Psychiatry

How physician therapy sparked a medical career transition

Physician

May 17, 2026

I come from a generation that does not believe in therapy. Not because we do not believe it is effective, but because we believe we can handle things on our own. If things are hard, we push through. If we need help, we figure it out independently. By the time I became a physician, self-reliance was not just a value, it was my tried-and-true survival strategy. I remember years ago, …

Emotional over-functioning drives the competence trap

J.H. Lynn

Conditions

May 15, 2026

There is a danger in being good at holding everything together. People start to believe you do not need holding. Competence becomes camouflage. Reliability becomes a cage. And one day you wake up realizing you have become the infrastructure of a life that no one is helping you carry. For those who thought they could carry everything alone, I have realized there comes a time when a “foreclosure notice” may …

Physician retirement is a myth for the ripening doctor

Farid Sabet-Sharghi, MD

Physician

May 15, 2026

“Are you retired yet?”

The question caught me off guard. It was not the query itself, I have reached my mid-60s, after all, but the underlying assumption it carried. Having practiced for over three decades, I found myself momentarily silenced by a word that feels entirely foreign to my current internal state.

As a psychiatrist, I have spent a lifetime listening to the narratives of others. Now, I find my own narrative …

When GLP-1 doesn’t work, look at chronic stress

Carrie Friedman, NP

Conditions

May 15, 2026

A 59-year-old woman sat tearfully in my office today. She had spent seven weeks on tirzepatide with virtually no weight loss. “How is this possible?” she asked. “I’m eating like a saint.”

She had struggled with obesity and weight-related frustration for years. Recently divorced, grieving a death in the family, caring for a mentally ill adult daughter, working full time, sleeping poorly, and living with severe anxiety, she described her stress …

Moral injury in medicine goes beyond simple burnout

Gus W. Krucke, MD

Physician

May 14, 2026

Most young physicians enter medicine with a sincere desire to help people. They expect long hours, difficult training, and personal sacrifice. What many do not expect is how profoundly the environment around them will shape not only how they practice medicine, but who they become.

Medicine teaches many things that never appear on a syllabus. A resident quickly learns which patient encounters generate complaints, portal messages, administrative scrutiny, or poor satisfaction …

Why psychiatric medications often fail autistic patients

Carrie Friedman, NP

Conditions

May 13, 2026

In clinical practice, it is not uncommon for autistic patients to arrive after years of treatment with a firm conclusion: Psychiatric medications do not work for them. This belief is typically built on multiple medication trials, inconsistent benefit, and often significant side effects. But the conclusion itself may be misleading. What is often being observed is not true treatment resistance, but a mismatch between standard psychopharmacology and the neurobiology of …

Doctors with mental illness need our care, not silence

Michael F. Myers, MD

Physician

May 12, 2026

An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).

What follows is a slightly edited narrative, the story of Kieran Allen, MD. Dr. Allen is from Australia, a psychiatry resident (registrar) at the time of writing. Dr. Allen writes from a different perspective, that of someone with a relapsing and remitting mental illness. He focuses on this for the …

AI therapy chatbots are crossing into impersonation

Muhamad Aly Rifai, MD

Tech

May 11, 2026

For a moment, I wondered whether I had a crystal ball.

I had written several times on KevinMD about artificial intelligence in medicine. I had written for Forbes Business Council about AI as a developing cognitive tool, synthetic reality, executive distortion, and the danger of treating fluent output as reliable judgment. I kept returning to one warning. AI was one step away from a serious blunder, and that blunder …

Harm reduction effectively treats substance use disorder

Amanda Perez, MD, Mary Finedore, and Alyssa Lambrecht, DO

Conditions

May 11, 2026

My pager beeps as I walk through the hospital doors. It is a familiar message, “Your patient wants to leave.” We admitted John four days ago for opioid withdrawal and he is not yet ready to stop using opioids. When I walk in the room, I see him packing his bags. “So, John,” I say. “When you leave, your body cannot tolerate the same amount of opioids because you have …

Why bipolar II is not just a milder version of bipolar I

Ethan Evans, MD

Conditions

May 10, 2026

When I graduated from medical school, I carried an assumption I suspect many of us do: Bipolar II disorder is a “milder” version of bipolar I. After all, mania is dramatic. It is disruptive. It can involve psychosis, hospitalization, legal consequences, and financial devastation. Hypomania, by comparison, seems restrained: more energy, less sleep, no involuntary admission. The hierarchy seemed obvious. Mania is more severe than hypomania. Therefore bipolar I must …

Women physicians’ health is paying the price of medicine

Jessie Mahoney, MD

Physician

May 9, 2026

I knew from the beginning that something was wrong in the culture of medicine, but I never believed it would almost kill me. This is not a story about my health. It’s a story about why my health story is not unusual. I hope it becomes a call to action.

