When Taylor's father asked a doctor for help, he did everything right: He made the appointment, showed up, and told the truth. "I need help," he said. "I think I'm struggling with addiction." But the doctor just looked at him…
When Taylor’s father asked a doctor for help, he did everything right: He made the appointment, showed up, and told the truth. “I need help,” he said. “I think I’m struggling with addiction.” But the doctor just looked at him and shrugged: “Well, what do you want me to do about that?”
The truth is, as a medical community, we dismiss substance use disorder and the people who live with it …
When I read that experts had officially renamed PCOS to polyendocrine metabolic ovarian syndrome, my first reaction was not surprise. It was relief. After years of practicing medicine and six years of treating my own PCOS, someone had finally written…
When I read that experts had officially renamed PCOS to polyendocrine metabolic ovarian syndrome, my first reaction was not surprise. It was relief. After years of practicing medicine and six years of treating my own PCOS, someone had finally written down what my body had been trying to tell me the whole time.
Six years ago I was building my own practice from the ground up while quietly falling apart …
Recently, I called the office of my primary care physician. I asked the person who answered the phone, "Will the doctor sign an FAA BasicMed form?" The person said, "Let me check," and returned a minute later. "She cannot. You…
Recently, I called the office of my primary care physician. I asked the person who answered the phone, “Will the doctor sign an FAA BasicMed form?” The person said, “Let me check,” and returned a minute later. “She cannot. You need to see an FAA doctor.” I tried to explain that she could, but I could not convince the desk person.
The following explains BasicMed, the Federal Aviation Administration (FAA) program …
We have spent years talking about what is wrong with nursing culture. "Nurses eat their young." New nurses leave too soon. Burnout is everywhere. Tension on the floor feels almost expected. We have named it. We have seen it. Most…
We have spent years talking about what is wrong with nursing culture. “Nurses eat their young.” New nurses leave too soon. Burnout is everywhere. Tension on the floor feels almost expected. We have named it. We have seen it. Most of us have lived it.
But naming it hasn’t fixed it. If anything, the conversation keeps circling the same territory without getting any closer to the root of it. And I …
We are exquisitely good at managing the aging emergency and strikingly bad at preventing it. That is a system design choice, not a clinical inevitability. Every physician who cares for older adults knows the pattern. A patient we have seen…
We are exquisitely good at managing the aging emergency and strikingly bad at preventing it. That is a system design choice, not a clinical inevitability.
Every physician who cares for older adults knows the pattern. A patient we have seen for years, stable, independent, managing, arrives one day transformed by a single event: a fall, a hospitalization, a stroke, an acute delirium. And in the seventy-two hours that follow, a family …
When the president announced that Tylenol caused autism (it does not), he commented that leucovorin, a cancer medication, treated the condition. His remark had an outsized impact on the public, despite counter-statements by autism specialists. I can understand the response.…
When the president announced that Tylenol caused autism (it does not), he commented that leucovorin, a cancer medication, treated the condition. His remark had an outsized impact on the public, despite counter-statements by autism specialists. I can understand the response. What mother-to-be would take the chance, even if untrue, that Tylenol may cause autism? Or if parents have a child with this condition, would they not be willing to try …
Here is a question I have never been able to get comfortable with: How did we build an entire prescribing system for one of the most common infections in America without ever confirming what we are treating? Acute sinusitis generates…
Here is a question I have never been able to get comfortable with: How did we build an entire prescribing system for one of the most common infections in America without ever confirming what we are treating?
Acute sinusitis generates more than 30 million patient encounters a year in the United States. Antibiotics are prescribed at 84 to 91 percent of those visits. And at virtually none of them does …
When Alexander Zverev lost to Taylor Fritz in the Halle semifinal tennis tournament, he didn't blame his pancreas. He did the professional thing: He admitted Fritz outplayed him. But Zverev also let slip a detail that deserves more than a…
When Alexander Zverev lost to Taylor Fritz in the Halle semifinal tennis tournament, he didn’t blame his pancreas. He did the professional thing: He admitted Fritz outplayed him. But Zverev also let slip a detail that deserves more than a post-match shrug. Before the match, his glucose sensor decided to go rogue. Based on its creative interpretation of his blood sugar, Zverev injected a dose of insulin better suited for …
Tooth decay is one of the most common chronic diseases of childhood, yet it is almost entirely preventable. Despite advances in dental care, millions of children continue to experience cavities that affect their ability to eat, sleep, concentrate in school,…
Tooth decay is one of the most common chronic diseases of childhood, yet it is almost entirely preventable. Despite advances in dental care, millions of children continue to experience cavities that affect their ability to eat, sleep, concentrate in school, and thrive.
Much of our current approach focuses on treatment rather than prevention. Even when we promote prevention, we often rely on ideal routines that are not consistently achievable for many …
We discuss quite a bit in clinical practice about why we have mental health issues, and how a feeling of anxiety often has significant nuance in terms of diagnosis. Let's start with good old-fashioned anxiety. Anxiety is the feeling of…
We discuss quite a bit in clinical practice about why we have mental health issues, and how a feeling of anxiety often has significant nuance in terms of diagnosis. Let’s start with good old-fashioned anxiety. Anxiety is the feeling of being in danger or there being some sort of threat when one is not present, and this comes down to how our brains are wired for survival.
In April 2025, Gilead Sciences paid $202 million to settle allegations that it paid kickbacks to doctors through speaker fees and lavish dinners in return for more written prescriptions for their drugs. This is the illegal version that made the…
In April 2025, Gilead Sciences paid $202 million to settle allegations that it paid kickbacks to doctors through speaker fees and lavish dinners in return for more written prescriptions for their drugs. This is the illegal version that made the news headlines.
