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What happens when you match into a residency but it still feels like a loss? Kathleen Muldoon is a coach and medical educator with 20 years of experience partnering with medical students through …
When what’s in the envelope doesn’t match what you expected [PODCAST]
Health care-associated infections (HAIs), including Clostridioides difficile infection (CDI), Candida auris, and multidrug-resistant organisms (MDROs), persist as significant challenges for U.S. hospitals despite advancements in infection management, environmental cleaning, and isolation protocols. These infections pose a huge threat to patients and health care staff. But at the bedside, there is one persistent issue that seems more overwhelming and messier than other protocols dealing with fecal incontinence in critically ill patients …
How fecal incontinence impacts infection prevention today
I sometimes find myself reflecting when my well-cited journal articles begin to show a decline, whether gradual or sudden. In academic medicine, citations have become a form of currency, used not only to trace ideas but also to measure worth. Yet what gets cited is not always what matters most. In biomedical research, citations support arguments and help measure impact. In principle, they show how knowledge develops over time. In …
How citation metrics reshape modern academic medicine
She was already seated when I walked in. On the desk in front of her sat a large sleeve, the kind that holds imaging films, oversized and awkward, the kind that no longer fits in a folder or a binder or anywhere in a modern clinic. Beside it was a folder. Labs indexed by specialist and date. Notes from orthopedics, neurology, rheumatology, pain management, and physical therapy. Every test, every …
The referral trap: How specialization fragments care
As a physician managing patients with chronic pain in California, I’ve witnessed the tension between necessary regulations and the daily reality of helping people in genuine distress. In the meantime, as a chairman for the National Campaign to Protect People in Pain (NCP3), I know how important it is to advocate for our patients. While foundational reviews on prescription drug oversight provide helpful context on opioids and NSAIDs (for details, …
California opioid prescribing: What the data actually shows
Whether parent coaching is getting delivered formally, through parent behavior training programs, or informally, through evidence-based parenting advice and recommendations shared in clinic with the family, parent coaching has become an essential part of clinical care today, both in general and in subspecialized pediatric clinics. The American Academy of Pediatrics (AAP) recommends anticipatory parenting guidance to be provided starting at the first visit. The AAP also recommends that pediatric health …
How cultural competence transforms modern parent coaching
While excellent guides exist for research topic discovery or planning, and finding suitable journals for publication, a short practical checklist to help trainees determine if a project proposal is a great fit is useful (see the checklist below). Here, I outline items to consider before you commit to a project and provide my take on two main categories of topics: 1) those where a single NO generally should lead to …
A 20-item checklist for trainee research projects
10 years ago, I met a local news health reporter at my cousin’s house. By then, I had been a general surgery attending for almost a decade and was shocked by the lack of public health education about anal health care issues. I had also amassed a particularly busy proctology clinic over the years, seeing patient after patient who had suffered for extended periods, afraid to see a doctor and …
How anal health education helps detect anal cancer
Policy changes eventually become operating decisions
Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain services, then asks the obvious question: How much revenue is at risk?
That question matters, but it is not the only operator question. Medicare practice expense and related Physician Fee Schedule changes also affect the billing-service decision. If the practice outsources billing, the policy change does not …
How Medicare changes affect medical billing contracts
Randy McNeely: We are never more vulnerable than in the moments when life delivers news we did not expect, and are not prepared to hear. That moment came for my wife and me in early August 2023.
A few weeks earlier, Kimberly was helping our daughter move a small chest freezer when she felt a sharp twinge in her right thigh. It seemed like a pulled muscle, so she treated it …
Compassionate health care transforms the patient journey
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Why do patients refuse statins backed by decades of data in millions of people yet eagerly inject peptides tested in fewer than 20? Emergency medicine physician and longevity practitioner Vikas Patel confronts this …
14 patients studied, thousands injecting: the peptide evidence gap [PODCAST]
Crypto. Bitcoin. Gold. Every few years, a new wave of thinking challenges the traditional dominance of the dollar. People look for alternative stores of value, something more stable, more independent, or more future-facing. But while everyone is debating what the next currency might be, we are overlooking the one that is already here, quietly gaining power behind the scenes: data. As artificial intelligence (AI), machine learning, and digital infrastructure continue …
How data monetization acts as a new digital currency
My patients don’t wait for me anymore. That’s not a complaint. It’s a clinical reality I had to sit with before I could do anything useful about it.
Patients started arriving at appointments having already run their symptoms through an AI chatbot. Sometimes they’d decided not to come in at all. Sometimes they were right. Sometimes they weren’t. I’ve spent the last several years building an AI-assisted triage and treat virtual …
AI chatbots and patient safety need physician design
Before the imaging, the lab work, or the referral, there is a moment when the body is already speaking.
The way someone walks into the room. The hesitation before sitting down. The guarded turn of a shoulder. The subtle shift away from one hip before pain is ever described.
Medicine once placed enormous value on these observations. Observation was not separate from diagnosis; it was the beginning of it.
Sherlock Holmes famously suggested …
Reclaiming the lost art of the physical exam
A little-known and misunderstood disease affecting as many as 12 million Americans, putting them at risk of potentially deadly complications, is often missed or misdiagnosed.
Primary aldosteronism (PA) is a serious condition that affects as many as 5 to 10 percent of adults with high blood pressure (BP). High BP is widely prevalent in the U.S., nearly half of all adults (almost 120 million individuals) have it. Yet, for many years, …
Primary aldosteronism hides behind high blood pressure
Thirty years ago, I ran a cardiac arrest in the operating room. The patient survived. The room eventually quieted down. The nurses began cleaning up. People moved on to the next case.
But I remember standing there afterward feeling exhausted and unsettled. It had been several months since my ACLS recertification, and during the code I caught myself mentally reaching for details of the algorithm that had once felt automatic. I …
Cognitive overload in cardiac arrest is a human problem
The week of Thanksgiving, my dad drove my mom to the emergency room for stomach pain so severe she could not stand up straight. Three days of tests. Specialists rotating in and out. No clear answer. Then, almost miraculously, she started feeling better on her own. The doctors sent her home on Thanksgiving Day with some pain management and a collective shrug. We sat around the table that night genuinely …
Artificial intelligence can prevent a delayed diagnosis
In a group text with fellow pediatricians, I received a message asking if anyone knew where a child could get a blood draw that was not the emergency room. The question came from a colleague on behalf of another physician friend. She was worried her son might be anemic because of how he looked pale and was unusually fatigued.
She had just switched jobs and her son was not covered yet …
Health insurance coverage loss threatens sick children
“Can we fit just a few more?” This was the question I was asked one snowy evening. Pretty soon, I found myself surrounded by no less than 20 people. They had all convened here to see the man lying in bed at the center of the room. He had struggled with cancer, which had progressed through numerous treatments, leading to his current intubated and sedated state. As an internal medicine …
How cancer care terminology harms patient choices
“I wish I could get a free boob job.”
It is a comment I heard more than once after sharing I was undergoing a double mastectomy. I understand the impulse, people do not know what to say. But the joke reveals something worth examining: how little most people understand about what this surgery actually costs you.
At 28, I found out I carried the breast cancer gene 1 (BRCA1) mutation. At 34, …
Breast cancer rehabilitation requires occupational therapy
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