She is tall, thin and wears torn jeans like a mannequin. A silky top flows around her, masking the thin torso, the exposed ribs. Her hair is long, fine and the ends are perfect. Her face is smooth, drawn, a bit careworn, but that is why she is here. She carries herself with an aristocratic bearing that is not learned but genetically endowed over generations. She is rich, entitled and ...

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I’m a psychiatrist. I’ve been practicing for 30 plus years. I’ve worked in inpatient and outpatient settings seeing the typical mix of general psychiatric patients.  About five years ago, I was asked to take the training for a buprenorphine license to serve as a backup for our addiction psychiatrist in her suboxone clinic.  I did the training, doubting that I would every really use it on a consistent basis. But ...

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I answer every phone call from every patient myself. I have no staff to respond to issues that come up during the day. There are no colleagues that take my calls after hours. This was my choice in response to what everyone knows: Health care is broken.  I needed a radical change from the bureaucratic system that I experienced daily as a physician however I had no idea how to ...

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There are a lot of misconceptions about psychiatrists and the way we practice, mainly because our sphere of medicine is so vastly different from that of any other medical specialty (and yes, I have an MD!) Here are a few thoughts I hope will help you understand us and our field a little better. 1. Yes, we all have clocks in our offices. We watch the time to pace ourselves, not ...

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A provocative new study from Denmark supports a link between hormonal contraceptive methods (like birth control pills) and depression. The association seems to be strongest for adolescent girls. Huge studies like this are based on huge datasets. In this case, the study relies on the Danish medical system’s longstanding penchant for meticulous and integrated medical records. You couldn’t do this kind of research in the USA, where medical records ...

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As a forensic psychiatrist, I have testified in courtrooms, at depositions, legal hearings, and inquests. I’ve been cross-examined by attorneys whose agenda was to discredit my testimony or demean psychiatry as a medical specialty. Two criticisms frequently leveled at psychiatry are: 1) Psychiatry has not changed significantly for the last sixty years and, 2) Psychiatry is the least scientific of all medical specialties. These beliefs are not true. Over the last few ...

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I went into medicine because I wanted to learn about the craft, become proficient at healing disease and easing suffering, and because I genuinely liked getting to know more about my patients and hearing their stories. These reasons for going into medicine as a career and staying in medicine as a vocation have not changed significantly through the last three decades. The problem we are faced with pretty often nowadays is ...

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Waiting to get help to improve your life and relationship is like waiting for the cancer to spread. You feel a lump on your body. Do you wait a few months to see if it gets bigger? Do you make an appointment right away? Do you avoid making an appointment altogether and hope it just goes away on its own? Many times, we wait until after the divorce, after the accident, ...

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As doctors, we love to think we are intelligent, rational, thoughtful and caring human beings, and we take pride in our profession and the privilege and status it accords. We like to hold our heads high, puff out our chests, speak with authority and convey our hard-earned knowledge acquired over many years of undergraduate and post-graduate study. We like to think we know; we have answers; we can cope; we ...

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I probably set a record for the earliest a physician ever burned out: less than a year after earning my MD. Some may not call it burnout; it could just as well be called “internship." I call it burnout because beyond the exhaustion and can’t-take-it-anymore, there was a gnawing sense that something fundamental was missing -- something that no amount of time would fix. Over the next year or so, the ...

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