Physician Burnout and Mental Health

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.

When a medical student is victim-blamed

Anonymous

Medical Education

November 6, 2019

After third-year medicine, I was required to withdraw for handing in an assignment late. It was a paragraph of self-reflection; I couldn’t believe I was being kicked out for something so seemingly inconsequential.

My dealings with the faculty became increasingly hostile and negative. I realized that my fellow students had to band together. Otherwise, there will be no change. I have to say that at my medical school, they have been …

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When a medical student is victim-blamed

Psychological safety in health care: simple, important, fragile

Neil Baker, MD

Physician

October 31, 2019

With the epidemic in health care of overwork, stress, and burnout, psychological safety is a crucial factor in achieving the highest levels of quality of care and quality of work environment. While simple in concept, psychological safety is also quite fragile and needs careful attention on a day-to-day and conversation-to-conversation basis to assure it.

Psychological safety means that people feel safe to speak up about concerns, new ideas, negative feelings, and …

Why your doctor may be concerned about prescribing benzodiazepines

Arash Javanbakht, MD

Medications

October 29, 2019

As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.

There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …

Don’t use stimulants to cram for exams. It ruins sleep and doesn’t help test scores.

Sara C. Mednick, PhD

Medications

October 26, 2019

Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you “awesome at everything.” Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat.

Welcome to #GenerationAdderall, the …

All the wellness in the world won’t help physician burnout

Leonard Su, MD

Physician

October 26, 2019

I will always be a vascular surgeon.

But let’s be clear; I no longer practice vascular surgery.

Despite a busy practice, happy patients, local awards, and the respect of my peers, I quit. I gave it all up. All of the education, all of the endless training, all of the time, hard work, and, yes, all of the salary — I turned my back on it.

Why?

I am a recovering patient with constant …

Nicotine addiction happens quickly in vapers

Elly Yu

Conditions and Diseases

October 24, 2019

When Will tried his first vape during his sophomore year, he didn’t know what to expect. It was just something he had vaguely heard about at his high school.

“I just sort of remember using it a bunch of times, like in a row,” he said. “And there’s this huge buzz-sensation-like head rush. And I just … didn’t really stop.”

Will kept vaping nicotine addictively for the next year and a half. …

How “Joker” gets mental illness wrong

Dr. Sudhir Mane

Conditions and Diseases

October 20, 2019

Spoiler alert: Plot points of the movie “Joker” are revealed.

“Joker” opened to a mix of rave reviews and criticism on October 2, 2019, amid fears of mass-shootings at theaters in the U.S.

This left law enforcement agencies scrambling to beef up security at movie theaters to prevent any untoward incidents. Quite ironically, October 2, is also the 150th birthday of Mahatma Gandhi — the crusader and champion of non-violence.

Warner Brothers even …

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How “Joker” gets mental illness wrong

Get rid of the guilt. You matter as a physician.

Najma Hamdani, MD

Physician

October 17, 2019

“When you start seeing your worth, you will find it harder to stay around people who don’t.”
– Unknown

After graduating from my residency a few years ago, I accepted a job within my organization as a staff psychiatrist and a medical director.

The idea of familiarity was a big driver in my ambivalence towards pursuing alternate opportunities, even when they came knocking on my door. As the job started and progressed through …

Second-tier, off-label treatments for anxiety

Wallace B. Mendelson, MD

Medications

October 10, 2019

In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well. In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine. …

Burnout in fashion and medicine: A fashion designer turned physician compares notes

Hisla Bates, MD

Physician

October 8, 2019

“Fashion Is Moving Too Fast, and It’s Killing Creativity,” by Veronique Hyland, talks about burnout in the fashion industry. As a former Fashion Designer turn physician, my curiosity was piqued. If you substituted the word “medicine” for “fashion,” the title would be just as relevant to the medical industry, as it is to the fashion industry. Yes, medicine is moving too fast, and it’s killing creativity and our doctors. Burnout in the fashion industry stems from the need to …

Laughter breaks trauma’s grim spell

James S. Gordon, MD

Physician

October 7, 2019

Reader’s Digest used to tell us each month that “laughter is the best medicine.” Drawing …

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Laughter breaks trauma’s grim spell

Should pediatricians treat ADHD with medications or behavioral treatment first?

