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Patients know when you are not really present with them, and trust is built or broken in the first few minutes. Jess Bunin, an intensivist, and George Mount, a rheumatologist, co-founders of All Levels Leadership, argue that trust in clinical teams is …
How to lead a team through uncertainty without breaking trust [PODCAST]
There’s a certain kind of work in health care that never quite fits anywhere. It’s not the structured clinical note. It’s not the templated visit. It’s everything else. The documentation that still matters, but doesn’t fit the system built to hold it.
Most documentation systems in health care are built around a simple assumption: that clinical work is structured, discrete, and tied to a defined patient encounter. That works well in …
Clinical documentation workflow is not just an AI fix
As someone who spent years advocating for my medically complex son, I’m often asked how to do it. What advocacy looks like. How to push back. The truth is, advocacy itself isn’t that complicated. At its core, it’s standing up for what you know is right, and refusing to accept an unacceptable status quo. I believe the hard part is taking up space. Challenging people and systems that aren’t used …
How patient advocacy in the hospital can prevent a stroke
There is a particular cruelty in growing up, not the ordinary kind involving responsibility or the poetic loss of innocence. The cruelty is this: A child can survive something they do not yet have the language to name, carry it quietly for decades, and only begin to suffer its full weight once they have developed the cognitive architecture to understand what was done to them. The horror is not concurrent …
The hidden link between childhood trauma and addiction
For decades, an Alzheimer’s disease diagnosis has been viewed as simply a confirmation of a disease, not an opportunity for treatment. Typically, patients or family members would notice subtle changes in memory. Once these symptoms reached the point where concern was raised to a physician, and referrals were made, often leading to months of waiting to see a neurologist, opportunities for even symptomatic treatment were significantly smaller. This diagnosis-to-treatment gap …
Early Alzheimer’s detection is now a treatment decision
Most people find a new doctor by asking their friends and family who they go to. When you’ve got a solid referral or testimonial, a type of pseudo-trust is established.
But when a person does not live in the same area, or doesn’t have a referral from someone they trust, they start searching online. They compare websites, look at photos, read some pages, and possibly see the photos of the waiting …
Branding a medical practice is not vanity, it is trust
In 2021, I was asked, “If a patient is 200 pounds overweight and loses 100 pounds, would you tell them that’s not good enough?” It was a compelling question. In the words of my favorite surgical attending, we don’t let perfect be the enemy of good. We would celebrate that win, and keep going.
The next question stopped me: “Do you have strategies to help smokers make similar incremental change?”
I didn’t. …
Beyond 5 percent quit rates: nicotine harm reduction
I don’t know any physicians who aren’t worried about being sued. It is unfortunately very common in today’s world, with some specialties like neurosurgery and obstetrics disproportionately experiencing higher lawsuits. The fear of litigation is not benign, and health employers need to reduce litigation and better support staff.
Recently there has also been a trend with the so-called “nuclear verdict.” These are very costly jury verdicts that can devastate a physician …
5 ways hospitals can reduce medical malpractice claims
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Most physicians using AI on patient data have no idea what the real security risks are. Francisco M. Torres, an interventional physiatrist, and Purab Patel, a medical student with a programming background, argue that cybersecurity has become a patient safety issue in …
Why AI cybersecurity is now a patient safety issue [PODCAST]
That question came to me, again, at the end of a community webinar I gave recently for individuals living with vestibular disorders. It is the most common question I am asked when I speak to community audiences. It is asked without anger. It is asked the way someone asks a question they have lived with for years.
“Why don’t more health care providers know more about dizziness?”
I owe that question an …
The 15-provider road to vestibular disorder diagnosis
There comes a night, somewhere near the end of a long career, when a physician sits alone with himself after the corridors have emptied and the pagers have gone quiet. He turns the years over in his mind, the patients who lived and the ones who did not, the diagnoses made in time and the ones missed, the easy hours and the impossible ones, and he discovers that the question …
The one question that measures physician integrity
Xenotransplantation, the transplantation of animal organs, tissues, or cells into humans, has rapidly transitioned from speculative science to a clinical reality. It is driven by advances in genetic engineering, particularly CRISPR-mediated modification of donor animals. On the bright side, the field now offers a plausible solution to one of modern medicine’s most persistent crises: the global shortage of transplantable human organs. Recent milestones, including first-in-human pig heart and kidney xenotransplants, …
Xenotransplantation ethics tests our moral frameworks
During my Air Force years, I served under three commanders with three very different personalities. One was methodical and procedural. One was operational and instinctive. One was strategic and future-focused. They disagreed about many things, but they agreed about one: they wanted to retain me. All three wrote it in my Officer Evaluation Reports (OERs).
At the time, I didn’t think much about it. I was young, busy, and focused on …
3 Air Force leadership lessons from three commanders
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Something that I had been resisting tacitly for a while, eventually happened last week. As I was supposed to be all ears towards a patient, my concentration drifted towards the screen. The cursor blinked, translating his words into codes the system would accept as symptoms, durations, and checkboxes. When I looked back at him, he ebbed. The story had been interrupted, and I wasn’t sure I could retrieve it.
Modern medicine …
Narrative medicine is what AI in medicine cannot replace
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Medicare Advantage covers more than half of seniors, and the debate over what it really costs is stuck in two camps. Timothy Bulat, a senior consulting actuary who spent nearly two decades leading Medicare Advantage analytics inside a major insurer, raises a …
20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]
In oncology and survivorship care, one of the most common (and often least visible) experiences patients carry is fear of recurrence.
For many people, finishing treatment brings a sense of relief. But it can also bring something quieter that lingers. A watchfulness. A heightened sensitivity to the body. A subtle shift in how the future feels.
For others, this way of thinking begins earlier (at diagnosis, during treatment, or in the spaces …
Fear of cancer recurrence is a human response, not a flaw
We are living in an era where attention, not information, is the scarce resource. And what we pay attention to (not what we claim to value) reveals the architecture of our priorities.
Consider a few comparisons that, though deliberately absurd, tell a deeper truth. We now have more Marvel movies than major classes of antibiotics. The world produces more aspiring pop singers than there are widely used chemotherapy regimens. Strangely enough, …
The attention economy is starving public health
Daria D. learned how dangerous a “ghost network” is while fearing that her son would kill himself. Daria was desperate to find a psychiatrist to help her teenage son, who was suicidal. She called more than a dozen doctors listed in her insurance company’s provider directory. Half were listed with telephone numbers that did not work. The other half said they did not take her insurance or could not see …
Mental health ghost networks are badly hurting patients
After a scribing shift, I opened TikTok and found myself inside a growing hub the internet calls “Doc-Tok,” a thriving community of health care professionals sharing clinical takes, career glimpses, and the unfiltered reality of working in medicine. What I did not expect was how much of it was fear. Providers describing terminations over comments that any other member of the public could post freely. Nurses parsing their captions for …
3 changes physicians on social media need from institutions
In primary care, practice overhead is commonly described as 50 to 60 percent of collections. That range is repeated in continuing education, in vendor marketing, and in the operational frameworks new practice owners are handed when they ask what normal looks like. The range is not wrong. It is just too broad to be operationally useful.
A primary care practice running at 58 percent overhead might be perfectly stable, undercompensating its …
Why your overhead percentage is the wrong benchmark
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