Physician Suicide

Discover Your Odds of Getting into Medical School
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BrCo

BrCo

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"Pamela Wible, M.D., is a family physician born into a family of physicians. Her parents warned her not to pursue medicine, but she followed her heart only to discover that to heal her patients she had to first heal her profession. So she decided to lead a series of town hall meetings throughout Lane County, Oregon where she invited her community to design their own ideal clinic. Open since 2005, Dr. Wible's community clinic has sparked a movement in which citizens are designing ideal clinics nationwide. Her model is taught in medical schools and featured in Harvard School of Public Health's Renegotiating Health Care, a text examining major trends in American healthcare. Dr. Wible is the co-author of two award-winning anthologies and the author of the bestseller, Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. She has been interviewed by CNN, ABC, CBS, and is a frequent guest on NPR."
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This woman is brilliant. Thanks for sharing this video. :)

I don't necessarily believe in everything she says, but it's an interesting and new perspective presented in a very effective manner.

I almost think that part of the reason her practice works so well is because she's such an engaging person. I also don't think this practice model is necessarily the best for every patient. Some people don't want to get 'intimate' with a physician who's about to do a pap on them.

EDIT: Getting back to the main point, physician suicide is probably due to a number of factors. I think this physician touches on one of them and makes a good argument for a solution. She's a bit of an idealist, so naturally there are some flaws. But she refutes a lot of them with her current successful practice model.
 
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I wonder how much of physician suicide/depression is a result of the profession, and how much is due to the population it attracts. We often see studies saying "X% of physicians are depressed/ contemplated suicide, which is Y% greater than the general population." Has there ever been a longitudinal study of medical potential medical professionals that follows them throughout their career? What if it was possible (not that I necessarily endorse it) that medicine attracts a population at greater risk for depression and suicide than the norm? There are various studies that show increased probability for self-destructive behaviors among high-intelligence individuals, could it be argued that the medical "suicide epidemic" is in part a result of this?

Regarding her ideas toward medicine, I believe they may be "good" in some ways, bad in others. For the patients she is able to see, it is positive, but spending 30-60 minutes/patient means she can see ~15 patients/day? Less since she states working only part time. That seems like a difficult sell as an "answer" to healthcare in the US, but rather limited to a way to improve care for middle/upper class patients mostly already able to receive basic care. Also it seems that the focus on emotional connection is less valid outside of primary care, IMO. I'd prefer a surgeon (or other procedural specialist) focused on enhancing procedural outcomes and not making a life-altering ****up rather than having a nice clinical demeanor.
 
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Her approach can't really address the need for more primary care physicians since it takes way too long to deal with just one patient.
Still, I agree with her attempts to reform the hospital setting to be more accommodating to patient anxieties.
I also like the idea of not having to go through all the "middle man". There's way too much administrative costs in medical care for instance... not to mention having to fill out all those ridiculous documents to defend yourself from legal action and secure your paycheck. :panda:

She took advantage of her autonomy to really improve her work environment. Maybe we can follow suit with areas other than family medicine.. :eek:
 
Whether or not it's best for the overall healthcare system is up for debate, but I agree, it certainly seems like she, and the patients she is able to see, are much happier.
 
I love Pamela Wible. She would be hated on SDN though.
 
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hydroxyurea said:
I wonder how much of physician suicide/depression is a result of the profession, and how much is due to the population it attracts. We often see studies saying "X% of physicians are depressed/ contemplated suicide, which is Y% greater than the general population." Has there ever been a longitudinal study of medical potential medical professionals that follows them throughout their career? What if it was possible (not that I necessarily endorse it) that medicine attracts a population at greater risk for depression and suicide than the norm? There are various studies that show increased probability for self-destructive behaviors among high-intelligence individuals, could it be argued that the medical "suicide epidemic" is in part a result of this?

