I often wonder why giving has so little to do with how much one has. A millionaire may hesitate to part with even a few thousand dollars for a person in need, while someone with only a modest savings may readily give away a meaningful share of it for a good cause. Clearly, something deeper is at work than what we see outwardly. This raises an important question: why does …
Philanthropy for scientific research is underused
A pearl forms when an irritant gets trapped inside an oyster and can’t get out. The oyster doesn’t remove it. It layers over it until damage becomes structural. That’s what I keep seeing in patients who waited years before seeking psychiatric care.
The delay is often interpreted as denial or avoidance. In practice, many adults are functioning exactly well enough to normalize their suffering. They become so fluent at carrying anxiety, …
Why high-functioning adults are delaying psychiatric care
When institutions begin to fear the consequences of telling the truth, the First Amendment becomes a parchment promise rather than a living principle. Medicine is not immune to this cultural shift. Physicians who once spoke freely about patient safety, training standards, and systemic failures now hesitate, not because they lack conviction, but because the corporate structures around them punish candor. The result is a profession that has lost not only …
The quiet loss of dignity in medicine
In anesthesia, we meet patients at one of the most vulnerable moments of their lives. We care for patients as a team, and I’m grateful for the skilled certified registered nurse anesthetists (CRNAs) I work alongside every day. Often, we are asked to earn trust quickly, while patients place their safety and comfort in our hands. What we offer in those moments goes beyond technical skill. This is my attempt …
Anesthesiologist bedside manner matters more than skill
He is an engineer from Guatemala, in his sixties. The Spanish accent has gone mostly quiet after decades in the States, but not entirely. Six months ago I did a radical prostatectomy on him. Localized disease, favorable risk, I spared the nerves. It went the way you hope these things go.
Today, sitting across from me in my clinic, his prostate-specific antigen (PSA) is 0.05. Which, if you are not in …
Doctor patient trust cannot be automated
Walk into any medical school or residency program today and you will find coaching everywhere. There are coaches for Step exams, OSCEs, research productivity, wellness, leadership, residency applications, and even “professional identity.” On the surface, this seems like progress, offering structured support, individualized feedback, and measurable outcomes. But beneath this expansion lies a more uncomfortable question. Are we replacing meaning-making mentorship with episodic, transactional coaching?
Coaching: what it does well
At its …
Is coaching in medical education replacing mentorship?
My first experience of “providing care” did not unfold as I had imagined: after years of training, thoroughly studying everything there is to know about the human body, and being perfectly prepared to care for someone. Instead, it began quietly, with a white coat and a stethoscope that fit about as comfortably as my pseudo-physician identity, that is, to all of my friends not in medicine.
It was early in my …
A medical school experience that redefined providing care
What if I told you that burnout is not the most dangerous thing happening to primary care physicians right now? I actually think there’s something worse, and it’s happening quietly. Because many experienced doctors are slowly losing something they never expected to lose: themselves.
Not their license. Not their income. Not even their career. Themselves. Their energy. Their personality. Their joy. Their curiosity. Their life outside medicine.
Hello, I’m Dr. Gani. And …
Physician burnout is quietly costing doctors themselves
The name polycystic ovary syndrome may have unintentionally narrowed how medicine understood one of the most common endocrine disorders affecting women. The ovaries were visible. The deeper physiology was not.
For decades, the syndrome was largely framed around irregular ovulation, infertility, excess androgen symptoms, and the characteristic “string of pearls” appearance seen on ultrasound. Yet many patients experienced something far broader long before medicine fully acknowledged it. They struggled not only …
Polycystic ovary syndrome is more than ovarian
“The eyes only see what the brain knows.” A patient said this to me recently, and it stopped me in my tracks. He was reflecting on his own experience in the medical system: the many physicians he had seen for the same problems, and the various different diagnoses he had received. Although each of those physicians likely trained at LCME-accredited institutions, the path beyond medical school, including residency, fellowship, and …
How AI improves clinical reasoning for medical students
For most of my career as a bariatric surgeon, I told patients that surgery was the most reliable tool we had for significant, sustained weight loss. That conversation has fundamentally changed.
