One of us (NB) has been reasonably conscientious about his health for the past 50 years. He sees his PCP twice a year and has tried to set an example for his patients by focusing on diet and exercise. I have done well, except I need a little work on stress reduction and sleep hygiene. Curiously, in 50 years and more than 100 office visits to health care providers, no …
The mouth as a gateway: Why oral health matters for physicians
In today’s clinical oncology practice, the saying “no two cancers are alike” is more relevant than ever. I recently treated two patients with very similar advanced non-small cell lung cancer (NSCLC) who were both critically ill. However, molecular profiling revealed distinct genetic drivers for each case, leading to very different, highly customized treatment plans.
Patient presentation and initial assessment
Both patients, in their late 60s and never-smokers, presented with weight loss, worsening …
EGFR vs. ALK: How molecular profiling defines lung cancer treatment
I called my old professor the other day to ask a very specific question about the Geriatric Depression Scale and expressed to him a big frustration on my end on how we are no longer able to perform such complex assessments among our patients, especially in primary care. During residency, we are taught to take thorough histories and perform physical exams by the book, but in reality, it is very …
The lost art of connection: Why medicine needs to slow down
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Occupational medicine physician and life coach Claudine Holt discusses her article “Nervous system dysregulation vs. stress: Why ‘just relaxing’ doesn’t work.” Claudine challenges the common advice to treat burnout with self-care like …
Why “just relaxing” fails when your nervous system is stuck in survival mode [PODCAST]
For years, the U.S. has felt the impact of ever-rising health care costs while facing decreasing access, affordability, and worsening clinical outcomes, as compared to other countries. Multiple disruptive forces increasingly plague our health care system, our workforce and workplaces, health care facilities, health care consumers, …
The health care economic crisis: Why the system is failing in 2026
Consider a common scenario. A 65-year-old patient presents with intermittent chest discomfort present for several days and no prior history of heart disease, including among family members. The physical exam is unrevealing. An EKG and cardiac enzymes are negative. The clinician explains, “I do not see anything concerning. Given your age and symptoms, this is likely reflux. Let us have you wait three hours after eating before retiring for the …
Clinical communication skills: the power of structured language
For many years the health care industry has operated under the “prestige” hiring model. We have been led to believe that to solve the crisis of patient safety and quality, we basically need more of the “top-tier” talent and specialists for MDs, more PhD-level nurses, and highly credentialed execs.
But we are now in the first quarter of 2026 and the data tells a different story. In spite of record spending …
The health care credentialing gap: Why top-down hiring fails
Health care works best when it solves real problems in real lives. That is why recent research on ketamine therapy for chronic pain deserves attention. The peer-reviewed study looked at 20 adults living with chronic pain who also struggled with substance misuse. The results suggest that carefully designed pain treatment may help more than pain alone. It may also improve mood and support recovery from substance misuse. In a …
Ketamine therapy for chronic pain and substance misuse
Families worry about stock market crashes. Retirees check their portfolios, track dividends, and follow market headlines. But in aging societies, the event that truly destroys a household’s stability rarely happens on Wall Street. It happens in the bathroom. An older adult falls.
I have seen this sequence unfold many times. The patient survives the hospital stay. The fracture is treated, medications are adjusted, and discharge instructions are printed. Clinicians feel relieved …
How a broken hospital-to-home transition harms older adults
The clink of ice in the glass had been an evening “wind down” routine ever since the pandemic. It had served as a way to drown remnants of stress that bubbled up throughout the course of the day. This “routine” developed over weeks, but eventually evolved into dependence, addiction even, he worried. I need to do something about this before I lose it all, he thought one morning upon waking …
Kratom vs. 7-OH: Understanding the potency gap and risks
Six months ago, I encountered a challenge I never expected: a robotic-assisted radical prostatectomy. Even now, writing about it feels surreal. Cancer rearranges life without warning, and surgery, regardless of how “minimally invasive” brochures describe it, alters you in ways only understood through experience.
The post-op instructions said that, within hours of surgery, I needed to stay active. That sounded simple enough beforehand. But no one asked about my fitness …
Navigating postoperative complications and post-surgical depression
In the late 1990s, a U.S.-funded study randomized HIV-positive pregnant women in Bangkok, Thailand, to either a placebo group or a group treated with a short course of AZT. At the time, AZT was the standard of care in the U.S., and researchers knew the medication protocol worked at reducing mother-to-child HIV transmission by nearly 70 percent. The study looked at whether a shortened protocol could meaningfully reduce …
Repeating history: the ethics of the new Guinea-Bissau hepatitis B study
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, characterized by intrusive memories (flashbacks, nightmares), avoidance of reminders, negative mood changes (fear, anger, detachment), and heightened arousal (easily startled, irritability). The diagnosis of PTSD requires symptoms lasting over a month causing significant distress or impairment, and not due to substances or other conditions.
The five types of post-traumatic stress disorder
There are …
Understanding the types of PTSD and how to treat them
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Hematologist-oncologist Khushali Jhaveri discusses her article “What the research really says about infrared saunas.” Khushali shares her personal journey from skepticism to advocacy after experiencing the profound physiological shifts of infrared heat …
Heat therapy activates proteins that repair cells and protect the heart [PODCAST]
I have spent years watching the development of quality programs. What began as a way to ensure patient safety has gradually given way to an independent group of individuals whose job it is to interpret regulations and monitor those interpretations. In the process, the clinical richness of medicine has been lost. Judgment, narrative, and context matter less than forms and metrics. The work has shifted away from the bedside and …
The 9 laws of health care quality: Why metrics miss the point
Human milk contains more than nutrients; it carries a quiet, evolutionary intelligence expressed through chemistry. It is not conscious thought, but the slow wisdom of evolution written into molecules that nourish, protect, and guide.
Among its most remarkable ingredients are the human milk oligosaccharides (HMOs). These complex sugars, present at around 0.5 to 1.5 g/dL, are not there to feed the infant directly.
They move through the stomach and small intestine largely …
The evolutionary intelligence of human milk: HMOs and lactose
Imagine a patient who spends most of a therapy session talking about a single memory. He describes sitting in his car after visiting his mother in a nursing home, unable to start the engine. He sits there for nearly 20 minutes, staring at the steering wheel and wondering when the roles had reversed, when he had become the parent and she the child. Nothing dramatic happens in the session. No …
The hidden risks of AI-generated progress notes in psychotherapy
You probably weren’t thinking about AI the last time you sat in the dental chair. You were wondering whether that shadow on the X-ray meant a cavity, and whether it would hurt. But AI was quite possibly already at work behind the scenes, and it’s about to play a much bigger role in your next visit. As a general dentist, I’ve watched the conversation about AI in medicine grow louder …
How AI in dentistry is changing your next checkup
Life begins, and life ends.
We know this
the way we know the sun will rise,
as a fact, not a feeling.
Those we cherish
and those who cherished us
leave without rehearsal,
no warning bell
to soften the blow.
As if the heart
could ever be trained for absence.
They were threaded into the ordinary,
morning light, evening quiet,
the familiar rhythm of breath and belonging.
We assumed their nearness was permanent,
the way we assume tomorrow.
There were shared breaths of laughter,
tears that needed …
Grief and healing: Learning to live with absence
I worry about whether I can access a building much more at my current weight of 160 pounds than I did when I weighed 378 pounds.
My adult weight, until recently, averaged 300 pounds. But in early 2022 I weighed 350, and in 2013 I weighed 378.
At those weights, I worried about distances, the number of stairs, the width of doorways, and the strength of the furniture. Today, I still worry …
I lost 218 pounds and my ability to walk: a bariatric surgery regret
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