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Physician wellness coach Jessica Singh discusses the article “Physician burnout: Finding peace in a broken health care system.” Jessica shares a powerful narrative of a grueling swing shift in a rural emergency …
Finding peace and reclaiming humanity within a broken health care system [PODCAST]
One of the most common questions I hear in rehabilitation is not asked during therapy sessions. It is usually asked quietly by a family member after the session ends. “Will my mother walk again?” Families rarely ask about therapy intensity or functional scoring systems. They do not ask how many minutes of treatment occurred that day. They ask about walking. Walking represents independence. It represents the possibility of returning home. …
Why walking matters most in post-acute rehabilitation
In medicine, we are trained to recognize risk in our patients. But we often overlook those same risks in ourselves. Sometimes, the system overlooks them, too. During residency, performance is expected and endurance assumed. Health often declines quietly and almost invisibly. We label it “dedication”; we claim “resilience.” In reality, it is often neither. I learned this lesson over 48 hours, two days that would reshape both my career and …
The hidden crisis of trainee health during medical residency
In modern times, we frequently encounter messes in our public life. This seems particularly true in American health care, and it is certainly true in our politics. But few citizens seem to put the two issues together sufficiently to effectively demand change. Putting them together is what this article is about.
According to the nonprofit public interest group Open Secrets, individuals and political action committees spent a record $4.5 billion in …
Health care lobbying is destroying the U.S. system
A patient in his 20s recently came to see me in a state of severe distress. He described feeling consumed by his thoughts, constantly anxious, unable to function, and deeply exhausted. His sleep had collapsed. His sense of identity felt lost. He was experiencing persistent passive suicidal thoughts, not because he wanted to die, but because everything felt overwhelming and unrelenting.
Within three days of starting low-dose lithium at 150 milligrams …
Low-dose lithium treats suicidal ideation safely
I decided to be a physician because my mother died from tuberculosis, after quite a struggle, including with not only tuberculosis, but also with the United States Public Health System, when I was 15 years old. I got an academic scholarship to college and then put myself through medical school.
I did an internal medicine residency at Washington University and Barnes Hospital and was an emergency room physician for about seven …
Why Florida physician background checks are driving doctors away
There are moments in life when the identity you have carefully built over decades is interrupted so abruptly that you are forced to ask who you are when the familiar parts no longer function the way they once did.
For physicians, identity often begins early. We learn to attach meaning to competence, endurance, reliability, and service. We become the person others call when decisions must be made, when systems feel uncertain, …
Redefining physician leadership and adversity after a life-changing illness
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Physician and tax specialist Logan Foltz discusses the article “Physician tax strategies: Why your tax bill is so high and how to fix it.” Logan explains why the Internal Revenue Code patterns …
Why physicians pay more in taxes and how to reclaim your income [PODCAST]
The treatment of cardiovascular diseases has advanced at an extraordinary pace over the past half-century resulting in an age-adjusted 60 percent reduction in heart disease death rates. This dramatic decline is directly attributable to primary and secondary preventive therapies such as statins and small interfering messenger RNAs along with disruptive technologic advances in procedural techniques. New pharmacologic options for thromboprophylaxis and novel therapies for heart failure …
Why cardiovascular medicine should focus on patients, not environmental advocacy
One prominent characteristic of medicine is its ability to repeatedly remind you to be humble. There is always something new to learn about it, and in real life patients rarely present exactly as they do in the textbook. On top of that, health care workers commonly feel pressure to be perfect due to the potentially serious consequences of many medical mistakes. Of course, since we are human, we are bound …
Medical mistakes happen and you are still enough
Every week in the pediatric emergency department, I see the consequences of adolescent substance use that started too early and went unaddressed for too long. A teenager in crisis. A family blindsided. A window of prevention that closed long before anyone realized it was open.
We keep asking the same question: How do we reach kids before it gets to this point?
The answer, it turns out, might already be sitting in …
Peer-led storytelling in adolescent substance use prevention
“Pathology confirms invasive ductal carcinoma.”
I had said those words to patients many times before. This time, they were said to me. For years, I had been the voice on the other end of that call, gently guiding patients through one of the hardest moments of their lives. I knew how to say the words. I knew how to explain the diagnosis. I knew how to help women process what came …
Navigating dense breast tissue and breast cancer screening guidelines
It was a typical weekday morning. I woke up at 5:20, started a load of laundry, showered, dressed, unloaded the dishwasher, got the kids breakfast and lunch together, fed the pets, etc. After sending my husband off to work, I got the kids up and ready for the day. Things were going smoothly. I got my kids to school on time, and got into work early enough to go through …
Balancing part-time clinical work and motherhood
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Physician coach Apurv Gupta discusses the article “What is a loving organization?” Apurv describes his model of a loving organization as a system that designs the clinical environment to make safety and …
Why loving organizations are the secret to ending burnout in medicine [PODCAST]
15642, five numbers that have shaped my life. We all have a zip code that we call home, yet some of us can face detrimental health outcomes based on where we live. Dementia does not discriminate by zip code, but the comprehensiveness of care and patient outcomes often do. Rural families face greater barriers to accessing dementia care resources, which deepens inequities between urban and rural health care. Barriers include …
Bridging the gap in rural dementia care with technology
She was 16 the first time she noticed it. Milk. From her breasts. No pregnancy. No childbirth. No explanation. She told a provider. Labs were drawn. Her prolactin was elevated. She was told it was “not a big deal.” Over the years, multiple providers suggested she must be stimulating her nipples and advised her to stop. She insisted she was not. She felt embarrassed, dismissed, and increasingly reluctant to bring …
How diagnostic overshadowing delays hyperprolactinemia care
The modern acquired immunodeficiency syndrome (AIDS) epidemic was first recognized in the United States in early June 1981, when clusters of rare opportunistic infections were reported in young gay men in Los Angeles and other cities. Before the cause was understood, it was commonly called “GRID” (gay-related immune deficiency). In popular and some medical discussions, it was also referred to as the “gay plague,” “gay cancer,” and similar gay-specific labels. …
The hidden realities of the HIV/AIDS epidemic and U.S. health care policy
Patient engagement platforms are software systems that deliver clinical information to patients and manage patient questions and concerns outside of scheduled visits, including patient portals, mobile apps, and messaging systems. After nearly a decade of watching (and studying) the evolution of patient engagement platforms, I have come to see them as two distinct generations. I will refer to them as Generation 1 and Generation 2. Not because this distinction exists …
Understanding Generation 2 patient engagement platforms
I review your peer-to-peer calls. Here is why you keep losing.
I sit on the other side of your peer-to-peer call.
I am a physician medical director in utilization management. When you call to overturn a denial, I am the one listening. I have taken thousands of these calls over the past decade. I can tell within the first 30 seconds whether you are going to win.
Most of you lose. Not because …
How to win peer-to-peer calls: a medical director’s guide
We have been calling it burnout. The word took decades to arrive, and then it was everywhere. It appears in journal editorials, hospital wellness initiatives, and continuing medical education (CME) modules on resilience. It has validated scales. It is now the official language of physician distress. It is not wrong. But it is incomplete. It describes something real: exhaustion, detachment, the slow erosion of meaning. But burnout describes how the …
Beyond physician burnout and understanding structural immiseration
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