But if it’s the thought that counts…

        • http://www.idealmedicalcare.org PamelaWibleMD

          I do not know of ant place where you can not give simple gifts to a doctor. They may have to turn over tips to the clinic, but chocolates, cookies, carnations . . . . handmade notes. Go for it!!

  • JR

    My community has a non-profit that offers free counseling to a limited population. They have other services as well so it’s not obvious someone is coming there for counseling. They also have a crisis line where anyone can call anonymously and have someone to talk to. They do the following with their counseling participants:

    1. They recommend that patients do NOT tell anyone about their counseling to protect them legally.
    2. The counselors do not keep detailed patient notes, so that the notes will have limited use in a court case. Example note: “Discussed boundaries”.
    3. The non-profit has a sharp legal team (they also do legal advocacy) and will fight tooth and nail to protect those notes, even as limited as they are.

    I think that the special population of “doctors” would need a similar non-profit organization in place, especially one that has a hot line especially for medical personnel, and maybe tele-counseling since it would be hard to provide support for only local.

    Everyone should have access to counseling when in crisis…

    • http://www.idealmedicalcare.org PamelaWibleMD

      Totally agree. Due to all the physicians we have lost in town, we now have a Physician Wellness Program that offers free counseling and 24/7 access to help:

      http://www.lcmedsociety.com/physician_wellness

      All physicians and medical students should have access to such a program. We’ve taken in doctors from out of the county who have been desperate of help.

    • Anna

      In my region, we also have a physician help line. Sadly, I found them lacking in how they dealt with me and I got from them nothing but condescension. I’ve had to call them for three separate incidents, and each time I’d end up feeling worse than when I called them.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Who runs the help line? Were you talking to a psychologist? Another doc? Feel free to e-mail me privately as obviously your help line is not helping and may be hurting which is really counterproductive.

        • http://www.idealmedicalcare.org PamelaWibleMD

          E-mail via my contact page here: http://www.idealmedicalcare.org/contact.php
          Or call 541-345-2437.

          • Anna

            I’ll email you after work today.

          • Suzi Q 38

            Good.

        • Anna

          The help line is outsourced to “business counsellors” who deal with businesses of all sorts. So they try to treat MDs like CEOs. Yeah, makes no sense whatsoever. The spirit and good intentions are there, but the execution leaves a lot to be desired.

          • http://www.idealmedicalcare.org PamelaWibleMD

            That will never work for doctors. Docs really do best supporting one another. Shared trauma. We understand the pain – first hand. Have you ever asked a colleague for help? To just listen. . . . We are potentially the best counselors for one another. I do hope we start reaching out to one another . . just because . . .

  • http://www.idealmedicalcare.org PamelaWibleMD

    And why are you submitting to this inhumane schedule?

    • Anna

      Family practice where I live is solely fee-for-service. There is no other model. Sadly, I can’t afford not to work.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Fee for service does not equal assembly-line medicine. Where do you like? What state? In Oregon (and elsewhere) there are many docs in relationship-driven practices (vs. production-driven) who are FFS – including me.

        So wish you could attend my retreat next month. I could show you how of break free from production-driven medicine (and increase your salary):
        http://www.petgoatsandpapsmears.com/retreats.php

        • Anna

          I live in Canada, so the set up is different. I know the aim is for relationship-driven practices, but I just don’t see that happening here in my lifetime.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’ve had docs from Canada come to the retreats. Keep an open mind. Email me if you like. I may have some ideas that could help.

          • Anna

            I may take you up on that Pamela. I’m all for solutions.

          • Geoffrey Koerner

            Yael, thank you for your transparency. I hope through connecting with Pamela you’ll be able to find support, healing, and a renewal of the passion that led you to medicine in the first place.

  • Patient Kit

    This is truly heartbreaking. You docs have to somehow change your culture that apparently equates being human to being weak. Being human is not weakness. I imagine a lot of docs tend toward perfectionist personalities, which must be hard to deal with living in such an imperfect world and working in such an imperfect healthcare system. I imagine many docs are also feeling an extreme loss of control. I know that, as a patient in this system, I sure am. There are clearly many things that none of us can control. But we can start with those things that we can control — and, for me, that starts with how we treat each other. That, we can control.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Just being nice goes a long way.

      The suicidal doc from Philadelphia ended her letter, “I hope you continue to help physicians like you are doing . . .even having access to something to read like this blog helps tremendously. We don’t always need much. . . just something every so often. . .to keep things going.”

      Doctors endure so much pain. And we ask for so little.

      • Patient Kit

        And yet, so many peeps don’t seem to be able to master being nice and kind and polite to each other. To me, that’s something that should come naturally. Being nice and being strong, can easily coexist, even if none of us can be nice and strong all the time — because we are human — and imperfect. Not cold unfeeling machines or robots.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Reductionist medicine in a capitalist culture prizes fast-moving automatons.

      • Suzi Q 38

        I agree, but sometimes, it is the patients who are enduring the pain from a medical oversight or error.

  • guest

    I remember when I posted on here once that I felt I had PTSD after my residency, and a couple of the clearly older physician posters chided me for being “soft.” Is it any surprise that doctors who are depressed or traumatized feel alone without other options?
    During residency I became profoundly depressed and ended up taking a leave of absence. The only thing that saved my life at that time was a kind, devoted advisor who saw I was in trouble. Everyone else around me berated me, thought I was stupid, penalized me for being lazy and distracted.
    Things are better now that I am in practice and do the job on my terms.
    However, my colleagues (particularly the older male ones) still make snide comments about me or other younger physicians seeking a work-life balance. This is in a department where we lost one of our colleagues to suicide 5 years ago.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Thank you for posting. Obviously we need a more nurturing and less competitive environment in which to train our future healers. Why torment colleagues who are obviously suffering? Does anyone actually think this makes medical students into better doctors?

      • Patient Kit

        I guess they are testing to see if you guys are strong enough to “take it”. But the more I read about the medical education system, the more it sounds like doctor-on-doctor violence/abuse is widespread.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Why the abuse?

          1) Some docs think that they are doing it for our own good to toughen us up early so we can survive the rigors of the career.

          2) Some docs are just stuck in a cycle. They were abused in training so they continue the same.

          3) Cultural norm in some cut-throat institutions.
          Survival of the meanest?

          4) Some docs may have sadistic tendencies.

          Other ideas?

          • guest

            Hi Pamela. I honestly think some of my current colleagues are depressed themselves for various reasons. They take it out on us younger physicians for making choices they did not perceive they had.

            I don’t know what was going on in residency. I was a very high powered program, perhaps the top program in the country in my field. Before me there was one brave woman who took a leave of absence due to depression, and it rocked the program to its core. I am hoping there is more support available to the residents nowadays but at that place I would not be surprised if the “weak” were just weeded out.

            Anyway, I try to connect with my colleagues in private practice as much as I can. I have taken on a leadership position in order to extend to my colleagues, young and old, a willing ear and a warm heart.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Hmmm . . . I’ve always thought that maybe when docs are suffering, others keep them at a distance via bullying, snide comments, “suck it up” etc . . bc if we were to feel our collective grief, we’d all start to lose it. . .

