The scary reason 1 million Americans can never see their doctors again

Medical school knocked me to my knees. I haven’t been the same since. Even though I still have a sparkle in my eyes and joy in my heart, a piece of me is missing. I can never get it back. I’ve tried. My innocence is gone.

Like most students, I just wanted to help people. I wanted to heal the broken world, the injured hearts and souls of patients who would one day entrust me with their lives. Instead, I nearly lost my own life. The memorization-regurgitation method of medical education disturbed my creative, non-linear mind. I studied constantly—spitting back medical minutiae for multiple-choice tests. I’m an average test-taker, though I excel with patients. I’m happiest helping people.

 I cried my way through the first year of medical school. 

But it’s difficult to be happy (or to help people) in a medical culture that condones hazing, bullying, sexual harassment, and teaching by public humiliation. In my school, there seemed to be no end to the filthy jokes that demeaned female patients and classmates. In lectures, my instructors actually made fun of vegetarians for eating “health food.” When I protested the dog labs (as first-year medical students we had to kill dogs), the dean diagnosed me with “Bambi Syndrome.” I was belittled because I cared—about animals, about people, about my own health, and about this planet we call home.

I cried my way through the first year of medical school. As long as my tears kept flowing, I knew I would be okay. Crying meant that I could still feel pain. If I stopped crying, I thought I would go numb. One night I cried so much that I awoke the next day with my eyelids swollen shut. I could no longer bear to see the brutality.

I survived by clinging to my dream of being a caring family physician, of making house calls, of being a trusted and loving neighborhood doctor. I graduated from med school, completed residency, and got a job. I hated it. So I moved to another clinic. Then another. And another. After a decade of seven-minute visits at assembly-line clinics, I was nothing more than a factory worker. I felt like my dream was dead.

I wanted to die.

And, I thought I was the only doctor who felt this way.

 After a decade of seven-minute visits at assembly-line clinics, I was nothing more than a factory worker. 

Then I got a crazy idea. What if I asked for help? Not from the profession that wounded me. Instead I asked patients: “What is ideal health care? What kind of doctor do you want?”

They told me that an ideal doctor is happy, has a big heart and a great love for people and service. They described an ideal clinic as a sanctuary, a safe place, a place of wisdom with fun flannel gowns and complimentary 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!

I started writing and speaking about my dream-come-true clinic, how I survived med school, and how I recovered from my occupationally induced depression and suicidal thoughts.

Then something weird and unexpected happened. I started getting letters from suicidal medical students and doctors. I wasn’t the only one who had felt this way!

Each year more than one million Americans lose their doctors to suicide, and nobody ever tells patients the truth—the real reason they can’t see their doctors ever again.

Nobody talks about our doctors jumping from hospital rooftops, overdosing in call rooms, hanging themselves in hospital chapels. It’s medicine’s dirty secret—and it’s covered up by our hospitals, clinics, and medical schools.

 [Physician suicide] is 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 student wants to become a doctor in order to kill themselves. It’s the ultimate oxymoron: the barefoot shoemaker, the starving chef, the suicidal doctor.

So what the hell is going on? Why is the plague of physician and medical student suicide such a secret? Why am I the one piecing this together? 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 did both doctors I dated in med school die by suicide? Why did eight doctors kill themselves—just in my sweet little Oregon town?

There are answers. Finding them requires being willing to look at some very disturbing facts. It also requires the willingness to engage with people who have experienced and who continue to experience a great deal of pain. So I keep talking and writing—and listening for the truth. And because I’m listening with my heart and soul 24/7, my cell phone has turned into a suicide hotline and I’ve received hundreds of letters from suicidal physicians all over the world.

You may be wondering why so many people who want to help people end up killing themselves. That’s why I wrote this book.

Here’s a sneak peek inside:

December 3, 2015

Dear Dr. Wible,

I’m not sure you read your [Facebook] messages but feel compelled to thank you. I was finishing term two of med school and had a bottle of Xanax in my hand. I was ready, as so many of us are. I took three then three more and came across this link, “How to graduate medical school without killing yourself,” which I believe may have saved my life and a couple of close friends who are also suffering. I’m near the top of my class and praying for death to escape the trap I’m locked into. I was in true delirium from lack of sleep and fear of failure. Studying in my sleep and waking up every hour in panic. Med school is doable but why must it be taught in this format? I read your stories and I’m just in shock how many others feel like I do or I feel like they do. Please keep sharing. You are saving lives, friend.

Chris

I’ve been receiving letters like this for three years. Not all have happy endings. I also receive letters from families who have lost their brilliant, compassionate children—during medical school. And the suicides are not isolated to student doctors.

March 23, 2015

Pamela,

I am not surprised at the number of suicides among medical practitioners. I was a nurse for years and went back to school to be a physician assistant. There is so much abuse handed out in training. At the time I was in school, we still had some thirty-six hour shifts. It was difficult. At least at the university that I attended they had a buddy program. All of the first-year students were given a third-year student to help show us around and be a mentor. The problem was that before we even started our first classes, my mentor committed suicide. She was in her car on her way home still close to the hospital when she stopped at a red light then picked up a gun and shot herself in the head. The person behind her was a physician at the hospital. These things are not that unusual. It’s a sad state of affairs.