Regarding her ideas toward medicine, I believe they may be "good" in some ways, bad in others. For the patients she is able to see, it is positive, but spending 30-60 minutes/patient means she can see ~15 patients/day? Less since she states working only part time. That seems like a difficult sell as an "answer" to healthcare in the US, but rather limited to a way to improve care for middle/upper class patients mostly already able to receive basic care. Also it seems that the focus on emotional connection is less valid outside of primary care, IMO. I'd prefer a surgeon (or other procedural specialist) focused on enhancing procedural outcomes and not making a life-altering ****up rather than having a nice clinical demeanor.
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According to studies, the entering med school population suicide rate is the same rate as everyone else in the general population. It's on the other side that it's much higher in our profession than others.
 
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I was told recently by one of our deans that about ~150 medical students commit suicide each year. That's about 1/school!

DermViser said:
According to studies, the entering med school population suicide rate is the same rate as everyone else in the general population. It's on the other side that it's much higher in our profession than others.
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Goro said:
I was told recently by one of our deans that about ~150 medical students commit suicide each year. That's about 1/school!
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I could believe that. I imagine the ones that actually don't commit suicide, there are many that have drug abuse/substance abuse issues. Quite honestly, if I have a son or daughter, I would absolutely never let them enter the medical profession thru the MD/DO pathway. If you look at the NYU grad above he was top of his class in med school and matched into IM at Columbia, so contrary to what one may think, even academic performance is not predictive. The profession in general is just very taxing and it's hard to fathom that as a premed no matter what volunteering experiences they have (which many are just notch in gun belt type activities that admissions committees salivate over for some reason).
 
DermViser said:
According to studies, the entering med school population suicide rate is the same rate as everyone else in the general population. It's on the other side that it's much higher in our profession than others.
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I suspect (but of course, have no way of knowing) that a lot of this might be due to "station syndrome", the persistent belief that life's journey will become easier and better once we "reach the station", whatever that next milestone is: driver's license, graduate from high school, graduate from college, get accepted to medical school, get that coveted residency, become an attending, etc.

But once someone becomes an attending physician, that's really about it, isn't it? There's really not much more above and beyond that to pin one's hopes and dreams on, is there? So I'd suggest that most physicians are confronted with the "Is this really all there is?" crisis somewhat sooner than most other professionals, and in rather more absolute terms. Think of the investment made in becoming a doctor! And this is the payoff... Odds are, it's not as wonderful as you dreamed - life rarely is. That's a rather hard let-down.

Pam Wible reinvented medicine, at least as it impacts her world. I think she's on the right track --
 
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Yeah, the studies I'm familiar with indicate that it's a change that happens during the training pipeline or after.


As far has her practice style, it's important to remember that quantity of care provided doesn't equal quality of care provided. More visits doesn't necessarily equal better management. If she's able to address her patients concerns in a single longer visit they might not need to come back as frequently which frees her up from multiple visits for the same issue on that patient so she can see other patients. It would be interesting to look at that in depth.
 
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wholeheartedly said:
Yeah, the studies I'm familiar with indicate that it's a change that happens during the training pipeline or after.


As far has her practice style, it's important to remember that quantity of care provided doesn't equal quality of care provided. More visits doesn't necessarily equal better management. If she's able to address her patients concerns in a single longer visit they might not need to come back as frequently which frees her up from multiple visits for the same issue on that patient so she can see other patients. It would be interesting to look at that in depth.
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I could be wrong, but I believe she does direct pay practice. She doesn't take insurance.
 
DokterMom said:
I suspect (but of course, have no way of knowing) that a lot of this might be due to "station syndrome", the persistent belief that life's journey will become easier and better once we "reach the station", whatever that next milestone is: driver's license, graduate from high school, graduate from college, get accepted to medical school, get that coveted residency, become an attending, etc.

