Today I am a urologist, a cardiologist, a psychiatrist, a rheumatologist. But truly, I am a rural family medicine doctor in one of the most underserved counties in the country. And I am tired.
I do not pretend to have the depth of each specialist. What I have is necessity, a toolkit built on scarcity. Practicing medicine on an island, where specialists are rare, calendars are full for months, and visiting …
For years, hospitals have been urged to modernize. We are told to digitize workflows, optimize performance, and rely on dashboards and algorithms to improve efficiency. Much of this advice is reasonable. Medicine cannot function without systems.
But recently, while observing hospital transformation from within, I began to feel a familiar unease, one I had encountered before outside of medicine.
It reminded me of how digital platforms operate.
Platforms are not inherently unethical. They …
The frequency and severity of physician burnout have resulted in an epidemic that is impairing the American health care delivery system. Herbert Freudenberger coined the term burnout in 1977, referring to a syndrome characterized by emotional exhaustion, depersonalization or cynicism, and a lack of personal accomplishment. He noted that burnout reduced health care workers’ ability to provide excellent patient care and adversely affected their well-being.
Physician burnout is rampant in the …
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Double board-certified obstetrician-gynecologist and reproductive endocrinology and infertility specialist Erica Bove discusses her article, “Why do high-quality IVF embryos fail.” Erica explores the heartbreaking reality of recurrent implantation failure, challenging the assumption …
Adapted from Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity. (Penguin Random House Canada/Signal, 2025.)
February 1992. I’m in the consulting-room side of a one-way mirror divide. Opposite us in the room are four people: thirteen-year-old Sofia, her older sister Julieta, and their mother and father. The parents speak with a strong Spanish accent. The girls’ mother has an anxious look on her face. She …
Most of us have heard the ancient Indian and Buddhist parable “the blind men and the elephant.” Regardless of source, the parable usually contains these elements:
A ruler assembles several blind men and brings an elephant before them. One feels the head and says the elephant is like a pot; another the ear and says it is like a fan; another the leg and says it is like a pillar; another …
As a medical student, I’ve seen firsthand how stress and cognitive overload can wear people down, both in patients and in myself. During one particularly difficult exam block, a friend casually mentioned L-theanine, a supplement found in green tea, that supposedly helps with focus and calm. That got me curious: Was this just hype, or is there actually something to it?
So I took a closer look at the research.
L-theanine is …
I’ve been thinking about “choice” a lot lately, not the rich, ethically grounded version we teach in medical school, rooted in autonomy, informed consent, and shared decision-making, but a thinner, more selective version now circulating in political and legal discourse. The kind that sounds principled until you read the fine print.
The message goes like this: You may choose, just make sure you choose correctly.
It’s the literary equivalent of Animal Farm: …
Artificial intelligence has transformed pharmaceutical science more rapidly than any other part of health care. AI can now:
Recent analyses in Drug Discovery Today and …
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Physician advocate and physical therapist Kim Downey and counselor Shari Morin-Degel discuss their article, “Why burnout prevention starts with leadership.” Shari shares her personal journey from a trauma-exposed mental health professional to …
Every week in clinic, I meet patients who carry lab results like heavy burdens. Their cholesterol is “slightly high,” their thyroid level is “borderline,” or their blood sugar is “just above normal.” They arrive anxious, wanting certainty: Do I need treatment? Am I sick?
The truth is, much of medicine exists in the gray zone (values that are not clearly normal, but not clearly dangerous either).
What the research tells us
Borderline numbers …
All of the arguments for direct primary care (DPC) from a provider perspective are valid. As a psychotherapist and psychoanalyst, I have essentially run a direct care practice for the last 15 years. I don’t accept insurance and see patients as often and for as long as therapeutically necessary. So when DPC practices started rising in popularity, I was excited to try it. Unfortunately, as a patient who is medically …
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Health care executive Kevin King discusses his article, “How to stay safe from back-to-school illnesses.” Kevin explains why the return to classrooms often triggers a surge in respiratory illnesses (like the flu, …
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On a winter evening in Taipei, random violence erupted across two of the city’s busiest metro stations. Within minutes, lives were lost, dozens were injured, and a familiar cycle followed: shock, fear, calls for more security, and questions about public safety. But for those of us in health care, this should not be framed as a failure of policing alone. It should be recognized for what it truly is: a …
A few years ago, I met a talented internist who had been practicing for 15 years. She owned a small clinic, worked long hours, and ran a thriving patient base, but when we reviewed her financials, I realized she’d been paying far more in taxes and taking far more risk than she needed to.
Her response was one I hear often: “Clint, I’m not a businessperson; I’m a doctor.”
It’s a mindset …
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs. The child suffers not only from the caregiver’s direct …
“Doc, I’ve seen enough doctors. I only trust you. I want you to do my knee replacement and fix my heart.”
I heard the conviction in his voice when I heard these words from this patient. Sitting across from me was a 76-year-old army veteran I had cared for over two decades. He had seen multiple specialists, endured countless consultations, and, in the end, he wanted me, the physician who had …
Kelly D. Holder, PhD, and I first met at the Dr. Lorna Breen Heroes Foundation Health Care Worker Well-Being Day in Washington, D.C., where she was a presenter. I was impressed with Kelly’s work, focusing on helping health care professionals and leaders co-create a culture of well-being, which is so critical in medicine today.
This resonates deeply with Sarah Hollander, MD’s belief that the culture of medicine must change, starting in …
Medscape recently released a report entitled, “A Constant Evolution: The Unique Culture of Medical School: Medscape 2025 Report.” The report’s underlying premise is that a warm, welcoming, and supportive culture in medical school allows students to not only “survive” their training, but to truly “thrive” in their educational journey.
What defines medical education today
Yet, reading between the lines, this emphasis on “culture” and environment also poses a very different question: …
As elected officials and citizens brace for the possible expiration of federal subsidies for health insurance premiums, many wonder if there are alternatives to the confusing rebate/copay/deductible/premium drug coverage word salad (see: PSAOs, GPOs, NADACs, ASOs, MLRs, AWPs, WACs, U&Cs, MACs, BERs, GERs, DFERs, GDRs, NDCs, DIRs, and ERISAs).
Just because patients don’t understand the opaque layers/players behind the drug procurement affordability crisis, doesn’t mean that lawmakers do, say experts (which …
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