I still remember the first time I saw what bullying in medicine could do to a physician in training. It was not loud at first. It was not always obvious. It came wrapped in authority, tone, pressure, and the quiet threat that a career could be damaged by people in power. A resident nearing her final year of dermatology training was being bullied by program leadership and others in the …
Confronting the reality of bullying in medicine today
For years, I have heard breast cancer survivors share a common refrain: “I expected to lose my breasts. I did not expect to lose the ability to feel.”
Yet in exam rooms across the country, persistent numbness after mastectomy remains underdiscussed and poorly understood in routine care. It is often framed as an inevitable side effect rather than a life-altering outcome that impacts quality of life after cancer.
We have made tremendous …
Living with numbness after mastectomy: the unseen impact on survivorship
There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced inside for over two decades, saying you believe something that the evidence has not yet fully validated carries consequences. Raised eyebrows at conferences. The careful distance of colleagues. The quiet …
The clinical evidence and reality of peptide therapy
Most emergency departments feel perpetually behind. The waiting room fills, ambulances stack, and staff move quickly yet still feel behind. The reflex explanation everyone gives is capacity. We need more beds, more rooms, more space. That explanation is intuitive. It is also often incomplete.
In many departments, nothing meaningful happens after triage until a patient is placed in a permanent treatment room. No bed means no provider evaluation. No provider evaluation …
The physician-in-triage model and rapid evaluation in emergency medicine
I have treated over 10,000 bariatric patients across my career, and if there is one issue that comes up more than almost anything else, it is protein. Specifically, patients not getting enough of it. The research confirms what I see every day in practice. Only a minority of bariatric patients reach the recommended minimum of 60 grams per day, resulting in the loss of fat-free mass rather than the …
Why bariatric patients struggle with protein and how to fix it
Most internal medicine physicians assume that when they sit for a board examination, their answers determine one thing: whether they pass. Few realize that their exam performance has been linked to federal Medicare claims data and used in research, without their knowledge or consent.
The American Board of Internal Medicine (ABIM) has published studies linking board scores to clinical outcomes derived from Medicare claims. ABIM presents these analyses as quality research …
Why ABIM’s use of Medicare claims data violates physician autonomy
The stethoscope has always been more than a tool for auscultation; it is a physical bond between two human beings that no government has the authority to sever. In early 2026, as the Iranian regime launched a brutal crackdown on its own citizens, we witnessed the most extreme test of this bond. When the state demanded that physicians become extensions of the secret police, our colleagues in Iran chose the …
Iranian physicians in 2026: a testament to medical courage
You tell me it is all in my head.
As though my head were a small room where false alarms
ring for sport,
like I have no better way to spend my time and life.
You hold films up to the light,
of bones and blood,
nothing cracked or out of place,
or a catastrophe waiting in the wings
that has earned a name in your stack of books.
My blood you have drawn
has traveled through your machines
and has …
A patient’s poem on invisible illness and trauma-informed care
A dry cough can be one of the most misleading symptoms in medicine. At home, it can dominate the emotional climate of an entire household. It interrupts sleep, breaks conversations, unsettles meals, and keeps caregivers in a state of low-grade vigilance. It appears in cold air, at the beginning of a speech, during the first few sentences of a phone call, or in the quiet moment when everyone is finally …
How a minor dry cough amplifies caregiver burden in home health care
If you have nagging pain deep in your lower back or one buttock that never seems to settle, you are not alone. Many people chase answers through discs, nerves, or muscles, yet the real source turns out to be the sacroiliac (SI) joint. This connection between the base of your spine and your pelvis is built for stability with just a hint of motion. When it becomes irritated or unstable, …
How to treat sacroiliac joint pain effectively today
I want to tell you something attorneys already know but will never say to your face. When your expert report lands in their inbox and they read it, I mean really read it, they know within the first two paragraphs whether they are calling you again. Not after the case. Right then. And if the answer is no, they do not tell you. They do not give feedback. They do …
Why clinicians fail at writing expert reports
In September 2025, The Atlantic reported on a frenzy surrounding leucovorin, a folate derivative long used in oncology and rheumatology. Families desperate for answers were suddenly told it might be a miracle therapy for autism. Waitlists stretched years, clinics were overwhelmed, and hope surged. The problem was not just scientific, it was political. When President Trump and HHS Secretary Robert F. Kennedy Jr. endorsed leucovorin, they amplified demand …
Leucovorin for autism: Why physicians must protect hope from hype
We are nearing the end of the academic year, and I recently found myself standing in front of a room of first-year medical students offering what I called “observations.” Not punishments. Not a lecture. Observations. And an invitation. Because what I had been seeing was concerning: academic dishonesty, inappropriate use of artificial intelligence (AI), emotional volatility, and a level of disengagement that felt at odds with a curriculum intentionally designed …
Driving medical education reform through intellectual honesty
The internet has made patients more informed. It has also made some patients more misled. A small but growing body of medical commentary has used the provocative label “internet-derived information obstruction treatment (IDIOT)” syndrome to describe what happens when people trust online medical content so blindly that they delay care, stop treatment, self-medicate, or resist sound clinical judgment. The term appears in published reviews and commentaries, but it is not …
How IDIOT syndrome threatens value-based health care
Artificial intelligence is rapidly acquiring a reputation as an unreliable, even dangerous, force in medicine and drug development. Hallucinations, opaque decision-making, and high-profile failures have fueled resistance to its adoption across health care systems. But this backlash reflects not an inherent flaw in AI itself, it reflects how we are choosing to use it.
The dominant mistake is conceptual. We are treating AI as a replacement for human reasoning rather than …
The real problem with AI in medicine and drug development
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Internal medicine and functional medicine physician Shiv K. Goel discusses the article “Why lifestyle matters more than BPC-157 and semaglutide.” Shiv explains how the modern longevity boom has trained patients to seek …
True metabolic healing requires more than just prescribing expensive peptides [PODCAST]
The day I handed in my credentials as medical director, I sat in my car in the parking lot for a long time. I had held that role at Methodist Specialty and Transplant Hospital in San Antonio for years. I had built protocols, chaired committees, mentored residents, and managed crises at hours when the rest of the city slept. I was, by every conventional metric, succeeding. And yet there was …
Why leaving hospital medicine for private practice was worth the risk
These moments of hesitation keep happening to me. I recognize the harm. I can name it clearly. I have seen its effects over and over again with my patients. And yet, when the conversation turns to its cause, I hesitate. Not because I do not understand. Because I am supposed to stay neutral. Medicine has long held neutrality as a professional virtue. We are taught to rise above politics, to …
Why physician neutrality in the face of harm is a choice
In health care, we are trained to measure what we can quantify. We check blood pressure, glucose, cholesterol, and weight. We monitor lab trends and adjust medications. We look for numbers that confirm risk. What we do not routinely measure is whether a patient is living in a constant state of stress, even though the signs are often right in front of us.
In dentistry, those signs are hard to miss.
Over …
The hidden link between chronic stress and oral health
At 2 a.m., the hospital is quieter but the stakes are not. A single page can alter the trajectory of a patient’s life. A subtle clinical shift can mark the difference between stability and decline. At night, there is less margin for error, fewer immediate resources, and no room for hesitation. Not long ago, I was called to evaluate a patient who “just did not look right.” The vital signs …
How night shift medicine exposes the reality of physician stress
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