Conditions

Why telling kids to eat less and move more fails to address obesity

Conditions
July 19, 2025

Despite decades of public health messaging urging children to “eat less and move more,” rates of pediatric obesity continue to rise globally. In the U.S. alone, nearly 1 in 5 children and adolescents aged 2–19 years have obesity, with higher rates among those from low-income or minority backgrounds. While caloric balance is a basic principle of weight regulation, the oversimplification of obesity into a matter of willpower neglects the …

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Clinical ghosts and why they haunt our exam rooms

Conditions
July 18, 2025

As a quadruple board-certified physician and a patient with a complex autoimmune disease, I live on both sides of the examination table. My professional life is about finding answers; my personal life has been about the agony of waiting for them.

This dual perspective makes it impossible to ignore a systemic problem in modern medicine: A class of diagnoses that live in the shadows. Seronegative Sjögren’s, mast cell activation syndrome (MCAS), …

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High blood pressure’s hidden impact on kidney health in older adults

Conditions
July 18, 2025

Most people think of high blood pressure as a silent threat to the heart. But it’s time we start talking about another organ it quietly destroys: the kidneys.

As a public health researcher and clinician, I have seen how chronic kidney disease (CKD) creeps in unnoticed—especially among older adults—and how hypertension is often the unspoken culprit. Despite being preventable and treatable in its early stages, CKD remains a major cause of …

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How declining MMR vaccination rates put future generations at risk

Conditions
July 17, 2025

We thought we had moved on from diseases like rubella. But as measles makes a comeback, rubella may not be far behind, and this time, it could harm the next generation before it’s even born. Most people today have never seen a baby born with congenital rubella syndrome, a condition that causes blindness, deafness, heart defects, and developmental delays. That’s not because it stopped happening—it’s because vaccination kept rubella from …

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How one unforgettable ER patient taught a nurse about resilience

Conditions
July 17, 2025

Every ED has patients who become part of the landscape. They come in once or twice a week, for all kinds of reasons. Sometimes they have chronic medical conditions they are unable to manage. Sometimes they are on the outskirts of society due to mental health or substance abuse disorders. The ER promises a few hours of sleep in a safe place and a meal. I formed an uneasy alliance …

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Why regular exercise is the best prescription for lifelong health

Conditions
July 16, 2025

An excerpt from Tales from the Trenches: A life in Primary Care.

For nearly four decades in medical practice, I’ve been asked countless times about the best supplements or vitamins for improving health. Despite widespread hopes that pills can unlock vitality and longevity, the truth is less glamorous and far more powerful: The single best prescription for health is regular physical activity. Exercise, not supplements or medications, is the most …

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When the weight won’t budge: the hidden physiology of grief, stress, and set point

Conditions
July 16, 2025

We often speak of weight as a matter of simple math—calories in, calories out. But the body doesn’t work like an equation when it’s grieving or under chronic stress. It behaves more like a survivor, clinging tightly to resources in the face of perceived danger. And in that physiological equation, cortisol—our primary stress hormone—plays a central role.

The cortisol connection

Cortisol is released by the adrenal glands in response to stress through …

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Why peer support can save lives in high-pressure medical careers

Conditions
July 15, 2025

Locums can be a very challenging space, at least for anesthesiologists. Environments are frequently disrupted. There is often animosity between clinicians coping long-term with turmoil and inadequate staffing, and the temporary locums who fill a gap and are often paid substantially more for their intrusion. In anesthesia, the quality of the relationship between clinician and the total environment is essential. This includes nuances of the culture, scheduling structure and expectations, …

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Addressing menstrual health inequities in adolescents

Conditions
July 14, 2025

Menstrual health is one of the most neglected aspects of adolescent care—especially for teens living in poverty. For these adolescents, getting a period doesn’t just mean discomfort—it means missing school, hiding pain, and facing daily choices between basic needs and menstrual products.

In both low- and high-income countries, period poverty is a quiet crisis. In the U.S., nearly one in five teens has missed school because they couldn’t afford menstrual products. …

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Healing beyond the surface: Why proper chronic wound care matters

Conditions
July 13, 2025

An excerpt from Heal Your Wound: A Doctor’s Guide For Hard-To-Heal Wounds.

Chronic wounds are more than just a medical issue, they can be a daily challenge that can impact every part of a person’s life. From physical discomfort to emotional stress, these wounds often linger for weeks or months, especially when tied to conditions like diabetes, poor circulation, or limited mobility.

