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.
Developmental-behavioral pediatrics (DBP) was once defined by giants, leaders who authored textbooks, set standards, and gave the specialty a clear identity. Today, the field is fragmented, misunderstood, and too often hostile to new ideas. My own career arc illustrates how inbreeding and isolation have hollowed out DBP, leaving children without advocates and institutions without direction.
At a major military medical center, retired military DBPs replaced me. All were trained at that …
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Institutional inbreeding in developmental-behavioral pediatrics
As a psychiatrist, I often find myself confronting not only the symptoms of mental illness but also the deep scars left by stigma. Even in 2025, despite advances in neuroscience and a growing cultural focus on mental health, stigma remains one of the greatest barriers to healing. It manifests in silence, shame, and misunderstanding, and it affects patients, families, and even those of us within the psychiatric profession. Addressing stigma …
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How stigma in psychiatry affects patients
Developmental-behavioral pediatrics (DBP) has lost its identity, and my career shows what happens when leadership retreats.
When I applied for positions in Tucson and Jacksonville, I was not seen as a developmental pediatrician with expertise in neurodevelopmental disabilities. Instead, I became the dumping ground for “Stranger Things” (children whose needs were psychiatric, not developmental). Administrators and chiefs, lacking even a basic understanding of DBP, misrouted cases into my lap. The result …
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Developmental-behavioral pediatrics: the lost identity
As a practicing (“licensed”) psychologist, this issue comes up frequently. What are the differences among the myriad of mental-health professionals and does it even matter? As a researcher, as well as a clinician, my first inclination is always to look at the literature when seeking answers. What have others written on whatever topic it is that I am trying to better understand? Did someone else already answer my question? So, …
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Why psychologist training takes years
It’s a moment I’ve come to recognize too well as a psychiatry resident: a patient walks into my office already convinced of their diagnosis. They’ve watched a dozen videos, followed mental health influencers on Instagram, and taken online quizzes that “confirmed” what they suspected. They have ADHD, or autism, or borderline personality disorder. They’re not here for an evaluation; they’re here for validation.
On one hand, this moment feels like progress. …
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When patients self-diagnose from TikTok
Many of the physicians I work with live with a quiet weight of imposter syndrome. They show up every day for patients, teams, and families, yet doubt their own belonging.
I wrote a short reverse poem, “Worthy in Reverse,” as a way to explore how self-talk can shape that inner experience. This poem was inspired by “Worst Day Ever?” by Chanie Gorkin, which creatively uses structure to shift perspective.
It is simple …
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Imposter syndrome: a poem of self-talk
Have you ever wondered how a single online comment might shape your reputation as a physician? I have, especially after reading a review that sardonically suggested I had earned my medical degree from Amazon (the company, not the rainforest). The jab was clearly meant to sting. Although I regret the dissatisfaction behind it, it gave me pause. How much weight do we give these offhand remarks, and what do they …
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How online physician reviews impact your medical career
Keeping my head down and working through intern year was all I had known. My days blurred into nights, and my weeks into months. The dreary Pacific Northwest winters had only compounded this. Despite a quiet yearning for connection and community, I declined most social invitations. My sense of obligation did not end at the hospital doors. It followed me home, where expectations and emotional responsibilities lingered. I often felt …
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Divorced during residency: a story of clarity
Some cases linger in our memory because of the humanity at their center. The case of Charlie Gard, which unfolded in England in 2017, is one of those. It took place within the National Health Service and under a legal framework in which courts decide a child’s treatment when parents and clinicians cannot agree. Before it became a global controversy, before it drew international headlines, it began as something far …
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The ethical conflict of the Charlie Gard case
Halfway through a teletherapy session, you notice your therapist pause mid-sentence. They’ve just heard the soft clatter of your keyboard, or seen your eyes flick sideways to a second screen. You’re technically “there” on video, but a work email just popped up, laundry is buzzing, someone’s messaging you, and suddenly the session is sharing space with three other tabs in your brain.
On the therapist’s end, it can feel like talking …
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Gen Z, ADHD, and divided attention in therapy
The average KevinMD reader may wonder why I’m so prolific in my commentary on pediatric medicine and the systemic reforms it demands. The answer is simple: I go to the source. Always.
That habit was forged nearly 30 years ago when the American Academy of Pediatrics invited me to serve as contributing section editor for Developmental-Behavioral Pediatrics in AAP Grand Rounds. My role: select key studies, critique methodology, and distill bottom-line …
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Why we fund unproven autism therapies
As a psychiatrist, I’m often asked by family or friends to “help,” to intervene in the mental struggles of a loved one, a friend, or even a distant acquaintance. It usually begins with kindness and concern: “Could you just talk to them?” or “Maybe you can prescribe something, you’d know what’s best.” What follows is always a difficult conversation, because I have to explain something that sounds incomprehensible to most …
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Why psychiatrists can’t treat family members
A few days ago, I was speaking with a high-achieving, articulate, brilliant friend, someone always up and doing, super-expressive. During our conversation, I noticed her stumbling over her words, which was quite unusual, and her fidgety hands. She was narrating a traumatic incident that had occurred to her and how it tore her apart and made her simply give up on everything, in her words, “she was done.” Throughout the …
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Trauma in high-functioning adults
Applied Behavior Analysis (ABA) has become the default therapy for autism in the U.S., not because it’s the most effective, but because it’s the most entrenched. Mandated by insurers, funded by Medicaid, and marketed as “medically necessary,” ABA now consumes hundreds of millions of dollars annually. But here’s the truth: ABA is unproven, ethically fraught, and fiscally unsustainable.
As a developmental-behavioral pediatrician and lead investigator for the NIH-funded RUPP trials, I …
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Funding autism treatments that actually work
Every clinic has moments that stick with you. They aren’t always dramatic, but they show why some people end up suffering longer than they should. During my time working as a medical office assistant, I observed a recurring pattern that spanned across various age groups, backgrounds, and diagnoses. Patients didn’t delay care because they were careless. They delayed because the system had quietly taught them to.
One afternoon, a middle-aged woman …
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Why patients delay seeking care
For years, I believed that the best clinicians were the ones who never stopped. We covered extra shifts, skipped meals, charted past midnight, and proudly wore exhaustion as a badge of honor. My patients were happy, my colleagues admired my work ethic, and I was quietly unraveling.
The slow slide into burnout
Burnout didn’t arrive like a crisis; it crept in as a constant background hum. I began to dread the pager’s …
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The myth of endless availability in medicine
During a casual conversation about mental health, a friend admitted something striking: “I stopped going to therapy because I’d leave feeling great, but by the time I actually needed what we talked about, like in the middle of an argument or a panic attack, I couldn’t remember any of it. It felt like throwing money away.”
This confession revealed a silent challenge in mental health care. The issue isn’t finding the …
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The therapy memory recall crisis
She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …
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The hidden epidemic of orthorexia nervosa
Stimulant medications have long been considered the “gold standard” for treating ADHD. When I tell colleagues I don’t prescribe them, I often get pushback: “But it’s the first-line treatment for ADHD!” In my functional and integrative psychiatry practice, I am upfront: I do not prescribe stimulants for ADHD. For patients who are interested in stimulant treatment, I provide referrals to trusted colleagues who do. This decision is not about denying …
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Rethinking stimulants for ADHD
