When I first saw Jea-Hyoun, in a medical meet-cute straight out of a romantic comedy, she was being evaluated for thyroid cancer. I was an allergy/immunology fellow harried by a pile of paperwork. She was a patient, in the same building where she saw patients of her own as a psychiatry and family practice resident, preparing to see the specialist. We made awkward small talk in the hallway before she ...

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James is a tall, lanky Caucasian man, well into his 40s. He has brown curly hair and is not a bad looking fellow except for the vacant look in his large brown eyes. He is a pacer, which is a manifestation of his illness, and a consumer of excessive amounts of water. You have to talk right at James to be understood. I try to make eye contact. Sometimes he doesn't ...

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Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it along psychological lines: emotional exhaustion, a feeling of depersonalization and cynicism, and a low sense of personal accomplishment. Accordingly, the phenomenon of physician burnout is often framed as a personal problem to be solved by means of self-care. While this approach is undoubtedly helpful, it doesn't sufficiently address the structural factors that contribute to burnout in the first ...

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Stress is one of the epidemics of modern-day living—especially work-related stress. At a basic fundamental level, it’s just simply a chemical reaction. Your adrenaline and cortisol levels shoot up in response to a stressful stimulus, the primitive “fight-or-flight” response kicks in, and your brain and emotions go into overdrive. The problem with this acute response, is that it tends to lead to illogical thinking and an inability to really find solutions. Research also confirms that having chronically elevated stress hormones is very detrimental for your long-term health and ...

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If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened, but I’m not qualified to treat a broken hip. If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start ...

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Mr. Fine is in for the eleventh time in less than a week. I work as a social worker in a hospital emergency psych unit. Mr. Fine is suicidal again. It is kind of late in the evening when I see him, although it is my first time, I am the only social worker on tonight. This is the usual situation, one social worker per shift. The psychiatrist takes me aside, quietly ...

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Eighteen months out of residency and into outpatient psychiatry private practice, for the first time since before medical school, I'm coming home actually feeling a surplus of energy to put into my life outside of clinical practice. Sure, I did my best to maintain my interests and relationships during my training, but doing so felt like trying to wring blood from a stone. A slight sense of boredom in the evening, ...

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An excerpt from Long Walk Out of the Woods: A Physician's Story of Addiction, Depression, Hope, and Recovery. As a young child’s heart rhythm faded to a stop, I walked off the hospital floor and got in my car with a plan to end my own life. ...

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Recently, a fellow physician mom ended her life. While outwardly, a very vibrant, lively, and happy woman, she fought her own internal demons for some time. From what we know, she struggled with depression but was still committed to being a good mom, physician, and wife. Sadly, a few days before her birthday, she could no longer bear her sadness and decided to end her agony. I know many physicians’ ...

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An excerpt from Fallible: A Memoir of a Young Physician's Struggle with Mental Illness. Jason had an entire group of voices in his head that he called “the committee.” They talked nearly constantly, sometimes in a flat roar but often escalating to shouting. He described it as ...

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In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% ...

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Burnout is a big and burgeoning problem in the United States. According to a recent Mayo Clinic report, it affects 28% of the general working population. Among physicians, however, the rate is markedly higher, ranging from 44% to 54% in most studies.

More concerning are the consequences: Doctors who report burnout symptoms are twice as likely to ...

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A person rolls into an outpatient clinic. A pleasant bleach smell emanates from freshly scrubbed chairs. Happy chatter about people's lives, and this week's health issues are dimmed by the local radio station playing in the background. The person who just rolled in for the first time has a confoundingly complicating diagnosis. It's not the first sized holes in their body under their urine-soaked shorts they initially refuse to take off. ...

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I had been diagnosed three days prior, given lithium to stabilize and a benzodiazepine to sleep. I went home. Things did not get better. I had been admitted just that morning after a long, confusing night in the ED. I did not yet understand the severity of what had happened -- or even what had happened. The mania was still mostly euphoric and speckled with bursts of joy, but between these ...

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Mary Beth is a female in her early 30s, quite obese and mildly mentally repaired, as well as suffering from schizophrenia. She lives in a housing authority apartment, which is not a great place. But being highly subsidized, it is cheap! Her apartment is in a perfectly dismal condition. She lives in absolute squalor with garbage strewn around, and I am unable to figure out what to do about it. ...

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It wasn't until I first had to manage the aftermath of a sexual assault on a psychiatric unit one night during my residency that I realized psychiatry might have a problem with sexual safety. My fellow residents and I had never been informed of a management policy for inpatient sexual assaults, and my program's curriculum was silent on how to handle the issue. Because the assault involved a psychotic patient who was ...

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I have had the opportunity to consult with several physicians who needed to abruptly and permanently give up the practice of their chosen career without their consent. Causes of this involuntary termination included illness, burnout, and loss of license. What became very clear to them and to me was that the standard strategies for managing a work transition (e.g., defining transferable skills, exploring a range of job/work opportunities, learning new ...

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I bid farewell to four people this month who I've been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind. It is the nature of our healing practice to build trust ...

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The night I almost swallowed a bottle of Percocet post-call in residency is still clear in my mind, as is the hours leading up to it; the thoughts going through my head, the swirl of emotions seemingly pulling me like an ocean undertow.  I can only attribute my pause to a power greater than myself. The truth is when I look back on that night, I can see that those ...

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I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone. Why listen to an actress about medical treatment for addiction? First of all, doctors generally ...

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