Direct primary care vs psychotherapy models: Why they aren’t interchangeable

Physician
December 23, 2025

I read Zoe Crawford’s thoughtful KevinMD essay on the limitations of direct primary care (DPC) with great interest. Her frustration as a medically complex patient navigating a fragmented health care system will resonate with anyone who has struggled to obtain timely imaging, referrals, or specialty care. As a clinician who has spent a career thinking and writing about how health systems fail both patients and physicians, I agree with …

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Direct primary care vs psychotherapy models: Why they aren’t interchangeable

The hidden depth of the rural primary care shortage

Physician
December 23, 2025

Today I am a urologist, a cardiologist, a psychiatrist, a rheumatologist. But truly, I am a rural family medicine doctor in one of the most underserved counties in the country. And I am tired.

I do not pretend to have the depth of each specialist. What I have is necessity, a toolkit built on scarcity. Practicing medicine on an island, where specialists are rare, calendars are full for months, and visiting …

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The hidden depth of the rural primary care shortage

When hospitals act like platforms, clinicians become content

Conditions and Diseases
December 23, 2025

For years, hospitals have been urged to modernize. We are told to digitize workflows, optimize performance, and rely on dashboards and algorithms to improve efficiency. Much of this advice is reasonable. Medicine cannot function without systems.

But recently, while observing hospital transformation from within, I began to feel a familiar unease, one I had encountered before outside of medicine.

It reminded me of how digital platforms operate.

Platforms are not inherently unethical. They …

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When hospitals act like platforms, clinicians become content

Preventing physician burnout: an educational approach

Physician
December 23, 2025

The frequency and severity of physician burnout have resulted in an epidemic that is impairing the American health care delivery system. Herbert Freudenberger coined the term burnout in 1977, referring to a syndrome characterized by emotional exhaustion, depersonalization or cynicism, and a lack of personal accomplishment. He noted that burnout reduced health care workers’ ability to provide excellent patient care and adversely affected their well-being.

Physician burnout is rampant in the …

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Preventing physician burnout: an educational approach

Why high-quality embryos sometimes fail to implant [PODCAST]

Podcast
December 22, 2025
YouTube video

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Double board-certified obstetrician-gynecologist and reproductive endocrinology and infertility specialist Erica Bove discusses her article, “Why do high-quality IVF embryos fail.” Erica explores the heartbreaking reality of recurrent implantation failure, challenging the assumption …

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Why high-quality embryos sometimes fail to implant [PODCAST]

The risk of diagnostic ideology in child psychiatry

Conditions and Diseases
December 22, 2025

Adapted from Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity. (Penguin Random House Canada/Signal, 2025.)

February 1992. I’m in the consulting-room side of a one-way mirror divide. Opposite us in the room are four people: thirteen-year-old Sofia, her older sister Julieta, and their mother and father. The parents speak with a strong Spanish accent. The girls’ mother has an anxious look on her face. She …

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The risk of diagnostic ideology in child psychiatry

The blind men and the elephant: a parable for modern pain management

Conditions and Diseases
December 22, 2025

Most of us have heard the ancient Indian and Buddhist parable “the blind men and the elephant.” Regardless of source, the parable usually contains these elements:

A ruler assembles several blind men and brings an elephant before them. One feels the head and says the elephant is like a pot; another the ear and says it is like a fan; another the leg and says it is like a pillar; another …

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The blind men and the elephant: a parable for modern pain management

L-theanine for stress and cognition

Medications
December 22, 2025

As a medical student, I’ve seen firsthand how stress and cognitive overload can wear people down, both in patients and in myself. During one particularly difficult exam block, a friend casually mentioned L-theanine, a supplement found in green tea, that supposedly helps with focus and calm. That got me curious: Was this just hype, or is there actually something to it?

So I took a closer look at the research.

L-theanine is …

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L-theanine for stress and cognition

The political selectivity of medical freedom: a double standard

Health Policy
December 22, 2025

I’ve been thinking about “choice” a lot lately, not the rich, ethically grounded version we teach in medical school, rooted in autonomy, informed consent, and shared decision-making, but a thinner, more selective version now circulating in political and legal discourse. The kind that sounds principled until you read the fine print.

The message goes like this: You may choose, just make sure you choose correctly.

