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.

Integrating psychiatric care into primary care: The VA example

Shaili Jain, MD

Physician

July 19, 2014

For the better part of the last two decades I have practiced psychiatry in a variety of different American health care systems, and over these years I have, on numerous occasions, heard psychiatric services referred to in manner that imply (often subtly) that such services are not medical care. These references come not only from patients, but nurses and doctors (including myself) too.

“Yes Mr. Jones you need to follow up …

The economic case against the death penalty

Allen Frances, MD

Physician

July 17, 2014

I am not strongly against the death penalty on principle or on moral grounds — assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals.

I don’t even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a …

Thoughts about suicide post-stroke: A most difficult intervention

Kyle Bernard

Patient

July 15, 2014

The interview had lasted fifteen minutes so far, and we’d made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora’s medical history together.

A year earlier, Leora, in her mid-fifties, …

Recognizing and treating self-injurious behaviors in teens

Susie Raskin, LMHC

Conditions and Diseases

July 11, 2014

“Is it weird that I cut myself on purpose?”

A 14-year-old girl from a local middle school asked me this question at work last week. In my years as a Teen Xpress counselor, I have been asked about self-injurious behaviors many times.

They ask:

“What is it about?”

“Isn’t it just a way to get attention?”

“Why would someone do that?”

“Are they trying to kill themselves?”

It’s not only teens that ask about self-injury. I’ve …

The clear, killing acid of modern life

Greg Smith, MD

Physician

July 9, 2014

Floor technician.

Environmental technician.

Life coach.

Investment and retirement strategist.

Facility safety coordinator.

Interventional cardiologist.

Cardiothoracic and vascular surgeon.

Neurodevelopmental psychologist.

Are we hiding behind out words? Worse yet, are we afraid to be who we really are?

Maintenance man.

Trash man.

Knowledgeable and experienced friend.

Salesman.

Security guard.

Doctor.

Psychologist.

I see it every day. Someone comes to me for a run-of-the-mill mental health problem, absolutely nothing to be ashamed of, and asks for help. For whatever reason, when we get to the social history …

Read more…

The clear, killing acid of modern life

Ailments are big business

Hans Duvefelt, MD

Medications

July 8, 2014

Back when Prozac (fluoxetine) and Zoloft (sertraline) were new, I remember the mental acrobatics doctors made to justify giving these drugs to anxious patients. The drugs were approved for treating depression, but we knew they often seemed to help anxiety. The reason, we were told, was that some anxious patients were actually depressed, deep down, and we had just failed to recognize their depression.

Now, with studies to support their use …

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Ailments are big business

3 innovations to improve mental health treatment

Mary Giliberti and Stuart Lustig, MD, MPH

Conditions and Diseases

July 6, 2014

Our nation has recently witnessed another tragedy involving a young adult, with young adult victims. Facts often emerge slowly and it is important not to speculate about diagnoses through the news media; however, it seems clear in this case that mental illness is a factor — even though few people living with mental illness are violent.

To avoid tragedies, solutions are needed. One area of real promise is early …

The troubling deficiencies in our mental health system

Emily Newhook

Health Policy

July 4, 2014

Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional roller coaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates …

Living with my son’s schizophrenia: From fear to hope

Randye Kaye

Patient

June 21, 2014

When my son Ben was 20-years-old, he was finally diagnosed with schizophrenia after five years of chaos and frustration — what I later came to know had been symptoms of the gradual onset of his illness. At the time, I’d thought he was just having a tough adolescence. I’d thought perhaps he needed more father figures (Ben’s father had deserted the family when Ben and his sister were little, and …

Exploring the mind of a mass murderer

Allen Frances, MD

Conditions and Diseases

June 18, 2014

Mass murders are becoming a depressingly familiar routine in the United States — we can now expect to experience a media grabbing shooting about once a month. And the frequency can only increase as future cohorts of copycat killers are spawned by the seductive opportunity to temporarily gain the spotlight.

Amidst the anguish and heartbreak felt by the victims’ families, there are always two haunting questions. What motivates someone to kill …

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Exploring the mind of a mass murderer

Have ADHD diagnoses reached a tipping point?

Allen Frances, MD

Conditions and Diseases

June 13, 2014

I have been blogging and tweeting about ADHD a lot lately because I believe that change is in the air.

