When I was deciding whether to leave full-time clinical medicine, I asked my most trusted colleagues what they thought. Most of them did not understand why I would leave something I had worked so hard to build. Others suggested I not make a change so early in my career. My family did not understand the new job either, not even my husband. In the end I did it anyway.
After asking …
How to stop asking for permission and decide for yourself
It’s not a simple question, and one that many physicians outside our specialty still find surprisingly difficult to define. Have you ever called a rehab consult and struggled to understand why you need one? Many have. The truth is, physiatrists often think differently. Every specialty develops its own lens through which it views disease. A surgeon asks whether a problem can be repaired. A neurologist localizes it. An oncologist determines …
How does a rehabilitation physician actually think?
You open your health portal before bed, mostly out of habit, and there it is: a number in red. Or your doctor mentions, almost in passing, that your cholesterol has crept up and your blood sugar is “borderline.” Nothing hurts. You feel the same as last week. But something has shifted, and you know it. You’ve become a person with a problem.
I want to make the case that a red …
How to tell which abnormal test results actually matter
I left Nepal to train in a country I barely knew, carrying the kind of ambition that doesn’t leave room for doubt. Internal medicine residency, then a rheumatology fellowship at the National Institutes of Health (NIH). I pictured a career built in clinical research, publishing, discovering. That was the plan, and for years I didn’t question it.
The turning point
Then our daughter was born, and everything about that plan stopped making …
Physician burnout and the question science cannot answer
After more than three decades of practicing medicine in Maryland, I recently applied for medical licensure in Washington, D.C. I expected the process to be similar to neighboring Virginia, which offers an efficient pathway to licensure by endorsement or reciprocity for experienced physicians in good standing. Instead, I discovered that where I went to medical school more than thirty years ago (not my decades of practice, triple board certification, U.S. …
Why medicine needs a national physician license now
In the months since the United States marked its 250th anniversary, I find myself sitting in a unique vantage point. As a psychiatrist, my office acts as a microcosm of the American experience. Behind closed doors, the broad and often raucous headlines of our national discourse distill into the visceral, unfiltered reality of individual human experience. From this front-row seat, I witness our collective anxieties, our daily pains, and our …
Healing a divided nation begins in a psychiatrist’s office
“Don’t tell my parents,” Saru whispered as she leaned into my ear as if she was going to tell me her most precious secret. “But what I really want to do is be a stand-up comedian.”
It was the usual scene at a Nepali party. Women were dressed in the latest fashionable saris. Men, at different levels of intoxication, were huddled around laughing at a story. Loud Nepali music blared while …
Pre-med regret and the comedian who chose medicine anyway
Lawyers have to know the laws of the state where they practice. Physicians largely do not. Medical norms, ethics, and morals are close to universal, which means physician practice could in principle be governed by universal law. There are exceptions. Contraception is one, where even clinical practice is governed by state-specific law.
The broader pattern is stranger than the exceptions. Neither lawyers nor physicians should have to acclimatize to institutional norms …
A national medical license would cut administrative burden
Clinical trial enrollment in rare cancers remains stubbornly low. In T-cell lymphomas, a heterogeneous group of over a dozen distinct subtypes affecting roughly 9,000 new patients annually in the United States, fewer than 7 percent of eligible patients participate in clinical trials. This statistic has persisted for decades despite growing recognition of the problem by professional societies, advocacy organizations, and regulatory agencies.
The conventional explanation focuses on awareness. Patients don’t know …
Clinical trial navigation is a clinical access problem
The day I met my own system from the wrong side of the bed
I’ve spent a career on the clinician side of the bed: explaining procedures, reassuring families, and signing orders that were supposed to make pain tolerable and recovery humane. Then I had shoulder surgery in Florida.
I went in with a regional block, a plan, and the quiet confidence of someone with a high pain tolerance. Physical therapists have …
When policy erased my post-operative pain control
There are commercials on TV by prominent plaintiff personal injury law firms advertising for clients. One promotes “If we don’t win, you don’t pay.” Another promotes the notion that anyone who owns a phone already has a lawyer. Still others promote the types of injuries that can be monetized, but never mention medical malpractice.
