"I just don't feel like myself lately." It is one of the most common opening lines in midlife primary care, and one of the least diagnostically useful on its face. The patient is forty-four, sleeping badly, irritable in a way…
“I just don’t feel like myself lately.”
It is one of the most common opening lines in midlife primary care, and one of the least diagnostically useful on its face. The patient is forty-four, sleeping badly, irritable in a way she describes as unfamiliar, and struggling to hold a thought through a meeting. Her cycles are still coming, roughly. She has read about perimenopause and dismissed the idea, because she …
I trained in the era when newborn care was a choreography, not a ritual, not a preference, but a sequence built from epidemiology, autopsy reports, and the memories of children we could not save. In the nursery, two injections and…
I trained in the era when newborn care was a choreography, not a ritual, not a preference, but a sequence built from epidemiology, autopsy reports, and the memories of children we could not save. In the nursery, two injections and a few simple prophylactic steps prevented the worst horrors of early infancy:
Vitamin K IM: To prevent catastrophic late-onset vitamin K deficiency bleeding (VKDB)
I have practiced neurology for more than fifty years. I have treated patients with refractory neuropathic pain, central pain syndromes, spinal cord injuries, and the cruel mix of conditions that fall under no clean diagnostic label. I have watched patients…
I have practiced neurology for more than fifty years. I have treated patients with refractory neuropathic pain, central pain syndromes, spinal cord injuries, and the cruel mix of conditions that fall under no clean diagnostic label. I have watched patients who were finally stable, finally sleeping, finally functioning, lose their prescriptions not because their physicians did anything wrong, but because the government decided that looking different on paper is the …
"I have a lot of anxiety and stress. Can I get Prozac, Lexapro, or something like that?" "My moods are all over the place. One moment I'm happy, the next I'm sad, the next I'm enraged. Can I get a…
“I have a lot of anxiety and stress. Can I get Prozac, Lexapro, or something like that?”
“My moods are all over the place. One moment I’m happy, the next I’m sad, the next I’m enraged. Can I get a mood stabilizer?”
I hear requests like these constantly. They’re completely understandable. They also reflect a common misunderstanding: that psychiatry works the way the rest of medicine does, where a symptom leads straight …
Clinicians often meet men like K at the exact moment their lives start to quietly unravel. They don't walk in using the language of distress. They show up looking competent, composed, and in control, even as something inside them is…
Clinicians often meet men like K at the exact moment their lives start to quietly unravel. They don’t walk in using the language of distress. They show up looking competent, composed, and in control, even as something inside them is slipping. What looks like a business crisis is often an emotional one, driven by shame, isolation, and the belief that suffering must be carried alone.
I just finished watching Daniel Kokotajlo's interview on The Diary of a CEO with Steven Bartlett and reading his full AI 2027 publication in its entirety, and I haven't been able to shake the feeling that this conversation, one that…
I just finished watching Daniel Kokotajlo’s interview on The Diary of a CEO with Steven Bartlett and reading his full AI 2027 publication in its entirety, and I haven’t been able to shake the feeling that this conversation, one that has clearly sparked a wave of public unease since it aired, is a preview of what I’m already starting to see in the clinic. A patient recently described …
This article is for those living or needing to live a gluten-free lifestyle, but still also appreciate a good guide for the grocery store too. Up to 15 percent of Western countries avoid gluten. By the year 2030 there could…
This article is for those living or needing to live a gluten-free lifestyle, but still also appreciate a good guide for the grocery store too. Up to 15 percent of Western countries avoid gluten. By the year 2030 there could be up to 600 million people worldwide avoiding gluten, and those numbers could influence a buyers market of a whopping $13.67 billion.
Patients may not remember every lab draw, procedure, or study visit. But they will remember how they felt. One of the greatest privileges of working in clinical research for more than 20 years has been meeting extraordinary people. Clinical research…
Patients may not remember every lab draw, procedure, or study visit. But they will remember how they felt.
One of the greatest privileges of working in clinical research for more than 20 years has been meeting extraordinary people. Clinical research is often associated with science, data, and innovation. While those elements are essential, there is also a deeply human side to this industry. Behind every study, treatment, and medical advancement are …
I am not a Mormon male. But for fifteen years, I had been doing a remarkably good impression of one. And then, on a Wednesday evening in May 2026, I was outed. The termination letter was two pages, formal and…
I am not a Mormon male. But for fifteen years, I had been doing a remarkably good impression of one. And then, on a Wednesday evening in May 2026, I was outed.
The termination letter was two pages, formal and bloodless. Ninety days’ notice, effective August 31. “With or without cause,” it said, a phrase that is perfectly designed to be both legally protective and humanly devastating. It was signed by …
An excerpt from Peach Cobbler Is Not a Fruit. Laughter is good medicine. I don't merely believe that. I have prescribed it, inhaled it, survived by it, and, on more than one occasion, snorted it through my nose at profoundly…
Laughter is good medicine. I don’t merely believe that. I have prescribed it, inhaled it, survived by it, and, on more than one occasion, snorted it through my nose at profoundly inappropriate moments.
