Conditions

Physician boundaries: When compassion causes harm

Conditions
December 6, 2025

I used to believe that being a good physician meant being generous, flexible, and willing to bend the rules if it helped a patient. I don’t believe that anymore.

The lesson came from a young patient who walked into my traditional Chinese medicine (TCM) clinic one afternoon, looking exhausted, embarrassed, and desperate.

He needed a powdered herbal preparation that cost around NT$7,500 (about $230). He stared at the ground and whispered, “Doctor, …

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When TV shows use food allergy as murder

Conditions
December 5, 2025

As the holiday season approaches, many people look forward to gatherings, travel, and celebrations centered around food. For those living with food allergies, however, this time of year brings a different reality. It means navigating crowded parties where allergens are everywhere, traveling on airlines that may or may not honor allergy precautions, and repeatedly encountering people who still do not fully believe that food allergy is real or life-threatening. The …

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Institutional inbreeding in developmental-behavioral pediatrics

Conditions
December 5, 2025

Developmental-behavioral pediatrics (DBP) was once defined by giants, leaders who authored textbooks, set standards, and gave the specialty a clear identity. Today, the field is fragmented, misunderstood, and too often hostile to new ideas. My own career arc illustrates how inbreeding and isolation have hollowed out DBP, leaving children without advocates and institutions without direction.

At a major military medical center, retired military DBPs replaced me. All were trained at that …

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How new pancreatic cancer laser therapy works

Conditions
December 5, 2025

Researchers at Sichuan University in China have developed a laser therapy that selectively kills pancreatic ductal adenocarcinoma (PDAC) tumors while preserving the surrounding healthy tissue. The technology, built around a 6.1-micron laser, takes advantage of the characteristic collagen fingerprint within PDAC tumors to focus the laser energy where it is needed the most.

The technology has received full approval from the Chinese National Medical Products Administration and will be developed …

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Community hospital innovation: a survival story

Conditions
December 4, 2025

Innovation in health care is often described in technological terms (new devices, advanced imaging, digital platforms). But some of the most meaningful forms of innovation happen quietly, inside small hospitals struggling to survive.

This is the story of a community hospital in Taiwan that once faced collapse, and the unexpected lessons it offers to health care leaders everywhere.

Looking for a way forward

In the late 1990s, the hospital was in serious decline. …

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California’s opioid policy hypocrisy

Conditions
December 4, 2025

California’s opioid policies reveal a stark hypocrisy, imposing draconian restrictions on prescriptions for chronic pain patients (leaving wildfire survivors and others in unrelenting agony) while allocating over $100 million annually through initiatives like the California Harm Reduction Initiative (CHRI) and Proposition 36 to provide free needles, pipes, and fentanyl test strips to addicts with minimal oversight. This disparity is compounded by the Medical Board of California’s (MBC) overreach, where physicians …

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Developmental-behavioral pediatrics: the lost identity

Conditions
December 3, 2025

Developmental-behavioral pediatrics (DBP) has lost its identity, and my career shows what happens when leadership retreats.

When I applied for positions in Tucson and Jacksonville, I was not seen as a developmental pediatrician with expertise in neurodevelopmental disabilities. Instead, I became the dumping ground for “Stranger Things” (children whose needs were psychiatric, not developmental). Administrators and chiefs, lacking even a basic understanding of DBP, misrouted cases into my lap. The result …

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The haunting trauma of nursing

Conditions
December 3, 2025

We put on that strong face. Resilience. We learn to handle anything. But our outside appearance can fool you as our inner turmoil plays havoc emotionally.

I learned quickly that nursing was not all about holding hands with a sick child in the emergency room or fluffing up a pillow for a dying grandma. My initiation into the dark side of nursing began in the emergency department. I was fresh out …

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Why psychologist training takes years

Conditions
December 3, 2025

As a practicing (“licensed”) psychologist, this issue comes up frequently. What are the differences among the myriad of mental-health professionals and does it even matter? As a researcher, as well as a clinician, my first inclination is always to look at the literature when seeking answers. What have others written on whatever topic it is that I am trying to better understand? Did someone else already answer my question? So, …

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Patient modesty in health care matters

Conditions
December 2, 2025

Studies show that many patients have strong convictions regarding their rights and values. Some avoid or delay life-saving medical procedures due to modesty concerns, which can stem from religious, cultural, or personal reasons, or anxieties from previous bad experiences in medical settings. Some patients even travel to another state or country to seek medical care. Others who have been diagnosed with PTSD from abuse in medical settings avoid medical care …

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When patients self-diagnose from TikTok

Conditions
December 2, 2025

It’s a moment I’ve come to recognize too well as a psychiatry resident: a patient walks into my office already convinced of their diagnosis. They’ve watched a dozen videos, followed mental health influencers on Instagram, and taken online quizzes that “confirmed” what they suspected. They have ADHD, or autism, or borderline personality disorder. They’re not here for an evaluation; they’re here for validation.

