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.

Visiting my family member: A tale of two facilities

Betsy Nicoletti, MS

Conditions and Diseases

May 29, 2013

Recently, a member of my family was involuntarily admitted to the psychiatric unit of a major teaching hospital in New York City and remained there for two and a half weeks. During that time, the unit kept him safe and provided medication for mood stabilization and thinking. After seeing my family member, my first priority was to talk with the attending physician and care team.

Evidently, the attending doesn’t like to …

Introducing the Automated Psychiatrist Machine

Maria Yang, MD

Physician

May 28, 2013

Are you tired of waiting fifteen minutes only to spend ten minutes with your psychiatrist? Do you hate rearranging your busy schedule, fighting traffic, and trolling for a parking space just to spend a few minutes with your doctor? Wouldn’t it be easier if you could take care of your mental health according to your schedule, instead of someone else’s?

We are pleased to introduce the Automated Psychiatrist Machine (APM). The …

Creating value for others boost to our happiness

Alex Lickerman, MD

Conditions and Diseases

May 25, 2013

The set-point theory of happiness suggests that our level of subjective well-being is determined primarily by heredity and by personality traits ingrained in us early in life and as a result remains relatively constant throughout our lives. Our level of happiness may change transiently in response to life events, but then almost always returns to its baseline level as we habituate to those events and their consequences over time. Habituation, …

It’s time to treat mental illness in the ER with dignity

Greg Smith, MD

Physician

May 23, 2013

We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This …

One morning I woke up and I wasn’t an intern anymore

Arjune Rama, MD

Medical Education

May 22, 2013

One Saturday morning at the Salt Lake City Veterans Affairs Medical Center, I got out of a call room bed and realized I had done it. The year everyone dreads, the year everyone says, “you just need to get through” was finally over. I had completed my write-ups on all the patients I admitted overnight. My emergency room consultation requests had been seen. I checked my pager for missed pages: …

Understanding psychotic and bipolar disorders

Tali Shenfield, PhD

Conditions and Diseases

May 19, 2013

Psychotic and manic depressive disorders can not only disrupt the life of the person suffering with one of these illnesses, but the lives of family and friends as well.

You should seek professional advice if you suspect that you, a friend or a relative or even a spouse may be experiencing a psychotic or bipolar disorder. It’s important not to attempt a diagnosis yourself. There are many external factors that can …

The controversy over DSM-5 and the cataclysm in mental health

Suzanne Koven, MD

Conditions and Diseases

May 14, 2013

Here’s a joke I love: A man goes to an old-school psychiatrist who, at the first session, administers some Rorschach tests.

“Just tell me the first thing that comes to mind,” the doctor instructs the patient as he shows him the ink blots.

“Sex,” answers the patient.

“I see,” says the doctor. “And this one?”

“Sex.”

“And this one?”

“Sex again.”

“Well,” says the doctor, “I see we will have to work on your obsession with sex.”

“Me??” …

Why politicians should have backgrounds in clinical psychology

Alex Lickerman, MD

Physician

May 14, 2013

Of all the different criteria people use when deciding for whom to vote in presidential elections, I’ve never heard anyone talk about the importance of a background in clinical psychology—but it’s always struck me as important for a president to have as for a clinical psychologist. Certainly, foreign policy experience, a firm grasp of the principles of economics, a bold and confident leadership style, and the ability to get people …

Dealing with depression has made me a better doctor

Ronan Kavanagh, MD

Conditions and Diseases

May 10, 2013

I was a junior doctor when I experienced my first episode. The strange thing is, that despite my medical training (I may have bunked off a few of the relevant lectures in medical school), I didn’t recognize the symptoms.

I had lost my appetite and had lost weight. I wasn’t sleeping and was irritable, angry and tired most of the time. Most disturbing to me was a feeling (despite being surrounded by work …

Why the Connecticut gun law does not improve care for the mentally ill

Arjune Rama, MD

Physician

May 9, 2013

Like my fellow Connecticut residents still shaken by the Newtown shootings, I was excited and relieved when Connecticut Senate Bill 1160 (“An Act Concerning Gun Violence Prevention and Children’s Safety”) passed. The law establishes a dangerous weapons offenders registry and requires a universal background check for all gun purchases. Those wishing to purchase long guns will need an eligibility certificate which requires fingerprints, a firearms safety training course and a …

The big impact of small changes for DSM-5 ADHD diagnosis

Dr. David Shaffer

Conditions and Diseases

May 8, 2013

As chairman of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Work Group on Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders, I read the article on ADHD that appeared on the front page of The New York Times on April 1, 2013, with interest and also dismay, which was shared by my colleagues in the work group. We recognize the effort involved …

The other people in the waiting room

Maria Yang, MD

Patient

April 30, 2013

“I HEAR THEM! THEY ARE CALLING ME A CHEAP PROSTITUTE!”

