I thought about you, the patient that I’m about to perform surgery on, all night last night and because I doubted myself, I took clonazepam to calm the anxiety so I could sleep.  Today I’ve taken 10 mg of propranolol and some Kava, a natural supplement known to decrease anxiety. As I start the surgery, the propranolol coursing through my veins blocking the sympathetic nervous system, I fear it will come.  ...

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When I hung up my white coat for the last time and left the practice of medicine, the term, “physician burnout” was unfamiliar. It wasn’t until I stumbled across research studies many years later, in my work as a freelance writer, that I finally understood the underlying reasons that I needed to walk away. Today, you can’t read about health care without seeing the term. Does the widespread use of ...

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Imagine you are an ambitious new worker at a powerhouse institution. Your job performance is soaring, but you frankly work like a dog. Your weeks top out at 80 hours, you get maybe a single 24-hour block of time off every 7 days, you work weekends, and you often work up to 30 hours straight in one stint, sleep at work, and eat exclusively from food options in the building. You ...

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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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