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When was the last time your dentist mentioned that artificial intelligence was scanning your X-rays before you even sat down in the chair? General dentist Sowjanya Gunukula explains how …
AI is already reading your dental X-rays and you probably have no idea [PODCAST]
In 1988, an unusual scene unfolded at the French National Institute of Health and Medical Research Unit 200 in Clamart, France. The then editor of Nature, John Maddox, arrived at Jacques Benveniste’s laboratory accompanied by investigator Walter Stewart and the professional magician and skeptic James Randi. Their task was not to perform tricks but to examine an extraordinary scientific claim: that biological activity might persist even when no molecules of …
The memory of water and a historic scientific controversy
Frederick Smith is in his 70s, has advanced Alzheimer’s disease, and lives in a nursing home just south of Boston. He has not had a meal in three days because his roommate is stealing his food and no one has stopped it, either because staff have not noticed or do not have the time or training to intervene.
Tens of thousands of older adults spend their final days in nursing homes …
Why nursing home regulations must address mental illness
Every physician remembers the first time they ran a code. The adrenaline. The organized chaos. The moment you reach for the crash cart and trust, without thinking, that everything inside it is where it should be, that the medications aren’t expired, and that the equipment has been checked.
But here’s what most physicians don’t think about: Who’s making sure that crash cart is actually compliant? Who’s tracking whether every piece of …
The crash cart that taught me physician-led investing
In medicine, we are trained to notice decline. We track blood pressure, glucose, gait speed, medication lists, cognitive scores, fall risk, frailty, and health care utilization. These measures matter; they save lives and guide care. But we risk reducing aging to a checklist of deficits.
I was recently reminded that aging care requires something much harder to measure: the ability to let an older person remain whole.
Taiwan has entered a new …
Aging care is not about fixing every wrong note
In health care, we often talk about psychological safety as something leaders create, encouraging people to speak up, be open, and learn from mistakes. But in practice, many clinicians already know: Whether it is truly safe to speak depends on what happens after they do. The term “psychological safety,” introduced by Amy Edmondson, describes a shared belief that it is safe to take interpersonal risks. But in health care environments, …
Why psychological safety in health care systems matters
Efforts to expand diversity in education and the workforce, through affirmative action, Diversity, Equity, and Inclusion (DEI) initiatives, and policies such as the Rooney Rule, are grounded in a clear objective: to broaden access for groups historically excluded from opportunity. In many settings, these efforts have succeeded. A substantial body of evidence shows that such policies increase representation at the point of entry, particularly in selective institutions and competitive professional …
Measuring the real success of modern diversity initiatives
Medical students are often told that third-year clerkships are their place to shine because they will be evaluated as future physicians. Unfortunately, the evaluation systems themselves frequently undermine that goal. During an internal medicine rotation, I was told that my performance was “excellent,” to merit top marks, but awarding the highest grade would be inappropriate because it was my first rotation. In another clerkship, evaluations seemed driven less by clinical …
Why tiered clerkship grading fails medical students today
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This episode is sponsored by Novartis Pharmaceuticals Corporation.
In this sponsored episode from Novartis Pharmaceuticals Corporation, a leading preventive cardiologist walks through the 2026 cholesterol …
2026 cholesterol guidelines: LDL goals, Lp(a), and coronary calcium scoring [PODCAST]
I have watched the U.S. News & World Report “Best Medical Schools” rankings shape behavior in American medicine for decades. As a physician, educator, and someone who has mentored trainees at different stages of their careers, I have seen the rankings function both as a compass and as a distortion. They promise clarity in a complex landscape. Too often, they deliver something closer to a mirage.
The appeal is obvious. Medical …
Medical school rankings reshape what they measure
An excerpt from Before and Beyond the Scalpel: Prehabilitation and Pelvic Floor Recovery After Prostate Cancer.
When I heard the word “cancer,” I was not prepared, and I am a physician with more than 35 years of experience.
Intellectually, I knew prostate cancer carries a high cure rate when caught early, as mine was. I understood the staging, the options, and the survival statistics. I had counseled patients through diagnoses far …
The prostate cancer recovery few men are warned about
Suppose you were offered the following two work opportunities. Which would you choose?
Career A: an acceptable opportunity that pays slightly more than your current job; you’re guaranteed never to make less than you do today.
Career B: a dream opportunity that sings to your soul but comes with no guarantees. While you may make much more than you do today, you could also potentially take a six-figure pay cut.
In other words, …
Physician career choices come down to risk tolerance
At the end of a visit, it is common to say: “Call if things get worse.” It sounds supportive. It sounds open-ended. It sounds safe. But what does “worse” mean? More frequent pain? More intense pain? Pain that wakes the patient at night? Pain that interferes with work? Without definition, responsibility shifts quietly.
Modern care depends on patients, not simply to follow instructions, but to understand the treatment plan, to carry …
Shared responsibility in patient care needs boundaries
I remember the first time a resident came to me with a clinical question she had already answered, using ChatGPT. She was not asking for confirmation. She wanted to know if the answer was right. That moment changed how I think about artificial intelligence in residency education. I am a family medicine physician and associate program director. For years, I have been building what we call the Junior Preceptorship model, …
Artificial intelligence in residency education and family medicine
Clinical training does not teach operational survival
Clinical training prepares physicians for clinical decisions. It rarely prepares them for the operational decisions that determine whether an independent practice survives the first three years.
A new practice owner may understand diagnosis, treatment, documentation, and patient communication, yet still be unready for payer enrollment, days to get paid, denial management, lease math, compliance deadlines, electronic health record (EHR) tradeoffs, and vendor evaluation. These decisions …
Independent medical practice runs on operations
Chronic disease is rising. Our system is not designed for it. This is not a controversial observation. Across clinical practice, research, and health system leadership, there is growing recognition that the burden of chronic illness is increasing and beginning earlier in life. What is less often acknowledged is that the structure of our health care system has not evolved at the same pace. In clinical settings, this shift is already …
Why our health care system is failing chronic disease patients
I was watching a medical drama recently when a physician identified a patient’s age, not from a chart, but from their teeth. The logic was simple. Worn enamel. Coffee staining. Fully erupted molars. It made for good television. But it also revealed something much bigger, something we rarely talk about in medicine, and almost never teach outside of it: The body is always leaving clues. We just do not know …
Pediatric airway health and early childhood development clues
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What happens when a woman is diagnosed with a rare, estrogen-sensitive lung disease at 28, in her first week of residency, with no roadmap for whether she can safely …
She was learning to keep others breathing while losing her own air [PODCAST]
If anything represents the economic effects of medical malpractice, it is the following two cases. One involves a teenage mother and a major academic medical center. According to attorneys on both sides, the lawsuit is legitimate. However, its underlying merit is described as only 25.3 percent. Nevertheless, a legal strategy obscures this. The mother is 16 years old when she conceives and lives in a West African country until 17 …
The cost of chaos in medical malpractice litigation
For three months, I searched for a preceptor. I reached out to clinics, private practices, and community providers. I emailed offices, followed up, and posted in professional forums and Facebook groups. I approached the process with persistence and respect for the clinicians whose time I was requesting. Most of the time, I received no response. When I did, the answer was typically the same: not accepting students, already at capacity, …
The rising cost of clinical placements for nursing students
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