I grew up in Berkeley, where speaking up is a developmental milestone. Early in my medical training, I started asking questions. …

Clinician burnout demands better health care governance

Tiffiny Black, DM, MPA, MBA

Conditions

May 9, 2026

Clinician burnout is frequently discussed as a workforce challenge, a morale issue, or a retention concern. It is all of those. It is also something more. Burnout can function as a governance signal. Health care systems operate under sustained complexity: regulatory demands, reimbursement pressures, digital transitions, workforce instability, and constant performance scrutiny. In such environments, strain is not incidental. It is structural.

The governance question is not whether strain exists. It …

How corporate medicine is eroding truth and patient dignity

Ronald L. Lindsay, MD

Physician

May 9, 2026

The first time I received care as a patient in academic medicine, I felt something I did not fully appreciate until years later: safety. Not just clinical safety, but moral safety, the sense that the people caring for me were operating inside a culture that valued truth, transparency, and professional integrity. When I practiced and taught in academic medicine, I was surrounded by colleagues who believed, almost instinctively, that honesty …

Patient autonomy in psychiatry and the ethics of care

Wonyun Lee, MD

Physician

May 6, 2026

One of my patients, K, arrived in the United States in florid psychosis. Back in China, she worked as a housekeeper and lived independently. She took her medications reluctantly but consistently, forced upon her by her parents. After her parents passed away, she stopped her medications. She became convinced her life was being controlled by the Chinese government. In terror, she booked a ticket to the land of freedom, America. …

What hidden constraints shape clinical decisions?

Timothy Lesaca, MD

Physician

May 6, 2026

What if the biggest problem in medicine isn’t bad decisions but rather the decisions we cannot even consider?

Clinical decisions unfold through processes shaped by the environment, which determine what clinicians can notice, consider, and act on. What seems like individual reasoning is structured in advance by systemic and environmental forces.

Within this context, this paper introduces a concept that I call “invisible triage,” a preconscious process that restricts which options are …

Why physician well-being matters at every career stage

Farid Sabet-Sharghi, MD

Physician

May 6, 2026

The life of a physician is often viewed as a linear climb, a constant upward trajectory of achievement, responsibility, and endurance. But after decades in the field, I have come to realize that medicine is not a straight line. It is a series of seasons. If we fail to recognize the changing weather of our own lives, we risk arriving at the final season with broken bodies and weary minds. …

The real work starts after a mental health crisis

Kenneth Scott Burnham, DO

Physician

May 3, 2026

I have intubated people who took every pill they could find. I have told families, in bare conference rooms, that the person they brought in barely made it. I have done this across 23 years in emergency medicine, thousands of cases, in every configuration of crisis the human mind can produce, and I believed, the way physicians are trained to believe, that stabilizing the crisis was the job. That what …

How childhood scarcity fuels imposter syndrome in medicine

Archana Agarwal, MD

Physician

May 3, 2026

When I was growing up in Darjeeling, a single pair of school shoes had to last the entire year. They came from Bata, simple, sturdy, and meant to endure more than they reasonably could. My sister, just a year younger than me, had the exact same pair. Side by side, our shoes began their journey identical, but they did not age the same way. She was careful, measured, and gentle …

Integrity in medicine is quietly under strain

Patrick Hudson, MD

Physician

April 29, 2026

There is a sentence physicians have said for generations: “We’ll take good care of you.” It is a good sentence. Patients need to hear it, and most of the time it is said with sincerity. Yet there are moments, more now than before, when that sentence carries a second awareness alongside it. The emergency department is boarding. There may not be an inpatient bed for hours, sometimes longer. Tests, consults, …

6 signs of burnout in high-achieving students

Ritu Goel, MD

Conditions

April 29, 2026

The student sitting across from me didn’t think she was burned out. She had just made the dean’s list, locked in a competitive summer internship, and was running two clubs. She was sleeping four hours a night, had stopped texting friends back, and described feeling “nothing” when she opened her acceptance letter to a graduate program she had spent two years working toward. “This is just what college is supposed …

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