Doctors and suicides: interview with Pamela Wible

My interview with Pamela Wible:  she is a family physician born into a family of physicians. Despite her parents’ warning not to pursue medicine, Pamela followed her heart only to discover that to heal her patients she had to first heal her profession. Fed up with “assembly-line medicine,” Dr. Wible held town hall meetings where she invited citizens to design their ideal clinic. Open since 2005, Wible’s innovative model has sparked a populist movement that has inspired Americans to create ideal clinics and hospitals nationwide. When not treating patients, Pamela devotes her time to medical student and physician suicide prevention. Named the 2015 Women Leader in Medicine. With Dr. Wible, I want to discover more about the “I don’t want to live anymore” by physicians. She is very clear in writing that if they suicide, is because they want to end their pain. For me, it is exactly the same conclusion: when people literally want to die, as we have already said, they can do it for a specific cause, like martyrs of an ideology or an ideal: if they don’t want to live anymore is because the pain and sorrow in unbearable.

MGM. Dr Wible, the suicide number of physicians in The USA is called the hidden epidemy. Well, now it is not anymore so hidden thanks to your extraordinary work.  Which are the basic causes of these epidemy?

She answers me asking to go and see:  What I’ve learned from 757 doctor suicides. Here, below I quote which are for me are some of the most important findings.

PW:  Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment.

Malpractice suits kill doctors. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court on TV, and in newspapers (that live online forever). We continue to suffer the agony of harming someone else—unintentionally—for the rest of our lives.

Doctors who do illegal things kill themselves. Medicare fraud, sex with a patient, may lead to loss of medical license, prison time, and suicide.

Doctors have personal problems—like everyone else. We get divorced, have custody battles, infidelity, disabled children, deaths in our families. Working 100+ hours per week immersed in our patients’ pain, we’ve got no time to deal with our own pain. (Spending so much time at work actually leads to divorce and completely dysfunctional personal lives).

Bullying, hazing, and sleep deprivation increase suicide risk. Medical training is rampant with human rights violations illegal in all other industries.

Sleep deprivation is a (deadly) torture technique. Physicians have suffered hallucinations, life-threatening seizures, depression, and suicide solely related to sleep deprivation. Sleep-deprived doctors disclose hospital horrors that kill or injure patients. Others die in fatigue-related car crashes after long shifts. Resident physicians are now “capped” at 28-hour shifts and 80-hour weeks. If they “violate” work hours (by caring for patients) they are forced to lie on their time cards or be written up as “inefficient” and sent to a psychiatrist for stimulant medications. Some doctors kill themselves for fear of harming a patient from extreme sleep deprivation.

Blaming doctors increases suicides. Words like “burnout” and “resilience” are often employed by medical institutions as psychological warfare to blame and shame doctors while deflecting attention from inhumane working conditions. When doctors are punished for occupationally induced mental health conditions (while underlying human rights violations are not addressed), they become even more hopeless and desperate.

Sweet, sensitive souls are at highest risk. Some of the most caring, compassionate, and intelligent doctors choose suicide rather than continuing to work in such callous, uncaring and ruthlessly greedy medical corporations.

Doctors can’t get confidential mental health care. So they drive out of town, pay cash, and use fake names to hide from state medical boards, hospitals, and insurance plans that ask doctors about their mental health care and may then exclude them from state licensure, hospital privileges, and health plan participation

Doctors have trouble caring for doctors. Doctors treat physician patients differently by downplaying psychiatric issues to protect physicians from medical board mental health investigations. Untreated mental health conditions may lead to suicide.

Doctors’ family members are at high risk of suicide. By the same method. One physician died using the same gun his son used to kill himself. Kaitlyn Elkins, a star third-year medical student, chose suicide by helium inhalation. One year later her mother Rhonda died by the same method. At Rhonda’s funeral, I asked her husband if he thought his wife and daughter would still be alive had Kaitlyn not pursued medicine. He replied, “Yes. Medical school has killed half my family.”
MGM:   Do you think that the private and insurance system that you have in USA, in comparison to a functioning public system, might be a risk factor for this?

PW: Yes, only because it adds another onerous and dysfunctional layer of bureaucracy on top of a failing medical model. And some of the way that the FOR-PROFIT system works here is in WITHHOLDING care from those who need it.

Assembly-line medicine kills doctors. Brilliant, compassionate people can’t care for complex patients in 10-minute slots. When punished or fired for “inefficiency” or “low productivity” doctors may choose suicide. Pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients. Many doctors cite inhumane working conditions in their suicide notes.

Medical board investigations increase suicide risk. One doctor hanged himself from a tree outside the Florida medical board office after being denied his license. He was told to “come back in a year and we will reinstate your license.” Meanwhile he lost everything and was living in a halfway house.

MGM:  Therefore, we have to keep on defending an ecofriendly health care service, with proper paces and work load and time to establish nurturing relationship with patients, their caregivers and all carers. In UK, where there is a public NHS, there is a statement  in which it is declared that the people who work in  health care have a faster access to lethal drugs, and therefore can  commit suicide in an easier way. Do you believe in this explanation?

