Reclaiming physician agency in a broken system

Physician
November 14, 2025

“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.

By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership …

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The hidden epidemic of orthorexia nervosa

Conditions
November 14, 2025

She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …

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A question about maternal health and the rise in autism [PODCAST]

Podcast
November 13, 2025
YouTube video

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Patient advocate and author Irene Tanzman discusses her article “A mother’s question about PCOS and her son’s autism.” Irene shares her personal journey as a mother to a son with severe autism …

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Why early diagnosis of memory loss is crucial

Conditions
November 13, 2025

Memory loss is one of the most common and anxiety-provoking complaints in medicine. Over the past five years, the evaluation of cognitive decline has become remarkably refined. No longer is memory loss assessed solely to “rule out dementia.” Today, clinicians have tools to detect the beginnings of Alzheimer’s disease or other neurodegenerative conditions before major symptoms appear, allowing patients to make informed decisions about their work, life, and health.

The first …

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Why young people need to care about bone health now

Conditions
November 13, 2025

We all know high blood pressure and cholesterol can kill, but what about low bone mineral density? Bones are composed of calcium and phosphate, which is their mineral content. Bones low in calcium are said to have low bone mineral density, which can result in a condition known as osteoporosis. Osteoporosis develops over a lifetime and is impacted by your peak bone mass as a youth. Thus, most osteoporotic problems …

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What burnout does to your executive function

Physician
November 13, 2025

We talk about burnout like it’s just being “tired” or “stressed.” However, it is not. It is a fundamental breakdown of the operating system: your brain. I know, because I’ve been there. I was the high-performer, the one who “got things done,” until my executive function packed its bags and left the building. If you’re feeling this way, you’re not weak; your system is simply overloaded. You have entered the …

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The paradox of primary care and value-based reform

Policy
November 13, 2025

An excerpt from Wonderful and Broken: The Complex Reality of Primary Care in the United States.

In a health care system full of paradoxes, this is perhaps the most striking. Primary care delivering value-based care is seen by many as the solution for an inefficient, inequitable, and poorly-performing health care system. Yet it is a shocking mess of burnout and depletion. With all the radical intention of Lenin, we must …

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Why physicians must lead the vetting of medical AI [PODCAST]

Podcast
November 12, 2025
YouTube video

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Cardiologist Saurabh Gupta discusses his article “Physicians must lead the vetting of AI.” In this episode, Saurabh explores how artificial intelligence is reshaping medicine and why its future depends on physician leadership, …

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Dealing with physician negative feedback

Physician
November 12, 2025

In medicine, we are taught to care deeply.

When criticism arrives, whether from a patient, a colleague, an administrator, or an anonymous review, it stings. A lot. The sting usually lasts long after we read the words. It usually leads to rumination, self-doubt, and often even poor sleep, a questioning of our career choice, and our abilities.

Even with years of mindfulness, self-compassion, and coaching, I still feel upset when it happens …

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Deaths in custody highlight crisis in Philly prisons

Policy
November 12, 2025

The Kensington community is still reeling after the deaths of Amanda Cahill and Joey Gabor, who both died in custody shortly after being arrested during the area’s controversial narcotics sweeps at the end of 2024. While we don’t know the details behind these deaths, they are alarming and depict the vulnerability of those incarcerated with substance use disorder. We as physicians working to curtail the opioid epidemic must advocate for …

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Why CPT coding ambiguity harms doctors

Physician
November 12, 2025

Current Procedural Terminology (CPT) is the billing language of American medicine. The health care system established the CPT code that was created by The American Medical Association (AMA) in 1966 and updated yearly, as the national common language used by federal, public, and private plans.

Evaluation and Management (E/M) codes are the CPT section used for office and telehealth visits. In 2021, E/M rules changed. You select the visit level by …

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Why health care needs empathy, not just algorithms

Conditions
November 12, 2025

The algorithm flagged a potential drug interaction in milliseconds. It suggested an optimal dosing regimen based on kidney function, weight, and genetic markers. It even generated patient education materials in the right language and reading level. But the patient sat there, hands trembling, unable to ask the question that mattered most: “Am I going to die?”

That’s where artificial intelligence ends and where health care truly begins.

The seduction of technological solutionism

Health …

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Moral injury, toxic shame, and the new DSM Z code

Physician
November 12, 2025

The recent inclusion of moral injury as a Z code in the DSM marks a moment for mental health. Z codes place a diagnosis in an environmental or psychosocial context. After years of advocacy from clinicians and veterans, moral injury has entered our clinical lexicon. This action validates the linkage between our embeddedness in the world and our individual struggles, from soldiers and first responders to physicians navigating a broken …

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The problem with the 15-minute doctor appointment

Physician
November 12, 2025

You arrive on time: 8:20 a.m. for your 8:30 appointment. You’ve done your part; you showed up early, brought your insurance card, and maybe even filled out the forms online. You expect to see your doctor at 8:30. After all, that’s what the schedule says. But the clock, like the system, runs on its own rules. At 8:35, you’re still at the front desk. They’re scanning your card, verifying your …

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Fixing the system that fails psychiatric patients [PODCAST]

Podcast
November 11, 2025
YouTube video

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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “The crisis in inpatient psychiatric care.” In this episode, Muhamad examines the growing dysfunction within the nation’s psychiatric hospital system, …

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A doctor’s story of IV ketamine for depression

Conditions
November 11, 2025

I used to whisper it into the dark, lying awake, watching the clock creep past 2 a.m. My body was exhausted, but my mind refused to stop sprinting, running a veritable marathon most of the night. When the sun finally pushed through the curtains, it didn’t feel like morning. It felt like failure, another day to muscle through on fumes.

Sometimes that was the hardest moment of the day. Little sleep …

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South Carolina’s CON repeal: an opportunity for doctors

Policy
November 11, 2025

Imagine having to ask your competitors for permission to open a new business: a corner café, a diagnostic clinic, or a surgical center. For decades, that was the reality in South Carolina health care. Certificate of Need (CON) laws gave entrenched hospital systems the power to contest new outpatient facilities, imaging centers, and physician-led ventures. It stifled competition, raised costs, and preserved the status quo.

That era is ending. In 2023, …

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Physicians must lead the vetting of AI

Tech
November 11, 2025

Walking out of the cath lab one night after taking care of a patient with an acute myocardial infarction, a thought crossed my mind. In cardiology, we would never deploy a new device without vetting it. Before a stent ever touches a coronary artery, it undergoes bench testing, animal trials, and human studies to prove safety and efficacy. This process typically takes years, and in some cases, decades. Data points …

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Physician entrepreneurship and financial freedom

Finance
November 11, 2025

In a unique episode of the Wealth Planning for the Modern Physician podcast, host David Mandell, JD, MBA, sat down with a resident, although not your typical resident! Dr. Wendell Cole, an orthopedic surgery resident at the time, is also a fellow podcaster, author, and entrepreneur. Despite being in the early stages of his medical career, Dr. Cole had already built a track record of innovation and initiative. His story …

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Honoring medical veterans and health care heroes

Physician
November 11, 2025

This past August, our local hospital celebrated its 50th anniversary. The media published photos from 1975 of the ceremonial groundbreaking with hospital officials, including future Chief of Staff, Dr. David Mysko.

Dr. Mysko was the first doctor I met when I joined the staff in 1987. We played on “The Hospital Mashers,” competing with other community softball teams in a city league. As a family practitioner, he probably delivered many readers …

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