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.
My pager beeps as I walk through the hospital doors. It is a familiar message, “Your patient wants to leave.” We admitted John four days ago for opioid withdrawal and he is not yet ready to stop using opioids. When I walk in the room, I see him packing his bags. “So, John,” I say. “When you leave, your body cannot tolerate the same amount of opioids because you have …
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Harm reduction effectively treats substance use disorder
When I graduated from medical school, I carried an assumption I suspect many of us do: Bipolar II disorder is a “milder” version of bipolar I. After all, mania is dramatic. It is disruptive. It can involve psychosis, hospitalization, legal consequences, and financial devastation. Hypomania, by comparison, seems restrained: more energy, less sleep, no involuntary admission. The hierarchy seemed obvious. Mania is more severe than hypomania. Therefore bipolar I must …
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Why bipolar II is not just a milder version of bipolar I
I knew from the beginning that something was wrong in the culture of medicine, but I never believed it would almost kill me. This is not a story about my health. It’s a story about why my health story is not unusual. I hope it becomes a call to action.
I grew up in Berkeley, where speaking up is a developmental milestone. Early in my medical training, I started asking questions. …
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Women physicians’ health is paying the price of medicine
Clinician burnout is frequently discussed as a workforce challenge, a morale issue, or a retention concern. It is all of those. It is also something more. Burnout can function as a governance signal. Health care systems operate under sustained complexity: regulatory demands, reimbursement pressures, digital transitions, workforce instability, and constant performance scrutiny. In such environments, strain is not incidental. It is structural.
The governance question is not whether strain exists. It …
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Clinician burnout demands better health care governance
The first time I received care as a patient in academic medicine, I felt something I did not fully appreciate until years later: safety. Not just clinical safety, but moral safety, the sense that the people caring for me were operating inside a culture that valued truth, transparency, and professional integrity. When I practiced and taught in academic medicine, I was surrounded by colleagues who believed, almost instinctively, that honesty …
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How corporate medicine is eroding truth and patient dignity
One of my patients, K, arrived in the United States in florid psychosis. Back in China, she worked as a housekeeper and lived independently. She took her medications reluctantly but consistently, forced upon her by her parents. After her parents passed away, she stopped her medications. She became convinced her life was being controlled by the Chinese government. In terror, she booked a ticket to the land of freedom, America. …
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Patient autonomy in psychiatry and the ethics of care
What if the biggest problem in medicine isn’t bad decisions but rather the decisions we cannot even consider?
Clinical decisions unfold through processes shaped by the environment, which determine what clinicians can notice, consider, and act on. What seems like individual reasoning is structured in advance by systemic and environmental forces.
Within this context, this paper introduces a concept that I call “invisible triage,” a preconscious process that restricts which options are …
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What hidden constraints shape clinical decisions?
The life of a physician is often viewed as a linear climb, a constant upward trajectory of achievement, responsibility, and endurance. But after decades in the field, I have come to realize that medicine is not a straight line. It is a series of seasons. If we fail to recognize the changing weather of our own lives, we risk arriving at the final season with broken bodies and weary minds. …
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Why physician well-being matters at every career stage
My family’s story begins long before I was born, long before America existed, and long before medicine was a profession. It begins on a battlefield. In 1066, members of the Lindsay family rode with William the Conqueror at Hastings. They survived, were granted lands in Suffolk, and later moved north to Scotland, where they allied with King David I and became part of the Lowland nobility. From that era comes …
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A family legacy inspiring advocacy in neurodevelopmental care
I have intubated people who took every pill they could find. I have told families, in bare conference rooms, that the person they brought in barely made it. I have done this across 23 years in emergency medicine, thousands of cases, in every configuration of crisis the human mind can produce, and I believed, the way physicians are trained to believe, that stabilizing the crisis was the job. That what …
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The real work starts after a mental health crisis
When I was growing up in Darjeeling, a single pair of school shoes had to last the entire year. They came from Bata, simple, sturdy, and meant to endure more than they reasonably could. My sister, just a year younger than me, had the exact same pair. Side by side, our shoes began their journey identical, but they did not age the same way. She was careful, measured, and gentle …
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How childhood scarcity fuels imposter syndrome in medicine
There is a sentence physicians have said for generations: “We’ll take good care of you.” It is a good sentence. Patients need to hear it, and most of the time it is said with sincerity. Yet there are moments, more now than before, when that sentence carries a second awareness alongside it. The emergency department is boarding. There may not be an inpatient bed for hours, sometimes longer. Tests, consults, …
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Integrity in medicine is quietly under strain
The student sitting across from me didn’t think she was burned out. She had just made the dean’s list, locked in a competitive summer internship, and was running two clubs. She was sleeping four hours a night, had stopped texting friends back, and described feeling “nothing” when she opened her acceptance letter to a graduate program she had spent two years working toward. “This is just what college is supposed …
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6 signs of burnout in high-achieving students
You know what it feels like to keep working and pushing yourself when you are tired, distracted, or maybe even burned out. It’s common across professions, and we rarely speak about it openly. We almost never think of it as a safety issue. But for airline pilots, that silence can put hundreds of lives at risk.
That is why I believe this belongs in a conversation among clinicians. Medicine is often …
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Pilot mental health is a safety issue, not a stigma
Long before I stood on collapsing bridges between DBP and NDD, I was the 1977 kid who intentionally derailed Bobby Jr.’s grand “seed money” scheme for free home heating oil for the poor, not out of mischief, but because there was no plan behind it. It was a hallucinogenic vision dressed up as strategy, with no capability for realization. Even then, I could not pretend something workable existed when it …
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Bridging the gap in neurodevelopmental care and pediatrics
One of the most damaging patterns in health care is also one of the most accepted: delayed diagnosis.
What stays with me is not only the diagnosis that came too late. It is everything that happened before it. The months. Sometimes the years. The symptoms that were minimized, misread, or explained away. The patient who was still struggling, but without enough clarity to move care forward. The family trying to function …
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The hidden costs of delayed diagnosis and diagnostic ambiguity
Bree is an 11 1/2 year-old, 4.2-pound micro mutt who once lived on the streets of Long Beach. She eventually wound up at Long Beach Animal Care Services, where she sat in a crowded cold cement kennel with no bed, no blanket, no toys, and one very sick basset hound with parvovirus. Every dog in that kennel was scheduled to be euthanized on Christmas Eve 2014. If it weren’t for …
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What a tiny dog taught me about the nervous system