Patricia

These suicides are not isolated to students of medicine, to physicians, to physician assistants. The health care cycle of abuse impacts everyone in our hospitals, clinics, and medical schools. Including patients.

February 12, 2015

Pamela,

When I share what happens in our academic medical center with my non-medical friends, they are astonished and disbelieving. The level of bullying in my institution is amazing, including a faculty member seriously suggesting that a resident’s mistake was so heinous that he should “off ” himself. When I speak about changing the culture of medicine, my colleagues think it is impossible to support financially. In our institution, money is a deal breaker. We have a patient wellness program with financial/insurance premium incentives, but as far as I know, no physician wellness program with incentives. I will watch what happens with you with interest. Keep doing it.

Vicky

So what are the answers? How do we stop the cycle of institutional abuse? Physician suicide hotlines inside our hospitals? Resilience training for our wiped-out doctors? Meditation classes for medical students? Advocacy centers for mistreated patients?

February 13, 2015

Vicky,

It’s not costly or complicated to end bullying and hazing. It’s been outlawed at elementary schools, fraternities, and pretty much everywhere—except health care. How much does it really cost to be kind and compassionate? How much does it cost to replace hundreds of doctors who off themselves?

Pamela

I never went looking for suicides. These suicides found me. I have many suicide letters. This book contains only a small sample. Amid the letters and calls from struggling doctors, I also receive heartbreaking letters from patients like this one:

“Dear Dr. Wible, I just got home from another insulting, degrading appointment with my doctor. I’m literally crying as I write to you. . .”

I called her. She shared her horror story. I shared mine. She never knew doctors could be suicidal. She never knew that 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?

 The health care cycle of abuse impacts everyone in our hospitals, clinics, and medical schools. Including patients. 

To all those who have been injured by our medical system, I am sorry. I am sorry that parents who had planned to attend their child’s medical school graduation instead attend their child’s funeral. I am so sorry that doctors wear forced smiles while living lives of silent desperation for fear of seeking help for their trauma. And I am so very, very sorry that patients receive the scraps we offer them as wounded healers. We all deserve better.

This cycle of health care abuse is a global phenomenon. Letters in this book are from Canada, Egypt, India, South Africa, UK, and the USA. There is no country in which medical students are immune from the effects of a traumatic medical education. There is no perfect health system in which doctors do not struggle to preserve their humanity and patients do not die for lack of care. There is no amount of money, no high-priced health plan that will guarantee that the doctor controlling your ventilator is not sleep-deprived or suicidal. We are all at risk.

So how do we stop the cycle of institutional abuse? Physician suicide hotlines inside our hospitals? Resilience training for our wiped-out doctors? Meditation classes for medical students? Advocacy centers for mistreated patients?

 How could she know that abused medical students become abused doctors who may one day abuse patients? 

We must decide if our goal is to help victims cope with abuse or to end the abuse. I choose the latter. It’s not costly or complicated to stop bullying, hazing, and abuse. It’s been outlawed from elementary schools to fraternities and pretty much everywhere. 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 are forced to change. I favor the honor system. But what if those in charge are not behaving honorably? What if our medical system continues to blame, shame, and publicly humiliate its victims? What if that same system continues to deny, lie, look the other way, and—all too often—engage in a deliberate, active, ongoing cover-up of the facts about physician suicide? What can we do to stop this? I believe we can force change by simply shining a public spotlight on physician suicide.

Health care abuse is an assault on us all, and the cycle of abuse will be perpetuated—until someone stops it. That someone is you. So take action. Speak up when you witness bullying or abuse. If you feel mistreated as a patient, write a letter listing your complaints. Make positive suggestions when possible. If all else fails, boycott abusive health care systems. Tell your doctor you’re no longer interested in supporting assembly-line medicine. Support ideal care for patients—and doctors.

Of course, some major institutional and legislative reforms are needed as well. Happily, we are starting to see a few proposals here and there—real steps toward curing our highly dysfunctional medical system. Some of those reforms are touched on in this book, such as the “Show Me Compassionate Medical Education Act,” sponsored by Missouri State Representative Dr. Keith J. Frederick.

 I believe we can force change by simply shining a public spotlight on physician suicide. 

Ultimately, however, we will not be saved by laws and regulations alone. The factor that will make it possible for us to achieve these desperately needed changes is the light of compassion and truth that shines in each individual. That light is in this book. It blazes in the words of the doctors, patients, students, mothers, fathers, friends, colleagues, and fellow citizens whose letters are presented here.

We can heal each other. I know. In my darkest moments, patients have healed me. As my patient Rachel wrote in the final letter, “Love never dies.” In my own journey to learn what leads to physician suicide and how we can prevent it, I know the truth of Rachel’s words. I have seen that there is a love that is stronger than life, and even stronger than death. This is the love that will fuel the inevitable transformation of medicine. This is the love that will save us all.

On behalf of those we’ve lost and those who are barely hanging on, I thank you for spreading your love and shining your light into this world. We need you.

This is an excerpt from Physician Suicide Letters Answered by Pamela Wible, MD. It was published on Jan. 11, 2016 and can be purchased at Amazon.com.

Image by Eva Blue on Flickr, licensed under CC BY 2.0.

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