An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
If you are 35 or older and either pregnant or thinking about having a baby, you are not alone. The average age for women having babies in this country and around the developed world has increased significantly over the past two decades, and the percentage of women having children after age 35 has increased as well. The teenage …
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Patient advocate Timothy Thomas discusses his article “The Cap’n Crunch philosophy of medicine.” Timothy shares his personal experiences with gaps in primary care, from learning of his diabetes diagnosis at a Walmart …
Cap’n Crunch never held a true naval rank; he was called “Cap’n” because he was the highest-ranking person present, not because he replaced someone more qualified. In some clinics, it is the same: the system is built so you rarely, if ever, see a real doctor. Whoever is around with the right badge simply gets the title and responsibility by default. This “Cap’n Crunch” phenomenon is not limited to one …
In the early 1990s, while the American Academy of Pediatrics was formalizing its vision of the “medical home,” we were already living it, without a name, without a policy statement, and without institutional applause. At Minot Air Force Base in North Dakota, our pediatric team operationalized what would later be codified: interdisciplinary care, family partnership, coordinated services, and continuity across settings. We did not call it a medical home. We …
For years, concierge medicine and direct primary care (DPC) were viewed as fringe alternatives, reserved for affluent patients or entrepreneurial physicians willing to step outside the insurance system. But in my opinion, these models are no longer “nice-to-have” side projects. They’re becoming essential pathways for physicians to reclaim careers, reduce burnout, and meet patient expectations in an evolving health care landscape.
Burnout is pushing physicians to the edge.
The pandemic only magnified …
Recent research has revealed that atypical migraine can influence tinnitus in some individuals. Some patients report significant improvement in tinnitus when treated with migraine-specific therapies. But how can someone know whether migraine is a factor in their tinnitus, and what treatments might help?
Understanding migraine beyond headaches
Migraine is a complex neurological disorder, not just a severe headache. Some people experience migraine without ever having a headache. It is thought that inherited …
We have all been told the story: High cholesterol leads to heart disease, and statins are the magic bullet. The JUPITER trial, published in The New England Journal of Medicine in 2008, became one of the most heavily publicized pieces of “proof” supporting that belief. It claimed that rosuvastatin significantly reduced heart attacks, strokes, and cardiovascular events, even in people with normal LDL cholesterol levels.
But what if I told you …
South Asians are one of the fastest-growing immigrant populations in the United States, yet their health experiences remain poorly understood, often falling into broad “Asian American” categories that erase unique needs. The result is persistent inequities: South Asians face disproportionately high rates of conditions like diabetes, heart disease, and PCOS, while also contending with cultural stigma, language barriers, and limited representation in the health system.
As a public health professional and …
I was at one of the lowest points of my medical training. I had just finished my second-year exams. The stress had left me feeling hollow, anxious, and utterly drained. It was in this fragile state that my own body turned against me.
It started with a fever that would appear every evening. I told myself it was just the change of season. I took paracetamol and tried to ignore it. …
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Physician Jessie Mahoney discusses her article “Imposter syndrome is not a personal failing.” Jessie explains how self-doubt among physicians is less about individual weakness and more about a conditioned mindset reinforced by …
When you step into medical training, you’re often told, both implicitly and sometimes even explicitly, that certain parts of you don’t belong. Sensitivity, doubt, or even just being messy and human can feel like liabilities in a culture that prizes efficiency, certainty, control, and always “having the answer.” Many physicians I work with in therapy describe learning early on to “toughen up,” to silence the softer, more questioning sides of …
Twenty years ago, when I started medical school, I had no idea that this would be my path. Coming from a research background in cancer biology and biophysics, I did not have much exposure or interest in integrative medicine. My path to practicing integrative and functional medicine and incorporating new modalities to my foundation as a general internist, was not linear, and not expected.
I was pregnant twice during my three-year …
In medicine, we’re trained to stay. To endure. To prove our worth by how much we can carry and how long we can carry it. Our roles become our identities. Our achievements and labels become scaffolds of self-worth. In medicine, stepping down is often labeled as a sign of weakness. So we hold on to roles even when they no longer fuel us. We are usually still doing the job …
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When I received an invitation to a webinar titled “Special Session on a New Autism Risk Test,” I expected a discussion on screening strategies or intervention innovations. Instead, when I researched the company and reviewed its website, I discovered a pitch for a punch-biopsy-based lab test marketed as a way to detect autism risk in newborns as early as two days after birth.
As a nurse practitioner who treats autistic patients, …
When we think about palliative care, our first instinct is to picture pain medications, symptom checklists, and clinical protocols. But for patients with terminal brain cancer, the reality is much more complex. As speech declines, as motor function deteriorates, and as identity itself feels threatened, the greatest need is not always more medicine; it is meaning, connection, and dignity.
In recent years, I have had the opportunity to study an ancient …
Not long ago, a 36-year-old man came to the emergency room with crushing chest pain. He had no significant medical history, exercised occasionally, and thought heart disease was something he would only need to worry about decades from now. To his disbelief, he was having a heart attack.
Stories like his are no longer rare. Cardiologists and emergency physicians are increasingly seeing patients in their thirties and forties presenting with acute …
We often see media headlines or articles about scientific and medical advancements promising imminent treatments or cures. I am not referring to advertisements that frequently masquerade as stories for naturopathic, homeopathic, or other unproven remedies, but rather those from supposedly reliable sources, such as CBS, Yahoo, or the Chicago Tribune.
Reporters or news writers often compose them, despite lacking training in science or medical reporting. They frequently make inappropriate assumptions and …
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Psychiatrist Muhamad Aly Rifai discusses his article “A psychiatrist’s 20-year journey with ketamine.” Aly recounts his first encounters with ketamine at the National Institute of Mental Health, where its rapid impact on …
On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it permanent. That would not just be bad policy. It would be malpractice by Congress.
I think of a patient of mine in northeast Georgia who lives 90 minutes from my clinic. …
As a fertility specialist, recurrent implantation failure is one of the most difficult and heartbreaking problems we face. Over the last forty years, we’ve made tremendous improvements in both IVF protocols and lab techniques. A high-quality embryo may have up to a 70 percent chance of yielding a live birth. However, how do we approach the patient when high quality embryos are not taking? And what does the evidence really …
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