Reason
I find that this exercise of thanking and expressing gratitude makes my journey to the land of the unknown joyful. I thought I should do this when I have a clear mind and good health. I am teaching the residents now to understand its value. I am writing this now so that I am not too late to thank all those who helped transform my life. I want to show …
Gratitude in medicine: the people who carried me
In an early 2026 piece, I criticized the growing practice of outsourcing bedside ICU care to tele-critical care programs. I argued that replacing the in-person work of physicians, nurse practitioners (NPs), and physician assistants (PAs) with remote physicians leads to the lack of a bedside leader, shoddy exams, breaks in the continuity of care, the depersonalization of the doctor-patient relationship, and an overall degradation in the quality of ICU …
Tele-critical care today is not what the studies actually tested
Health care has never possessed more scientific knowledge, more sophisticated technology, or more specialized expertise than it does today. Yet despite these remarkable advances, chronic disease continues to rise, health care costs continue to escalate, physician burnout persists, and patients increasingly spend more years living with illness rather than enjoying health.
This paradox raises an important question. A probable explanation: Perhaps our greatest challenge is not a lack of scientific progress. …
Shifting health care toward prevention, not just treatment
I work with many victims of gaslighting around the country. We learn from each other. Those who have lost their licenses to work can follow these steps to regain their licenses and resume their careers.
First, acknowledge that any victim of gaslighting suffers some degree of PTSD. Severe gaslighting leads to complex PTSD. The federal Americans with Disabilities Act (ADA) laws put in place before 2000 state that those suffering from …
How clinicians find recovery from gaslighting
Medicine is built on language. Not just terminology, but a shared vocabulary that allows us to describe the body with precision, to communicate risk without panic, and to translate complexity into clarity for families. Yet in recent years, medical language has drifted toward two extremes: jargon inflation on one side, oversimplification on the other. Both leave patients, and young clinicians, unmoored.
I was reminded of this recently while helping my son …
What plain medical language gives families back
A miscreant is simply a troublemaker. When it comes to a medical malpractice lawsuit, the biggest miscreant is the defense attorney followed closely by the medical malpractice insurance company.
For a doctor, medical malpractice insurance coverage is the difference between financial security and ruin. I practice in the state of Maryland. Maryland law does not force physicians to buy medical malpractice insurance. Nevertheless, doctors must carry a policy, which has a …
Who your malpractice defense lawyer really works for
An excerpt from Live for Me, Nkem.
We fall into silence for a while before she says, “So what has Nkem done this time?”
My eyes meet hers. She crosses her arms, watching me like someone bracing for a fight.
I rub my face and breathe out. “She hasn’t done anything.”
“Hmm. You are not here to complain about her like you did before? Wasn’t it around this time last year, right after …
The signs of depression a husband almost missed
In 2024, I joined a medical mission trip across East Africa with my spiritual community. Our guiding principle was simple: “Love all, serve all.” The goal was selfless service: providing free medical care to anyone who needed it. Roughly sixty of us traveled together, physicians, pharmacists, nurses, and support staff, moving across rural sites to set up temporary medical camps.
We saw hundreds of patients in environments that shifted constantly: church …
The hard truth about short-term medical mission trips
In The Birth of the Clinic, Michel Foucault introduced the concept of the “medical gaze” to describe how physicians translate a patient’s lived experience into biomedical terms, emphasizing information that fits a clinical framework while setting aside what does not. Every gaze involves selecting certain details from the vast stream of sensory information. In medicine, that selection often privileges disease, symptoms, and measurable findings while overlooking the personal, social, and …
The ethics of medical images begins with provenance
Before my grandfather entered hospice, I believed it was where physicians sent patients to die. I saw it as the end of treatment, a quiet admission that medicine had given up. It was only through watching my grandfather’s final years that I came to understand hospice differently: not as the abandonment of care, but as one of its most compassionate forms.
