Red lights, green lights, and the art of resilience

Conditions and Diseases
June 24, 2026

Unlike my earlier pieces, which often stitched together studies and data to build an argument, this one grew straight out of ordinary mornings. Pulling up to the same stop sign on my commute, waiting for the light to turn green, easing over to let an ambulance through with its urgent lights flashing. Touched by a reality check, one of my friends who lost his significant other of long years has …

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Red lights, green lights, and the art of resilience

AI and clinical judgment belong together, not at war

Health Technology
June 24, 2026

For five years, I’ve navigated a complex medical journey. At age 38, at the peak of my health, I developed shortness of breath. I wrote it off as adult-onset asthma, fatigue, or “just getting older.” When I put a pulse ox on one morning and saw my numbers drop to 88 percent, I knew something was wrong. It was an arduous process, but I ended up with a diagnosis of …

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AI and clinical judgment belong together, not at war

The hidden costs of anabolic steroid side effects

Medications
June 24, 2026

He sat down and said, “Doc, I just want to sleep again.”

Marc, name and details changed, was 54. He hadn’t touched a needle in two years. His cardiologist was still watching his blood pressure. His body had not caught up with his decision to stop.

His labs told the story his competition photos never did. Elevated red blood cell count consistent with secondary polycythemia. Suppressed LH and FSH. Low testosterone. …

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The hidden costs of anabolic steroid side effects

Evidence-based medicine needs a broader view of evidence

Physician
June 24, 2026

One of the most common questions physicians ask when evaluating a new idea is simple: “Where is the evidence?” It is an appropriate question.

Scientific evidence has transformed modern medicine. It has helped identify beneficial therapies, eliminate ineffective treatments, improve patient safety, and extend human life. Few would argue against the enormous contributions of evidence-based medicine. As a physician, neither would I.

Yet over time, I have become concerned that we sometimes …

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Evidence-based medicine needs a broader view of evidence

Are physicians and nonphysician clinicians interchangeable?

Physician
June 24, 2026

After years in medicine, one loses patience with arguments that blur needed distinctions. One of the most consequential appears in claims that expanding roles for nurse practitioners, physician assistants, and other nonphysician clinical providers justify treating them as equivalent to physicians. Because care is team-based and work often overlaps, we are asked to believe that distinctions in training, judgment, supervision, and accountability matter less than they once did.

Teamwork is necessary …

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Are physicians and nonphysician clinicians interchangeable?

Language barriers in health care begin with the effort

Physician
June 24, 2026

When I was younger, I would sometimes take over a phone call for my parents, perhaps with the cable company or our phone service, if the conversation moved too fast or became too technical. They never asked me to do so in person, but occasionally, when I was feeling frustrated after tagging along on a trip to the bank or the store, I would interject a few words in Chinese …

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Language barriers in health care begin with the effort

Ethylene in plants and animals: one molecule, two stories

Conditions and Diseases
June 24, 2026

Ethylene is one of the simplest organic molecules, yet it has remarkably different meanings in plants and animals. I first became interested in ethylene during my predoctoral years because of its familiar role in fruit ripening. My interest took a different direction during my early research years at Louisiana State University and later at Southern University, when I began examining how ethylene may arise through oxidative chemistry and its possible …

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Ethylene in plants and animals: one molecule, two stories

Compassion fatigue is evidence of caring, not failing

Conditions and Diseases
June 24, 2026

There is a quiet accumulation that happens in caring professions. It rarely arrives all at once. More often, it builds gradually through repeated exposure to grief, crisis, trauma, fear, loss, and emotional responsibility. Over time, many health care workers begin carrying far more than their job descriptions ever acknowledge.

We call it compassion fatigue, burnout, stress, or emotional exhaustion. Different words, same reality. And yet many clinicians still quietly believe it …

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Compassion fatigue is evidence of caring, not failing

The blind spot before the first prenatal visit

Physician
June 24, 2026

I trained as an obstetrician-gynecologist outside the United States. Years later, I found myself in a very different position: not as the clinician taking the history, but as a high-risk pregnant patient trying to enter a new prenatal care system after moving across states.

That experience changed the way I think about prenatal access.

In medicine, we often treat the first prenatal visit as the true beginning of care. That is when …

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The blind spot before the first prenatal visit

Why ambient listening in medicine made me more human

Physician
June 24, 2026

When I was training to become a surgeon, there was an unspoken belief that the operating room was the pinnacle of the profession. The OR was where you proved yourself. Clinic was something to get through on the way to surgery later in the week. At least, that’s how it often felt to me.

