I met him as a patient with a back condition, not a cardiac patient. A 70-year-old man who looked like he had outrun aging through sheer willpower and a well-worn bicycle. He rode more than a hundred miles a week, had the resting heart rate of a seasoned athlete, and carried himself with the kind of confidence that comes from a lifetime of good health. His only complaint was lower-back …
The $500,000 drug and the cost of modern medicine
Early in my career, I saved a man’s life, and he was not pleased. Mr. H came to see me for knee pain. With my training still fresh, I moved through a standard review of systems. When I asked about cardiac symptoms, he mentioned that for several weeks, walking more than a block caused chest pain that resolved with rest. The knee was forgotten. I explained the cardiac risk, ordered …
Bridging the gap between a chronic disease diagnosis and treatment
“Why haven’t they scheduled your dad for his feeding tube placement? They just want another family conference.” I sighed and told my mother we may have to fight. The physicians caring for my father seemed ready to overrule her decision, even though she held his medical power of attorney. When I spoke with an intern, I explained that our family had not changed our mind about the course of treatment. …
When shared decision making gives way to medical paternalism
“I just do not want my life to change,” said my patient. “It does not have to. With the medicine we have now, people with HIV can live a perfectly normal life,” I responded. As a family physician in the Atlanta area, I see patients at all stages of their HIV journey, some newly diagnosed and scared, others living with the virus for years, undetectable, thanks to daily medication. What …
The reality of PrEP access and HIV prevention in Georgia
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What happens to patients with disabilities when the government signals their lives don’t matter, and what does that mean for the doctors fighting alongside them? Ashna Shome, a pediatrics resident with cerebral palsy, …
I have cerebral palsy and I’m a doctor. Here’s what policy cuts mean for patients like me. [PODCAST]
In Opinions, which is section 9.7.1 of the American Medical Association (AMA) Code of Medical Ethics, a physician serving as an expert witness has a duty to act as an objective, independent professional whose opinions are based on science, and not act as an advocate whose opinions win lawsuits. The question, which I now raise, is: “Are opinions expressed by a medical expert, which have 95 percent confidence (the …
Medical expert testimony vs. advocacy in the courtroom
In 1900, life expectancy in the U.S. was 47 years for men and women combined. By 2025, the figure had risen by about 32 years. Many U.S. citizens attribute this increase to the development of modern medicine and widespread availability of antibiotics. However, while antibiotics have indeed contributed, they are overshadowed by changes that most of us take for granted and simply do not think about.
Treatment of public water supplies, …
25 of 32 years of life expectancy came from this
There’s a moment that happens in almost every family caring for an aging parent. It usually begins the same way. Someone leans in, frustrated, exhausted, sometimes whispering, sometimes shouting, and says, “My family is crazy.”
As a geriatric psychiatrist, I hear this often. What’s interesting is that everyone says it. Every sibling group thinks the others are unreasonable. Every adult child believes they’re the only one who sees things clearly. Every …
The family caregiving truth nobody wants to admit
Every major AI chatbot fell for bixonimania, a fake disease made up by a team from the University of Gothenburg in Sweden, led by researcher Almira Thunstrom. Dr. Thunstrom uploaded two fake studies about a made-up skin condition termed as bixonimania to a preprint server in early 2024. The papers described the disease as characterized by sore eyes and dark pigmentation around the eyes supposedly caused by blue light …
AI medical misinformation fooled every major chatbot
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
In recent months, a heated debate has emerged about the credibility of major medical journals such as the New England Journal of Medicine, the Journal of the American Medical Association, and The Lancet. Critics, including United States Health and Human Services Secretary Robert F. Kennedy Junior, have argued that these journals are compromised by pharmaceutical industry influence and therefore cannot be trusted. At first glance, the claim may sound extreme. …
Evaluating the credibility of major medical journals today
For most of modern medicine, clinical intelligence lived inside physicians. You trained it for more than a decade. Medical school. Residency. Fellowship for some. Then years of repetition. Pattern recognition built one patient at a time. Judgment sharpened by experience. It walked into the exam room with you. It left the hospital at night. It lived in your head. That arrangement is starting to change. Artificial intelligence is beginning to …
The shift from physician clinical intelligence to AI infrastructure
Rural health clinics (RHCs) are Medicaid-funded community-based interventions that significantly improve maternal health in rural areas by increasing access to care. A study done in Egypt, an extremely rural country, showed that community clinics for rural health provided evidence-based interventions that have drastically lowered complication rates during pregnancy. Complications during pregnancy dropped from 38.1 percent to 15.1 percent, and postpartum complications from 81.7 percent to 7.0 percent. Although these solutions …
How rural health care access impacts maternal mortality
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
There is a large amount of evidence showing that keeping a consistent sleep schedule is incredibly important for a variety of health outcomes. Regular schedules are associated with improvements in alertness, health and safety behaviors, inflammation, mental health, cognitive performance, academic performance, sleep duration, and sleep quality. On the other hand, irregular sleep schedules have been linked to worse health outcomes across the board. Even so, sticking to a consistent …
How to build a bedtime routine for a consistent sleep schedule
For more than 25 years, I built physician extension systems. In rural family medicine, if you want your clinical judgment to reach more patients than your two hands can touch in a single day, you build systems. You hire nurses who triage, educate, and even scribe. You bring on a medical assistant who keeps the workflow moving. You eventually collaborate with a nurse practitioner (NP) or physician assistant (PA) who …
How artificial intelligence scales physician extension
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
A colleague recently reacted to the idea of physician-built AI with a kind of weary cynicism: AI glitches. All AI glitches. I understood what he meant. Many physicians have already lived through one wave of technology that promised efficiency and delivered frustration. We were told electronic medical records would improve care, streamline communication, and modernize medicine. In some ways, they did. But they also inserted screens into the exam room, …
Why physician-led AI adoption is essential for health care
How does medical misinformation on social media reshape the trust between doctors and patients? As a medical student in my internship, I ask myself this question almost daily. In an era where a quick search or a viral post can feel more convincing than years of medical training, how do we rebuild the fragile bridge of trust between physicians and patients? And perhaps more importantly: How do we, as future …
How medical misinformation impacts doctor-patient trust
There is a place some patients end up living when they have complex medical illness. It sits somewhere between stable and emergency, and people like me spend a lot of time there. I live with serious medical conditions that keep me mostly homebound and often bedbound. My days revolve around things many people thankfully never have to think about: feeding tubes, medications, blood pressure swings, heart rate problems, and trying …
The hidden struggles of medically complex homebound patients
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