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What if the cure for physician burnout isn’t a wellness workshop but a 10-minute exercise you can do alone in a quiet room? Brian Sayers is a rheumatologist in Austin, Texas, with nearly …
Why a rheumatologist asks every doctor to remember being six years old [PODCAST]
Frontline clinicians work in a paradox. We care for others at their most vulnerable moments, yet we struggle to admit our own vulnerability. We recognize pain in patients, but we may miss it in the colleague working with us. We respond quickly to patients’ clinical deterioration, but we ignore our emotional deterioration until it becomes dangerous.
Frontline clinician suicide is not only an individual tragedy. It is also a workplace warning …
Clinician peer support is a patient safety issue
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. …
Normal labs miss what most patients are living through
My mother died recently. I received the death certificate. I disagree with her cause of death. The doctor who completed her worksheet did not know her well. The death certificate has a diagnosis that she never had that was handed down from her previous doctor. It omitted a long-standing, chronic disease. Why am I bothered? Because I would complete death certificates on a routine basis, for I am a hospice …
Death certificate errors expose flawed medical history
Bone loss is one of the most predictable surprises in medicine.
It is predictable because the risk factors are everywhere: menopause, aging, low muscle, low protein intake, steroid exposure, inflammatory disease, low sex hormones, diabetes, smoking, alcohol, thyroid disease, malabsorption, kidney disease, eating disorders, and medications that quietly affect bone. It is a surprise because many patients do not know there is a problem until something breaks. That is not prevention. …
Early bone loss is missed until something breaks
When a patient walks into my office after five failed antibiotic courses, the first thing that goes through my mind isn’t clinical. It’s human. I’m worried about what happened to the healthy bacteria in her nose, the protective organisms that have been defending her sinuses since the day she was born. I’m worried about her gut. And honestly, I’m worried about something bigger than both: the generations of kids and …
Recurrent sinus infections leave damage beyond your sinuses
Key issues in California’s health care system highlight some structural problems that hit patients, doctors, and communities hard. These aren’t abstract policy debates; they are day-to-day realities in pain management, chronic care, and everyday practice. Core issues, which were pulled from the previously published articles, include but are not limited to:
How gold cards can drive California pain management reform
The primary care crisis has been well documented. Experts cite low pay, lack of respect and administrative burden, all of which have contributed to burnout and a growing shortage of primary care physicians (PCPs). But even if we solve those problems, are PCPs well-prepared to care for an increasingly older, sicker population saddled with psychiatric disease? For many PCPs practicing today, the answer is no. There are myriad reasons for …
Primary care crisis requires new training and skills
The extra 90 days is not a rounding error
A 90-day credentialing timeline and a 180-day credentialing timeline can sound like two versions of the same problem. They are not. The second version can mean another quarter of rent, software, malpractice coverage, staff time, loan payments, marketing spend, and owner compensation before the practice can bill a major payer.
For a typical primary care startup, 90 additional days of fixed costs can …
3 reasons credentialing delays push past 90 days
She came back three weeks later, sicker. She had been seeing a physical therapist for her lower back pain. At her last visit she mentioned that her cough was getting worse. He said nothing, and she did not push it. She assumed if it mattered, he would have said so.
What she did not know was that she had been told she was seeing “the doctor.” Not a physical therapist. The …
Institutional misrepresentation harms vulnerable patients
Most young physicians enter medicine with a sincere desire to help people. They expect long hours, difficult training, and personal sacrifice. What many do not expect is how profoundly the environment around them will shape not only how they practice medicine, but who they become.
Medicine teaches many things that never appear on a syllabus. A resident quickly learns which patient encounters generate complaints, portal messages, administrative scrutiny, or poor satisfaction …
Moral injury in medicine goes beyond simple burnout
Most clinicians give little thought to ethics and law until something goes wrong. This is understandable. They are immersed in concrete clinical tasks, ordering tests, reading reports, examining patients, and running clinics. Ethics can feel abstract and legal rules distant from daily practice.
As an ethicist and trial attorney, I see the consequences of ethical error every week. They can harm patients, erode trust in the profession, and destroy promising careers. …
Why clinical ethics and medical law demand your attention
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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
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