A few weeks ago, I went to the DMV to renew my driver’s license. At the very end of the process, after the routine questions and fine print, a single prompt appeared with a small checkbox next to it: Do you want to register as an organ donor?
I selected “yes,” but then I paused. Not because I was conflicted, but because I realized how easily I could have done nothing. …
Opt-in vs. opt-out: How defaults shape organ donation rates
The holidays are good for the soul, but often hard on the heart. Weeks of indulgent meals, disrupted sleep, increased alcohol intake, stress, and inconsistent routines can quietly strain cardiovascular health, especially for men. As the calendar turns and routines resume, the post-holiday period presents a valuable opportunity to reset habits, reflect on seasonal excesses, and refocus on heart health before temporary behaviors become lasting risks. Understanding how seasonal habits …
Post-holiday heart health: How to reset your cardiovascular habits
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Psychedelic-assisted therapy: science, safety, and regulation.” Muhamad explores the complex landscape of psychedelic medicine, balancing the growing public interest with …
Navigating the hype and hope of psychedelic medicine [PODCAST]
I went in for a routine dental cleaning. It was never provided.
I’ve spent my career on multiple sides of health care, independent practice, hospital-owned systems, and health insurance, which has made me acutely aware of how incentives and operational norms can quietly shape care. Still, what happened during this visit surprised me.
After I was brought back to the exam room, I was told bitewing X-rays would be taken before the …
Informed refusal vs. denied care: a dental case study
Decades ago, becoming a doctor felt like the obvious choice. People asked, “Why wouldn’t you?”
Today, the question has flipped: “Why would you ever do that?”
I’m a doctor. I graduated from UCLA, and I’m now an anesthesiology resident at Mount Sinai. I also help thousands of premeds get into medical school every year. And when I see doctors leaving medicine or premeds walking away before they even apply, I don’t think …
Informed consent for premeds: Is a medical career worth it?
We are taught to watch for conflicts of interest in the form of pharmaceutical pens and consulting checks, yet we often overlook the most pervasive corruption of all: the ticking of the clock.
We traditionally describe medical conflicts of interest in corporate terms: free dinners, speaking fees, and consulting arrangements. These temptations are real, and they deserve the scrutiny and rules we apply to them. But they are external distractions. The …
The ticking clock: How time constraints in medicine hurt patient care
Type 2 diabetes and metabolic disease are now so common that they are treated as an expected part of modern life rather than as a systemic failure. Roughly 90 percent of American adults are now prediabetic or diabetic, and most are unaware of it. This progression quietly opens the door to heart disease, non-alcoholic fatty liver disease, cancer, neurodegeneration, and other chronic illnesses that are then managed downstream.
We are not …
Insulin resistance is not a disease: a metabolic reframe
When I was a teenager, practical computers did not yet exist. In 1966, my first exposure to a computer in engineering school was a room-sized mainframe whose fast memory consisted of a foot-tall rotating magnetic disc that could store 8,000 “bytes” (each byte containing eight “bits,” which allow for 256 possible values representing alphabetic letters or numbers).
At the time, we could forget about storing the full text of the King …
Understanding Moore’s Law and the exponential growth of technology
Historically, diabetes management focused on blood glucose control and preventing severe complications such as neuropathy and amputation. Over the past two decades, this limited view has proven insufficient for long-term health. Many now emphasize risk factor management, lifestyle changes, and early screening instead of crisis response.
The vascular health risk of a diabetes surge
Diabetes is an epidemic: In the last decade alone, the number of adults living with the disease globally …
From glucose to vascular health: the future of diabetes care
“The only thing that will change will be our name.”
These were the words shared by a senior partner when our staff was informed that the partnership had decided to sell the practice to a private equity firm. Unfortunately, as the story unfolded, that was also the moment that my future changed.
I was an associate when those now infamous words were uttered. While I was wary of this transition, it was …
“The only thing that will change will be our name”: a private equity cautionary tale
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Physician, author, and health care reform advocate David K. Cundiff discusses his article “Accountable care cooperatives: a 2026 vision for U.S. health care.” David analyzes the severe funding crisis affecting American families …
Community cooperatives offer a solution to the affordable health care crisis [PODCAST]
Steven couldn’t remember when he first noticed the spot on his toe, only that it began as a blister a few weeks earlier. He finally saw his doctor, but only when the entire toe had turned black. His doctor referred him to me, but he missed the appointment because the drive was 90 minutes, and he couldn’t take the day off work.
Two weeks later, half of his foot was dead, …
The vascular surgeon shortage: Why amputations are rising
When I told ProPublica that it was too expensive to protect us, I was naming what every number in this piece confirms. The system made a calculation about what our lives were worth, and it got the math catastrophically wrong.
I have been a nurse for almost 20 years, working in emergency departments, intensive care units, and eventually the back of a helicopter as a flight nurse. I have watched the …
The shadow ledger: Uncovering the financial cost of nursing turnover
Sometimes, the smallest failures expose the largest truths. At a remote Air Force base hospital, a silent pager revealed not my incompetence, but my supervisor’s lack of leadership, and set in motion a chain of events that reshaped the hospital’s command structure and ultimately influenced the future of Air Force pediatrics.
What began as a malfunction during an award ceremony became the catalyst for decisive leadership, a reorganization of medical services, …
Leadership in action: How a broken pager fixed a hospital
If you want to understand what “profits before patients” means in American health care, don’t start with a spreadsheet. Start with a story.
During residency, I cared for a middle-aged mother of two who came to our community hospital emergency room struggling to breathe. It didn’t take long to realize she needed something we couldn’t offer: urgent heart surgery at a larger hospital.
After a 30-hour shift, I filed the transfer request …
Profits before patients: the hidden cost of U.S. health care
If you asked ten physicians to explain how they maintain board certification, you’d get at least ten different answers, maybe more. Some take quarterly quizzes. Some submit CME attestations every five years. Some do both. Others, grandfathered in before time-limited certification existed, do nothing at all. Yet every one of them carries the same professional label: board-certified physician.
That simple title, once synonymous with competence, now hides a dizzying patchwork of …
Why maintenance of certification varies widely: a system in crisis
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Practicing anesthesiologist and the physician co-founder of Marit Health Rob Anderson discusses his article “Why can’t finding a doctor job be like Zillow.” Rob shares his personal journey through divorce and house …
Modern technology must revolutionize the archaic physician job search [PODCAST]
What do old people die from?
Ella passed away last week at age 84. I have cared for her since she was admitted to the nursing home two years ago. Her granddaughter called me wanting to know the cause of death. In old age, the cause of death is often the wrong question, as the end is usually not a single cause but a slow convergence of many.
Ella had a list …
Why death certificates fail to capture the reality of aging
Artificial intelligence is no longer approaching medicine. It is already embedded inside it. It drafts our notes. It summarizes research. It suggests differentials. It triages messages. It promises efficiency, scale, and relief from burnout. Physicians are adopting it quickly. That speed should give us pause.
The greatest threat facing physicians in 2026 is not resisting artificial intelligence. It is allowing artificial intelligence in health care to be designed without us. Every …
AI governance in health care: Why physicians must lead the design
After I got diagnosed with celiac disease when I was 19, I faced a difficult choice every time friends invited me out: I could either stay home, or I could risk getting terribly sick.
I was a college volleyball player at West Virginia University when I started experiencing severe migraines and stomach issues. I could not eat anything without getting sick, which resulted in me losing 40 pounds in just two …
Managing celiac disease: Overcoming the hidden social burden
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