Last week, a former patient came back to see me after spending several months with another doctor at a practice where I once worked. During our visit, the patient seemed uneasy and told me that the other doctor had made disparaging comments about me. I did not believe the patient meant to hurt me by sharing this. Still, the words stung. More importantly, the patient had been placed in an …
When criticizing another physician harms the patient
In the months since the United States marked its 250th anniversary, I find myself sitting in a unique vantage point. As a psychiatrist, my office acts as a microcosm of the American experience. Behind closed doors, the broad and often raucous headlines of our national discourse distill into the visceral, unfiltered reality of individual human experience. From this front-row seat, I witness our collective anxieties, our daily pains, and our …
Healing a divided nation begins in a psychiatrist’s office
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Ketamine made headlines for the wrong reasons, and people who could be helped by it are staying away. Jim Ellwood is an anesthesiologist who has given ketamine in the operating room and taken …
Ketamine for depression: what actually makes it dangerous [PODCAST]
California’s SB 903 cleared the legislature on August 31, with the Assembly concurring in Senate amendments by a vote of 40 to 0. It now sits on Governor Newsom’s desk. Assuming he signs it, it’s a real, needed law: It bars companies from advertising AI products as “therapy,” and it puts disclosure, consent, and human-oversight requirements around AI used inside licensed clinical care.
When I wrote about this bill back …
Why the AI therapy law will not protect your patients
When a chatbot agrees with something false, it rarely has to lie to do it.
That’s the finding from a new MIT-affiliated study modeling how sycophancy compounds over a conversation. Researchers built a Bayesian simulation running 10,000 conversations across 11 levels of chatbot agreeableness. At the highest sycophancy setting, roughly half of simulated users ended the conversation at 99 percent confidence in a belief that was demonstrably false. When the …
Is chatbot sycophancy dangerous for psychotic patients?
They met in the U.S. Army and fell in love instantly. Though they went their separate paths, they both had brief but failed marriages and then reunited. It was a second marriage for both of them as they muddled through their previous baggage from their first marriages.
He was a captain in the Army, 6 feet tall. She was a 5’2″ petite, bright, and smart medic. They clicked quickly and reconnected. …
Alzheimer’s paranoia and the gun nobody locked up
I’d really like to talk with my fellow women.
There is a courtroom in Plymouth, Massachusetts where a jury is deciding whether a mother is criminally responsible for the deaths of her three children. This mother was a labor and delivery nurse. She had a five-year-old, a three-year-old, and an eight-month-old. Her defense says she was in the grip of postpartum psychosis. The prosecution says she knew exactly what she was …
Maternal mental health and the myth of endurance
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At one university, the share of students receiving disability accommodations rose sevenfold in a decade. Is that progress? In this episode, health care educator and patient advocate Richard A. Lawhern argues that psychiatric …
Why overdiagnosis is failing the students it claims to help [PODCAST]
I had been driving for fourteen years before I moved to the United Kingdom two years ago. Back home in Malaysia, driving had become almost instinctive. It was something I rarely thought about. But moving countries meant starting over. To continue working as a community psychiatry registrar, I needed a U.K. driving license.
Twice I took the practical driving test. Twice I failed. I could spend hours dissecting the examiner’s decisions, …
How a failed driving test shook my confidence in medicine
An excerpt from Essays and Echoes: Reflections from a Life in Medicine.
Every year, someone ranks the best states in which to practice medicine, presumably because physicians have been unable to make major life decisions without consulting a color-coded map.
The 2026 WalletHub survey evaluates all 50 states and Washington, D.C., across 19 measures, including physician wages, malpractice costs, hospital availability, projected competition, and burnout. Montana ranked first, New York …
What do best states to practice medicine rankings miss?
The Lindsay Clancy trial has raised a popular concern surrounding the notion of mothers having “intrusive thoughts” after delivery, specifically dangerous ones that, as in this case, may even be related to the murders of Lindsay Clancy’s three young children. However, “intrusive thoughts” are common after delivery and show up in many different ways in psychiatry, most of which are not dangerous. For example, one common and very scary …
Lindsay Clancy trial: intrusive thoughts versus psychosis
On August 3, a nineteen-year-old sailor went overboard from the aircraft carrier USS Abraham Lincoln. Rescuers pulled him from the water and took him for medical care. According to his wife, he was attempting to die by suicide. The Navy has not confirmed this, but news reports say charging documents accuse him of malingering under Article 83 of the Uniform Code of Military Justice and being absent without leave under …
Punishing a suicide attempt teaches people to hide it
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After 20 years as a pediatrician, she stopped believing burnout meant she couldn’t hack it. The problem was never her. In this episode, pediatrician and physician career development coach Gita Balakumar reframes burnout …
What a dragonfly teaches physicians about burnout and self-compassion [PODCAST]
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When I was just a Medium-Sized Bad Wolf loping through the forest, I stumbled upon a doctor in a white coat, carrying a bag of supplies. It was Sunday night, and dinner options were scarce, since most other humans were home with their families.
“Where are you going so late, Doctor?”
She sighed. “Another patient who refused the flu vaccine is sick with the flu, so I’m bringing them Tamiflu.”
I tricked her …
Medical satire: A wolf can pass as your doctor now
The practice of medicine was once anchored to a physical place. Whether it was an office, a hospital, or an outpatient clinic, there was a threshold to cross, a door to close, and a boundary that separated the physician from the patient. Today, that fortress has vanished. We are now connected to our work on a constant basis. Between electronic messages, automated requests for prescription refills, and the endless stream …
Why physician burnout starts with cheap dopamine
Jack, a seventy-six-year-old hospice patient and veteran of the Vietnam War, had time on his hands. Stuck in a hospital bed, looking back on his life, he was increasingly focused on his time as a young infantryman caught up in the “catastrophe of war.”
Looking back and taking stock in one’s life is common as patients approach the end of their lives. In 1963, Robert Butler, MD, called this process Read more…
Combat grief is the wound veterans never mourn
An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).
In an interview that Dr. Grinspoon did with the New York Post in 2016, “I was a doctor – and a drug pusher,” he describes making a home visit as a medical student to tend to a stage 4 cancer patient. While there, he steals a dozen of the patient’s …
Physician addiction is a disease of silence and shame
In November 2023, before ChatGPT-driven psychosis cases had made a single headline, a Danish psychiatrist named Søren Dinesen Østergaard published a short, almost speculative paper in Schizophrenia Bulletin. His question: Would generative AI chatbots generate delusions in individuals prone to psychosis? At the time, it read like an interesting hypothesis from someone paying close attention to a technology most of psychiatry hadn’t thought much about yet.
This February, Østergaard and …
How to ask patients about AI chatbots and psychosis
A 911 dispatcher might never see the blood, the wreckage, or the scared family waiting by the road. But they hear everything. They hear the panic in a parent’s voice when a child stops breathing. They listen as domestic violence happens in real time. Sometimes, they stay on the line during a suicide attempt, a shooting, or someone’s last moments. All the while, they have to get an address, figure …
911 dispatcher mental health is not a wellness issue
I don’t like who I’ve become, working in primary care.
In the medical community, it seems like we’ve discussed the root causes of burnout ad nauseam: too much paperwork, too many in-basket messages and inane patient requests, too many clicks in the EMR, too-short appointment times, too much corporate consolidation and insurance overreach. But as I see it, the end result, the final common pathway, is this: Most of us have …
I don’t like who I’ve become in primary care
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