            Example from my town:
            1) One of our top docs dies by suicide.
            2) Office staff immediately disconnect themselves from him by saying “that was ultimate act of selfishness” and other less-than -compassionate statements. (He is not one of us)
            3) Making him “different than the rest of us” mentality somehow protects the group from feeling the pain and recognizing that with the right set of circumstances 100% of us could make the same choice to end our lives.

            Thoughts?

          • RenegadeRN

            Please don’t think this only applies to physicians! This is where the term “nurses eat their young” comes from.

            Many years ago I was bullied by a preceptor, but was so damn determined to succeed I didn’t recognize it as such.

            It took me walking into the break room and seeing another RN crying, and later finding out she was crying FOR ME!

            She was appalled at my treatment and had been told to shut up and stay out of it.

            Critical care can give RNs PTSD, more frequently than you think!
            Great but sad article.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Oh no. Somehow I figured this was part of medical culture. Impacts everyone. Maybe not the janitors. Who knows? We really do cannibalize one another.

          • FEDUP MD

            I kid you not, I was bullied by a janitor in med school. Like in Scrubs,but you know, not funny.

          • http://www.idealmedicalcare.org PamelaWibleMD

            What? You’re kidding.

          • FEDUP MD

            Sadly, no.

          • RenegadeRN

            Sadly, yes they do.
            I didn’t realize it could be so bad in the physician culture too… But people are-underneath any title,…. Just people.

          • dawn learsy

            Yes, I think this is a profession that attracts some very compassionate people and also it attracts psychopaths. Workplace bullying is something I found in every setting I have worked in. I have been bothered by it times more than others, but it is part of the culture of medicine. Doctors can be very competitive by the nature of the educational process that leads to fulling our educational requirement. We can be competitive to our own demise.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I can say that I have ever been bullied in medicine. I have had doctors in med school make fun of me for shopping at health food stores and eating organic, but I have never been hazed or bullied. The forced dog labs were absolutely dehumanizing. I protested and had to meet with the dean who allowed me to continue medical school without killing dogs. I just never realized that becoming a healer would mean killing the innocent.

          • SteveCaley

            Amen. Read Robert Hare’s work – he’s a psychologist who contributed a tremendous amount to the study of psychopathy. I believe that in our society, narcissists and psychopaths are lionized and admired. The psychological Public Health of a society is how well it cleans out the sick f__’s from positions of power. For us, we’re stone-age brachiators.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Mostly due to fear? As you may have read earlier, physicians are afraid of some of their abusive superiors.

          • Geoffrey Koerner

            Perhaps in an amygdala-based fight-or-flight reaction, the abusers are so scared and traumatized that they self-protect themselves by reestablishing as the “alpha” by emotional violence. Just a pondering on my part.

          • SteveCaley

            Doctors who were never mentored, have not the slightest clue how to be mentors. The point of residency is to learn to accomplish many things, usually small things. I was hated in residency, and that’s a shame – I learned a lot, but sadly it’s because I was a better self-teacher than my “mentors.”
            Sadly, I found later in my career when I worked with the incarcerated population, that so many of them reminded me of my Residency attendings. Residency trained me for dealing with Axis II disorders.
            I am fascinated by psychopathy and sociopathy; I am just sad that many of them are on the wrong side of the bars. There are some very sick people involved in the training of human beings. I’ve met murderers who have more inherent empathy and decency than some of those guys in training programs.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Murderers with more empathy than residency directors? After reading some of the posts here, I’m not sure you are so far off. Good that we can shine the light on this together.

          • guest

            Can you recommend good reading material? I am also fascinated by sociopathy and would be interested to learn more. What deranges a mind to the point that they can be so cruel to others?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. And how does sociopathy manifest in health care professionals? And how can they screen medical school applicants out who have these issues?

          • Suzi Q 38

            I think sometimes that it is the “power” of it all.
            There are sociopaths in every walk of life, so I would think that medicine would be no exception.

          • SteveCaley

            They are awful. I think that everyone needs to know how they operate, because their M.O. is they cause a trail of wreckage wherever they go.
            Power is their cocaine, their up-drug. They gravitate to the exact worst places – where they have an influence in the development of others. Another good reference on them is Scott Peck’s People of the Lie Some people might be put off by his strong religiosity; but he’s right on in understanding that there is no real boundary between psychopathy and deliberate evil. Healthy cohesive societies keep “sheepdogs,” in a sense, to protect the herd from predators. Ours has been fragmented and indifferent for so long, we aren’t good at that response.
            Forty years ago or so, that dirtbag psychopath Richard Speck murdered women in Chicago one night; and the community heard and ignored their cries for help. It made the news; it was a symptom that our society couldn’t protect itself from predation. We have improved a little; not much. Our society needs to improve its self-protection, not with guns or locks, but with identification and sequestration of psychopaths.
            Again, read Peck and Hare, and you will get a far more educated description and understanding than my mere ramblings here.

          • SteveCaley

            I’m not an expert – Dr. Robert Hare, of British Columbia, is a
            psychologist who has been interested in this class of mental illness. “Snakes in Suits” tell you about high-functioning sociopaths in society; a rather unsettling concept.

            His online site is http://www.hare.org/ and he is very clear and
            honest. The site has many links; a very good one is to a top-notch
            article in the Guardian that discusses psychopathy.
            The key point
            is that it’s probably a developmental failure in the brain, that leads
            but does not excuse their behavior. They do not have native empathy; people
            are objects or property, not “like-me” creatures.
            Stunningly, it seems rather
            tolerated in American culture, even romanticized for women. Trying to
            “fix” them is like trying to “fix” a toaster from blowing up when you
            drop it in the bathtub. You can’t, so stay out of the bathtub, that’s
            the only solution.
            They are born this way – but society either sets
            up behavioral controls and limits, or lets them go about having their
            way. Asian societies tend to “wall off” their sociopaths from
            vulnerable members of society. Us – not so much. They do not become
            dangerous, they are dangerous. 25% of American males who are
            incarcerated have ASPD, an umbrella term that encapsulates psychopathy.
            Start with Hare, and you can’t go wrong, IMHO.

          • SteveCaley

            Quick PS: I just ran across this link on Dr. Hare’s website (see below.) I have no idea what the big picture is intended to be, but the short clip is accurate and without any clear error. It features Hare and Babiak, and it is good.
            http://www.fisheadmovie.com/watch1

          • guest

            Thanks! I bought one of Hare’s books on my kindle.

          • Suzi Q 38

            Scary. There are probably some very sick people actually treating human beings.

            Both of my errant doctors were accomplished liars. They would lie when confronted about the treatment in my case when confronted by the CEO.
            I asked the CEO to ask them for proof that they did this or that. If they facilitated a smooth transfer to the next hospital, prove it. I wanted to see the actual paperwork he filled out so that I could apologize for thinking he did not do it.

            She notified me that I was right, they did not do what they should have done for me.

