The medical students I work with are already starting to close doors. They are in their twenties, still in training, and they are already narrowing, already deciding which parts of themselves fit inside the life they are building toward. I recognize it because I did the same thing. I just did not realize it until much later. And no one told me there was another way to look at it. …
Why career pivots are a valid path in medical training
As a physician who has spent years managing patients with persistent pain, I often encounter the same frustrating cycle. A patient arrives with unrelenting back pain that has lasted for months. They describe not just physical discomfort but a deepening sense of hopelessness, fatigue, and withdrawal from life. Is the pain causing the depression, or did underlying depressive symptoms amplify an initially manageable ache into something chronic and debilitating? It …
How to treat chronic pain and depression together
Every research mentor eventually faces a difficult question: What, and who, will continue when the work is no longer theirs to carry forward?
We often speak about mentoring, yet the dilemma of mentorship is rarely addressed directly. Perhaps it lies at the intersection of responsibility and uncertainty. Mentorship is often imagined as guidance freely given, with apprenticeship unfolding naturally. In modern academic life, however, the laboratory is shaped not only by …
How research laboratory culture shapes mentorship in academic life
A patient walks into my office. She is 52, exhausted, brain-fogged, gaining weight, and six years into sertraline 100 mg. I mention methylene blue as a mitochondrial support at 10 mg orally.
She looks at me like I just suggested arsenic.
“My pharmacist said I can never take methylene blue because I am on an antidepressant. He said it causes serotonin syndrome.”
I hear this every week. And every week I have to …
51 cases that reframe methylene blue serotonin syndrome
Each May, during Mental Health Awareness Month, the health care industry releases its usual statements about access to care, workforce stress, and the enduring shadows of stigma. I usually read them between back-to-back appointments, staring at a screen full of diagnostic codes. The systemic issues are always important, yet, amidst the charts, the 20-minute med checks, and the rhetoric, there remains a more profound question I have to ask myself …
Therapeutic alliance in psychiatry matters more than ever
In the modern clinic, we often operate under an unstated a priori assumption that if a phenomenon is real, its primary explanation must be molecular. As a psychiatrist, I find this reductionist bias increasingly apparent in how we conceptualize “breakthrough” treatments like ketamine therapy for depression or chronic pain. When we discuss how ketamine works, the conversation almost instantly gravitates toward the neurotransmitter system, synaptic plasticity, glutamate surges, and the …
Ketamine therapy and the primacy of mind in modern medicine
Two days after Christmas, I walked into a store and saw Easter Cadbury Eggs already on the shelves. Not a single mattress sale for Presidents’ Day in sight. Just a clean leap from tinsel to tulips, as if the world had quietly decided to skip the expected steps and sprint ahead. It struck me because that is exactly what my life feels like right now. For decades, I lived inside …
Leaving clinical practice for medical advocacy and purpose
From the outside, medicine is often imagined as a profession defined by urgency and dramatic turning points. People picture emergency rooms where rapid decisions determine outcomes, life-saving interventions performed under pressure, and moments when a physician’s action decisively alters the course of illness. These moments certainly exist, and they remain some of the most visible parts of medical practice, but they represent only a small fraction of what most physicians …
The human side of medicine in quiet clinical moments
My wife and I recently spent a few days on vacation at a South Carolina beach. We took time to stroll on the sand, take naps, kick back, and read. However, in the last-minute rush to pack for our trip, I managed to leave my Kindle at home. Thus, I began the mental journey that resulted in this article.
