As an intern, I once cared for an elderly gentleman who came in with heart failure. In no time, we grew fond of each other. It was almost like he looked forward to my visits. He sometimes called me “sunshine.” I am not sure if he meant it in a way that meant that I woke him up every morning. He was almost ready to go back home when he …
Most third medical students look forward to their psychiatry block. After twelve plus hour days and six day weeks on internal medicine, OB/GYN and surgery, the reasonable hours on psychiatry seems like a dream. While my classmates viewed psychiatry as a break, I dreaded it. This was not my first time on an inpatient psychiatry ward.
My world and fate forever changed when I was twelve years old. Sometimes depression is …
The psychiatry rotation terrifies this medical student. Here’s why.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 26-year-old man is evaluated for a 3-month history of depressed mood, poor concentration, decreased energy, increased sleep, and weight gain. He reports missing many days at work and that his work performance has lagged. He has no suicidal ideation. He states that his current symptoms differ markedly from his usual state of being “highly …
MKSAP: 26-year-old man with depressed mood and poor concentration
Chapter 1: Physiology
“I am a brain, Watson. The rest of me is a mere appendix.”
– Sir Arthur Conan Doyle
Bound by flesh and bone, therein lies a mystery of undefined potential which the cosmos cannot even parallel in mystery and in complexity beautiful and terrifying. It is that which allows movement to leave the study hall beneath the starry sky, professors to lull us to sonorous sweet slumber, to remember minute …
My brain: In sickness and in health
I was incredibly nervous going into my first day in the inpatient child/adolescent psychiatry unit. “Was this where the truly psychotic kids are? Am I going to be safe here?” I wondered as I casually introduced myself to the staff on the floor. After a morning of sitting in on group therapy led by psychologists and occupational therapists, I calmed down. Against the backdrop of the soothing soft pastel colors, …
The one lesson I learned working in a psych unit
In January, the National Academy of Medicine is launching a new committee to address the high rates of depression and suicide among physicians and other health care workers in the United States. They plan to bring together medical professionals, educators and hospital administrators, and I hope they will also bring to the table professionals who have experienced burnout, and who may have attempted suicide due to burnout. I say this …
We cannot afford to lose our physicians to suicide
I listened to a Planet Money podcast recently titled, Burnout. It dealt with the origin and characteristics of burnout, and I would highly recommend it.
You’ve all heard the term and have a vague knowledge of what burnout is, I’m sure. You may have experienced it yourself. It affects call center employees (as in the podcast), all sorts of service workers, doctors and other health care providers and countless others.
Looking back …
How this psychiatrist handles burnout
Someone presented me with the opportunity to write a section on psychiatry for medical students. This is wonderful (an opportunity to influence future physicians!) and terrible (GAAAAH there’s so much in psychiatry!). Between thinking about psychiatry at multiple levels at work and thinking about the foundations of psychiatry while writing the section, I’ve felt cognitively impaired when thinking about what I should write here.
But the thinking never stops … and …
What this physician learned from writing about psychiatry
I’m just coming out of two years of sleep deprivation.
Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was up every three hours at night for the last two years.
This has given me more experience in living with sleep deprivation than I ever wanted and plenty of time to think …
Sleep deprived and exhausted? These tips will help.
Cheryl lost her son Sean to suicide in medical school. Just a few months ago. Her only child. Cheryl didn’t know that medical students were at high risk of suicide — until her son was dead. Nobody warned her.
Rhonda lost her daughter Kaitlyn to suicide in medical school. Unable to recuperate from the pain of her daughter’s suicide, Rhonda died by suicide …
Warning: Medical school may kill your child
Psychosomatic. I learned not to use that word forty years ago, after I’d told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!”
Well, maybe I should’ve been more circumspect. I hadn’t realized until then that people can understand “psychosomatic” in a different way than I do. I’d meant what …
It’s time to phase out the word “psychosomatic”
She is tall, thin and wears torn jeans like a mannequin. A silky top flows around her, masking the thin torso, the exposed ribs. Her hair is long, fine and the ends are perfect. Her face is smooth, drawn, a bit careworn, but that is why she is here. She carries herself with an aristocratic bearing that is not learned but genetically endowed over generations. She is rich, entitled and …
I’m a psychiatrist. I’ve been practicing for 30 plus years. I’ve worked in inpatient and outpatient settings seeing the typical mix of general psychiatric patients. About five years ago, I was asked to take the training for a buprenorphine license to serve as a backup for our addiction psychiatrist in her suboxone clinic. I did the training, doubting that I would every really use it on a consistent basis. But …
Why this doctor is drawn to the treatment of addiction
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I answer every phone call from every patient myself. I have no staff to respond to issues that come up during the day. There are no colleagues that take my calls after hours. This was my choice in response to what everyone knows: Health care is broken. I needed a radical change from the bureaucratic system that I experienced daily as a physician however I had no idea how to …
A physician quits and practices medicine her way
There are a lot of misconceptions about psychiatrists and the way we practice, mainly because our sphere of medicine is so vastly different from that of any other medical specialty (and yes, I have an MD!) Here are a few thoughts I hope will help you understand us and our field a little better.
1. Yes, we all have clocks in our offices. We watch the time to pace ourselves, not …
11 things your psychiatrist wants you to know
A provocative new study from Denmark supports a link between hormonal contraceptive methods (like birth control pills) and depression. The association seems to be strongest for adolescent girls.
Huge studies like this are based on huge datasets. In this case, the study relies on the Danish medical system’s longstanding penchant for meticulous and integrated medical records. You couldn’t do this kind of research in the USA, where medical records …
Does birth control cause depression?
As a forensic psychiatrist, I have testified in courtrooms, at depositions, legal hearings, and inquests. I’ve been cross-examined by attorneys whose agenda was to discredit my testimony or demean psychiatry as a medical specialty. Two criticisms frequently leveled at psychiatry are: 1) Psychiatry has not changed significantly for the last sixty years and, 2) Psychiatry is the least scientific of all medical specialties.
These beliefs are not true.
Over the last few …
The integration of psychiatry with neuroscience, biochemistry, and genetics
I went into medicine because I wanted to learn about the craft, become proficient at healing disease and easing suffering, and because I genuinely liked getting to know more about my patients and hearing their stories. These reasons for going into medicine as a career and staying in medicine as a vocation have not changed significantly through the last three decades.
The problem we are faced with pretty often nowadays is …
The fine line that we walk as physicians
Waiting to get help to improve your life and relationship is like waiting for the cancer to spread. You feel a lump on your body. Do you wait a few months to see if it gets bigger? Do you make an appointment right away? Do you avoid making an appointment altogether and hope it just goes away on its own?
Many times, we wait until after the divorce, after the accident, …
When should doctors see a therapist?
As doctors, we love to think we are intelligent, rational, thoughtful and caring human beings, and we take pride in our profession and the privilege and status it accords. We like to hold our heads high, puff out our chests, speak with authority and convey our hard-earned knowledge acquired over many years of undergraduate and post-graduate study. We like to think we know; we have answers; we can cope; we …
We are all responsible for physician suicide
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