School had just started for the new school year. It was hot and humid. I had just retired from ICU nursing and behavioral health, a 46-year career and never skipping a beat. After several months of retirement, I couldn’t sit still. I was bored and had that nagging feeling that I wasn’t done yet with my career. Maybe that nagging feeling was guilt. Like you can’t quit. You can’t stop. …
A school nurse’s story of trauma and nurse burnout
There are many ways to say “no” in medicine.
“No, this antibiotic won’t help a viral infection.”
“No, this test won’t change our management.”
“No, that surgery carries more risk than benefit.”
And then there is the newest way:
“No, the algorithm doesn’t prioritize your health.”
Welcome to WISeR, short for “Wasteful and Inappropriate Service Reduction,” a Medicare pilot program that promises to usher artificial intelligence into health care decision-making with all the subtlety of …
WISeR Medicare pilot: the new “AI death panel”?
For years we have told patients the same thing when they have trouble finding a doctor: Go to your insurance directory, look it up, they can help you.
And despite saying that, many of us have quietly known for a long time that this advice is broken. We still give it. We give it hoping for the best, knowing there really are not many other useful options to offer at this …
Ghost networks in health care: Why physicians are suing insurers
There is a dangerous assumption circulating in skilled nursing facility (SNF) boardrooms: “If it’s documented in the EMR, we are protected.”
For years, this logic held up. Compliance was a game of checkboxes. Did the nurse educate the patient? Check. Did the patient verbalize understanding? Check. Is the care plan signed? Check.
But the regulatory landscape has shifted beneath our feet. The Department of Justice (DOJ) and CMS are no longer just …
SNF discharge planning: Why documentation is no longer enough
Holding my mother in my arms as she took her last breath changed the way I understand care. That moment, Easter Monday in Canada, was heartbreaking and transformative. Her unwavering faith and peaceful passing contrasted sharply with the confusion that followed when CPR began despite her do-not-resuscitate (DNR) order. I felt helpless.
The experience became the catalyst for my commitment to advocacy and ethical clarity. It taught me that even well-intentioned …
How honoring patient autonomy prevents medical trauma
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Medical oncologist, geriatrician, and physician scientist GJ van Londen and Chief of Genetic and Genomic Medicine at the University of Pittsburgh School of Medicine Gerald Vockley discuss the article “FDA delays could …
Regulatory red tape threatens survival of rare disease patients [PODCAST]
We’ve been thinking about remote patient monitoring (RPM) the wrong way.
Picture this. A patient comes home from the hospital after a cardiac scare. They’ve got a smart scale on their chest, maybe a blood pressure cuff on the counter, and a nurse scheduled to stop by later in the week. The care team, the patient, and the tech are all working together in the hopes that things don’t get worse.
The …
Why remote patient monitoring needs a preventive shift
Eight years ago, motivated by concern for my six grandchildren and future generations, I began a systematic study of climate change through the assessment reports of the Intergovernmental Panel on Climate Change (IPCC). That work led me to focus on a central omission in mainstream climate modeling: The failure to model global conversion to exclusively organic agriculture.
In 2024, the preprint journal SSRN published my scenario to reduce net projected greenhouse …
Ecovillages and organic agriculture: a scenario for global climate restoration
Pick up a bestselling nonfiction book today and you’ll see confident claims about habit change, dopamine detoxes, and rewiring the “default mode network.” These ideas now circulate in podcasts, blogs, and social media as if the brain were an appliance that simply needs the right setting. But in real life, human behavior is not so easily reconfigured.
