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Physician coach Nicole Perrotte and physician advocate and physical therapist Kim Downey discuss their article, “Love, empathy, and the triangle of exhaustion: Why humanity must come first.” Nicole introduces her powerful framework, …
In elementary school, my teachers always told us it was important to understand math because “you won’t always have a calculator in your pocket.” That sentiment hasn’t aged well, given that my iPhone and Alexa are always within reach. But no one said, “You better learn this because one day you’ll be teaching your own kids during a plague.” That was where the real value lay. In medical school, I …
Brick-and-mortar stores must deal with online competition. Even health clinics face disruption from telemedicine. Yet optometrists have special protection in South Carolina.
When a telehealth company invented a safe and effective way for doctors to renew vision prescriptions remotely, political insiders rallied in Columbia to ban the service in South Carolina. Now, nine years later, the state-sponsored favoritism could end.
The South Carolina Supreme Court, which already rejected an attempt to …
The FDA is failing rare disease patients. I’m one of them.
I’ve been on elamipretide for three years now. It is the only treatment that has made a meaningful difference in my life with primary mitochondrial myopathy—a degenerative genetic condition that impairs how my cells convert food and oxygen into energy. Mitochondria provide over 90 percent of the energy our bodies need; when they fail, the highest-demand tissues—like muscle, brain, and …
More than 78 million Americans rely on Medicaid or CHIP for their health care. Yet many still cannot access FDA-approved digital therapeutics because their state does not include them in covered benefits.
Prescription digital therapeutics (PDTs) are software-based treatments authorized by the FDA. They are delivered through smartphones or tablets and are used to manage conditions such as substance use disorder, ADHD, diabetes, and chronic insomnia. For people who face long …
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Pediatrician Arti Lal discusses her article, “Why ADHD in women is finally getting the attention it deserves.” She explores why new ADHD diagnoses nearly doubled for adult women from 2020 to 2022 …
When I was a young bonnie lad of just 16, I was lucky enough to score a meeting with Sandy Napel, PhD at Stanford University’s Radiological Sciences Laboratory (RSL). I demonstrated a prototype algorithm that automatically identified the position and course of arteries on CT scans. It was the first shot in a nearly decade-long academic research career that included early publications on using neural networks (the precursor to today’s …
When so many children and adults struggle with obesity, it’s easy to see why weight loss is often celebrated. Unfortunately, health care professionals sometimes apply those same social narratives to clinical decision-making, and the consequences can be dangerous.
I’ve developed two distinct clinical niches: metabolic dysfunction and tuberculosis. A colleague once asked me to review the chart of a patient with a history of obesity who had been admitted to an …
Let’s start with a simple truth: Medicine is hard.
It’s hard for doctors, and it’s hard for patients. The headaches of today’s health care ecosystem—endless paperwork, shrinking appointment times, and the ever-present shadow of insurance approvals—can make it feel like the heart of medicine is slipping away.
Lost in the system
For years, I practiced in the traditional insurance-based model. I loved being a doctor, but I found myself spending more time on …
Are 10 percent (or 25 percent) of all the physicians in your specialty breaking the law?
Of course not! Who would think such a thing?
Your friendly neighborhood “nonprofit” hospital, that’s who!
I have been reviewing physician employment agreements for almost 40 years, and in the last few years I have noticed a spike in the number of agreements that “cap” physician salary. A shocking number of hospital employment agreements provide that the …
The ED is swamped with new patient arrivals. As a result, the 20-year-old who told the triage nurse he is having difficulty breathing waits an hour before his turn in the triage room. The emergency department technician hands me the ECG—sinus tachycardia—and takes the vitals.
Me: “What brings you to the emergency department today?”
Him: “I feel like I cannot breathe. It started all of a sudden at work.”
As I scroll through …
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Emergency physicians Resa E. Lewiss and Courtney M. Smalley discuss their article, “Why point-of-care ultrasound belongs in emergency department triage.” Amid the crisis of overcrowded waiting rooms and long wait times, they …
“My PSA came back at 6.2 — does that mean I have cancer?”
It’s one of the most common and emotionally charged questions I hear in the clinic. The prostate-specific antigen (PSA) test, once celebrated as a breakthrough in early cancer detection, has become a double-edged sword. For many men, a slightly elevated PSA level is enough to trigger panic — and for some physicians, enough to trigger a biopsy.
But here’s …
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An excerpt from Medicine is a Practice: The Rules for Healthcare Marketing.
“I’m late! I’m late! For a very important date!”
— The White Rabbit, Alice’s Adventures in Wonderland, Lewis Carroll
Lewis Carroll wrote about the tardiness of the White Rabbit in Alice’s Adventures in Wonderland in 1865. The problem of tardiness is older than the White Rabbit, and lack of punctuality plagues every profession and human interaction. Unfortunately, in the medical …
Medicine has long valorized the early riser – the physician who arrives before sunrise, who joins 7:30 a.m. meetings and stays for evening journal clubs, case conferences, and post-dinner networking events. These scheduling patterns have come to symbolize dedication, productivity, and professionalism. However, for many physicians, particularly those with caregiving responsibilities, these norms reflect more than tradition; they represent structural exclusion.
The architecture of medical professionalism was built on an outdated …
Physicians are human. Medicine is a career—not a lifelong vow of self-sacrifice.
Yes, for some, it may feel like a calling. But let’s be clear: Choosing medicine doesn’t mean surrendering your identity forever. Times have changed. Our mindset must, too.
Working part-time, seeking balance, or transitioning into leadership, education, or non-clinical roles is not a betrayal of the profession. It’s growth. Yet these choices are too often dismissed as abandonment.
We must let …
“The value of intuition in clinical practice” prompted me to reflect on one of the deeper regrets I carry from my clinical practice—those moments when I didn’t fully acknowledge or act upon a parent’s intuition, often a mother’s, that something was wrong with their child.
As clinicians, we are trained to listen for clinical “buzz words”—specific complaints or symptom patterns that guide our diagnostic reasoning. These cues form the backbone …
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Certified financial planner Brian Case discusses the article, “Personal financial planning shouldn’t be a taboo subject.” They explore the often-overlooked link between financial stress and the crisis of physician burnout, turnover, and …
The Pitt was compelling TV.
As an emergency nurse educator for a Stanford campus in Northern California, there is one thing that is required viewing for my new graduate nurses: The Pitt.
The ambitious series did an admirable job portraying the complex world of the emergency department. The procedures were clinically accurate. The spectrum of patients and social issues was nuanced and believable. They even showcased the incidence of post-COVID PTSD, an …
She was 68. Diabetic. Living alone with chronic osteoarthritis. Like many patients, she carried a story more complex than any preoperative checklist could capture: a long history of opioid dependence, obesity, limited mobility, and no one at home to help her recover.
Her total knee replacement—performed with state-of-the-art robotic precision—was flawless. The surgical plan was executed to perfection. The implant was perfectly aligned. She was discharged on time, per protocol.
But protocol …
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