But here is the good news: With the right …

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Why specialist pain clinics and addiction treatment services require strong primary care

Conditions
July 13, 2025

Specialist pain clinics and addiction management services are vital in addressing some of the most complex and costly health care conditions. However, their success depends on stable and robust primary care systems. Without strong primary care as a foundation, these health care initiatives risk fragmentation, poor continuity, and low patient accountability. Stable primary care ensures timely access, coordinated care, longitudinal monitoring, and patient engagement, all essential elements for the value-based …

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What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

Conditions
July 12, 2025

I had a stroke at the age of five.

It was an ischemic event, rare in children, difficult to diagnose, and often missed in early stages. I experienced a sudden loss of motor function that led to a long period of rehabilitation. I spent months relearning how to walk, balance, and perform basic movements, guided by physical therapists and the steady structure of routine. I was too young to understand what …

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Facing terminal cancer as a doctor and mother

Conditions
July 11, 2025

In elementary school, my teachers always told us it was important to understand math because “you won’t always have a calculator in your pocket.” That sentiment hasn’t aged well, given that my iPhone and Alexa are always within reach. But no one said, “You better learn this because one day you’ll be teaching your own kids during a plague.” That was where the real value lay. In medical school, I …

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Why doctors must stop ignoring unintentional weight loss in patients with obesity

Conditions
July 10, 2025

When so many children and adults struggle with obesity, it’s easy to see why weight loss is often celebrated. Unfortunately, health care professionals sometimes apply those same social narratives to clinical decision-making, and the consequences can be dangerous.

I’ve developed two distinct clinical niches: metabolic dysfunction and tuberculosis. A colleague once asked me to review the chart of a patient with a history of obesity who had been admitted to an …

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Why hospitals are quietly capping top doctors’ pay

Conditions
July 10, 2025

Are 10 percent (or 25 percent) of all the physicians in your specialty breaking the law?

Of course not! Who would think such a thing?

Your friendly neighborhood “nonprofit” hospital, that’s who!

I have been reviewing physician employment agreements for almost 40 years, and in the last few years I have noticed a spike in the number of agreements that “cap” physician salary. A shocking number of hospital employment agreements provide that the …

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Why point-of-care ultrasound belongs in emergency department triage

Conditions
July 10, 2025

The ED is swamped with new patient arrivals. As a result, the 20-year-old who told the triage nurse he is having difficulty breathing waits an hour before his turn in the triage room. The emergency department technician hands me the ECG—sinus tachycardia—and takes the vitals.

Me: “What brings you to the emergency department today?”

Him: “I feel like I cannot breathe. It started all of a sudden at work.”

As I scroll through …

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Why PSA levels alone shouldn’t define your prostate cancer risk

Conditions
July 9, 2025

“My PSA came back at 6.2 — does that mean I have cancer?”

It’s one of the most common and emotionally charged questions I hear in the clinic. The prostate-specific antigen (PSA) test, once celebrated as a breakthrough in early cancer detection, has become a double-edged sword. For many men, a slightly elevated PSA level is enough to trigger panic — and for some physicians, enough to trigger a biopsy.

But here’s …

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America’s ER crisis: Why the system is collapsing from within

Conditions
July 8, 2025

The Pitt was compelling TV.

As an emergency nurse educator for a Stanford campus in Northern California, there is one thing that is required viewing for my new graduate nurses: The Pitt.

The ambitious series did an admirable job portraying the complex world of the emergency department. The procedures were clinically accurate. The spectrum of patients and social issues was nuanced and believable. They even showcased the incidence of post-COVID PTSD, an …

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Why timing, not surgery, determines patient survival

Conditions
July 8, 2025

She was 68. Diabetic. Living alone with chronic osteoarthritis. Like many patients, she carried a story more complex than any preoperative checklist could capture: a long history of opioid dependence, obesity, limited mobility, and no one at home to help her recover.

Her total knee replacement—performed with state-of-the-art robotic precision—was flawless. The surgical plan was executed to perfection. The implant was perfectly aligned. She was discharged on time, per protocol.

But protocol …

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Why psychotherapy works and why psychotherapy fails

Conditions
July 7, 2025

What is psychotherapy?

Psychotherapy is a talking process between a patient and a psychotherapist. Psychotherapy makes connections among feelings, thoughts, impulses, and behaviors to understand what works and what gets in the way of meeting life’s goals, reaching one’s fullest potential, feeling successful, and being fulfilled. This is accomplished by self-reflection. By examining life patterns, changing, improving, and unlearning emotional and behavioral habits that get in the way and are no …

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