In this interview, TEDMED’s Dr. Nassim Assefi and founder of the Ideal Medical Care movement Dr. Pamela Wible discuss physician suicide, sexism in medical school, and how to escape “assembly-line medicine.” You can watch Pamela’s TEDMED 2015 talk, “Why doctors kill themselves,” here.
Nassim: You’re one of the few physicians I know who’s been outspoken about physician suicide, open about her own history of depression while in medical practice, and proactive in addressing medical student and physician mental health. How did you become such an activist?
Pamela: I’m an activist and community organizer at heart. I was born into a family of physicians, activists, and entertainers. My grandfather started the motion picture workers union in Philadelphia. I’m related to Curly, Moe, and Shemp of the Three Stooges. It’s in my blood to be joyful, comedic, and lighthearted, but also to speak up for the oppressed and victimized. I’m a born healer and problem solver—whether it’s a patient with an ingrown toenail, a doctor with PTSD, or a suicidal health system. I’m curious, relentless, and very vocal about injustice. Yet without action, words fall flat. Action is what excites me most.
Nassim: You’re a somewhat controversial figure in such a conservative profession. You wear glitter, throw Pap parties, and even deliver balloons and homemade soup to your patients during house calls. Is this quirkiness and whimsy an intentional strategy to spread joy and love in your medical practice or just an extension of who you are? Have you ever received pushback from a mistrusting patient or colleague?
Pamela: My personality and my glitter are not strategic. I’m just being me. I find that when I am free to be myself, my patients feel free to be themselves. Authenticity is therapeutic for us all. Authenticity is also sorely lacking in health care, much to the detriment of physicians and patients. Medicine has too many starched white coats and not enough color, soul, and feeling. My patients are relieved and even thrilled to meet a “real” doctor who is a “real person.” Once (in response to an article I wrote for a medical journal) I did receive a letter from a male clinic manager who claimed my appearance was unprofessional. I recited his letter and responded to his concerns in my TEDx talk, “How to get naked with your doctor.”
A surprise birthday party physical at Pamela’s clinic.
Nassim: You’re a pioneer of the Ideal Medical Care movement, have written a book about it, and offer courses and retreats to help doctors escape “assembly-line medicine.” Can you give me the nitty-gritty on ideal medical clinics?
Pamela: I’m simply practicing medicine the way my dad used to practice as a neighborhood doctor back in the 1950s (though I’m pretty sure he didn’t throw Pap parties for his ladies). Like my dad, I have no staff and I’ve never turned anyone away for lack of money. My dad and I genuinely love people, and I’m sure patients can feel the love.
I see 6 to 8 patients per half day for 30-60 minute visits. I document on an electronic medical record that I created myself on my Apple laptop. I accept insurance and submit claims in 1-2 minutes after each visit through a free online clearinghouse. I roll out the red carpet for every patient, whether millionaire or homeless. It’s VIP without the fee. By cutting out the middlemen, I decreased my overhead from 74% at my favorite assembly-line job to nearly 10%, leaving me with 90% of the revenue I generate. Physicians who practice this way can exceed their previous full-time salaries working a fraction of the hours. However, most doctors enjoy their newfound freedom and autonomy more than money. No amount of money can compensate for a miserable life and most doctors today seem pretty miserable.
Meanwhile, I’m happy. My patients are happy. I feel like I’m on vacation 24/7. I rarely get after-hours calls. Plus, I’ve never sent anyone to collections in 11+ years. This feels like the only viable way to practice medicine.
Best of all, our clinic was designed by my patients. I held town hall meetings and invited my entire community to design their ideal medical clinic. I collected 100 pages of written testimony, adopted 90% of citizen feedback, and we opened one month later with no outside funding.
What Pamela calls the “reverse white coat ceremony” physicians’ retreat.
Nassim: Your mother, Dr. Judith Wible, is a psychiatrist and has a scholarship for visionary female medical students in her name. Did she play a role in your activism?
Pamela: Yes. My mom is an activist and leader in the women’s rights movement. During my childhood she took me in my stroller to women’s liberation marches, bra burnings, and all of that. She and I went to the same medical school too, and what she went through was much worse than what I had to deal with due to out-of-control sexism and harassment.
Nassim: You’ve had some major success lately. A new book, Physician Suicide Letters Answered, that was #1 on Amazon for Medicine for a month after release, a new house bill in Missouri that addresses depression and suicide in medical schools, and you’re being featured in an upcoming documentary, Do No Harm, by an award-winning filmmaker, Robyn Symon. Are you optimistic that all this attention will translate into more compassionate medical education and practice for the students and doctors?
Pamela: I’m a perpetual optimist. All these successes couldn’t have happened without public and professional support and a willingness to finally address medical student and physician suicide. It is a defining moment for us all.
Nassim: So, what’ s next for you?
Pamela: I’ve been sent on some Michael Moore-style missions through hospitals with secret film crews for the documentary. That’s really fun! I’d love to dig deeper into investigative journalism.