Why do so many doctors die by suicide?
In April 2022, I spoke with Pamela Wible, MD, a family physician from Eugene, Oregon, who has spent a decade answering calls from doctors who are thinking about ending their lives. She has written books and given TED Talks. Yet, the work I most wanted to ask about was the phone she keeps within reach.
This is an archive episode, recorded when the show covered addiction and recovery broadly. We talked about why medicine loses so many of its own and what helps a person who feels trapped. Dr. Wible speaks openly about suicide, including her own experience. If you are struggling right now, the help line at the end of this description is for you.
How did one family doctor become a suicide helpline?
At 1:02, Dr. Wible explained where it began. In 2012, three doctors in her town died by suicide within about a year, and at the third memorial service she started counting the physicians she had known who had died that way. She had been suicidal herself years earlier, and at the time she believed she was the only physician who had ever felt that way.
So, she started writing and speaking about it right away. At 3:27, she described how people simply began contacting her, because almost nothing else came up when they searched for help. Once people told her she had saved their lives, it was hard to stop.
What helps a person who reaches out in crisis?
At 4:07, I admitted I would be terrified of saying the wrong thing. Dr. Wible’s answer was calm. Most people reach out to her well before the final moment, she does her best to call back quickly, and she does not hold herself to a superhuman standard. At 7:12, she added that she has never called the police or contacted a medical board about a caller, because the calls are confidential.
From 8:51, she described what works. She keeps people on the phone, gets to the root of what is causing the pain, and offers options they had not considered. In her view, a person in that state is caught in distorted thinking, and simply seeing other directions can pull them out of it. Interestingly, some callers end the conversation laughing.
At 6:14, I shared an idea I first heard in a lecture years ago. Suicidal thoughts deserve the same urgency as chest pain. Unfortunately, people often wait on both, not wanting to bother anyone, and a doctor may also fear what speaking up will do to a career.
Is the problem in the person or in the environment?
At 10:27, I explained why this topic belongs on the show. Substance use and suicide are closely related, because in both cases people feel trapped and see no way out. The difference, as I put it, is that a person who is still alive can come out of it.
At 15:40, Dr. Wible put it plainly. In her view, much of the distress she hears about is caused by the environment rather than by a chemical imbalance. Medical training, she said, is rife with human rights violations, and the job asks doctors to be superhuman while seeing sad things all day. Feeling sad in response is a normal, human reaction.
Can a doctor be worked to death?
At 16:56, I suggested that medical education selects for people who will study and work without limit, and that what happens to some of them might be called a work overdose. Dr. Wible agreed. At 17:32, she described death by overwork, partly self-inflicted and partly imposed by an industry with no safe limits on hours, unlike pilots or nurses with a union.
Why does a delay matter so much?
At 19:08, I said that even though I am not suicidal, I would not want a gun in my house. A moment of frustration with life should never be that close to something irreversible.
At 19:38, Dr. Wible agreed. The goal is a delay long enough to interrupt an impulsive moment, because physicians she interviewed after a survived attempt told her the final decision took only minutes. Still, she does not believe these deaths come out of the blue. In her view, there were many missed opportunities over years, from childhood through medical training.
At 21:01, I mentioned Malcolm Gladwell’s book Talking to Strangers, which describes how suicides in England fell sharply once a common household means was made safe.
What should happen after someone survives a crisis?
At 24:14, Dr. Wible described a pattern she sees often. A resident who is exhausted and afraid of harming patients is admitted for psychiatric care and then sent straight back to the same overloaded ward.
Her answer is to recognize the core issue and get the person out of the burning building. What she wants is humane work hours, real breaks, time with family, and an end to the abuse that pushes caring people to this point.
Does harsh training make better doctors?
At 26:51, I described my own residency. It was mostly humane, but for one month each year we trained at a more traditional hospital, with nights of almost no sleep and calls for small things a nurse could have handled.
At 28:13, Dr. Wible said that teaching by terror is unsustainable. She suggested training should follow each trainee’s goals, so a future outpatient family doctor is not spending months in a neonatal intensive care unit. At 29:02, I agreed. Being tortured did not make me a better doctor. Years of listening to patients and learning did.
Is leaving medicine the answer?
From 30:38, Dr. Wible talked about the hopeful side of her work. She encourages doctors to build a practice around what they love, such as a psychiatrist she worked with who now focuses on people facing infertility.
At 32:40, she told me she had retired her own medical license the previous October to work full time with physicians. Fortunately, she says, that lets her tell a doctor who has lost a license that she has none either, and that many good paths are still open to them.
Of course, she does not tell everyone to leave. At 37:15, she warned against running from medicine in desperation and suggested some doctors might practice part time while doing other work. Too often, she said, we stay in cubicles far too small for our dreams.
Who is Pamela Wible?
Pamela Wible, MD, is a family physician from Eugene, Oregon, who has run a free suicide helpline for physicians since 2012. She writes and speaks about physician suicide, was one of the primary subjects of the documentary Do No Harm, and now works as a coach and consultant for doctors. Her website, Ideal Medical Care, offers free books and years of material on suicide.
What can listeners take away from this conversation?
Suicidal thoughts deserve the same urgency as chest pain, and the person in pain is not always the problem. As Dr. Wible put it at 44:11, distress can be the body’s call to change something in your life, rather than a reason to give up your life. Reaching out to a colleague, a friend, or a crisis line is where that change can begin.