But once someone becomes an attending physician, that's really about it, isn't it? There's really not much more above and beyond that to pin one's hopes and dreams on, is there? So I'd suggest that most physicians are confronted with the "Is this really all there is?" crisis somewhat sooner than most other professionals, and in rather more absolute terms. Think of the investment made in becoming a doctor! And this is the payoff... Odds are, it's not as wonderful as you dreamed - life rarely is. That's a rather hard let-down.

Pam Wible reinvented medicine, at least as it impacts her world. I think she's on the right track --
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I think it has more to do with the fact that it's NEVER-ENDING. Think about it: 4 years of college (and all the ridiculousness and gamesmanship to get into med school) + 4 years of medical school (and all the ridiculousness and gamesmanship to get into any residency, much less the residency you want) + 3-7 years of residency (and all the ridiculousness and gamesmanship to get into a fellowship), then as an attending, when you have no fall back you have to keep up with new advances and do CME, MOC, recertification, deal with peer review, hospital admins, patient safety boards, etc. Then sprinkle thru out a little sleep deprivation and people dying on you left and right, and now these days in which you have politicians, media, patients all pointing their fingers at physicians as the culprits for everything wrong in the healthcare system and it's no wonder the suicide rate is so high.

Medical education is like a merry go-round that doesn't stop and you can't jump off and take a break and jump back on without closing all your options permanently after you've invested years upon years and 6 figures in debt. People will always tell you along the path that once you get to this particular stage it gets easier. For some that's the case, for many it usually isn't. You either recalibrate your expectations accordingly or you don't. Naturally the ones that don't have a much harder time. It's why going into medicine with rose-colored glasses as the thing to fill a void (emotional, financial) is not a good game plan.
 
Goro said:
I was told recently by one of our deans that about ~150 medical students commit suicide each year. That's about 1/school!
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Do you think this creates for admissions to accept more emotionally stable and healthy students? I've heard that the suicide rate is higher at more prestigious schools whether it is medicine, law or any other professional school;this via word of mouth and I don't assume it to be entirely true.
 
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Most people are really good at hiding their emotional demons. In my students, they don't become apparent until they start failing. One CAN pick up on people who have flat, unemotional response or affectation, and these end up not being admitted.

pbrocks15 said:
Do you think this creates for admissions to accept more emotionally stable and healthy students? I've heard that the suicide rate is higher at more prestigious schools whether it is medicine, law or any other professional school;this via word of mouth and I don't assume it to be entirely true.
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Goro said:
Most people are really good at hiding their emotional demons. In my students, they don't become apparent until they start failing. One CAN pick up on people who have flat, unemotional response or affectation, and these end up not being admitted.
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True, no student would show that their unstable emotionally during an interview with hopes of being accepted. Is it possible that more schools incorporating Problem Based Learning could decrease the chance of student suicide because it will require they engage with other students? Just a thought, I doubt there is evidence although it would be interesting to know.
 
I doubt it. Those students would just fail to contribute.

pbrocks15 said:
True, no student would show that their unstable emotionally during an interview with hopes of being accepted. Is it possible that more schools incorporating Problem Based Learning could decrease the chance of student suicide because it will require they engage with other students? Just a thought, I doubt there is evidence although it would be interesting to know.
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PamelaWibleMD said:
I've just joined SDN if anyone wants to chat. I'm always available at 541-345-2437.
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Is this really Pamela Wible? Otherwise it's not right to put someone's phone number without their permission.
 
I'm trying to start a new thread, but I do not know how. Here is what I am trying to post as a new blog if someone can help me post it properly.

Subject: Double Suicide ~ Med Student & Her Mom

In case you all have not heard, Rhonda Elkins, mother of MS3 Kaitlyn Elkins R.I.P., has also taken her life. She found me through an SDN thread and reached out to me. We became friends and spoke often on the phone. She wanted so much to save other medical students and their families from the grief she and her family endured.

