When I began studying medical ethics, forty-five years ago, patient autonomy and informed consent (IC) were major issues. While some academics and practitioners today argue that autonomy has been overly emphasized, in my decades of practice and as a patient,…
When I began studying medical ethics, forty-five years ago, patient autonomy and informed consent (IC) were major issues. While some academics and practitioners today argue that autonomy has been overly emphasized, in my decades of practice and as a patient, I have yet to see IC properly administered.
There is little oversight of medical IC by a federal or state agency, but to state that it is required and its general …
We know when a patient's laboratory values have improved. We know when the infection has cleared, the fracture has been repaired, or the heart failure has stabilized. But before declaring treatment successful, we should ask a more ordinary (and often…
We know when a patient’s laboratory values have improved. We know when the infection has cleared, the fracture has been repaired, or the heart failure has stabilized. But before declaring treatment successful, we should ask a more ordinary (and often more consequential) question:
Can this person safely get out of bed?
Too often, health care discovers the answer only when discharge is approaching. Rehabilitation is then asked to solve, in a matter …
Obsessive-compulsive disorder (OCD) is one of the most delayed diagnoses in psychiatry, and much of that delay happens in offices like ours. Patients typically notice their first symptoms in adolescence or early adulthood but are not correctly diagnosed until roughly…
Obsessive-compulsive disorder (OCD) is one of the most delayed diagnoses in psychiatry, and much of that delay happens in offices like ours. Patients typically notice their first symptoms in adolescence or early adulthood but are not correctly diagnosed until roughly a decade later. One outpatient study found an average of about 12.8 years between symptom onset and diagnosis, and a meta-analysis of 31 studies put the pooled duration of untreated …
1. The six-week myth vs. the thirty-year reality We all know the current standard of maternal health care operates on a dangerous illusion: the big ole' six-week checkup. We tell moms that once they pass this test, congrats! Recovery is…
1. The six-week myth vs. the thirty-year reality
We all know the current standard of maternal health care operates on a dangerous illusion: the big ole’ six-week checkup. We tell moms that once they pass this test, congrats! Recovery is complete and they are cleared to return to normal life and exercise.
It would be convenient if bodies healed by the calendar, wouldn’t it? What really happens during pregnancy, birth, and lactation …
A recent study found that, compared with people from other cultures, Americans are less likely to report feeling a sense of obligation to be present for their friends. If that reflects a broader cultural shift, it raises an uncomfortable question:…
A recent study found that, compared with people from other cultures, Americans are less likely to report feeling a sense of obligation to be present for their friends. If that reflects a broader cultural shift, it raises an uncomfortable question: Is this same emphasis on personal autonomy and individual comfort seeping into health care? Are health care professionals increasingly opting out of their obligation to care for patients when the …
A routine EKG at my annual physical was supposed to be uneventful. Instead, it ended my marathon career. This past winter, I was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited heart disease associated with ventricular arrhythmias, sudden…
A routine EKG at my annual physical was supposed to be uneventful. Instead, it ended my marathon career.
This past winter, I was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited heart disease associated with ventricular arrhythmias, sudden cardiac arrest, and an increased risk of life-threatening events during intense endurance exercise. I had no symptoms. No warning signs. I felt like the healthiest version of myself. Yet suddenly I …
CSI:OPIOIDs (Clinical Context of Suicide Following Opioid Transitions) is a rigorous scientific research study that systematically examines suicides occurring after prescription opioid dose reductions or discontinuations in patients with long-term (chronic) pain. Using psychological autopsy methods using detailed interviews with…
CSI:OPIOIDs (Clinical Context of Suicide Following Opioid Transitions) is a rigorous scientific research study that systematically examines suicides occurring after prescription opioid dose reductions or discontinuations in patients with long-term (chronic) pain. Using psychological autopsy methods using detailed interviews with bereaved survivors combined with medical record review where obtainable, it seeks to characterize the multifactorial demographic, societal, clinical, and health-system factors involved. The study began as a pilot supported by …
Addiction. The American Board of Preventive Medicine certified me as an addiction medicine specialist so how bad can the term be? My patients called themselves addicts. Heck, they called themselves junkies and fentanyl fiends. That's not a license to stigmatize.…
Addiction. The American Board of Preventive Medicine certified me as an addiction medicine specialist so how bad can the term be? My patients called themselves addicts. Heck, they called themselves junkies and fentanyl fiends. That’s not a license to stigmatize. Nor does it mean that substance use disorder patients appreciate people outside the clan calling them that. Just treat people with respect. The affliction truly is a disease, not a …
In a recent poll, people indicated interest in maintaining brain health but expressed ignorance on how to do so. In a second poll, most men believed the herpes vaccine was only for young women, while in a third poll, only…
In a recent poll, people indicated interest in maintaining brain health but expressed ignorance on how to do so. In a second poll, most men believed the herpes vaccine was only for young women, while in a third poll, only about 50 percent of women were aware of the importance of breast cancer screening. Other polls on health care information knowledge have shown similarly large awareness gaps. Given the substantial …
Every joint replacement patient leaves my office with a plan. When to walk, how to ice, when to drive, when to come back. We talk about stairs, showers, sleep, and the first night home. What most of them do not…
Every joint replacement patient leaves my office with a plan. When to walk, how to ice, when to drive, when to come back. We talk about stairs, showers, sleep, and the first night home. What most of them do not leave with is an answer to a question they are thinking about and almost never ask: When can I have sex again?
