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Postdoctoral researcher Wei Zhang discusses the article “Peripheral artery disease prevention: Saving limbs and lives.” Wei explains how peripheral artery disease acts as a silent burden on the “life-highway” vessels of …
Early screening saves limbs from silent vascular disease [PODCAST]
For the past month and maybe longer, I have been waking up with pressure in my chest. It worsened in December and continued to worsen in the new year. I had identified it as anxiety, but felt it was of a different quality than my run-of-the-mill anxiety. This feeling was more anguished.
During the first week of January, I volunteered at a clinic, where I saw patients, assessed, and treated psychiatric …
The “ethical canary”: How moral injury signals systemic failure
Our current scheme and its overbearing credentialism is out of date and cannot keep up with a rapidly changing health care environment. Greater flexibility is needed for the well-being of patients and physicians alike.
Professional burnout and anticipated physician shortages continue to be highly debated topics. Indeed, the American Medical Association reports that 45 percent of physicians have symptoms of burnout, and the Association of American Medical Colleges anticipates a …
Beyond Flexner: Why we must rethink medical training reform
Recently, I was asked to write about my experience as a rural emergency physician in New Mexico. The timing was uncanny: I am in the final shifts of my first job out of my emergency medicine residency on the East Coast, having spent more than four years working in emergency departments across western rural New Mexico, primarily within the Indian Health Service.
Summarizing this experience concisely feels impossible. Every emergency physician …
Rural emergency medicine in New Mexico: a physician’s firsthand account
She did not begin with the abuse; she began with sleep.
“I do not know why the news is bothering me so much,” she said. “I cannot turn it off. I feel on edge all the time.”
She was in her late 50s, successful, articulate, and with no prior trauma history documented in her chart. She insisted she was not “overreacting,” just “sensitive to injustice.” At the time, headlines were saturated with …
Trauma reactivation: Why news headlines trigger past abuse
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Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Why CPT coding ambiguity harms doctors.” Muhamad analyzes the landmark case of United States v. Ron Elfenbein, where …
Ambiguous billing rules threaten every doctor in practice [PODCAST]
Every day, millions of Americans take medications to manage chronic conditions or prevent disease. Prescription drugs are vital tools in modern medicine, but in some circumstances, they can also lead to serious adverse drug interactions, diminished quality of life, and even life-threatening complications.
This is a complex issue with high stakes for patients. Older adults, in particular, are often prescribed multiple drugs by different doctors for different reasons. The Centers for …
Deprescribing in health care: Why less medication can be more
On January 29, 2026, the European Journal of Pediatrics formally retracted what had been the largest randomized clinical trial examining folinic acid as an intervention for autism. The reason, according to the journal’s notice, was direct: The study’s data did not support its published conclusions.
Originally released in 2024, the trial reported that 24 weeks of oral folinic acid therapy produced a “significant reduction” in autism symptoms among 77 children. In …
What the folinic acid retraction means for autism treatment
Value-based care represents one of health care’s most important transformations, driving hospitals and health systems to focus on outcomes that truly matter. To succeed in this model, organizations must track and improve their performance metrics continuously, making data health care’s most valuable currency. It is the foundation for improving patient care, reducing complications, and optimizing resource allocation. Yet despite the growing volume of performance metrics being collected, a critical gap …
Value-based care data gap: Why metrics fail to reach the bedside
As physicians, most of us do not need another Zoom webinar on burnout; we need open space.
Even at the earliest stages of training, we are made to feel that we cannot take a break. In a med school course I teach, I assigned a renewal activity with a short reflection. Some protested, but most expressed gratitude for an assigned pause.
Many admitted how afraid they felt to step away, to take …
The pause medicine never taught us to take
I remember a patient who sat silently, staring at the hospital ceiling. She had survived a sudden illness that left her body weak and her spirit shaken. No tests, medications, or procedures could touch the despair in her eyes. In that moment, I realized something fundamental: The physician’s presence itself can be the most potent form of care.
Medicine, at its best, is more than diagnosis or intervention. It is an …
The healing power of physician presence in modern medicine
Almost every day, a physician says to me some version of the same sentence.
It may sound like frustration about metrics. Or exhaustion. Or administrative opacity. But beneath it is something more elemental:
“I am grieving what I hoped medicine would be.”
When that sentence is spoken plainly, without defensiveness, something shifts.
The suffering moves from defect to meaning.
Grief, in existential thought, is not weakness. It is evidence of attachment. We grieve what we …
How naming grief can restore meaning in medical practice
Robert felt winded climbing stairs. At 76, he attributed his fatigue to age. He thought his heart medications needed adjusting. His cardiologist agreed, tweaking his blood pressure pills. Six months later, Robert collapsed. In the ER, doctors found his heart walls dangerously thickened, stiff as leather.
A simple nuclear scan revealed the truth: transthyretin amyloid cardiomyopathy, or ATTR-CM, a progressive disease where misfolded proteins infiltrate the heart. Had anyone suspected it …
ATTR-CM screening: the missing link in heart failure diagnosis
When I arrived at a regional military hospital, it was not a dispensary or a community clinic. It was the referral hospital for the northern tier missile and bomber bases, positioned just below the major medical centers. We were second tier, but the stakes were global.
Into that setting, I brought the medical home and a mini-developmental clinic. Through a program for exceptional family members, families from around the world found …
The honest broker in pediatrics: Building the medical home
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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article “Why doctors must stop waiting and reclaim their lives.” Jessie explains how medical training conditions doctors to view endurance as a virtue …
Waiting for the system to change causes burnout [PODCAST]
Every major policy in medicine is supposed to rest on evidence. We track outcomes for new drugs, devices, and procedures. We measure hospital mortality, infection rates, and adherence to guidelines. Yet one of the most time-consuming and expensive physician policies of all, Maintenance of Certification (MOC), has never been held to that same standard.
For decades, the American Board of Internal Medicine (ABIM) and other specialty boards have argued that recertification …
MOC patient outcomes: Why recertification doesn’t guarantee quality
At 62, I unwittingly became a cliché: the physician who makes a poor patient.
The hard lump in my right breast, directly inferior to the nipple at the 6 o’clock position, shocked and shook me in the middle of a long August night when it first poked me as I tossed and turned my way through a bout of insomnia.
A screening mammogram for September 12 had been on my calendar for …
When the doctor becomes the patient: a breast cancer journey
Sarah, a new attending, has been asked to work with June, a PGY-1 resident who has struggled with new admissions.
On rounds, June recommends a urinalysis for a patient with advanced dementia and new agitation.
“Why a UA?” Sarah asks.
“Behavior changes can indicate a urinary tract infection in older adults,” June replies, confident and fluent.
Inside, Sarah splits. She wants to teach, to pause, invite uncertainty, and help June reason through delirium and …
Why medical education assessment kills curiosity in residents
In medical school, I’ve been taught to take chest pain seriously. If a patient presents with angina, there are clear guidelines, robust evidence, and standardized protocols to follow. Yet, when a patient comes into the clinic describing mood swings, fatigue, or pain tied to their menstrual cycle, the responses of clinicians are often vague, stating, “That’s normal.” Behind that simple phrase lies decades of neglect in how we study, fund, …
Menstrual health in medicine: Addressing the gender gap in care
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Physician, author, and health care reform advocate David K. Cundiff discusses his article “Accountable care cooperatives: a community-owned health care fix.” David outlines a transformative plan to replace the fragmented U.S. insurance …
Community ownership transforms the broken health care system [PODCAST]
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