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What if the biggest threat to your success in medical training has nothing to do with how much you study? Vance Lehman, professor of neuroradiology and chief of neuroradiology education at the Mayo …
One silly mistake can sabotage your medical career before it starts [PODCAST]
She sat across from me, results in hand, and asked the question I have heard more times than I can count.
“If everything is normal, why do I still feel like this?”
I did not have a clean answer. Not because she was wrong to ask. Because she was right, and medicine, at that moment, had run out of language.
Her CBC was normal. Her CMP was normal. Thyroid unremarkable. Inflammatory markers unimpressive. …
Symptoms with normal labs deserve a better question
On November 22, 2025, Tatiana Schlossberg, a 35-year-old journalist and the daughter of Caroline Kennedy, announced that she was dying from a rare and particularly aggressive form of blood cancer called acute myeloid leukemia (AML). In a heart-wrenching essay in The New Yorker, she described having been diagnosed with the disease just a few hours after delivering a healthy baby girl and when she was seemingly in the prime of …
Can clonal hematopoiesis improve blood cancer screening?
In 2019, I completed my medical training in Russia and arrived in the United States as a Fulbright Scholar. My award carried the U.S. president’s personal signature, a powerful welcome to a country I saw as a place of opportunity, freedom, and cultural exchange. It felt like a once-in-a-lifetime honor that most foreign physicians can only dream of. Then came the COVID-19 pandemic. In early 2020, while still in the …
International medical graduates need real protections
In clinical practice, it is not uncommon for autistic patients to arrive after years of treatment with a firm conclusion: Psychiatric medications do not work for them. This belief is typically built on multiple medication trials, inconsistent benefit, and often significant side effects. But the conclusion itself may be misleading. What is often being observed is not true treatment resistance, but a mismatch between standard psychopharmacology and the neurobiology of …
Why psychiatric medications often fail autistic patients
I used to think health care finance was mostly about numbers. Then I worked inside the financial operations of a health care organization and realized how much patient care depends on systems most people never see. One experience has stayed with me ever since.
A claim for care that had already been provided was sitting in a billing backlog, approaching the payer’s filing deadline. The treatment had been completed. The staff …
Missed claims filing deadlines threaten patient care
Emergency medicine is exciting, at least, that is the story we tell. It is so exciting that there are entire television (TV) shows built around it. Resuscitations, critical illness. And medical mysteries we get the first crack at solving. That is what draws people in. It is what drew me in. But the truth is, real emergency medicine does not look like television. After medical school and residency, after the …
Point-of-care ultrasound transforms emergency medicine
If the quality of health care was the only major determining factor of health outcomes, then the healthiest cities in the U.S. would simply be those with the best health care facilities. Recent national rankings of city health status, based on composite measures of health care access, food environment, physical activity, and built infrastructure, reveal a different reality. The cities that perform best are those where health is structurally …
Health outcomes rely on more than just health care
It is 2:17 a.m. in a crowded emergency room. A patient is rushed in. The patient is unconscious, unstable, and rapidly deteriorating. There is no time to obtain a detailed medical history, no opportunity for a careful discussion of risks, and obviously no time to seek consent. The doctor decides to take immediate action which saves the patient’s life. Weeks pass. The same doctor is served with a lawsuit.
At first …
Medical malpractice risks persist even after saving a life
There is a part of nursing we do not talk about. Not in school. Not in orientation. Not even with each other most of the time. It is the part where you learn to function in environments where violence, whether real or threatened, becomes part of the job. And over time, you start to notice something: You are not reacting to the stress the way you used to, and you …
Nursing violence causes silent and painful cumulative stress
There is a quiet but growing discomfort among physicians working at the intersection of clinical care and aesthetic medicine. It is not about technique. It is not about patient demand. It is about something more fundamental: the pace at which practice is evolving compared to the pace at which evidence is being produced. Over the past decade, aesthetic medicine has expanded rapidly. Procedures once considered niche are now routine, widely …
Aesthetic medicine needs stronger scientific evidence
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What if the real driver of aging isn’t your mitochondria or your telomeres but the tiny capillaries you never think about? Double board-certified emergency and internal medicine physician Kenneth Ro returns to the …
You can’t stent a capillary: Why aging starts in your smallest blood vessels [PODCAST]
The 72-year-old woman sitting in front of me had spent nearly a decade anxious. Not ordinary stress, not fleeting worry, but the kind of chronic physiologic anxiety that hijacks sleep, amplifies rumination, tightens the chest, and slowly shrinks a person’s world. For over eight years, she had been treated with escalating doses of bupropion, eventually reaching 450 mg daily, the maximum recommended dose. And I found myself returning to a …
Psychiatric polypharmacy is a reassessment failure
An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).
What follows is a slightly edited narrative, the story of Kieran Allen, MD. Dr. Allen is from Australia, a psychiatry resident (registrar) at the time of writing. Dr. Allen writes from a different perspective, that of someone with a relapsing and remitting mental illness. He focuses on this for the …
Doctors with mental illness need our care, not silence
Primary care is often described as broken, but that diagnosis misses the real issue. The clinical foundation remains strong. The problem lies in how access to care is designed and delivered.
Primary care isn’t broken; access is.
People can manage nearly every aspect of their lives instantly through technology, yet health care still relies on outdated models that require patients to wait days or even weeks for routine care. This creates frustration …
Primary care access is the real problem, not the system
If you are a physician, you have likely heard the question: “What would you do?” Increasingly, the answer is shaped before you have the chance to speak.
Patients assume that the physician responsible for their care is the one making the decisions. In many cases, that assumption no longer holds.
Modern health care is organized around teams, protocols, and layers of oversight that shape decisions before they reach the bedside. These structures …
Physician autonomy and the hidden curriculum of medicine
An excerpt from Beyond Medicare For All: Cracking the Code of the Healthcare Affordability Crisis.
If our goal is high-quality, comprehensive, affordable health care for all, we must make health care less profitable. If health systems and corporations continue to control health care and their main goal is profit, health costs will continue to rise faster than the ability of society to pay, regardless of any reform efforts.
On the other …
A Medicare for All alternative that keeps insurers in
I am 75 years old, and I can see perfectly. My vision is 20/20. The tests are normal. The symptom is not. The disturbance is monocular, dynamic, and light-based, not structural, not degenerative in any way that current imaging captures. And yet, every day, I see the world through a veil of intrusive light that no one seems willing to investigate.
After months of medical appointments, I have learned a difficult …
Unexplained symptoms require deeper medical curiosity
Hospitals operate around the clock.
Emergencies do not pause at midnight. Sepsis progresses overnight. Stroke symptoms emerge at 3 a.m. Trauma arrives unannounced. Respiratory failure does not respect business hours. While much of the world sleeps, health care professionals continue making high-stakes decisions in ICUs, emergency departments, labor floors, hospital wards, and operating rooms across the country.
Yet there remains a conversation health care systems are still largely avoiding: What is the …
How to redesign night shift in health care
I stood knocking at the door of my hospice patient like I did every Monday for the past eight months. A musically talented man in his early 40s was always waiting for my weekly nursing visit, more so for the aspect of socialization. He was diagnosed with colon cancer two years prior and had a colostomy bag, leaving this once vibrant, social, even handsome man a shell of what he …
Clinician grief is a hidden crisis in modern hospice care
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