Showing posts with label depression. Show all posts
Showing posts with label depression. Show all posts

Thursday, March 1, 2018

Out of the Straightjacket

Michael S. Weinstein, M.D., M.B.E.
N Engl J Med 2018; 378:793-795

This is the narrative of a trauma surgeon who has a history of major depressive illness.  He tells it as it was; including his psychiatric hospitalization, electroconvulsive therapy, and recovery.  In some ways, this is a restitution story.

Dr. Weinstein addresses important areas we’d rather not face.

We often make decisions in the face of uncertainty that deeply affect our patients’ lives. When things went wrong, I frequently blamed myself. I learned that doubt, ignorance, and lack of confidence were my own failings.”

“Though I had mental illness, I still saw it as a weakness, a personal fault. I remember early in my career hearing of a colleague who took a leave of absence for a “nervous breakdown.” I joked about it, said he was weak. Now it was my turn.”

“I wanted out, out of work and out of life. I wished I would get hit by a car, and sometimes took steps to increase my risk. I felt trapped in my work and worried that I would expose my shortcomings if I sought a leave or disclosed my feelings. I’ve subsequently learned that my colleagues were quite concerned about me but found me unreceptive to attempts to help. I was trying to get help in many ways, but nothing seemed to work.”


This is an important topic.  We’d rather not acknowledge it.  The best-selling author, Sherwin Nuland, was a surgeon who similarly was hospitalized for major depression.  He chronicled that in his autobiography, “Lost in America.”

Sunday, December 10, 2017

The Steeper Obstacles Faced by Women in Medicine

by Dhruv Khullar


Happy medical residents are all alike. Every unhappy resident would take a long time to count.


A new study in JAMA Internal Medicine suggests yes.* Dr. Constance Guille and colleagues analyzed the mental health of more than 3,100 newly minted doctors at 44 hospitals across the country. Before starting residency, men and women had similar levels of depressive symptoms. After six months on the job, both genders experienced a sharp rise in depression scores — but the effect was much more pronounced for women. A major reason: work-family conflict, which accounted for more than a third of the disparity.

The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties. 

This article is worth reading by all trainees, prospective physicians, and practicing doctors.
Someday, this may be the reality
 *  Work-Family Conflict and the Sex Difference in Depression Among Training Physicians. Constance Guille, etl a.  JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138  
Conclusions and Relevance:  This study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.

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