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.
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 …
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Core values were key to reclaiming my physician identity
The first day I sought counseling, I felt like I was committing a crime.
Our afternoon anatomy lecture had just ended, and the entirety of our first-year medical class—clad in hunter green scrubs and reciting the intrinsic muscles of the back—paraded in what looked like a single-file line to our cafeteria.
“Act natural,” I thought. “Don’t let anyone find out what you’re up to.”
My friends veered right to enter the cafeteria as …
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Start with the students: Addressing the future of physician suicide
The front-desk clerk, Ruth, comes to me and says Rose Henderson wants a cab voucher signed — which guaranteed payment. Rose could not be made to understand, Ruth tells me, that we are not permitted to sign vouchers when the person, the client, comes to our offices solely for the purpose of picking up cash … which is Rose’s purpose.
We are Rose’s payee, which means we handle her money. I …
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My patient isn’t doing well. Is it my fault?
“Under duress, we do not rise to our expectations. We fall to our level of training.”
– Bruce Lee (supposedly)
When I was looking for My Patient, well before his neighbor grabbed my butt, I remember noticing that most of the slots in the doors of the isolation jail cells were open. These slots are tall enough to pass a softball and wide enough to pass a clipboard. They are about three …
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When a patient in jail lacks impulse control
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
It takes an average of 10 years between symptom onset for mental health conditions to be accurately diagnosed and therefore treated. In addition to general misunderstandings about mental health, the nationwide shortage of mental health providers is one unignorable cause for this devastating delay. But why is there a shortage? Well, the bottom line is … the bottom line.
In simple terms, insurance companies do not pay enough for mental health …
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Improve mental health by improving how we finance health care
Wiley Boynton is dead. I first heard the news when Katie, a colleague, called me on my cell phone. Wiley had been taken to the hospital with a knife wound.
I asked her right away: “Self-inflicted?”
“I think so,” she said.
A self-inflicted knife wound might be possible, I figure with someone like Wiley, considering the violent world he came out of. I know quite a lot about him.
Wiley is around 40 years …
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Could this patient have been saved?
We knew that the most powerful way to provide substance abuse treatment is in a group setting. Group members can offer support to each other and call out each other’s self-deceptions and public excuses, oftentimes more effectively than the clinicians. They share stories and insights, car rides, and job leads, and they form a community that stays connected between sessions.
Participants with more experience and life skills may say things in …
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The most powerful way to provide substance abuse treatment is in a group setting
I recently discovered a fact about the United States of America that should be a source of embarrassment for all Americans. What I found out is this: There is not a single safe injection site anywhere in the entire country. Safe injection sites save the lives of people addicted to opioids, such as heroin and fentanyl. These sites exist in countries around the world, and they are working every day …
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Making America great again with harm reduction
Anita is 37 with blonde, wild, disheveled hair. She is overweight, has bad teeth, wears too much make-up, and is severely depressed — sometimes psychotic. She tells me she often hears voices. And she constantly complains that the medicine she gets from our clinic (and she gets a lot), does not take the edge off her feelings.
She has severe anger and is in an anger-management group at our offices. Each …
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Preceding traumas lead to current ones
When I first saw Jea-Hyoun, in a medical meet-cute straight out of a romantic comedy, she was being evaluated for thyroid cancer. I was an allergy/immunology fellow harried by a pile of paperwork. She was a patient, in the same building where she saw patients of her own as a psychiatry and family practice resident, preparing to see the specialist. We made awkward small talk in the hallway before she …
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Finding meaning in the intersection between marriage and medicine
James is a tall, lanky Caucasian man, well into his 40s. He has brown curly hair and is not a bad looking fellow except for the vacant look in his large brown eyes. He is a pacer, which is a manifestation of his illness, and a consumer of excessive amounts of water.
You have to talk right at James to be understood. I try to make eye contact. Sometimes he doesn’t …
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Can a unique boarding home save my patient?
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 …
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What Karl Marx can teach doctors about burnout
Stress is one of the epidemics of modern-day living—especially work-related stress. At a basic fundamental level, it’s just simply a chemical reaction. Your adrenaline and cortisol levels shoot up in response to a stressful stimulus, the primitive “fight-or-flight” response kicks in, and your brain and emotions go into overdrive. The problem with this acute response, is that it tends to lead to illogical thinking and an inability to really find solutions. Research also confirms that having chronically elevated stress hormones is very detrimental for your long-term health and …
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How physicians can deal with stress
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 …
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When primary care handles the consequences of psychiatric medication prescribing
Mr. Fine is in for the eleventh time in less than a week. I work as a social worker in a hospital emergency psych unit. Mr. Fine is suicidal again. It is kind of late in the evening when I see him, although it is my first time, I am the only social worker on tonight.
This is the usual situation, one social worker per shift.
The psychiatrist takes me aside, quietly …
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The suicidal patient who couldn’t be placed
Eighteen months out of residency and into outpatient psychiatry private practice, for the first time since before medical school, I’m coming home actually feeling a surplus of energy to put into my life outside of clinical practice. Sure, I did my best to maintain my interests and relationships during my training, but doing so felt like trying to wring blood from a stone.
A slight sense of boredom in the evening, …
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How to lead a sustainable life: A physician’s victory over burnout
Recently, a fellow physician mom ended her life. While outwardly, a very vibrant, lively, and happy woman, she fought her own internal demons for some time. From what we know, she struggled with depression but was still committed to being a good mom, physician, and wife. Sadly, a few days before her birthday, she could no longer bear her sadness and decided to end her agony. I know many physicians’ …
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Who are the doctors who end their own lives?