    • Suzi Q 38

      Those doctors were jerks.
      I am glad you took care of yourself.

      • guest

        Thanks Suzi, that’s very sweet.

    • Geoffrey Koerner

      Keep up the good fight, guest! One can only give what one has, so in aiming for work-life balance, you have more to give than those who don’t. Criticism for doing what is good and healthy does hurt, and I hope you find solace and encouragement among us here.

  • guest

    This story makes me so terribly sad. I have small kids and work my job on my terms for them, but I have that option. I wish there were other options for you. Will you please send me a message if you ever need to talk or unload? Please don’t feel alone.

    • Anna

      Thank you for your support :)

      • guest

        Anna, also, I am on a site called mommd.com. Lots of mom physicians go on there and vent. I have connected with very nice women in my field. Best wishes to you.

        • Anna

          Thank you. I will go check it out.

  • liz1rn1

    I work with physicians every day, and I definitely see a lot of depression and anger. But I think a lot of those things that do this to doctors affect all healthcare workers. I know as a nurse I deal with a lot of the same feelings. Very good article.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes. Trickle-down effect can’t be good for anyone.

    • DoubtfulGuest

      That should be a whole post, in addition to this one, about nurses’ emotional stress. Have you ever written one or thought about writing one? It’s often very physically strenuous work, too, isn’t it? Speaking as a patient, thanks for all that you do.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Yes, I should take on nurses next. On my list.

  • futuredoctorweirdo

    I’m happy to say that I attend a very progressive medical school with pass/fail (ie. non-competitive, cooperation-encouraging) grading, integrated wellness education and access to wellness activities (yoga, massage, etc), confidential counseling which we are encouraged to use, anti-bullying policies which they seem to take seriously, and clinical mentors who are really wonderful. It’s still difficult and intense, of course, but it is at least humane. Facing the realities of modern medicine beyond med school — and the reality of overwhelming student loan debt — is still really confusing and daunting. I’m inspired by ideal practices, but don’t necessarily want to own my own business. Is it possible to be a happy, loving, whole human being who is also a hospitalist? Can balanced docs infiltrate mainstream institutions? I hope so! I think that this conversation is so important, and I hope that docs will start to have it more often. Thanks, Pamela.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes! It is possible to be a happy doctor anywhere. As you point out you attend a very progressive medical school which probably has happier med students that the average med school. SO . . . happy hospitalists need progressive hospitals. There are better employers than others. Always interview physicians who have recently left their positions at a hospital or clinic before you sign on the dotted line.

  • LeoHolmMD

    Thanks for doing this. Just lost a doc in our home town. Beyond time to take this seriously.

    • http://www.idealmedicalcare.org PamelaWibleMD

      I thought I was the only one contemplating suicide back in 2004. I’m still shocked how common these desperate thought are among doctors and I have been writing about this for 18 months.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Be true to yourself always. What triggered your suicidal thoughts? Anything in specific? Bullying? Hazing? Curious . . .

  • http://www.idealmedicalcare.org PamelaWibleMD

    OMG. Doctors who prey on doctors are the worst. I am so sorry you suffered at the hands of other healers.

  • Anna

    I’ve been there. Doctors bullying other doctors is something that needs to be exposed more. And this is more than just the older generation telling us to toughen up. I’m talking true bullying, belittling as a person, career threatening bullying. I nearly quit medicine (and life) because of what I went through.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Your peers? Residency director? Boss? I’ve noticed many docs who escape into administrative positions are not particularly kind to their doc underlings. Anyone else notice the same?

    • guest

      Can you be more specific? What kind of bullying occurred? I’m mystified by this. I had not so supportive colleagues but I never encountered overt hostility.

      • http://www.idealmedicalcare.org PamelaWibleMD

        One doc told me her residency director told her, “I can end your career in a minute.” I think threats like this are extremely damaging – after all our time and commitment to the field of medicine.

        Anna, I would also be interested in your specific examples if you care to share them.

        • Anna

          I got that threat multiple times. “I know people in high places, I can make sure you never work in this city again.” I’ve also had charts thrown at me because I had misspelled a word (nothing dangerously misspelled, something like using “their” instead of “there”). I’ve been grabbed as I was going into an examining room and told “this is one of my patients, so I’d better not hear any complaints” – I had a hand shaped bruise on my arm for a week after that encounter. Oh, and my “favourite”: “I could make your life so miserable you’ll have a miscarriage so you don’t need to take maternity leave.” Yeah, that one was particularly damaging.

          • http://www.idealmedicalcare.org PamelaWibleMD

            That is HORRIBLE!!!!!! So . . .as far as you know is this man still on the loose? Has he gone in for therapy? He needs it. Has he even apologized?

          • Yael

            No apology, no therapy. I get panic attacks when I see him. Or even if I find myself in situations where I may run into him. Like the Safeway close to that clinic. True PTSD.

          • http://www.idealmedicalcare.org PamelaWibleMD

            You are still working there?

          • Yael

            No, thank god.

          • SteveCaley

            I find myself coming back today to the board, to see how you are doing. Please hang in there. Cruel behavior forfeits any legitimate claim to authority. I am wishing the best for you.

          • Yael

            Thank you for your kind words. Thankfully, I’m thriving in a more collegial practice. My patients who have followed me tell me that I seem lighter and happier. It dismays me that my patients saw a change in me, I thought I hid it well.

          • SteveCaley

            ” It dismays me that my patients saw a change in me, I thought I hid it well.” You’ve got to work on hiding your humanity better, then. Caring people still can read through you, and it sounds like your patients might even care about you. :-) Not all the healing goes one way, you know.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Ok. Questions:

            1) Was he like this with everyone or just you?

            2) I’m assuming this is a man. I can not even imagine a woman threatening another woman with a miscarriage. I hope he never sees your kid for a WCC. Do you think this was misogyny? Curious if hazing and bullying is more of a male sport on women and “weak”/vulnerable men.

            3) Was he your boss? Residency director?

            4) What do you think in retrospect fueled his rage?

            Pamela

          • DoubtfulGuest

            I imagined it was a woman, actually. Hopefully Dr. Anna will set us straight.

          • Anna

            Pamela, he was like this to me, the receptionists and the young female drug reps. He threw a stool at a drug rep for “standing in his space”. He was the clinic director. I can’t even begin to think what fueled this, I’m not a big enough person yet to see beyond the hate (his) and fear (mine).

          • Yael

            by the way, yes, I changed my disqus name because i’m having a panic attack at being discovered.

          • http://www.idealmedicalcare.org PamelaWibleMD

            This is so sad. Doctors contact me all the time to talk about their despair and suicidal thoughts. Some never share their names. One woman just cried on the phone with me for 10 minutes. I don’t know what happened to her. I just hope she is alive.

          • DoubtfulGuest

            Dr. Wible, based on Dr. Yael’s comment above, should her other name perhaps be edited out of any of our responses to her?

            I’m sorry, I was incorrect about it being a woman. This is horrible either way.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Working on that now.

