Thanksgiving is my favorite holiday. I love the cooking, the noise, the parade, the extra side dishes no one really has room for. Every year I tell my parents I want to “go bigger”: more food, more people, more traditions. And every year, my mother looks at me with a mix of love and exasperation and says some version of, “Can we please do a little less this year? My …
Aging parents and Thanksgiving: a gentle check-in
A few days ago, I was speaking with a high-achieving, articulate, brilliant friend, someone always up and doing, super-expressive. During our conversation, I noticed her stumbling over her words, which was quite unusual, and her fidgety hands. She was narrating a traumatic incident that had occurred to her and how it tore her apart and made her simply give up on everything, in her words, “she was done.” Throughout the …
Trauma in high-functioning adults
Female athletes have redefined strength and endurance, but one common issue still hides in silence: urine leakage during training or competition.
It’s more common than most realize. In certain sports like gymnastics, trampolining, and CrossFit, the rates are particularly high. Still, many women keep silent, assuming it’s a normal side effect of being active or that nothing can be done.
As a urologist, I often meet women who are in top physical …
Female athlete urine leakage: A urologist explains
Applied Behavior Analysis (ABA) has become the default therapy for autism in the U.S., not because it’s the most effective, but because it’s the most entrenched. Mandated by insurers, funded by Medicaid, and marketed as “medically necessary,” ABA now consumes hundreds of millions of dollars annually. But here’s the truth: ABA is unproven, ethically fraught, and fiscally unsustainable.
As a developmental-behavioral pediatrician and lead investigator for the NIH-funded RUPP trials, I …
Funding autism treatments that actually work
Every clinic has moments that stick with you. They aren’t always dramatic, but they show why some people end up suffering longer than they should. During my time working as a medical office assistant, I observed a recurring pattern that spanned across various age groups, backgrounds, and diagnoses. Patients didn’t delay care because they were careless. They delayed because the system had quietly taught them to.
One afternoon, a middle-aged woman …
Why patients delay seeking care
Canada’s primary health care crisis has garnered news headlines and political attention, but an equally alarming crisis is ongoing in long-term care (LTC). More than five years after COVID-19’s deadly sweep through LTC homes, exposing long-standing deficiencies in funding, infrastructure, infection control, staffing and working conditions, many problems remain, driving a critical staffing shortage, burning out workers and impacting resident care. With the need for LTC …
The burnout crisis in long-term care
Since a diagnosis of colon and rectal cancer in 1993, I have had a number of serious complications and a recurrence. Some, if not most of what occurred could have been avoided. My experience points to some gaps in my health care that providers and patients might want to consider.
I was given the option to choose a cancer treatment and made the wrong choice. As a busy university administrator, I …
A story of gaps in cancer care
On July 6, 2025, in Nanjing, China, a construction worker plunged onto a steel rod that pierced him from pelvis to chest. That night, doctors fought millimeter by millimeter through a five-hour battle against death.
The call at midnight
The phone’s shriek tore through the heavy summer silence just after midnight.
Professor Ji Zhenling, president of Nanjing Jiangbei Hospital, surfaced from sleep, the warmth of his pillowcase still pressed against his cheek. His …
The night of an impalement injury surgery
The question “What’s strong with me?” startled me the first time I heard it. Because we direct so many of our day-to-day thoughts to what’s wrong, it can feel odd to ask what’s strong. But this simple question has the power to release the tight hold that problems have on our thoughts and open a new way of thinking. We’ve all had moments when problems seem so big that it’s …
Finding your child’s strengths: a new mindset
An important paper, “How to communicate medical numbers,” was published in a recent edition of the Journal of the American Medical Association (JAMA). This is so important, for the doctor-patient relationship, for what journalists write for the public, and for individual decision-making. One of the authors, Angie Fagerlin, PhD, of the University of Utah medical school and Salt Lake City Veterans Affairs Medical Center, was interviewed for a …
How to better communicate medical numbers
The creed of compliance
In every hospital, a grotesque comedy unfolds: Poor Sod, our hapless patient, lies gut-shot, aorta spewing like a B-movie fountain. Clinicians, faces blank as overcooked porridge, scurry in a choreographed panic, clutching flowcharts like sacred scrolls. Monitors bleep like a chorus of lobotomised parrots. A registrar, mad enough to trust his gut, tries a life-saving stunt not in the Holy Manual. A nurse, eyes glinting with the …
Bureaucratic evil in modern health care
The day before the attack, a senior physician at a Catholic university hospital in Taiwan sat with young medical students at noon, talking not about lawsuits or hospital finances, but about Brahms. He loved four-hand piano pieces, especially Brahms’s Hungarian Dances, and he would explain how two players must breathe together, listen to one another, and balance passion with discipline. For him, this was also a lesson about medicine: You …
Protecting elder clinicians from violence
I just read the new Cleveland Clinic Journal of Medicine introduction by its editor-in-chief, and it’s laying out the usual playbook: demonize lipoprotein(a) (Lp(a)), list all the terrible things it does, and hint that salvation is around the corner, pending results of a major pharmaceutical trial, of course.
It’s a neat narrative arc.
But it’s incomplete.
What’s missing is the one question almost no cardiology article seems willing to ask:
Why does Lp(a) exist …
Why does lipoprotein(a) exist?
For years, I believed that the best clinicians were the ones who never stopped. We covered extra shifts, skipped meals, charted past midnight, and proudly wore exhaustion as a badge of honor. My patients were happy, my colleagues admired my work ethic, and I was quietly unraveling.
The slow slide into burnout
Burnout didn’t arrive like a crisis; it crept in as a constant background hum. I began to dread the pager’s …
The myth of endless availability in medicine
Idaho has become the first state to end Medicaid funding for Applied Behavior Analysis (ABA) therapy. This marks a shift away from concerns about inflated billing and variable outcome metrics toward a model focused on measurable and inclusive care. As a pediatrician who participated in NIMH-RUPP trials and has observed the clinical evolution of ABA, I recognize the significance of Idaho’s decision. The state acted proactively rather than awaiting federal …
A new autism care model in Idaho
He came to my office holding the results of his coronary CT scan. His eyes went immediately to the numbers, his voice tense: “Doctor, my FFR is 0.86. Do I need a stent?”
This is not an unusual question anymore. Coronary CT angiography with fractional flow reserve (FFR-CT) is rapidly becoming a common tool in cardiology. It gives us noninvasive insight into whether a coronary lesion is functionally significant. In plain …
What an FFR-CT score means for your heart
For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an advance directive. And he did: It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.
But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, …
Advance directives not honored: a wife’s story
During a casual conversation about mental health, a friend admitted something striking: “I stopped going to therapy because I’d leave feeling great, but by the time I actually needed what we talked about, like in the middle of an argument or a panic attack, I couldn’t remember any of it. It felt like throwing money away.”
This confession revealed a silent challenge in mental health care. The issue isn’t finding the …
The therapy memory recall crisis
Most men have heard jokes about finishing too soon, but few talk about it seriously, even when it causes anxiety, frustration, or distance in their relationships. Premature ejaculation (PE) is one of the most common male sexual health concerns, yet it remains buried under stigma and silence.
As a urologist, I often meet men who have struggled quietly for years, wondering whether what they experience is “normal,” if it can be …
A urologist explains premature ejaculation
She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …
The hidden epidemic of orthorexia nervosa
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