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What keeps millions of people from sitting in a dentist’s chair, even when modern technology has made procedures more comfortable than ever? Kaushal Shah is a general dentist and dental director managing multiple …
Why your patient’s biggest barrier isn’t pain. It’s walking through the door. [PODCAST]
There is a danger in being good at holding everything together. People start to believe you do not need holding. Competence becomes camouflage. Reliability becomes a cage. And one day you wake up realizing you have become the infrastructure of a life that no one is helping you carry. For those who thought they could carry everything alone, I have realized there comes a time when a “foreclosure notice” may …
Emotional over-functioning drives the competence trap
An excerpt from Lifeline: What To Do After A Mental Health Crisis.
I have spent over two decades in emergency medicine. I know what a mental health crisis looks like. I know the clinical signs, the language, the interventions. I have initiated more psychiatric holds than I can count, written discharge summaries for people leaving my ER with a handful of pamphlets and a follow-up appointment I quietly hoped they …
Physician depression doesn’t always look like depression
“Are you retired yet?”
The question caught me off guard. It was not the query itself, I have reached my mid-60s, after all, but the underlying assumption it carried. Having practiced for over three decades, I found myself momentarily silenced by a word that feels entirely foreign to my current internal state.
As a psychiatrist, I have spent a lifetime listening to the narratives of others. Now, I find my own narrative …
Physician retirement is a myth for the ripening doctor
A 59-year-old woman sat tearfully in my office today. She had spent seven weeks on tirzepatide with virtually no weight loss. “How is this possible?” she asked. “I’m eating like a saint.”
She had struggled with obesity and weight-related frustration for years. Recently divorced, grieving a death in the family, caring for a mentally ill adult daughter, working full time, sleeping poorly, and living with severe anxiety, she described her stress …
When GLP-1 doesn’t work, look at chronic stress
A set of medical malpractice cases can be presented as examples of a legal strategy that may undermine a fair trial. In Case A v. Medical Center A, a 16-year-old girl conceives in and lives in a developing country until 17 weeks of gestation and receives no prenatal care until 20 weeks of gestation, when she arrives in the United States. At that time, she is found to have chlamydia.
Other …
How a diversionary legal strategy harms medical malpractice
An apology after medical harm still matters, but perhaps not for the reasons medicine once believed.
For a long time, medicine saw apologizing after a bad outcome as risky or, at best, a way to protect oneself. Doctors were told to say as little as possible: Avoid guessing, don’t admit fault, and don’t apologize. This made sense in a legal system where lawsuits are common. But after a serious mistake, staying …
Medical apology laws don’t reduce malpractice lawsuits
A new federal Health Care Advisory Committee has been announced to guide policy for Medicare, Medicaid, and other major health programs. Its mission is ambitious: improve outcomes, modernize care, and address the growing burden of chronic disease.
But there is a glaring omission. Not one independent, private practice physician, someone who manages chronic illness in the community every day, is represented. That is striking because at least one-quarter of all physicians …
Independent physicians are missing from health care policy
Nobody in my residency program would have predicted I’d end up in venture capital. Certainly not me.
I immigrated to the United States from India with a straightforward plan: become the best physician-scientist I could and build a career in academic medicine. For the first chapter of my professional life, that’s exactly what I did. I trained in internal medicine, published over 100 peer-reviewed papers including in the New England Journal …
Physicians in venture capital see what others miss
Physicians make the worst patients. Not because we are demanding or entitled, but because we know exactly what is happening behind the curtain. We know when a delay is avoidable. We know when a clinician is being rushed. We know when a decision is being shaped by billing codes rather than clinical judgment. And we know when a system is quietly failing us, the same system we once defended, taught, …
Why corporate medicine fails every physician-patient
There are moments in medicine when the entire architecture of modern health care reveals both its brilliance and its limitations at the same time.
Years ago, a familiar face appeared quietly in our treatment room, though diminished enough that several people did not recognize him immediately. He had once been the life of every room he entered, effortlessly social, funny, alive in the particular way some people seem born carrying light …
Continuity of care in HIV/AIDS lives in the people who stay
This photo shows one of my patients’ children. (I am sharing the photo with the family’s consent.) Can you guess the secret behind this photo? Let me tell you about the background.
The difficult diagnosis of pregnancy-associated breast cancer
Mrs. U was in her first trimester of pregnancy when she discovered a lump in her right breast. Work-up revealed that it was a highly …
The tragic reality of pregnancy-associated breast cancer
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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
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