Alex Smith

Conditions and Diseases

October 6, 2019

When children are diagnosed with attention deficit hyperactivity disorder, stimulant medications like Ritalin or Adderall are usually the first line of treatment.

The American Academy of Pediatrics issued new guidelines Monday upholding that central role of medications accompanied by behavioral therapy in ADHD treatment.

Some experts say, however, they are disappointed the new guidelines don’t recommend behavioral treatment first for more children, as that might lead to better outcomes, recent research suggests.

When …

MKSAP: 54-year-old woman with flushing of the face

mksap

Conditions and Diseases

October 5, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old woman is evaluated for flushing of the face of 1 year’s duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, …

A physician’s career as an opioid prescriber and addict

Anonymous

Physician

September 30, 2019

I sat in the back seat of a police patrol car handcuffed with a mind imprisoned by addiction. My day had finally arrived after months of a manhunt by state detectives for operating a fraudulent prescription enterprise to support my obsession and compulsion with cocaine. No more unmarked police cars staked outside the crack houses that I frequented or my mother’s home or in pharmacy parking lots waiting to capture …

A patient confesses that he cuts himself

Dr. Nkeiruka U. Orajiaka

Conditions and Diseases

September 29, 2019

I walked into the room and said: “Hi, Jason.”

“Do you think it’s deep enough to need stitches? I am really scared of needles,” was his reply to me.

I said, “Why don’t you let me take a look, and we can both come up with a plan of how to make it look better?”

“So do you think it needs stitches or not? I’m really scared.”

After taking a good look at his …

Medicine must stop eating its own

Brian J. Yount, MD

Physician

September 29, 2019

Despair has been trying to find me again. That fickle nightmare is breathing down my neck once more. I know her all too well — she has nipped at my heels most of my career and has kept me running for the past 20 years. Running from friendships, running from family, running from loss, running from debt, running from jobs, running from guilt — running as hard as I can, …

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Medicine must stop eating its own

To reduce suicides, follow the data

Maureen O’Hagan

Conditions and Diseases

September 28, 2019

On Kimberly Repp’s office wall is a sign in Latin: Hic locus est ubi mors gaudet succurrere vitae. This is a place where the dead delight in helping the living.

For medical examiners, it’s a mission. Their job is to investigate deaths and learn from them, for the benefit of us all. Repp, however, isn’t a medical examiner; she’s a Ph.D. microbiologist. And as the Washington County epidemiologist, she was most accustomed …

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To reduce suicides, follow the data

What’s the best way to treat doctors and nurses with drug addiction?

Emma Yasinski

Medications

September 26, 2019

Dr. Wesley Boyd, an associate professor of psychiatry at Harvard, has spent years working with state programs that help doctors, nurses and other health care workers who have become addicted to opioids get back on their feet professionally.

He supports these non-disciplinary programs, in which doctors and nurses enroll for a number of years and are closely monitored by addiction specialists and state authorities as they seek to maintain or restore …

Resiliency in the face of despair, as told by an orphaned Drexel fellow

Marie Rodriguez, MD

Physician

September 20, 2019

I was on my honeymoon in the Bahamas when I first heard the news: Hahnemann hospital was closing, and so was my child and adolescent psychiatry fellowship program — along with every other fellowship and residency program in the hospital. I was actually running outside enjoying the beautiful weather of the tropics and getting ready to go on a “swimming with the sharks” expedition when I got the email that …

Overcoming the challenges prosperity can bring to teens and young adults

Miles J. Varn, MD

Conditions and Diseases

September 19, 2019

They received a call that their 19-year-old son had been transported to the local hospital, extremely agitated and intoxicated, with a blood alcohol level of .245. What they learned over the next few days was that this wasn’t the first time their son had been drinking heavily on a weeknight. He confessed that the pressure of keeping up with his classes, sports commitments, and making new friends often left him …