Thursday, July 16, 2026

Physician Burnout: A little madness to keep you sane !

 Physician, Heal Thyself

Last Sunday, I attended a clinical meeting where there was an interesting debate:

“Is physician burnout an individual problem or a systemic problem?”

Both sides presented compelling arguments. The healthcare system has undoubtedly become more demanding. Long working hours, administrative burden, increasing corporatization, pressure of numbers, financial targets, patient expectations, medico-legal concerns… all of these contribute.

Yet, as I drove back home, I couldn’t stop thinking about another aspect of burnout—one that perhaps receives far less attention.

Maybe the seeds of physician burnout are sown much earlier.

From our childhood, most doctors are conditioned to excel. We are taught to chase marks, ranks, distinctions and medals. We learn to compete, outperform and constantly strive to be better than everyone else.

Years later, the numbers simply change.

Marks become degrees.

Degrees become surgeries.

Surgeries become patient volumes.

Patient volumes become revenue.

But the race never really ends.

Somewhere during this journey, medicine slowly stops being what we do and starts becoming who we are.

And that, I believe, is where the real danger begins.

When we expect medicine to provide us with our identity, our purpose, our recognition, our happiness, our emotional fulfilment and our self-worth, we unknowingly place an impossible burden on one profession.

No profession can carry that weight forever.

Burnout rarely arrives dramatically.

It begins with a whisper.

A quiet feeling that says:

“I’m doing everything I always wanted to do… I have achieved what I had dreamt of… then why am I still not happy?”

That whisper is probably the earliest warning sign.

If we wait until exhaustion becomes breakdown, prevention has already become treatment.

So what can we do?

For me, the answer lies in prevention—not after burnout, but long before it.

1. Redefine your identity.

Be a doctor.

But don’t be only a doctor.

Be a spouse.

A parent.

A friend.

A traveller.

A reader.

A musician.

A biker.

A photographer.

A writer.

Whatever keeps another part of you alive.

The more dimensions your identity has, the less likely one setback can consume your entire existence.

2. Learn the meaning of “enough.”

This may be the hardest lesson.

There comes a point where increasing wealth, status and achievements add very little to our happiness.

Beyond that point, the pursuit itself often starts taking away the very happiness we are trying to create.

Perhaps we need the courage to consciously let go of 10–20% of the endless chase.

Ironically, that small sacrifice may make the remaining 80–90% far more meaningful, productive and enjoyable.

3. Remember that medicine is only the fuel.

I often think of life as an engine.

Medicine is the fuel.

It gives us direction and purpose.

But no engine can run on fuel alone.

It also needs lubrication and cooling.

Without them, friction increases.

Heat builds up.

Eventually the engine fails.

Our hobbies, passions, relationships, rest, laughter and moments of joy are the lubricant and coolant of life.

They are not luxuries.

They are maintenance.

4. Steal time for your passions.

People often say,

“I don’t have time.”

Perhaps we never will.

Maybe we have to steal it.

There may even be a sense of guilt while doing so.

But that time isn’t stolen from medicine.

It is invested in becoming a happier, healthier human being—and therefore, a better doctor.

Profession keeps us sane.

Passion allows us to become delightfully insane.

And I think we need both.

Without a little childlike madness, adulthood becomes unbearably heavy.

5. Respect your body.

Our body is the instrument through which we serve humanity.

We maintain our medical equipment meticulously.

We upgrade technology regularly.

Yet we often neglect the one instrument that matters the most.

Exercise.

Sleep.

Nutrition.

Relaxation.

Meditation.

Recovery.

These are not signs of laziness.

They are professional responsibilities.

If we don’t invest time in our health today, we may be forced to spend far more time as patients tomorrow.

6. Invest in people and places.

Family.

Friends.

Meaningful conversations.

Shared laughter.

Travel.

Mountains.

Forests.

The sea.

Sunrise.

Sunset.

A walk under the trees.

Nature has a remarkable ability to reset the human mind.

Perhaps because that is where we were always meant to belong.

Even within our homes, I believe each one of us should have a small corner that belongs only to us—a quiet space where, even for five minutes, we can simply breathe, reflect and reconnect with ourselves.

7. Live by a philosophy, not merely by targets.

Targets have finish lines.

Philosophy does not.

Targets tell us where we are going.

Philosophy reminds us why we began.

Without a philosophy, life quietly becomes a rat race.

And one day we may discover that although we reached the podium, we somehow lost life itself.

For me, medicine has been one of life’s greatest blessings.