How do I approach this today?
Today my practice focuses on helping people come off benzodiazepines and other medications gradually, and on medication for alcohol and opioid dependence. Physical dependence is not addiction, and the safest way off is usually slow.
Call 911 or go to an emergency department if there is a seizure, confusion or hallucinations, or thoughts of self-harm. For thoughts of suicide or any mental health crisis, you can also call or text the 988 Suicide and Crisis Lifeline.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (45 minutes)
Dr. Mark Leeds [00:00] Dr. Pamela Wible, welcome to the podcast.
Pamela Wible, MD [00:03] Thank you. Thanks for inviting me.
Dr. Mark Leeds [00:05] Thank you for joining me. So you’ve done so many things. You’ve written books, several books. You’ve done TED Talks. You’ve made a major film. You’ve been on TV shows. You’ve done a lot of things, and it’s really incredible. And most importantly, I know for years you’ve been helping people, mainly health care providers, people who were maybe having suicidal ideations, people who are considering the possibility of ending their own life. And it’s really incredible work. It’s just hard to even conceive of that for years and years, you’ve made yourself available to people, that besides all these big things that you’ve done, you’ve just been there with your phone, just ready to help. And I think that’s just incredible. Can you tell us more about that, about about how long have you been doing that for? How many calls do you get? Just all the stuff about the phone calls and everything.
Pamela Wible, MD [01:02] Well, I’ve been doing it since 2012. Since we had three doctors in my small town, smallish town, Eugene, Oregon, die by suicide within just over a year. And I didn’t quite understand that we had a suicide problem among physicians until I was at the third gentleman’s memorial service. And then I just started counting how many people that I knew that died under suspicious circumstances or by suicide that were physicians. And I knew 10, I was like in the, mid to early part of my career. And I thought, Oh, that’s kind of odd to know 10 people, including both men I dated in med school who died by suicide, not while I was dating them, but they died when they were married with children and, you know, having left their whole life behind. Right. Presumably successful in their careers, you know, so it’s just kind of odd to think about these successful doctors leaving the planet when they took an oath to do no harm to others and presumably themselves. So there you go. I thought that was kind of strange. And because I’m a healer, I feel like it’s within my wheelhouse to understand why people are dying. And because I’m just a curious person on the planet and everyone who I know who had died by suicide were in the medical field as physicians. I thought that was worthy of exploration. And because I had been suicidal myself in 2004 and at the time, I thought I was the only suicidal physician on the planet. It was like personally a wake up call for me. So I had every personal reason to do my own inquest. I don’t know what you want to call this, but I mean, this was like my own little science project, kind of like a hobby, like collecting stamps. Like I had to get to the bottom of what’s going on. And I had no idea that it would have such profound impact on the rest of my career or help save other people. I mean, I was just trying to understand why these people died. So I, then what ended up happening because I started writing and speaking about this pretty much immediately after that memorial service, because if you were to Google physician suicide back then, like nothing would come up except maybe like what I was writing so then I became the place that people went to for questions and to discuss this topic because I guess there was literally like no competition for running a physician suicide helpline back then right yeah so I think what ended up happening is just organically I became elected appointed by the people seeking me out as their suicide helpline like I didn’t this wasn’t a decision I made like oh I’m going to run a doctor suicide helpline it’s just that people kept contacting me and utilizing me this way so I sort of became the physician suicide helpline and once people told me that I had saved their lives because I had answered the phone written the article responded to their comment emailed them back like it was kind of hard to say oh I think I’ll stop doing this now you know what I mean I just kind of had to keep going. Does that make sense?
Dr. Mark Leeds [04:07] Oh, yeah. And I mean, to me, it’s a scary thing. I mean, to think, because I imagine right away when you’re talking about just answering those phone calls, you know, that may come at any hour of the night, I would imagine. I just imagine like, what would it be like to, you know, someone’s sitting on a ledge on a building and say, it’s just me there. And I walk up and talk to them. I would be terrified of what am I going to say? What if I say the wrong thing? You know, I wouldn’t even know where to start. But I guess when you’re in that situation, you just have to do your best because you have to say something. You have to at least be willing to listen, I guess.
Pamela Wible, MD [04:40] Yeah, I mean, and most people thankfully reach out to me before they have a gun in their mouth or on the ledge of a building. I mean, one woman had a noose already sort of prepared and, you know, she emailed me, please help me. And she’s like, oh, if you didn’t call me back, I already had the noose. And, you know, like I don’t hold myself responsible. Like if I was out to dinner or away, like, I mean, there are universal, universal forces at play. There’s so many unseen forces and confounding factors on like who stays, who goes. I just feel like, hey, my humanitarian contribution here is to run a free suicide helpline while I’m awake and available. You know what I mean? So my best to be returning calls and getting back to people. Well, apparently I do get back to people sooner than even the National Suicide Helpline, where people have told me they’ve been on call on hold for three hours. So, you know, OK, well, I mean, I’ve gotten back to people within a few minutes and I don’t hold myself to superhuman standards on this, but I do my best and have been doing this for 12 or 10 years now since 2012. So, yeah, I find it really fulfilling, I think, within family medicine, which is my specialty of choice. I haven’t really felt the rush of saving somebody’s life as much as I felt it doing, I guess you would call this emergency emotional and spiritual help for my colleagues. So, yeah. Yeah.
