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Former Treasurer of the American College of Physicians Janet A. Jokela discusses the article “The service of humanity: Recommitting to physicians’ ethical duties.” Janet reflects on her visit to the Ronald Reagan …
Reclaiming human dignity as the foundation of medical practice [PODCAST]
A little boy shuffles down the hallway in his yellow hospital-issued socks, completing yet another lap around the unit. You would never guess that he has leukemia, a blur of dark hair and restless energy. In many ways, he is the healthiest child on the pediatric oncology floor. Today marks his twentieth consecutive day in the hospital. Yet he does not have to be here to receive the drug he …
The pediatric home health system is failing children with cancer
Your patient stops showing up for follow-ups. They are rationing medications you prescribed. They cannot afford the specialist you referred them to.
You assume it is financial stress or insurance issues, but it could simply be due to what is missing from your chart notes, a pattern that is especially common among military veterans navigating disability benefits.
After more than 20 years in clinical practice serving patients with disabilities, including many military …
How your clinical notes impact military veterans’ disability benefits
Imagine a 54-year-old construction worker named Mike living with debilitating chronic lower back pain after years on the job. His doctor recommends a targeted epidural steroid injection and a short course of physical therapy combined with a non-opioid medication that has helped many patients in similar situations regain function and avoid surgery. But the insurance company says no. First, Mike must try cheaper generic pain pills that barely touch his …
How prior authorization and step therapy harm pain management
I really tried to have AI come up with an innocuous-sounding title for this piece: “Caring Hearts, Lighter Wallets: The Financial Reality of Primary Care.” But my poor judgment prevailed so I just decided to insult all of my colleagues right from the start. I assure you, for better or worse, that this article is my original opinion although with AI editing for grammar and clarity (but unfortunately not brevity). …
Many physicians do not talk about this openly, but at some point in their careers, a quiet question begins to surface: Is this really what it is supposed to feel like? After years, often decades, of training, sacrifice, and dedication, all of us as primary care physicians find ourselves in a position that, on paper, looks successful. We are caring for thousands of patients, maintaining full schedules, and carrying immense …
Overcoming physician burnout with a new care model
Today I received a call from my son’s school informing me that he had been suspended for injuring his teacher and hurting another staff member. The week prior, I had received multiple calls requesting that I pick him up early due to escalating behaviors.
My story is not unique. Across the country, parents of children with autism navigate aggressive outbursts, elopement, self-harm, and school suspensions. We juggle IEP meetings, medication adjustments, …
When the doctor is also the patient’s mom: Navigating severe autism
Many clinicians recall cases that stand out not for their diagnostic complexity, but for their ethical dilemmas. One such experience involved a long-time patient, a devout Catholic in his 70s, who asked if donating his body to science conflicted with his church’s teachings.
For years, I have displayed a favorite prayer on a poster in my office called “Prayer of the Catholic Physician.” This display gave my patient the opening to …
How ethical dilemmas in medicine affect body donation
The American education system was not designed to produce scientists; it was designed to produce “interchangeable parts.” Frederick Gates, the architect of the Rockefeller-funded General Education Board, famously stated: “I do not want a nation of thinkers, I want a nation of workers.” While we like to imagine medical education has evolved, the reality is that our high-stakes testing, from the GRE to the USMLE, serves as a high-fidelity filter …
Why standardized medical exams filter for compliant workers
The second time I landed in the U.K., the dream felt different. My first trip was for an exam; this time, it was for good. I walked into the arrivals hall with two bags. One was a worn suitcase packed with stethoscopes and textbooks. The other was invisible but far heavier, filled with my parents’ hopes and my wife’s unwavering faith.
In the bustling chaos of the international boarding area, after …
Finding purpose as an international medical graduate in the U.K.
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Family physician, medical device inventor, and health care entrepreneur Tod Stillson discusses the article “AI governance in health care: Why physicians must lead the design.” Tod warns that the greatest threat to …
Why physicians must lead the design of artificial intelligence in health care [PODCAST]
In an increasingly globalized world, pathogens travel faster than ever before. Commercial aviation connects remote villages to major metropolitan hubs in less than a day. Supply chains stretch across continents. Climate change is expanding the geographic range of disease-carrying animals and insects. Against this backdrop, the decision by the United States to withdraw from the World Health Organization (WHO) is not merely short-sighted, it is strategically misguided and frankly dangerous.
Global …
Global health security and WHO: Why U.S. withdrawal is dangerous
Sleep is a commonly overlooked aspect of women’s health, yet its absence is quietly taking a toll on millions of lives. Caregiving responsibilities, hormonal shifts, and the relentless mental load of modern life leave women uniquely vulnerable to poor sleep. For many women, poor sleep and feeling tired is seen as normal or expected. Cultural and clinical stigmas often discourage women from seeking help, with many being told …
Why women’s sleep struggles are often dismissed, misdiagnosed, or overshadowed
Health care initiatives will not succeed on policy language alone. They must work in patients’ daily lives. That means helping patients take medications correctly, monitor symptoms early, comply with treatment plans, recover safely after procedures, and stay engaged in long-term behavior change. Persuasive technologies are designed to help people adopt and keep using digital or other products. The best persuasive technologies for modern or value-based health care are not the …
Using persuasive technologies in value-based health care
Previously, I urged readers to use the internet for information about health conditions, medications, and other medical concerns to help make informed decisions about their care. I must modify this based on an online search experience I had that yielded mostly garbage. If I had not known what to seek, I would have been confused, ended my search prematurely, as I expect most people would have, and learned nothing.
To simplify …
How to find reliable online health information and avoid medical misinformation
For much of modern American medicine, we operated with an unspoken assumption: Resources would expand to meet demand. If complexity grew, we added specialists. If volume increased, we built. If margins tightened, we layered new reimbursement strategies. That operating model now feels more like an illusion.
Workforce shortages, supply chain instability, climate disruption, and rising costs have made constraint structural rather than episodic. We are practicing in a globally interdependent system …
Overcoming resource constraints in American medicine
Perhaps the time has arrived to view the clinical practice of medicine differently. The practitioners are now broadly identified either as primary care providers or specialists. Specialty care is more easily defined, but whether such care is used appropriately is another question.
Primary care now includes pediatrics, internal medicine, and family practice with an increasing number of physician extenders, nurse practitioners, and physician assistants. Primary care has transitioned into something quite …
Why we need a new medical specialty to fix corporate medicine
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Pediatric hematology-oncology physician and co-founder of Pink Coat, MD Tammie Chang discusses the article “Unhooking from the ego in medicine.” Tammie shares her personal journey through depression and clinical burnout, explaining how …
Finding peace by unhooking from ego and achieving a loving presence in medicine [PODCAST]
When actor John Davidson, who has Tourette’s syndrome, reportedly uttered a racial slur during the British Academy of Film and Television Arts (BAFTA) ceremony, the public reaction was swift and emotionally charged. For many people, the involuntary outburst reflected true feelings or a subconscious racial bias. However, that is not the case with certain forms of Tourette’s.
Coprolalia, the involuntary expression of socially inappropriate or taboo words, is among the most …
Coprolalia and Tourette syndrome: Understanding involuntary vocal tics
I have sat in a lot of rooms where smart, well-meaning people puzzle over why American medicine keeps producing the same outcomes: Too few doctors in too many places, primary care is underfunded, and rural hospitals are consistently closing. The answer, frustrating as it is, comes down to a single systems principle: Every system is perfectly designed to get the results it gets. By that standard, we should not be …
How medical education debt drives the physician shortage
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