Rhonda took her life the same evening I gave this presentation to medical students "How to graduate medical school without killing yourself." -->http://www.idealmedicalcare.org/blog/how-to-graduate-medical-school-without-killing-yourself/

Other threads on SDN that reference Kaitlyn & her mother:
http://forums.studentdoctor.net/search/3460480/?q=kaitlyn elkins&o=relevance

I will be speaking in Newark, Scranton, Philadelphia, and Washington DC next month on physician and medical student suicide prevention. Would love to meet up with anyone on the forum.
 
PamelaWibleMD said:
I'm trying to start a new thread, but I do not know how. Here is what I am trying to post as a new blog if someone can help me post it properly.

Subject: Double Suicide ~ Med Student & Her Mom

In case you all have not heard, Rhonda Elkins, mother of MS3 Kaitlyn Elkins R.I.P., has also taken her life. She found me through an SDN thread and reached out to me. We became friends and spoke often on the phone. She wanted so much to save other medical students and their families from the grief she and her family endured.

Rhonda took her life the same evening I gave this presentation to medical students "How to graduate medical school without killing yourself." -->http://www.idealmedicalcare.org/blog/how-to-graduate-medical-school-without-killing-yourself/

Other threads on SDN that reference Kaitlyn & her mother:
http://forums.studentdoctor.net/search/3460480/?q=kaitlyn elkins&o=relevance

I will be speaking in Newark, Scranton, Philadelphia, and Washington DC next month on physician and medical student suicide prevention. Would love to meet up with anyone on the forum.
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Yes, I believe Kaitlyn's mom is also an SDN user as well. Such a sad case as well. I'm just amazed that things so got bad in their lives that they saw committing suicide as the ONLY viable option. I think what's hard to pin down is why?

Kaitlyn was doing fine in medical school, did very well on her boards, etc. and still had her MS-3 clerkship year to go thru according to her mom.

Sean O'Rourke graduated from NYU, graduated AOA, was an intern at Columbia (I believe) and committed suicide within 2 months of starting.

I realize it's maybe someone else trying to find a sensible reason, but I realize this may not be possible.
 
When we do not understand why someone dies, we do an autopsy. When we do not understand why someone dies of suicide, we must do a psychological autopsy which is an investigation into a person's death by reconstructing what the person thought, felt, and did before death, based on information gathered from personal documents, police reports, medical & coroner's records, and interviews with families, friends.

I have performed psychological autopsies on 3 victims (Kaitlyn & 2 young docs age 25, age 29) that I will be presenting in my talk: "Physician Suicide 101: Secrets, Lies & Solutions" in Washington DC at the AAFP conference. I will also try to post the contents on my blog after the talk so all can see the results.
 
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wholeheartedly said:
Yeah, the studies I'm familiar with indicate that it's a change that happens during the training pipeline or after.


As far has her practice style, it's important to remember that quantity of care provided doesn't equal quality of care provided. More visits doesn't necessarily equal better management. If she's able to address her patients concerns in a single longer visit they might not need to come back as frequently which frees her up from multiple visits for the same issue on that patient so she can see other patients. It would be interesting to look at that in depth.
Click to expand...

One 60-minute establish-care visit for a new older patient who gets their last 10 years of questions answered is probably worth at least a dozen 10-minute appointments.
 
PamelaWibleMD said:
One 60-minute establish-care visit for a new older patient who gets their last 10 years of questions answered is probably worth at least a dozen 10-minute appointments.
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Without a doubt. There is only so much even the most brilliant physician can do in 15 minutes, particularly when the issues are subtle and/or nuanced and no hard-science test or remedy exists.
 
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PamelaWibleMD said:
I've just joined SDN if anyone wants to chat. I'm always available at 541-345-2437.
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Hey, good to see you over here on SDN. We've both posted over on KevinMD, though you're much more prolific with that, than me. There's a lot of heavy lifting to be done over here. Lol. Good to have you on board. You'll find me over on the Emergency Medicine forum where all of my KevinMD posts originated. I like what you're doing. :thumbup:


Edit: Just now saw that you got deleted/banned. How weird this place is sometimes. :ShakesHead:
 
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