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.
We are taught from the first days of medical school that bedside manner is a clinical tool as vital as a stethoscope. We are told to listen, to mirror, and to connect. But for many of us, this directive has quietly morphed into a high-stakes performance. If you find yourself leaving the exam room physically exhausted, not from the medicine, but from the emotional labor of managing patient reactions, you …
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The people-pleasing in medicine that burns doctors out
Developmental-behavioral pediatrics did not collapse overnight. It eroded the way institutions usually do: slowly, quietly, and then all at once. For those of us who practiced during its rise and decline, the story is not merely professional history. It is a record of what happens when a field built on dignity, patience, and longitudinal care is left without structural support.
For decades, developmental-behavioral pediatrics (DBP) served as a stabilizing force for …
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The slow collapse of developmental-behavioral pediatrics
When I started my first full-time faculty position, one of my biggest worries was how I would manage working with the interdisciplinary team. I’d spent the last few months working as a locum at my most recent site of training, where I’d had years to develop rapport with consultants, nurses, allied health, and other staff. While that experience left me feeling confident in my abilities on the clinical side of …
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Impression management nearly burned me out
A lawsuit filed this month in California should make every clinician managing a psychotic disorder pay attention. According to the filing, a Bay Area man with schizoaffective disorder (stable for years, medicated, working, helping raise his sister’s kids) began using ChatGPT’s GPT-4o model in a way that gradually shifted from tool to companion. When he shared a personal theory he’d developed about “mathematical cosmology,” the chatbot didn’t push back …
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AI chatbots and psychosis: the question nobody asks
Yesterday, I read an article that stopped me. Rachel Wells, a writer and technology entrepreneur, publicly shared that her family is facing the loss of their home. She described continuing to write, build, pitch, and speak about artificial intelligence (AI) and the future of work while privately confronting a far more immediate question: Where will my family live?
Her story stayed with me because it exposes something larger than one family’s …
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Celebrating resilience can conceal a private crisis
I write this to “honor” my sister Gail on her sixty-seventh birthday, not with nostalgia, but with clarity. My sister Gail was the golden child when we were young. That never changed, not after adolescence, not after tragedy, not even after adulthood should have leveled the field. When our father died in an air crash, I was thirteen and she was eleven. The family mythology stayed intact: She remained the …
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Breaking generational patterns in a family of favorites
This morning I’m celebrating. I did something last night for the very first time. I walked on stage alone, opened my mouth, and sang. I’ve marveled at every singing performance I ever attended, wondering, how do they do that? And now, I can say, I have.
I’m a high-achiever. I say that with a bit of embarrassment. It feels like a pejorative term: the student who does it all, who joins …
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Physician perfectionism can keep you from ever trying
Patient details have been changed and combined where necessary to protect privacy.
This week, I evaluated two young people who had recently been hospitalized after developing psychosis in the setting of heavy cannabis use. Both had been discharged with serious psychiatric diagnoses and multiple medications. Both families were frightened. And in both cases, the central clinical question remained insufficiently answered: Was this the onset of a primary psychiatric disorder, or was …
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Is it cannabis-induced psychosis or bipolar disorder?
My name is Tony Grandelis. I’m an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what addiction recovery has taught me about fixing a broken health care system, one principle at a time. Today, I want to talk about resentments, which are, in my opinion, some of the most under-recognized causes of burnout in medicine.
In recovery, …
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Resentment in medicine is a leading cause of burnout
Every physician carries the imprint of their training. Some of those imprints are gifts: a clinical insight, a way of listening, a habit of precision. Others are burdens we never asked for. We inherit not only the wisdom of our mentors, but also their blind spots, their anxieties, and sometimes their failings.
Early in my career, I trained under a mentor who, at the time, was widely admired. He was charismatic, …
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Guilt by association in medicine: My mentor fell, not me
In patients with chronic disabling physical symptoms, clinicians often overlook an associated mental illness. Why? Patients typically do not offer the psychological symptoms needed to make a diagnosis. Instead, they emphasize physical symptoms and their disability. To make a diagnosis, I’ll review that clinicians need to view severe physical symptoms as a “red flag” for a comorbid mental health problem.
An earlier KevinMD post highlighted that primary care providers lack …
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Comorbid mental illness affects 30 million Americans
When most people hear the words seasonal affective disorder, they picture winter. Dark mornings. Short days. Cold weather. Fatigue. Oversleeping. Wanting to stay under the covers. Only wanting to go out for donuts.
But seasonal depression does not always come in winter. For some people, summer is the difficult season. And summer-pattern seasonal affective disorder can look very different from the winter depression most of us recognize. Instead of slowing down, …
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Summer seasonal affective disorder hides in plain sight
Making the decision to leave clinical practice was a leap off a cliff into thin air when I wasn’t sure I had a place to land. Who was I, what would I do, if I wasn’t a physician? It felt like such a loss; I loved being able to do such deeply meaningful work.
This was back in the dark ages of the late 1990s, before “burnout” was a household word. …
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Women physicians are leaving. Whose problem is it?
Imagine walking into a busy clinic shift. The pages are going off, patients need attention, and the emotional weight of the work feels heavy on your shoulders. In moments like these, the ancient wisdom of Stoicism can serve as a quiet anchor. Philosophers like Seneca, Marcus Aurelius, and Epictetus understood that life brings many challenges. They taught practical ways to respond with clarity, courage, and compassion. Their reflections on action …
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Stoicism for physicians: a quiet anchor on hard shifts
A friend once asked me a question that stopped me in my tracks. Not externally. Internally. I am a highly verbal person inwardly, and while the conversation continued around me, another one had already begun in my head.
Earlier that day I had been cataloging the various grievances I believed had been inflicted upon me by another person I had once counted as a friend. After listening patiently for some time, …
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Why we need closure, and why we may not
An attending physician recently described one of the most troubling encounters she had witnessed involving a medical student. A student emerged from a well-child visit and offered a reassuring summary: “The kid is fine. Everything is good.”
The patient, however, was not a child whose history could be dismissed with a casual adjective. The child had undergone surgical repair of a ventricular septal defect and had a history of failure to …
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Why “fine” is not clinical reasoning in medical education
In my thirty years of clinical practice, I have witnessed the landscape of the human face undergo a quiet, profound transformation. It is not happening through biology, but through the scalpel, the needle, and the digital filter.
For most of human history, an aging face was a history book. It served as a cartography of experience, where lines around the eyes mapped a lifetime of laughter, and furrows in the brow …
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Our obsession with youth is making us shallow
Autism care in the United States did not collapse overnight. It collapsed because the discipline designed to guide it, developmental-behavioral pediatrics, stepped back while other systems stepped forward. That silence created a vacuum, and applied behavior analysis (ABA) filled it. Not because ABA offered the most humane or developmentally grounded model, but because it was present, reimbursable, and organized. Silence did the rest.
I saw the consequences of that silence in …
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Why autism care collapsed into one model
Military sexual trauma (MST) affects an estimated 1.4 million U.S. veterans and is one of the most consequential noncombat-related health burdens associated with military service. Military trauma is still commonly viewed through the lens of combat exposure, but MST is a distinct form of military trauma involving interpersonal violation, power imbalance, disrupted trust, and long-term mental and physical health consequences.
For clinicians, MST should not be understood simply as another cause …
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Military sexual trauma is not just another cause of PTSD
