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 still feel a little anxiety whenever I ask someone about suicide.
I have no fear when asking The Question — “Have you been thinking about killing yourself?” — but sometimes I find that I’m not breathing while I await the answer.
What if this person says “yes”?
This anxiety persists even though it’s literally part of my job to ask this question. Despite having asked this question thousands of times, I still …
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When asking about suicide, are you ready for the answer?
It is not clear whether Anthony Bourdain and Kate Spade were getting drug treatment for depression. What is clear is that suicide in the U.S. has never been higher even as the use of SSRI antidepressants has also never been higher. One in every eight American adults recently took an antidepressant says the CDC and the number is only rising. Are the drugs working?
The use of …
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Antidepressant use and the climbing rate of the suicide
I’ve thought a great deal about what to say, if anything, about the two suicides recently of two people who were not merely celebrities in the TMZ sense, but people who represented creativity — perhaps in a way that seemed tangible to the rest of us — and seem to have become celebrities almost by happenstance.
Suicide is not an unfamiliar or difficult topic for me. After all, I am someone …
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It’s time to create the safety net by normalizing psychiatric care
As is often the case when flying I was rewarded for offering a greeting to my row mate on the plane with a bit of insight and knowledge I’d have missed had I not simply reached out a hand and said, “Hi, I’m Darrell.” My momentary companion (we each moved to more spacious seats) had been a schoolmate of the recently deceased Kate Spade. He confirmed her years-long struggle with …
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Call suicide by what it is: the cause of death
“I am so happy I’m not in residency anymore!” he said with a big grin on his face. “I mean, I learned a lot, don’t get me wrong,” he tried to rectify the situation after realizing who he was talking to, “I just remember how tired I was and how I never saw my family.”
This was not the first, nor the last, time I heard something like this. So many …
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The next time you see a medical student, give support
Where I practice, the process of referring a patient suffering a mental illness is quite infuriating. The wait to get in to see a psychiatrist or psychologist can be months all the while patients are suffering. Worse yet, with certain insurances, there are just no mental health providers available for any of their covered patients. The failure of treating mental health disease in the U.S. is glaring.
In the U.S., approximately …
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The U.S. is failing at mental health care
What is borderline personality disorder (BPD)? According to the National Institute of Mental Health, unstable moods; impulsive and reckless behavior, and unstable or volatile relationships may be indicative of BPD. People with BPD often have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides. They often make poor life choices and take unwise risks. Thus, adults with …
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Borderline personality disorder in medical practice
Well done! Strong work! You’ve done it!
Four years (often more) of perspiration have earned you two extra letters (often more) in your name. You should be proud. Nothing should get between you and a gigantic glass of bubbly today. The world feels different. You feel different. But are you?
The thing about ceremonies that feature costumes, protocols and rituals is that they confer upon participants a sense of change. Just look …
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What you need to hear at your medical school graduation
Cyberbullying is a major and growing public health problem associated with increased risk of greater psychiatric morbidity and mortality among children and adolescents. Its prevalence, varieties, associations with other forms of maltreatment, risk factors and deleterious effects in different populations are poorly understood.
Furthermore, effective, evidence-based approaches to screening and prevention in different populations are lacking. Developing such approaches is challenged by the rapidity and unpredictability with which electronic social media …
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Cyberbullying and mental illness in kids
Announce to friends that you have cancer, and they will probably react with sympathy and compassion. Tell them that you’ve broken your leg, and they’ll offer to get your groceries and drive you to medical appointments.
Share that you suffer from depression — and the sound of silence will fill your head.
Depression has been my companion for as long as I can remember. My maternal grandmother, who immigrated to this country …
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My depression won’t defeat me
Earlier this month, one of us visited a prominent U.S. medical school to give a lecture on the topic of burnout and how physicians can find more fulfillment in the practice of medicine. Sadly, that very day, a fourth-year medical student there took her own life.
The problem was not personal failure. She had recently matched into a competitive residency program at the one of the nation’s …
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Medicine leads the professions in suicide. What can we do about it?
There were about nine of us waiting to cross the street. Several were Asian; there were also a few black and brown men.
A van approached the curb to turn. It was one of those vans with a back door that slides along a track. That back door was wide open, even though the van was in motion. As it pulled closer, we saw that there were three young white men …
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The small steps to ensure everyone experiences dignity
Mental illness might be smarter than us. It seems to have figured out how to get around asking for our permission and instead to beg for forgiveness once damage to function and health already has been done.
That’s the only way to explain the following: it takes not five weeks or three months but 11 years for someone who exhibits signs of mental illness to first seek help for that disorder. That is, if they …
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No more excuses for mental health: Technology offers new hope for intervening early
Martha (not her real name) was not an overly complex case in my field of geriatric psychology. But the case was complex enough to require multiple approaches and reliable follow up. And in rural Mississippi, follow up can be elusive. Soon it occurred to me that Martha’s case is emblematic of how caring for this vulnerable population often runs up against a huge problem — the Medicare merry-go-round.
A 78-eight-year-old with …
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The Medicare merry-go-round in geriatric psychiatry
The hardest thing about medical school isn’t learning medicine. It isn’t the hours. It isn’t the tests. It’s that you sign away control over years of your adult life.
When I started my clerkship year in January, I felt like I was stepping onto a conveyor belt and would not be allowed off for twelve long months. For the entirety of 2018, my days are planned for me, my hours are …
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To change the culture, start with clinical education
We are in the midst of an epidemic of physician burnout, depression and suicide. Although the causes are debatable, there can be little doubt that increasing demands for financial performance and patient satisfaction, decreasing autonomy, and physicians’ individual liability for systemic risk management decisions in a majority of practice settings are significant contributors to these adverse outcomes.
At the same time physician burnout, depression, and suicide rates have been rising; tremendous …
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It’s time for hospitals to publicly disclose physician satisfaction, burnout, and suicide rates
It is no secret that President Trump’s former nominee to run the Veterans Administration, Navy Rear Admiral Ronny L. Jackson, has withdrawn his nomination amidst allegations related to his behavior: that he drank on the job, was a bully in the office and improperly gave out prescription medication. He has vehemently denied the allegations and characterized them as false and fabricated.
Dr. Jackson is an Iraq War veteran who …
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Dr. Ronny Jackson: A victim of political accusations, or physician burnout?
I believe there’s no such thing as work-life balance. I think this every morning when I leave for work, watching my two-year-old son press his face against the front window and wave at me as I back down the driveway. It comes up again at work, as I guiltily feel relieved when a patient cancels and I have an unexpected half hour to work on a behavioral science presentation for …
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There’s no such thing as work-life balance
Physician burnout is the depression of the medical world. We are aware of its presence and the detriment it can cause, but yet, we don’t really like to talk about it. The problem is, just like depression, if we don’t talk about it or seek to address it, it persists and leads to a number of unwanted outcomes including decreased productivity, decreased patient satisfaction, and increase in medical errors. And …
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Burnout: Don’t blame the clinicians; blame the system
The words were like bitter candies that I had been sucking on, hoping to come to a sweet center. I had walked the hallways of the hospital holding them in the silky pocket of my cheek for weeks. Finally, afraid I would choke, I spit them out into the middle of the dinner table.
“I think I’m depressed.”
I stared down at the tablecloth, moisture collecting on the base of my water …
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Fight depression during residency by fostering connections