Dr. Mark Leeds [06:14] Yeah, I can imagine. Yeah, I can imagine it would be a great feel. You know, it is it is lifesaving. And that reminds me a lot. They used to tell us. I don’t know who told me this, what lecture I heard it in, but that suicidal thoughts are kind of people should think of it like like chest pain. You know, like, you know, someone who has chest pain and they may be having a heart attack. A suicidal thought should be taken as seriously. But in reality, people who get chest pain don’t always take it seriously. They don’t want to bother anybody. You know, like, oh, maybe it’s indigestion or maybe it’ll go away or I don’t want to cause any trouble or disrupt anybody’s day. And I’ll just wait, see what happens. And I would imagine suicidal thoughts are similar. You know, people don’t want to cause any trouble or lead to, you know, cause you know, as soon as you know, I would imagine you tell someone and then they like, Oh my God, you’ll call the police, call, call everybody. And next to you’re, you’re in a psych ward for a few days. And someone, a doctor would, would be worried that their career would be affected. Maybe they’re hoping things will pass and they’ll get back to work and it’s all normal again.
Pamela Wible, MD [07:12] I mean, I’ve never called 911, never admitted anyone, never in 10 years contacted a medical board, you know, like this is purely confidential, you know, and I’m not in charge of whether somebody stays or goes. I just do my best for them. And, you know, there’s one woman who contacted me from an unknown number and a throwaway email who I had no idea who she was and she just sobbed the whole time. And so I just kept talking and, you know, we, I kept her on the phone as long as I can. I have no idea what happened to her, but I don’t hold myself responsible. I do the best I can, you know, in the situation that I’m in. And as far as I know, there’s like three people I made contact with in the last 10 years who did end up dying by suicide after connecting with me. One was a man in India. I never spoke to him, but we emailed back and forth. And I think six months after his last email, you know, he had like a, you know, a minor argument with his wife and whatever, just hung himself, you know, like, I don’t hold myself responsible for this, you know, like I, you know, so there’s him and, you know, another gentleman who was an anesthesiologist and, you know, like they never died immediately after I talked to them, but, you know, some months later, you know, like there’s always going to be people who make that decision. I just do the best I can, you know, when I’m connecting with them. So I think that’s probably a good track record. I don’t know. I don’t know what a good track record is for a suicide helpline, but yeah.
Dr. Mark Leeds [08:44] Have you learned over the years, like what works and what doesn’t, like what works best in talking to people?
Pamela Wible, MD [08:51] Yeah. Like keeping them on the phone and giving, getting to the root of the issue, like what is actually causing the problem. And a lot of it for physicians that are in toxic work environments. And as you know, they don’t seem to find, they feel entrapped. So sometimes if I can give them like an array of options that, you know, when they get off the phone, they say, wow, I’ve never thought about that. I didn’t know I could do that. You’ve given me a lot to think about. Some people get off the phone and they’re laughing because we’re having such a great time. And they have, I guess the release, you know, there’s a connection between tragedy and comedy. And sometimes when you can allow people to speak and you can really get to the heart of the matter, there’s like this, almost like a comedic release where they’re like, you know, we’re talking like two souls, like lost in the universe, because let’s just face it, we’re all sort of souls lost in the universe. And some people are more clear about what they should do next in their lives. And other people are at the end of their rope, you know what I mean? And so to be able to connect at a soul level, but also give strategic career and personal life help based on me being suicidal, and having heard thousands of hours of suicidal doctors on the phone. Like I have, you know, generally a clear view of directions they could take that are life-saving and inspiring. So I think that helps them have, you know, another option because they’re having distorted thinking process that is essentially sort of almost like a thought disorder, like, you know, sort of a little micro psychotic, you know, they’re not able to think clearly. So if they can start to see different options, it really pulls them out of it.
Dr. Mark Leeds [10:27] Yeah. One reason I find this, the whole topic really intriguing in this podcast is usually about addiction. And I feel like addiction is very close to related to suicide. And some people even say that addiction is like a slow form of suicide, a person just slowly killing themselves. And of course, the difference is that there’s hope they’re still alive, they can come out of it where suicide can’t, can’t be fixed once it happens. But they are similar in some ways. But yeah, and people do, you’re right, like people feel trapped, you know, they feel like they have no way out. And I guess like when you’re helping them to find, you know, you kind of point out that there are ways out of things, you know, you’re not, things aren’t hopeless, you know, there’s options. I mean, even like, but I can see like a doctor, a resident, you know, someone who has loans hanging over their head and family expecting that they better have the name, you know, doctor after their name or in front of their name, actually, or whatever, you know, that, you know, a visa
Pamela Wible, MD [11:32] Attached to the hospital, they’ll be deported if they don’t finish their program. And they’re, you know, in a toxic program in New York City during the pandemic, you know, there’s every reason to say like, oh, wow, like that could go poorly right
Dr. Mark Leeds [11:45] Yeah yeah I mean like what it really does sound bad I mean like you know I feel like I’ve been in difficult situations and looking it’s something like that where you just described I’m like oh my god you’re going to be sent back to like a maybe a third world country and live in a miserable life and maybe have no way out once you go back like how do you even get
Pamela Wible, MD [12:01] Like excommunicated from your family as sort of a failure when they you’re you or their star child you know what I mean
Dr. Mark Leeds [12:07] Yeah yeah and that and that can go I mean that’s a whole nother topic Like that can go on for life. I mean, if you do everything perfectly or not perfectly, you’re always going to be the maybe the black sheep of the family. But yeah, so yeah. So you actually made a movie called. Are you a part of one of the filmmakers and do no harm?
