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She built a thriving practice in Manhattan and appeared all over the media. Then she walked away, and it was never burnout. Samantha Nazareth is a gastroenterologist and the author of the memoir …
Leaving her practice to reinvent herself from scratch [PODCAST]
An increasing number of pre-med students in the U.S. are electing to take a gap year, but is this the best option for them? More importantly, is it best for the medical field as a whole?
Many students believe taking a gap year improves their admission chances. While compounding variables prevent conclusive proof that a gap year directly helps, the extra time is understandably attractive, as it allows students to improve …
Why nearly every pre-med now takes a gap year
The letter says denied. It’s not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there’s no real reason to think this one would be different.
Nothing about that moment is really a decision anymore. It stopped being one a while back, and nobody noticed exactly when.
The …
Prior authorization appeals stopped being a decision
I’ve been doing this long enough to have believed in technologies that failed, and doubted technologies that succeeded. That is a humbling education, and it is the one I trust most.
I watched the Prostatron arrive, microwave thermotherapy that was going to spare men the operating room for their prostates. It had its moment, and then the moment passed. I watched Computer Motion’s ZEUS, a surgical robot of real elegance (the …
Fat quality, not quantity, is the number that matters
The central limitation in evaluating racial parity in physician discipline is not the absence of concern, but the absence of standardized upstream data. Existing national systems primarily capture terminal outcomes. The National Practitioner Data Bank (NPDB), for example, receives reports of certain adverse clinical-privileges actions, including review actions restricting privileges for more than 30 days and certain surrenders while under investigation. It does not comprehensively capture the discretionary steps …
Is racial bias in physician discipline being measured?
“It is better to have one bad general in charge than two good ones.”
– Napoleon
In Arizona, you may name multiple agents to act on your behalf under a single durable medical power of attorney. However, it is generally advisable not to go down this route. This is because with multiple agents in charge, there is a likelihood of conflict.
Multiple agents are all authorized to make choices about your end-of-life decisions. …
Why naming co-agents in your power of attorney backfires
A resignation letter arrives with ninety days written on it. Most practices read that as ninety days to find a replacement, and the search starts that afternoon. What the letter actually started is three clocks running at once, and only one of them speeds up when the practice hires faster. The payer contracts have their own notice terms. The medical records have their own custody obligations. And the replacement physician, …
The revenue gap a physician notice period never closes
When my chronically ill daughter was about five years old, a (hopefully) well-meaning family member got very angry at me for taking what they called unacceptable risks with her and her health. My family member went on to tell me all about a friend of theirs who had a similar-aged child who had a heart transplant and had since that time lived in a bubble. They were very proud of …
What my chronically ill daughter taught me about failure
A 911 dispatcher might never see the blood, the wreckage, or the scared family waiting by the road. But they hear everything. They hear the panic in a parent’s voice when a child stops breathing. They listen as domestic violence happens in real time. Sometimes, they stay on the line during a suicide attempt, a shooting, or someone’s last moments. All the while, they have to get an address, figure …
911 dispatcher mental health is not a wellness issue
An excerpt from Everything Is Going to Be All Right: A Faith Journey Through Alzheimer’s.
Listening to Christian music in her room in the nursing home, I turned to my wife. “Isn’t it going to be amazing when we see Jesus face-to-face?”
She smiled and leaned forward to look directly into my eyes. She told me, “Everything is going to be all right.”
Crystal clear. In a season when words are garbled …
Caring for my wife with Alzheimer’s taught me to surrender
The latest health craze from the wellness world is growing across social media platforms, leaving many wondering if they can stop taking their cholesterol medications. According to Google Trends, Americans are Googling “nattokinase” 130 percent more now than they did this time last year, and #natto pulls up over 200,000 posts on Instagram. Interest has also been fueled by high-profile influencers like Joe Rogan, whose podcast published an enthusiastic …
Nattokinase vs. statins and the limits of plaque data
“People aren’t the problem. The problem is the problem.” I heard that sentence for the first time sitting in a circle of student desks in a restorative and transformative justice class two years ago. I didn’t know then that I was about to spend the rest of my medical training inside an institution that had reached the exact same conclusion decades earlier, and then largely failed to live by it.
In …
Why blaming doctors makes patients less safe
I woke up in the recovery room looking for a clock on the wall. It was two hours past when my surgery was supposed to end.
Before my mind caught up to my body, I understood that a complication had occurred. My hand went to my throat, which was bandaged and sore. I tried to speak, but nothing came out.
That silence is where this story really begins.
This September is Thyroid Cancer …
Voice loss after thyroid surgery changed how I heal
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There is a sentence I hear from older patients that bothers me more than it used to.
“I guess I’m just getting old.”
They say it almost apologetically. They came to see me because they can’t breathe through their nose, they wake up exhausted, or have lived with sinus pressure and congestion for years. But somewhere near the end of the visit, another symptom slips out.
“I can’t concentrate like I used to.” …
When chronic sinusitis and brain fog get blamed on age
I know things are busy right now. We are stressed, and not the kind of stress that lunch-hour chair yoga fixes. Stress shows up in small ways, like a grocery cart left in a parking lot instead of being returned to the corral. It’s not laziness, it’s bandwidth. But it also means the next person has a little more work to do.
The same thing happens with referrals. A referral that’s …
What makes a pain management referral actually land
As a health care educator and patient advocate on the one hand, and a retired nurse on the other, the authors regularly correspond with doctors, nurses, and nurse practitioners. Richard Lawhern is a nationally recognized subject matter expert on pain management. Debra Lewis is a retired nurse who shares stories here of some of the nurses who were referred to her for tutoring after graduating from nursing school but failing …
NCLEX failure rates expose gaps in nursing education
As a family nurse practitioner, I’ve learned that the most meaningful moments in medicine rarely happen because I found the perfect medication. They happen because someone finally felt heard.
Every day in primary care, patients arrive carrying more than symptoms. They bring uncertainty, fear, frustration, and often years of feeling overlooked. Many have seen multiple clinicians, searched endlessly for answers online, or quietly accepted that their concerns are “just part of …
In primary care, listening is a clinical skill
Your net worth statement is the only financial document in America that routinely counts someone else’s money as yours.
It lists the retirement accounts, the brokerage, the house, the practice interest, and adds them with the quiet confidence of arithmetic. The number is not wrong so much as incomplete. It books your assets at gross, and the largest have a co-owner who has not yet invoiced you. A $5 million pre-tax …
Retirement account taxes distort physician net worth
An excerpt from A Failure of Imagination: How the Healthcare System Fails Neurodivergent People—and What We’re Doing Instead.
I’m a physician. That’s the only formal training I have. When I set out, I didn’t know how to start or run a nonprofit. I didn’t know how to build a medical practice, let alone a model of health care delivery from scratch. But I did know this: If you want to …
The system isn’t broken. It was built this way.
An excerpt from Treating a Broken System: A Physician’s Cure For the Healthcare Crisis.
I remember the event clearly, even though it was more than forty years ago. I was a fairly new faculty member in a Philadelphia university medical center, having finished my residency in internal medicine a few years prior. My wife, Terry, and I had been married for six years, and we had two kids at the …
Why should doctors treating family members step back?
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