Veronica Kelley was working at an office building across the street from the Inland Regional Center in San Bernardino, Calif., in December 2015 when a county employee and his wife entered with semiautomatic rifles and opened fire, killing 14 and wounding 22. Most of the victims were co-workers of the gunman.
The couple went on to wound two police officers later that day before being fatally shot by …
The lingering effects of a mass shooting
“It is high time for us to recognize that the physicians who spend so much of their lives caring for us are often suffering in silence, and effective interventions would be good medicine for all of us.”
– Joan M. Anzia, MD
On February 4, 2007, I attempted to take my own life.
It was Super Bowl Sunday, and the Colts were playing the Bears. My wife Charlene and I were home, and …
The deadly silence of physician depression and suicide
Dear emergency department clinicians:
We at the top of the administrative and regulatory chain understand that you deal with enormously complicated mental health and substance abuse patients all the time. Your resources are limited, and the demands placed upon you are growing.
As such, we (the anointed and well-meaning) wish to offer you some guidelines based on our committee’s extensive lunch-time meetings and brainstorming sessions. All of which, you will certainly understand, …
Dear emergency department clinicians: a letter from administration
Claire Elise Boucher, 31, known professionally as Grimes, is a Canadian singer, songwriter, record producer, and visual artist. Her music incorporates elements of varied styles, including dream pop, R&B, electronic music, and hip hop. Since 2018, Boucher has been in a relationship with technology entrepreneur Elon Musk.
Grimes recently became the star of a new Adidas advertising campaign. In announcing this new …
Elon Musk’s girlfriend had eye surgery for depression. Is there science behind that?
A career as a physician has traditionally been considered to be among the best vocations that talented students can pursue. That may no longer be the case. All too many doctors report that they are unhappy, frustrated, and even prepared to leave the profession. That should worry all of us. The physician burnout crisis is likely to affect our quality of care and our access to health care providers.
According to …
Physician burnout is as much a legal problem as it is a medical one
In May 2019, headlines of a study out of University of Michigan hit the lay media: “New Doctors’ DNA Ages 6 Times Faster Than Normal in First Year.” Using DNA samples submitted by medical residents across the country, the Intern Health Study measured telomere length before and after residents completed their intern years. Loss of telomere length has been associated with morbidity, mortality, and even depression. A …
The entire medical education system needs sweeping change
When we began exploring the concept of moral injury to explain the deep distress that U.S. health care professionals feel today, it was something of a thought experiment aimed at erasing the preconceived notions of what was driving the disillusionment of so many of our colleagues in a field they had worked so hard to join.
As physicians, …
Moral injury in health care: What have we learned?
An excerpt from Understanding Medicines for Anxiety.
In addition to medicines with FDA indications for anxiety, such as benzodiazepines and some antidepressants, a number of drugs are frequently prescribed off-label. Among these are gabapentin and the related compound pregabalin, collectively known as gabapentinoids. Their popularity is remarkable: gabapentin has been …
Off-label use of gabapentin and pregabalin for anxiety
As physicians, we face the formidable task of working with patients who appear angry, never content with care or “made better” by anything we do. They may be known as “difficult,” unpleasant, or demanding. These patients are the most challenging and often the least rewarding to care for. But does it have to be that way?
A number of years ago at my first post-residency job in an urban safety-net primary …
How trauma-informed care promotes healing
A young man’s life is over too soon. He had been seen more than four times by more than ten different physicians and in four different clinical settings in the two weeks leading up to his death. Each time he was accompanied by a concerned loved one. Each time his depression was discussed in detail. Each time a medical professional determined that it was safe to send him home. Yet, …
A physician’s role in enlisting help to prevent suicide
An excerpt from Understanding Medicines for Anxiety.
Although the SSRIs (selective serotonin reuptake inhibitors) are among the most widely prescribed medicines for depression, they also have a useful role to play in treating anxiety disorders. In this article, we will look at their benefits and limitations when used in this …
Think beyond benzodiazepines for anxiety
Literature surrounding the effects of social isolation and loneliness for older adults is no longer lacking. Studies and articles outlining the dreadful consequences of these epidemics have even pierced large media outlets like Time magazine, where they emphasize how one in three older adults are lonely.
While any attention brought to the fact that the age group containing people age of 85 and up is …
The suffocation of social isolation
The World Health Organization (WHO) recently announced the 11th revision of the International Classification of Diseases will have a new code: gaming disorder.
For those who eagerly await play-by-play updates to ICD codes, this may be old information. Others may have noticed the brief, but sensational media blip created in June after a few news outlets tasked their hippest interns to tackle the insurmountable task of educating the world on what …
Understanding the backlash to gaming disorder
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In family medicine residency back in the early 2000s, we had a then-novel curriculum in narrative medicine. During inpatient rounds, we would sometimes get a few minutes to write down our thoughts about a patient’s experience. I remember how cathartic even refreshing at times that felt, to write my feelings about my first patient on the wards with severe heart failure or that sweet toddler I had to put an …
Doctors die. But the good ones leave a legacy.
Although Arnold Knutsen and I “met” virtually five years ago, we only first spoke on the phone recently when he called to share his story. He’s the eldest member of the online benzodiazepine support group we cohabitate. His posts in the group always reeked of desperation, and there was a palpable sense of urgency to his pursuit of a cure for his situation. It was clear …
Are benzodiazepines “the worst thing that’s ever happened to people”?
I excel at intellectualization. It is a fickle defense mechanism, allowing the observer to fully comprehend the situation in front of them without fully engaging in the emotional context. Throughout my medical training, intellectualization has aided me at many patient bedsides and through emotionally charged family conferences. I am reminded of many moments on neurology wards when a patient’s emotionally charged question was reinterpreted and deflected through a purely intellectual …
A psychiatric hospital in Uganda: a medical student’s reflection
Here is a standard emergency department situation, played out all across America today.
Patient X has schizophrenia. He takes medication, but only until he feels better. He is calm when he takes it, but sometimes aggressive and assaultive when out of treatment and off medications.
Patient X decides to leave town and drive somewhere else because he is angry at 1) family 2) significant other 3) health care system 4) situation.
He is …
The default for psychiatric patients: “Send them to the ER”
It happens all too often.
You have not been taking good care of yourself. You don’t eat, you sleep poorly, and you neglect your medical health. Over months or sometimes years, you begin to isolate yourself from your friends and family. You can’t seem to hold a job. You lose interest in once pleasurable activities. Your thinking becomes odd, your thoughts distorted and fragmented and strange. No one knows about that …
Treating schizophrenia with long-acting injectables
To my knowledge, three people who were under my care killed themselves.
The first was a young man — late 20s, maybe? — who I met while I was a psychiatry intern. He was hospitalized in the psychiatric unit where I had just started my rotation. I did not have the opportunity to get to know him well. Our paths crossed, at most, for two days. He had a diagnosis of …
The end of a life never just impacts the individual who died
“Complementary and alternative medicine” (CAM) is a category that includes all the methods of physical or mental healing that do not fall under the umbrella of western medicine. Examples include comprehensive healing traditions from other cultures, such as Chinese or Ayurvedic (Indian) medicine; herbal remedies; and a wide variety of mind-body treatments, such as meditation and yoga. CAM treatments are popular everywhere, including here in the U.S. …
The allure of complementary and alternative medicine
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