Pamela Wible, MD [12:29] Well, I’m not the filmmaker, but I was interviewed as like one of the primary subjects in the film again, because back in 2014. I don’t know if you recall, there were two 26-year-old interns who stepped off buildings in New York City within the same week, I think within three days of each other. And so that sort of made a little media burst where usually this is pretty silent. You know, I’ve got like close to 2000 doctor suicides on my suicide registry, and most of them have had no media coverage and their names never to be uttered again. When they stopped producing revenue, you know, maximum per millisecond you know there’s just not a lot of honoring of deceased doctors that medical institutions or even peers want to do because of the state of denial and just for pr purposes and other reasons right and so these people once they die it’s like they never lived and their names never uttered again and so very few get media coverage but these two because they happen so close in time, hit the media in New York City. And then as a result, the filmmaker who did the Do No Harm film was handed this like article from maybe the New York Times or whatever on these deaths. And so she started researching it. And of course, my name popped up, you know, he said, you should do a film on this. My name popped up. And so she called me and asked me would I help her, you know, of course, if you’re making a documentary, you need to interview current subjects that are suffering the loss. So I was able to like give her various families that she might use in her documentary. And, you know, luckily there was a courageous couple that were willing. Can you imagine to have cameras follow them around within three weeks, a month or so of their son’s death as a fourth year medical student right before graduation? I mean, that, you know, that’s pretty, not everyone would agree to that. Right. And so, you know, once she has people that would agree to tell their story, then she has a documentary or the makings of a documentary. So it took four plus years to finish it, but it is on Amazon Prime and it’s called Do No Harm, Exposing the Hippocratic Hoax. And do no harm film dot com is how you would access it. If anyone.
Dr. Mark Leeds [14:42] Yeah. Can you say that one more time?
Pamela Wible, MD [14:44] It’s do no harm film dot com.
Dr. Mark Leeds [14:48] OK, do you know? Yeah. I was just visiting there the other day and I see you get a lot of extras when you rent it. There’s, I think, some extras where you do some interviews or you talk on some of the extras, and there’s a lot of great material in there in addition to the film. Yeah, I definitely recommend people watch that. I was thinking while you were talking about how someone might think that suicide is like a disorder or like a sign of a mental disorder. And, you know, just like with addiction where people might say, oh, you must have additional, you know, you’re self-treating some psychiatric disorder and we need to get you on medication. And I’ve been hearing a lot of talk lately, maybe people don’t need all the psych meds that they get put on. And maybe it’s not a disorder, but maybe it’s just a person is not in the right environment. And I think that’s what you’re saying here, that just because a person… Oh, go ahead.
Pamela Wible, MD [15:40] I think you’re right. It’s really exogenously induced versus sort of an endogenous chemical imbalance and for those who are not physicians listening meaning it is caused by your environment especially for physicians our training environment is rife with human rights violations and our work environment forces us into this godlike superhuman impossible to achieve persona and so that can create havoc with our psyche and so yeah and then just amid the pandemic or even on your best day you might see terrible things not to tell somebody they have cancer or whatever it’s a hard job, just like police and firefighters have a hard job. And so it should be normal to expect that we’d have mental health issues if we’re compassionate human beings and a hard job seeing sad things all day long. And I think like our culture is sort of devolved to the point where there’s a lot of sad things to look at and see and homelessness and social decay and social collapse and financial collapse, whatever. There’s a lot of sad things happening. And so like the normal person should have sort of a congruent response to that, which would be feeling sad, you know?
Dr. Mark Leeds [16:56] Yeah. And it also seems like the medical education system selects for people that are predisposed to maybe what you call work addiction, or maybe people that they’re very, very hardworking people, people that might study 12 hours a day or more to get ready for medical school. And they’re willing to do anything, ready to do anything, won’t say no to any job. And you might even say that maybe this is like a, you know, if you’re addicted to work, if you have a work addiction, maybe this is a work overdose, you know, to a point where.
Pamela Wible, MD [17:32] That is a good way of looking at it’s death by overwork and it’s partially self-inflicted and partially inflicted by an industry that has no standards, safe standards, like pilots, for example, can only fly eight to nine hours straight and 14 hour shifts, you know, including whatever breaks or something. But you know, there’s no, as you know, like physicians could work endlessly. It’s not like nurses who have a nurse’s union and get paid overtime and have set hours, right? Physicians, ultimate liability, you could be on for 33 days straight on call as an orthopedic surgeon, you know, Like this is just like ridiculous and definitely would lead to death by overwork or suicide by overwork. The death by overwork would be like heart attack, strokes, you know, congestive heart failure. You know, like you literally can’t stay up that many hours without getting really sick. And then, you know, some people just die by suicide. So, yeah, it’s terrible that we allow a health care industry. How ironic to abuse their own people and that we would have one of the higher if not the highest suicide rate of any profession and leading the group would be male anesthesiologists and by the way also female veterinarians are high in their suicide rate mostly because they have access to painless lethal means at a moment’s notice so if you have an addiction and you have a painless lethal drug right in front of you and you’re having a bad day, you know, talk about like a permanent solution to a temporary problem.
