Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.” They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.” So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going ...

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Inquisitive reader Amy asked me if I had any opinions about online screening for depression. The British Medical Journal recently published a debate on this issue. What an excellent question, Amy! I read the opposing arguments, and these are my thoughts: First, I see two different issues. The first is whether the 9-question Patient Health Questionnaire (PHQ-9) is an appropriate tool to use to screen for depression. The second is ...

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A female friend, who is not a physician, recently asked me, “Do you find that, in your position, men treat you differently? Meaning, do they show you the same kind of respect that they show their male colleagues?” The group of medical directors were seated around the table. The meeting was supposed to go on for six hours. While I was not the only female in the room, I was the ...

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My cohort graduated from our psychiatry residency almost ten years ago. The level of frustration and disappointment we’ve all experienced within the past two years is striking. Some have taken leadership roles, only to relinquish them because of fatigue from fruitless discussions with administrators. Others have tried to alert senior managers about dangerous and irresponsible clinical practices. Their efforts were unsuccessful because concerns about finances trumped concerns about clinical services. With ...

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I know of only two people who, upon starting medical school, knew that they wanted to become psychiatrists. (How did they know what they wanted to do eight years before they did it?) They both achieved their professional goals: One created a community clinic for people with severe psychiatric illnesses. The other became an addiction psychiatrist and now oversees an entire substance use disorder program for a health care organization. I ...

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Someone presented me with the opportunity to write a section on psychiatry for medical students. This is wonderful (an opportunity to influence future physicians!) and terrible (GAAAAH there’s so much in psychiatry!). Between thinking about psychiatry at multiple levels at work and thinking about the foundations of psychiatry while writing the section, I’ve felt cognitively impaired when thinking about what I should write here. But the thinking never stops … and ...

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During medical school, professors advised us to “have hobbies” and to “do stuff outside of medicine”:

  • “It’ll give you have something to talk about with patients.”
  • “It’ll help you maintain balance as you go through your training.”
  • “It’s important for self-care.”
Medical students, as a population, tend to be compulsive and there’s always more to read and learn. (Medicine, like many fields, entails lifelong learning, even when you are tired of ...

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The New York Times and NPR recently published articles related to the Goldwater Rule. In short, a magazine sent a survey to over 12,000 psychiatrists in the U.S. with the single question of whether they thought presidential nominee Mr. Barry Goldwater was fit to serve as president. Few psychiatrists responded. Of those that did, more than half -- still over 1,000 -- said that he was ...

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Somehow people knew he was about to enter the room. The thirty or so people in the room were seated, though people began to stand up. “Are we supposed to stand up for the surgeon general?” I asked the person sitting next to me. She shrugged. If we remained seated, everyone would have noticed. So we stood up. “I’ve been in this position for a year and a half,” Dr. Murthy ...

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A reader I respect asked me for my thoughts on trigger warnings. Per Wikipedia, trigger warnings are “warnings that the ensuing content contains strong writing or images which could unsettle those with mental health difficulties.” Let’s put aside the last part of that definition, “those with mental health difficulties”, as some articles suggest that trigger warnings are not limited to those with mental health difficulties. Part of ...

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