Psychiatry

Trying to bury trauma does not work

Conditions
May 13, 2021

Rationale: Sometimes it helps to talk about trauma; sometimes it helps to just listen. Having a safe, supportive, confidential, affirming environment to do both or either is important.

Background: I have been offering workshops on “managing stress and avoiding burnout” for years. I have always acknowledged the importance of yoga and other complimentary, often behavioral, strategies for stress management. Exercise, hobbies, socializing, pets, good diet, and anything else that works for …

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Ahimsa means do no harm, including doing no harm to ourselves

Physician
May 11, 2021

To be the best healers possible for others, we have to show compassion for and take care of ourselves.

I wrote a previous article published in KevinMD titled, “Self-care is not selfish: It’s imperative to save the practice of medicine.”

Self-care includes doing no harm to yourself.

During our medical training, many habits and thought patterns were deeply ingrained. These thought patterns, while they may have been helpful in …

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Doctors’ mental health: Don’t wait until it’s too late

Physician
May 5, 2021

One of our most talented residents committed suicide during my psychiatric training. I remember relaxing with him in a VA hospital call room several months before his death, laughing together at some of the idiosyncrasies of our unit attending.

He opened up to me about his doubt in his choice in psychiatry and how he was considering a transfer into internal medicine. Having made the opposite transition just months before, I …

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When an attending was canceled by a resident

Physician
April 30, 2021

I am a psychiatrist who volunteers his time on the clinical faculty of the local medical school. This is a role I have valued over the years that has allowed me to give back and mentor young residents as my senior colleagues did for me during my training.

Recently, I had a chilling experience that has caused concern and pause. I was supervising a first-year resident who was presenting a patient …

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Save the savers: I’m so tired of physician suicide

Physician
April 23, 2021

This beautiful man lost his life to suicide recently. He was an emergency physician and an incredible advocate for LGBTQIA health care. He was funny and bright. He posted almost daily with funny quips, stories from the ER and support for his colleagues. He was a shining star in our specialty, and now he’s gone. I never had the honor of meeting him in person, but I knew him well …

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The soul-sucking, energy-draining life of a physician

Physician
April 15, 2021

It is not a secret that being a physician can be exhausting and time-consuming, but do most nonphysicians really know what it’s like to be one? The answer is a resounding no. Television glamorizes the role of the physician and hides the tedious everyday realities. Spouses and partners of physicians know too well the frustration of having a partner that seems to be “always working and not shutting work off.”

Being …

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Avoiding the pitfalls of integrating primary care into community-based mental health centers

Physician
April 12, 2021

Providing primary care to patients with mental illness is a challenging task that requires highly skilled and experienced practitioners comfortable with the full array of biopsychosocial problems with which these patients present. For example, understanding the side-effect profiles of psychiatric medications and their impact on problems such as diabetes and other complex endocrinopathies requires highly evolved clinical skills.

Optimally, the successful care of these patients is best provided in close collaboration …

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Don’t yell at me. I’m trying to help.

Conditions
April 11, 2021

For many years, I have treated individuals with substance use disorders. I have found this work to be both gratifying and frustrating. Part of the frustration stems from interactions with governmental agencies and families.

The families are, of course, fearful and frustrated. They are watching their loved ones “die” before their eyes and want someone to fix it. It is difficult to understand that their loved one’s brain has changed, that …

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The pandemic’s epidemic: opioid use disorder and subpar suboxone access   

Meds
March 26, 2021

The COVID-19 pandemic has devastated America’s health, taking more than 500 thousand American lives, upending the economy, and perpetuating racial health disparities. It also has worsened the country’s ongoing opioid use disorder (OUD) epidemic. In fact, in the twelve-month period ending June 2020, 83 thousand Americans died of a drug overdose, the highest ever recorded in a one-year period and 21 percent higher than the previous year. This dramatic increase in overdose deaths is mostly attributable to the synthetic opioid fentanyl.

The U.S. …

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The updated benzodiazepine boxed warning: What you need to know

Meds
March 23, 2021

“I am [sharing] my story as I would like to raise awareness about the dangers of benzodiazepines and advocate for stronger warning labels.”

I paused to wipe away tears before typing the final words of Bobbi’s report into the FDA’s MedWatch online reporting system. Bobbi, a physician assistant, was forced into medical detox by her state medical board after suffering adverse effects from prescription clonazepam. Six years …

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The confusing policy surrounding the buprenorphine X-waiver

Meds
March 18, 2021

In the waning days of the Trump administration, a surprising announcement came down from the Department of Health and Human Services (HHS) that the barrier required to write buprenorphine prescriptions for opioid use disorder would be lifted via reform of the so-called “X-waiver.”

The X-waiver is a rare regulation in American medicine that requires an 8-hour training and documented DEA permission before a medical doctor can prescribe Suboxone to …

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When the teen with depression and anxiety is yours

Conditions
March 17, 2021

Every week, I see a teen with depression and/or anxiety. Sometimes that teen is mine.

And while I can certainly opine over the lack of mental health resources for our children and teens — you have to be a certain age, you have to have certain insurances, if you’re uninsured or underinsured, you can see a community health professional but only for eight sessions — what I really get frustrated with …

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Maybe we’re not all hanging in there. And that’s OK.

Physician
February 22, 2021

Long ago, in the BC (before COVID) era, I would chat up a local in a foreign country. Their usual response upon learning I was from the U.S. would be to seek clarification on aspects of American culture found most peculiar. There were your usual suspects — the Electoral College, imperial versus metric systems, and why we’re obsessed with the Kardashians — but the most common question was about our …

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Jealousy and missed opportunities in medicine

Education
February 20, 2021

“Julie” began the telehealth encounter in her car, greeting me with a cheerful smile. The sun glimmered through the driver-side window, illuminating the water spots to sparkle like diamonds.

“How are you doing with your suboxone dose? Do you feel that you need to go up, or are you happy with your current dose?” I asked.

“Everything is going great,” she said. “I feel no cravings – only some constipation. Otherwise, everything …

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What’s in your grief toolkit?

Conditions
February 20, 2021

Loss is incurable, but grief is metamorphic. The end of another human life is a fluid experience for those left behind. For most of us, grief legitimizes the range of human emotion and, at least temporarily, erases the idea of being too sensitive.

There are many ways in which this paradigm is unequal, particularly for individuals who frequently confront death. It seems that when a challenge moves into the …

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Managing stress with coping strategies for the perfectionist-driven physician

Physician
February 15, 2021

As doctors, we are taught the art of assessing our patients through the doctor-patient relationship. We learn a series of open-ended questions to gain insight into our patients’ values and thoughts regarding their personal health. We learn how to evaluate lab values and make diagnoses. Through all of this, we strive to make optimal decisions for our patients to avoid the legal ramifications of medical errors and because physicians thrive …

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