Dr. Mark Leeds [19:08] Yeah. Yeah. That is a thing. I mean, I, you know, I’m not, I’m not suicidal, but at the same time, I wouldn’t want to have a gun in my house because I wouldn’t want to like on that one moment where I’m really frustrated with life and thinking, wow, you know, what am I even doing? This isn’t, none of this is worth it. This just seems hopeless. You know, you don’t want to have, you want it to be like, Like, oh, if I needed a gun, I have to drive to Walmart and go ask them and maybe wait a certain amount of time or whatever. But by the time I even get to the store, I’ll probably go shop for something else. So, yeah, it’s good not to have that stuff right in front of you.
Pamela Wible, MD [19:38] Yeah. I mean, even though you can use any method around a knife and carbon, you know, there’s a lot of methods. It’s just the matter of desperation and being able to access a method. Something that was super cool I learned at an event, there was a guy that didn’t want to give up his gun and he was suicidal. But he did agree to freeze it in the freezer in a block of ice or something. So it would just be sort of harder to get to it, but he didn’t have to give it up to anyone. That was kind of a cool idea. You just wanna create enough of a delay so that you don’t do something impulsive. I interviewed a number of physicians who survived their suicide attempts, male physicians, and I asked them how long between when you decided, this is it, you know, I’m done, and you grabbed the pills or got the gun or whatever, it was three to five minutes. So at the end, it is like a pretty definitive, impulsive decision that can’t probably be stopped unless you’re heroically standing right next to the person, right? So I feel like all of these suicides, there were hundreds of missed opportunities over, you know, decades leading up to this, including childhood events and medical education. And so I don’t think even though to the outsider, it could look like, oh, this came out of the blue. Actually no it didn’t you know for most people this has been like a slow brew
Dr. Mark Leeds [21:01] Yeah yeah there was in there was that malcolm gladwell book that he talked about that I can’t talking to strangers that was the name and at one one chapter he talked about suicide and an epidemic of suicides in england many years ago decades ago or whenever it was where they had a certain kind of gas going into their homes and the women were committing suicide by putting their heads in the ovens. And it was always a very neat suicide. And they would lay down something for their head. And they didn’t want any mess to be cleaned up afterwards. And then when they changed the kind of gas that they were using at some point, it was a major overhaul that they had to do. Somebody was studying it. And they were studying to see if people would start using different methods for suicide. And what they saw was that rather than the methods changing, the number of suicides dropped drastically. And the conclusion they came to is that people tend to be set on a certain method. They determine if they’re going to use a gun, they’re going to use the oven with a gas or maybe a jump. And maybe if you can take the gun away, they might not go for the knife. Maybe if you take that one thing they’re thinking about away, that might be a solution for some people.
Pamela Wible, MD [22:10] Yeah. And with doctors, it really varies depending on culture, geography, and even specialty. For example, doctors in India are generally hanging from ceiling fans sometimes with their saris. Like that’s just kind of the Indian way to do it, which is pretty simple, which you can’t really take that away because your ceiling fans everywhere and everyone’s in a sari, you know, in your house. But then like obviously in the western part of the U.S., access to guns is pretty much everywhere. Right. Right. So that’s, yeah, that’s an easy, impulsive way. But then by specialty, of course, anesthesiologists and veterinarians are using what they have, you know, and how are you going to, that’s really touchy. Like, how are you going to get control of that drug from a veterinarian, you know, or an anesthesiologist who could type in some patient’s chart name and access the stuff in an impulsive move, right? Vascular surgeons will slice themselves. You know, like just they sort of use what it is that they’ve been doing all along. You know what I mean? Yeah. And interestingly, if they’re upset with their employer, they’ll do it at work. Or if it’s a personal issue at home, they’ll enact this at home. So the location has a lot to do with the there’s like an underlying message often with all of these.
Dr. Mark Leeds [23:33] Yeah. Yeah, that makes sense. So, after, after a person has like, you know, hopefully a suicide attempt was unsuccessful or they were able to be talked out of it. The, it, I mean, a person doesn’t necessarily have to go to a psych hospital or be in a straitjacket or whatever, especially if it’s their environment, it’s not nothing wrong is wrong with the person, but the environment is what’s doing it. The optimal thing would be to help that person out of the environment, you know, help them out of the burning building or whatever you want to call it, where they’re, you know, the thing that’s killing them. Like what’s the best way to do that for, you know, in your situation, the people that you talk to?
