At some point, you will sit in a waiting room and not know what to say. You will be handed a form asking about your symptoms and realize you cannot describe them precisely enough to feel useful. A physician will ask how long this has been going on, and you will wish you had written it down. You will leave with instructions you mostly understood, a follow-up you are not …
Why don’t we teach health literacy like driver’s ed?
I sit within four silent walls,
Waiting for answers
That may never come.
The clock moves,
The sun rises and falls,
Yet the questions remain.
Uninvited companions occupying
Every corner of the room.
What is happening within me?
Why does this pain cling so tightly,
Wrapping itself around muscle, bone,
Thought and spirit?
I try to escape it.
I call upon memories of laughter,
Of loved ones gathered around a table,
Of morning birdsong
And summer breezes moving through trees.
But pain is stubborn.
It follows me there,
Casting …
A poem on the doctor-patient relationship and facing fear
Working as an emergency medicine physician, I come into contact with people on the wrong side of the law regularly. We evaluate local inmates for a variety of complaints such as chest pain, sports injuries, falls, seizures, etc. We also get a number of patients from the back of police cars and the city jail holding center. These come in as requiring “medical clearance for incarceration.” Most of the time, …
Treating prisoners in the emergency room without losing me
While the field of artificial intelligence has existed for decades, the release of OpenAI’s large language model (LLM) to consumers provided the propelling boost for AI’s widespread adoption. This transformation is evident across nearly every aspect of health care. It can be seen in the surging number of research publications on AI in medicine and is perhaps felt even more in clinical practice, where patients, physicians, and health care providers …
Can AI defeat death? Physicians need evidence first
When a child is diagnosed with ADHD, the conversation is often much narrower. Medication. Maybe a school form. Maybe a vague suggestion to “try therapy.” Then parents are sent back into the same exhausted home, the same chaotic mornings, the same homework battles, the same social struggles, the same emotional explosions, and the same school system that often does not know what to do with a child who is bright, …
How to build an ADHD treatment plan beyond medication
I suppose I have the same split personality most doctors have toward their careers. There are days I love it. I’m a cataract surgeon, I give people back their vision, and it’s almost like having a Marvel superpower. I don’t shoot LASIK lasers out of my eyes or sprout scalpels from between my knuckles, but give me an operating microscope and good things will happen to your vision. And then …
The hidden variable in the physician burnout debate
Every few months, another wellness initiative arrives in medicine.
An email reminds us to prioritize self-care. A flyer advertises resilience workshops. A mandatory lecture explains the signs of burnout and encourages us to seek support before we reach a crisis point.
During one of these wellness presentations, my phone buzzed repeatedly with clinical messages while a slide on the screen discussed protecting our emotional reserves. Around me, people answered texts, checked emails, …
You cannot mindfulness your way out of understaffing
A young Black woman waits in a psychiatric emergency room. She is grieving, traumatized, and depressed. The clinician, however, describes her as “guarded,” “hostile,” and “paranoid” in the chart. She leaves with a schizophrenia diagnosis, a prescription for a first-generation antipsychotic, and a future shaped by a label she should never have received.
This is not a hypothetical situation. The Harvard Review of Psychiatry documented this case in 2023. She was …
Racial bias in schizophrenia diagnosis must end
The narrative in a recent essay on tele-critical care is wrenching, and the case it describes deserves the somber consideration that any preventable death in the intensive care unit (ICU) demands. Its indictment of tele-critical care, however, conflates a single tragic outcome with the totality of an evidence base that, taken as a whole, supports the careful expansion of ICU telemedicine, not its retreat. To frame tele-critical care as …
Why tele-critical care deserves expansion, not retreat
Every week, another article lands in my inbox telling me AI will change medicine. What none of them include is a straight answer to the question every physician is actually asking: Which tools should I use Monday morning, and which ones can I safely ignore?
After years in emergency medicine and now building clinical infrastructure for preventive care, I’ve watched this space closely enough to separate what’s working from what’s being …
AI tools for physicians: What to use, what to ignore
A patient discharged from the ICU on a ventilator may no longer fit the traditional image of “critical care,” but that does not mean the medical complexity disappears.
