I see it every week in my practice: Patients obsessed with their cholesterol numbers. LDL, HDL, triglycerides, the full alphabet soup. They have been trained to believe these numbers hold the keys to life and death.
But here is something I cannot stop thinking about: When you look under the microscope, an atherosclerotic plaque (the thing that clogs arteries and leads to heart attacks) looks an awful lot like a tuberculosis …
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Physician leader Janet A. Jokela discusses its article “Collective action as a path to patient-centered care.” The piece reflects on the evolution of physician unions since the 1980s, beginning with housestaff associations …
As an academic trauma surgeon and intensive care physician, I have spent decades honing my clinical skills and teaching them to others. The recent milestone reached by Microsoft’s new AI system, the MAI Diagnostic Orchestrator (MAI-DxO), is a reminder that the cognitive frontier of medicine is shifting, not gradually, but in leaps. MAI-DxO reportedly diagnosed complex cases from the New England Journal of Medicine with eighty percent accuracy, compared to …
Most of us have done it: a new symptom pops up, and instead of calling a doctor, we type it into Google. In that moment, the internet feels like the fastest way to get answers. But when it comes to urology, a field where stigma, fear, and embarrassment often hold people back, the flood of conflicting or misleading information online can do more harm than good. That’s where digital health …
Emergency medicine has evolved far beyond what its founders envisioned. Once an afterthought of the health care system, it is now the gateway to care for millions. Every day, our emergency departments serve as the front door of the hospital and, for many, the only door into health care.
This is why I argue that emergency medicine safeguards human rights.
Consider the patient mix of any emergency department: we care for the …
Back-to-school season is one of the busiest times of the year for health care providers (HCPs). Doctors’ offices are full of young patients and families preparing for the year ahead, checking off physical exams, immunization forms, and age-based screenings. These visits are more than just routine; they are critical opportunities to talk about risk factors and catch early signs of health issues. Yet too often, one disease slips through the …
Before venturing into medicine, I was focused on aviation, training as a pilot at age 15. To this day, I can still recite every step of the engine-failure sequence from memory. Pilots are trained this way for a reason: They spend hours in simulators practicing under duress, so that when something goes wrong in the real world, they respond instinctively. By the time they are in the cockpit with passengers …
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Urologist Fara Bellows discusses her article “When recurrent UTIs might actually be bladder cancer.” Fara shares the story of a 91-year-old patient whose recurrent urinary infections masked an underlying bladder cancer diagnosis, …
I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.
How it works
The cycle is simple:
The weight of a number
Three years ago, I sat in my car during a work break, hands trembling as I opened my MCAT score report. The number stared back at me: 494. My heart sank. As a husband and father of two young girls, I had poured five months into prep courses, question banks, and late-night study sessions, all while balancing family and work. I walked out of that eight-hour …
As a physician provider in my State Physicians Health Program, I have watched brilliant colleagues flicker out. Not because they lacked skill or grit, but because the system treated their humanity like an optional feature. We train physicians to master physiology, not how to metabolize grief. We celebrate heroics, not healing. Then September arrives, Suicide Prevention Month, and we draft statements. The statements are sincere. They are not sufficient. It …
I have spent decades learning about how bodies and brains work, but nothing has taught me more about complexity than raising my autistic son. He is nine, curious, brilliant, and completely captivated by chemistry. He can explain the structure of an atom with more clarity than most high school students.
But when we step into the real world (classrooms, stores, even family gatherings), sometimes his brain does not get to shine. …
“I was excited to see you today because I thought you were going to answer all my questions,” a patient once told me. I smiled, masking the insecurity. “I wish I could.”
The truth is, I often cannot (at least not in a single visit). Medicine is rooted in curiosity and lifelong learning. Patients expect certainty, but doctors live with uncertainty. We know enough to know how much we do not …
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In my years as a physician on the front lines of addiction and pain medicine, I have never encountered a medication as transformative as buprenorphine (Suboxone). I have seen patients, broken by years of opioid addiction, have their lives change within an hour of their first dose, ready to reclaim a life they thought was lost. For these patients, buprenorphine is as essential as insulin is for a person with …
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Health care executive Ashish Mandavia discusses his article “Why U.S. health care pricing is so confusing—and how to fix it.” Ashish explains how systemic misaligned incentives, opaque insurance practices, and weak enforcement …
I never expected that iron deficiency anemia would change the course of my life. I felt off. Tired in a way that sleep could not fix. Foggy, weak, emotionally distant. At first, I thought I was just worn down from work and the daily grind. I was not myself, physically, mentally, or emotionally.
Eventually, I was diagnosed with iron deficiency anemia, a condition many associate with mild fatigue or simply “not …
Kidney stones are not only about what you eat or the genes you inherit. They are also about where you live and how hot it gets. Every summer, urologists notice the same pattern: as the temperature climbs, so do the visits for kidney stones. Because heat and humidity do not just make us sweat, they change how our bodies handle water and minerals. Dehydration concentrates the urine, crystals form more …
Let me just start by saying: If you are reading this and thinking, “Who voluntarily takes medical board exams at 63?” You are absolutely right. Normal people do not do that. They take up golf from the Green tees, try to marry off their kids, and complain that the younger generation cannot drive. But me? I spent four precious months of my remaining life cramming for the ABIM boards like …
The night shift was unusually calm. Mr. T, a 74-year-old admitted for pneumonia, had completed his evening antibiotics and was resting quietly. His blood pressure, heart rate, temperature, and oxygen saturation were all within normal limits. The nurse’s 2 a.m. note was brief but telling: “Less talkative tonight,” “Needed encouragement to walk to the bathroom,” “Left most of his dinner untouched.”
By morning, Mr. T was febrile, hypotensive, and confused. Within …
Appointments booked months out. Overwhelmed specialists. ERs struggling to stay staffed. The physician shortage is not coming. It is already here.
The Association of American Medical Colleges projects a shortfall of more than 124,000 physicians by 2034. But that number does not capture the reality that doctors are leaving medicine quietly, every single day. Some retire early. Others step into nonclinical roles. Many more are simply trying to find a better …
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