A new kind of capital For decades, we have treated brain health solely as a medical issue, something to address only when it begins to fail. That's beginning to change, as more experts recognize that the capabilities of the human…
A new kind of capital
For decades, we have treated brain health solely as a medical issue, something to address only when it begins to fail. That’s beginning to change, as more experts recognize that the capabilities of the human mind (our ability to think, adapt, learn, and make decisions) impact more than just the day-to-day lives of individuals. They influence the well-being and stability of families, workplaces, populations, and society …
A meaningful portion of my practice involves reconstructive work, not the kind that follows trauma or cancer, but the kind that follows cosmetic procedures that went wrong. Patients come to me after abdominoplasties that developed into sepsis, after injections administered…
A meaningful portion of my practice involves reconstructive work, not the kind that follows trauma or cancer, but the kind that follows cosmetic procedures that went wrong. Patients come to me after abdominoplasties that developed into sepsis, after injections administered by unlicensed individuals, after hair transplants that left permanent scarring. Much of what I do in the consultation room is assess what can be improved, what cannot be reversed, and …
We measure blood pressure before a patient has a stroke. We check cholesterol before a coronary event. We evaluate vision before impairment interferes with driving or reading. So why is hearing treated differently? For many people, the last routine hearing…
We measure blood pressure before a patient has a stroke. We check cholesterol before a coronary event. We evaluate vision before impairment interferes with driving or reading.
So why is hearing treated differently? For many people, the last routine hearing test they remember was in elementary school. Decades pass before anyone checks again, often after the problem has become impossible to ignore. Conversations are frustrating, family members are repeating themselves, and …
This month, the Centers for Medicare and Medicaid Services (CMS) announced a new 173-page toolkit to help states ensure more effective and less costly autism care for children. The launch came as government data shows spending on care increased by…
This month, the Centers for Medicare and Medicaid Services (CMS) announced a new 173-page toolkit to help states ensure more effective and less costly autism care for children. The launch came as government data shows spending on care increased by 421 percent between 2021 and 2025, far outpacing the 67 percent growth in the number of children receiving services. It also followed recent investigations by the New York …
"Do No Harm" is perhaps the most famous medical maxim. But reciting it is one thing; living by it is another. Sometimes, the question of "harm" is up for debate. Throughout history, physicians have lent their knowledge to all manner…
“Do No Harm” is perhaps the most famous medical maxim. But reciting it is one thing; living by it is another. Sometimes, the question of “harm” is up for debate. Throughout history, physicians have lent their knowledge to all manner of atrocities, warfare, torture, and mass sterilization, often justified under the supposedly noble pursuit of “reducing harm.”
Capital punishment or the death penalty is another instance of this dilemma. Doctors shouldn’t …
Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years.…
Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years. What most of us, myself included, haven’t been saying nearly often enough is anything about the brain, and a study published this summer in Molecular Psychiatry is a good reason …
There is a conceptual inconsistency in contemporary medicine that I have become increasingly unable to reconcile. Psychiatry recognizes psychic pain as a genuine clinical phenomenon, and suicidology has long recognized unbearable psychological pain as integral to suicidal states. Neuroscience has…
There is a conceptual inconsistency in contemporary medicine that I have become increasingly unable to reconcile. Psychiatry recognizes psychic pain as a genuine clinical phenomenon, and suicidology has long recognized unbearable psychological pain as integral to suicidal states. Neuroscience has simultaneously demonstrated that nociception, affective pain, reward, motivation, salience, stress responsivity, and emotional regulation are interconnected biological processes.
Yet when psychic pain becomes intolerable, psychiatry has remarkably little therapeutic infrastructure directed …
As an incoming fifth-year dental student beginning my clinical internship at Tamale Teaching Hospital, the major tertiary referral center for northern Ghana, I expected to refine my surgical hand and master diagnostic pathology. The fine instructors at the department made…
As an incoming fifth-year dental student beginning my clinical internship at Tamale Teaching Hospital, the major tertiary referral center for northern Ghana, I expected to refine my surgical hand and master diagnostic pathology. The fine instructors at the department made this possible, but I also got to witness firsthand the brutal arithmetic of health care access in the northern parts of Ghana.
She first presented to our oral and maxillofacial …
The hidden agenda of medical school curricula is loud and clear: Acuity equals status. Students are taught that the "best and brightest" belong in the windowless trauma bays of the ER or the high-pressure theaters of the OR. In this…
The hidden agenda of medical school curricula is loud and clear: Acuity equals status. Students are taught that the “best and brightest” belong in the windowless trauma bays of the ER or the high-pressure theaters of the OR. In this antiquated hierarchy, sleep medicine is often paternalistically patted on the head and labeled a “lifestyle” specialty, the medical equivalent of a quiet retirement.
In community interventional psychiatry practices, the typical referral looks the same week after week. The patient is in the fifth or sixth year of a major depressive episode and carries a list of four, five, sometimes seven antidepressants they have…
In community interventional psychiatry practices, the typical referral looks the same week after week. The patient is in the fifth or sixth year of a major depressive episode and carries a list of four, five, sometimes seven antidepressants they have “failed.” They are finally sent for transcranial magnetic stimulation (TMS) or esketamine (Spravato) long after the point when those treatments would have done the most good. By the time the …