And the legal version? It may be sitting in your medicine cabinet.
Medicine tells a clean story about diagnosis. A set of symptoms appears. A clinician evaluates them. Tests are ordered. Patterns emerge. A name is assigned. Uncertainty resolves. That version is comforting because it suggests order: cause, method, resolution. It also…
Medicine tells a clean story about diagnosis. A set of symptoms appears. A clinician evaluates them. Tests are ordered. Patterns emerge. A name is assigned. Uncertainty resolves. That version is comforting because it suggests order: cause, method, resolution. It also collapses under sustained complexity. For some patients, that collapse is not theoretical. It is lived over years.
Our son started entering hospitals at 8 months old.
Gowned and gloved, mask in place, surgical technician Savannah Stanford prepares the operating room. She tears open plastic wrapping with a practiced pop and rip. The sound, sharp as a pistol crack, cuts through the silence before the day's first…
Gowned and gloved, mask in place, surgical technician Savannah Stanford prepares the operating room. She tears open plastic wrapping with a practiced pop and rip. The sound, sharp as a pistol crack, cuts through the silence before the day’s first case. Blue drapes spill over the table; syringes clatter against stainless steel. “A lot of wrappers,” she said. “A lot of plastic. Some things come in multiple plastic wrappers, not …
Everyone celebrates a successful hospital discharge. The patient is medically stable. The paperwork is complete. The prescriptions have been sent. Transportation has been arranged. Another bed becomes available for the next patient who needs care. On paper, the system worked.…
Everyone celebrates a successful hospital discharge. The patient is medically stable. The paperwork is complete. The prescriptions have been sent. Transportation has been arranged. Another bed becomes available for the next patient who needs care. On paper, the system worked.
Yet discharge is not the finish line. It is a transition point. For hospitals, discharge often marks the successful completion of an episode of care. For patients and families, it marks …
I remember my early years in interventional physiatry with a clarity that only comes from repetition. A young patient, often in their twenties or thirties, would walk in with a single, unremarkable complaint: axial low back pain, non-radiating. The exam…
I remember my early years in interventional physiatry with a clarity that only comes from repetition. A young patient, often in their twenties or thirties, would walk in with a single, unremarkable complaint: axial low back pain, non-radiating. The exam told a consistent story: pain reproduced with extension and rotation, no radicular findings, and no neurological deficits. Imaging was equally quiet: maybe a mildly bulging disc, some early facet hypertrophy, …
Medicine trains us to master physiology, pharmacology, and diagnostic reasoning. We spend years learning how to manage ventilators, interpret imaging, and navigate complex clinical decisions. But the skills that actually determine whether a physician survives a career, or is broken…
Medicine trains us to master physiology, pharmacology, and diagnostic reasoning. We spend years learning how to manage ventilators, interpret imaging, and navigate complex clinical decisions. But the skills that actually determine whether a physician survives a career, or is broken by it, are almost never taught. They are quiet skills. Uncelebrated skills. Skills that determine whether you can practice with dignity in a system that often makes dignity difficult.
Chronic pain affects millions and demands a nuanced, individualized strategy. Providers draw from training and comfort zones, but the scientific literature supports a multimodal framework that integrates pharmacological, rehabilitative, psychological, and interventional options. No single modality universally outperforms others. Outcomes…
Chronic pain affects millions and demands a nuanced, individualized strategy. Providers draw from training and comfort zones, but the scientific literature supports a multimodal framework that integrates pharmacological, rehabilitative, psychological, and interventional options. No single modality universally outperforms others. Outcomes improve when treatments target the underlying pain generator, whether nociceptive, neuropathic, inflammatory, or vertebrogenic, while considering patient-specific factors like comorbidities and functional goals.
Picture two patients seated in the same waiting room, hearing the same diagnosis from the same physician on the same day. From that moment, their lives diverge, each setting out on a journey shaped by individual choices, relationships, and ways…
Picture two patients seated in the same waiting room, hearing the same diagnosis from the same physician on the same day. From that moment, their lives diverge, each setting out on a journey shaped by individual choices, relationships, and ways of coping.
For one patient, the diagnosis becomes a consuming shadow. Every ache signals a smaller world. Fear and anger begin to strain relationships that were once strong. Work no longer …
Every physician has seen it. A healthy young woman gives birth, recovers from the immediate demands of pregnancy and childbirth, and returns to the responsibilities of work and family. Years later, often decades later, she presents with chronic knee pain,…
Every physician has seen it.
A healthy young woman gives birth, recovers from the immediate demands of pregnancy and childbirth, and returns to the responsibilities of work and family. Years later, often decades later, she presents with chronic knee pain, hip discomfort, lower back pain, or declining mobility. Eventually, some of these women progress to knee replacement surgery.
We usually regard these events as unrelated. Perhaps they are not.
As someone who has spent decades peering into skulls and pondering the fragile machinery inside, I have seen firsthand how our gray matter can falter under the weight of time, genetics, and disease. In my world as a neurosurgeon, the…
As someone who has spent decades peering into skulls and pondering the fragile machinery inside, I have seen firsthand how our gray matter can falter under the weight of time, genetics, and disease. In my world as a neurosurgeon, the brain is the ultimate paradox: a brilliant, three-pound masterpiece capable of infinite consciousness, yet completely vulnerable to the slightest microscopic flaw.
There is perhaps no greater testament to this vulnerability than …
