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.

ADHD: Not all complex problems have simple answers

Claudia M. Gold, MD

Conditions and Diseases

October 9, 2012

I’ve been thinking about the phrase, “the fallacy of simple answers,” in preparation for writing about a new book I was asked to review, Pills are Not For Preschoolers. Author Marilyn Wedge gives a clear and compelling argument for the use of family therapy in treatment of behaviorally symptomatic children. Unlike the title suggests, the book is not primarily about preschoolers, but offers multiple examples of her successful work …

Resilience is critical for a healthy life

Dennis S. Charney, MD and Cheryl De Jong-Lambert

Physician

October 6, 2012

It’s been reported that James Eagan Holmes, more infamously known as the movie-theatre gunman who killed 12 people during a midnight showing of Batman in Aurora, Colorado, sent a text to a classmate asking whether she knew what “dysphoric mania” was. (It is a bipolar condition that in its extremes, can include mania and paranoid delusions.) Did he have it?

Similarly we wonder whether a near-death accident in childhood, one that …

Gun violence and mental illness: Why I feel sympathy for the devil

Deborah Serani, PsyD

Physician

October 5, 2012

I have mental illness. It’s taken hours of talk therapy, months of finding the right dosage and timing of medication, and years of work to learn how to live successfully with it. I’ve redefined how I think and feel, and learned what kinds of people and experiences to limit or allow in my life. Now in my 50’s, I’ve come to know the textures of my own mental illness and …

When patient histories start to blur

Greg Smith, MD

Physician

October 3, 2012

I am guilty of neglect.

I’ll admit it. I’ll own it. I’ll embrace it.

When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, …

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When patient histories start to blur

Can you really be a doctor today and have it all?

Greg Smith, MD

Physician

September 13, 2012

I am so glad that I’m only a partially conflicted, semi-neurotic, intermittently confused middle-aged psychiatrist. It would be so much harder to be a young guy, just coming out of residency, trying to decide what to do and how and where to do it. The stress!

When I finished training, career paths were relatively easy to research, vet, and decide upon. You could go into private practice, in a group or …

What makes a psychiatrist?

Greg Smith, MD

Physician

August 31, 2012

Years.

Years of learning that the smallest details of a patient’s life can be the most compelling and important part of their story.

Years of listening to tales of love, anger, and loss until the patterns become less daunting and more obvious.

Years of hearing things that are so bizarre, so far-fetched, so on the fringe of humanity that nothing surprises anymore, but everything still fascinates unceasingly.

Years of trying every new thing under …

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What makes a psychiatrist?

Why the diagnosis of bipolar disorder isn’t clear

Steve Balt, MD

Conditions and Diseases

August 29, 2012

I have a confession to make. I don’t know what “bipolar disorder” is. And as a psychiatrist, I’ll admit that’s sort of embarrassing.

Okay, maybe I’m exaggerating when I say that I don’t know what bipolar disorder is. Actually, if you asked me to define it, I’d give you an answer that would probably sound pretty accurate. I’ve read the DSM-IV, had years of training, took my Boards, treated people in …

Involuntary commitment for James Holmes: Is his psychiatrist to blame?

Kristina Fiore

News

August 2, 2012

The majority of killers involved in recent mass shootings had encounters with the mental healthcare system before they committed their acts of violence, with some even being legally compelled to seek help.

Few seemed surprised when it came out over the weekend that James Holmes, 24, who allegedly killed 12 and wounded 58 others at a movie theater shooting in Aurora, …

Eliminate the guilt in parenting

Claudia M. Gold, MD

Conditions and Diseases

July 24, 2012

In my behavioral pediatrics practice, it is not uncommon for parents to go to great lengths to put up a good front. They feel terrible shame about moments of out-of-control behavior, and also fear that I will blame them for their child’s troubles. They focus primarily on “what to do” about their child’s difficult behavior. However with time, and the realization that I am interested in understanding, not shaming or …

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Eliminate the guilt in parenting

What could bring psychiatry to its knees, or save it

Steve Balt, MD

Physician

July 23, 2012

The practice of medicine has changed enormously in just the last few years. While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services. Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access …

DSM-5 will capture the dynamic nature of mental illness

David Kupfer, MD

Conditions and Diseases

July 20, 2012

Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing.

Historically, disorders were classified …

Do people need to suffer the consequences of their bad behavior?

Greg Smith, MD

Physician

July 19, 2012

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

What are bath salts and why are they dangerous?

Roy Michael Stefanik, DO

Medications

July 5, 2012

Bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and purchased in places such as tobacco and convenience stores, gas stations, head shops, and the Internet.

They are stimulants that mimic cocaine, lysergic acid diethylamide (LSD), methamphetamine, or methylenedioxymethamphetamine (ecstasy). According to a recent article in the Journal of Psychosocial Nursing, the most common bath salts are MDPV, mephedrone, and methylone. These drugs cause …

Applying ADHD lessons to medical marijuana

Steve Balt, MD

Medications

July 4, 2012

An article in the New York Times recently described the increasing use of stimulant medications such as Adderall and Ritalin among high-school students. Titled “The Risky Rise of the Good-Grade Pill,” the article discussed how 15 to 40 percent of students, competing for straight-As and spots in elite colleges, use stimulants for an extra “edge,” regardless of whether they actually have ADHD. I’ve written about ADHD. It’s a real …

Ask your doctor smart health questions

Dinah Miller, MD

Physician

June 26, 2012

Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it’s wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask. There is nothing specific …

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Ask your doctor smart health questions

What does patient centered care say about psychiatry as a science?

Steve Balt, MD

Physician

June 20, 2012

When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.” Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions. What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, …

Should medical students consider a combined psychiatry residency?

Julia Frank, MD

Medical Education

June 19, 2012

“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”

Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …

Reflecting on the first AA meeting

Nonmaleficence

Patient

June 5, 2012

I recently attended my first AA meeting. It surpassed many of my expectations; however it ruined others and left me slightly dumbfounded.

My imagination, with the help of television and movies, painted a picture in my mind of what an AA meeting would be like. It portrayed a room filled with people that obviously looked like addicts; unkempt appearances, borderline offensive hygiene, and at least one person emitting a radiance of …

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Reflecting on the first AA meeting

Solving the different behaviors that lead to obesity

Roxanne B. Sukol, MD

Conditions and Diseases

June 4, 2012

All kinds of behaviors can have an effect on your weight, and the solution to each is different.

Maybe portion size is your biggest issue. Maybe it’s hard to get moving, even though you know you need to get some exercise. Maybe you have a sweet tooth that you can’t shake. Maybe you’re completely stressed out, and you never get a decent night’s sleep. Maybe you are a nighttime snacker. Or …

When the homeless disappear

Maria Yang, MD

Physician

May 29, 2012

Two weeks had passed before I learned what happened.

I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He was sitting in front of a closed shop.

“Hi. How are you?”

“Fine.”

People in the neighborhood took care of him. Surrounding him were several plastic bags holding neatly stacked styrofoam containers filled with soup. …

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When the homeless disappear