          • DoubtfulGuest

            Since you appear to be new here, I wanted to make sure you’re aware you can edit your comments for quite awhile after posting. Several days at least, maybe weeks. Or you can delete them entirely and just put some special character or the word “deleted” in its place. Just can’t leave the space completely blank. I learned this by saying stupid things that I later regretted. Obviously better to think before I speak so as not to disrupt the flow of the posts. But given your concerns I want to make sure you knew you have options even after posting. I hope everything turns out well for you. I’m so sorry you are going through this.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I hope your pregnancy went well. Did you ever think of reporting him somewhere? Now that (I assume) you are no longer working there.

          • Yael

            My pregnancy is still ongoing. And I thought of reporting him but am too scared to. Other doctors have advised me against it because they’re scared of what he could do.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I wonder how many other people are scared to report him.

          • DoubtfulGuest

            What fueled his rage is not your problem anyway. I hope you get all the help and support you need to recover from this.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’m trying to understand why docs prey on other docs. His rage is fueled by something . . .

          • DoubtfulGuest

            Fair enough. I just think when we ask the victim what they think caused it, it could be taken to imply they’re somehow responsible. I do understand you docs have unique stressors that you need to discuss amongst yourselves. I just wonder what else might have been involved, too. What if he grew up in an abusive home? What if he has a brain disease that affects his behavior? Or an extra Y-chromosome? It could be any number of things, couldn’t it? I agree the systemic causes need to be sorted out.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Clarification: Never once did I think Yael was to blame.

          • SteveCaley

            We ought to have some place to report this sh_t. Thank goodness for the internet – weed out these creeps.

          • http://www.idealmedicalcare.org PamelaWibleMD

            More healing than you can imagine comes from sharing our stories on cyberspace. Just reading these letters has encouraged several doctors to call and e-mail me. They have thanked me. Why? They no longer feel alone.

            Now we need the collective courage to turn these bullies over to therapists or mandatory anger management classes or something.

          • Yael

            This post and commenting on this post has been greatly cathartic. I finally admitted to myself and my husband that I have PTSD from all the sh_t I’ve been through. Today, I had a good long cry at work between patients. I completely lost it, but it was a good, healing feeling. I still have no tangible solutions at hand, but it’s a step in the right direction.

          • http://www.idealmedicalcare.org PamelaWibleMD

            OMG! Great, great, great! The diagnosis is the first step in coming up with a treatment plan. SO . . .I’d love for you to attend my retreat next week. FREE. Will waive tuition costs. We need to meet. Will be the best CME of your life. Even have two recent graduates of med school flying in from the Philippines!!!! It is not necessarily easier to be a doc in other countries.

            http://www.petgoatsandpapsmears.com/retreats.php

          • Yael

            Thank you for your generous offer, Pamela. Unfortunately, my OB will no longer let me travel :)

          • DoubtfulGuest

            I’m so sorry, Dr. Anna. That’s disgusting, what they did to you.

          • Suzi Q 38

            I am glad that you do not work there anymore.

      • DoubtfulGuest

        Dr. guest, a poster we were talking with has a safety concern and changed her disqus name just a little while ago. I was thinking it would help if we all edit her old name out of our responses to her? Thanks. Hope you are having a good day.

        • guest

          Understood. I will edit my posts.

          Hopefully other posters can understand why we choose the handle “guest!”

  • Courtney Barnes

    This is heartbreaking. I’ve been a nurse for 13 years, mostly in the ED. I’ve had the distinct privilege of working with some amazing docs. They’ve taught me so much and I hate to think of them suffering like this!
    I know this is all geared toward physicians, and I so appreciate you bringing more attention to this, but I’m wondering if you could comment on the weird abusive cycle of nurse-physician relationships that I’ve observed. It seems to me that some of the old-school nurses were probably berated and verbally abused by old-school docs. So they get some pleasure in being mean to residents and med students…like they’re in a temporary position of power so they use it. Then the residents and med students eventually graduate and become attendings…and they’ve developed a disdain for nurses, so they’re verbally abusive to them….and the cycle continues.
    I’m not implying that every nurse or every physician does this. I just think it’s weird that we can be so awful to each other! I don’t think it dawned on me until I had been nurse for several years. By that time, most of the residents were my age or younger, so I guess it became easier to see them as fellow humans. But I distinctly remember working a crazy night shift in the ER. It’s a teaching hospital so residents often come down and do the admissions for the patients that need to stay. This first year resident came down to admit one of my patients and when I first saw him it dawned on me that he looked absolutely terrified. I don’t mean terrified by the prospect of admitting a patient-he just looked overwhelmed as hell. I guess at that moment I saw the ED through his eyes. It was nuts. There were patients on beds in the hall because we were so slammed, there was a bad MVA in the trauma bay and the ED attending was tied up and “Med-Com” was blowing up with paramedics bringing in more patients. Everyone was stressed. This poor resident had no idea where the charts were, where his patient was, and where he could sit down for a second to review anything about the patient’s history. At that moment I was just sort of overcome by how bad that must suck! (Probably could have expressed that more eloquently but oh well). So I just asked him if I could help him find something or someone. He looked so grateful when I showed him where “stuff was” and cleared a spot on the desk for him that I thought he was going to cry. No big deal, he got his bearings and admitted the patient just fine and the crazy night eventually ended. He was on call several times after that so I saw him a lot that summer…and he was always really nice to me and a pleasure to work with. I know it sounds dumb but I really think he appreciated someone just treating him with a shred of compassion.
    My point is that it wasn’t particularly difficult for me to be decent to him. It probably took an extra 60 seconds. I’m not a rude person by nature anyway, but it’s easy to get caught up in the craziness of the ED and managing a patient assignment. Its very easy to forget how overwhelming it can be when the environment is so unfamiliar. Even for physicians.
    After that seemingly insignificant experience I’ve tried to go out of my way to be friendly and accommodating to the residents. (Unless one is blatantly being a jerk but that’s quite rare). I don’t mean “friendly and accommodating” in a kiss-ass way, just more compassionate and empathetic. Hopefully it makes a little bit of a difference. I really hate it that docs are being made so miserable. I just wish there was something more I could do to help fix it! I love my docs :-(

    • http://www.idealmedicalcare.org PamelaWibleMD

      OMG. Thank you. If we could all just offer a “shred of compassion” to one another, I think we’d finally have a health care system in this country.

      We all become so robotic, detached, overworked at times we lose our humanity and the trickle down effect on nurses – and back on doctors – is horrible. A vicious cycle of abuse that can be broken with simple gestures of kindness like clearing a spot on a desk for a tired doctor.

      • Geoffrey Koerner

        Even us, as patients, can give a quick word of encouragement to a harried healthcare person, e.g., “Dude, I can see you’re doing your best. Thanks for giving what you’ve got.” While saying such things may not be received in the spirit in which it’s given, I believe it’s the right thing to do anyway.

    • SteveCaley

      I’m heartbroken and pessimistic about the future of MD’s when I saw what’s happened to RN’s. They are 10 years “ahead of the curve” for MD’s. Abusers are sickos – no matter what they call themselves. But Nursing – real nursing – has gone extinct, and I’m really sad.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Perpetual optimist here. We are going through a big paradigm shift. I see beauty on the horizon. Keep the faith. Be the change.

