Psychiatry

If you go to medical school, you will be stressed: bigly

Education
April 6, 2018

Two recent posts highlight the problems facing many medical students today.

The first was by an anonymous rising fourth-year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.”

The second was by another anonymous student who described how miserable he (or she) has been …

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Using marijuana 2 times a month cost this doctor his license

Physician
March 23, 2018

If a physician has a substance use or mental health problem, it is in everyone’s interest — the physicians themselves, their patients and their families — for them to get treatment. And if they go for treatment, they deserve to be treated fairly, but given my six years of experience as an associate director in one state physician health program (PHP) and in working with physicians from all across the …

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10 tips to help patients through benzodiazepine withdrawal

Meds
March 20, 2018

As physicians, we are experts at prescribing medications. However, we often fail miserably when it comes to recognizing adverse reactions and tapering medications. It’s something that is simply lacking in our medical training. I have become a victim of this with benzodiazepines, as I detailed in a prior blog post. Benzodiazepines, in particular, are very difficult drugs to taper. I would like to share with you …

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Don’t ignore ADHD in adults

Conditions
March 6, 2018

Eight-year-old Tommy has trouble paying attention in school, is always restless in class, unable to complete his tasks, hyperactive both in school and home and his teacher discusses the possibility of him having ADHD with his parents. They decide to take him to see a pediatric psychiatrist. After some analysis, he’s diagnosed with ADHD, prescribed with Ritalin and is on his way home with his medicine. Classic childhood ADHD story, …

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Is your spouse experiencing physician burnout?

Physician
March 5, 2018

Many things in life can only be truly appreciated once reflected upon — like the onset of dementia, depression, and cancer, just to name a few. This got me thinking about the onset of burnout and how the true presentation in life is quite different than reading about it.

The term “burnout” is often thrown around loosely but is an actual syndrome comprised of the progression of “exhaustion, cynicism and reduced …

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How psychiatrists became lesser physicians

Physician
February 28, 2018

Recently, a form showed up on my desk to sign, approval for something or other. Not uncommon, given my role at the time as a chief psychiatrist, I signed dozens of such letters, memos, or forms, drafted by an administrative assistant.  I signed so many; I never looked at the last line — at how my name had been typed out.  Just once my eyes wandered to the end and …

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Rappers: Stop glamorizing prescription drug use

Physician
February 25, 2018

During his 2004 stand up “Never Scared,” Chris Rock said, “I love rap music, but I am tired of defending it.” That statement, for me, holds true more today than ever before. Mumbling about nonsense is already hard to defend and only gets worse when the first line to every song these days has a reference to drugs.

Drugs, sex, and money have always been an important part of music, and …

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Why do medical students kill themselves?

Education
February 16, 2018

“I can’t do this anymore,” Mary* said to me after morning rounds.

As third-year medical students, this could have been in reference to a number of things: 5 a.m. rounds, practice sutures, 14-hour days, the list goes on. Though I later learned Mary was simply referring to living.

An article recently published by JAMA showed depression or depressive symptoms among medical students was as high as 27.2 …

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What’s the cost of being a doctor in recovery?

Physician
February 15, 2018

I am a physician in recovery and just celebrated my fifth-year anniversary on October 11, 2017.

While in active addiction, my drugs of choice were benzodiazepines and opioids that I washed down with top-shelf alcohol. Near the end of my usage, I was diverting scheduled drugs in order to feed my addiction. After an unsuccessful suicide attempt, I finally admitted myself for treatment.

As part of the treatment process, I enrolled with …

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A physician suicide: covered up with a tarp and silence

Physician
January 22, 2018

Another young doctor recently jumped to her death in New York City. She landed at the entrance of the building where she lived.

Within less than an hour, I received the following emails about her. All published with permission.

Hello Pamela, I am not a doctor, but a mother of 3 and a wife of a resident physician. Tonight I watched AGAIN the police …

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You can’t separate mind and body in medicine

Physician
January 22, 2018

According to the American Psychological Association and the American Academy of Family Physicians, well over half of patient visits to primary care physicians are for mental health issues. So, as part of my book, I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship, I asked about mental health.

None of the doctor interviewees disagreed with the important role that …

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Lessons from the psychiatric ward

Education
January 7, 2018

The specter of the psych ward looms large in popular culture: video games, horror movies, novels — the concept of a locked inpatient psychiatric ward is shorthand for a variety of terrors. This perception is driven by a complex cocktail of factors. Psych ward patients have struggled with historical and current abuses, which are compounded by misunderstanding and ignorance around mental illness.

During third year, I spent a six-week rotation in …

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End the resident physician abuse now

Physician
December 21, 2017

Let’s talk about the cycle of abuse. No, I am not referring to the very serious issue of domestic violence. Instead, I am talking about the graduate medical education system. No one is a resident forever: the duration of each residency is predetermined with a wide range of three to nine years. The self-limited nature of this experience decreases the incentive for participants to advocate for changes. And the attitude …

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A doctor saved a patient’s life. Twice.

Physician
December 18, 2017

I have good days and bad.  Some days I am content, connected, focused, and motivated.  On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.

On other days, not so much.  I wake up as grumpy Rob and (despite multiple cups of coffee) the old codger doesn’t leave me alone.  I keep score of all the ways in which life …

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It’s time to stop prejudging your patients

Physician
November 27, 2017

Recently I had an interaction online with a physician regarding his thoughts on ADHD treatment. (Let’s call him Dr. Stigma). This post is not about doctor-bashing but more to point out the prevalence of stigma against those with a psychiatric diagnosis even from within the medical community. Stigma, unfortunately, is so indoctrinated into our culture that sometimes people don’t recognize the pure ugliness of their words.

Dr. Stigma’s comments:

Many patients use …

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Physician wellness programs are lipstick on a pig

Physician
November 17, 2017

Here it comes — another email about “physician wellness,” advertising mindfulness training, an ice cream social, or a volunteer day. As a psychiatrist, I can attest to the importance of tending to one’s own mental and physical health in order to strive for wellness. However, the trend of implementing physician wellness programs throughout the U.S. is nothing more than putting proverbial lipstick on a pig. Or, stated differently, this may …

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I was attacked by a patient and want my fear to help others

Physician
November 1, 2017

I have been working with psychiatric patients for the better part of 30 years. During this time, I have worked in psychiatric emergency rooms, prison wards, substance abuse treatment centers and inpatient psychiatric units. I have been proud of the fact that, despite working in some dangerous areas, I have never been harmed by a patient. I have been threatened, swung at — but never injured. Once a patient decided …

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