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.
Medical school had trained me to move quickly; there was always another exam to prepare for, another deadline to meet, another task to attend to as I worked toward the next milestone. When I learned that I would need to remediate, what initially felt like an academic setback gradually became something else: an opportunity to notice habits I had carried into both medicine and my relationships.
Without the familiar rhythm of …
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Active listening in medicine starts with slowing down
At 5 p.m., the clinic closes. The appointment schedule ends, routine messages move into the next business day’s queue, and results that arrive later may wait for review. Patients are directed to an after-hours line, urgent care, or the emergency department if the situation cannot wait.
Illness follows a different schedule. A medication started on Wednesday causes dizziness on Friday night. A fever rises on Saturday. Pain that was intermittent during …
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The clinic closes at 5. Illness does not.
Psychiatry occupies a place in public discourse that no other medical specialty does. Its language permeates everyday conversation, its concepts appear in film and literature, and its diagnoses are invoked casually in both social and digital spaces. No cardiologist or gastroenterologist encounters anything quite comparable.
Psychiatry deals directly with the domains that define human experience: emotion, thought, behavior, and relationships. Unlike ischemia or amyloid deposition, these are not biological processes removed …
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When mental health labels become part of who we are
In nearly every occupation in America, women live longer than men. This is one of the most stable findings in public health, true for teachers, lawyers, engineers, retail workers, and factory workers alike. Medicine is the exception.
A 2025 analysis in JAMA Internal Medicine, led by researchers at Harvard Medical School, examined more than 3.6 million deaths recorded in the National Vital Statistics System between 2020 and 2022. Physicians as a …
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Women physicians die sooner. Hospitals still won’t act.
Zane Shamblin was a 23-year-old recent graduate of Texas A&M University who died by suicide in July 2025. Shamblin had talked with ChatGPT for hours on the day of his suicide. CNN published an investigation of the case in which it reviewed nearly 70 pages of chats from the day of Shamblin’s suicide and excerpts from thousands more pages of conversations from the preceding months. Shamblin had been using …
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AI chatbots and suicide: what our tests found
An excerpt from Behind the Couch.
If you were to ask me how many patients I have seen over the years, I could only give a very rough estimate. Unless, of course, I were to dig deeply into my records. But from that great mass of people, a number of patients will always remain in my memory. Some were simply more remarkable than others, more unusual, or they came with …
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Treating a narcissistic patient who would not sit down
Patients start glucagon-like peptide-1 (GLP-1) drugs expecting to think less about food. They did not expect to think less about alcohol. The nightly drink became easier to skip. Cigarettes felt less urgent. Cannabis, gambling, or compulsive shopping sometimes lost their pull. As “food noise” quieted, another possibility emerged: Perhaps these drugs were turning down craving itself.
At first, these reports might have seemed like coincidences. Instead, they sparked new research. Scientists …
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Semaglutide and cravings: what the 2026 trial changed
Early in the morning of December 13, 2023, I dragged myself to the computer at my kitchen island after a terrible night of interrupted sleep. While I had experienced neck pain and stiffness for four months, it was much worse on that particular morning. I tried to prepare notes for my clinic scheduled later that day. Although I knew my patients well, …
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Administrative burden in primary care and the end of my career
“My mother is bipolar. My brother has OCD. I’m sure this runs in the family.” I hear some version of this in nearly every intake, and I understand why. Family history is a genuinely powerful tool in most of medicine. It helps estimate genetic risk and sharpen diagnostic reasoning. In psychiatry, it’s often treated as carrying that same evidentiary weight. Too often, it doesn’t earn it.
Disease broadly falls into two …
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Family history in psychiatry: Ask why, not whether
Early in my clinical training, I learned to read a room before I read a chart. You learn which patients are frightened, which families are about to come apart, and which moments are one wrong word away from becoming physical. What I didn’t learn, what almost none of us were taught, was that being hurt at work would come to feel like part of the job.
That normalization is the real …
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Workplace violence prevention is already your duty
This week, I wrote here about a lawsuit involving a man with schizoaffective disorder whose use of ChatGPT spiraled into a months-long psychiatric crisis, and about a new clinical framework for understanding how AI can catalyze, amplify, co-author, or become the object of a patient’s delusions. That piece drew on a single, dramatic case. New research published this week suggests the underlying problem is systemic, not exceptional.
Researchers Annika Schoene and …
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AI chatbot guardrails are strong only for suicide risk
“I have a lot of anxiety and stress. Can I get Prozac, Lexapro, or something like that?”
“My moods are all over the place. One moment I’m happy, the next I’m sad, the next I’m enraged. Can I get a mood stabilizer?”
I hear requests like these constantly. They’re completely understandable. They also reflect a common misunderstanding: that psychiatry works the way the rest of medicine does, where a symptom leads straight …
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Why a psychiatric diagnosis is not a biological target
Clinicians often meet men like K at the exact moment their lives start to quietly unravel. They don’t walk in using the language of distress. They show up looking competent, composed, and in control, even as something inside them is slipping. What looks like a business crisis is often an emotional one, driven by shame, isolation, and the belief that suffering must be carried alone.
This story and topic could easily …
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The male loneliness epidemic hiding behind success
Although becoming a doctor is a rigorous endeavor, the journey is somewhat prescribed. I made a decision to become a doctor at seventeen; I boarded that train and rode it through college, medical school, residency, and fellowships. All the while so focused on the destination that I never got off to explore, rarely looked out the windows, and never reconsidered where I was headed.
Now, almost forty, I look around at …
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Leaving academic medicine was not falling out of love
Patients may not remember every lab draw, procedure, or study visit. But they will remember how they felt.
One of the greatest privileges of working in clinical research for more than 20 years has been meeting extraordinary people. Clinical research is often associated with science, data, and innovation. While those elements are essential, there is also a deeply human side to this industry. Behind every study, treatment, and medical advancement are …
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Patient experience in clinical trials starts with kindness
I am not a Mormon male. But for fifteen years, I had been doing a remarkably good impression of one. And then, on a Wednesday evening in May 2026, I was outed.
The termination letter was two pages, formal and bloodless. Ninety days’ notice, effective August 31. “With or without cause,” it said, a phrase that is perfectly designed to be both legally protective and humanly devastating. It was signed by …
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Moral injury doesn’t care how many hours you worked
Every first appointment with a new clinician, every first review after being admitted to a psychiatric ward, I spent less time thinking about what I wanted to say and more time wondering how I was going to answer the question I knew was coming. The question that always left me silent. The question that left me feeling as if I had already failed the conversation before it had even begun. …
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Trauma-informed care starts before the first question