But so have writing, travelling, trekking, motorcycling, music, photography and lifelong learning.

None of these have made me a lesser doctor.

If anything, they have made me a more complete human being.

And I have increasingly come to believe that better human beings almost always become better doctors.

Perhaps the ancient words have never been more relevant than they are today:

“Physician, heal thyself.”

Not because doctors are special.

But because doctors are human.


Wednesday, February 18, 2026

When education kills …

 

Exam के नम्बर ज़्यादा और Life के कम … 🥲

These days every time I read about a child dying by suicide because of studies… something inside feels deeply wrong with the world we have built.

No child actually wants to die.  

They only want the pressure to stop.

Somewhere we started believing that education is everything.  

And then slowly… marks became more important than learning, performance more important than personality, and comparison more common than conversation.

Truth is — education is overrated.  

And exam marks are grossly overrated.

They have almost no direct relationship with success in real life.  

But they have a very real relationship with anxiety, fear and silence.

We say we are preparing children for the future —  

but are we preparing them for life… or just for an occupation?

Life will give them failure.  

Life will give them rejection.  

Life will hurt them at times.

And that is not a tragedy — that is training.

If we constantly protect them from failure and push only for success, we are not helping them…  

we are weakening them.

A child must learn:

how to lose,

how to cope,

how to stand up again,

how to be okay even when they are not the best.

Learning should be a happy process.  

Not a daily performance review.

We should raise children who know how to live —  

not children who only know how to compete.


Let them play.  

Let them have passions.  

Let them build physical and mental strength.  

Let them experience boredom, disappointment and recovery.


Because a happy child becomes a stable adult.


Before asking: “Kitne aaye?”  

maybe ask: “Tum theek ho?”


Marks improve.  

Careers change.  

Life finds its way.


But a child who feels loved only when successful  

slowly stops feeling safe.


We don’t need perfect children.  

We need emotionally secure humans.


After all…  

the child is the father of the man.


Parents, think. 🙏🏻

Saturday, July 26, 2025

Autism and ADHD (and Dyslexia): Disorders or Simply Different?

In recent years, our understanding of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) has evolved significantly. Traditionally, these have been viewed as medical conditions — “disorders” that require correction. But an increasing number of experts and advocates believe that they might simply represent natural variations in human behaviour and brain function, rather than diseases.


The Lens of Neurodiversity


The neurodiversity movement emphasises that human brains are wired differently. Just as we recognise variations in personality, creativity, or intelligence, neurodiversity suggests that traits seen in autism or ADHD are not necessarily flaws — they are different ways of perceiving and interacting with the world.


  • Autism: Often linked with deep focus, attention to detail, and unique problem-solving approaches.
  • ADHD: Associated with high energy, adaptability, and quick, creative thinking.


These traits can be advantages in the right environment, though our current education and work systems are often structured for “neurotypical” patterns of thinking.


When Is It a Disorder?


Autism and ADHD are classified as disorders when symptoms cause significant difficulties in everyday functioning — for example, severe communication challenges, impulsive actions leading to harm, or inability to manage daily tasks. But in many milder cases, these differences do not require “fixing” — only understanding, support, and acceptance.


Lessons from Nature


Interestingly, similar behavioral variations exist in animals. Some are naturally more focused, while others are more impulsive or exploratory — roles that may benefit the group as a whole. This suggests that behavioral diversity could be an evolutionary strength, not a weakness.


The Way Forward


Perhaps the real question isn’t “What’s wrong with these individuals?” but “How can we create environments where different minds can thrive?”

By recognising and celebrating these differences, we move from a mindset of “cure” to one of inclusion and empowerment.


My views about Dyslexia are the same which I even more strongly feel that is a normal variation rather than a disorder or disability. And I speak from personal experience !


- Dr Sanjay Dhawan

Wednesday, June 29, 2022

All psychiatrists are slightly mad, so are we.




I was in third year of my medical school in New Delhi and was eagerly looking forward to my two weeks posting in psychiatry. G B Pant Hospital associated with Maulana Azad Medical College had a renowned department of psychiatry. I had a very keen interest in functioning of human mind & psychiatry. Overwhelmed with enthusiasm I had bought two books of psychiatry while most of my fellow students didn’t care to have even one. Not only had I bought the books but also I had started reading them well in advance so that I could make most of my anticipated fortnight in the psychiatry wards. 