What I’ve observed is that habits, motivations, and compulsive patterns are shaped not only …
Why sustainable habit change requires more than willpower
Environmental justice, health disparities, and climate change are deeply interconnected, with climate change acting as a threat multiplier that exacerbates existing health inequities, particularly among marginalized and underserved communities. Environmental justice refers to equitable and meaningful involvement in environmental policies, regardless of income, race, etc. Historically marginalized communities of color, the low-income population, and indigenous people are disproportionately exposed to ongoing as well as historical environmental policies. Health disparities arise …
How environmental justice and health disparities connect to climate change
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President and chief executive officer of the National Psoriasis Foundation (NPF) Leah M. Howard discusses her article “Pharmacy benefit manager reform vs. direct drug plans.” Leah analyzes the recent emergence of direct-purchase …
Sustainable legislative reform outweighs temporary discount programs [PODCAST]
A vacant expression covered the face of a 14-year-old boy who lay almost lifeless in a hospital bed, completely unaware of the frantic hustle that surrounded him. Once an extraordinary student-athlete, intracerebral hemorrhage unjustly robbed him of his robust character. This was my most significant interaction with a patient. I knew him not as the student-athlete, nor the boy from neurosurgery, but as my youngest brother. With limited access to …
Examining the rural divide in pediatric health care
“Turn on, tune in, drop out” was a rallying cry for liberation. “What a long, strange trip it’s been” is how we nostalgically narrate the aftermath. Psychedelic-assisted therapy now sits somewhere between those two cultural bookends: a rapidly professionalizing clinical enterprise and a booming, loosely regulated marketplace of “retreats” selling healing, insight, and transcendence.
The science behind psychedelics is more real than ever. So are the risks. The problem is …
Psychedelic retreat safety: What the latest science says
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Imagine a cancer therapy that bypasses the immune system and strikes tumors with greater precision. The advantages of a blindfolded immune system could mean reduced therapeutic side effects and delivering more of the drug to where it is needed the most. Now imagine that this potentially safer and highly effective therapy was available on demand. Thanks to a new generation of genetically modified biologics, it may be closer than we …
How CAR-NK cancer therapy could be safer than CAR-T
Artificial intelligence (AI) is rapidly entering clinical spaces, and ChatGPT is among the tools drawing increasing interest. Hospitals recognize their potential to reduce administrative burden, improve communication, and support clinical decision-making.
But with this potential comes responsibility. Deploying large language models (LLMs) in health care without proper oversight can lead to misinformation, privacy breaches, and erosion of patient trust. Before implementation, hospitals must establish a framework grounded in safety, ethics, and …
ChatGPT Health in hospitals: 5 essential safety protocols
In caring for patients with chronic illness, we often assume that if people truly understood the consequences of poor disease management, they would change. We explain complications, cite lab values, outline risks, and sometimes lean into fear in hopes that it will motivate action. When patients do not follow recommendations, we label them as noncompliant or unmotivated. Yet chronic illness is not managed in exam rooms or hospital beds. It …
Why fear-based approaches fail in chronic illness care
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Premedical student Samah Khan discusses her article “The crisis of physician shortages globally.” Samah draws a powerful parallel between the medical exodus in Pakistan and the doctor deserts of California’s Central Valley, …
Medical brain drain leaves vulnerable communities without life-saving care [PODCAST]
“If you ask what they like about their surgeon and they only say they are nice? I don’t want a nice person.” This sentiment comes from Dr. Oz, a boarded and licensed thoracic surgeon, and was posed to the house of medicine at the 2025 House of Delegates Interim Meeting.
I have grappled with what being a good surgeon means to me. Our training would have us believe that a good …
Why a nice surgeon might actually be a better surgeon
The American Board of Internal Medicine (ABIM) made headlines in late 2024 when it announced the elimination of its unpopular two-year Maintenance of Certification (MOC) point requirement. On paper, this looked like progress, a gesture toward simplification after years of criticism from physicians who felt trapped in an expensive, time-consuming cycle that added little value to their actual practice. But beneath the surface, the reform raises a harder question: Has …
Did ABIM MOC reform actually fix the problem for physicians?
Scrotal pain in young men is a frequent reason for emergency department visits and urology consultations. While many underlying causes are benign and self-limiting, others, most notably testicular torsion, represent true urologic emergencies in which delayed intervention can result in irreversible testicular damage.
The clinical challenge lies in distinguishing conditions that allow for short-term observation from those requiring immediate evaluation. This distinction is particularly important in adolescents and young adults, …
Scrotal pain in young men: When to seek urgent care
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