This is the worst of times for ADHD diagnosis because statistics show it is wildly overdiagnosed and overtreated. This is possibly the best of times for ADHD diagnosis because I think we have reached the tipping point and feel hopeful that the ADHD fad will soon begin to fade.

We humans are …

The military is off-track when dealing with mental health problems

Allen Frances, MD

Conditions and Diseases

June 4, 2014

The headline reads, “Study: Mental illness rate higher in soldiers.”

The article goes on to offer alarming statistics:

The rate of major depression is five times as high among soldiers as civilians; intermittent explosive disorder, which results in episodes of extreme anger, is six times as high; and post-traumatic stress disorder was nearly 15 times higher than among civilians, the study found.

This would be pretty scary if true — but …

A physician’s story of mental illness

Kyle Bradford Jones, MD

Physician

May 26, 2014

Pamela Wible, MD, a family physician who is an expert in physician suicide prevention, recently asked other physicians why so many in the profession kill themselves. The answers were plentiful, tragic and not at all surprising.

One physician confessed to having post-traumatic stress disorder after medical school. Another cited constant sleep deprivation. Yet another mentioned the combination of a crushing workload, a difficult boss and payers who are more …

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A physician’s story of mental illness

The depressed may appear like you and me

Afshine Ash Emrani, MD

Conditions and Diseases

May 25, 2014

I received a panic call from Jim, who had been a patient for over ten years. His 5-year-old daughter had passed out. Amanda was rushed to the ICU for new onset diabetes. After stabilization, she was transferred by helicopter to a university hospital for an insulin pump insertion. He knew that her life, his life, would never be the same.

Two weeks later, I received another call from Jim. This time, …

Psychiatric hospitals need meaningful use incentives

Edmund Billings, MD

Health Technology

May 22, 2014

Imagine you go to work one day and your boss says all employees will be evaluated based on the performance of a new set of job skills that require additional training and, perhaps, new computer hardware and software. The boss also announces that some employees will be reimbursed for the cost of acquiring these skills and tools. You aren’t among this privileged group.

In government, this is called an unfunded …

Out of the many he has seen, he will do his best to help just this one

Greg Smith, MD

Physician

May 19, 2014

She looked like a whipped puppy that had had a garden hose turned on it and slunk off to a far corner of the yard to dry out in the sun.

She sat there, wizened but hard, thin and wiry, dressed in standard issue blue emergency room scrubs, thin tanned face, long stringy, wet prematurely gray hair falling limply around her shoulders. She looked down at the floor, but when her …

How do psychiatrists manage clinical uncertainty?

Steven Reidbord, MD

Conditions and Diseases

May 16, 2014

Lucia Sommers of the department of family and community medicine at the University of California, San Francisco commented on my last post, noting that clinical uncertainty among primary care physicians (PCPs) is usually regarded as tolerable at best. She was delighted that I called such uncertainty intellectually attractive, and something to embrace in psychiatry. Sommers and her co-author John Launer recently published a book that argues for managing clinical uncertainty in primary care using …

Hitting rock bottom can change lives for the better

Anonymous

Physician

May 10, 2014

An excerpt from Hope For Addiction: Help and Hope for Families of Those Struggling with Addiction.

The law states that no one can be forced into treatment against their will unless they are at risk of harming themselves or others (this varies by state, but the laws are very similar …

We will never really understand the motivations of mass murderers

Allen Frances, MD

Physician

May 2, 2014

After every mass murder, the question everyone asks is why it happened. How could anyone possibly be so violent, or so evil, or so out of control, or so crazy as to engage in the wholesale and indiscriminate killing of a bunch of people who are usually complete strangers?

In some cases, there are longstanding preexisting warning signs: a history of mental illness, substance use, isolation and/or estrangement; the repeated experience …

Dealing with all the behavioral conditions of unknown etiology

Steven Reidbord, MD

Conditions and Diseases

May 1, 2014

A few years ago I wrote that uncertainty is inevitable in psychiatry. We literally don’t know the pathogenesis of any psychiatric disorder. Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric. Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric conditions went to neurology; brain tumors and hemorrhages went to neurosurgery; and so forth.

This leaves psychiatry …