Booking a hospital appointment is usually the easy part of medical travel. The difficult work begins when the patient asks what the appointment is supposed to accomplish, who has reviewed the records, and what happens if the answer is "Treatment…
Booking a hospital appointment is usually the easy part of medical travel. The difficult work begins when the patient asks what the appointment is supposed to accomplish, who has reviewed the records, and what happens if the answer is “Treatment is not appropriate.” Those questions determine whether a patient is making an informed decision or simply moving between health systems with a suitcase full of hope and an incomplete medical …
A physician I follow on social media is an incredibly talented artist. He turns medical scenarios into cartoon sketches, as if they belong in a Sunday newspaper instead of on a telephone screen. One of his recent renderings depicted the…
A physician I follow on social media is an incredibly talented artist. He turns medical scenarios into cartoon sketches, as if they belong in a Sunday newspaper instead of on a telephone screen.
One of his recent renderings depicted the typical ICU patient: intubated, sedated, and surrounded by machines. Standing beside the hospital bed were two individuals with captions over their heads saying, “Look at all of this! This is torture! …
"I'm so OCD." "I think I'm a little OCD, I like things neat." Clinicians hear versions of this constantly, said casually, sometimes as a joke, sometimes with a note of pride. The person is usually describing themselves as particular, exacting,…
“I’m so OCD.” “I think I’m a little OCD, I like things neat.” Clinicians hear versions of this constantly, said casually, sometimes as a joke, sometimes with a note of pride. The person is usually describing themselves as particular, exacting, or a little controlling. Almost none of it has anything to do with obsessive-compulsive disorder (OCD).
OCD is defined by intrusive, unwanted thoughts that generate real anxiety, disgust, or dread, and …
Imagine trying to complete a complex jigsaw puzzle when most of the pieces are missing. For decades, that has been the reality of genetic research in Charcot-Marie-Tooth (CMT) disease. Much of what the world knows about CMT has been built…
Imagine trying to complete a complex jigsaw puzzle when most of the pieces are missing. For decades, that has been the reality of genetic research in Charcot-Marie-Tooth (CMT) disease. Much of what the world knows about CMT has been built from Western patient populations, creating a knowledge base that is valuable but incomplete. If we are serious about developing treatments that work for everyone, the global scientific community must pay …
A recent JAMA Pediatrics article concludes that the Autism Diagnostic Observation Schedule (ADOS) is "generally not required" for diagnosing autism in young children. The authors report 90 percent agreement between a clinician's initial diagnosis and the diagnosis made after reviewing…
A recent JAMA Pediatrics article concludes that the Autism Diagnostic Observation Schedule (ADOS) is “generally not required” for diagnosing autism in young children. The authors report 90 percent agreement between a clinician’s initial diagnosis and the diagnosis made after reviewing ADOS results. They argue that experienced developmental-behavioral pediatricians (DBPs) can diagnose autism accurately without structured tools.
That conclusion may hold inside the eight academic centers included in the study. It …
Although people who smoke cigarettes say that clinicians routinely advise them to quit smoking, this is not reflected in the studies of electronic medical records, pharmacy claims, or medical claims. A recent article in the American Journal of Managed Care…
Although people who smoke cigarettes say that clinicians routinely advise them to quit smoking, this is not reflected in the studies of electronic medical records, pharmacy claims, or medical claims. A recent article in the American Journal of Managed Care reported that only 1 percent of outpatient office visits at an academic medical center billed for tobacco treatment. A repeat of the same study design published in …
The separation of mental and physical health care still rests on a Cartesian inheritance, the old assumption that mind and body are fundamentally different kinds of things, one physical and mechanical, the other immaterial and spiritual. That framework may have…
The separation of mental and physical health care still rests on a Cartesian inheritance, the old assumption that mind and body are fundamentally different kinds of things, one physical and mechanical, the other immaterial and spiritual. That framework may have served a purpose in an era when medicine lacked the tools to explain what it could not measure, allowing physicians to attend to the body while matters of the mind …
A few months ago, a new patient walked into my clinic carrying a folder nearly two inches thick. She had undergone years of physical therapy, chiropractic care, epidural steroid injections, anti-inflammatory medications, opioid therapy, and consultations with multiple specialists. Before…
A few months ago, a new patient walked into my clinic carrying a folder nearly two inches thick. She had undergone years of physical therapy, chiropractic care, epidural steroid injections, anti-inflammatory medications, opioid therapy, and consultations with multiple specialists. Before sitting down, she asked a question I now hear almost weekly: “Doctor, what about stem cells? I’ve heard they can regenerate my spine.”
History deserves honesty. Years have passed since the height of the COVID-19 pandemic, and with distance comes a natural desire to reflect on what happened. We should absolutely evaluate the decisions that were made. We should question policies, examine the…
History deserves honesty.
Years have passed since the height of the COVID-19 pandemic, and with distance comes a natural desire to reflect on what happened. We should absolutely evaluate the decisions that were made. We should question policies, examine the evidence, and learn from our mistakes. That is how science grows, and health care improves.
But there is a difference between learning from history and rewriting it. Lately, I have watched with …
My testosterone level is 177 ng/dL. I am intimately familiar with this number, having checked it myself on my own laboratory slip, just as I have reviewed countless lab results for patients throughout my 35-year medical career. But this time,…
My testosterone level is 177 ng/dL. I am intimately familiar with this number, having checked it myself on my own laboratory slip, just as I have reviewed countless lab results for patients throughout my 35-year medical career. But this time, however, the patient’s focus was on me.