In post-acute ventilator units, respiratory failure continues to be managed every day through ventilator monitoring, airway and secretion management, weaning attempts, oxygen titration, tracheostomy care, and ongoing assessment across interdisciplinary teams. The setting changes. The clinical dependency often does not. Yet once these …
Post-acute ventilator care does not end at discharge
The U.S. health care system is facing a serious workforce shortage. In pediatric oncology, the stakes are especially high. But the issue is not simply a lack of available positions. Increasingly, it is a recruitment and retention challenge.
Recent pediatric hematology-oncology fellowship data shows that while training positions increased by 36.6 percent between 2009 and 2025, applicants increased by only 8.3 percent. During that same period, the applicant-to-position ratio declined …
The pediatric oncology workforce shortage is widening
By the end of my Step 2 preparation, I had stopped reading questions the way I once thought doctors were supposed to. I was no longer carefully evaluating full of clinical pictures. I was scanning for fingerprints.
A few trigger words could collapse an entire question into a likely answer before I had fully processed the stem. A young woman with abdominal pain and hypotension. An elderly smoker with painless hematuria. …
How Step 2 pattern recognition fooled me into passing
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A third-year medical student told me last month she was not going to apply to radiology. She had been interested all through second year, had done a sub-internship she liked, and had the grades to match anywhere. Then she changed her mind. The reason, almost verbatim: “My advisor said I should not go into a field that AI is going to replace.”
She is not the only one. I have heard …
Is AI replacing radiologists? A radiologist disagrees.
“You will never walk again.”
As a doctor, I had delivered difficult news to patients before. But nothing prepared me for hearing those words myself after I was struck by a car in 2008 and suffered a catastrophic spinal cord injury. In an instant, I went from physician to patient.
Before my injury, medicine was built around certainty for me: diagnoses, treatment plans, measurable outcomes. Then I entered the world of rehabilitation, …
A doctor turned patient on what healing really requires
For many people, mornings no longer begin gently. The day now arrives all at once: emails, headlines, notifications, unanswered messages, schedules, worries, reminders, and the quiet pressure to immediately become productive. Before the body has fully awakened, the mind has already entered a state of vigilance.
Increasingly, I meet patients who describe feeling exhausted before the day has meaningfully begun. Not necessarily in the dramatic language of burnout or acute crisis, …
How nervous system overload masquerades as personal failure
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Most clinical research treats patients like data points. What gets lost when researchers stop listening to the people they study, and what does it cost the science itself? Niharika Singh is a biomedical engineer and pre-medical student with research experience at Genentech, …
Patient involvement and the future of clinical research [PODCAST]
Adult ADHD is real. It is impairing. It is often missed, especially in bright, high-achieving adults, women, and people who learned to compensate for years before finally burning out. But the solution to underdiagnosis cannot be overdiagnosis.
We are now seeing a second problem emerge: rushed adult ADHD evaluations, often completed in 30 to 60 minutes, sometimes based heavily on a brief questionnaire, followed quickly by stimulant prescribing. The patient may …
Rushed adult ADHD evaluations put patients at risk
Behavioral health is a core component of first-line, non-opioid treatment for chronic pain in most major medical guidelines, including the Centers for Disease Control and Prevention, the American College of Physicians, the World Health Organization, the American Academy of Neurology, the American Headache Society, and the American College of Gastroenterology. And yet, the concept of behavioral health to treat chronic pain still surprises many people, including …
Central sensitization is the key to treating chronic pain
I remember the moment clearly. A hot July day, standing at my mailbox, opening an envelope from a genetic testing company. I expected reassurance. Instead, I saw a result sitting in the bright red end of the risk continuum. As far from “OK” as it could get.
Years earlier, my son had mentioned that his 23andMe test showed he carried a gene that might lead to Alzheimer’s “when he was old.” …
Why the case against APOE4 testing no longer holds
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