        • Bruce

          Overcoming the shame, and admitting and airing the social pathology, is the first step toward social healing. Thank you for contributing so much to that “first step”, as well as to spreading models for the healing itself!

    • Geoffrey Koerner

      Courtney, I’m glad you wrote. It sounds like you really grasp the severity of the problem AND you, as shown through your interaction with the resident, are an agent for change. Good for you – and for us all.

    • Bruce

      Such “random” acts of compassion as you described can have a disproportionate beneficial effect on a whole working community — a kind of POSITIVE contagion!

  • Rob Burnside

    Ever-increasing responsibility with steadily- eroding autonomy, complex problem solving with insufficient time for the task, the cumulative effects of stress and revulsion, and perhaps most important of all–debilitating social anomie in what once was, and still needs to be a highly social profession. These are the issues as I see them, and I don’t see them getting any better. Like the military, contemporary med school grads should plan for “twenty years and out.” Anything more than that is likely to be lethal in one form or another. Physician suicide is the saddest and most damning irony of all, but it tells us something and we need to listen.

    • http://www.idealmedicalcare.org PamelaWibleMD

      What does it say about a civilization when healers are harming themselves? The ultimate sickness.

      • Rob Burnside

        That we’ve reached and passed the point of diminishing returns in the healthcare time/money matrix. And I don’t know what the solution is, though I keep hoping an industry-wide sabbatical program will take hold. It may be the only way to tolerate the heat without leaving the kitchen entirely.

        • http://www.idealmedicalcare.org PamelaWibleMD

          I welcome anyone needing respite to my retreat: Live Your Dream; Revolutionize Your Medical Practice! FREE TUITION for medical students.
          Do not suffer in silence. Come heal with like-minded physicians: http://www.petgoatsandpapsmears.com/retreats.php

          • Rob Burnside

            Need a ranger out there?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Wanna come?

          • Rob Burnside

            My sources say, “Yes!” but I’m nearly homeless (apt. bldg has been sold) and you might have to keep me for awhile. Cold, wet nose. Barks at the moon. Shots are up to date and fully housebroken. Woof!

          • Rob Burnside

            Of course! Who wouldn’t?

        • Bruce

          You said it, so well!

          • Rob Burnside

            Thanks, Bruce. Wish I could actually do something about it. A recent NYT Tuesday Science Section carried news of software that will interpret facial expressions of pain more accurately than we humans can. Clearly, we’re headed toward 120 volt A.C. plug-in physicians. I can almost see the Insta- Doctor now, at laundromats and airports everywhere, between the soda and the snack machines. Twenty-four hour service without all those messy human issues. Exact change required.

          • http://www.idealmedicalcare.org PamelaWibleMD

            That is not gonna work any better than instant Top Ramen soup or an instant marriage. For quick superficial needs maybe, but healing? Really? People need a shaman not a plug-in docs.

          • Rob Burnside

            Just as you’ve been telling us all along! Only now, after perhaps too many morning coffees, I’m imagining an Instant Alternative Medicine machine next to the Insta-Doctor unit at my favorite laundromat. As a society, we seem to have the ability–along with the inexplicable propensity–to reduce everything good to “drive-thru.” And self-driving cars? I don’t even want to touch that one.

      • Rob Burnside

        That we’ve reached, and probably passed, the point of diminishing returns in the healthcare time/money matrix.
        I keep hoping an industry-wide sabbatical program will take hold. This might help considerably.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Ya mean a strike?

          • Rob Burnside

            Hmmm…you do make some wonderful signs.

          • Bruce

            Hmmm!

            Doctors to the “illness-maintenance” corporations: stop imposing death on doctors and patients alike, or we stop working for you!

      • Bruce

        It says: Time to heal the civilization itself, as a whole!

    • SteveCaley

      The nursing bucket has a hole in it – five years and out, for the average nurse, I’m told. It doesn’t matter how fast you get ‘em to the front if they’re being mowed down….

      • Rob Burnside

        If that’s true, things are much worse than I thought. Makes me want to turn on a “Marcus Welby” re-run and step into the screen.

  • dawn learsy

    I know I have PTSD from medicine. Training programs knew it as well. You had to dissociate to survive. It was expected. Overall, the expectation for a doctor is to be more than human. We have not taken care of ourselves, our profession, and others in our profession. In return, we are suffering, and the continued expectation is that we sacrifice ourselves more, with less independence, lower compensation, more regulations, and less respect. I wonder if NP who do not go through residency have a similar problems. In retrospect I wish I had gone this route—- easier, less demands, and similar benefits.

    • http://www.idealmedicalcare.org PamelaWibleMD

      I think most of us have had PTSD. The impact on those around us (spouses, NPs, PAs, patients can’t be good), How far into your training do you think you developed this? In med school? Why?
      Thank you and I’m sorry.

      • dawn learsy

        The start of my PTSD started when my first patient was dying and we had formed a close bond. I so emphathize with my patient I emotionally followed him through all his stages of dying . It was terrifying and I had no control no matter how hard I worked. Even trying to patch up family relations, so there were be loved one by his side, fell short. All followed by endless days and nights in the hospital seeing one tragedy after the other, all in a background of no sleep and poor eating habits, and a particular maligant working atmosphere. (Nursing staff —–at least when I was starting out —- was particularly nasty to the female interns. Attendings were just sadistic.)

        • http://www.idealmedicalcare.org PamelaWibleMD

          All too familiar. And why? Totally unnecessary. We need free weekly therapy sessions throughout our training. We need safe rooms in hospitals where we can cry together.

          I went to a grief ritual led by a woman from Africa. In her culture, it was mandatory that all members of the community grove together for several days each year. Yes, everyone stands together and cries and shrieks and screams around the fire for all their losses over the past year. This is MANDATORY. If a community member tries to opt out they are FORCED to join in. Why? They found that those people who did not grieve became trouble makers and undermined the health of their tribe.

          I think it’s time we take the same approach in medicine. We need mandatory grieving sessions. My God -look at all the tragedy we are exposed to daily, hourly . . .

          • DoubtfulGuest

            How does one cry on demand, though? I’m not sure that forcing emotional expression is going to be helpful. People have different ways of dealing with their feelings, some healthy some not, but there is more than one healthy way. This could be a slippery slope toward a different kind of bullying…how about a medical culture of support and caring with no forced expression?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Everyone grieves in their own way.

          • SteveCaley

            To show up and be human – that is what kept me alive. I told my mom that I have a peculiar response – every time I’ve had to tell a patient that they have a terminal illness, I cry. She said I’m like my grandpa (whom I never met.) Crying’s never embarrassed a patient. And that’s the only one that counts. There is a need to just all be human together….
            I remember being with a family when my patient passed away in hospice. I was sitting on the bed at the VA, he was comfortable, and I sat right next to him when he Went. Now, no patient, no family, does anything but grieve the way that they grieve; sometimes it’s loud and horrible, sometimes it’s peaceful and spiritual. I was honored to be there when this veteran Went.

