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Triple board-certified physician in adult and geriatric psychiatry and addiction medicine, and the founder of The Aging Parent Coach Barbara Sparacino discusses her article “Why caring for a parent is hard for …
Medical expertise does not prevent caregiving grief [PODCAST]
During my pediatrics rotation in my third year of medical school, the most important skill I learned was how to listen more carefully.
Children rarely have the language or power to fully articulate their needs. They are forced to rely on adults, systems, and institutions to advocate on their behalf. In pediatrics, that responsibility is not an abstract idea. It shows up in exam rooms where parents must choose to pay …
Why AAP funding cuts threaten the future of pediatric health care
A patient stopped me in the hallway recently, not in an exam room, not seated, not “ready” for a clinical conversation. Just a human being catching me between visits and asking a question that felt heavier than any lab result:
“Doc, is this finally the thing that will work? Or is it just another trap?”
That question is the GLP-1 era in one sentence. And with the launch of oral Wegovy, it …
Oral Wegovy: the miracle and the mess of the new GLP-1 pill
We owe patients a better explanation about food.
The food didn’t change. The world did, and our guidelines followed.
For many patients, dietary advice feels less like science and more like whiplash.
Their breakfast looks the same. Their milk is the same. Their daily habits are exactly where they left them. What shifts, sometimes violently, is the label we attach to it: healthy, unhealthy, recommended, discouraged.
Consider milk
For decades, we told patients to switch …
Why dietary advice changes: It is not the food, it is the world
Few things scare parents faster than seeing blood where it doesn’t belong.
Maybe your child took a hard fall off a bike. Maybe there was a rough sports collision. Maybe it was a car accident, and everyone is still shaking. Then a nurse asks for a urine sample, or your child goes to the bathroom and you notice pink or red in the toilet.
Your mind immediately goes to the worst place.
As …
Blood in urine after a child’s injury: When to worry
An excerpt from On All Sides of the Bed: One physician’s/CEO’s journey.
In the early summer of 2013, our hospital collided with a Black Swan.
Before Europeans discovered Australia, they were familiar only with white swans. The discovery of black swans overturned a long-held assumption. In business and risk theory, a “Black Swan” refers to a rare, unpredictable event with massive consequences, a concept popularized by Nassim Nicholas Taleb. For us, …
Managing a Black Swan in health care: a lesson in transparency
Human rights are understood to be universal and egalitarian. They are inalienable, indivisible, and grounded in a shared moral intuition: that human dignity deserves protection. One of the most widely accepted expressions of that intuition is the obligation to care for those who are physically or emotionally ill. Yet despite this near-universal belief, modern health care systems continue to struggle with a fundamental question: Is health care a human right, …
Health care as a human right vs. commodity: Resolving the paradox
Voicemail has quietly become one of the most fragile points in outpatient care, not because clinicians or staff are failing, but because the system itself no longer fits the reality of modern health care.
Every day, patients call clinics with legitimate needs: appointment requests, medication questions, post-procedure concerns, insurance clarifications. When no one answers, they are routed to voicemail and asked to leave a message. From that moment on, the system …
Why voicemail in outpatient care is failing patients and staff
For those who know me personally, you know that I have vitiligo. Vitiligo is an autoimmune disease affecting the skin, where there are patches of depigmentation (the skin appears white or pink). It is sometimes associated with other medical conditions.
I met someone recently and they said that they were curious about my skin. I am used to looks or questions and am happy to educate people about vitiligo, so I …
Living with vitiligo: Overcoming shame and control
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Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “How deprescribing in psychiatry offers a path to safer care.” Muhamad explores the growing movement to reduce unnecessary …
Stopping medication requires as much skill as starting it [PODCAST]
Conventionally, medical malpractice is argued using inductive reasoning. There is nothing wrong with inductive reasoning. It is a component of critical thinking. However, it is just a component. Inductive reasoning is more subjective than objective and the influences of selection bias, avoidance bias, and confirmation bias are undetectable.