All imply that a contingency fee totally forgives clients of all legal transaction costs. All imply a …
A frivolous malpractice lawsuit still raises your premium
For years, I gave my patients advice that I was not following myself. Reduce your stress. Protect your sleep. Listen to your body. Set healthier boundaries. Then I would finish a full day of back-to-back appointments and stay late answering inbox messages, reviewing charts, completing forms, and responding to insurance demands. I would go home physically tired but mentally still at work, replaying the day and thinking about everything waiting …
Why primary care burnout is really a patient-care problem
Imagine with me, it’s January and you are sitting at work. Your muscles start to ache, and you have a strong desire to lay your head down on the desk for a quick rest. Maybe you overdid it shoveling snow a couple of days ago. Maybe you slept wrong.
Over the next 24 hours, you feel worse. You develop a headache. Your eyes burn. Your nose drips like a faucet one …
A cold cost $945. The cost of primary care is broken.
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I had been driving for fourteen years before I moved to the United Kingdom two years ago. Back home in Malaysia, driving had become almost instinctive. It was something I rarely thought about. But moving countries meant starting over. To continue working as a community psychiatry registrar, I needed a U.K. driving license.
Twice I took the practical driving test. Twice I failed. I could spend hours dissecting the examiner’s decisions, …
How a failed driving test shook my confidence in medicine
She was a young mother.
We had never met her before. She arrived gasping for air. Within moments, the room was full. Everyone came together with one purpose, to save her. Then her heart stopped.
CPR began immediately. The obstetric team delivered the baby while compressions continued. Thirty minutes passed. No pulse. We kept going. Every voice in the room was thinking out loud. What are the reversible causes? Keep going. Don’t …
The grief health care workers carry after maternal death
I am writing this from the slow, disciplined landscape of recovery (one repaired shoulder, one sling, and one unrepairable truth): Medicine did not suddenly become fragile when AI arrived. It did not suddenly become threatened when APRNs and NPs expanded their scope. It did not suddenly become replaceable in the twenty-first century.
Medicine became fragile when institutions discovered they could dispose of physicians and still call it progress.
I know this because …
The physician disposability nobody wants to name
The health care system is supposed to put the patient first. Physicians evaluate, diagnose, treat, and manage risk. Hospitals, insurers, administrators, and regulators exist to support that clinical relationship and not to displace it.
Yet the current structure of American medicine produces the opposite outcome. Patients face longer waits and higher barriers. Independent physicians confront declining real reimbursement and mounting administrative demands. Practices are acquired by health systems. Physicians spend more …
The hidden payment gap crushing independent physicians
An excerpt from Essays and Echoes: Reflections from a Life in Medicine.
Every year, someone ranks the best states in which to practice medicine, presumably because physicians have been unable to make major life decisions without consulting a color-coded map.
The 2026 WalletHub survey evaluates all 50 states and Washington, D.C., across 19 measures, including physician wages, malpractice costs, hospital availability, projected competition, and burnout. Montana ranked first, New York …
What do best states to practice medicine rankings miss?
I was in my car in the parking lot. It was a long day at the clinic. And I did not want to go back in the next morning.
Us doctors aren’t supposed to say that. When we feel it, we always repeat the same things to ourselves. “You’re tired.” “You’re burned out.” “You need sleep, or a vacation, or perspective, because do you have any idea what you have?” Those …
Why I left insurance-based medicine and came back
If you are sued and satisfied with your defense, read no further. If not, you may find this article helpful.
Merit is inconclusive in every medical malpractice lawsuit ever filed, and it starts with the certificate of merit. To be clear, a certificate of merit is not proof of negligence. Proof is determined at trial. Merit is a measure for the reliability of evidence used in the proof of negligence, and …
Why merit decides a medical malpractice case
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