Students have been sharing with me their reasons for deciding to pursue a career in internal medicine, a fitting topic for this year’s upcoming Internal Medicine Day. The most moving stories are those describing them seeing the person behind …
Celebrating internal medicine through our human connections with patients
As a research scientist who is devoted to ensuring that immigrant nurses have successful U.S. careers, the issue of internationally educated nurses’ (IENs’) cross-culture language competence has recently been both a sensitive and front-and-center issue pervading my work. In my more than 30 years in the health care sphere, the topic is now reaching a fever-pitch as IENs increasingly enter the U.S. health care workforce and play a critical role …
The debate on English tests for immigrant nurses
The Federally Qualified Health Center stands as perhaps the most eloquent institutional response to the perennial tension between medicine as market commodity and medicine as moral imperative. In the concrete reality of the FQHC (with its sliding-fee scales, its community governance structures, and its legislative mandate to serve the underserved) we find materialized those aspirations that have animated medical ethics since the Hippocratic tradition: that healing should flow toward need …
The FQHC model and medicine’s moral promise
Into this psychological wasteland, we’re now introducing AI companions as the solution. Meta’s personas, Character.AI’s virtual friends, and romantic chatbots; the market for artificial intimacy is exploding. The promise is seductive: connection without risk, companionship without effort, and validation on demand.
But here’s what these AI relationships actually do: They allow users to avoid the very challenges that build psychological resilience. Genuine relationships require vulnerability, the ability to tolerate conflict, and …
At age 81, I speak and write voluminously as a health care educator specializing in public health policy and practice for the treatment of pain and addiction. My wife and I are also careful about getting our periodic vaccinations for flu and COVID-19. A few days ago we responded to an invitation from our pharmacy to drop in for our shots on a walk-in basis. The process turned out to …
The frustrating bureaucracy of getting a vaccine
I define a frivolous medical malpractice lawsuit as being caused by a random error of nature.
Plaintiffs are entitled to feel aggrieved and to seek legal counsel. Some, however, have ulterior motives.
Plaintiff attorneys are “good Samaritans.” They work for a contingency fee. This invites ulterior motives; however, because these attorneys bear the cost, motives do not matter. Only the value of a case matters and there is artificial intelligence to weed …
Who profits from medical malpractice lawsuits?
The pandemic changed us in ways that cannot be measured by infection rates alone. Beyond the physical toll, it left lasting scars on our mental health. Fear, uncertainty, and isolation became daily realities. As a health professional and researcher, I wanted to understand how people could begin to heal. During my doctoral work, I studied adults who engaged in different wellness practices after the pandemic. Some found relief in nature: …
Healing from the pandemic’s mental toll
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Professor and patient advocate Edward G. Rogoff discusses his article “How to choose the right doctor for you.” In this episode, Edward explains why selecting the right physician is one of the …
Choosing the right doctor: How patients can take control of their care [PODCAST]
When I tell colleagues that I offer Valtrex (valacyclovir) and low-dose lithium orotate to patients worried about developing Alzheimer’s, the silence in the room thickens. Someone always asks, “Where’s the randomized controlled trial?” That’s exactly the problem. We keep waiting for perfect evidence while the disease eats away at people’s brains.
I’m an internist and lipidologist who’s spent years watching the medical establishment chase the wrong villains, like cholesterol, salt, …
The infectious hypothesis of Alzheimer’s disease
I shake my head in disbelief. Is this really happening in the United States? As a pediatrician and public health advocate, I believe we are witnessing the literal systematic dismantling of our health care system.
Case in point: the federal government’s mishandling of two recent lead contamination crises (in Michigan and Wisconsin). These failures not only expose children to preventable toxic harm, but also reveal a deeper breakdown in democratic accountability …
A pediatrician on the lead contamination crisis
When people discuss physician burnout, they often reduce it to a workplace issue: long hours, endless charting, electronic health records that seem never to end, and patient loads that test the limits of human capacity. The solutions we’re offered sound deceptively simple: take a vacation, practice gratitude, do yoga, and meditate more. It’s as if wellness could be squeezed into the fifteen minutes we have left after charting at midnight. …
Physician burnout as a relationship crisis
I didn’t realize how exhausted I was until everything stopped. First came burnout, the quiet unraveling so many physicians know too well. Then grief followed. I lost my mother unexpectedly to an aggressive cancer and, three years later, my father after years of caregiving through advanced Parkinson’s disease. These losses shattered not only my heart but the way I viewed my life and work. For years, I practiced medicine within …
Something is wrong with our health care system. Our country spends more per capita than any other developed nation, yet we have some of the worst health care outcomes. Rising costs are making health care prohibitive. Access to the system is becoming a growing concern. Medical care has become bureaucratic, bulky, and inefficient. I am a retired physician, a urologist, who has observed the health care system from outside medical …
The decline of the doctor-patient relationship
Presidents are not immortal. But for much of American history, their bodies have been treated as state secrets, curated, concealed, and choreographed for public reassurance. When illness is hidden, the cost is not just clinical. It is geopolitical.
Warren G. Harding: collapse before the scandal
President Warren G. Harding died suddenly on August 2, 1923, at age 57, while touring the country on his “Voyage of Understanding.” He collapsed in San Francisco’s …
The secret illnesses of U.S. presidents
I put it on one night among tears and grief. It slid onto my skin like butter, like it was meant for me. It hugged my torso and clung to all the wrong places. The truth is, I had worn it before. I am unsure exactly when I last stopped wearing it. Unlike the donning of the letter, the removal is much quieter. I probably did not realize exactly when …
A psychiatrist’s scarlet letter of shame
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Physical therapists Kim Downey, Ziya Altug, and Shirish Sachdeva discuss their article “How physicians can reclaim resilience through better sleep, nutrition, and exercise.” In this episode, Kim, Ziya, and Shirish explain how …
How sleep, nutrition, and exercise restore physician well-being [PODCAST]
The numbers are staggering. Americans made 139.8 million emergency department visits in 2024, that is 42.7 visits per 100 people, with behavioral health issues driving an unprecedented surge. Behind these statistics lies a harsh reality: depression, a leading cause of ill health and disability worldwide, is overwhelming our emergency departments with cases they were never designed to handle. This tsunami of mental health crises creates a vicious cycle. …
The physician mental health crisis in the ER
(Author’s note: This article has been a year in the making. Each time another mass shooting makes headlines, I think, this is the moment to speak, and then life intervenes. The opportunity to contribute meaningfully feels missed. But the cruelest irony is this: Wait ten more days, and there will be another tragedy to make the conversation relevant again. That, in itself, is the most heartbreaking fact of all.)
“Study my …
Is mental illness the root of mass shootings?
Introduction
In a recent episode of the Wealth Planning for the Modern Physician podcast, host David Mandell, JD, MBA, welcomed Dr. Michael Ast, an orthopedic surgeon specializing in adult reconstruction and joint replacement surgery. Beyond being an accomplished clinician at the Hospital of Special Surgery in New York, Dr. Ast also lectures often on business and career issues, and is especially passionate about teaching younger physicians how to build their practices …
How new physicians can build their career
“To practice medicine,” a mentor once told me, “is to live with the tension between what you can do and what you should do.”
I didn’t understand him then. I do now. It is two in the morning in a Chicago hospital. The unit hums with fluorescent fatigue. A man in his fifties lies gasping for air, his lungs crowded by metastatic cancer. His chart lists “full code.” His daughter, sobbing …
Moral distress vs. burnout in medicine
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