Health care often talks about burnout as if it were a recent discovery. But for many clinicians, the exhaustion they feel did not begin with them. It was inherited, passed down through a system that normalizes overwork, silence, and sacrifice as the price of practicing medicine.
Every generation of providers has heard the same message: This is just how it is. Long shifts, missed meals, unsafe staffing ratios, and silence in …
Kratom (Mitragyna speciosa) has become a topic of significant debate among clinicians, policymakers, and the public due to differing views on its safety, pharmacology, and regulatory requirements. A recent article raises important concerns about kratom’s pharmacological actions, potential for addiction, psychiatric risks, and regulatory challenges. Although the goal of protecting public health is admirable, it is crucial that discussions around kratom are rooted in current scientific evidence and avoid …
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Physician Jessie Mahoney discusses her article “Imposter syndrome is not a personal failing.” Jessie explains how self-doubt among physicians is less about individual weakness and more about a conditioned mindset reinforced by …
When you step into medical training, you’re often told, both implicitly and sometimes even explicitly, that certain parts of you don’t belong. Sensitivity, doubt, or even just being messy and human can feel like liabilities in a culture that prizes efficiency, certainty, control, and always “having the answer.” Many physicians I work with in therapy describe learning early on to “toughen up,” to silence the softer, more questioning sides of …
In medicine, we’re trained to stay. To endure. To prove our worth by how much we can carry and how long we can carry it. Our roles become our identities. Our achievements and labels become scaffolds of self-worth. In medicine, stepping down is often labeled as a sign of weakness. So we hold on to roles even when they no longer fuel us. We are usually still doing the job …
When I received an invitation to a webinar titled “Special Session on a New Autism Risk Test,” I expected a discussion on screening strategies or intervention innovations. Instead, when I researched the company and reviewed its website, I discovered a pitch for a punch-biopsy-based lab test marketed as a way to detect autism risk in newborns as early as two days after birth.
As a nurse practitioner who treats autistic patients, …
When we think about palliative care, our first instinct is to picture pain medications, symptom checklists, and clinical protocols. But for patients with terminal brain cancer, the reality is much more complex. As speech declines, as motor function deteriorates, and as identity itself feels threatened, the greatest need is not always more medicine; it is meaning, connection, and dignity.
In recent years, I have had the opportunity to study an ancient …
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Psychiatrist Muhamad Aly Rifai discusses his article “A psychiatrist’s 20-year journey with ketamine.” Aly recounts his first encounters with ketamine at the National Institute of Mental Health, where its rapid impact on …
Psychiatry, perhaps more than any other medical specialty, is a field defined by ambiguity. Unlike other branches of medicine, where diagnostic tests and standardized protocols guide treatment, psychiatry often operates in a landscape where clear-cut answers are rare. The psychiatrist’s primary tools are not scalpels or stethoscopes, but words, presence, and (most crucially) the self.
Psychological transference and countertransference: double-edged swords
Psychological transference and countertransference are central to the practice of psychiatry, …
Here is what I have seen across two decades of admitting and managing patients on inpatient psychiatric units. People do not ask for a locked door when life is comfortable. They come to us when the ground drops out. Families arrive with the weight of sleepless nights in their faces. Emergency clinicians pass me the chart, then the baton, and sometimes the quiet plea that says please help this person …
You are entering orders, rounding, or thinking through a patient problem in the hospital when a team member interrupts. Then comes another interruption. And another. You lose your train of thought, and you feel your jaw clench. Does this sound familiar? Physicians are expected to be efficient, accurate, and approachable, yet these three goals are nearly unattainable due to constant interruptions. Studies show that physicians are interrupted, during critical tasks, …
An excerpt from Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock.
Dr. Raul Morales sat alone in Exam Room 3, now used for storage, staring out at the fading autumn light through a slit in the blinds. The clinic was quiet, eerily so. His last patient had left an hour ago. He was supposed to be packing up his …
Sarah, an emergency room nurse with eight years of experience, did not leave because she stopped caring. She left because the numbers no longer worked. Student loans outpaced her wages, overtime became mandatory without premium pay, and patient loads rose to unsafe levels. Eventually, the arithmetic of her life and work collapsed.
Sarah’s story is not unusual. Across the country, clinicians are leaving medicine in numbers that no longer feel like …
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In 2024, centralized cryptocurrency exchanges recorded approximately USD 18.4 trillion in trading volume, with Binance alone accounting for forty percent (~USD 7.7 trillion). While the total number of cryptocurrency holders exceeded 600 million globally, active traders (those engaging in high-frequency or large-scale trading) appear limited to thirty to sixty million monthly users. Epidemiological data indicate these traders skew male (≈sixty-one percent), primarily aged 25 to 34 (thirty-four percent of owners), …
As a founder in digital mental health, I’ve watched our industry celebrate reaching $8.34 billion in valuation while systematically failing 40 percent of the population. This isn’t just a moral failure, it’s a $20 billion market opportunity that’s being ignored because of cultural blindness. For physicians trying to refer diverse patients to digital mental health resources, the options are frustratingly inadequate. With the total U.S. behavioral health market valued …
As a physician provider in my State Physicians Health Program, I have watched brilliant colleagues flicker out. Not because they lacked skill or grit, but because the system treated their humanity like an optional feature. We train physicians to master physiology, not how to metabolize grief. We celebrate heroics, not healing. Then September arrives, Suicide Prevention Month, and we draft statements. The statements are sincere. They are not sufficient. It …
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Pediatrician and certified coach Jessie Mahoney discusses her article “Why so many physicians struggle to feel proud—even when they should.” Jessie explains how medical training conditions doctors to downplay success, deflect compliments, …
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Why kratom addiction is the next public health crisis.” Muhamad explains how kratom, a botanical imported from Southeast Asia, has …
The urgency epidemic
I was in my office at 8 p.m. about a year ago. My back was hunched, phone in one hand and papers in the other, with twenty open tabs glaring at me from two adjacent monitors. I heard a nearby door shut and wondered, “Why is my colleague leaving so late?” Then it hit me: Have I thought of leaving yet?
If you asked me what I was doing …
The brain is a pattern-seeking organ that continually organizes the world into a more predictable experience. Our first predictions arise out of early childhood and are predicated on messaging from primary caregivers. These are deeply buried in implicit memory meaning that much of what we anticipate from interactions lies outside of our awareness. Over the course of a lifetime, these guiding assumptions working in the background are continuously modified in …
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