          • DoubtfulGuest

            Oh, I didn’t mean to suppress crying. No, never. Patients want to see that their doctor cares, and it is just being human. I read that crying helps us get rid of stress chemicals, is that true?

            I only meant for some people, the timing can be different. Like they get really quiet for awhile, need to take a walk or something first. I wouldn’t want those people to be criticized for not displaying grief all the same way, on schedule. Too much pressure on doctors, how do we fix that?

            Do you know this song? I watched this many times growing up: http://www.youtube.com/watch?v=Y52bs0aX6v8&feature=kp

          • http://www.idealmedicalcare.org PamelaWibleMD

            OMG! I LOVE THIS SONG!!! Free to be you and me. That just says it all.

          • Geoffrey Koerner

            Thanks for sharing the video. Whether with tears or not, I’m thinking authenticity is the core issue – I know I’m still working on it myself.

          • http://www.idealmedicalcare.org PamelaWibleMD

            You are a good, good man.

          • Geoffrey Koerner

            Steve, should I ever be told I had a terminal illness, I’d want it to be told through tears, for it would make it easier for me to cry. If the messenger spoke with “professional stoicism”, I think I’d get very un-nice (to put it mildly). You put it so well when you wrote, “There is a need to just all be human together.” I’m glad to see you’re part of the solution.

          • Bruce

            “there is a need to just all be human together”

          • Bruce

            Amazing, the emotional/psychological insights sometimes embodied in the institutions of tribal societies!

            It’s time for medical schools to cop to what they are doing to their students, by at least offering, as you indicated –

            * weekly therapy sessions for medical students

            * open 24/7 Grief Safe Rooms / “Grief Chapels” for medical students

            * ~ Monthly [optional] Collective Grieving Sessions for medical students

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thank you Richard. For everything you do!

  • Suzi Q 38

    Being at the bottom of your class is not indicative of the type of doctor you could potentially be in the “outside” world.
    Patients don’t look up your class standing. I don’t ask doctors if they were “last in their class” or at the top of the class.
    Are you “people and street” smart? Are you an inquisitive “detective” who has good instincts about treating patients??
    Being the the first in your class is something to be proud of, but it doesn’t necessarily mean that you will be a good clinical physician.

    Since I have had my ordeal of cancer and cervical spine surgeries, I have had about 8 physicians (one GP and 7 specialists). They were all smart, but not all of them were good listeners or good clinicians. Not all of them thought much about how they could help me. The ones who did mean the world to me.

    The physician who ignored my obvious pleas for help was an MD, a Phd, and a gyn/oncologist. He was very smart, but so much a good listener and clinician.

    Get into a more positive mode and “talk yourself up.”
    If you are more positive about yourself, others will believe it and be more positive about you. Sometimes, we are our worst enemies. Don’t destroy all the work and dedication that you have expended so far. There is an end to all of this class placement.

    You may be better with the actual patients, and no one or any school can teach you how to be good at that.

    It comes from within.

    What is an MS-2?

  • http://www.idealmedicalcare.org PamelaWibleMD

    Amen Sister!

  • http://www.idealmedicalcare.org PamelaWibleMD

    Things are actually improving. With public (and physician) awareness we can evolve. Many med schools have anti0bullying policies. You may ask about these as you are interviewing.

  • http://www.idealmedicalcare.org PamelaWibleMD

    I have found that patients are mirrors and they teach me exactly what I need to learn (weirdly) about myself. I used to suffer from a lot of anxiety. Guess what? I attracted a lot of high anxiety patients with challenging psych issues. They helped me see my own pathology. As I got healthier I attracted healthier patients. Very interesting journey this has been.

    Being self employed has been the greatest personal growth experience of my life. In a good way.

    Thank you for liking my articles. I try to cover original topics with great graphics thanks to my wonderful photographer.

  • JR

    I think they’ll find that much, much, smaller ketamine doses are needed than what they are using now… it looks like they are doing about .5 mg/kg but it has an effect at a dose about 1/3 or 1/4 of that…

    … not that any one I know got a hold of some ketamine as a teenager, broke it up into 3 or 4 doses and took it once a month for period pain and found out their ptsd symptoms improved as well…

  • http://www.idealmedicalcare.org PamelaWibleMD

    We can not sit back silently and take the abuse any longer. As physicians, it is our moral duty to save one another.

    • Bruce

      I like your recent suggestion: Physicians should STRIKE against the corporate-bureaucratic abuse of patients and doctors alike.

      Doctors used to be independent, self-employed.

      But now, increasingly, things have been arranged so as to increasingly force them to become salaried employees of vast corporate private bureaucracies, reducing them to little more than [ultra-]high-wage workers, slaves to those private bureaucracis.

      Many doctors should, therefore, consider adopting the defensive weapons that other waged and salaried employees have adopted in the past, with SOME success in holding off the corporate destruction of their lives.

      Some doctors should try unionization, and MORAL strikes — strikes, not so much for higher salaries, but strikes against the corporations-imposed IMmoral working conditions of doctors, and the corporate assembly-line and other abuses of patients.

  • Sydney Ashland

    Yes, physicians are suffering from PTSD and they are getting sick themselves. I hear it all the time and it is heartbreaking. Time for us to attend to our physicians. Interesting that we use the term “attending” to refer to our physicians, yet they are given no time or space to truly invoke the energy of “attending.”

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes, who attends to physicians? Where and who can docs call when they are suicidal?

  • http://www.idealmedicalcare.org PamelaWibleMD

    As barbaric as bullfighting.

  • http://www.idealmedicalcare.org PamelaWibleMD

    What would be good ways of measuring that? Or judging compassion on applications and resumes?

    • Sydney Ashland

      Psychotherapy or counseling could be required or more social science classes in general. Rather than just highlighting hard science experience, community service and volunteerism could be yardsticks.

      • SteveCaley

        And realize that the “machine” reaches back into high school, and before. The more effective you are at in creating a “false self” that is a prodigy, the more likely you are to shine.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Most suffer in isolation. Most turn to nobody. Yet they give so much to others.

  • Guest

    Agreed.

  • SteveCaley

    We are building a society that human beings cannot live in. If humans cannot be doctors, then there will be no doctors – no matter how many iDoc apps are peddled.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Doctors may indeed be the canaries in the coal mines. What does it say about a civilized society when its healers are harming themselves?

      • Bruce

        It says that, not just too many individuals within the society, but the society itself, as a whole, is sick!

    • Yael

      Is it that humans can’t be doctors, or doctors can’t be human? Society expects so much from doctors, and the medical establishment expects much out of us as well. If we show one crack, one shred of vulnerability, the establishment takes advantage of that crack to tear us to pieces and destroy us. To survive as physicians, we must have that wall… and ultimately, some of us crumble under that very wall because there is no proper foundation.

