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.
For over twenty years, I’ve had a recurring nightmare: I’m back in medical training, and my patient is crashing. To save them, I must enter my medical orders into the electronic health record (EHR). The only problem is, there are no open computers. I could give a verbal order in a real-life emergency, but those aren’t the rules in this nightmare world. I go from computer to computer, begging for …
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The emotional toll doctors face: a book review
According to the National Institutes of Health, the majority of individuals experience several traumatic events in their lifetimes, but do they all develop post-traumatic stress disorder (PTSD)? If you question the general populace or the media, they would indicate that PTSD is extremely common. Although it varies by sub-population, for the general populace, 13 and above, the rate of diagnosed PTSD is 4 percent to 8 percent. It is highest …
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PTSD: Why trauma’s impact is more complex than you think
Recently, I encountered a stark reminder of the challenges facing our mental health care system. A 16-year-old Black boy came to us at Boston Community Pediatrics (BCP) in a state of crisis, expressing suicidal thoughts and a deep sense of fear. As part of our integrated behavioral health model, my mental health colleague and I immediately recognized the urgency of his situation. We arranged for an Uber to transport him …
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The urgent need for equity and accessibility in pediatric mental health care
In the weeks after her mother died, Stacy’s mind was filled with thoughts about things she believed she’d done wrong and ways she’d let her mother down. “I shouldn’t have gotten so impatient with her”; “I should have been kinder, should have spent more time with her.” She was even tormented by the inaccurate belief that she had caused her mother’s death by failing to “try harder to get her …
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The dangerous impact of cognitive distortions on grieving
I spend most of my working hours trying to unlock superpowers. When I chose to pursue medicine—pediatrics, and later, developmental behavioral pediatrics—I didn’t realize I would be learning to decode languages. These languages aren’t always spoken, yet over time, I’ve developed a sharp instinct for reading them. Every time I step into an exam room, my task is to slowly unravel how a child sees the world, communicates with it, …
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Bridging worlds through the language of neurodiversity
Over the past several months, I’ve’ been busy assembling various essays into a book—essays I’ve written and published here on KevinMD and elsewhere. The manuscript is now complete. Here’s a brief pitch I’ve given to about two dozen publishers (I do not have an agent):
Dear Acquisitions Editor:
I am writing to ascertain your interest in publishing my manuscript tentatively titled Narrative Rx: A Quick Guide to Narrative Medicine for Students, Residents, …
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The challenges and triumphs of self-publishing in a conventional world
Karen, age 46, mother of two, is a world-renowned physician who has headed numerous clinical trials and has saved many lives. She suffered from public speaking anxiety disorder. Mike, age 26, a college graduate, spends most of his life in his room. He doesn’t work, is socially paralyzed, and spends over 100 hours a week with various technology dependencies. His parents walk on “eggshells” for fear of triggering his anger. …
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When high achievers and isolated adults share a common enemy: social anxiety
As health care professionals, have you ever stopped and asked yourself, “How am I doing?”
A humble doctor once asked my team, “How are you doing on a personal level?” That question stopped me in my tracks. None of us knew how to answer. Were we okay? Were we coping? Maybe we were, but maybe we weren’t. The truth was, we didn’t know. His question echoed in my mind for days, …
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Work-life balance in health care: Is it a need or a necessity?
A widow’s walk, also known as a widow’s watch or roof walk, is a railed rooftop platform often having an inner cupola or turret, frequently found on 19th-century North American coastal houses. The name is said to come from the wives of mariners, who would watch for their spouses’ return, often in vain, as the ocean took their lives, leaving the women widows. In other coastal communities, the platforms were …
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The widow’s walk: a poignant tale of loss, love, and recovery
Eight female nurses at a United Kingdom hospital are suing their employer for not assuring their psychological and physical safety. The nurses work in specialized areas that require their changing uniforms once daily. There is a trans-female nurse, similarly specialized, who changes with them. He wanders about the locker room in briefs or nude, the women report, ogling them as they exchange clothing. It has also been related that he …
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Nurses sue over trans colleague’s actions
As an outpatient adult psychiatrist, I have witnessed an increasing trend of patients seeking a diagnosis of attention deficit and hyperactivity disorder (ADHD). Often, these patients have had friends or family members diagnosed with the condition and wonder whether they have it as well. They have read about ADHD online and felt that the described symptoms matched perfectly with their lived experience. They were never diagnosed as children but remember …
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Is the surge in adult ADHD diagnoses helping or harming patients?
I had a dismal start to the second year of my psychiatric residency, and my subpar performance was noted by many faculty members. One professor approached me and told me to discuss the situation with my psychotherapy supervisor, adding, “Don’t let your supervisor sugarcoat it.” The professor knew that my advisor was an extremely kind and gentle person who would prefer to leave out the details of my performance so …
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The growing discrepancy between health care promises and practice