PW: Yes, especially with anesthesiologists, as here in United States, Male anesthesiologists are at highest risk.  They die most by overdose. Many are found dead in hospital call rooms.

MGM: So look out for anaesthesiologists as a possible category at risk of fragility. Also in Italy, where there should be a public health care system, however with huge cut of resources and an average mean age of the physicians class of 51 years, we do have an alarming situation on suicide, with a double rate of self-inflicted death than in the average population. Dr Wible, do you think that some factors are universals, as being in touch with pain, the sorrow and the death of the patients?

PW: Yes. Vicarious trauma and Post Traumatic Stress Disorder (PTSD) are real for doctors. This is something that I think every emergency physician and neonatologist and surgeon have probably experienced. I consider myself fortunate in family medicine. I don’t feel that I’ve had much of this. However, being on the phone with a neonatology fellow recently who called me wondering if it was normal for her to have like panic attacks and start crying in the middle of the night, when she . . . I asked her kind of what she’s doing. Well she’s flying around in a helicopter, picking up half-dead babies… I think that would cause anyone on the planet to be having panic attacks.  This is occupationally-induced PTSD, vicarious trauma and there’s no help. … This is why these people are crying to me on the phone at midnight wondering if they’re normal. You’re normal. It’s a normal reaction if you’ve seen that much trauma to have panic attacks.

MGM:  Do you think that there is a bias in teaching in our academies of Medicine and Nursing, teaching the possibility to save everybody, not talking enough of the natural cycle between life and death and not considering anymore death as a limit? Like a superhomistic approach in which death of the patient becomes a Taboo (with so much available enabling technology)?

PW: Yes, Academic distress kills medical students’ dreams. Failing boards exams and being unmatched into a specialty of choice has led to suicides. There is really is a lack of leadership in medicine. What’s ending up happening is you have the old guard just preparing people to do it the same way we’ve always done it because that’s how we’ve always done it. The world is not what it was 20, 30, 40 years ago. There are so many things that have changed in medicine. To have this knee-jerk reaction to lock medical students back into this regurgitation-memorization cycle when we can obviously access things at our fingertips. We need to have the joy of learning. We need to stop pushing people to continue in a system that’s obviously failing and imploding, right? We need new thinking. We need new ways of training physicians. We need to stop terrorizing them and violating their human rights.

People don’t make in into medical school without determination, intelligence, compassion and to beat this out of them—a love of learning and a love for humanity—is absolutely the wrong way to train people. I’m going to give some examples of two people who’ve written to me here lately.

One says, “I had married the year before residency, and for the first two years, I was either at work or asleep, so I didn’t see my wife. It was the start of the erosion of the relationship that led to divorce years later. I also suffered permanent health problems, some extreme sleep deprivation. Prior to residency, I slept fine eight hours a night and had regular bowel movements. Since my internship, I developed lifelong severe insomnia and went for decades on four to five hours of sleep per night as well as severe constipation using the toilet about every five days.”

MGM:  Dr. Wible provides a lot of commentary of harsh pressure, difficult exams, bullyish situation in academy: beyond this,  in my opinion lessons are overwhelmed by a technocritical approach and humanities, with the development of empathy, self-knowledge and knowledge of the others as “people” and not just as “broken machine” is one of the possible cause of this depersonalization, alienation which could lead to suicide.  Dr. Wible, in your website you mention about possible Ideal medical care. Could you explain the basic concept of this Ideal Medical care? Does it have to do with the services to patients and physicians, as well to architecture of setting of care……?

PW: Simplifying the delivery of health care by removing the no-value added intermediaries and allowing patients and doctors to design their ideal medical clinics and hospitals. In hospital there should be a ball room, one could smell scents, colours should be everywhere, there should be one silent room to confort the pain and the sorrow. The food should be good. And much more‎.

MGM: At this point I ask our readers to write in this link how they would project their Ideal setting of care. We did it already for the very first time in 2004 and 2005 in an oncological department, where we asked to patients, their family members and doctors to design their hospital room, write the rules they want and they don’t want, and the best strategies for living together in the so called “constellation, patient, family and health care professional”. Please, reader leave your voice about your ideal World of Care.

Dr. Wible, You have organized retreats for physicians and for other health care workers. I think that this might be a wonderful support and help also for physicians and nurses of other countries: how are they organized?

PW: By myself. Bi-annually and open to anyone in the world who wishes to come. More here: Physician Retreat: Live Your Dream. I also offer smaller monthly retreats for individuals and small groups. This is a scheme of her course:

WEEK 1 ~ Patient Success Secrets. Claim your vision, define your ideal client and learn tips & tricks to attract a ton of loyal patients for life.

WEEK 2 ~ Joy of Doctoring. Overcome fatigue with enthusiasm by turning work into play—and get PAID for having fun with patients.

WEEK 3 ~ Mentorship & Networking. Pair up with a mastermind partner & discover the benefits of asking for help.

