How does the EHR drive burnout? Let’s count the ways. By understanding this, we can develop countermeasures to lower the impact and reduce the risk of physician burnout.
We’ve all seen the studies that show that for every hour we spend with a patient, we spend two hours on administrative work, and we take hours of work home with us each night. But as we’ll see, it’s not all just about …
How does the EHR drive burnout? Let’s count the ways.
“I think my friend has attempted suicide” an 11-year-old child haltingly admitted after I introduced myself as a crisis counselor with a national hotline and asked how I could help.* Over the next half hour I learned that this child and her friend had been facing ongoing cyber- and face-to-face bullying at school that was such a common occurrence the caller sounded nonchalant. The caller’s friend, however, had already attempted suicide at least …
How the show 13 Reasons Why can help you in the exam room
A woman recently requested a medication evaluation at the suggestion of her psychotherapist. The caller told me her diagnosis was borderline personality disorder. She hoped medication might ease her anxiety. She also admitted that two other psychiatrists refused to see her because she was too “high risk.” I asked if she was suicidal. Yes, thoughts crossed her mind. However, she never acted on them, and was not suicidal currently. I …
Does the high-risk psychiatric patient pose a risk for the patient or the doctor?
It wasn’t until I was six months into my second depressive episode that I discovered depression existed. I didn’t know it was a real disease. I didn’t know that my grandmother got electroconvulsive “shock” therapy in the 1950s. I only knew something was terribly wrong when I sat crying for 20 minutes in front of a pile of laundry one morning because the thought of choosing clothes and going through …
We need to talk about mental illness in the medical field
As a physician, all the mounting negative news I read about doctors can’t help but hit me straight in the gut. This is especially true when reading about a tragic murder of a sweet and highly dedicated 32-year-old physician, Dr. Tracy Sin-Yee Tam and the serious injuries to five other physicians on June 30th at NYC’s Bronx Lebanon Hospital. Can you blame me for advocating for my esteemed colleagues? Everybody’s …
The moral assassination of physicians must stop
Recently, I learned that YouTube star Stevie Ryan completed suicide. As she found her fame via social media, her death has also been the focus of the virtual world. Her death spawns a tremendous amount of questions that are left unanswered regarding why and how did this happen.
In case you missed the details of the story, Stevie completed suicide by hanging. She had tweeted the day before that, “The man …
Real grieving after suicide doesn’t occur on social media
On June 30th, a physician entered a hospital in New York City with an assault rifle. He killed one person, a physician, and wounded six others. He then set himself on fire and shot himself in the chest, dying by suicide.
I, nor anybody else, knows this man’s motives or what was going on in his head. But one detail in the story stuck out to me.
According to CNN, …
How do we create the medical culture that is conducive to physicians’ health?
Recently, I attended a conference where a recognized expert in physician burnout was a keynote speaker. As I sat through this lecture on physician burnout, it struck me that we may be approaching burnout in an entirely wrong way. We either look at it from a disease standpoint along the lines of PTSD or depression. Alternatively, we view it as Read more…
Physician burnout is the inevitable result of a failed medical education system
A long time ago, when I was interning in an emergency department, several ambulances arrived at once from the site of a bombing. They unloaded three victims plus a mass of assorted limbs. As I placed an endotracheal tube in one patient, the awfulness suddenly hit me: These people had probably been sitting peacefully at home only a half-hour earlier, and now they were a mass of gore. Overwhelmed, I …
Doctors experience PTSD every day
Imagine that you come home to find your daughter in tears. She’s been acting strangely for the past year, but she never tells you what’s going on. This time she finally tells you: She can’t stop thinking about killing herself with a knife in the kitchen. After an hour of talking, you realize that she doesn’t want to die, but she has obsessive thoughts about hurting herself. She’s overwhelmed, and …
Children suffer mentally, but no one helps
Dear Dr. Wible,
I lost my beautiful son Evan to suicide four weeks ago. He was a second year internal medicine resident — a very smart, loving and funny man! He left a lengthy letter and in it he stated, “I do not want any attention drawn to this.” I have been crying all day reading your book and blog and I’ve seen …
I just lost my son to suicide. What can I do?
Why can’t doctors be depressed? They encounter challenging and emotional situations every day, and they are robbed of the emotional intelligence training necessary to handle them properly.
The 32-year-old single mother of two who was recently diagnosed with metastatic breast cancer and given a prognosis of four months to live. The 13-year-old daughter who suffered her first seizure while swimming alone in her home pool and now lies paralyzed in the …
Why can’t doctors be depressed?
I am not an employee. Maybe I should have said this four years ago when I was an employee. When I opened my private practice in 2014, I was running away from something as much as I was running to something new. I’ve been out of training for over a decade. Early in my career, I envisioned myself as an employee of either a non-profit organization working with underserved communities …
Caring for employees is the right thing to do
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It started with nightmares. I would wake up frightened, covered in sweat and searching my empty room for an intruder. It progressed. I started setting traps on my doors to see if anyone was coming into my apartment when I wasn’t there. I didn’t open my blinds often. And when I did, I ensured no one would be able to see inside. I meticulously planned movements outside my apartment — …
Why don’t doctors talk about mental health?
I had an interesting conversation with a patient in the office some time ago.
He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than …
Is there a medication that can combat rigid and robotic thinking?
December 2012, three days before Christmas. It started as an ordinary day, but soon it would become the turning point of my career. As I entered my office, I noticed a different energy in the room. The receptionist looked at me and said, “Doc, one of your patients died last night.” As a psychiatrist, I am not used to the feelings generated when someone you cared for, passes in the …
How are we supposed to deal with death?
“We don’t want them here.”
President Trump could not have sent a clearer message to Muslim children around the world. In the eyes of our nation’s elected leader, these kids are not wanted in the United States.
Trump’s immigration policies have been focused on keeping “radical Islamic terrorists” out of the United States, but research in child psychiatry suggests that …
How President Trump may be radicalizing Muslim children
I have lived for some time with depression. Most of the time, it is nagging in the background, helped by exercise, family and friends. But a few times, despite my best efforts, it has gotten out of control.
At the middle of my chief year in November, it came to a head. I was under tremendous pressure to apply for fellowship when I didn’t think it was what was best for …
I had depression, and my fellow doctors treated me horribly
She didn’t seem obviously depressed as I entered the room.
“So, we have you taking a good dose of both antidepressants now,” I said. “How are you doing?”
“I feel about the same.”
“Have you done anything lately that could have made you feel a little better?”
“I’m not sure …”
“I’ll give you some examples. They can be different things for different people. It could be reaching out to a friend, helping a neighbor, …
Help people let go of struggling and move toward valued living
During my two years off from medical school, I’ve been volunteering as a court appointed special advocate for children in the foster care system. And I’ve spent a lot of time reading about how these kids’ experiences could affect the rest of their lives.
The seminal research on this happened in the late 1990s using data from more 17,000 Kaiser patients. What the researchers found was that patients who reported more adverse …
What this medical student learned after working with foster children
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