A decade ago, Alzheimer’s disease slowly began taking that man …
What hospice care really means to a grieving family
I have been practicing medicine since 1985. With good fortune, I hope to continue practicing for several more years.
When younger physicians ask what medicine was like when I began, I am careful not to romanticize the past. The pre-computer era had many shortcomings. Paper charts were often unavailable. Records were fragmented. Laboratory results could be misplaced. Communication was slower. Finding information could be frustrating. Many aspects of modern medicine are …
What 40 years of technology in medicine gained and cost
At 5 p.m., the clinic closes. The appointment schedule ends, routine messages move into the next business day’s queue, and results that arrive later may wait for review. Patients are directed to an after-hours line, urgent care, or the emergency department if the situation cannot wait.
Illness follows a different schedule. A medication started on Wednesday causes dizziness on Friday night. A fever rises on Saturday. Pain that was intermittent during …
The clinic closes at 5. Illness does not.
In nearly every occupation in America, women live longer than men. This is one of the most stable findings in public health, true for teachers, lawyers, engineers, retail workers, and factory workers alike. Medicine is the exception.
A 2025 analysis in JAMA Internal Medicine, led by researchers at Harvard Medical School, examined more than 3.6 million deaths recorded in the National Vital Statistics System between 2020 and 2022. Physicians as a …
Women physicians die sooner. Hospitals still won’t act.
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Last month marked the fourth anniversary of Dobbs v. Jackson Women’s Health Organization, the Supreme Court decision that fundamentally changed reproductive health care in the United States, returning many parts of the country to a reality that most practicing physicians and many patients had never experienced. Since then, access to reproductive health care and even routine pregnancy care, like miscarriage management, is based not on medical evidence or clinical judgment …
Four years after Dobbs, the untold stories still matter
Early in the morning of December 13, 2023, I dragged myself to the computer at my kitchen island after a terrible night of interrupted sleep. While I had experienced neck pain and stiffness for four months, it was much worse on that particular morning. I tried to prepare notes for my clinic scheduled later that day. Although I knew my patients well, …
Administrative burden in primary care and the end of my career
I don’t know when things started taking the wrong turn.
There are moments when words refuse to come, when they arrive after the moment they are needed, or sometimes do not arrive at all. It is not that I lack thoughts. I have them. Too many, sometimes. But when they are demanded in a precise moment, when someone expects an explanation, a response, a justification, my mind becomes strangely distant from …
Why becoming a senior resident is so uncomfortable
A recent article in the Philadelphia Inquirer described a female psychiatrist whose license was revoked after the state medical board found that she had a years-long sexual relationship with a male patient she began treating at seventeen, while continuing to prescribe him a rotating regimen of up to twelve medications, including stimulants and benzodiazepines. The board also found that she prescribed medications to his mother and father, even though …
Sexual misconduct in psychiatry taints every prescription
My wife answered our telephone. A representative of the state university asked her about my interest in participating again in her group’s research project. She handed the handset to me. For several years, my name has resided in the database of their Office of Human Research. My honoraria, when they offer one, have ranged from a crisp, minimally circulated $50 bill, to gift cards of $15 to 50, and an …
What I learned as a research volunteer at 70
“The brain is a wonderful organ. It starts working the moment you get up in the morning and does not stop until you get into the office.”
– Robert Frost
Since the publication of my first nonfiction book, Failure to Treat: How a Broken Healthcare System Puts Patients and Practitioners at Risk, I have been deluged with medical stories. In fact, nearly everyone who has read the book has been anxious …
Cookbook medicine and the loss of clinical judgment
Although becoming a doctor is a rigorous endeavor, the journey is somewhat prescribed. I made a decision to become a doctor at seventeen; I boarded that train and rode it through college, medical school, residency, and fellowships. All the while so focused on the destination that I never got off to explore, rarely looked out the windows, and never reconsidered where I was headed.
Now, almost forty, I look around at …
Leaving academic medicine was not falling out of love
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