Today I am a urologist, a cardiologist, a psychiatrist, a rheumatologist. But truly, I am a rural family medicine doctor in one of the most underserved counties in the country. And I am tired.
I do not pretend to have the depth of each specialist. What I have is necessity, a toolkit built on scarcity. Practicing medicine on an island, where specialists are rare, calendars are full for months, and visiting …
The frequency and severity of physician burnout have resulted in an epidemic that is impairing the American health care delivery system. Herbert Freudenberger coined the term burnout in 1977, referring to a syndrome characterized by emotional exhaustion, depersonalization or cynicism, and a lack of personal accomplishment. He noted that burnout reduced health care workers’ ability to provide excellent patient care and adversely affected their well-being.
Physician burnout is rampant in the …
“Doc, I’ve seen enough doctors. I only trust you. I want you to do my knee replacement and fix my heart.”
I heard the conviction in his voice when I heard these words from this patient. Sitting across from me was a 76-year-old army veteran I had cared for over two decades. He had seen multiple specialists, endured countless consultations, and, in the end, he wanted me, the physician who had …
Let’s discuss primary care. That’s primary care, as in P-R-I-M-A-R-Y C-A-R-E.
Why the emphasis?
Sadly, I don’t …
It was past 7 p.m. when I finally reached home after another long day in the outpatient oncology clinic. My mind still echoed with the day’s stories: patients fighting pain, families clinging to hope, and the small victories that made the exhaustion feel almost worthwhile. There was emotional fatigue, but also peace.
Then I opened WhatsApp. The headline jolted me: “Doctor in Chennai stabbed by patient’s son after mother’s death.” He …
“Once in a while you get shown the light
In the strangest of places if you look at it right.”
That line from Scarlet Begonias (lyrics by Robert Hunter, melody by Jerry Garcia) has followed generations like a benediction disguised as a song lyric. Released in 1974 on the Grateful Dead album From the Mars Hotel, it has become something more than poetry. It is a philosophy of attention, a reminder that …
Illness is inevitable, and medical care can be expensive. The U.S. is the only developed nation without some form of universal health care. Instead, it relies on a for-profit system in which insurance companies often seek ways to reduce costs, sometimes by delaying or denying coverage for services. These delays can include requirements such as prior authorization or peer-to-peer reviews for standard, guideline-directed treatments. This process takes up health care …
Robert E. Lee did not lose Gettysburg because he lacked courage or troops. He lost because he was blind. His cavalry commander, J.E.B. Stuart, galloped off on his own, leaving Lee without reconnaissance. By the time Stuart returned, George Custer cut him to pieces. Leadership without recon is leadership without eyes.
Screening tests are the point in a military formation. They provide the initial lay of the land. In medicine, they …
A new patient recently told me, “I’ve already seen two doctors about this.” She meant a life coach with an online certificate and a therapist with a doctorate in education. Neither was a physician. Neither had examined her, ordered labs, or considered medical causes for her rapid cognitive decline.
When I evaluated her, it was immediately clear she needed urgent neurological workup. She wasn’t suffering from “stress.” She had an early …
Standing in the middle of the parking lot of the Berkeley 2000 Recreation Center in February 2021, Molly Humphreys, in a single frame, captures an important moment in the public’s collective health, though it can be easily missed if we don’t pause and absorb its significance. In the chaos of 2025, it would be careless to not linger on this image.
A masked …
In my previous critiques of the failure of the American Academy of Pediatrics (AAP), the American Board of Pediatrics (ABP), and the Society for Developmental and Behavioral Pediatrics (SDBP) titled “Why developmental and behavioral pediatrics faces a recruitment collapse,” I argued that “leadership presence without leadership action is theater.” The SDBP strategy had no actionable items.
Any military historian will tell you that in addition to an overall strategy, you …
I work as an emergency physician in the emergency department at a Level 1 trauma center. Because time is of the essence, when we get a trauma into the ED, they are automatically deemed a Doe – John or Jane. Due to the number of traumas we see at our trauma center in a given year, another word gets added to the Doe to make them easier to identify. It …
Let’s be honest. Most frontline clinicians don’t wake up worrying about CDC updates. They’re worrying about whether the ED has enough staff, or whether the patient they discharge will receive the follow-up care they need.
So when another vaccine recommendation or public policy update drops, often contradicting the last, it’s no wonder people roll their eyes. The problem isn’t that clinicians don’t care about public health; it’s that the messaging often …
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For two months I have staged testimony, written op-eds, and amplified coalition voices about the collapse of developmental and behavioral pediatrics (DBP). This piece is an epilogue, a reckoning with a specialty that once held promise but now clings to aspirational posters instead of actionable reform.
The poster problem
The Society for Developmental and Behavioral Pediatrics (SDBP) recently circulated a flyer titled Critical Outcomes in DBP. Page 2 lists “Solutions” to the …
No matter the specialty, the best doctors make it look effortless and “easy.” Whether it’s suturing a jagged laceration, reading an MRI spine with multi-level degeneration, or delivering a ten-pound baby with shoulder dystocia, the most skilled physicians can handle it without breaking a sweat. But we know it took many years of training, proficiency, feedback, and improvement to master their craft.
I’m not going to argue that surgical procedures are …
The moon was full, the stars shone bright
I thought I’d settle down for the night
Upon my soft pillow my head got caught
Until a phone call stirred me from my foolish thought
On Friday night of weekend call
One patient had refused it all
When Pit was offered, she said, “No way!”
Internals too were brushed away.
We waited calmly, full of grace
For natural labor to take its place
And sure enough, on Sunday’s eve
After a day …
Most physicians practicing medicine today were trained to diagnose and treat patients, not to navigate one of the most complex industries in the world, an industry characterized by ever-changing payer contracts, evolving reimbursement structures, complex and sometimes mystifying coding, and challenging operational realities. Despite the lack of training, these same physicians and providers are leading multimillion-dollar businesses and are expected by their health systems to reduce costs, improve outcomes, and …
At a northern U.S. Air Force base, it did not take long for the hospital administration to realize that the Red Cross volunteer in pediatrics (my late wife Kathy) was no ordinary civilian. With her two-year degree in medical technology and a bachelor’s in biology, plus board certification through the American Society for Clinical Pathology, Kathy quickly caught the attention of Capt. Humphries, the chief of the hospital laboratory.
Unlike most …
Something very distinctive happens once students complete medical school and residency: some of them start acting like excrement. Not all, but enough that most of us have witnessed the transformation. Maybe you’ve noticed it in your mentees, or in the children of friends and colleagues who went into medicine. Maybe, uncomfortably, you’ve wondered if it happened to your own children. And, if you’re like me, reflecting at the tail end …
This morning, I woke up to a message from a friend that he had seen on social media a colleague he went to university with had, a few days ago, died by suicide. Last week, I had an email in my inbox from a young doctor in a training program informing me four of their trainee colleagues in the last 24 months have died by suicide. The week before, my …
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