In the past three years, GLP-1 receptor agonists, a class of medications originally developed for type 2 diabetes, have redefined what is medically achievable for patients with obesity. As someone who has performed hundreds of bariatric procedures and now helps …
How GLP-1 medications compare to bariatric surgery
I had matched into one of my top pick residencies, and I was living out my “dream life.” I was a very proud active-duty military member, and I was an oral and maxillofacial surgery resident. I loved where I lived, and my co-residents were amazing. The program fit my personality, and I was surrounded by extremely supportive attendings with few exceptions. I had gotten exactly what I had hoped for …
Overcoming physician burnout during medical residency
I still remember the heavy silence of the psychiatric unit during the peak of COVID-19. No family visitors, no group therapy, just the low hum of monitors and the crushing weight of isolation. One of my patients had survived a suicide attempt after losing his wife and daughter in a car accident. His grief filled the room like something physical.
As a registered nurse, my role was clear: manage crises, deliver …
How moving from nursing to medicine improves oncology care
The challenges in dealing effectively with this issue are compounded by multiple factors. These include an overall national shortage of physicians, particularly in rural communities, as well as being more prevalent in some specialties than others.
In addition, if an impaired physician has been a long-standing member and past leader of the medical staff, is responsible for a significant number of hospital admissions, has consistently participated in the institution’s annual fundraising …
Why hospitals delay action on impaired physicians
I have been gathering information about the neuroscience of happiness for over a year now, since the completion of my previous book, Legal Mind in Medicine, and decided to put a glimpse of it in an article form for the Memorial weekend reading.
Happiness stands as a central human pursuit, shaping our physical health, mental resilience, productivity, and relationships. As physicians, understanding the science of well-being offers real value. It …
Lifestyle, mindfulness, and the neuroscience of happiness
The conversation in the surgical ICU happens the same way every time.
“His creatinine spiked post-op, but it came back down before discharge. The labs look normal now. The kidney recovered.”
Cardiac surgeons hear this reassurance so often it’s become standard. The patient leaves the hospital with normal kidney function on the discharge summary. By every conventional metric, the surgery was a success. The acute kidney injury was resolved.
Except it didn’t. Not …
When normal creatinine hides post-operative kidney injury
The emergency department was bright after midnight. An older man in his 80s arrived short of breath and frightened, surrounded by anxious family members. He had diabetes, chronic kidney disease, heart failure, and a recent fever. The nurse checked his blood pressure and tried to calm his daughter. The physician reviewed the chart and knew immediately: This would not be a simple night.
In medicine, we often work in the gray …
The hidden cost of medical malpractice litigation
We spend a lot of time talking about how broken the medical system is: burnout, moral injury, administrative overload, loss of autonomy. We propose solutions: better workflows, more staffing, policy reform, technological innovation. But there is a harder truth we tend to avoid. The overall medical training system needs an overhaul.
Medical training does not just teach knowledge and clinical skill; it shapes identity, hierarchy, and thought patterns. From the earliest …
Why medical training ignores the business of medicine
Patients often assume that someone is directing their care. That there is a clinician who sees the whole picture, integrates the information, and guides what happens next. In many cases, that is not how modern care is structured. Patients move between clinicians (primary care, specialists, urgent care, consultants), each focused appropriately on a specific aspect of the problem. Each encounter may be thorough. Each decision may be reasonable. Each plan …
Fragmented care needs clinical direction, not more data
I was a resident physician in New York City when I met a Jamaican woman in her early 40s, newly diagnosed with type 2 diabetes. The hospital was always crowded and the schedules unpredictable, making continuity difficult. But appointment after appointment, she found her way back to me. She trusted me and even brought me gifts on holidays.
Her hemoglobin A1c was 7.2. She had mild obesity, and no major complications. …
How lifestyle interventions reverse type 2 diabetes
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