My Kindle has been one of the nicest gifts my younger daughter …
Why physical books matter in a social media world
It is 3 a.m. and you are wide awake, not because of your overnight shift or a surgery you are prepping for, but because the stress you have been carrying for months will not let you sleep. You know you need help. You also know you probably will not ask for it. Somewhere in the back of your mind, a fear: that a mental health diagnosis could surface in your …
How credentialing and culture impact physician mental health
After a decade of wellness programs, mindfulness apps, reduced shift lengths, scribes, and employee assistance programs, physician burnout rates are essentially unchanged. The AMA’s 2023 national survey found burnout affecting 45 percent of physicians, nearly identical to where we started. Burnout peaked at 62.8 percent in 2021, the highest ever recorded. Physicians still face double the burnout risk of other American workers. The well-intentioned people running these programs know they …
Why current solutions to physician burnout are failing
Super Typhoon Sinlaku got the coverage it deserved, the satellite loops, the wind speed updates, the landfall reports over the Northern Marianas. Every wobble in the eye wall drew a headline. No one was talking about what was happening inside people’s bodies. I have sat with patients days after a storm passed, experiencing blood pressure that will not budge and hands that will not stop shaking, and the sky has …
Natural disaster trauma requires mental health planning
He had just been named a partner. The youngest in the firm’s history. The first thing he said when he sat down in my office was, “I think they made a mistake.” I have heard some version of this more times than I can count, from physicians, attorneys, founders, and C-suite executives. People whose resumes would make anyone’s jaw drop, yet who live with a persistent, quiet dread that someone …
How imposter syndrome affects high-achieving professionals
ADVERTISEMENT
We turned pharmacies into the backbone of public health during coronavirus disease 2019 (COVID-19). Then we went back to paying them like retail stores. The result is what I think of as the pharmacy paradox. We expanded their role without changing the economics that sustain them. Now, across the country, those same pharmacies are closing, quietly and disproportionately in the communities that need them most.
In 2021, the corner drugstore ceased …
Pharmacy closures threaten our entire public health system
Intro
This is not a story of a 28-year-old successful serial entrepreneur, nor a work of personal development literature. It is rather an auto-dissection of a very regular and tired doctor who was arrogant enough to co-found a medical startup and become its chief executive officer (CEO) without having any qualifications for it whatsoever.
It is also not a story of great success (yet) merely because the journey is in its diapers …
Pathogenesis of a medical startup: a physician’s diary of daring, doubting, and doing it anyway
We enter the cathedral of medicine with a specific architecture of the soul: high ambition, perfectionism fueled by a productive neuroticism, and a boundless capacity for self-sacrifice. For many of us, the “best years” (the physical and cognitive prime of our 20s and 30s) are traded for the fluorescent hum of the wards and the weight of six-figure debts. This financial burden does more than strain the bank account; it …
The existential crisis of aging in medicine
I am sharing my experience of what I believe to be retaliation and the non-renewal of my contract at a major academic medical center in New York following my refusal to engage with inappropriate advances. As an international medical graduate who immigrated to the U.S. from Brazil at the age of three, I have devoted my life to medicine and patient care. Throughout my career, I have worked across multiple …
How an international medical graduate fought workplace retaliation
I began my physical medicine and rehabilitation residency in 1986, during the height of the acquired immunodeficiency syndrome (AIDS) epidemic. Fear shaped every personal interaction. We were still learning how human immunodeficiency virus (HIV) spread, how to protect ourselves, and how to care for patients who were as terrified of the diagnosis as they were of the disease.
Of all the many patients I saw that year, one has particularly stayed …
Unrecognized depression is a hidden crisis in medicine
You open the chart. You start clicking. Labs here. Imaging there. Notes in four different tabs, none of them organized in any order a clinician would have chosen. Prior hospitalizations buried three levels down behind a menu that requires two clicks just to find the menu. Medication reconciliation on a screen you have to navigate to separately. Problem list in one place, active diagnoses in another, allergies somewhere a third …
Severe note bloat is fueling dangerous physician burnout
Ask any clinician about the drive home after a case goes bad and the patient outcome is tragic. It is a specific kind of heavy silence. We have all had the experience. You do not forget it. You replay the tape in your head dissecting every move, carrying a stain that does not wash off or show mercy. It owns you.
We have had a name for this for 20 years: …
The second victim label ignores patient safety reality
Get free updates delivered free to your inbox.
