My wife is dying.
The day has yet to be determined, but the causes are certain. Stage 4 metastatic pancreatic and liver cancers will allow her a few weeks more in which to say goodbye to a large circle of family and friends. She has decided not to undergo chemotherapy or radiation that at best might extend her life by a few weeks, at the cost of the quality of whatever …
Lessons from 47 years: long-term marriage and palliative care
Imagine a world-class anesthesiologist at a major hospital in Manhattan. She is fully credentialed, board-certified, and has been saving lives at that facility for 5 years. On her day off, she wants to pick up an extra shift at a surgery center 3 blocks away that is currently short-staffed and desperate for help. Logic says she should be able to walk in, show her “Ready-to-Work” status, and start. Instead, she …
Health care credentialing is broken: How to fix the staffing crisis
A pharmaceutical representative recently brought lunch to my office to present a new drug. The drug may help some patients. The food was abundant. The room was full, with excess all around, including leftovers that were eventually thrown away. None of that is unusual in American medicine.
What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the …
Why I stopped accepting pharmaceutical-sponsored lunches
The repeal of the “X-waiver” in the Consolidated Appropriations Act of 2023 was widely celebrated as a long-overdue step toward expanding access to buprenorphine for opioid use disorder (OUD). By removing the requirement for supplemental training and a special DEA designation, policymakers hoped to normalize treatment and reduce barriers for clinicians.
Yet nearly two years after, buprenorphine prescribing remains inconsistent across the country. Only one in four Americans …
Why buprenorphine prescribing still lags after the X-waiver repeal
“Why are you studying that? Philosophy won’t help you save lives.” If I had a dime for every time someone said this to me, I could single-handedly fund an entire class’s medical school tuition. Being a pre-medical student who majored in philosophy feels like being the only person asking “why” in a room full of people asking “how.” I have thought to myself many times that there is no balance …
Philosophy in medicine: Why doctors need to ask “why”
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Internal medicine physician Corinne Sundar Rao discusses her article “Physician on-call compensation: the unpaid labor driving burnout.” Corinne argues that the term “call” is a euphemism used to extract free labor from …
Unpaid on-call shifts are driving doctors into early retirement [PODCAST]
I first learned to respect silence over a chessboard. Two players sit across from one another, the clock ticking audibly, 64 squares holding more possibility than certainty. You arrive, survey the position, and wait. You gather information, recall principles, recognize patterns, and only then commit, knowing that every decision constrains the future in ways you cannot fully predict.
Now, as a third-year medical student on clinical rotations, I find myself standing …
What chess taught me about clinical reasoning and humanism
I never imagined that providing standard, evidence-based medical care, and explaining that care clearly to patients, could put me at risk of federal prosecution.
Yet that is the position I find myself in today.
I am a board-certified family medicine physician and the founder of a small queer- and trans-owned clinic providing gender affirming care. Our clinic is now at the center of a Department of Justice appeal after we Read more…
Physician free speech rights under fire: the DOJ vs. patient education
He came in wanting to get his smile back. I did not know he was also asking for his life.
He sat down in my chair and did not say much at first.
That happens a lot in a MassHealth practice in Massachusetts. People come in with more than just one problem. They carry shame, years of avoiding problems, and a lifetime of being told by systems, situations, and sometimes even their …
Treating methamphetamine-associated dental disease in safety-net clinics
In my first week of anesthesiology residency at the Hospital of the University of Pennsylvania, I learned two things at once: how to keep other people breathing and how it feels to lose your own air. My chest filled with liters of lymphatic fluid. A scan showed lungs that looked like lace. The diagnosis was LAM, lymphangioleiomyomatosis, a rare, estrogen-sensitive lung disease that overwhelmingly strikes women in their reproductive years.
At …
Reproductive care for rare diseases: the missing playbook
“Overdiagnosis is a myth that has been created by a handful of individuals who provide no care for women with breast cancer.”
This quote by Dr. Daniel Kopans encapsulates a long-standing and intense debate in the medical community regarding cancer screening.
In the Dec. 9, 2025, issue of the New York Times, Gina Kolata quoted H. Gilbert Welch, MD, on his perspective that “treatments need to be balanced with the consequences …
The myth of cancer overdiagnosis: Why screening saves lives
Medical innovation is often framed as something that begins once a product is built, tested, funded, and approved. But anyone who has spent time in medicine or biomedical research knows that is the farthest thing from the truth. Innovation usually starts much earlier with a moment of frustration, a recurring inefficiency, or a quiet realization that something in patient care could work better.
What’s less clear is how we’re supposed to …
Early-stage medical device innovation: How to discuss untested ideas
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Family physician and health benefits advisor Jonathan Bushman discusses his article “The 5 percent problem: the low value of primary care.” Jonathan contrasts the grueling decade of training and massive debt required …
Primary care receives only five cents of every health care dollar [PODCAST]
Across the United States, rural maternity care is in crisis. Hospitals continue to close labor and delivery units, entire counties are left without obstetric services, and pregnant patients are forced to travel hours for routine care or delivery. These closures are often framed as inevitable, driven by low volume, unsustainable costs, and staffing shortages, but this narrative ignores both the root causes of the problem and the solutions already within …
Rural maternity care in crisis: 5 solutions to save local OB units
I’m Tommy. Bipolar type one, I’m told. I actually have something to say, something to share.
The thing no one talks about in mental health, bipolar type one specifically, is how seductive and sweet the upswing feels. It’s deeply more than just “good” to me. It feels like the limits of the brain have been cut loose, severed, done away with. Suddenly all those moments and ideas and thoughts and connections …
Bipolar I and the illusion of insight: a firsthand account
Once upon a time, clinicians didn’t have enough data about their patients.
To put it mildly, things have changed. Today we’re drowning in data. As a practicing emergency physician, it is a reality I see every day.
In an emergency department (ED) environment characterized by constant time pressure, staffing constraints, and high patient acuity, clinicians sometimes must wade through reams of electronic health records (EHR) data to find critical patient information that …
AI in health care data management: Curing the EHR overload
I have spent my career believing in systems. As physicians, we are trained to trust oversight. We are taught that regulatory bodies exist to protect patients, maintain standards, and intervene when care falls below acceptable levels. We are taught that if we act ethically, document carefully, and prioritize patients, the system will ultimately be fair. What we are not trained for is what happens when that power becomes opaque.
Over the …
The hidden toll of physician regulatory investigations
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Family physician Travis Walker discusses his article “A physician father on the Dobbs decision and reproductive rights.” Travis reflects on the glaring double standard facing his daughter compared to his sons in …
Physician father wrestles with daughter’s post-Dobbs future [PODCAST]
If you are frustrated by your high tax bill, you are not alone. I have spoken with many doctors who experience sticker shock when they see their total annual tax liability after completing residency. Stories in the media, such as The Atlantic’s recent study on billionaire taxes, about how rich people avoid taxes only fan the flames. It is no surprise, then, that one of the most common financial …
Physician tax strategies: Why your tax bill is so high and how to fix it
The attending scrolls through the chart before morning rounds. The progress note is polished. The assessment is structured. The differential is surprisingly thorough. A predictive model flags the patient as high risk for deterioration within 24 hours. He did not write most of it.
An AI assistant drafted the note. A risk algorithm generated the alert. A decision-support tool suggested broadening the workup. He reviewed it. He agreed with most of …
AI in clinical documentation: Who is liable for medical errors?
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