Every week in clinic, I meet patients who carry lab results like heavy burdens. Their cholesterol is “slightly high,” their thyroid level is “borderline,” or their blood sugar is “just above normal.” They arrive anxious, wanting certainty: Do I need treatment? Am I sick?
The truth is, much of medicine exists in the gray zone (values that are not clearly normal, but not clearly dangerous either).
What the research tells us
Borderline numbers …
All of the arguments for direct primary care (DPC) from a provider perspective are valid. As a psychotherapist and psychoanalyst, I have essentially run a direct care practice for the last 15 years. I don’t accept insurance and see patients as often and for as long as therapeutically necessary. So when DPC practices started rising in popularity, I was excited to try it. Unfortunately, as a patient who is medically …
On a winter evening in Taipei, random violence erupted across two of the city’s busiest metro stations. Within minutes, lives were lost, dozens were injured, and a familiar cycle followed: shock, fear, calls for more security, and questions about public safety. But for those of us in health care, this should not be framed as a failure of policing alone. It should be recognized for what it truly is: a …
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs. The child suffers not only from the caregiver’s direct …
Kelly D. Holder, PhD, and I first met at the Dr. Lorna Breen Heroes Foundation Health Care Worker Well-Being Day in Washington, D.C., where she was a presenter. I was impressed with Kelly’s work, focusing on helping health care professionals and leaders co-create a culture of well-being, which is so critical in medicine today.
This resonates deeply with Sarah Hollander, MD’s belief that the culture of medicine must change, starting in …
The denial came back in less than three seconds.
A physician had just submitted a renewal for a medication her patient had taken for years, one that kept her stable, out of the hospital, and able to function. She expected the usual wait time. Maybe an hour. Maybe a day.
Instead, an automated message appeared: “Denied: automated appropriateness determination.”
No reviewer. No rationale. No path for appeal. Only an algorithm, silent, opaque, and …
Medicine is getting faster, louder, and more efficient, and many of us feel something quietly slipping away. We talk about burnout, moral injury, and depersonalized care, but the deeper question is often left untouched: How do we keep the soul of medicine alive while building systems that must scale?
I encountered that question in an unexpected place, not in a policy meeting, not in a spreadsheet, and not in an architectural …
You are the expert of your body. You know when something isn’t right.
Yet many patients leave an exam room feeling worse than when they came in, not because of their illness, but because they were told, directly or indirectly, that nothing is wrong. Their symptoms are minimized, reframed, dismissed, or worse, attributed to anxiety, stress, age, or weight. They are left questioning their own experience and perception of reality.
This is …
The nurse adjusted my father’s blanket for the third time that hour, her voice soft as velvet. “We just hate to see him suffer like this,” she whispered. My mom and I watched her check his IV with the tenderness reserved for wounded pups.
Three floors down, four years earlier, this same hospital discharged me mid-vomit with a gastric outlet obstruction and a white blood cell count that screamed infection. “Go …
Tick-borne illnesses continue to rise across the U.S. and Europe, and clinicians are feeling the impact. More patients are showing up with early Lyme disease, more are asking about prophylaxis, and more travelers want advice about tick-borne encephalitis (TBE). At the same time, vaccine development is finally accelerating after years of stagnation. For busy clinicians, here is a concise update on what’s new and what to tell patients in 2025.
Lyme …
Causing quite a stir, Mark Zuckerberg (Meta’s CEO) recently proposed Artificial Intelligence (AI) companionship for those suffering from social isolation. All of this unfolds amid a climate of epidemic-levels of loneliness, as declared by the Surgeon General, and the storms it has unleashed upon the edifices of our personal and collective health. The irony, even horror, was not lost on many: The very tools and companies, in …
Being a family physician and geriatrician for more than 38 years, I’m trying to better understand why our elderly patients, and in general, elderly people, suffer from dehydration. For sure, there are many reasons. Some of those are simple, but some of the hidden ones we don’t think about. For example, just by getting older, we end up having less water in our bodies. Living in a humid area and …
I was on a call a few months back with a new physician assistant. She was still finding her footing, and she shared a moment that stuck with me. Almost in a whisper, she told me: “No one, not a single person, will ever know what it took, just to keep her alive.” This feeling lingered with her long after the adrenaline of the stressful code had faded.
That hit me …
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Something unusual is happening in medicine. A once-rare diagnosis (gender dysphoria) has become common among American children and adolescents. An estimated three percent of youth now identify as transgender, and another two percent are questioning their gender identity. That surge should have prompted urgent, transparent scientific inquiry. Instead, the field of pediatric gender medicine has become one of the most ideologically-charged, and least open to critical debate, areas in modern …
Despite decades of progress in reducing the prevalence of cigarette smoking, tobacco use remains a leading cause of preventable death and disease, and a significant driver of health care costs in the United States. Smoking cessation therapy is consistently ranked among the most cost-effective clinical preventive services and is considered to be “the gold standard of health care cost-effectiveness.” Yet, delivery of evidence-based treatment …
“The Power of Vulnerability,” a TED Talk by Brené Brown, PhD, has been viewed more than 66 million times. Rather than interpreting vulnerability as a sign of weakness, she suggests that it is a measure of courage, which, in turn, is the “birthplace of innovation, creativity and change.” She asserts the courage to acknowledge imperfection, to be kind to ourselves and to others, actually strengthens us. Brown concedes that …
When I first began working with clinical AI tools, I felt the kind of excitement many young clinicians and researchers feel today. For the first time, it seemed possible to reduce cognitive overload, surface hidden patterns, and give clinicians more time to focus on what mattered most: patients. AI felt less like a threat and more like a long-awaited collaborator.
As a young clinician-scholar, I did what many of us do. …
Apurv Gupta, Michael Mantell, and I recently had a conversation exploring how compassion, culture, and systems come together to heal not only patients, but those who care for them. We discussed how loving organizations outperform others, how shared responsibility for well-being transforms outcomes, and why “when two hearts touch, that’s healing!” We learned about real hospitals already leading this movement, and how we can all open our thinking to see …
This past year, I’ve found myself in many different rooms (on podcasts, in boardrooms with legislators, and in conversations with program directors at medical schools and hospitals) talking about what humanity truly means in clinical and caregiving professions.
I hear back from my third- and fourth-year medical students about how this work shows up for them in clinics, auditions, and residency interviews. They describe moments when an intentional emphasis on humanity, …
Walk into most community pharmacies today and you’ll notice something off. The pharmacist who used to remember your name and medication history is gone. The one who caught that dangerous drug interaction last year? Also gone. In their place, a rotating cast of temporary faces, each one just trying to survive the shift.
This isn’t about a labor shortage. We have pharmacists. What we’re losing is something else entirely. Expertise, continuity, …
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