Medicine is more than biology; it is organization. Every country builds its system of care according to its culture, economy, and priorities. In Japan, where I have spent the past few years, health care feels like an extension of social rhythm: precise, deliberate, quietly humane. In the United States, where I trained, the emphasis is on innovation and specialization, but often at the cost of coordination. Now, as I prepare …
Idaho has become the first state to end Medicaid funding for Applied Behavior Analysis (ABA) therapy. This marks a shift away from concerns about inflated billing and variable outcome metrics toward a model focused on measurable and inclusive care. As a pediatrician who participated in NIMH-RUPP trials and has observed the clinical evolution of ABA, I recognize the significance of Idaho’s decision. The state acted proactively rather than awaiting federal …
He came to my office holding the results of his coronary CT scan. His eyes went immediately to the numbers, his voice tense: “Doctor, my FFR is 0.86. Do I need a stent?”
This is not an unusual question anymore. Coronary CT angiography with fractional flow reserve (FFR-CT) is rapidly becoming a common tool in cardiology. It gives us noninvasive insight into whether a coronary lesion is functionally significant. In plain …
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Health care executive Kimberly Smith discusses her article “Why clinicians must lead health care tech innovation.” Kimberly explains why clinicians, who are on the front lines of patient care, are in the …
For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an advance directive. And he did: It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.
But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, …
You notice them wherever they go. The new titans of industry dressed like college kids on their way to class. Recently, I saw a picture of Jack Dorsey, the founder of Twitter, in a plain cotton T-shirt and nerdy trousers. With his overgrown beard completing the look, he resembled a man emerging from months deep in the jungle after a survivalist contest. Then there is Mark Zuckerberg, perpetually clad in …
During a casual conversation about mental health, a friend admitted something striking: “I stopped going to therapy because I’d leave feeling great, but by the time I actually needed what we talked about, like in the middle of an argument or a panic attack, I couldn’t remember any of it. It felt like throwing money away.”
This confession revealed a silent challenge in mental health care. The issue isn’t finding the …
Most men have heard jokes about finishing too soon, but few talk about it seriously, even when it causes anxiety, frustration, or distance in their relationships. Premature ejaculation (PE) is one of the most common male sexual health concerns, yet it remains buried under stigma and silence.
As a urologist, I often meet men who have struggled quietly for years, wondering whether what they experience is “normal,” if it can be …
Professional medical organizations, such as the American Medical Association (AMA), American Hospital Association (AHA), and American College of Physicians (ACP), do more than set policy. They are custodians of medicine’s ethical core, defenders of science, and guardians of public trust. Yet, at critical moments, these organizations too often fall back on a strategy of silence. That silence is not neutral. It carries real consequences.
Mixed messages, missed voices
Consider a recent example. …
“The most expensive piece of medical equipment is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.” Dr. Atul Gawande, an endocrine surgeon practicing at Brigham’s Women and Children Hospital in Boston, Massachusetts, wrote those words in the June 1, 2009, edition of the New Yorker in an article entitled, “The Cost Conundrum.” In that article, Dr. Gawande compared health care expenditures …
“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.
By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership …
She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …
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Patient advocate and author Irene Tanzman discusses her article “A mother’s question about PCOS and her son’s autism.” Irene shares her personal journey as a mother to a son with severe autism …
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Memory loss is one of the most common and anxiety-provoking complaints in medicine. Over the past five years, the evaluation of cognitive decline has become remarkably refined. No longer is memory loss assessed solely to “rule out dementia.” Today, clinicians have tools to detect the beginnings of Alzheimer’s disease or other neurodegenerative conditions before major symptoms appear, allowing patients to make informed decisions about their work, life, and health.
The first …
We all know high blood pressure and cholesterol can kill, but what about low bone mineral density? Bones are composed of calcium and phosphate, which is their mineral content. Bones low in calcium are said to have low bone mineral density, which can result in a condition known as osteoporosis. Osteoporosis develops over a lifetime and is impacted by your peak bone mass as a youth. Thus, most osteoporotic problems …
We talk about burnout like it’s just being “tired” or “stressed.” However, it is not. It is a fundamental breakdown of the operating system: your brain. I know, because I’ve been there. I was the high-performer, the one who “got things done,” until my executive function packed its bags and left the building. If you’re feeling this way, you’re not weak; your system is simply overloaded. You have entered the …
An excerpt from Wonderful and Broken: The Complex Reality of Primary Care in the United States.
In a health care system full of paradoxes, this is perhaps the most striking. Primary care delivering value-based care is seen by many as the solution for an inefficient, inequitable, and poorly-performing health care system. Yet it is a shocking mess of burnout and depletion. With all the radical intention of Lenin, we must …
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Cardiologist Saurabh Gupta discusses his article “Physicians must lead the vetting of AI.” In this episode, Saurabh explores how artificial intelligence is reshaping medicine and why its future depends on physician leadership, …
In medicine, we are taught to care deeply.
When criticism arrives, whether from a patient, a colleague, an administrator, or an anonymous review, it stings. A lot. The sting usually lasts long after we read the words. It usually leads to rumination, self-doubt, and often even poor sleep, a questioning of our career choice, and our abilities.
Even with years of mindfulness, self-compassion, and coaching, I still feel upset when it happens …
The Kensington community is still reeling after the deaths of Amanda Cahill and Joey Gabor, who both died in custody shortly after being arrested during the area’s controversial narcotics sweeps at the end of 2024. While we don’t know the details behind these deaths, they are alarming and depict the vulnerability of those incarcerated with substance use disorder. We as physicians working to curtail the opioid epidemic must advocate for …
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