The afternoon began like any other day in medical school.  Students arrived at the lecture hall and took their seats.  An individual with long blue-and-white hair and handlebar mustache entered the room wearing oversized fish-print pants, a loose-fitting clown shirt, and a single earing fashioned out of a bent fork.  He casually strolled up to the front, introduced himself as Dr. Patch Adams, and told us that the ...

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Studies have varied in their estimates of depression in medical school students, but they all show a similarly startling trend. Medical students have a higher depression rate than their non-medical counterparts. This culminates later in life with physicians with higher than average alcohol abuse problems and higher than average suicide rates, with male MDs 1.5 times as likely, and female MDs twice as likely to commit suicide than their
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The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.” The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: ...

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My patient sat in front of me, silent.  She was a beautiful, elderly woman, always well dressed in bright, matching outfits, and not a single hair out of place.  Her lipstick was perfectly applied.  She normally had a quick wit, joking about how she might drop a few knickknacks from my office into her handbag on her way out. Not today.  Today her tears flowed.  Today was the day she grieved ...

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While slogging through a crappy first draft of a document about the value of psychiatrists in mental health and substance use disorder services, I did a literature search for supporting evidence. I found nothing. (1) “So how exactly are we helpful?” I mused out loud. Maybe we aren’t: There are groups out there who do not believe that psychiatrists can or do help anyone. I am an N of 1. ...

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As a fourth-year medical student in a sub-internship in internal medicine, I have something that no doctor in America has. I have as much time as I want to spend with my patients. Don’t get me wrong, I am still a student. I’m still paying hospitals to let me be there, and I only have a maximum of four patients per day, but I inevitably end up spending more time ...

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“How far did you go in school?” This is a question that I ask every new patient as a matter of course. Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients. Now, leaving the ...

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The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save ...

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The one question every medical school admissions committee will ultimately ask: “Why do you want to be a doctor?” As if the many overqualified and seemingly undervalued applicants rejected each year do not have a sufficient answer. My answer was stereotypical, but I meant it. “I want to help people.” Four years later, I am a University of California, San Diego emergency medicine resident. And I am also fortunate to be a ...

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I’ve been intrigued by the recent presidential debates and interviews and analyses and pundit commentary. One of the issues that has come up has been how the candidates handle adversity, even at this very early time in the 2016 race. They say that Donald Trump is in it for the thrill and the fun and sheer ego-boosting ride that is pre-caucus and pre-primary politics, when the love of the American people can ...

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