We talk with Dr. Jason Knight about what burnout really looks like in medicine and why a hard day is not the same thing as a broken relationship with the work. We push past buzzwords to name root causes, moral injury, and the practical steps clinicians and leaders can take to rebuild a sustainable healthcare workforce.

• distinguishing clinical exhaustion from burnout using emotional exhaustion, efficacy, and depersonalization
• why generic wellness programs fail when they are not matched to the real driver
• the limits of resilience and why burnout is a shared workplace problem
• the six-domain mismatch model: workload, control, reward, community, fairness, values
• how rural care, maternity deserts, and legal constraints amplify workload and control gaps
• moral injury in healthcare and how it differs from second victim syndrome
• building better measurement than once-a-year engagement surveys
• having productive leadership conversations by pairing data with real stories
• creating psychological safety for learners and addressing power dynamics
• returning to center through presence, journaling, and community
• using the Maslach Burnout Inventory to name what is mismatched
• normalizing “I need help” and reducing isolation as a risk factor
• Dr. Knight’s 78-Day Spiritual Reset and why reflection can support recovery

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram

0:00 Welcome And Guest Setup

1:28 Wellness Without Root Cause

3:10 Burnout Versus Exhaustion Defined

6:56 Resilience And System Failures

12:34 Six Burnout Mismatch Domains

19:37 Moral Injury And Second Victim

27:13 Track Wellness Beyond Annual Surveys

29:21 How To Talk With Leadership

38:17 Returning To Center Through Presence

44:34 Practical Tools To Get Help

53:20 Reasons For Hope And Farewell

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We dig into how good stories and elegant mechanisms can seduce clinicians into using fertility and surgical “add-ons” long before the evidence is ready. We also connect policy, access, and misinformation to a disturbing rise in ectopic pregnancy deaths, then end with what better studies should look like when patient safety is on the line.

• why low-dose naltrexone becomes a fertility add-on despite unclear mechanisms
• biologic plausibility versus proof, and why theory cannot replace trials
• what the available LDN data looks like, including weak endpoints and missing live birth outcomes
• practice inertia, file drawer bias, and when a therapy belongs in routine care
• ProPublica’s ectopic pregnancy mortality signal and how to interpret CDC WONDER data
• COVID-era care disruptions, hospital closures, and delayed early pregnancy evaluation
• Dobbs-era legal ambiguity, chilling effects, and implications for methotrexate timing
• a new Nature Medicine finding on ISM2 as an early biomarker for preeclampsia and fetal growth restriction
• V-NOTES versus vaginal hysterectomy trial design problems, including power, exclusions, and comparators
• conflicts of interest, blinding failures, and how low-quality studies pollute meta-analyses
Everybody remember to get your ABOG stuff done in the next month or so.

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram.

0:34 Low-Dose Naltrexone For Fertility

8:38 Evidence Gaps And Practice Inertia

17:14 Ectopic Pregnancy Deaths Are Rising

22:00 Access Problems And Social Media Misinformation

24:15 Abortion Bans And Delayed Ectopic Care

29:32 ISM2 Biomarker For Preeclampsia Risk

32:31 V-Notes Versus Vaginal Hysterectomy Study

41:40 Power, Outcomes, And Unfair Comparisons

47:50 Conflict Of Interest And Broken Blinding

55:09 Where V-Notes Came From

1:01:31 Skills, Tradeoffs, And Final Reminders

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Tara Chettiar joins as we talk through what the Lindsay Clancy case surfaces about postpartum mood disorders and why the public often misunderstands psychiatric illness when it gets filtered through legal arguments and internet certainty. We focus on practical clinical signals, especially sleep disruption, and what real safety planning and system reform should look like for postpartum families.

• why we avoid diagnosing a public case and instead look for system lessons
• how legal “insanity” clashes with the clinical spectrum of impairment
• why med lists get misread and what SSRI activation can signal
• baby blues versus postpartum depression and postpartum anxiety over time
• postpartum OCD intrusive thoughts versus psychosis and delusions
• sleep deprivation as the clearest danger sign and how it presents
• what families can do in an acute postpartum mental health crisis
• first line outpatient medication basics for OB GYN care
• why postpartum psychosis needs emergency level triage
• mother baby units and why the US has so few
• what a postpartum mental health safety plan includes, including guns and pills
• better screening in pregnancy, EPDS versus PHQ-9, and why anxiety matters
• workforce gaps and why OBs, family medicine, pediatrics, and ER teams need training
• Resources: Postpartum Support International at 1-800-944-4773 and text help, the National Maternal Mental Health Hotline at 833-TLC-Mama (852-6262), and 988

Be sure to check out thinking about obgyn.com for more information.
And be sure to follow us on Instagram.

0:00 Welcome And Trigger Warning

1:30 Meet Tara And Her Work

7:10 Why The Clancy Case Matters

11:55 Legal Binary Versus Clinical Reality

12:50 Med Lists And Public Misreads

14:50 SSRI Insomnia And Bipolar Red Flags

18:15 Baby Blues Through Psychosis Spectrum

24:00 Intrusive Thoughts Versus Psychosis

28:13 Sleep Loss And Family Warning Signs

30:45 First Line Meds And Titration

34:55 ER Triage And Postpartum Advocacy

39:05 Mother Baby Units And Step Down Care

42:30 Safety Plans Means And Support

45:35 Screening Tools EPDS Over PHQ9

48:05 Workforce Gaps And Training Fixes

49:55 Policy Social Support And Paid Leave

52:40 Hotlines Resources And Closing Thoughts

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