      • SteveCaley

        Society eats so many people alive in so many fields. Look at our entertainers. They are in golden cages, many of them. I have had the opportunity to see known entertainment stars for medical visits. They are coddled by their handlers, but they are performing animals; and when they lose their tricks, they are discarded. Look at Michael Jackson. He was a 50-year-old that never got within a stone mile of normal.

        • http://www.idealmedicalcare.org PamelaWibleMD

          At some point we have to agree to be victims.

          • Bruce

            Kudos to you, Dr. Wible, that you have demonstrated in action, in practice, and called so many other doctors’ attentions to, the fact that they need not “agree to be victims”; that they CAN escape corporate victimization, and strike out on their own, e.g., with their own “ideal medical clinics”!

          • http://www.idealmedicalcare.org PamelaWibleMD

            Healing comes in many forms. No right or wrong way to heal BUT docs must first claim that they are victims and only they can change that. We must consent to being victimized for it to continue.

            Of course, doctors who are victims teach patients to be victims. We are their role models.

    • Bruce

      This situation has arisen, in part, because we as a society have allowed a magnified profit motive — the malignant profit motive of parasitic corporate private bureaucracies — to hijack medical care in this country.

      These private corporate bureaucracies cannot exist on the basis of “country doctor” profits.

      They require VAST quarterly profit-flows, to feed the ever-increasing voracious appetite of the Wall Street 1%.

      Healing, health, wellness is not what motivates these corporations.

      If the many are healthy, if the many are healed, if the many are achieving ever-higher levels of positive wellness, then these corporate bureaucracies are approaching profitlessness.

      They only make a profit if the many get sick.

      Their super-profits only continue if the many STAY sick.

      • http://www.idealmedicalcare.org PamelaWibleMD

        The cure? DISINTERMEDIATION ~ remove the middle man ~ covered in my TEDx talk.

  • SteveCaley

    America tolerates a beastly aggressive attitude in its interpersonal relationships. In many cultures,, our status quo in behavior is considered belligerent. That’s why people are unnerved by Americans elsewhere -we’re used to hostility and conflict.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Solution?

  • Geoffrey Koerner

    Hmm, maybe we should look at where the Taiwanese went and see what good they found.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Ah. . a good weekend research project for you Geoffrey. :))

      • Geoffrey Koerner

        ….and so I did! “Taiwan Takes Fast Track to Universal Health Care”, an NPR article from 2008, gives a quick overview of some of the nifty, sensible, and sane things the Taiwanese have done on the administrative side of things that I believe deeply support the sanity of the doctors and patients.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Aha! Will check that out . . . Thanks!!

  • Geoffrey Koerner

    Lori, I think you phrased this so well. Thanks for sharing.

  • SteveCaley

    Naw. I think some folks are made with a natural “no-kill switch” in their minds that prevents them from doing it, even if they’re stressed enough to. Don’t insult your guts, SP.
    My career path could have been really whiz-bang and zoom if I didn’t have a set of morals holding me back. Could have been WAY more wealthy and successful, whatever that means. I’ve never seen a headstone that said, “Thanks for all the striving and overtime and great business connections, Dad!” That tells ya something…

    • Bruce

      I bet that your “set of morals, holding me back” has saved you from a “wealthy”, empty life of repressed self-loathing and meaningless “status”. The kind of “success” that comes from “gaining at the expense of harm to others” is like the “vintage beverage” experience of sucking from a cess pool: ‘SUCK-CESS’!

  • http://www.idealmedicalcare.org PamelaWibleMD

    I think there are pockets of despair in all fields. The standard path through medicine (PA or MD/DO) leads to assembly-line medicine and (at least for me) a lot of heartache. I was never able to be the kind of doctor I had imagined while captive on a treadmill. Those who are happiest seem to have figured out a way to have more autonomy and time to develop patient relationships. Also helps to be in a high reimbursement and low malpractiice zone. There are so many factors. Your daughter should identify what exactly she wants to do and then pick the best career for herself. Don’t chose a career based on fear. PAs would have less autonomy that doctors most of the time. She is welcome to attend my retreat for free next week (waived tuition):
    http://www.petgoatsandpapsmears.com/retreats.php

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thank you for your empathy and insight. I hope you will share this piece with oner patients. Healing is a collective effort.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Why are we so scared?

  • http://islanddirectcare.com Chap Caughron

    Dr. Wible, great work! I was recently approached by someone inspired by your work who is now helping physicians make transformation in their lives. She was intrigued by my practice in Galveston, Texas and mentioned that it is very similar to yours (IslandDirectCare.com). I too am inspired by your work but have to disagree with the notion to mandate any particular services. An act of kindness can not be forced, and we will not reach salvation through legislation. In many ways, it is myriad senseless rules and regulations that have made the situation for physicians and their patients so difficult. I work hard every day to care for my body, mind, and spirit to serve as a leader. The last thing that I need is another unfunded mandate but rather peer encouragement to be the change I want to see. The direct primary care model is incredible for patients and doctors. I am excited to practice medicine again. Thank you again for creating these necessary dialogues.
    Chap Caughron, MD

  • http://www.idealmedicalcare.org PamelaWibleMD

    Could it get any worse. I guess it can in Mexico. No “minor beatings” here . . . yet.

    Anyone in US sustained a minor beating at work?

  • Suzi Q 38

    “…..I love the idea of being intimate with patients, but I have felt that sometimes when I open myself up to patients, I get burned…..”

    How so? Do they eventually expect more time than you can give? How do you get burned?

    • http://www.thepatientdoc.com The Patient Doc

      Well they expect more time or favors. They expect they can have whatever they want as soon as they. They start calling me by my first name. They start asking me to do things Im not comfortable with. And when they dont get what they want they become very angry cause they had felt entitled. I think one of the biggest betrayals was when I shared with a patient that I had lupus because she was crying that her daughter was just diagnosed. I said I would help her daughter, get resources for her, even talk to her. I asked my patient to keep it a secret so mh bosses wouldn’t know. Eventually she asked for paperwork to be filled for her daughter who I had not examined recently, and when I said I couldnt without seeing her she complained to admin and told them I had lupus.

      • Suzi Q 38

        “…Eventually she asked for paperwork to be filled for her daughter who I had not examined recently, and when I said I couldnt without seeing her she complained to admin and told them I had lupus.”

        I am so sorry this happened.
        That lady should have never done what she did. Some people have no morals and have some nerve.

        I understand why you are very careful not to get too friendly anymore.

        We are not all like she was, thank goodness.

      • DoubtfulGuest

        Wow, that’s a doozy of a betrayal. I’d feel the same way, reluctant to trust anyone. I was wondering, too, so I was glad Suzi Q 38 asked. Sometimes we patients make social blunders and it helps to hear what not to do, for prevention. But this kind of thing is a whole other ballgame.

  • Sharon

    These stories are tragic all of the way around. I can relate to many sentiments shared, including the shocking disappointments with the realities faced, particularly in today’s medical climate. I am so sorry for your loss….everyone’s loss.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Nobody needs to suffers alone. Please call a colleague. Our trauma is shared. If you can not find a colleague to talk to, please call me. http://www.idealmedicalcare.org

  • Bruce

    Soldiers — socially idealized as heroic, patriotic defenders of our freedom, and of the freedom of others — are lately dying by their own hand in record numbers.