Now, ten years into practice, what some would call mid-career, I’ve realized something unexpected: The clinic is …

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Why ambient listening in medicine made me more human

How Medicare is breaking nursing home care [PODCAST]

Podcast
June 23, 2026
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Imagine being penalized for delivering good care to your frailest patients. Medicare’s quality scoring program was built for healthy outpatients, not the elderly residents of nursing homes, but it is the system doctors who round in skilled nursing facilities are forced to …

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How Medicare is breaking nursing home care [PODCAST]

Physician moral injury and the doctors trying to stay

Physician
June 23, 2026

My wife did not want to leave. That is the part that matters most.

After residency, this was the only hospital she had ever known as an attending physician. It was where she became a doctor in the fullest sense of the word: not the title earned at graduation, but the identity built over years of showing up for patients, colleagues, emergencies, births, losses, complications, and ordinary days that were not …

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Physician moral injury and the doctors trying to stay

A letter to a young physician on meaning and endurance

Physician
June 23, 2026

Dear Colleague,

I write to you not from the comfortable distance of theory, nor from the elevated podium of idealization, but from the lived terrain of more than three decades in clinical medicine. Every observation I share with you in this letter has been tested against the unforgiving evidence of real patients, real wards, real disappointments, and real triumphs. These are not abstractions. They are conclusions I have arrived at by …

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A letter to a young physician on meaning and endurance

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International medical graduates and the hidden curriculum

Physician
June 23, 2026

Next month, thousands of resident physicians will begin their journey toward U.S. board certification. They will spend countless hours studying clinical guidelines, refining their diagnostic skills, and learning the intricacies of patient care.

According to the 2026 National Resident Matching Program (NRMP) Match results, international medical graduates (IMGs) remain an essential component of the U.S. physician workforce. Of the 9,682 IMG applicants who matched this year, 6,733 were non-U.S. citizen IMGs, …

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International medical graduates and the hidden curriculum

When a health insurance denial leads to death

Health Policy
June 23, 2026

For generations, the struggles between patients and health insurers have played out in the quiet corridors of bureaucracy and the echoing halls of the courts. When a claim is denied, the journey that follows is often a weary procession: appeals, reviews, complaints, and lawsuits. Even when an insurer is found at fault, the reckoning is almost always measured in a payment here, a penalty there, and maybe a sanction filed …

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When a health insurance denial leads to death

How merit in medical malpractice drives avoidable costs

Physician
June 23, 2026

Thirteen thousand medical malpractice lawsuits with billions of dollars as either plaintiff verdicts or settlements are reported each year by the National Practitioner Data Bank. Hence there are big bucks to be made and these account for only 33.3 percent of all medical malpractice lawsuits that are litigated. Therefore, there are 40,000 medical malpractice lawsuits, which are litigated. Of these, 27,000 have no awards because they end favorable for the …

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How merit in medical malpractice drives avoidable costs

Physician moral injury is not burnout, it is accuracy

Health Technology
June 23, 2026

At 6:14 on a Monday morning, I open the electronic medical record (EMR) before I open the lights. The clinic does not open for two hours.

The ambient scribe ran on every encounter last week. Most notes are clean. Some need edits I will read between patients. The scribe captures the conversation. The clinical impression is still mine.

Beside the queue, the prior authorization dashboard shows eight denials from last week. Two …

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Physician moral injury is not burnout, it is accuracy

Grieving as a doctor when medicine cannot save your own

Physician
June 23, 2026

There is a particular kind of grief that medicine does not prepare us for: losing someone you love while understanding exactly how hard everyone tried to save them.

My cousin died from cancer only months ago. But to me, she was never simply my cousin. She was my little sister in every way that mattered. Someone I loved instinctively, someone I felt responsible for protecting long before illness entered our lives. …

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Grieving as a doctor when medicine cannot save your own

The brain signal that drives polycystic ovary syndrome

Conditions and Diseases
June 23, 2026

For many years, anti-Müllerian hormone (AMH) was viewed primarily as an ovarian marker. Clinicians used it to estimate ovarian reserve, assess follicular activity, and counsel patients regarding reproductive aging and fertility treatment response. In polycystic ovary syndrome, now increasingly reframed as polyendocrine metabolic ovarian syndrome (PMOS), AMH levels were often recognized as elevated, largely because of the increased number of small arrested follicles characteristic of the condition.

But emerging evidence suggests …

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The brain signal that drives polycystic ovary syndrome

Continuous glucose monitor accuracy and patient trust

Conditions and Diseases
June 23, 2026

As a medical student, I see every day how uncontrolled blood sugar quietly destroys organs. Most of my classmates file this away for exam day, while I’m glued to my CGM app because these sequelae are not hypotheticals for me.

A continuous glucose monitor (CGM) has been the backbone of my daily management since my type 1 diabetes (T1D) diagnosis five years ago. On July 1, 2026, my longtime sensor will …

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Continuous glucose monitor accuracy and patient trust

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