Physicians writing on KevinMD about burnout, moral injury, depression, and suicide in medicine: what causes burnout and whether the word fits, resilience training and why physicians distrust it, who leaves and why, the fear of seeking help and the licensing questions behind it, what physicians say actually helps, and, on the patient side, psychiatry, access to care, and the arguments over diagnosis and treatment. Three maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Physician suicide: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.
I currently split my time between two worlds. I see patients in clinic and also work on AI and innovation in the health system. Most days, the dichotomy is an asset. Some days, it feels like it is two different jobs that share one calendar.
AI has closed much of the knowledge gap in medicine and did it faster than expected. The chart review, the differential diagnoses, the literature search, it …
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AI and clinical judgment: why patients still trust doctors
For those of us who have spent decades practicing medicine across multiple systems, the daily reality feels less like the noble healing art we trained for and more like a corporate assembly line. We watch as science-based, patient-centered care is nickel-and-dimed by administrators into mere metrics. In our exhaustion, we can easily identify with Odysseus. Like the legendary king wandering the dark seas, we feel a profound sense of alienation, …
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Moral injury in medicine is an odyssey without Ithaca
I very recently started work at a new hospital as part of a yearly rotation while in training. This hospital has a fire board with the names of staff, followed by two small circles containing the words IN and OUT, and a tiny black magnet that closely resembles a knight from a portable chessboard. The idea, at least at first glance, seems deceptively simple.
Two days into my new job, a …
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Human factors in health care start with better design
We spend our days in the quiet reality of clinical practice. We chase elusive diagnoses, weigh the fine distinctions of symptom presentation, and measure our clinical instincts against rigorous decades of peer-reviewed science. We sit across from human beings in moments of vulnerability, applying a lifetime of anatomy, neurobiology, and pharmacology to parse real suffering from pathology.
Yet, step outside the exam room door, and we are met with a deafening …
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3 reforms to counter wellness influencers in practice
Every caregiver of someone with schizophrenia or bipolar disorder knows this moment: Someone you love is in crisis, and at some point (because it’s 2 a.m., because the on-call line is busy, because you don’t know what else to do) you open a browser or a chat window and type the question directly. What crisis resources are there for psychosis? What crisis resources are there for mania?
Those two questions aren’t …
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Why AI crisis advice may fail families facing psychosis
A recent public discussion following a tragic event has reduced a complex clinical reality to a simplistic narrative: Telehealth, psychiatrists, or psychiatric medications must be to blame.
That conclusion may feel satisfying in the aftermath of an incomprehensible loss. But it is not how medicine, causation, or accountability should be understood.
A postpartum patient who is unable to get out of bed may appropriately receive care by telehealth. Virtual visits can be …
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Telehealth and postpartum psychosis defy simple blame
Gambling as a recreational activity continues to expand, driven by the constant availability of online platforms. Sports betting, casino-style games, and real-time micro-betting are now accessible on smartphones at any hour, turning what was once occasional into a continuous presence shaped by artificial intelligence, big data, and app designs that permit bets before, during, and after events.
Gambling disorder is recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth …
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Underage online gambling needs more than a checkbox
Physicians reassure people every day:
- “Your tests are normal.”
- “There is nothing dangerous going on.”
- “This is good news.”
- “You are going to be OK.”
We usually say these things with good intentions. We want to reduce fear, provide perspective, and help patients leave our offices or emergency departments feeling safer than when they arrived. But sometimes reassurance does not reassure.
The patient continues asking questions. They return to the emergency department. …
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How to reassure patients: 5 steps beyond normal tests
Cannabis use disorder (CUD) and cannabis withdrawal syndrome (CWS) have been recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for more than a decade. Researchers have documented symptoms of anxiety, irritability, insomnia, depression, decreased appetite, intense cravings, physical symptoms, and more. Despite years of published evidence, cannabis use disorder remains one of the most underrecognized and under-resourced substance use disorders in health care. The latest findings from …
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Why cannabis use disorder and withdrawal go unnoticed
How do I know if I’m burned out or just unhappy at work? On the surface, this is a straightforward question. Job burnout is one thing; professional dissatisfaction is another. We have validated survey questions for each, like the Maslach Burnout Inventory and the Physician Worklife Survey, and measures that can differentiate burnout from dissatisfaction, like the Professional Fulfillment Index. But I’ve found that when physicians are no longer thriving …
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Burnout or job dissatisfaction: 4 causes usually in play
In the digital age, we have been conditioned to trust the social proof of a high star rating. We see five stars on a retail site and immediately assume the product is excellent. But as a psychiatrist, I have learned that when it comes to medicine, that logic is fundamentally flawed. In fact, if you encounter a physician with 375 five-star reviews and not a single negative comment on social …
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Patient satisfaction scores punish the doctors who say no
During deliberations in the recent murder trial of Lindsay Clancy, jurors made an unusual request. They asked to see the bags of prescription medication bottles that had been introduced into evidence.
Clancy’s defense had argued that she was suffering from postpartum psychosis when she killed her three young children in 2023, and that her condition had been compounded by overmedication and inadequate psychiatric care. Prosecutors disputed that account. After weeks of …
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12 psychiatrists missed my medication-induced psychosis
I have intubated people who intentionally overdosed on many things they could find. I have sat with families in the minutes after we lost someone who didn’t have to be lost. I have written discharge summaries for patients I worried about the moment they walked out the door.
For twenty-three years, I was the doctor on the other side of the crisis. Then I wasn’t.
It didn’t arrive the way emergencies do: …
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Physician mental health and the shame of asking for help
The effectiveness of a health care system is routinely judged by the care patients receive. Far less attention is given to the conditions under which that care is delivered. Health care policy continues to emphasize insurance coverage, access to care, rising costs, workforce shortages, and health outcomes. Yet one question remains largely unaddressed: Who is caring for our physicians?
Physician well-being has traditionally been viewed as an individual concern. Current evidence …
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Physician well-being is not an individual problem
The room was still dark, my cat curled next to me, when I looked at the clock: 4:18 a.m. It was well before my alarm was set to go off, but I knew I wasn’t going to fall back asleep. Reluctantly, I grabbed my phone, put on my slippers, and shuffled downstairs to the coffee maker. While the coffee brewed, I skimmed my email and read the news headlines. Coffee …
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Physician burnout often begins with self-abandonment
Every caregiver of someone with a serious mental illness knows the moment: You’re searching an app store at 2 a.m., looking for something, anything, that might help your loved one track symptoms, stay on a medication schedule, or just feel less alone between crises. You download it. You show them how to use it, gently, because trust is already fragile. And if you’re lucky, it becomes part of the routine …
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Half of mental health apps vanish within 3 years
“I know the treatment probably won’t work,” a patient nearing the end of life tells the doctor. “I want to try anyway.” The patient understands the risks but still hopes for a little more time. The physician wants to honor that hope while worrying that side effects could make the patient’s remaining days more painful. If the treatment requires resources in short supply, other patients’ needs make an already difficult …
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Medical ethics principles do not decide hard cases