It’s the literary equivalent of Animal Farm: …

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The political selectivity of medical freedom: a double standard

The AI innovation-access gap in medicine

Medications
December 22, 2025

Artificial intelligence has transformed pharmaceutical science more rapidly than any other part of health care. AI can now:

  • Identify molecular targets faster than human researchers
  • Compress early discovery timelines from years to months
  • Simulate how millions of compounds might behave in the body
  • Predict toxicity or poor efficacy before a drug is ever synthesized
  • Help design personalized therapies built on real-world clinical data

Recent analyses in Drug Discovery Today and …

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The AI innovation-access gap in medicine

Leadership buy-in is the key to preventing burnout [PODCAST]

Podcast
December 21, 2025
YouTube video

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Physician advocate and physical therapist Kim Downey and counselor Shari Morin-Degel discuss their article, “Why burnout prevention starts with leadership.” Shari shares her personal journey from a trauma-exposed mental health professional to …

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Leadership buy-in is the key to preventing burnout [PODCAST]

A daughter’s reflection on life, death, and pancreatic cancer

Conditions and Diseases
December 21, 2025

She was a rocker. She loved the Doors, Pink Floyd, Mick Jagger, Led Zeppelin, and Bob Dylan.

She led a quiet life growing up. She was the “invisible child” among her siblings. They all had their labels in this household.

Progressively moving up the executive ladder as her daddy deteriorated (no longer a functional alcoholic), her mommy was distant and negligent and tended to care only for herself: designer clothes, perfect hairdo.

Mary …

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A daughter’s reflection on life, death, and pancreatic cancer

What to do if your lab results are borderline

Conditions and Diseases
December 21, 2025

Every week in clinic, I meet patients who carry lab results like heavy burdens. Their cholesterol is “slightly high,” their thyroid level is “borderline,” or their blood sugar is “just above normal.” They arrive anxious, wanting certainty: Do I need treatment? Am I sick?

The truth is, much of medicine exists in the gray zone (values that are not clearly normal, but not clearly dangerous either).

What the research tells us

Borderline numbers …

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What to do if your lab results are borderline

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Direct primary care limitations for complex patients

Conditions and Diseases
December 21, 2025

All of the arguments for direct primary care (DPC) from a provider perspective are valid. As a psychotherapist and psychoanalyst, I have essentially run a direct care practice for the last 15 years. I don’t accept insurance and see patients as often and for as long as therapeutically necessary. So when DPC practices started rising in popularity, I was excited to try it. Unfortunately, as a patient who is medically …

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Direct primary care limitations for complex patients

Understanding the unseen role of back-to-school diagnostics [PODCAST]

Podcast
December 20, 2025
YouTube video

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Health care executive Kevin King discusses his article, “How to stay safe from back-to-school illnesses.” Kevin explains why the return to classrooms often triggers a surge in respiratory illnesses (like the flu, …

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Understanding the unseen role of back-to-school diagnostics [PODCAST]

Public violence as a health system failure and mental health signal

Conditions and Diseases
December 20, 2025

On a winter evening in Taipei, random violence erupted across two of the city’s busiest metro stations. Within minutes, lives were lost, dozens were injured, and a familiar cycle followed: shock, fear, calls for more security, and questions about public safety. But for those of us in health care, this should not be framed as a failure of policing alone. It should be recognized for what it truly is: a …

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Public violence as a health system failure and mental health signal

Physician asset protection: a guide to entity strategy

Physician Finance
December 20, 2025

A few years ago, I met a talented internist who had been practicing for 15 years. She owned a small clinic, worked long hours, and ran a thriving patient base, but when we reviewed her financials, I realized she’d been paying far more in taxes and taking far more risk than she needed to.

Her response was one I hear often: “Clint, I’m not a businessperson; I’m a doctor.”

It’s a mindset …

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Physician asset protection: a guide to entity strategy

Understanding factitious disorder imposed on another and child safety

Conditions and Diseases
December 20, 2025

Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs. The child suffers not only from the caregiver’s direct …

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Understanding factitious disorder imposed on another and child safety

Physician grief and patient loss: Navigating the emotional toll of medicine

Physician
December 20, 2025

“Doc, I’ve seen enough doctors. I only trust you. I want you to do my knee replacement and fix my heart.”

I heard the conviction in his voice when I heard these words from this patient. Sitting across from me was a 76-year-old army veteran I had cared for over two decades. He had seen multiple specialists, endured countless consultations, and, in the end, he wanted me, the physician who had …

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Physician grief and patient loss: Navigating the emotional toll of medicine

Joy in medicine: a new culture

Conditions and Diseases
December 20, 2025

Kelly D. Holder, PhD, and I first met at the Dr. Lorna Breen Heroes Foundation Health Care Worker Well-Being Day in Washington, D.C., where she was a presenter. I was impressed with Kelly’s work, focusing on helping health care professionals and leaders co-create a culture of well-being, which is so critical in medicine today.

This resonates deeply with Sarah Hollander, MD’s belief that the culture of medicine must change, starting in …

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Joy in medicine: a new culture

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