The day arrived and we, a group of about ten students, wandered to the psychiatry ward on the ground floor of the hospital. The place had a eerie feel to it. We would not know who’s a patient there or who wasn’t. Timidly we enquired about where & to whom did we need to report. We were directed to a consultant’s room where were made to stand in a line facing the consultant. He was slouching on his armchair. Parched white face, thin lips, hair long, oiled and thrown back; and an expression suitable perhaps for the outer space or another world. Suddenly he emerged from his interstellar thoughts & asked:

“Third year students?”
“Yes sir”, we replied in unison & with optimism.
“Hmm”, he was barely audible & then returned to his thoughts. It was a long time, he may have travelled around some imaginary planet before he returned and uttered:
“Third year. Ok. Go to Dr Gupta (not real name) he will take your class.” 

This premonitory introduction should have revealed to our naïve minds the nature of days to come. Each day was eventful and, in retrospect, very fascinating. There were encounters with patients, with patients posing as well meaning relatives of other patients and with most other consultants. 

The outcome of the posting was that all probability of my considering a career in psychiatry was shattered into pieces. I concluded that the life & work environment of psychiatry practice was too overwhelming for people to stay sane. However, I didn't consider that the individuals opting for a career in mental health were already predisposed to be affected by it. And I did challenge myself by thinking that I was generalizing too much and that 2 weeks of spending time in a place was too short to make any judgement (leave alone diagnose) on people who are running the show. So I kept my mind & eyes open in the years that followed. I came across may a psychiatrists & psychologists - as friends or as colleagues - during my life as a doctor; barring a few exceptions my opinion was only reiterated that there was something peculiar or odd about their personalities.

Being fascinated by the subject of mind I started reading about & the works of some iconic figures in the fields - Carl G Jung, Sigmund Freud, etc - not only to learn from their knowledge but also to get a glimpse into their minds. To my surprise both these great leaders in the fields also demonstrated quirks in their personality & thought process. While Jung used to have visions, some vivid dreams, hypnogogic phenomenon and a clear acknowledgement of two personalities, Freud was too obsessed with sexuality and would explain every psychological disturbance in a person on the basis of some childhood sexual complex or event; he also showed some traits of neurosis in his behaviour. 

I have seen psychiatrists & psychologists showing signs of depression, anxiety, narcissism, substance abuse, etc. Even the ones who appear perfectly normal & stable from far reveal some weak areas on close exploration. It is probable that because of their own demons & instabilities they get drawn to the profession of mental health - with a desire to help others & to help themselves.

"Am I being biased & judgmental ?" I thought to myself. And this self-doubt made me explore this subject further. I started looking at everyone - all those who were not psychiatrists - other doctors, other professional, general public - basically everyone around. My observations startled me. Everyone, yes everyone is prone to depression, to anxiety, to delusional thoughts, to illogical behavior, to hypochondria, to a degree of mania, to some narcissism, etc. Basically everyone is slightly mad - at some time or even all the time. So not just psychiatrists but philosophers like Neitsche, composers like Mussorgsky, leaders like Hitler, painters like Van Gogh, etc., they all exhibited some traits of madness.

The emotions or feelings of depression, anxiety, phobia, obsession, delusions, etc are to an extent normal & experienced by everyone sometime or the other. They become abnormal when they become severe in intensity & prolonged enough to cause distress to the individual & interfere with person's normal functionality & pursuit of life. So the abnormality does not exist in the quality of the feelings but the quantity & duration of the feelings. We are all given to imagine things but when the imagination becomes so strong that the person starts perceiving things - hearing sounds, seeing imagery, etc. then it becomes hallucination. It may be safe to say that a psychiatric illness may be just an extreme state of normal mind but of a nature whose magnitude & duration is beyond the voluntary control of the person.

How does it help to know this ? 

Knowing the functioning of human mind not only helps understand others but also ourselves. Everyone goes through phases of emotional distress & sometimes awkward behavior or introversion. An awareness of plethora of disturbing emotions & feelings will make us more empathetic towards others & will provide us a clarity of thought to deal with our own situation.

Some madness is good for growth - it provides creativity & drive to do thing different & better. Look at all the successful institutions, businesses, corporates, etc., and it’s very likely that you may find a slightly mad man as the top leader. 

So if you find a mad streak in yourself, don’t shun or shy away from it, embrace it & channelise it to make your life better, to achieve something great.

Lastly, if you do feel overwhelmed by your emotions, thoughts or situation, don't hesitate to reach out to a friend, a counselor or even a psychiatrist. You are very likely to get an empathetic response from them because they themselves may be familiar with what you are going through.