Last Fall I had the opportunity to attend TEDMED as a TEDMED Scholar, and one presentation in particular stood out for many attendees in the medical profession - Dr. Pamela Wible presented on the topic of physician suicide; a talk so powerful it grabbed the attention of the American Medical Association, was cited in Globe and Mail, and is now the inspiration behind a documentary on physician suicide called "Do No Harm." Her talk, as well as the others, is available here.
Like Dr. Wible, other physicians, and medical educators, have spoken out about their own experience with physician wellness. It is a topic relevant to those in the healing professions but also for anyone who has ever been a patient - it can affect quality of care and become a health systems issue. I had a chance to chat with Dr. Wible about this difficult topic, and garner some of her ideas for ways to address it. This article is the second of a three-part series interviewing engaging speakers from TEDMED -- speakers that aimed to push the envelope in their work, and innovate the world of health and medicine today and into the future.
[Dr.Pamela Wible speaking at TEDMED. Palm Springs, California. November 2015. Photo Credit: Sandy Huffhaker]
AK: Thank you for sharing your incredible talk at TEDMED last fall, and your very unique introduction to the profession! So, what inspired you to give a talk on physician mental health and suicide? What are some important statistics that we should know?
PW: My TEDMED talk was inspired by the hundreds of letters I've received from suicidal docs.
Many are published in my new book, Physician Suicide Letters -- Answered. I lost both doctors I dated in med school to suicide. We've lost eight physicians in my town to suicide (three in 18 months). More than one-million patients in the United States lose their doctors to suicide each year. This is a public health crisis.
Even more startling is we are not collecting the data. Researchers estimate we lose more than 400 doctors per year in the U.S. to suicide (an entire med school) and 150 med students yearly. We're a highly regulated profession. Doctors are tracked endlessly and publicly shamed if we veer off course in any way, and if we die by suicide, suddenly it's like we never existed.
AK: We know that the medical profession is centuries old; but, arguably, physician wellness issues may be as old as the profession itself. Why are they only coming to light now?
PW: The numbers of deaths speak for themselves. Social media and public pressure for transparency in healthcare are moving the conversation forward. Reductionist medicine, the foundation of Western medical education, has a fatal flaw. The opposite of holistic medicine (which integrates mind, body, and spirit), reductionism leads to the disintegration of mind, body and spirit of our healers. Medical student and physicians are wounded by the very educational system that claims to help them deliver health care. The intergenerational emotional wounds lead to a culture of bullying, hazing, abuse and ultimately despair, depression, and even suicide of our doctors. Physician suicide is a canary in the coal mine - the extreme result of many of our doctors struggling with occupationally-induced wounds with nowhere to turn. The way we describe burnout should also be revisited - I discuss more about this in these videos.
AK: Something that struck me in your talk, and something I had some difficulty understanding, was how you mentioned that we overly emphasize resilience training - for example meditation classes, and that by nature (in order to get through all of the requirements to be accepted and succeed in medical school) most physicians are resilient. Instead you urged the audience to look at other factors. Can you expand on that?
PW: The cycle of healthcare abuse impacts us all. Abused medical students become abused doctors who may one day harm patients. How can we give patients the care we've never received? Sleep deprivation, bullying, hazing is the norm in many schools and hospitals. This has disastrous consequences for human health of our students, doctors, and patients. Nobody wants a sleep deprived physician who has PTSD from training to be controlling their ventilator. After surviving a 100-plus hour work weeks, we don't need more resilience, we need more resistance to abuse.
AK: The media and some reports describe that it is not unusual for physicians and trainees to be, as one prominent physician thought-leader put it, 'taught to run away from our emotions, even though we can't hide from them.' But the culture of medicine is, by nature, hierarchical, and can serve a purpose from an evaluative point of view. Also, the hours required are often necessary to reach a level of competence (up to 10,000 to be a 'phenom'). How can the profession balance the need to train physicians well with avoiding some of the pitfalls you describe?
PW: The current medical culture glorifies self-neglect. The doctor who can perform the most surgeries on the fewest hours of sleep without eating or bathroom breaks is revered. Medicine is an apprenticeship profession. We learn by studying the doctors ahead of us. If our superiors are abusive, jaded, cynical that creates a future physician workforce that emulates those physicians. Throwing scalpels at students, publicly demeaning students as described in this video does not yield healthy doctors. We need to foster a compassionate and caring learning environment, where students can meet their basic physiologic needs (like eating and sleeping).
AK: Another interesting analogy you provided in your talk was comparing the "suicidal doctor" to a "barefoot shoemaker" -- it's a concept that sounds illogical. Why might non-doctors have trouble understanding why physicians can be "unhealthy," particularly when it comes to emotional wellness? How can non-physicians be engaged in the issue of of physician mental health and suicide?
PW: Across North America (and arguably the world), our doctors are jumping from hospital rooftops, overdosing in call rooms, found hanging in hospital chapels. No medical school wants to be known as the suicide school. No hospital wants to be number one for interns jumping from rooftops. No one wants to become a doctor -- to kill themselves. It's the ultimate oxymoron: the barefoot shoemaker, the starving chef -- the suicidal doctor. Non-doctors have no idea what medical school feels like for a student. Many doctors describe training as a soul crushing boot camp, a dehumanizing nightmare. The best way to change this dehumanizing culture is to start treating doctors as human beings (who bleed, suffer, cry, get divorced, feel depressed when they lose a patient). The public needs to have a realistic understanding of who we are.
[Book Cover: "Physician Suicide Letters" by Dr. Pamela Wible. Photo Credit: GeVe, graphic design: Kassy Daggett]
AK: You've raised some really interesting points, and there has been a lot of media attention about physician wellness lately. So, it seems this issue is everyone's radar, which is a good thing. You have clearly been involved in this area for some time, so say a medical trainee or their loved one is reading this right now, where else might you direct them to find more information about physician suicide and available supports for trainees and their family members?
AK: I'll ask a different side of a question that was already asked by Dr. Sinsky in your AMA interview. You describe how you help physicians design an "ideal practice," one in which they are eager to get to everyday, where the environment is supportive, and colleagues are collegial. Say you are tasked with improving the systems you describe - one that maximizes satisfaction of everyone involved. What might this framework look like? And, more importantly, is it realistic?
PW: Model what works. Study programs that produce happy doctors and learn from what others are doing right. I'm happy to help any Dean or med school. It is possible to graduate happy doctors! Let's work together and make this happen. It's not costly or complicated to end bullying, hazing, and abuse. Its been outlawed from elementary schools to fraternities. Why not residencies? Why not medical schools?
AK: I'd like to shift gears a bit if that's ok. If you were presented with a magic (repurposed) genie lamp that could grant you three wishes to improve the well-being of doctors today, what would those be?
PW: One, stop bullying, hazing, and the culture of abuse in medical education. Two, bring suicided medical students and physicians back to life so they can be the amazing healers they were born to be.
Three, embrace each other. We are spiritual beings having a finite human experience. Let's treat others as the sacred, beautiful people we are in medical training and beyond so that we can all live our dreams fearlessly.
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