Career

The prevalence of professional burnout ranges from 25% to 60% among practicing physicians. No wonder then, that the workshop on physician burnout was packed at the APA annual meeting.

As an employed physician, when I was off, I was off. In private practice, the same is not true.

It’s hard to believe that it’s been two years since I saw my first patient in my very own office.

The goal of the survey was to go beyond ethical lessons, useful as these may be, and to learn how Psychiatric Times’ readers-who are on the front line of psychiatric practice-handle a series of hypothetical ethical scenarios.

In addition to receiving birthday cards, on this birthday, one of our bloggers, Dr. Moffic, decided to send out a card to all those he loved. It is being reprinted here. "If you are what you love, There is no longer reason to be most modest, so step aside Muhammad Ali, for I Am The Greatest!"

Whether planned or unplanned, a physician's departure from your practice will definitely have an impact, so be prepared.

Every case of patient violence against clinicians provides lessons to be learned in safety management. Here: some key points that can enhance physician safety and help minimize the risks.

Here is a “pocket guide” for clinicians drawn from actual cases. With some modification, the list could become a patient information sheet or office policy.

The debate within the medical profession over “conflicts of interest” (COIs) has often been shrill, and sometimes seems to be based on misunderstandings or myths about what COIs entail. In this psychiatrist’s view, it is helpful to step back from confident proclamations, acknowledge that the issues involved are complex, and aspire to some semblance of humility. Nobody has cornered the market on “the right way” to deal with COI in the realms of medical research, publication, and education.1 At the same time, as Alan Stone, MD, has noted (personal communication, August 27, 2009), ethical considerations lie at the heart of any debate on COI-in particular, the ancient dictum, “Do no harm.” Indeed, ethicist James M. DuBois has pointed out a direct connection between some types of COI and harm to the general public: “Mental health consumers are at risk when studies that involve questionable scientific and publication practices are translated into therapeutic practice.”1(p205)

What safeguards does Psychiatric Times build into its review policies to avoid conflicts of interest (COIs)? Do these policies apply to the “supplements” sometimes mailed out with the regular publication?

In a highly charged environment in which reports of potential conflicts of interest between physicians and pharmaceutical companies dominate the headlines almost daily, we want to point out that the supplements that were mailed with this month’s issue of Psychiatric Times were based on meetings funded by drug companies. The supplement on treatment-resistant depression, which was sponsored by Lilly USA,includes an article that focuses on the company’s drug Symbyax.

There are dogmatists (and many of them) of this variety who think that they can be good mental health professionals by simply applying the truths of, say, Freud (or Prozac) to all. This article, and the 2 that will follow in future issues, are addressed to those who know that they do not know or at least want to know more.

Regular readers of Psychiatric Times know that we have been engaged in a comprehensive review of our “conflict of interest” (COI) and disclosure policies, which now include posted disclosure statements from all our editorial board members. So far as we are aware, Psychiatric Times is the only major psychiatric journal to require this of its editorial board, as well as of our regular writers.

In our own time, many so-called conflicts of interest (COI) boil down to temptation, as James DuBois,3 professor and department chair of health care ethics at Saint Louis University, notes in his excellent chapter on this subject. A physician-researcher is tempted to slant the results of his or her study in order to maintain funding from a medical technology company.

There are no books written by, or even about, locum tenens psychiatrists. Why is that? Why is their story-the story of psychiatrists who "hold a place," participate a bit, and then move on-not shared? Is there nothing in their experience worth sharing?

Discussions of psychiatric ethics often devolve into discussions of applicable law. Although ethics is often operationalized by a society's laws, ethics differs dramatically in its foundations, framework and purpose.

In the current climate of psychiatric medicine, changes that greatly impact a psychiatrist's time, income potential and career enjoyment are constantly occurring. Is a career in psychiatric administration and academics a rewarding combination?

The ranks of the elderly are swelling, yet fewer and fewer physicians are choosing to practice geriatric psychiatry. What will be the impact on older patients who receive their mental health care from primary care physicians?

As health care continues to shift in the United States from fee-for-service to managed care, and away from specialist-driven care to the primary care gatekeeper, it is necessary to re-examine psychiatric training and the psychiatric services that are being provided.