Psychiatry

Core values were key to reclaiming my physician identity

Physician

February 28, 2020

My identity crisis attempted its first appearance five years ago. I had decided to leave my job as a psychiatrist in an outpatient, community-based practice. My professional role had become incongruent with the doctor I had envisioned becoming. In my misalignment, I had lost clarity in my identity as a physician. I was frustrated and felt ineffective and disconnected from my work.

I suspected that some of my colleagues were struggling …

Stressed is desserts spelled backward

Jasmine Toor, MD

Physician

February 5, 2020

Tiramisu, chocolate mousse, red velvet cake, freshly baked cookies, and warm brownies topped with ice cream. These are some of my favorite desserts and the things I start thinking about when I am under intense stress. I often gaze at the bakery section at the grocery store just to take a look when I feel overwhelmed with stress at work or home. It is the classic description of what we …

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Stressed is desserts spelled backward

What Karl Marx can teach doctors about burnout

Farid Alsabeh

Conditions

January 17, 2020

Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it along psychological lines: emotional exhaustion, a feeling of depersonalization and cynicism, and a low sense of personal accomplishment.

Accordingly, the phenomenon of physician burnout is often framed as a personal problem to be solved by means of self-care. While this approach is undoubtedly helpful, it doesn’t sufficiently address the structural factors that contribute to burnout in the first …

When primary care handles the consequences of psychiatric medication prescribing

Hans Duvefelt, MD

Physician

January 13, 2020

If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened, but I’m not qualified to treat a broken hip.

If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start …

A physician’s story of addiction, depression, hope, and recovery

Adam B. Hill, MD

Physician

January 6, 2020

An excerpt from Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery.

As a young child’s heart rhythm faded to a stop, I walked off the hospital floor and got in my car with a plan to end my own life. …

How your mind can turn against you

Kyle Bradford Jones, MD

Conditions

January 4, 2020

An excerpt from Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness.

Jason had an entire group of voices in his head that he called “the committee.” They talked nearly constantly, sometimes in a flat roar but often escalating to shouting. He described it as …

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How your mind can turn against you

Stop cutting patients off their prescribed benzodiazepines

Christy Huff, MD

Meds

January 2, 2020

In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% …

Waking up to the sexual violence in America’s psychiatric units

Brian Barnett, MD

Physician

December 24, 2019

It wasn’t until I first had to manage the aftermath of a sexual assault on a psychiatric unit one night during my residency that I realized psychiatry might have a problem with sexual safety.

My fellow residents and I had never been informed of a management policy for inpatient sexual assaults, and my program’s curriculum was silent on how to handle the issue.

Because the assault involved a psychotic patient who was …

A psychiatrist can’t help patients anymore

Jamian Reed, DO

Physician

December 22, 2019

I bid farewell to four people this month who I’ve been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind.

It is the nature of our healing practice to build trust …

What can a famous actress teach us about curing addiction?

Mark Leeds, DO

Physician

December 18, 2019

I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.

Why listen to an actress about medical treatment for addiction? First of all, doctors generally …

A physician got a DUI. The physician health program didn’t help.

Anonymous

Physician

December 11, 2019

A physician health program, PHP, is a state agency that is responsible for advocating, treatment referral and physician monitoring, residents and medical students who have substance abuse disorders, psychiatric disorders and/ or boundary issues. There are two ways of becoming a part of these programs, self-referral or be reported. Currently, 47 states have a PHP, and the issue is that there is no set guideline and several variables in the …

The secret to travel doctor success? Bring your family.

John Gallehr, MD

Physician

November 29, 2019

I recently returned from my second extended stay in New Zealand with my family. The entire experience was wonderful, but perhaps our most memorable day began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of …

Stop telling doctors what to do

Najma Hamdani, MD

Physician

November 22, 2019

I enjoy a fairly small private practice and a manageable telepsychiatry side job with good support staff. But even the small scale of my outpatient clinical practice doesn’t fully insulate me from the pain of unnecessary practices that I wish would become obsolete.

1. Preauthorization. The dance of preauthorization starts with the naivety on my part that I decide what medication my patient should be on. I spend precious time crafting …

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Stop telling doctors what to do

A call to increase the availability of the Butrans patch

Cara Zimmerman, MD

Conditions

November 20, 2019

Janelle had overdosed 32 times.

Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She …

Why your doctor may be concerned about prescribing benzodiazepines

Arash Javanbakht, MD

Meds

October 29, 2019

As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.

There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …

Don’t use stimulants to cram for exams. It ruins sleep and doesn’t help test scores.

Sara C. Mednick, PhD

Meds

October 26, 2019

Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you “awesome at everything.” Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat.

Welcome to #GenerationAdderall, the …

How “Joker” gets mental illness wrong

Dr. Sudhir Mane

Conditions

October 20, 2019

Spoiler alert: Plot points of the movie “Joker” are revealed.

“Joker” opened to a mix of rave reviews and criticism on October 2, 2019, amid fears of mass-shootings at theaters in the U.S.

This left law enforcement agencies scrambling to beef up security at movie theaters to prevent any untoward incidents. Quite ironically, October 2, is also the 150th birthday of Mahatma Gandhi — the crusader and champion of non-violence.

Warner Brothers even …

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How “Joker” gets mental illness wrong

Get rid of the guilt. You matter as a physician.

Najma Hamdani, MD

Physician

October 17, 2019

“When you start seeing your worth, you will find it harder to stay around people who don’t.”
– Unknown

After graduating from my residency a few years ago, I accepted a job within my organization as a staff psychiatrist and a medical director.

The idea of familiarity was a big driver in my ambivalence towards pursuing alternate opportunities, even when they came knocking on my door. As the job started and progressed through …

Second-tier, off-label treatments for anxiety

Wallace B. Mendelson, MD

Meds

October 10, 2019

In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well. In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine. …

Burnout in fashion and medicine: A fashion designer turned physician compares notes

Hisla Bates, MD

Physician

October 8, 2019

“Fashion Is Moving Too Fast, and It’s Killing Creativity,” by Veronique Hyland, talks about burnout in the fashion industry. As a former Fashion Designer turn physician, my curiosity was piqued. If you substituted the word “medicine” for “fashion,” the title would be just as relevant to the medical industry, as it is to the fashion industry. Yes, medicine is moving too fast, and it’s killing creativity and our doctors. Burnout in the fashion industry stems from the need to …

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