Psychiatry

Precision psychiatry is finally catching up to medicine

Conditions

May 21, 2026

One of the hardest parts of practicing psychiatry is that we still cannot reliably predict which medication will work for which patient.

A patient comes in struggling with depression. We choose a medication based on symptoms, history, side effect profile, family history, clinical experience, and sometimes educated guesswork. Then we wait. Sometimes the medication helps quickly. Sometimes it causes side effects. Sometimes nothing happens at all. Then we adjust, augment, switch, …

How psychological safety reduces clinician burnout

Nicholas Testa, MD

Physician

May 21, 2026

Burnout among nurses and clinicians has been a prominent topic over the past decade. The combination of regulatory requirements, higher patient demands, and leaner budgets in the shadow of coronavirus disease 2019 (COVID-19) has fueled the embers that have allowed this crisis of clinician burnout to smolder.

Simultaneously, health care systems are striving to deliver better clinical results in a world where transparency in data and public reporting is the expectation. …

Why physicians miss business owner stress in patients

Timothy Lesaca, MD

Physician

May 20, 2026

The ECG was normal. The troponin was negative. The stress test was reassuring. Yet the patient in front of you looked as if he had been living under siege for months.

He was not sleeping. His blood pressure had worsened, despite medication adherence. He described chest tightness, reflux, headaches, irritability, and difficulty concentrating. He woke most nights around 3 a.m., his heart beating fast, checking an account balance, and then lay …

Why your physician guilt may not actually be yours

Christie Mulholland, MD

Physician

May 20, 2026

I was doing the dishes recently when I was hit with a stomach-dropping sensation and an unprompted memory. A negotiation I’d had years ago with my department. I had secured fair compensation for work they needed done, using the leverage I had. I walked away feeling good about it. And yet, standing at the sink with my guard down, years later, I felt a flash of guilt so unexpected it …

Social media addiction rulings impact mental health

Oliver Power

Conditions

May 20, 2026

Recently, a California jury found the tech giants Meta and Google guilty for the depression and anxiety which ensued in a young woman following her compulsive use of social media. The court found the corporations liable for features that cause children to become addicted to the platforms and that it results in the aforementioned mental health distress. Many are calling this ruling social media’s tobacco moment, citing parallels …

How cultural competence transforms modern parent coaching

Najat Fadlallah, MD

Conditions

May 19, 2026

Whether parent coaching is getting delivered formally, through parent behavior training programs, or informally, through evidence-based parenting advice and recommendations shared in clinic with the family, parent coaching has become an essential part of clinical care today, both in general and in subspecialized pediatric clinics. The American Academy of Pediatrics (AAP) recommends anticipatory parenting guidance to be provided starting at the first visit. The AAP also recommends that pediatric health …

How physician therapy sparked a medical career transition

Shahrzad Rafiee, MD

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 …

Psychiatry

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