Physician Burnout and Mental Health

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.

The gifts of burnout: An evolutionary wake-up call for doctors

Lisa Chu, MD

Physician

January 24, 2015

It has been fourteen years since I graduated from the University of Michigan Medical School. I have journeyed far from the field of medicine, and yet my heart keeps hearing the call to return to my physician communities and share what I have learned. I simply cannot ignore my sense that the pain within our health care system – now felt at every level, including patients, physicians, and payors — …

The Dzhokhar Tsarnaev defense: Will marijuana play a role?

Judith G. Edersheim, MD, JD

Physician

January 20, 2015

January marked the start of what promises to be a four-month public reckoning: the trial of alleged Boston Marathon bomber Dzhokhar Tsarnaev. If the press reports about the evidence against him are accurate, most of the trial will not be about guilt or innocence; it will be about sentencing. Not a who-done-it, but a why-done-it.

If Tsarnaev is found guilty, the death penalty will be on the table, and the proceedings will …

What does it mean to be a competent psychiatrist?

Steven Reidbord, MD

Physician

January 13, 2015

What defines a competent psychiatrist? To staunch critics of the field, perhaps nothing. Some believe psychiatry has done far more harm than good, or has never helped anyone, rendering moot the question of competency. What defines a competent buffoon? A skillful brute? An adroit half-wit? Having just finished Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, a reader might easily conclude that psychiatric competency is …

I’m happy: A social worker’s story

Raymond Abbott

Patient

January 9, 2015

On my voice mail is a message from Donald Wyatt. He doesn’t often call, but every Monday morning he comes to see me at the Louisville, Kentucky, mental health clinic where I’m a social worker.

His message is brief: “I’m not feeling well, and I am planning a trip to either St. Louis or Elizabethtown.”

I smile, wondering at the odd pairing. Elizabethtown is a small city of 50,000 people. And, well, …

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I’m happy: A social worker’s story

Improve the inequalities among physicians

Brian J. Dixon, MD

Physician

January 7, 2015

Our current health care system will fail; it’s simply a matter of time. Yet the delivery of efficient, quality, and progressive health care is quite possible once we shift our thinking. A true paradigm shift in medicine begins with first establishing that each pillar in health care has an equal responsibility in making a new system work: patients, providers, and places (facilities).

This article pertains to only the provider portion.

As …

Will the psychologists involved in torture be held accountable?

Bob Doherty

Health Policy

December 30, 2014

Whatever happened to “first, do no harm?”

One of the findings included in a Senate investigative committee’s report on the U.S. government’s post-9/11 torture program was that it was designed by two psychologists. They were paid “$80 million to develop torture tactics that were used against suspected terrorists in the wake of the September 11 attacks on the Pentagon and the World Trade Center” — including “waterboarding and mock burial on some of the …

How physicians and psychologists agree to torture others

Maria Yang, MD

Physician

December 29, 2014

Atul Gawande posted a series of tweets, based on findings in the Senate CIA torture report, about the significant role physicians and psychologists played in torture. He comments, “But the worst for me is to see the details of how doctors, psychologists, and others sworn to aid human beings made the torture possible.”

Agreed. Upon reading how these professionals used their knowledge to torture their fellow human beings I felt disappointed, …

A doctor wants to leave medicine to sell Tupperware

Pamela Wible, MD

Physician

December 21, 2014

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A letter received by Pamela Wible, MD.

Dear Pamela:

I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is …

Suicide: A doctor’s story

Richard Gunderman, MD, PhD

Physician

December 18, 2014

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It is estimated that approximately 14 percent of U.S. physicians in training are depressed and another 10 percent experience suicidal ideation. Some 400 U.S. physicians take their own lives each year. Hampering efforts to deal with such problems is the stigma associated with them. I knew a top medical student who was reluctant to seek mental health care in part because …

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Suicide: A doctor’s story

A child psychiatrist: Whether I choose to be one or not

Greg Smith, MD

Physician

December 14, 2014

Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me.

He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be …

The Shooting at Sandy Hook report: 4 things we can learn from it

Claudia M. Gold, MD

Physician

December 4, 2014

The recently released report, Shooting at Sandy Hook Elementary School, from Connecticut’s Office of the Child Advocate offers a searing in-depth account of the holes in our mental health care system. The report is careful to point out that no causative link exists between their findings and the events at Sandy Hook. However, this in-depth investigation offers an opportunity, if we are able to hear and take action on its …

Physician suicide 101: Secrets, lies and solutions

Pamela Wible, MD

Physician

November 13, 2014

This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.

Why did you go to medical school?

I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction …

Giving extremists a fake psychiatric diagnosis

Allen Frances, MD

Conditions and Diseases

November 11, 2014

Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior?

Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only …

Cognitive behavioral therapy: Why parents should be involved

Claudia M. Gold, MD

Conditions and Diseases

November 10, 2014

While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:

A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains …

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Cognitive behavioral therapy: Why parents should be involved

After the latest school shooting, social media accounts should be monitored

Dominic A. Carone, PhD

Physician

November 4, 2014

In the wake of the latest school shooting in the state of Washington, much attention has been paid to the shooter’s (Jaylen Fryberg’s) Twitter account. In fact, after a school shooting, social media sites are typically the first place that people go to learn about the assailant. While this is understandable, one has to wonder if any of these school shootings …

A civil war in psychiatry: Is there common ground?

Allen Frances, MD

Physician

October 29, 2014

There will never be any compromise acceptable to the die hard defenders of psychiatry or to its most fanatic critics.

Some inflexible psychiatrists are blind biological reductionists who assume that genes are destiny and that there is a pill for every problem.

Some inflexible anti-psychiatrists are blind ideologues who see only the limits and harms of mental health treatment, not its necessity or any of its benefits.

I have spent a good deal …

Primary care physicians: 7 tips to treat health anxiety

Lynne S. Gots, PhD

Conditions and Diseases

October 28, 2014

Before the Internet age, people with excessive and irrational worries about their health (we called them “hypochondriacs”) went to their doctors for reassurance. Today these patients still schedule appointment — often with exasperating frequency — with their primary care physicians when they’re concerned about an unusual lump or vague symptom. But most likely they’ll have first consulted WebMD or the Mayo Clinic website and come up with a differential diagnosis of their …

Suicide puts the medical profession in a difficult position

Elaine Khoong, MD

Physician

October 26, 2014

Recently, I wrote about the importance (and difficulty) of maintaining a healthy lifestyle as a resident. Now, I’d like focus more specifically on the toll that residency — and in general, a career in medicine — takes on a health care provider’s mind and soul.

As you may have heard, in August two young physicians decided to end their lives. No one …

Lesson learned: Not everyone is crazy

Edmund Messina, MD

Physician

October 23, 2014

An excerpt from The Spattered White Coat: Intense experiences which formed a young doctor.

I’ll never forget one of the first patients I interviewed. When I went to get him, I could see him sitting in the waiting room, looking around and scratching his arms repeatedly. He was a very …

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Lesson learned: Not everyone is crazy

Should we use antipsychotics to treat ADHD?

Claudia M. Gold, MD

Conditions and Diseases

October 19, 2014

Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.

When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range …