Her shouting is like a gas: It completely fills the space, regardless of the size of the container. The sound originates deep in her abdomen and bellows from her mouth before reverberating throughout the room.

“THESE DISGUSTING MEN,” she shouts, “KEEP CALLING ME A WHORE! I AM NOT A WHORE!”

Her wrinkled hands flecked with liver spots loosely hold a fashion magazine open. …

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The other people in the waiting room

Against the medicalization of marijuana

Steve Adelman, MD

Medications

April 29, 2013

As an addiction psychiatrist, I have seen marijuana do far more harm than good. So with the medical use of marijuana in Massachusetts now legal under state law, what should physicians do?

Recently, I attended a chilling presentation from Dr. Kevin Hill, an addiction psychiatrist at McLean Hospital, at a meeting of the Massachusetts chapter of the American Society of Addiction Medicine on the topic “Medical Marijuana: What is the Proper …

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Against the medicalization of marijuana

After the Boston Marathon: Trauma itself can bring strength

Suzanne Koven, MD

Physician

April 26, 2013

Not long ago I noted a certain older patient’s name on my schedule. I really dreaded seeing her. It’s not that I dislike her–in fact she’s one of my favorite patients. It was just that I hated the prospect of seeing her looking as poorly as I knew she would. She’d been through so much: an accident resulting in devastating injuries followed by painful surgeries, and, worst, in the middle …

What being mindful will reveal to us

Alex Lickerman, MD

Conditions and Diseases

April 20, 2013

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Research shows numerous benefits to meditation: it reduces stress, increases positive emotion, and even treats acute pain. Commonly, meditation involves focusing on one’s breathing as a way to anchor one’s attention in the present moment. Practitioners are also frequently taught to separate their experiences (breathing, pain, thoughts) from their judgments about them. Thus, with respect, for …

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What being mindful will reveal to us

The locked inpatient psychiatry unit: What’s it really like?

Arjune Rama, MD

Physician

April 19, 2013

As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. …

Getting into residency: 5 tips for a dynamic personal statement

Helen M. Farrell, MD

Medical Education

April 16, 2013

It’s that time of year when third year medical students are grappling with anxiety as they prepare their residency applications. Those uncertain feelings of ambivalence can only be assuaged by a successful “match.” Critical to recruitment committees, but often overlooked by students, are the influential personal statements.

Everybody coming out of medical school has a long list of accomplishments and abilities. The competition is steep. A powerful narrative has the potential to …

When I grow up, I want to be a drunk

Maria Yang, MD

Physician

April 16, 2013

I want to wake up feeling restless and uncomfortable. It’ll be neat to drag myself out of bed to open that first bottle of wine. I’ll drink all of it within an hour. Then I’ll go to the liquor store. The guy behind the counter will know that, everyday, I will buy a pint of vodka from him. He will look at …

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When I grow up, I want to be a drunk

Prevent physician burnout with these 2 mobile apps

Dike Drummond, MD

Health Technology

April 15, 2013

Forget Angry Birds and other mobile apps that do a great job of helping you waste time. And set aside for now the apps that help you find information and practice clinical medicine more efficiently. It was only a matter of time before mobile apps would be developed that can actually help you prevent physician burnout.

Here are my two favorite free mobile apps to help you lower stress and create …

The co-location of mental health care services in pediatric practices

Claudia M. Gold, MD

Physician

April 7, 2013

Patricia Wen’s front page story, “Children’s Access to Mental Health Care is Growing,” in which she describes the “co-location” of mental health care services in pediatric practices, brought me back to the summer of 2011 when I attended a meeting of a working group of the Massachusetts Chapter of the American Academy of  Pediatrics (MCAAP.) The task of this working group, a subgroup of the MCAAP task force on mental …