On one hand, this moment feels like progress. …

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Alcohol, dairy, and breast cancer risk

Conditions
December 1, 2025

Delta Airlines has been raising money for the Breast Cancer Research Foundation by selling cocktails and rosé on board flights for 20 years. This month, it’s Une Femme Sparkling Rosé. Delta also serves gouda and cheddar slices, along with chicken salad sandwiches topped with queso. Have a drink or two, snack on cheese, and feel good about sending money for research, a party for a cause.

Yet, studies have shown that …

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Infertility public health: the WHO’s new global guideline

Conditions
December 1, 2025

Infertility affects one in six people of reproductive age worldwide, yet it remains one of the most overlooked public health challenges of our time. For decades, millions of individuals and couples have navigated this journey in silence, carrying grief, stigma, financial strain, and deep uncertainty about their reproductive futures. Despite its prevalence, infertility has rarely been treated as a global health priority.

That changed this year when the World Health Organization …

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Imposter syndrome: a poem of self-talk

Conditions
December 1, 2025

Many of the physicians I work with live with a quiet weight of imposter syndrome. They show up every day for patients, teams, and families, yet doubt their own belonging.

I wrote a short reverse poem, “Worthy in Reverse,” as a way to explore how self-talk can shape that inner experience. This poem was inspired by “Worst Day Ever?” by Chanie Gorkin, which creatively uses structure to shift perspective.

It is simple …

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Modified DSM-5 opioid use disorder criteria for pain patients

Conditions
December 1, 2025

Two years ago, I asked, “Doctors diagnosing addiction: Are the blind leading the blind?”

The estimated rates of substance use disorder among clinical patients treated for pain vary greatly, depending on whom one believes. Studies also suffer from a widespread failure to address genetically mediated variability in minimum effective opioid dose between individuals. Thus, I have many times respectfully suggested that the entire body of literature on opioid …

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Why is compression stocking compliance low?

Conditions
November 30, 2025

Every cardiology clinic has them: patients with swollen, aching legs and bulging varicose veins. We talk about conservative management: exercise, leg elevation, and, of course, compression stockings. And almost without fail, patients smile politely, nod, and then admit at the next visit: “I couldn’t wear them. They’re too tight, too hot, too uncomfortable.”

The paradox of a simple solution

Compression stockings are one of the most effective noninvasive treatments for varicose veins …

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Why you need a GLP-1 exit plan

Conditions
November 29, 2025

I’ve seen clients start GLP-1 medications full of hope, and stop them feeling betrayed by their own biology. Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way: one step forward, five steps back.

We …

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Why not all ADHD generics are created equal

Conditions
November 29, 2025

A 2022 KevinMD article raised concerns about generic formulations of ADHD medications. The author described what many patients and families had already discovered: Not all generics are created equal. For those of us who lived through the substitutions, the difference was not abstract. It was a roller coaster that intruded on daily life, even on vacation.

The generic in question was manufactured by Mallinckrodt. Unlike Concerta, which uses an osmotic-controlled …

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Early Alzheimer’s blood test: Is it useful?

Conditions
November 29, 2025

In May, a published report indicated that changes indicative of Alzheimer’s disease (AD) were detected at age 24 via a blood test, which is increasingly available. These changes may begin earlier, but these were the study’s youngest participants. There are no medical treatments for these early manifestations, and aside from providing knowledge of a possible future and potentially causing anxiety, what value does the test hold? Unless a person has …

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The patient carryover crisis: Why discharge education fails

Conditions
November 28, 2025

I still remember the feeling of relief standing by my uncle’s bedside. The monitors were humming with steady rhythms; the surgical team was congratulating themselves on a textbook procedure. By all clinical metrics, he was a success story. The intervention worked. The pathology was addressed. He was “stable.”

We celebrated his discharge as a victory lap. We trusted that the packet of papers in his hand (filled with appointments, medication schedules, …

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