A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not describing a job. He was describing a sentence he had to serve.
That word, trapped, comes up more than exhaustion does.
This piece is about that feeling and what the evidence actually …
Physician autonomy predicts who leaves, not exhaustion
I have spent years in front of cameras. Fashion events, interviews, photographs, social media, and meetings are part of my professional life, so I have always been conscious of my smile. I wanted it to look beautiful, modern, and natural, not like a row of extremely white, identical teeth. I wanted a smile that suited my face and made me feel confident whenever I laughed, spoke, or saw myself in …
Cosmetic dentistry abroad is not about the lowest price
California’s SB 903 cleared the legislature on August 31, with the Assembly concurring in Senate amendments by a vote of 40 to 0. It now sits on Governor Newsom’s desk. Assuming he signs it, it’s a real, needed law: It bars companies from advertising AI products as “therapy,” and it puts disclosure, consent, and human-oversight requirements around AI used inside licensed clinical care.
When I wrote about this bill back …
Why the AI therapy law will not protect your patients
This summer has offered a compelling case study on why there’s a pressing need for the emerging field of climate medicine and what the medical system must prepare for in the years ahead as extreme heat waves, powerful storms, and out-of-control wildfires become the norm. While commonplace in the West, wildfire smoke has once again drifted in from Canada to reach the East Coast. Catastrophic flooding has devastated …
Climate medicine deserves the seriousness we gave HIV
I vividly recall the expression on Tim’s face during his initial visit to my exam room. Rather than relief, he exhibited suspicion. After enduring years of chronic pain, Tim had been referred to me, an interventional physiatrist, and had come to perceive a referral to “pain management” not as an opportunity for assistance, but as a judgment. He feared I would regard him not as a patient in need, but …
Why a pain management referral feels like an accusation
Health care’s relationship with artificial intelligence (AI) often swings between two extremes: enthusiasm and anxiety. On one hand, AI is helping clinicians reduce administrative work, uncover relevant information buried in medical records, and identify opportunities to improve patient care. On the other, regulators are becoming increasingly concerned about how AI is used in high-stakes decisions that affect payment, compliance, and patient outcomes.
In February 2026, the Office of Inspector General …
Can AI in risk adjustment be trusted to code accurately?
A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient’s face changes. The staffer wasn’t hired for this conversation and doesn’t have much beyond “that’s what the system says you owe.”
This exact scene runs in practices everywhere, multiple times a day, and almost nobody standing at that desk was ever specifically trained …
Patient balance collection is nobody’s actual job
It has been 30 years since the term “hospitalist” was introduced, and while the specialty has grown into one of the fastest-growing medical specialties in the United States, it now faces a defining inflection point. Excessive bureaucratic tasks, financial pressures, escalating documentation demands, and the growing burden of electronic health records (EHRs) are often cited as primary drivers of burnout, affecting over one-third of hospitalists. As an example, hospitalists spend …
AI in hospital medicine can give hospitalists time back
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A resident read a student’s personal statement and asked why she didn’t just use ChatGPT. The comment landed like a wound. In this episode, certified coach and professor Kathleen Muldoon returns to unpack …
She spent weeks on her personal statement. Then someone asked why she didn’t use AI. [PODCAST]
Last summer I received a $9,000 bill for an overnight hospital stay that I probably could have done without, medically speaking. It started two days earlier, when I went in for a prostate biopsy. Mind you, this was my third biopsy and each one, including this one, turned out to be negative. Nevertheless, my doctor keeps asking me to undergo these invasive …
Not medically necessary: the three words that cost me $9,000
I have some version of the same conversation every week now. A patient is starting semaglutide or tirzepatide, and partway through the visit they ask the question I suspect most of us are hearing constantly: What happens if I ever stop?
For a while I gave the honest-but-incomplete answer, that we’d cross that bridge when we got there. I don’t anymore, because I think the real answer has less to do …
GLP-1 weight regain: We are funding the wrong half
For decades, stroke survivors have been told the same thing: Whatever function you haven’t recovered in six months, you likely never will. That assumption is now being dismantled. The American Stroke Association estimates that 1 in 4 American adults will experience stroke in their lifetime, often with devastating consequences. The 2011-2018 National Health and Nutrition Examination Survey estimated approximately 5.7 million U.S. adults living with at least one disability due …
Is chronic stroke recovery really capped at 6 months?
When a chatbot agrees with something false, it rarely has to lie to do it.
That’s the finding from a new MIT-affiliated study modeling how sycophancy compounds over a conversation. Researchers built a Bayesian simulation running 10,000 conversations across 11 levels of chatbot agreeableness. At the highest sycophancy setting, roughly half of simulated users ended the conversation at 99 percent confidence in a belief that was demonstrably false. When the …
Is chatbot sycophancy dangerous for psychotic patients?
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Today, less than half of rural hospitals in the U.S. still offer labor and delivery services, and since 2020, 139 of them have stopped delivering babies altogether. That is usually treated as a public health statistic. It is also an economic one. Each closure does not just push expectant mothers into longer drives to the hospital, it pushes out physicians, jobs, young families, and the investment that follows them. So, …
What maternity care deserts cost a town
It sounds like a ridiculous question. Until you’re a doctor with a social media following and you know the parents of the child you’re worried about are watching.
Before COVID, I loved the spontaneous, ridiculous moments that broke up the intensity of hospital life. Flash mobs with nurses. Dancing with OR staff. Laughing with ICU doctors. Small moments of silliness among people doing very serious work.
Then COVID hit, and the dancing …
The question doctors on social media should ask first
They met in the U.S. Army and fell in love instantly. Though they went their separate paths, they both had brief but failed marriages and then reunited. It was a second marriage for both of them as they muddled through their previous baggage from their first marriages.
He was a captain in the Army, 6 feet tall. She was a 5’2″ petite, bright, and smart medic. They clicked quickly and reconnected. …
Alzheimer’s paranoia and the gun nobody locked up
I’d really like to talk with my fellow women.
There is a courtroom in Plymouth, Massachusetts where a jury is deciding whether a mother is criminally responsible for the deaths of her three children. This mother was a labor and delivery nurse. She had a five-year-old, a three-year-old, and an eight-month-old. Her defense says she was in the grip of postpartum psychosis. The prosecution says she knew exactly what she was …
Maternal mental health and the myth of endurance
Halfway through our dry run, we paused in the boardroom of a national health insurance company. Talking points refined. Slides polished. Empty chairs at empty tables, staring back at us. I didn’t linger on the silence then. Now, as a medical student, I cannot escape it. Because empty chairs look different here. Perhaps, they reflect the same fracture that plagues the reality of patients, providers, employers, and payors caught within …
Why employer-sponsored insurance fails your employees
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At one university, the share of students receiving disability accommodations rose sevenfold in a decade. Is that progress? In this episode, health care educator and patient advocate Richard A. Lawhern argues that psychiatric …
Why overdiagnosis is failing the students it claims to help [PODCAST]
I had been driving for fourteen years before I moved to the United Kingdom two years ago. Back home in Malaysia, driving had become almost instinctive. It was something I rarely thought about. But moving countries meant starting over. To continue working as a community psychiatry registrar, I needed a U.K. driving license.
Twice I took the practical driving test. Twice I failed. I could spend hours dissecting the examiner’s decisions, …
How a failed driving test shook my confidence in medicine
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