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.
I first became acquainted with Michael after another case manager I work with, a woman, reported the proprietor of the group home (sort of a boarding house, really), Miss Samantha, as she was known, and whom I knew slightly, said she wanted Michael out because of his sometimes bizarre behaviors, often frightening to her neighbors. Miss Samantha is a tall, white-haired woman of some dignity. Sort of Southern in her …
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In social work, small actions make a big difference
One of the greatest health challenges in our lives is the phenomenon of burnout. It occurs when there is enough negative stress that persists over time. As many of us know, stress is an integral part of being human. It can be positive (an upcoming wedding or birth of a child) or negative (job loss or physical injury). At its core, stress is any physical, mental, or emotional factor, external or …
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The connection between atrial fibrillation and burnout
The ongoing COVID crisis in the U.S. has highlighted our broken heath care system. And with it, has come an opportunity to begin to fix the system. Some touted mindfulness as a panacea pre-COVID – suggesting that if clinicians reframed the situations around them, they could better cope and continue. This backward argument echoes the idea that clinicians should redouble their resilience rather than address the core drivers of their distress. …
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Mindfulness as a diagnostic tool, not a treatment
He shoved the paper with the address in his pocket. Then he found his little black bag with the oils and other implements for giving what once was called the last rites of the church, but were now termed the sacrament of the sick, and headed off in the direction of the Flats. Sixty-six Center Street. He’d been there before, he was sure. Only the week before, the adjoining block …
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A priest, a police officer, and tragedy
Public health safety measures in the wake of COVID-19 have transformed health care into virtual medicine overnight. From psychiatry to surgery, all of the medical specialties have adapted technology-enabled virtual appointments. The support for health care providers has been pervasive in the past few weeks-from celebrity shout outs to presidential gratitude. It certainly is a daunting time to be a physician. As physicians remind themselves of their ethical duties enumerated …
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The withdrawal of effective sexual offender treatment during COVID-19
She was naked in her seclusion room — a padded cell — with her gown on the floor and drenched in her urine.
I was her nurse.
I gave her lithium.
She put the pill in her mouth and then spit it at me in my face. Then her tirade began:
“I’m Jesus. The FBI is watching us. The computer chip in my head said to kill, kill, kill you.
They’re watching me. They’re watching …
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The genius within a schizophrenic mind
It’s scary. Like 9/11, we have a new reference point touching everyone on the planet: life before COVID-19 and life after. Regardless if you get it or don’t, the unknowns and secondary consequences are scary. Life before COVID was scary, too, minus the urgency.
Before COVID, we sensed the weight of living on a sick planet. We felt powerless to change the tide of forces affecting our lives for the worst. …
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COVID illuminates silent fear
Every physician I know has a story about an unanticipated patient event. A story that was traumatic at the time and easy to now recall in fine detail. A story that was so impactful that it still haunts them. When a patient suffers an adverse event, many people are affected — the patient, his or her family, and the health care providers. The physicians and their team who are most …
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Second victim syndrome in the time of COVID-19
“Doctor, I can’t wear a face mask, can you write me a medical excuse?”
My first reaction was a resounding No. COVID-19 cases are surging in many parts of the country; we’ve only just emerged from our own deadly surge in Boston. It’s essential that we employ every measure we can to prevent spreading this deadly virus—and that includes universal masking.
But then this patient described how she had …
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The challenge of trauma-informed care in the age of COVID
Mary is a woman of sixty years. She is obese. Originally from rural Alabama, she told me her aunt and uncle raised her, and they were bootleggers, making their own liquor. By age fifteen, she was drinking this homemade hooch. She never told me how she made her way to New York and New Jersey, where her kids now live, and where she once had a husband. She is unsure …
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A social worker’s sickest patient
Our country, and the world, is beyond exhausted by COVID-19 and the utter chaos and destruction of lives it has caused. All people, including physicians, are being pushed beyond capacity. What do we mean, collateral damage? Originally related to war: the unintended result of a terrible, unprecedented event or action. We may not be in a traditional war, but make no mistake, we are in a war.
Imagine – you have …
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Mental health care is the not so silent collateral damage of COVID-19
I have been drinking since I was 13 years old. I honestly didn’t realize that I had a problem until the last couple of years. The problem wasn’t so much that I drank in excess, or got in trouble at work, with the law, or with my family. The problem was that I couldn’t handle the full breadth of my emotions. Too much sadness, or even too much elation, was …
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I stopped drinking and then there was a pandemic
“I can’t take this, doc. It’s gonna kill me. I can’t. I just can’t,” exclaims my patient with persistent refusal of his medication. My frustration is met with my patient care team’s hesitation to give him the medication with fear of further conflict and possible escalation to violence. But who’s at fault? Any of us? All of us?
My second patient, lying on the MRI table, shaking his head swiftly in …
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What happens when patient capacity and autonomy diverge?
First and foremost, a mental health crisis is a medical emergency well within the sector of public health. Therefore, the question of who should respond to mental health emergencies is one in which physicians and all medical providers should have a say. Medical providers should not only be aware of the systems in place to respond to mental health crisis but must advocate for patient safety as a measurable outcome …
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Who should be the first responders to mental health crises?
Debby Ann has a pit bull, and I remembered that when she called me recently. It had belonged to her son, who is now deceased. He was murdered. She wants to meet me for lunch.
Debby Ann is a pretty lady, at least she was the last time I saw her. We worked together for a while. She has an especially pretty face, and nice blond hair. In her twenties, I …
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The social worker and a patient who lost her son
For as long as I could remember, I had always wanted to be a doctor. I used to destroy my younger sister’s dolls, giving them incurable, permanent-marker-based diseases, surgically treating various ailments with craft scissors.
The other earliest memory I have is of being told I had a few months to live at the age of five. I remember sitting in the surgeon’s office, staring at the lucite paperweight on his …
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How discovering trauma changed this doctor’s life
Patricia, she is maybe 40. She is mentally ill. Her mother was shot while cooking in her kitchen with a rifle someone was fooling with, and the weapon went off. Patricia was there to see her mother’s head just about blown off. She was 16 then.
I don’t know why I mention the long-ago shooting, except it never goes far out of my mind when the subject is Patricia.
Persons like Patricia …
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The forgotten letter a social worker wrote on behalf of a psychiatrist
This is the text of the keynote graduation speech given to the child and adolescent psychiatry residents at the Mount Sinai Hospital in New York City on June 18, 2020.
Let me begin by confessing that I am not a child psychiatrist.
I am an adult psychiatrist.
Or, as my mother says, I’m almost a real doctor.
One of the first things one learns as an …
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Wisdom for child fellows and fellow children
