Two days after Christmas, I walked into a store and saw Easter Cadbury Eggs already on the shelves. Not a single mattress sale for Presidents’ Day in sight. Just a clean leap from tinsel to tulips, as if the world had quietly decided to skip the expected steps and sprint ahead. It struck me because that is exactly what my life feels like right now. For decades, I lived inside …
Leaving clinical practice for medical advocacy and purpose
An excerpt from Those Shoes: A Physician’s Reckoning with Life, Death and the Medical Machine.
The nurse caught me before I walked in the room, “This next patient says he knows you.” I looked in the room and saw Jim, the gate guard in my neighborhood. “What’s he here for?” “Back pain,” she said, with a look I recognized. “You know what he wants.” I knew what she meant. Back …
Trusting clinical intuition to spot an atypical heart attack
From the outside, medicine is often imagined as a profession defined by urgency and dramatic turning points. People picture emergency rooms where rapid decisions determine outcomes, life-saving interventions performed under pressure, and moments when a physician’s action decisively alters the course of illness. These moments certainly exist, and they remain some of the most visible parts of medical practice, but they represent only a small fraction of what most physicians …
The human side of medicine in quiet clinical moments
It is 3 a.m. and you are wide awake, not because of your overnight shift or a surgery you are prepping for, but because the stress you have been carrying for months will not let you sleep. You know you need help. You also know you probably will not ask for it. Somewhere in the back of your mind, a fear: that a mental health diagnosis could surface in your …
How credentialing and culture impact physician mental health
In today’s fast-paced health care environment, many clinicians face overwhelming demands: packed schedules, electronic documentation, administrative pressures, and institutional productivity targets. While these pressures are real, an alarming concern has emerged in clinical practice. Patients increasingly feel that their voices are not being heard. They report that their providers seem distracted, rushed, or focused on screens rather than on the human being sitting in front of them. As a clinician …
Why listening is the core of patient-centered care
I started volunteering on Saturday mornings out of a feeling of restlessness. Having been in primary care for several years, I was looking for something new, to break from routine, and to feel like I was doing real good. Which is how I ended up at our medical student-run free clinic, and have been blessed with an opportunity that has grown into a primary passion of mine. We see mostly …
Why relationship-centered care matters in medicine
The Ruth Jackson Orthopaedic Society (RJOS) Dr. Jessi Block Courage Award is awarded annually to an RJOS member who demonstrates strength and integrity in the face of everyday obstacles. The definition of courage is “the ability to do something that frightens one” and “strength in the face of pain or grief.” Courage is a conscious choice and a willingness to confront a difficult situation. As health care professionals, we become …
How one doctor navigated orthopedic residency while pregnant
Prologue
As a practicing gastroenterologist for more than 50 years, now emeritus, I was privileged to have had colleagues with expertise in many specialties to whom I could refer patients. Since my career began, the constellation of these specialists has increased considerably. Patients often find themselves moving from one “ologist” to another, each very skilled but focused on a particular organ system. From the patient’s perspective, maneuvering through the complexities of …
A humorous parody of medical specialties and the modern patient
The recent record snowstorm in New England got me all in a deep wintery nostalgia. I contacted my friends back in Boston who have been living there for well over 40 years to get their perspectives, and it brought back memories of living on the East Coast and surviving the seemingly interminable long winters there before I moved to California in the late 1980s. Most prominently in my memory is …
Surviving a hospital blizzard as a physician on call
We turned pharmacies into the backbone of public health during coronavirus disease 2019 (COVID-19). Then we went back to paying them like retail stores. The result is what I think of as the pharmacy paradox. We expanded their role without changing the economics that sustain them. Now, across the country, those same pharmacies are closing, quietly and disproportionately in the communities that need them most.
In 2021, the corner drugstore ceased …
Pharmacy closures threaten our entire public health system
Intro
This is not a story of a 28-year-old successful serial entrepreneur, nor a work of personal development literature. It is rather an auto-dissection of a very regular and tired doctor who was arrogant enough to co-found a medical startup and become its chief executive officer (CEO) without having any qualifications for it whatsoever.
It is also not a story of great success (yet) merely because the journey is in its diapers …
Pathogenesis of a medical startup: a physician’s diary of daring, doubting, and doing it anyway
We enter the cathedral of medicine with a specific architecture of the soul: high ambition, perfectionism fueled by a productive neuroticism, and a boundless capacity for self-sacrifice. For many of us, the “best years” (the physical and cognitive prime of our 20s and 30s) are traded for the fluorescent hum of the wards and the weight of six-figure debts. This financial burden does more than strain the bank account; it …
The existential crisis of aging in medicine
Calls to declare family physicians the “backbone of health care” are emotionally appealing, but they do not withstand scrutiny. When we examine training pathways, cost structures, insurer incentives, and real-world performance, a different picture emerges, one in which many other clinicians are better trained for the populations they serve and, critically for insurers, far cheaper. This is not an attack on family physicians. It is a call for accuracy in …
Rethinking the role of family physicians vs. specialists
You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptoms warranting a specific imaging study, medication, or procedure. You know what they need. The evidence is clear. But instead of moving forward with care, you are forced into a gauntlet of prior authorizations, peer-to-peer reviews, …
Administrative burden is driving severe physician burnout
I have practiced medicine for 45 years. In that time I have learned that the biggest threat to a patient is not a missed diagnosis. It is a missed owner. Every patient has a story. Most of them have a complicated one. Multiple doctors, multiple medications, multiple specialists, multiple systems. And in all of that complexity, nobody steps forward and says: I own this patient. I will follow the thread …
Patient ownership is the key to a better health care system
I grew up in a family of nine in New Delhi, where scarcity was our daily companion. We had no processed food, no artificial dyes, no glyphosate-laced cereal aisles stretching into infinity. We ate whole foods, not by philosophy, but by necessity. We moved our bodies, not by gym membership, but because life demanded it. We slept when the sun went down and woke when it rose. Circadian rhythm was …
Make America Healthy Again fails true functional medicine
I am sharing my experience of what I believe to be retaliation and the non-renewal of my contract at a major academic medical center in New York following my refusal to engage with inappropriate advances. As an international medical graduate who immigrated to the U.S. from Brazil at the age of three, I have devoted my life to medicine and patient care. Throughout my career, I have worked across multiple …
How an international medical graduate fought workplace retaliation
Ask any clinician about the drive home after a case goes bad and the patient outcome is tragic. It is a specific kind of heavy silence. We have all had the experience. You do not forget it. You replay the tape in your head dissecting every move, carrying a stain that does not wash off or show mercy. It owns you.
We have had a name for this for 20 years: …
The second victim label ignores patient safety reality
An excerpt from The Hidden War in Medicine: The Fight No One Warned Us About.
We entered medicine believing something many young doctors believe. That medicine was a noble profession built on collaboration, compassion, and a shared mission: fighting disease! We had many glorious moments that make you cry tears of joy when a patient had been finally healed. From the outside, that is the image everyone sees. Doctors working …
How the hidden war in medicine affects young doctors
I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work shows a steep drop in her blood count. We are working together to understand what is going on. As I prepare to enter orders in the electronic health record (EHR), …
The hidden clinical cost of HCC coding in primary care
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