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.
Two recent posts highlight the problems facing many medical students today.
The first was by an anonymous rising fourth-year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.”
The second was by another anonymous student who described how miserable he (or she) has been …
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If you go to medical school, you will be stressed: bigly
My physician advocacy began in February of 2017. I was reading a Medscape article about a doctor who was discussing the issue of physician suicide. She had her own website and newsletter.
After discovering the staggeringly high number of physician suicides, of which I was unaware, I signed up for the newsletter because I wanted to learn more. One day I received her newsletter; within it was a story about an emergency medicine (EM) physician …
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What this doctor decided to do about physician suicide
If a physician has a substance use or mental health problem, it is in everyone’s interest — the physicians themselves, their patients and their families — for them to get treatment. And if they go for treatment, they deserve to be treated fairly, but given my six years of experience as an associate director in one state physician health program (PHP) and in working with physicians from all across the …
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Using marijuana 2 times a month cost this doctor his license
As physicians, we are experts at prescribing medications. However, we often fail miserably when it comes to recognizing adverse reactions and tapering medications. It’s something that is simply lacking in our medical training. I have become a victim of this with benzodiazepines, as I detailed in a prior blog post. Benzodiazepines, in particular, are very difficult drugs to taper. I would like to share with you …
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10 tips to help patients through benzodiazepine withdrawal
She is 61, and she can’t help but smack her lips together repetitively. She has no teeth, and the curvature of her spine makes her a miniature version of what she once was. Her frizzy hair is a purple-gray tone, and there are dark particles of something in the knots alongside her left temple. Her clothes are too loose, and there are food stains on her shirt. The ambulance arrived …
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How this emergency physician’s shift really went
You don’t have to like everyone under your care. And you probably won’t, which is OK.
Own how you feel. If you insist on telling yourself that you should like someone when, in fact, you don’t, it will come out in other ways: The tone of your voice, the expressions on your face, the way you position your body.
There might completely understandable reasons why you don’t like the person under your …
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You don’t have to like everyone under your care
I recently attended a conference in San Francisco, California, where the increasing amount of physician suicide was discussed in concert with the ramifications of a psychiatric diagnosis for physicians. An attendee addressed the audience after the presentation. She disclosed that she was a resident physician and that she had been previously hospitalized for five days with symptoms of severe anxiety, depression, and suicidality. As tears welled in her eyes, she …
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A stigma no physician can afford
Eight-year-old Tommy has trouble paying attention in school, is always restless in class, unable to complete his tasks, hyperactive both in school and home and his teacher discusses the possibility of him having ADHD with his parents. They decide to take him to see a pediatric psychiatrist. After some analysis, he’s diagnosed with ADHD, prescribed with Ritalin and is on his way home with his medicine. Classic childhood ADHD story, …
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Don’t ignore ADHD in adults
Many things in life can only be truly appreciated once reflected upon — like the onset of dementia, depression, and cancer, just to name a few. This got me thinking about the onset of burnout and how the true presentation in life is quite different than reading about it.
The term “burnout” is often thrown around loosely but is an actual syndrome comprised of the progression of “exhaustion, cynicism and reduced …
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Is your spouse experiencing physician burnout?
“You need to get here now!” The nurse whispers anxiously. It’s after midnight. One of our hospice patients has just died at home, and her husband is threatening to shoot himself when the funeral home shows up.
“Has the funeral home been called?” I ask.
“No.”
“Does he have a gun or weapon?”
“We’re out in the country. There are deer heads on the wall.”
I try not to stereotype, but deer heads are a …
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This social worker has no fear
As part of the interview for my book, I asked about the role that mental health plays in healthcare. Responses were unequivocal: It plays a vital role. All of these doctors have patients who are depressed, anxious, traumatized, or otherwise in need of mental health services. My doctor interviewees frequently added comments about lack of access to mental health services and insurance interference.
Refusal to pay is a big problem, according …
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A consistent and clear picture of significant barriers to mental health care
It is a miracle that more doctors have not succumbed to substance use disorder at some point in their training or career. It is a fact that many have. The number of doctors and other healthcare providers who have struggled with substance-related issues is probably far greater than we can imagine. This is because of a culture of secrecy and implied threats. Doctors who need help think there is nowhere …
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We cannot afford to lose more doctors to drug addiction
Recently, a form showed up on my desk to sign, approval for something or other. Not uncommon, given my role at the time as a chief psychiatrist, I signed dozens of such letters, memos, or forms, drafted by an administrative assistant. I signed so many; I never looked at the last line — at how my name had been typed out. Just once my eyes wandered to the end and …
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How psychiatrists became lesser physicians
Despite loving my patients, I burned out. I chose my own quality of life over continuing to work with the chronically mentally ill population that I adored. This patient population is frequently shortchanged with their quality of care, and I have joined the ranks of people failing them.
This is my experience working in one mental health clinic in the United States. Every clinic runs differently, and there are fantastic systems …
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Patients lose when physicians burn out
Lately, I have been seeing a lot of writing from Pamela Wible, MD. And today, I re-read her article about doctor suicides. As I read and reflected on how medicine has changed during my lifetime, I am struck by the degree to which the humanity scrubbed out of the system. I think about the times when I thought, “You know, it is not worth …
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A physician thinks about his future
There is growing recognition that the broken American health care system is taking a toll, not just on patients and their families, but on health care professionals as well. Nearly half of all physicians in various surveys now report that they are burned out. Inevitably, the experts are lining up to further study the issue and to teach doctors better coping skills.
In terms of the need for further study, I am but a simple country doctor, but I think the …
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Therapy and self-help strategies aren’t the answer to solving physician burnout
During his 2004 stand up “Never Scared,” Chris Rock said, “I love rap music, but I am tired of defending it.” That statement, for me, holds true more today than ever before. Mumbling about nonsense is already hard to defend and only gets worse when the first line to every song these days has a reference to drugs.
Drugs, sex, and money have always been an important part of music, and …
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Rappers: Stop glamorizing prescription drug use
I recently had the opportunity to be the informal medical navigator for a friend with an acute psychiatric crisis. This previously “normal” friend lives alone, is a high-functioning professional and was unable to sleep, to eat, to finish a coherent thought or to carry on his business for several weeks.
I was called to help after an embarrassing public meltdown. The first problem was finding a doctor who would deal with …
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Why do we treat psychiatric illness different from other illness?
As a psychiatrist, I’ve spent almost two decades caring for patients who have survived sexual trauma, be it childhood sexual abuse, rape or repeated and threatening forms of sexual harassment.
I’ve witnessed how when the assailant was known to the victim, especially someone from whom they expected comradery or even just professionalism, it can be devastating. The fact that the assailant came from within a trusted circle often delivers the toughest …
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What #MeToo must learn from the science of sexual harassment
Across the United States at least forty people die each day from overdosing on opioids like Vicodin, codeine, heroin, and oxycontin. Seven percent of drivers who died in car crashes last year were found to have prescription opioids in their systems — seven times more than in 1995.
Considering these alarming rates of overdosing and DUIs, this is serious business. Authorities view it in their traditional way: the problem is drugs. …
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There’s no easy way out of the opioid epidemic