Medicine is serious business. Patients entrust their bodies, fears, secrets, and occasionally their entire futures to the care and judgment of their physicians. The work demands rational thought, scientific …
Many lifelong cigarette smokers and their doctors have pushed smoking cessation to the bottom of the problem list and thus never get to discuss it again. A recent announcement from the FDA may give you a second chance to continue…
Many lifelong cigarette smokers and their doctors have pushed smoking cessation to the bottom of the problem list and thus never get to discuss it again. A recent announcement from the FDA may give you a second chance to continue that conversation.
Every first appointment with a new clinician, every first review after being admitted to a psychiatric ward, I spent less time thinking about what I wanted to say and more time wondering how I was going to answer the question…
Every first appointment with a new clinician, every first review after being admitted to a psychiatric ward, I spent less time thinking about what I wanted to say and more time wondering how I was going to answer the question I knew was coming. The question that always left me silent. The question that left me feeling as if I had already failed the conversation before it had even begun. …
This is why we get it wrong As clinicians, we were taught that advance directives (ADs) and Portable Orders for Life-Sustaining Treatment (POLSTs) protect patient autonomy. So, we encourage our patients to complete them. Hospitals and health systems promote and…
This is why we get it wrong
As clinicians, we were taught that advance directives (ADs) and Portable Orders for Life-Sustaining Treatment (POLSTs) protect patient autonomy. So, we encourage our patients to complete them. Hospitals and health systems promote and measure our efforts. Public and private insurers pay for it. And policymakers celebrate them.
But these familiar tools upon which we so heavily rely at the end of life have been creating …
Developmental-behavioral pediatrics did not collapse overnight. It eroded the way institutions usually do: slowly, quietly, and then all at once. For those of us who practiced during its rise and decline, the story is not merely professional history. It is…
Developmental-behavioral pediatrics did not collapse overnight. It eroded the way institutions usually do: slowly, quietly, and then all at once. For those of us who practiced during its rise and decline, the story is not merely professional history. It is a record of what happens when a field built on dignity, patience, and longitudinal care is left without structural support.
For decades, developmental-behavioral pediatrics (DBP) served as a stabilizing force for …
As a pediatric endocrinologist, I often meet families on one of the hardest days of their lives: a T1D diagnosis. I watch as the shock sets in. I hear their worries, their concern for the future, and the questions that…
As a pediatric endocrinologist, I often meet families on one of the hardest days of their lives: a T1D diagnosis. I watch as the shock sets in. I hear their worries, their concern for the future, and the questions that arise when I mention that family history can increase the risk of developing the disease by up to 15-fold. “What does this mean for our family? Could this happen to …
When I started my first full-time faculty position, one of my biggest worries was how I would manage working with the interdisciplinary team. I'd spent the last few months working as a locum at my most recent site of training,…
When I started my first full-time faculty position, one of my biggest worries was how I would manage working with the interdisciplinary team. I’d spent the last few months working as a locum at my most recent site of training, where I’d had years to develop rapport with consultants, nurses, allied health, and other staff. While that experience left me feeling confident in my abilities on the clinical side of …
The occasional "Doc, can you look in my ear?" or "Doc, my throat's been scratchy, can you check it?" used to catch me off guard. I'd oblige, but with a disclaimer: "Well, I'm just a vagina doctor, but you're here…
The occasional “Doc, can you look in my ear?” or “Doc, my throat’s been scratchy, can you check it?” used to catch me off guard. I’d oblige, but with a disclaimer: “Well, I’m just a vagina doctor, but you’re here and, for some reason, I have an otoscope in my office, so let’s take a look.”
It never quite made sense to me. Why ask your OB/GYN to sort out an …
More than thirty-four years in long-term care, first as a social worker and admissions director in skilled nursing, later on the technology side, I have sat with countless families at the moment they needed help most. A parent who could…
More than thirty-four years in long-term care, first as a social worker and admissions director in skilled nursing, later on the technology side, I have sat with countless families at the moment they needed help most. A parent who could no longer manage at home. A spouse whose memory had begun to slip. An adult child trying to make sense of a hospital discharge plan they did not see coming.
Yesterday, I read an article that stopped me. Rachel Wells, a writer and technology entrepreneur, publicly shared that her family is facing the loss of their home. She described continuing to write, build, pitch, and speak about artificial intelligence (AI)…
Yesterday, I read an article that stopped me. Rachel Wells, a writer and technology entrepreneur, publicly shared that her family is facing the loss of their home. She described continuing to write, build, pitch, and speak about artificial intelligence (AI) and the future of work while privately confronting a far more immediate question: Where will my family live?
Her story stayed with me because it exposes something larger than one family’s …
After almost any major medical event, someone walks you through what happened. A surgeon explains the procedure, a cardiologist reviews test results, and even a routine outpatient visit ends with some version of: here's what we found, here's what it…
After almost any major medical event, someone walks you through what happened. A surgeon explains the procedure, a cardiologist reviews test results, and even a routine outpatient visit ends with some version of: here’s what we found, here’s what it means, here’s what’s next.
After birth, that conversation often doesn’t happen at all.
I had a birth that didn’t go the way anyone planned. There were interventions I didn’t fully understand in …
