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What if the biggest driver of unnecessary ER visits, malpractice claims, and patient anxiety isn’t a missed diagnosis but a missed sentence? Alan P. Feren, a retired surgeon, independent physician, health care consultant, …
Patients don’t need certainty, they need your reasoning out loud [PODCAST]
Early detection has always been one of medicine’s most powerful tools. The sooner we can identify cognitive, behavioral, or neurological conditions, the greater the potential benefit for patients, their caregivers, and their providers. That truth is even more pressing today. Thanks to rapid advances in artificial intelligence and speech analysis, vocal biomarkers have emerged as a fast, accurate, and non-invasive way to screen for a growing range of conditions. The …
How vocal biomarkers are revolutionizing early detection
One of my patients, K, arrived in the United States in florid psychosis. Back in China, she worked as a housekeeper and lived independently. She took her medications reluctantly but consistently, forced upon her by her parents. After her parents passed away, she stopped her medications. She became convinced her life was being controlled by the Chinese government. In terror, she booked a ticket to the land of freedom, America. …
Patient autonomy in psychiatry and the ethics of care
What if the biggest problem in medicine isn’t bad decisions but rather the decisions we cannot even consider?
Clinical decisions unfold through processes shaped by the environment, which determine what clinicians can notice, consider, and act on. What seems like individual reasoning is structured in advance by systemic and environmental forces.
Within this context, this paper introduces a concept that I call “invisible triage,” a preconscious process that restricts which options are …
What hidden constraints shape clinical decisions?
As a board-certified physical medicine and rehabilitation (PM&R) physician, I have guided patients through musculoskeletal care. Recently, my focus has shifted toward regenerative medicine, particularly platelet-rich plasma (PRP) therapy. What began as curiosity is now a strong commitment to understanding these therapies for patients who have exhausted conventional treatments.
This new focus led me to attend an intensive weekend course with experts from orthopedics, sports medicine, PM&R, rheumatology, and pain medicine. …
PRP therapy protocols lack expert consensus
In my years as an ICU nurse, I learned to recognize a pattern. The patients I cared for in trauma surgical intensive care often arrived after a cascade of preventable events. A missed medication. A symptom that went unaddressed. A follow-up appointment that never happened. By the time they reached my unit, the question was no longer how to keep them well at home. It was how to bring them …
Patients pay when Medicare care coordination codes go unused
The life of a physician is often viewed as a linear climb, a constant upward trajectory of achievement, responsibility, and endurance. But after decades in the field, I have come to realize that medicine is not a straight line. It is a series of seasons. If we fail to recognize the changing weather of our own lives, we risk arriving at the final season with broken bodies and weary minds. …
Why physician well-being matters at every career stage
Recently, I found myself in a place many physicians know professionally but dread personally: the waiting area outside a procedure room, this time as a mother. My six-year-old underwent what was supposed to be a simple elective procedure under general anesthesia at a day surgery center. He walked in smiling. He was put to sleep by using inhalational anesthesia through a mask. We were debriefed briefly by the ear, nose, …
How implicit bias in health care impacts patient safety
If you have just matched into residency, the profession is about to begin shaping you in ways that are not always visible at first. You have made the right decision and chosen a life of service, one whose rewards are far greater than a bank account will ever reflect. What follows is not part of a curriculum, and it will not be captured on a slide. It is learned more …
Finding meaning and purpose in medical residency training
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What happens when patients from opposite ends of the political spectrum sit together in your waiting room and start talking like neighbors? Psychiatrist Farid Sabet-Sharghi explores why the medical …
Your waiting room does what social media cannot [PODCAST]
Tickborne diseases are the most common vector-borne infections in the U.S., and for decades Lyme disease has dominated the conversation in endemic regions. But ticks are carrying more than Lyme alone and co-infections are becoming harder to ignore. New research suggests ticks are harboring a wider mix of pathogens than previously recognized, and that co-infections are becoming an increasingly important part of the clinical picture.
A recent study published in Ecosphere …
Why tickborne co-infections are changing Lyme disease care
In global conversations about the future of radiology, artificial intelligence (AI) is often positioned as the solution to the field’s most pressing challenges. From improving diagnostic accuracy to reducing physician workload, the possibilities seem extensive. Yet, as a medical student training in Nigeria, I have come to realize that the conversation around sustainability in radiology must begin much earlier, specifically at the point of access. In my training, I have …
Artificial intelligence in radiology and global health equity
Travel time to get to an operating room (OR) has increased since 2010. In 2020, 44 percent of rural adults traveled for 60 minutes or longer to get to a place to receive surgery compared to approximately 37 percent in 2010.
Longer travel to receive surgery results in delayed treatment. Delayed treatment causes the development of more complicated cases, higher complication rates, and poorer outcomes for those who receive …
How mobile surgical units improve rural surgical access
There have been unanswered questions about endometriosis for as long as it has been identified as a medical condition. We do not know yet why an estimated one in 10 women of reproductive age worldwide develop this often painful, chronic condition while others do not. We do not have a single, successful non-surgical treatment for endometriosis, characterized by lesions that mimic the tissue of the endometrial lining of …
Why systemic endometriosis requires whole-body care
I have come to a realization, one that has been building quietly over years of practice, long before I had the language to articulate it fully. We are very good at doing what we were trained to do. And yet, something about what we are doing is not enough.
As physicians, we are exceptionally skilled at identifying symptoms, categorizing them, and intervening with precision. We move quickly. We think algorithmically. We …
Why physicians treat symptoms not causes of disease
As a pain physician treating injured workers daily as well as being a qualified medical examiner (QME) or Independent Medical Examiner (IME) providing independent opinions, and a business owner cutting checks for workers’ comp premiums, I see the system’s strengths and serious strains up close. It started with good intentions: a no-fault safety net, so workers get care and some income if they’re hurt on the job, without dragging employers …
How workers compensation reform can cut litigation costs
Not long ago, when the president announced that Tylenol caused autism, he commented that leucovorin, a cancer medication, treated the condition. It was disturbing to see the outsized impact the pronouncements of a nonscientist had on the public, despite counterstatements by autism scientists to the contrary. I can fully understand the response. What mother-to-be would take the chance, even if untrue, that Tylenol may cause autism? Or if parents have …
How medical misinformation drives demand for nonscientific treatments
Clear, factual information regarding the roles and responsibilities of anesthesia care team members is increasingly difficult to find. In health care, “scope of practice” defines the range of responsibilities professionals may perform based on their license. As many state legislatures and Washington, D.C. are currently in session, anesthesiologists across the country are advocating for patient safety by promoting anesthesiologist-led care, not as part of a “scope” agenda, but as a …
Opt-out states and physician-led anesthesia care explained
Do you ever feel like a hovering helicopter, eyes fixed on every corner of the horizon, yet swift and nimble to the next need, while trying to stay aloft with a missing blade? If you have ever stood in the middle of a shift, a surgery, a conversation, or a decision that could not wait, and felt all of that at once, then you already know what it is to …
What physicians and dragonflies share in resilience and agility
I recently reviewed the case of a 17-year-old who came into the emergency department (ED) after a friend found him unresponsive at a party. He had taken what he thought was a Percocet. It was fentanyl. He survived because his friend called 911 and paramedics arrived with naloxone in time. But here is what happened next: nothing. He was observed, medically cleared, and discharged. No one offered him naloxone to …
Treating adolescent opioid use disorder with buprenorphine
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