Pamela Wible, MD [24:14] Well, I think a lot of doctors are in situations where they’re, they’ve got like, they’re a resident with a high census and sleep deprivation, and then they’re a perfectionist. So they feel like, gosh, they can’t keep up and they might be harming people that’s a really hard pill to digest for a physician and so you know they’ll go inpatient psych and then crazily they’ll be discharged right back out to the high census ward where they you know what I mean like this is where they where they where they had the problem you know I mean like this happens this happens so even with in one case I remember like the parents of this resident moved in with him in his apartment, you know, to overlook, you know, and basically talk about helicopter parents, you know, like trying to save their son, didn’t want to leave him alone for a minute. But hey, back at the hospital with high census, I think he just stepped off the building. You know, I mean, you can’t be with somebody 24 seven, but you can recognize what the core issue is that led to their suicidal thoughts and remove them from the burning building. You know, there’s one building in particular in New York City where two J-1 visas stepped off the same building from Mauritius from the same country and died in about the same spot on the sidewalk. And you’re like, okay, I think there needs to be some investigation here. However, the police never investigate suicides. They just determine if it’s a suicide or homicide. If it’s a homicide, presumably they go look for the person who created the situation. If it’s a suicide, they don’t go looking for the person that harassed the person that died by suicide. They just write down suicide and then the case is closed. So that would lead to clusters of suicides happening in one location without investigation. And so I still get calls from people who live in that building and they tell me they want to jump out of the building, but they can’t because the windows have been bolted shut and they put chain link fence on the on the roof. So, okay, so that slows them down, but it still doesn’t change the fact that there’s probably like hundreds of residents living in that building that all want to like have that either have passive or active suicidal thoughts. They just can’t open the window. You know what I mean? When I talk about solve this, let’s do more than bolting people in their apartments and chain link fencing them into their toxic jobs. I’m talking about work hours that should be humane, breaks, being able to see their family, you know, like to stop the human rights violations and the abuse that lead these loving, sensitive people to want to take their own lives.
Dr. Mark Leeds [26:51] Yeah. Do you think a doctor can be trained to do their job just as well without that kind of training? Because I did kind of, honestly, my residency was not all that hard. I kind of picked a place that was very nice. You know, we learned a lot in the clinics. We didn’t have to stay overnight at the hospital very often. And but they did send us for one month each year to this nearby hospital to do pediatrics. And they were like a much more traditional program. And so we got like a taste of it for a month every year. And but I remember this one doctor talking to the group of residents, the ones who were being abused at this other hospital. And he told them, he said, you guys have it easy. You don’t know what I went through when I went through training. You guys just have such easier hours and less work than what I had. And for me, what they were doing was unbelievably hard. Like, I couldn’t take it that month of like getting no sleep and then having to sleep in the hospital. And then all night the nurses calling because they feel like it’s just for really like pointless little things. I was running off to the floor and they would give me some, you know, something they could have handled. Like they didn’t really need to call someone. It almost seemed like they’re calling me just because, you know, he shouldn’t be allowed to sleep. You know, we’re awake. Why is he sleeping? But I was already had already been awake for like 18 hours before that. And I’d be awake the next day. And that was just like one month. I can’t imagine that people go through years and years and years of that.
Pamela Wible, MD [28:13] Yeah, well, that’s it’s going to shred your telomeres, shorten your lifespan. Like that stuff is unsustainable. And learning and teaching by terror environment is not ideal, you know. So I and also I think we should be teaching toward like the objectives of the trainee so if you’re going to do outpatient family medicine why are you in the NICU for two months you know it doesn’t make any sense so let people have a personalized track that really focuses on their area of interest you know that makes a lot more sense because having everyone undo a little bit of everything, it doesn’t really, it creates problems. You know, like it’s just, it doesn’t make any sense.
Dr. Mark Leeds [29:02] Yeah. And so, yeah, I mean, I believe that a doctor can be, you know, just as good at their job. But yeah, like being tortured didn’t make me a better doctor. You know, but, you know, working for years and years and having work experience and listening the patients and learning from them and learning from reading. And I mean, there’s a lot of other ways a person can become a good doctor and good at what they’re doing, especially if they like what they’re doing. Yeah, […] And I mean, I can’t imagine, you know, going into, I mean, I know surgeons that are now doing family practice, and they went through at least six years of surgical residency just to come out and do the same job that I’m doing with three years of residency. And I mean, but yeah, it’s definitely doing the job that you love. Like, for example, I’m doing addiction treatment now and helping people with drug dependencies, and I love doing that. And I just did not like the HMO clinic lifestyle of what I was doing in the beginning. But yeah, so let’s talk about the hopeful part about it. You’re also helping people to find better careers, to find how they can do what they love and where they’ll really be, maybe find happiness and fulfillment.
Pamela Wible, MD [30:38] Yeah, I think as you probably know, because we’ve spent some time together in the past, I encourage people to live their dreams. I know that sounds really fluffy, but you actually can do what you’re passionate about and it can be a targeted niche of your currently more homogenized generic practice. And I feel like that will actually prevent us from losing so many doctors to early retirement or sort of like this escapism into like flipping houses and doing things that make no sense for our skillset. If we can just take what we love and leave what we don’t love behind and take our autonomy back and practice medicine. Like, for example, there’s a woman who just got, I think, kind of bored with generic adult psychiatry. I asked her what her passion was, and she said it was infertility. So now she has an infertility psychiatry practice where, you know, 10% of women are infertile, and they would love to go to a psychiatrist that specializes in infertility, you know? And so to niche down what it is that you’re really passionate about and serve those people at the highest level is gonna be so much better than being a jack of all trades and doing a little bit of everything kind of randomly. And unless you love that, if you love being an urgent care doctor, keep going. But if you don’t love general everything, then niche down to addiction or addiction in men or whatever it is. I just feel like there’s a huge need out there for people that have specialized interest and certain targeted populations that are complex.
Dr. Mark Leeds [32:15] Yeah. Yeah. I think the work you’re doing is incredible. And it always comes up in conversation that just, you know, who’s, who’s doing this kind of thing and who’s helping people with, you know, what are the whole idea of like the micro practice and the ideal clinic and doctors looking for direction and your name just comes up in conversation all the time. So I think it’s incredible what you’re doing.
