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 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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Don’t yell at me. I’m trying to help.
What is stress? Stress is a bodily response to external pressures. It’s an emotional state that we go through when dealing with difficult situations, and it can have a major impact on our health. When faced with work deadlines, family problems, and other daily stresses, our bodies release hormones such as cortisol and adrenaline into the bloodstream. These chemicals can lead to high blood pressure or weaken the immune system …
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Stress and medicine: My salute to frontline workers
Health care workers pride themselves on their ability to be empathetic but professional. Many of us calmly deliver news of adverse outcomes and prognoses to patients and family members every day, then go home to a family or personal life, and try to compartmentalize thoughts of our patients’ diseases, injuries, or deaths.
At least that’s how it may appear to others, even fellow health care professionals. But having worked in pediatric …
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You’re not alone: Clinicians and the need to address grief
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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The confusing policy surrounding the buprenorphine X-waiver
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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When the teen with depression and anxiety is yours
In her February 11, 2021 press briefing, White House Press Secretary Jen Psaki stated, “The president, vice president, secretary, and senators established the mutual understanding that America needs to build new infrastructure across urban and rural areas, and create millions of good-paying jobs in the process of supporting the country’s economic recovery in the months and years ahead.”
What we need by the end of 2021 is a mental health infrastructure …
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We need a mental health infrastructure bill
It’s Wednesday at 3:27 p.m.
I was just in the kitchen cutting potatoes for a belated birthday dinner which, ironically, will be happening very early this evening. I noticed a missed text on my phone and decided to call back, as was requested. It was from a member of “a network of licensed physicians” as they are looking for Massachusetts physicians credentialed to certify for medical cannabis. I am one of …
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Cannabinoids are medicine, but patients aren’t getting the care they need
As early as April 6, 2020, the New York Times (NYT) published an article revealing early pandemic statistics that showed the death rate for people with intellectual or developmental disabilities (IDD) who received residential services in New York State (NYS) was double that for the general population. As difficult as the pandemic has been for all of us, it was clear from the beginning that some were more vulnerable than …
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The impact of COVID-19 on those with disabilities and mental illness
Burnout has been an issue for those in health care long before the COVID-19 pandemic, but the increased stress and anxiety we face now have caused a host of new problems. The current environment health care professionals (HCPs) find themselves in has brought issues of physical and emotional exhaustion, compassion fatigue, and moral injury, not to mention more instances of second victim syndrome (the effect of an unanticipated, adverse medical …
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Peer support during the era of COVID-19
In a February 2021 Facebook Live presentation sponsored by Seattle Children’s Hospital, Jill Escher, the president of the National Council on Severe Autism (NCSA), called for splitting the autism spectrum.
In some individuals, autism spectrum disorder (ASD) presents as a serious developmental disability affecting communication, learning, motivation, and all aspects of daily living. These individuals require 24/7 level care. Others on the spectrum have mild differences in …
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Why health care professionals must call for splitting the autism spectrum
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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Maybe we’re not all hanging in there. And that’s OK.
“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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Jealousy and missed opportunities in medicine
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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What’s in your grief toolkit?
As COVID-19 cases surge across the country, we appear to have another long winter ahead of us in 2021. In March of 2020, stay-at-home orders were put in place, schools closed, and many people were spending more time at home than ever before. While being home has offered benefits to some, others have been trapped in terrifying circumstances with no escape.
In March of 2020, domestic-violence hotlines prepared for increased call …
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The shadow pandemic of intimate partner violence