One year ago, I underwent a prostatectomy for low-grade, minimally aggressive prostate cancer. The surgery was successful, and the pathology results were reassuring. My …
When trauma threatens a child's permanent tooth A new electric scooter for a tenth birthday party. In the excitement of trying it out for the first time and demonstrating the speed to friends, the new rider doesn't notice the curb…
When trauma threatens a child’s permanent tooth
A new electric scooter for a tenth birthday party. In the excitement of trying it out for the first time and demonstrating the speed to friends, the new rider doesn’t notice the curb and goes flying over the handlebars. Landing face-first on the sidewalk, the upper lip and front teeth bear the brunt of the impact. This scenario is occurring with increased frequency, especially …
Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive. What they do not know is that the research designed to help them recover more safely…
Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive.
What they do not know is that the research designed to help them recover more safely at home may never be completed.
In mid-July, the Agency for Healthcare Research and Quality (AHRQ) began notifying researchers across the country that dozens of active research grants would be terminated. As …
Both lay dabblers and scholars of history repeatedly admonish us that history repeats itself. Historical context can help us understand and grapple with issues that have plagued and continue to plague humankind. The United States is not alone in having…
Both lay dabblers and scholars of history repeatedly admonish us that history repeats itself. Historical context can help us understand and grapple with issues that have plagued and continue to plague humankind.
The United States is not alone in having a dubious record of misogyny and glaring inequities in the treatment of women and people of color. In recent decades, people have re-examined historical teachings through the lens of human rights, …
Medical fields don't evolve because someone discovers a new molecule. They evolve because someone notices something obvious that everyone else has learned to ignore. In developmental-behavioral pediatrics, what shaped my early career was four studies that ended up influencing the…
Medical fields don’t evolve because someone discovers a new molecule. They evolve because someone notices something obvious that everyone else has learned to ignore. In developmental-behavioral pediatrics, what shaped my early career was four studies that ended up influencing the field more than I expected. I didn’t set out to be a contrarian. I simply had a habit of asking questions that didn’t fit the standard research template.
Few psychiatric terms have migrated into everyday language as completely as "bipolar." It is now routinely used to describe irritability, emotional volatility, and rapid shifts in mood. Yet this widespread usage reflects a fundamental misunderstanding of the condition itself. At…
Few psychiatric terms have migrated into everyday language as completely as “bipolar.” It is now routinely used to describe irritability, emotional volatility, and rapid shifts in mood. Yet this widespread usage reflects a fundamental misunderstanding of the condition itself.
At the center of the confusion is a mismatch of scale. The public conception of “mood swings” involves rapid fluctuation, changes occurring over minutes or hours. These shifts may be mild, or …
In medicine, we are trained to react to alarms. A monitor beeps. A CT scan lights up. A lab value crosses a dangerous threshold. We move. Public health is harder. Sometimes the most important signal is not a siren, but…
In medicine, we are trained to react to alarms. A monitor beeps. A CT scan lights up. A lab value crosses a dangerous threshold. We move.
Public health is harder. Sometimes the most important signal is not a siren, but a persistent hum. That is where mpox appears to be now.
Walk into any tumor board and you can watch the problem resolve itself for one hour a week. A radiologist, a pathologist, an oncologist, and a surgeon each hold a piece of the same patient. It is one of the…
Walk into any tumor board and you can watch the problem resolve itself for one hour a week. A radiologist, a pathologist, an oncologist, and a surgeon each hold a piece of the same patient. It is one of the most valuable hours a hospital spends, and one of the few moments when the system concedes that a single physician cannot see an entire case.
During my years in clinical dentistry, I repeatedly met patients whose oral disease had been causing symptoms long before they reached a dental office. Some had mentioned bleeding gums to another health care professional but did not understand that the…
During my years in clinical dentistry, I repeatedly met patients whose oral disease had been causing symptoms long before they reached a dental office. Some had mentioned bleeding gums to another health care professional but did not understand that the symptom required evaluation. Others had lived with painful chewing, loose teeth, or persistent dry mouth while managing diabetes, cardiovascular disease, or multiple medications. By the time they sought dental care, …
Ethics education differs from other disciplines because its main goal is not to transmit information but to encourage moral reasoning. When students leave an ethics course, we hope they will be better equipped to analyze competing values, evaluate evidence, and…
Ethics education differs from other disciplines because its main goal is not to transmit information but to encourage moral reasoning. When students leave an ethics course, we hope they will be better equipped to analyze competing values, evaluate evidence, and justify their conclusions, not merely adopt those of the instructor. When you think about it, the teaching of ethics is itself an ethical act that can carry responsibilities extending beyond …
"I've never really been able to focus, but it's only become a real problem in the last few years, since I started this job. Could I be evaluated for adult ADHD?" I hear a version of this request often, and…
“I’ve never really been able to focus, but it’s only become a real problem in the last few years, since I started this job. Could I be evaluated for adult ADHD?”
I hear a version of this request often, and it captures a confusion built into the term itself. “Adult ADHD” sounds like it names a condition that begins in adulthood, the way adult-onset diabetes or adult-onset asthma can. It doesn’t, …