Pamela Wible, MD [32:40] You might not know, but I actually retired my medical license last October. I don’t know if I, you know, if you knew that.
Dr. Mark Leeds [32:47] But yeah, I think I saw that announcement on social media here.
Pamela Wible, MD [32:49] So it’s really cool because now I am completely rogue. You know, I’m like people already thought I was running rogue before and kind of a rebel in medicine. But now I’m like unattached to the Oregon Medical Board, even though I have all these old certificates on the wall, though I never will use my big diploma from Texas behind my head. But the point is, what’s really cool now is that I can sort of do anything. And I, you know, what has happened, and I think, you know, I’ve helped a lot of physicians with the suicide stuff and the coaching, I guess you would call it, although I hate that word because it’s so generic, you know, but like helping people reimagine, reinvent their lives and their careers, and do what they were born to do on this planet. So doing that like oddly became the bulk of my income, like literally 95% of my income last year had to do with coaching and consulting and I made like I don’t know it’s embarrassing $4,000 from my clinic so you know you sort of wonder like why do I keep this clinic going when the bulk of my income and what I’m really passionate about is not so much ingrown toenails and pap smears but helping save physicians lives so they can go out and do what they were born to do and help human beings on this planet. So, yeah, I made the decision to just go full time rogue rebel coach consultant type person for physicians. And it’s been really fun because now a lot of odd things have happened. Like I was in a laundromat last two weeks ago and I ran into 11 Spanish speaking roofers from Kansas and I just answered all their medical questions for free. Like I just I don’t have to really worry about like oh is this like did I just start a patient physician relationship with the Spanish from Kansas or can I just answer this question and be nice sitting by the dryers you know what I mean and in the past I think I would have thought like oh wait am I allowed to do this like can I get in trouble is something to turn me in the medical board you know like I feel like I can do really what’s right now without like this background radiation of like regulatory environment circulating through my head you know yeah other thing you know like I do retreats all the time with doctors and even like psychedelic retreats it’s like wow I don’t have to think about like oh huh am I gonna get in trouble for this like hmm somebody turned me into a medical board like who cares like I don’t need a medical board like I don’t need like again most of the stuff that I do has nothing to do with patients in oregon like I’m helping physicians in germany and switzerland and people are calling you know I mean like how is the Oregon Medical Board going to monitor what I’m doing talking to a physician who’s suicidal in Switzerland? You know, at a certain point, it doesn’t make sense. And it almost like is too confusing, like to involve any sort of regulatory agency at a state level in what I’m doing. So I feel very ultimately extremely liberated now because I can do whatever I want without asking permission. Not that I was asking a lot of permission before, but now I can really do whatever I want on the spur of the moment. So the reason why this is also good is that I’m on the phone with suicidal doctors who are unmatched medical graduates, lost their license, having medical board issues. And I can like legitimately tell them, hey, I don’t have a license either. No reason to die. You know, before I would say that. And I think they would think, well, that’s easy for you to say because you have a medical license and you’re telling me I don’t have, you know, that I should feel better than I feel. It’s like, look, you can make a great living. You’re a smart person. If you made it this far in your education, you’re in the top 5% of people on the planet who’ve gone to this level of PhD, you know, doctorate level training, don’t tell me you don’t have the skill set to do something that would earn a lot of money and give you a lot more pleasure than being locked into a high regulatory, you know, industry like medicine. So I feel like I’m a better example for people who are suffering. I can give them more plan A, B, C’s and D’s.
Dr. Mark Leeds [36:44] Yeah, that sounds great. That reminds me of a book I’m reading now where the guy talks about having a one year, five year and 10 year plan. And maybe, I don’t know if you had planned it this way, but you might, you might’ve looked back and imagine like 10 years, the plan is get rid of the medical license, five years, still have it, but be halfway there and doing, doing other things. But I mean, people, I imagine maybe you help people with that of like, you know, you don’t have to be a doctor forever, but at least make the best of it for now and start planning for the future when you can move beyond that.
