TEDMED talk by Pamela Wible, MD, on the need to heal the medical profession
I love the three things that people fear the most: death, disease, and public speaking. Here's how it all started. At four, I was so talkative and bossy no babysitter would stay with me, so I tagged along with mom, a hospital psychiatrist, interviewing suicidal patients. Then she'd drop me off at the morgue with dad, a pathologist. He'd open up these big cooler doors and say, "Good morning. Is anyone home?" Then he'd introduce me to his patients as a doctor in training and leave me there talking. My first captive audience. Now, I'm a doctor and I'm speaking on behalf of thousands of doctors who couldn't be with us, but they're here in spirit. I simply ask that you open your heart to their words.
"Dear Mama and Daddy. I know you may not understand why I didn't seek help, but this choice makes sense to me. I know I would have been such a successful doctor and wife and mother. I love you so much. Your daughter, Kaitlyn." Date of death: April 11th, 2013. Cause of death: asphyxiation by helium inhalation due to untreated depression in medical school.
Each year, more than 1 million Americans lose their doctors to suicide. Across the country, our doctors are jumping from hospital rooftops, overdosing in call rooms, found hanging in hospital chapels. It's medicine's dirty secret and it's covered up by our hospitals, clinics, and medical schools.
No medical school wants to be known as the "suicide school." No hospital wants to be #1 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. Why? What the hell is going on and why is it such a secret? Why am I piecing this together between patients? I'm a solo family doc, yet somehow I've become an investigative reporter, a specialist in physician suicide. Why? Mostly because I can't stop asking why. Why both doctors I dated in med school died by suicide and why eight doctors killed themselves just in my sweet little town. I keep talking and writing and listening for the truth. Because I'm listening with my heart and soul 24/7, my cellphone has turned into a suicide hotline and I've received hundreds of letters from suicidal physicians.
You may be wondering why do so many people who want to help people kill themselves? Anna, a retired surgeon, writes, "Dear Pamela, I was happy, secure, and mostly unafraid until med school. I recall in vivid detail the first orientation day. Our anatomy professor stood before an auditorium filled with 125 eager, nervous, idealistic, would-be healers and said these words, 'If you decide to commit suicide, do it right so you do not become a burden to society.' He then described in anatomical detail how to commit suicide." What better way to bring shame to your alma mater than with a failed suicide? Alma mater means "kind mother," yet doctors describe med school as a soul-crushing bootcamp, a dehumanizing nightmare, my own personal Vietnam. Medical training is neither motherly nor kind.
"I love you, Mom. I'm sorry. Vincent." Date of death: August 25th, 1998. Cause of death: asphyxiation by hanging due to bullying, hazing, and sleep deprivation as an intern at a New York Hospital. Sleep deprivation is a torture technique. Fear as a teaching tool just teaches us to be afraid. I can help doctors, though there's one group I can't help: patients. From all over the country, they write me, begging me to find them caring doctors. How can we give them the care we've never received? "Dear Pamela, I definitely graduated med school with PTSD. It has changed me forever. I will never be the same again. We had two suicides and one murder, skull crushed with a bat and another serving life in prison for murdering a classmate after a delusional episode after not sleeping for a month. Please change medical education. We were so beaten down. It takes a lot for me to cry, but I cried all the time, along with everyone else, but we hid it from each other, of course."
Fact: We enter medicine with our mental health on par with or better than our peers. Suicide is an occupational hazard of our profession. "Dear Some, my family, I love you. To others who have been good friends, I love you too. This is just the end of the line for my particular train. Earth wasn't a great place for me. We'll see what else is out there. We'll miss you all. I'm sorry, for what it's worth. Love, Greg." Date of death: June 22nd, 2012. Cause of death: hemorrhage by transection of the major arteries to his wrists and ankles.
Okay, what happened here? Greg died just a few hours after being told not to follow his psychiatrist's safety plan. By who? By an agency with no physician oversight that controlled his medical license. Our medical schools, clinics, hospitals, and related agencies actually cause mental health conditions in doctors. Then they blame us and force us to release our confidential medical records, and in the end, they take our license, but it gets worse. "Dear Pamela, do you know what really hurts? The fact that anyone can look me up on the Internet and read my dirty laundry. I'm publicly shamed, punished for being ill. I will only know peace when I am gone. Maybe that's why my friend, an excellent psychiatrist, drives 200 miles out of town, pays cash, and uses a fake name to get mental health care." "Dear Pamela, you don't know how thankful I am for your article on physician suicide. I wanted to hug you after reading it. I had a really rough day. 130 outpatients, 60 emergency admissions, and a 12-hour shift. I'm a final-year internal medicine resident in one of the busiest hospitals in India. Two patients on each bed, two lying together on the floor, poverty, misery, pain all around. I've declared 12 patients dead in a day. I just don't feel death anymore. I just don't feel human. My uncle died recently. I felt nothing. This profession demands too much from us. I've thought of suicide a thousand times. The misery is too much for me."
I'm a perpetual optimist, yet after a decade of seven-minute visits at assembly line clinics, even I felt suicidal. I thought I was the only one. Then I got this crazy idea. What if I ask for help? Not from the profession that wounded me, so I asked patients. What is ideal health care? What kind of doctor do you want? They told me an ideal doctor is happy, has a big heart, and a great love for people and service. An ideal clinic is a sanctuary, a safe place, a place of wisdom with fun flannel gowns, complementary massage while waiting, where nobody is turned away for lack of money. I followed their instructions and opened their ideal clinic, the first clinic designed entirely by patients. My life is like a love fest now. My patients and I have inspired hundreds of doctors all across the country to open ideal clinics. At times, I feel like the happiest doctor in America until I get yet another call about a suicide or I read a letter like this.
"Dear Dr. Wible, I'm a patient who just got home from another insulting, degrading appointment with my doctor. I'm literally crying as I write to you." I call her. She shares her horror story. I share mine. She never knew doctors could be suicidal. She never knew she could be the victim in a cycle of abuse that began on day one of med school when her insulting doctor was still an idealistic student. How could she know that abused medical students become abused doctors who may one day abuse patients? How do we stop institutional abuse? Physician suicide hotlines inside our hospitals? Resilience training for our wiped out doctors? Meditation classes for medical students? Wait, is our goal to help victims cope with abuse or to end the abuse?
It's not costly or complicated to stop bullying, hazing, and abuse. It's been outlawed from elementary schools to fraternities. Why not health care? Medical culture and education must change, yet cultures and institutions don't change because we ask them to change, even when it's in their self-interest. They change when they're forced to change. I favor the honor system. What if those in charge are not behaving honorably? What if our medical system continues to blame, shame, and publicly humiliate its victims? Maybe it's time for us to give them a dose of their own medicine. How? By shining an embarrassing public spotlight on physician suicide.
On behalf of those we've lost and those who are barely hanging on, I want to thank you for shining your light into the darkness. Because if we all shine our lights together, there is no darkness to fear. But mostly I want to thank you for your courage, for following a fearless little four-year-old through the morgue and into the coolers to meet a few of her friends.