I was in a deep sleep when my phone rang. I looked around; it was still dark. For a moment, I thought it was my alarm, but it was only 5 a.m. It was not the alarm after all. Instead, it was a phone call from an unknown number. I answered it, and to my surprise, it was a patient I had seen in the clinic the previous week. She …
A touching story of patient gratitude and a dozen eggs
As a physician, I encounter humanity at its most unguarded. I have held trembling hands, delivered devastating news, and witnessed emotions stripped of pretense. In exam rooms and hospital corridors, patterns emerge with unsettling consistency. Under stress, fear, or pain, humans default to self-protection. We become impatient. Defensive. Sometimes cruel. Not because we are irredeemable, but because survival instincts speak loudly when vulnerability is exposed. Kindness, by contrast, does not …
The medical case for teaching kindness in early childhood development
Again, I must discuss two cases of medical malpractice which I feel best demonstrate the quagmire our health care system finds itself in. One is a medical malpractice case against a hospital. It follows that this case also has a merit of only 33.48 percent. Nevertheless, there is a legal strategy that tips the scale by not permitting testimony discussing conditions occurring in another country, where the first 17 …
How medical malpractice cases reveal health care system flaws
Last year I watched a patient of mine, I will call him Raymond, navigate what should have been a straightforward referral to cardiology. He had insurance. Good insurance. The kind politicians point to when they say the system is working. It took 11 weeks, four phone calls, two prior authorizations, and one emergency department (ED) visit to get him seen. He was not uninsured. He was not poor. He was …
Why we must fix our fragmented health care system architecture
She was forty-eight years old and had already been through enough.
Her uterus had prolapsed. If you have not heard the term, let me be plain. The uterus had descended through the vaginal opening. It was outside her body. This is not a metaphor and it is not a minor complaint. It is a complete structural failure of the pelvic floor that turns walking, sitting, and basic dignity into a daily …
Prior authorization during surgery is not oversight
One of my patients, K, arrived in the United States in florid psychosis. Back in China, she worked as a housekeeper and lived independently. She took her medications reluctantly but consistently, forced upon her by her parents. After her parents passed away, she stopped her medications. She became convinced her life was being controlled by the Chinese government. In terror, she booked a ticket to the land of freedom, America. …
Patient autonomy in psychiatry and the ethics of care
What if the biggest problem in medicine isn’t bad decisions but rather the decisions we cannot even consider?
Clinical decisions unfold through processes shaped by the environment, which determine what clinicians can notice, consider, and act on. What seems like individual reasoning is structured in advance by systemic and environmental forces.
Within this context, this paper introduces a concept that I call “invisible triage,” a preconscious process that restricts which options are …
What hidden constraints shape clinical decisions?
The life of a physician is often viewed as a linear climb, a constant upward trajectory of achievement, responsibility, and endurance. But after decades in the field, I have come to realize that medicine is not a straight line. It is a series of seasons. If we fail to recognize the changing weather of our own lives, we risk arriving at the final season with broken bodies and weary minds. …
Why physician well-being matters at every career stage
Recently, I found myself in a place many physicians know professionally but dread personally: the waiting area outside a procedure room, this time as a mother. My six-year-old underwent what was supposed to be a simple elective procedure under general anesthesia at a day surgery center. He walked in smiling. He was put to sleep by using inhalational anesthesia through a mask. We were debriefed briefly by the ear, nose, …
How implicit bias in health care impacts patient safety
If you have just matched into residency, the profession is about to begin shaping you in ways that are not always visible at first. You have made the right decision and chosen a life of service, one whose rewards are far greater than a bank account will ever reflect. What follows is not part of a curriculum, and it will not be captured on a slide. It is learned more …
Finding meaning and purpose in medical residency training
In global conversations about the future of radiology, artificial intelligence (AI) is often positioned as the solution to the field’s most pressing challenges. From improving diagnostic accuracy to reducing physician workload, the possibilities seem extensive. Yet, as a medical student training in Nigeria, I have come to realize that the conversation around sustainability in radiology must begin much earlier, specifically at the point of access. In my training, I have …
Artificial intelligence in radiology and global health equity
I have come to a realization, one that has been building quietly over years of practice, long before I had the language to articulate it fully. We are very good at doing what we were trained to do. And yet, something about what we are doing is not enough.
As physicians, we are exceptionally skilled at identifying symptoms, categorizing them, and intervening with precision. We move quickly. We think algorithmically. We …
Why physicians treat symptoms not causes of disease
Clear, factual information regarding the roles and responsibilities of anesthesia care team members is increasingly difficult to find. In health care, “scope of practice” defines the range of responsibilities professionals may perform based on their license. As many state legislatures and Washington, D.C. are currently in session, anesthesiologists across the country are advocating for patient safety by promoting anesthesiologist-led care, not as part of a “scope” agenda, but as a …
Opt-out states and physician-led anesthesia care explained
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Do you ever feel like a hovering helicopter, eyes fixed on every corner of the horizon, yet swift and nimble to the next need, while trying to stay aloft with a missing blade? If you have ever stood in the middle of a shift, a surgery, a conversation, or a decision that could not wait, and felt all of that at once, then you already know what it is to …
What physicians and dragonflies share in resilience and agility
Physicians are trained to listen for symptoms that point to deeper problems. For example, chest pain can mean heart disease, and ongoing fatigue might signal depression or another illness. I once cared for a middle-aged teacher who showed how political divisiveness can affect health. She came in with headaches and trouble sleeping. While we spoke, she shared that her symptoms got worse during heated political debates at her school and …
How political divisiveness impacts your health and well-being
My family’s story begins long before I was born, long before America existed, and long before medicine was a profession. It begins on a battlefield. In 1066, members of the Lindsay family rode with William the Conqueror at Hastings. They survived, were granted lands in Suffolk, and later moved north to Scotland, where they allied with King David I and became part of the Lowland nobility. From that era comes …
A family legacy inspiring advocacy in neurodevelopmental care
Diagnostic radiology, as a physician-staffed specialty, will not exist in its current form within 20 years. Neither will diagnostic pathology. Neither, in all likelihood, will the outpatient model of endocrinology or general internal medicine as we currently understand it. These are not fringe predictions from technologists who have never set foot in a hospital; they are the logical endpoint of capability curves …
Why artificial intelligence displacement threatens medical specialties
I have intubated people who took every pill they could find. I have told families, in bare conference rooms, that the person they brought in barely made it. I have done this across 23 years in emergency medicine, thousands of cases, in every configuration of crisis the human mind can produce, and I believed, the way physicians are trained to believe, that stabilizing the crisis was the job. That what …
The real work starts after a mental health crisis
When I was growing up in Darjeeling, a single pair of school shoes had to last the entire year. They came from Bata, simple, sturdy, and meant to endure more than they reasonably could. My sister, just a year younger than me, had the exact same pair. Side by side, our shoes began their journey identical, but they did not age the same way. She was careful, measured, and gentle …
How childhood scarcity fuels imposter syndrome in medicine
It was a cold January night, around two in the morning on my third consecutive 34-hour shift as a senior pediatric resident at a major freestanding children’s hospital in the northeast. My floor had absorbed four admissions in the last hour, our eleventh of the night. The last was a teenage boy, new onset type 1 diabetes presenting in diabetic ketoacidosis. By the time the call came through from the …
Why artificial intelligence in medicine cannot replace clinical intuition
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