Pamela Wible, MD [37:15] But I’ve actually worked in the other way too, where I was on the phone recently with a doctor who’s also a pilot who also does all these other things and builds real estate. And I, he wanted to maybe give up his medical license and just do all these other things. And I’m like, oh, wow, you have so much experience. Like don’t run away from medicine, like leave when you feel like it’s gracefully time to exit versus in some sort of desperation with like, I hate my current practice model. And I just think people should enjoy medicine, but maybe not do it full time. Maybe do it 0.5 FTE, maybe 0.25 FTE while doing other things. I just think if everyone were to run away from medicine because they hate it at point, you know, a 1.0 or 1.5 or 2.0 FTE, you know what I mean? Like, that’s like leaving behind your legacy as a healer on this planet to flip houses, which makes no sense. You know what I mean? Like, I don’t think people went into medicine on a whim just because it was like a random idea. I think if you made it this far in medicine, like there’s something about it that appeals to you. So why run away from it until it’s very obvious that you need to be doing something else. And, 19 years ago, I saw an astrologer who did a reading on me and had no idea anything about me as she came I was like 35 years old she came in to my house or you know and basically said you’re a healer but you’re not going to need to go to medical school that was like the first thing out of her mouth and I’m like really then why did I she’s like you went to medical school and I’m like yeah did did you finish and I’m like yeah she goes you’re a doctor and I said yeah she goes you actually have a license and I said yeah and she goes, oh my gosh, you’ve come further than I thought. And then she went on to say that I don’t need any of this and I can give it up because it’s really not what I’m supposed to be doing. And you know, that’s really hard to hear when you’re 35. You mean like, I just got board certified, but I don’t need to do any of this. And I could just like walk away now that I’ve spent like 20 years getting here. She’s like, yeah. And I, and so basically it took me 19, talk about pre-planning. I didn’t pre-plan any of this. I was like holding onto my medical license for dear life, you know, maybe because of two mythological or sort of distorted thinking patterns. One is like both my parents are physicians. So I feel like my connection with my parents emotionally, it’s almost like giving up a family business. You know what I mean? It’s not just me walking away from medicine, but it’s me walking away from my medical relationship with my parents, which was really strong. Right. And also I had this feeling like, oh, I can’t legitimately go out there and help other people launch their ideal clinics if I’m not running an ideal clinic. But that’s also a myth because if you look at the Olympics, like there’s lots of Olympic coaches who are no longer doing gymnastics at age 50 or 60, but they’re really good at coaching gymnastics. So it’s like, why wouldn’t I be able to help people with all my hours of expertise in this area without having to prove that I’m actually still dealing with ingrown toenails and pap smears? And, you know, so I think, yeah, maybe that’s more than you wanted to hear. But all I’m saying is I think we hold on to certain things, including marriages and professions, way longer than we need to as some sort of like a pacifier or, you know, we can’t stand change. And I just think people should be open minded because there’s a lot more for us to experience on this planet in human form than we’re allowing us to experience. We artificially narrow our world down and stay in cubicles that are far too small for our dreams. Which ultimately will kill you from boredom and despair.
Dr. Mark Leeds [40:51] Yeah, yeah, that’s incredible. And that makes perfect sense, the idea of, you know, an athlete becomes a coach or maybe even an announcer, sportscaster. You know, you can only do so many years and eventually you move on to something maybe in the same related field, helping other people or cheering on other people. It makes perfect sense. Oh, yeah, one thing that you said caught my attention. You said something about a psychedelic retreat. Yeah what kind of what kind of psychedelic retreat is that like what do you what do you do
Pamela Wible, MD [41:21] Oh lsd mushrooms you know like I don’t really advertise this and I’m not interested in helping people recreationally with any of this all has to my whole goal by the way I’m focused on healers and I don’t care if you’re a doctor a nurse an unlicensed woman that I met at the laundromat who wants to be a doula you know like it doesn’t matter to me like who you are but if you feel like serving human beings at the highest level, I somehow am in the field of helping healers become self-actualized, whether they’re licensed or not. And sometimes you can have more power and help more people without a license. Sometimes licensed people are sort of jealous of unlicensed people who are successful entrepreneurs or whatever they do, because, wow, you have a skill set that’s so niched out and so specific to you. There’s no regulatory board that even follows that. You know what I mean? And so that there’s a certain freedom in doing that. And so when I have retreats, which I do them the first week of every month on the Oregon coast, different topics like writing your book, physician trauma recovery, launch your ideal coaching clinic practice, you know, I don’t know if there’s somebody who I feel like needs more intense experience with kind of a mind altering substance as a little tea. I would not do this haphazardly. Like it would be somebody that I’ve been working with for months to years and deep, deeply, you know, and if I felt like that would be a safe thing for them to try to help them break out of a counterproductive thinking pattern. And they were stable. I think it’s really terrible to do. I think it’s terrible when people go overseas to like Jamaica or Mexico to like a psychedelic retreat with, I don’t know, 30 people they don’t know and they’ve had suicidal thoughts and they haven’t been vetted out and then they’re like in a completely foreign environment like that is very destabilizing and potentially dangerous so I feel like a lot of people are trying things recreationally and also in groups that are not facilitated properly and so yeah and I think a lot of people are curious about these sorts of things and they do have amazing healing potential so they just have to be done properly so that’s all
Dr. Mark Leeds [43:36] Oh yeah Yeah, and as probably a lot of people know now, it’s becoming mainstream medicine, or it will be probably in three to five years or so. I mean, there’s just companies that can’t wait to get their psilocybin, DMT, and all these other things, ibogaine derivatives, and get them to market as actually FDA-approved treatments. So it’s interesting. So, Dr. Pamela Wible, I normally would ask the person at the end of an interview, what’s the best way to contact you? But I think people could probably just Google your name. But what is the best way to get in touch with you?
Pamela Wible, MD [44:11] Idealmedicalcare.org is easy to spell. And that’s how you would get to my contact page or retreats. There’s a bunch of free books on there. I have a free ebook and free audio book. I’m happy to help people with almost anything. And I have 10 years of material really in-depth on suicide on my website that I think most people could relate to. Whether you’re a doctor or not. And so I would encourage anyone who’s suffering to open their mind to all your internal healing potential and to recognize that maybe this isn’t your fault and you’re in an environment that’s not healthy for you and it’s your body’s call to action for you to change your life in some way versus giving up your life.
Dr. Mark Leeds [44:58] Yeah, definitely. Dr. Wible, thank you for joining me today. Thank you for joining me on the podcast
Pamela Wible, MD [45:04] Yeah thank you for inviting me mark
