Pamela Wible, MD is a family physician in Eugene, Oregon, who advocates for abused physicians and has analyzed more than 350 suicides among physicians and medical students. She believes that physician abuse is extremely common and is often implicated in many physician suicides.

“Physician abuse is so widespread that it has become the norm,” says Dr Wible. “Those who don’t recognize that they are victims of abuse are at high risk of becoming the victimizers. Thus, the cycle continues. The abused victims often turn on each other as they are placed in survival mode and forced to compete with one another. 

“Physicians may begin to bully one another because of their dangerous working conditions. Victim blaming and shaming, bullying and hazing all lead to increased suicides.”


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Dr Wible believes the term “physician burnout” should be banished. “Please stop using the word ‘burnout,’” she implores. “You’re not burned out. You’ve been abused. Let’s get the diagnosis right.”

Dr Wible goes on to say, “Physician and medical student suicide is a global crisis. And often the abuse preceding these suicides constitutes a violation of basic human rights.”

“Human rights violations are clearly described in the UN Universal Declaration of Human Rights, Articles 5 and 24,” she says.5  “These state that no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment, and that everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.”

“The 80-hour-work-week restriction on residents remains unenforced by the Accreditation Council for Graduate Medical Education (ACGME) and now this organization plans to increase interns’ shifts from 16 hours to 28 consecutive hours.”

The abuse continues beyond residency, as physicians are pressured by their employers to see increasing volumes of patients with minimal staff or system support, and forced to put in countless hours of uncompensated time—or face angry patients, medical malpractice suits, complaints to the medical board and/or probationary employment status.

“Most employees are protected by Occupational Safety and Health Administration (OSHA) and labor laws,” explains Dr Wible. “Medical students, interns, residents and physicians are not protected by labor laws. They are not given bathroom breaks or time to eat meals. They are forced to work inhumane hours and are subjected to extreme human suffering and death in the workplace without mental health care or debriefing. ‘Burnout’ is a victim-blaming and shaming term of oppression that covers up these human rights violations. Physicians and doctors-in-training are victims of human rights abuse.”

We, as physicians, often speak out loudly against abuse affecting our patients. It is part of our creed. But it’s now time for us to speak out against the human rights violations affecting our profession as well. Even if we do not do this for our own sake, then we must do it for the sake of our patients, who depend on us for their care and well-being. 

If physician abuse causes the suicide of one single medical student or physician, that is one suicide too many. But there are many, many more victims of this professional malignancy…with immensely tragic and far-reaching consequences.

Note: To read Dr Wibles’ blog about medical student and physician suicide, go to: http://www.idealmedicalcare.org/blog/

References

1. Shanafelt TD, et al. “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.” Mayo Clinic Proceedings. 90(12): 1600 – 1613.

2. Peckham C. “Medscape Lifestyle Report 2016: Bias and Burnout.” Medscape. Updated 2016. Available at: http://www.medscape.com/features/slideshow/lifestyle/2016/public/overview. Accessed November 22, 2016.

3. Rosenthal DI and Verghese A. “Meaning and the Nature of Physicians’ Work.” N Engl J Med. 2016. 375: 1813-1815.

4. Merlo LJ, et al. “Substance Use Disorders in Physicians: Epidemiology, Clinical Manifestations, Identification and Engagement.” UpToDate. Topic 7806 Version 15.0.

5. The Universal Declaration of Human Rights (UDHR). United Nations. Available at: http://www.un.org/en/universal-declaration-human-rights/. Accessed November 22, 2016.