WEEK 4 ~ Creative (& Cost-Saving) Business Strategies. Find unique office locations. Explore innovative staffing solutions. Get low-cost malpractice insurance & more!

WEEK 5 ~ Boost Your Self-Confidence Now! Expand your definition of what it means to be a doctor and break free from fear-driven medicine.

WEEK 6 ~ Build Your Community. Engage your town to help design, create and fund your clinic. It’s fun!

WEEK 7 ~ Financial Freedom For Physicians. Discover the top 12 business models and find the right one(s) for you. Decide whether to accept insurance.

WEEK 8 ~ Media & Marketing. Never waste money on advertising. Be media savvy & publicize your unique message for free.

WEEK 9 ~ How To Love The Stuff You Hate. Learn the key to painless refills. Always get paid for paperwork. Stop no shows. Never follow stupid rules—by making your own!

WEEK 10 Retreat! Create your personal action plan among your new found friends at the MOST BEAUTIFUL mountain retreat. Enjoy an off-the-grid, off-the-Internet experience for five days with NO CALL!!!!

MGM: I feel that some points can fit into the Italian health care services, but some other like the fact to be paid, is different, because I think that in Italy, doctors are well paid and that money is not the main reason for suicide. I love the idea to ask more money for any useless bureaucracy to fill in. And I love the idea to talk about Joy in the caring profession. Furthermore, the courage to stay offline for five days, to do a wash out period from overwhelming social and digital society, a little bit, like to get rid of possibly  most severe addiction of our age.

Dr. Wible, I have been watching your continuous honoring the suicides of your colleagues, keeping alive their memory. It’s a great sign of respect. Which are the effect of this behaviour in your colleagues and in the public opinion?

PW: I think others are now starting to realize that we have an epidemic and that this is truly a public health crisis. Cultural taboos reinforce secrecy and suicide is a sin in many religions. Islam and Christian families have asked that I hide the suicides of family members. Indian families often claim a suicide is a homicide or an accident, even when it’s obviously self-inflicted.

Media offers incomplete coverage of suspicious deaths. Articles about doctors found dead in hospital call rooms claim “no foul play.” No follow-up stories.

Medical schools and hospitals lie (or omit the truth) to cover up suicides—even when media and family report cause of death. Medical student Ari Frosch stood in front of a train, yet his school reported he died at home with his family. Though the family of psychiatrist Christine Petrich shared that she bought a gun and killed herself (after just getting her hair done and planning a surprise trip to Lego Land and Disney for her kids) on their GoFundMe page, her employer wrote she “passed away.” Shouldn’t the department of psychiatry take a more active interest in physician suicide?

Euphemisms cover up doctor suicides. Suicide is omitted from obituaries, funerals, clinics, hospitals, and medical schools. Instead we hear “passed away unexpectedly in her sleep” and “he went to be with the Lord.” Secrets will not save us. We’re unlikely to make a medical breakthrough on a hidden medical condition.

I’ve been shunned for speaking about doctor suicide. After being invited by the AMA to deliver my TEDMED talk, I was disinvited shortly before the event because they were “uncomfortable” with physician suicide.

Ignoring doctor suicides leads to more doctor suicides.

MGM: Thank you so much for having shared with us your knowledge and your opinion. Personally, I had spoken of this issue of suicide, in UK and in ITALY providing the statistics in USA, in class in this February this year with different kind of health care operators. Yes. Dr. Wible is right: talking of this topic bring embarrassment, and people attending the class at the beginning where saying: but it is USA, a complete different system. When I brought the Italian data, our double rate of suicides of doctors compared to the averages, well, people remained in silence, and they wanted immediately to change the topic.  As a sort of protection, but silence has to be broken, and a serious reflection should start to make better, our health care service and to improve lives of all people who days and night dedicate their life to our wellbeing.

Maria Giulia Marini

Epidemiologist and counselor in transactional analysis, thirty years of professional life in health care. I have a classic humanistic background, including the knowledge of Ancient Greek and Latin, which opened me to study languages and arts, becoming an Art Coach. I followed afterward scientific academic studies, in clinical pharmacology with an academic specialization in Epidemiology (University of Milan and Pavia). Past international experiences at the Harvard Medical School and in a pharma company at Mainz in Germany. Currently Director of Innovation in the Health Care Area of Fondazione ISTUD a center for educational and social and health care research. I'm serving as president of EUNAMES- European Narrative Medicine Society, on the board of Italian Society of Narrative Medicine, a tenured professor of Narrative Medicine at La Sapienza, Roma, and teaching narrative medicine in other universities and institutions at a national and international level. In 2016 I was a referee for the World Health Organization- Europen for “Narrative Method of Research in Public Health.” Writer of the books; “Narrative medicine: Bridging the gap between Evidence-Based care and Medical Humanities,” and "Languages of care in Narrative Medicine" edited with Springer, and since 2021 main editor for Springer of the new series "New Paradigms in Health Care."

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