In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% …
Stop cutting patients off their prescribed benzodiazepines
Burnout is a big and burgeoning problem in the United States. According to a recent Mayo Clinic report, it affects 28% of the general working population. Among physicians, however, the rate is markedly higher, ranging from 44% to 54% in most studies.
More concerning are the consequences: Doctors who report burnout symptoms are twice as likely to …
Physicians are suffering, and they need help
A person rolls into an outpatient clinic. A pleasant bleach smell emanates from freshly scrubbed chairs. Happy chatter about people’s lives, and this week’s health issues are dimmed by the local radio station playing in the background.
The person who just rolled in for the first time has a confoundingly complicating diagnosis. It’s not the first sized holes in their body under their urine-soaked shorts they initially refuse to take off. …
When a medical facility isn’t equipped to handle profound mental health issues
I had been diagnosed three days prior, given lithium to stabilize and a benzodiazepine to sleep. I went home. Things did not get better.
I had been admitted just that morning after a long, confusing night in the ED. I did not yet understand the severity of what had happened — or even what had happened. The mania was still mostly euphoric and speckled with bursts of joy, but between these …
Give your psychiatric patients a reason to trust
Mary Beth is a female in her early 30s, quite obese and mildly mentally repaired, as well as suffering from schizophrenia. She lives in a housing authority apartment, which is not a great place. But being highly subsidized, it is cheap! Her apartment is in a perfectly dismal condition. She lives in absolute squalor with garbage strewn around, and I am unable to figure out what to do about it. …
Getting pregnant may have saved her life
It wasn’t until I first had to manage the aftermath of a sexual assault on a psychiatric unit one night during my residency that I realized psychiatry might have a problem with sexual safety.
My fellow residents and I had never been informed of a management policy for inpatient sexual assaults, and my program’s curriculum was silent on how to handle the issue.
Because the assault involved a psychotic patient who was …
Waking up to the sexual violence in America’s psychiatric units
I have had the opportunity to consult with several physicians who needed to abruptly and permanently give up the practice of their chosen career without their consent. Causes of this involuntary termination included illness, burnout, and loss of license. What became very clear to them and to me was that the standard strategies for managing a work transition (e.g., defining transferable skills, exploring a range of job/work opportunities, learning new …
I bid farewell to four people this month who I’ve been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind.
It is the nature of our healing practice to build trust …
A psychiatrist can’t help patients anymore
The night I almost swallowed a bottle of Percocet post-call in residency is still clear in my mind, as is the hours leading up to it; the thoughts going through my head, the swirl of emotions seemingly pulling me like an ocean undertow. I can only attribute my pause to a power greater than myself. The truth is when I look back on that night, I can see that those …
The thought cancers that almost took my life
I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.
Why listen to an actress about medical treatment for addiction? First of all, doctors generally …
What can a famous actress teach us about curing addiction?
The pediatrician kept on telling me that everything was fine. What could possibly be wrong? His motor skills were right on time, if not a little early. He even had emerging problem-solving skills. He did things like push a chair up to a shelf to climb up and get what he wanted. Three decades later, he still does clever things that make me question why he is so impaired.
Unfortunately, there …
Patients with severe autism: medical and dental care in the community
A physician health program, PHP, is a state agency that is responsible for advocating, treatment referral and physician monitoring, residents and medical students who have substance abuse disorders, psychiatric disorders and/ or boundary issues. There are two ways of becoming a part of these programs, self-referral or be reported. Currently, 47 states have a PHP, and the issue is that there is no set guideline and several variables in the …
A physician got a DUI. The physician health program didn’t help.
An excerpt from Mind Bubbles: Exploring mindfulness with kids.
I am not a pediatrician. My training as an OB/GYN taught me to care for mothers-to-be and bring their babies safely into the world—and then hand them over to the waiting pediatrician. I am also a mom and mindfulness teacher, however, …
Mindfulness training should start as soon as kids can grasp the concept
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National attitudes have greatly shifted over the last 25 years towards the idea that mental and emotional well-being are vital to a person’s overall health. Today, nearly six in ten Americans have sought or want to seek mental health care for themselves or someone they love. While stigma and costs persist as primary barriers to progress for solving the mental health crisis, the key issue—as we have increasingly come to …
How to overcome the gaps in behavioral health
I recently returned from my second extended stay in New Zealand with my family. The entire experience was wonderful, but perhaps our most memorable day began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of …
The secret to travel doctor success? Bring your family.
Jacob is just past 30 by a year or two. He is, as I like to describe him, a little boy trapped inside a man’s body and very much mentally ill. He started off with fetal alcohol syndrome, which means his mother drank heavily when she was pregnant. I am not sure I believe that diagnosis is correct, by the way. Fetal alcohol syndrome is a much more complicated condition …
What will happen when the mentally ill get older?
While researching for my next book, I noticed a peculiar trend: Most news reports about suicide linked victims to mental illness. It is nearly always depression, multiple personality disorder, or more depression.
While it is true that personal mental illness and a family history of mental illness are often bonafide risk factors for suicide, they — collectively as mental health issues — are only one of many underlying causes of suicide …
It wasn’t depression that led this physician to suicidal ideation
I enjoy a fairly small private practice and a manageable telepsychiatry side job with good support staff. But even the small scale of my outpatient clinical practice doesn’t fully insulate me from the pain of unnecessary practices that I wish would become obsolete.
1. Preauthorization. The dance of preauthorization starts with the naivety on my part that I decide what medication my patient should be on. I spend precious time crafting …
Stop telling doctors what to do
Janelle had overdosed 32 times.
Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She …
A call to increase the availability of the Butrans patch
What is the unspoken fatal epidemic of our time? And the greatest predictor of overall health, happiness, job satisfaction, and resiliency? Loneliness.
As a clinical cardiologist, I am committed to the health and well-being of my patients.
As a recovering burned-out physician who suffered in silence for years while hiding this so well from others, I am committed to finding solutions to help my partners suffering so often in silence.
As a husband, …
What a cardiologist wants you to know about loneliness
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