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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
Modern medicine loves numbers. LDL. A1c. BMI. Tumor diameter. Pounds lost. They are easy to measure, easy to track, and easy to celebrate. But none of them are the disease itself.
As GLP-1 prescribing accelerates and insurers increasingly define success by weight reduction, we are repeating a familiar mistake: Elevating a surrogate marker to the status of a biological endpoint.
BMI was never designed to diagnose disease in individuals. Adolphe Quetelet created …
GLP-1 agonists and weight loss: Treating the disease, not the number
In clinical practice, reassurance is both necessary and responsible. When a clinician says “nothing concerning,” it is rarely casual. It reflects a judgment: no immediate danger, no clear evidence of serious disease, no indication for urgent intervention. It is often the appropriate conclusion at that moment in time. But what happens to that statement after the visit ends is less often considered. Because outside the clinical context in which it …
How clinical reassurance impacts patient communication
An excerpt from The Leadership Prescription: How High-Performing Clinicians Become Visionary Leaders.
There I was in my habitual rhythm, seeing patients back-to-back and enjoying it. After all, seeing the patients was the fun part; the administrative burden that accompanied it was nauseating and heralded the real risk of burnout. The administrators regarded me as someone who could easily create rapport with the patients. I was the kind of physician who …
The physician leadership transition: Moving beyond the exam room
In the wake of the October 2023 Hamas attacks on Israel, allegations of antisemitism surged on American campuses, including at the University of Pennsylvania. In response, the Equal Employment Opportunity Commission (EEOC) launched a Title VII investigation and subpoenaed Penn for the names and contact information of faculty and staff affiliated with Jewish organizations and Jewish Studies programs. Penn resisted. Faculty groups intervened. The phrase that reverberated through court filings …
Balancing civil rights and trauma in an antisemitism investigation
As physicians, we rarely disagree about first principles. Nutrition, physical activity, sleep, stress, and behavioral patterns sit at the foundation of nearly every chronic disease conversation. We counsel patients on these topics every day, sometimes passionately, sometimes hurriedly, often within the narrow time constraints of a packed clinic schedule.
Yet an uncomfortable gap persists between what we know drives long-term outcomes and what we are realistically able to deliver in routine …
Lifestyle medicine support: Bridging the gap in patient care
An excerpt from The Temple Road: A Doctor’s Journey by permission of Texas Tech University Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Throughout my years in medical training, I had heard the maxim, “Medicine is an art.” And yet this notion seemed abstract to me; after all, I had been steeped in science.
Then I came under the …
The art of medicine and clinical reasoning: a lesson at the bedside
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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
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