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Family physician and health benefits advisor Jonathan Bushman discusses his article “The 5 percent problem: the low value of primary care.” Jonathan contrasts the grueling decade of training and massive debt required …
Primary care receives only five cents of every health care dollar [PODCAST]
Across the United States, rural maternity care is in crisis. Hospitals continue to close labor and delivery units, entire counties are left without obstetric services, and pregnant patients are forced to travel hours for routine care or delivery. These closures are often framed as inevitable, driven by low volume, unsustainable costs, and staffing shortages, but this narrative ignores both the root causes of the problem and the solutions already within …
Rural maternity care in crisis: 5 solutions to save local OB units
I’m Tommy. Bipolar type one, I’m told. I actually have something to say, something to share.
The thing no one talks about in mental health, bipolar type one specifically, is how seductive and sweet the upswing feels. It’s deeply more than just “good” to me. It feels like the limits of the brain have been cut loose, severed, done away with. Suddenly all those moments and ideas and thoughts and connections …
Bipolar I and the illusion of insight: a firsthand account
Once upon a time, clinicians didn’t have enough data about their patients.
To put it mildly, things have changed. Today we’re drowning in data. As a practicing emergency physician, it is a reality I see every day.
In an emergency department (ED) environment characterized by constant time pressure, staffing constraints, and high patient acuity, clinicians sometimes must wade through reams of electronic health records (EHR) data to find critical patient information that …
AI in health care data management: Curing the EHR overload
I have spent my career believing in systems. As physicians, we are trained to trust oversight. We are taught that regulatory bodies exist to protect patients, maintain standards, and intervene when care falls below acceptable levels. We are taught that if we act ethically, document carefully, and prioritize patients, the system will ultimately be fair. What we are not trained for is what happens when that power becomes opaque.
Over the …
The hidden toll of physician regulatory investigations
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Family physician Travis Walker discusses his article “A physician father on the Dobbs decision and reproductive rights.” Travis reflects on the glaring double standard facing his daughter compared to his sons in …
Physician father wrestles with daughter’s post-Dobbs future [PODCAST]
If you are frustrated by your high tax bill, you are not alone. I have spoken with many doctors who experience sticker shock when they see their total annual tax liability after completing residency. Stories in the media, such as The Atlantic’s recent study on billionaire taxes, about how rich people avoid taxes only fan the flames. It is no surprise, then, that one of the most common financial …
Physician tax strategies: Why your tax bill is so high and how to fix it
The attending scrolls through the chart before morning rounds. The progress note is polished. The assessment is structured. The differential is surprisingly thorough. A predictive model flags the patient as high risk for deterioration within 24 hours. He did not write most of it.
An AI assistant drafted the note. A risk algorithm generated the alert. A decision-support tool suggested broadening the workup. He reviewed it. He agreed with most of …
AI in clinical documentation: Who is liable for medical errors?
“The problem is not that physicians play games. The problem is that we are embarrassed to admit we need ways to feel alive again.”
At 3:17 a.m., we called the code. Thirty minutes of compressions. Three rounds of epinephrine. A room filled with controlled urgency. When it ended, the monitors fell silent before the hallway did. I finished my documentation. I washed my hands. I walked to my car. And I …
Physician burnout and gaming: Why doctors turn to video games
After more than 25 years in oncology rehabilitation, clinical education, and survivorship care, I’ve learned to be cautious about “good” numbers from common tools like BMI and bathroom scales that don’t match what is actually happening in the body. A recent study confirms it: When used alone, BMI has been found to misclassify up to 34 percent of the general population as obese.
This year, it became more personal when …
Beyond BMI: Why weight management must look inside the body
Treatment of people who use tobacco is different. Most treatments given to patients are reasonably successful, but cigarette smokers who are trying to quit will make multiple attempts before they remain abstinent, sometimes as many as twenty. Within hours of stopping, nicotine users can begin to experience withdrawal symptoms which include craving, anxiety, irritability, and restlessness that continue to increase and can rapidly be relieved by another cigarette.
Some people trying …
Learned helplessness and self-efficacy in tobacco treatment
Unfortunately, we’re all too familiar with the tragic headlines:
We can easily conclude from these stories that ketamine, propofol, and fentanyl are inherently dangerous substances. When used irresponsibly or in the wrong hands, they are dangerous. But as an anesthesiologist, I, and many other medical professionals, use these …
The truth about ketamine: an anesthesiologist explains drug safety
As a pain physician, I spend my career advocating for patients who struggle to access appropriate pain management. I write often on hurdles like restrictive opioid policy, excessive regulatory scrutiny, prior authorization, and administrative burdens that detract from patient care. Yet nothing prepared me for the visceral reality of being the patient on the other side of the system.
From physician advocate to patient in the system
My recent experience, unrelated to …
Why doctors struggle with health care system delays
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Internal medicine physician Sally Daganzo discusses her article “The hidden epidemic of orthorexia nervosa.” Sally explains how the pursuit of a perfect diet can spiral into a debilitating obsession where food rules …
Orthorexia nervosa turns healthy habits into a harmful obsession [PODCAST]
The fissuring of health care, along the lines of “The Fissured Workplace: Why Work Became So Bad for So Many and What Can Be Done to Improve It” by David Weil (2014), may not be entirely negative after all. Outsourcing patient contact services, perioperative or otherwise, to centralized, multilingual third-party entities with nationwide reach may be the need of the hour in an ever-evolving multilingual society seeking health care. In …
Outsourcing patient contact: a solution for multilingual health care
An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).
Foreword by Jennifer Breen Feist
Foreword by Jennifer Breen Feist, who lost her beloved sister, Dr. Lorna Breen, to suicide on April 26, 2020. After describing the initial shock and unwanted global publicity of her death, she wrote this:
As the emails, letters, and phone calls continued to pour in, my husband …
Physician mental health and suicide prevention: stories of survival
I recall the moment I fully grasped the critical importance of the physical exam and how easily it can be overlooked, often with serious consequences.
Early in my fellowship, an elderly patient was referred to our team with an apparently straightforward case of sciatica. His MRI revealed a disc herniation at L5/S1 with foraminal narrowing, prompting discussion about whether an epidural injection or surgery would be more beneficial. I was tasked …
The enduring value of the physical exam in modern medicine
Recently, Dr. Tara Kiran made headlines when her robust national OurCare survey revealed 5.9 million Canadians still lack a primary care provider, the point-of-entry health professional, like a family doctor or nurse practitioner, who provides routine care.
Those who do have a primary care provider often wait weeks for an appointment, then get rushed through in minutes. Emergency departments overflow with patients who have nowhere else to go.
The federal government …
From Singapore to Canada: a blueprint for primary care transformation
I recently went to Quest Diagnostics for a TB test and a couple of basic labs my doctor ordered. At check-in, I recalled my insurance had changed in the new year and I did not have the updated information readily available. I did not have time to reschedule nor sort it out so figured I could pay cash and reconcile it later. That seemed reasonable, if inconvenient.
When I asked what …
Health care price transparency: Why patients are bypassing insurance
A few weeks ago, I went to the DMV to renew my driver’s license. At the very end of the process, after the routine questions and fine print, a single prompt appeared with a small checkbox next to it: Do you want to register as an organ donor?
I selected “yes,” but then I paused. Not because I was conflicted, but because I realized how easily I could have done nothing. …
Opt-in vs. opt-out: How defaults shape organ donation rates
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