Deductive reasoning is also a component of critical thinking. It is not immune from these same biases; however, deductive reasoning is more robust …
Deductive reasoning in medical malpractice: a quantitative approach
I am not a doctor. I am a software developer who taught herself mobile development while working full-time and raising two kids. But I built a clinical simulation app used by medical students, and here is how I made sure it is actually clinically sound.
The credibility problem
When you don’t have an MD, you can’t rely on intuition or clinical experience. Every design decision has to be defensible, referenced, and auditable. …
Building a clinical simulation app without an MD: a developer’s guide
When clinicians think about stroke recovery, attention often focuses on motor deficits, speech impairment, and the risk of recurrent cerebrovascular events. Cognitive outcomes, however, are frequently treated as secondary or inevitable consequences rather than primary targets of intervention. This oversight carries consequences. Post-stroke cognitive impairment (PSCI) is common, persistent, and one of the strongest predictors of long-term disability, institutionalization, and caregiver burden, yet it remains under-recognized in routine care.
As acute …
Post-stroke cognitive impairment: the hidden challenge of recovery
The years pass without ceremony.
They do not always announce themselves.
Sometimes they slip by like quiet weather,
like afternoons we cannot later recall
except by the way the light
once rested against a wall.
Time moves like autumn wind,
unannounced,
persistent,
tender in its own indifferent way.
A milkweed stands in a field,
having grown tall without noticing
the exact moment it became mature.
Its green has deepened,
its stem stiffened with understanding.
Now the wind arrives,
and the pods open
not in grief,
but in readiness.
Each …
The milkweed and the wind: a poem on aging as renewal
“I don’t know” may be one of the most difficult phrases to both hear and admit. As a patient, fewer words can make you more anxious, and as a health care provider, fewer words can make you feel more powerless. As a whole, the medical community has fostered and embraced a culture of certainty, discouraging the phrase “I don’t know” because of the helplessness it can instill in patients and …
The cost of certainty in modern medicine
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Palliative care physician and certified physician development coach Christie Mulholland discusses her article “5 things health care must stop doing to improve physician well-being.” Christie challenges the pervasive narrative that younger physicians …
Blaming younger doctors for setting boundaries ignores the broken system [PODCAST]
During the COVID-19 pandemic, conversations about burnout and stress exploded, particularly among health care workers. Much of the advice centered on self-care practices: taking time off, scheduling massages and spa days, practicing mindfulness, protecting your evenings, using your PTO. While these strategies are valuable, they are not the full story.
Positioning self-care as the solution to stress oversimplifies a much deeper physiological process. For many patients (and clinicians) stress is not …
Nervous system dysregulation vs. stress: Why “just relaxing” doesn’t work
Based on our combined experience of over 70 years in patient advocacy, pain management, and behavioral neurology, we are convinced that U.S. public perception and public policy on treatment of pain have been driven almost entirely by sociopolitical and legal factors. Seldom in recent years has policy been significantly influenced by science.
The U.S. enjoyed a brief period of scientifically enlightened policy in the late 1990s through 2008. A large number …
U.S. opioid policy history: How politics replaced science in pain care
Emergency medicine trains clinicians to recognize patterns early, anticipate deterioration, and intervene before outcomes become irreversible. We pride ourselves on seeing what others miss. Yet we are repeatedly instructed, explicitly or implicitly, to ignore the largest pattern of all. Political decisions consistently and predictably shape who arrives in our emergency departments, how sick they are, and how unsafe the environment becomes for the people expected to care for them.
If political …
Alex Pretti’s death: Why politics belongs in emergency medicine
In recent years, medicine has become more open about burnout, workforce shortages, and the challenges facing women in health care leadership. We write about mentorship programs, leadership pipelines, and the need to bring more women into ownership and executive roles. We celebrate women who build clinics, lead departments, and create space for others to rise.
What we talk about far less is what happens when women actually meet each other in …
Women in health care leadership: Navigating competition and mentorship
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