Physicians writing on KevinMD about burnout, moral injury, depression, and suicide in medicine: what causes burnout and whether the word fits, resilience training and why physicians distrust it, who leaves and why, the fear of seeking help and the licensing questions behind it, what physicians say actually helps, and, on the patient side, psychiatry, access to care, and the arguments over diagnosis and treatment. Three maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Physician suicide: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.
In a world of diverse mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost their former prominence. Only a small fraction of patients have the time, money, and interest to engage in long-term, open-ended mental exploration — even if doing so would get to the root of their problems and lead to lasting improvement.
More commonly, emotional distress is dealt with in emergency departments, in crisis clinics, on the medical and surgical floors of hospitals, in …
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It’s time for psychodynamically informed clinical thinking
No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight.
That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali …
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There she was, hanging in our closet
A few weeks after I started residency, two of my peers killed themselves in New York City. No one I knew was surprised.
Intern year is hell, and everybody knows it from TV shows like “Scrubs” and books like “House of God.” Old doctors tell tall tales of working a million hours without sleep before training standards got “soft,” limiting residents’ monthly work hours to 320 and requiring four days off. …
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Stressed and sad as a medical intern? You’re not alone
I’ve known since I was very young that I just experienced life differently than did my extroverted family members and friends. During parties, they seemed to truly enjoy the loudness and chaos of get togethers and the seemingly endless small talk, while I would secretly yearn to return home so that I could read my latest novel in peace. An older family member once told me that I would eventually …
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Can physicians be introverts? A introverted physician speaks her mind.
Many patients are referred to me as a psychiatrist to treat their depression. The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right? Not always.
Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms. Well, sometimes …
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The answer to depression isn’t always an antidepressant
“I attribute my success to this-I never gave or took any excuse.”
-Florence Nightingale
I was publically thanked today for doing my job. No, really. By two of my coworkers, actually. It sort of took me aback just a bit.
Over the past Christmas holiday a couple of patients, being human as we all are, forgot to get their medications squared away before the clinic was going to close for a total of …
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It’s 2017. There’s no excuse to be disconnected.
Medical science is moving forward at breakneck speed. Advancements in stem cell research, robotics and nanotechnology promise a new era of molecularly targeted medications, replacement body parts, and regenerative treatments to combat disease and decline. But if a picture is worth a thousand words, then the footage of Jimmy Carter, looking healthy at the inauguration, his advanced melanoma now in remission, says more about our accomplishments than a year’s worth …
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Hope and trust are two powerful medicines we should use more of
I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. I’ve done thousands of consults in over two dozen South Carolina emergency departments over the last half-dozen years. We have now gone over thirty thousand consults as a group.
It never ceases to amaze me, as I fire up my computer, log on to my systems and bring …
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Why do people kill themselves?
In the past few weeks, we have lost two female physician colleagues tragically to suicide, a pediatrician and psychiatrist. In the general population, males take their lives at four times the rate of females. However, for physicians specifically, the suicide rate is evenly distributed between genders; making our occupation the one with the highest relative risk for women to die by suicide. …
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Physicians must stop losing their own
Mukhwas are the Indian equivalent of an after-dinner mint. Sweet and flavorful, but typically only distributed through one tiny spoonful at a time, mukhwas are the perfect way to completely clear your palate, wiping clean the last remnants of a tantalizing meal. A small dosage of the mukhwas completely nullifies the aftertaste, so that the attention is no longer on the meal that has just passed. It’s the gustatory equivalent …
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How practicing mindfulness between patients makes you a better doctor
On January 31, 2017, the Psychology Today editorial staff published a well-balanced summary of the debate over whether to declare President Trump mentally ill. While the debate focuses on mental health professionals such as psychiatrists and psychologists who are credentialed to make such diagnoses, the question clearly goes further.
Public commentary following this and other articles expresses outrage — not only at the behaviors and policies of Trump himself, but also at any suggestion …
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Little is gained by arguing that President Trump has a psychiatric disorder
I know of only two people who, upon starting medical school, knew that they wanted to become psychiatrists. (How did they know what they wanted to do eight years before they did it?) They both achieved their professional goals: One created a community clinic for people with severe psychiatric illnesses. The other became an addiction psychiatrist and now oversees an entire substance use disorder program for a health care organization.
I …
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Why it’s important to know yourself
This week, a resident asked, “What do you say to suicidal physicians?”
1. I don’t say anything. I listen without judgment. Our culture doesn’t support physicians asking for help — or revealing their suffering. As a result, physicians fear sharing suicidal thoughts with friends and family because we’re the ones that others rely on for help. Physicians fear speaking to their program directors or employers because of professional retaliation and loss …
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3 things to say to a suicidal physician
He was a small but very intelligent and articulate young man. I had seen him before, but it had been quite a while. He came to me complaining (as did his family) that he was having some trouble controlling his anger, dealing with quarrelsome students at school, and not always getting his assignments inside or outside of school completed in a timely manner.
We discussed the usual ways to approach this, I …
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We all have glitches. I know I do.
For much of her adult life, Cassie (not real name) struggled to get out of bed. Taking her kids to school, let alone showering or preparing meals was often more than she could handle. Cassie has bipolar disorder, and while she had health insurance through her employer, it did not offer mental or behavioral health benefits. The therapy and prescriptions she needed were too expensive. She was desperate, barely holding …
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Moving mental and behavioral health beyond parity
If you Google “misophonia” you might be shocked to find numerous articles discussing the tragic suicide of 52-year-old Russian-born scholar, Dr. Michelle Lamarche Marrese. Journalist Joyce Cohen was the first to report Marrese’s suicide in the New York Post piece “She could hear everything and it cost her her life.” Cohen explains that she and Marrese had been corresponding about Marrese’s struggles with misophonia for over 14 months, and that …
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Misophonia and suicide: Sound thinking is required
In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.
Medical training has long had its culture rooted in ideals of suffering. Not so much for …
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There is something rotten inside the medical profession
Over the past couple of months, I have had the privilege of meeting with several colleagues in my community. When I contacted them, I offered to bring them lunch if they would give me a few minutes to share an idea about a project that I am really excited about. However, what I really wanted was a chance to engage with physicians who I knew little more than their name …
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What a psychiatrist learned when she tried to connect with her colleagues
An article released in the JAMA sites evidence that the suicide rate in America has risen by 24 percent in the last 15 years associated with a significant reduction in the numbers of psychiatric beds available. The U.S. has had a lower capacity for psychiatric patients than comparable countries in Europe for years, but between 1998 and 2013 that number dropped even further.
Waiting in the ER for days
This …
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Why America fails at psychiatric care