    Physicians — socially idealized as highly educated, highly paid, highly socially contributory masters of the healing arts and sciences — are also lately dying by their own hand, in record numbers.

    It seems we have a rash of suicides lately where people’s identities and self-esteem are based upon social ideals, which used to be true(r), but which have been replaced lately by a reality that has become sordid instead.

    • http://www.idealmedicalcare.org PamelaWibleMD

      We have lost connections with ourselves in modern society. What are we working for? What are we fighting for? What are we living for? Many people have lost their way.

  • Bruce

    You said it — the medical students/doctors shoulder all of the educational DEBT, most of the RISK, and most of the LAW SUITS, while the conglomerates, insurance companies, pharmaceutical giants, etc., abscond with most of the PROFITS, and doctors and patients together enter the quicksand of the resulting “sickness unto death”.

  • SteveCaley

    You are not alone, you are not to be ignored. Being a person, a human being in medicine, can be exquisitely painful. The paradox is those who surrender their humanity seem to be getting along quite painlessly, thank you very much.
    The worse the burn, the less the pain….

  • http://www.idealmedicalcare.org PamelaWibleMD

    Men do not even like to ask for directions when lost in a car. How likely is it that a male doctor would ask for mental health help? A lot less likely. Ya know, many men do not even go to the doctor unless they are near dead or their wives make the appointment and force them.

    Yes. Bring the services to them. With no stigma. Normalize mental health and allow docs to be human.

    Thank you so much for clarifying PTSD and Betrayal Trauma. Good to know and spot on. And thank you for wanting to help. We need you.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Shelters for battered doctors. I really like that image. And MUCH needed.

  • http://www.idealmedicalcare.org PamelaWibleMD

    You are the majority. You were never alone. Though I’m sure you felt isolated. As I did in the past. I am trying to give doctors the help that I needed and never could find during med school and beyond.

  • DoubtfulGuest

    I wish the public was more aware of this. It seems quite a few people mistakenly think that doctors would have all the connections to get the best care, confidentially. The ‘physician help’ programs are often a cover for disciplinary processes, aren’t they?

    I wouldn’t hesitate to trust a physician who had sought counseling. It’s not my business anyway, but in general I just see it as a responsible adult way to cope with our problems. I also spent a lot of time in therapy and overall it helped a lot. Everyone should be able to get that kind of care with no negative consequences.

  • http://www.idealmedicalcare.org PamelaWibleMD

    I can understand your fear. You must pursue your dreams, your life’s calling. Healing is a deep spiritual calling for most. Having awareness of the wounds that one may sustain in training will help you prevent falling prey to the (unnecessary) suffering. Some recommendations:

    1) There are more humane medical schools and more humane residency programs. Choose those over “name brand” schools that may be less supportive of student mental health.

    2) Keep debt level low (get scholarships, maybe do loan repayments through health service programs) as high debt often keeps docs in jobs they hate and they end up feeling trapped.

    3) Never sign your life away on a contract with a third party or employer that is abusive and/or devalues you.

    4) Have mentors in medicine who are happy and well adjusted.
    I’m here if you need me. 541-345-2437 – call anytime.
    (some on list may not agree that I am well adjusted :)

    5) Be integrated. Stay centered, grounded. Do not let anyone kill your spirit, shut down your heart.

    6) Remember: You can only be victimized if you allow it.

    ~ Pamela

    • http://jarederivative.tumblr.com/ Gerard

      Thanks, Pamela. :)

      I wont let life beat me down to my knees. I just wont let it. :3

      • http://www.idealmedicalcare.org PamelaWibleMD

        Patients are literally dying for doctors who will stand up against all the abuse and be real healers.
        All this abuse just trickles down to poor patient care. And doctors dying far too young.

        • NDfollowingTrueSelf

          This is how to be truly busy. Treat each patient like you wish yourself to be treated. Why? Why do you want to do this? If you don’t know with a deep passionate answer that make me laugh or cry, find our first, go explore, find yourself and save yourself some time and money.

          • http://www.idealmedicalcare.org PamelaWibleMD

            There is a lot of talk about “integrative medicine” and the ultimate way to practice integrative medicine is not to dissociate from yourself. Be an integrated person who did not lose your heart and soul in your training. That is what it means to be human. How can we provide health care when we are the walking wounded?

      • http://www.idealmedicalcare.org PamelaWibleMD

        Here is a talk I just gave to medical students. This will inspire you to continue on your nobel journey into our beloved profession:

        http://www.idealmedicalcare.org/blog/create-your-ideal-clinic-dr-wible-speaks-at-oregon-college-of-oriental-medicine/

  • http://www.idealmedicalcare.org PamelaWibleMD

    If doctors are victims, patients learn to be victims. If doctors are discouraged, patients learn to be discouraged. If we want happy, healthy doctors, why not start by filling our clinics and hospitals with happy, healthy doctors?

    • NDfollowingTrueSelf

      Well said Pamela. You have the true passion and heart of a healer.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Resonates with me. You are in the middle of the bell curve as far as I can see. Medical training and practice have real emotional and spiritual (as well as physical) impacts on those who choose to be healers. And there is a huge lack of transparency and help for those who suffer. The norm is to fake it. Pretend to be happy. Pretend you love your job. And then when you off yourself one day, everyone seems shocked because nobody saw it coming.

  • http://www.idealmedicalcare.org PamelaWibleMD

    I do have a solution piece to physician suicide that Kevin will run on Monday. Here is a preview:

    Physician Suicide Etiquette: What to do when your doctor dies suddenly:

    http://www.idealmedicalcare.org/blog/physician-suicide-etiquette/

  • http://www.idealmedicalcare.org PamelaWibleMD

    Nearly 1,000,000 Americans will lose their doctor to suicide n 2014.

    This IS a public health crisis.

  • Mary Riley

    I was so happy to find this article, healthcare providers that I meet feel under siege. It is good that this topic is out in the open and discussed. This is a tragedy beyond words. Doctors as well as other healthcare providers should be revered and respected. Currently, they are exhausted and disinterested due to work demands that overwhelm.

    • http://www.idealmedicalcare.org PamelaWibleMD

      What does it say about a civilization when its healers are harming themselves?

    • http://www.idealmedicalcare.org PamelaWibleMD

      Mary ~ Please share this blog with others-especially those in health care. Thank you for caring. <3

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thanks for sticking with your beautiful wife. She deserves to be a real doctor and not a factory worker on an assembly line. Hugs to Yvonne! So proud of you both!! :)

  • http://www.idealmedicalcare.org PamelaWibleMD

    I’ve always felt to heal my patients, I had to first heal my profession and help my colleagues.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Like building a house without a foundation. The doctor-patient relationship IS the foundation of health care.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Don’t give up your dreams. Call me anytime you need help. 541-345-2437. :) Pamela

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thanks Randy! Appreciate all your support over the years.

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