My first memory of encountering a person who appeared to have no place to live was during my first year of college at UCLA. A man was sitting outside a mini-mart, his legs crossed and his hair long. He looked tired, and his clothes had stains on them. Feeling pity for him, I went into the mini-mart and purchased a turkey sandwich on wheat. “Here,” I said as I handed him ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

You could feel the air rushing out of her lungs and into your face if she was screaming at you. “STOP CALLING ME A WHORE! I AM NOT A WHORE, YOU DIRTY N-GGER!” No one, in fact, was calling her a whore. “DON’T LIE TO ME, MOTHERF-CKER! I HEAR ALL OF YOU CALLING ME A WHORE! I HEARD IT, JUST NOW!” Her best defense was a loud offense that included liberal use of racial ...

Read more...

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. ...

Read more...

I recently completed the buprenorphine waiver training. Buprenorphine, itself a partial opiate, is a medication that can be prescribed to patients who have opiate use disorders (e.g., taking Oxycontins or injecting heroin to get high). A physician must complete an eight-hour training and take an exam to become eligible to prescribe this medication. The physician must then apply for a specific “X license” through the DEA to prescribe it. In some ...

Read more...

I’ve been invited to speak to a group of attorneys who work at the interface of psychiatry and the law. The topic of my talk? “Psychiatry 101.” A psychiatrist who gave this talk to a similar group a few years ago advised me: “You should assume that lawyers are laymen. It’s surprising how little they know, given the work that they do.” This teaching opportunity to teach has given me pause: What is mental ...

Read more...

My husband was in the aisle seat, I was in the middle seat, and The Man was in the window seat. The Man had one white earbud in his ear; the other one was dangling in his lap. His right thumb swiped through several screens of his smartphone in less than a second. He heaved a sigh. “This is f*cking lame,” he muttered. The plane was supposed to take off 15 minutes ago. ...

Read more...

When he and I first met, he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!” I did. The next week, he answered my questions about the pencil drawings on his walls. “My name ...

Read more...

Atul Gawande posted a series of tweets, based on findings in the Senate CIA torture report, about the significant role physicians and psychologists played in torture. He comments, “But the worst for me is to see the details of how doctors, psychologists, and others sworn to aid human beings made the torture possible.” Agreed. Upon reading how these professionals used their knowledge to torture their fellow human beings I felt disappointed, ...

Read more...

Please don’t call call me a “prescriber.” Yes, I know it’s easier to say “prescriber” than “psychiatric nurse practitioner or psychiatrist.” The word “prescriber,” however, puts severe limits on what I can do and how I can help. You may believe that, because I have a license to prescribe medications, that’s all I choose to do. In fact, you may believe that’s all I know how to do. Psychiatrists can do a lot more than that. As ...

Read more...

Four adages I learned in medical training that I still speak of today: “Common things are common.” (The alternate version of this that might have more appeal to zoologists: “When you hear hoofbeats, think horses, not zebras.”) This cautions physicians to remember that it is more likely that the patient has a common condition than a rare one. Although it is prudent to consider all the possible diagnoses that might match a given ...

Read more...

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories