Why DPC market-model fit matters most

Physician
November 5, 2025

In my previous article, I examined why direct primary care (DPC) practices fail, focusing on financial modeling, compliance risks, and the gap between what’s legal and what’s sustainable. But there’s a more fundamental issue that precedes all of those concerns: market-model fit.

The direct primary care community loves to debate panel size, membership pricing, and model purity. We dissect what went wrong when practices fail. We blame insufficient commitment, poor …

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The quiet will of a healer

Physician
November 5, 2025

As physicians, we are trained to balance truth with compassion, and science with empathy. It’s a delicate balance and an uncertain path. Medicine requires both strength and vulnerability because navigating this balance can leave ambiguity as to whether the healer’s words heal as much as intended. These moments also reveal the tension between knowledge, ethics, and emotion, a struggle between the imperative to speak to fact and the human need …

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Clear communication is kind patient care

Physician
November 5, 2025

I walked into the exam room to meet with a woman recently diagnosed with breast cancer. She had undergone a PET CT scan to evaluate for the extent of her disease. She sat on the exam table, clearly very anxious and upset. She told me that she had been up most of the night with her PET scan report, Googling about different organs and language that she did not understand. …

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Helping children overcome anxiety [PODCAST]

Podcast
November 4, 2025
YouTube video

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Physician executive Mona Potter discusses her article “When anxiety runs the show: How medication can help kids thrive.” In this episode, Mona explores how clinical anxiety differs from everyday worry, why it …

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Can flu shots prevent heart attacks?

Conditions
November 4, 2025

As an internist and lipidologist, I’ve spent decades parsing data on statins, ezetimibe, PCSK9 inhibitors, and the endless parade of “LDL-lowering breakthroughs.” Yet the most potent, and perhaps the most underappreciated, intervention to prevent heart attacks each winter doesn’t come from a cardiology journal or a pharmaceutical rep. It comes from your local pharmacy fridge. For years, I’ve told my patients that getting a flu shot may prevent a heart …

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The hidden cardiovascular cost of alcohol

Conditions
November 4, 2025

A glass of wine with dinner. A cocktail on a Friday evening. A few beers over the weekend. For many of my patients, alcohol is woven seamlessly into daily life: a social lubricant, a way to unwind, even something they’ve been told might be “heart-healthy.”

Yet, in my clinic, I see the other side. A patient who comes in with fluctuating blood pressure, convinced their readings must be wrong. Another who …

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A cautionary tale about pramipexole

Meds
November 4, 2025

I never thought I’d be the cautionary tale.

For decades, I worked at a financial company. I’m a youth sports coach, a husband, and a father of two. I’ve spent decades coaching, mentoring players, and proudly producing high school sports telecasts. I built a life around leadership, precision, and community.

But none of that prepared me for what happened when I was prescribed pramipexole (Mirapex) to treat Parkinson’s.

The warnings were there: compulsive …

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What is professional inertia in medicine?

Physician
November 4, 2025

I learned that in a rural exam room where four agencies circled a child with autism; and no one moved. Not the nurse. Not the case manager. Not the system. The child failed the Autism Screening Test. He was nonverbal, avoided eye contact, even with his parents, and flapped his hands while playing with toys in unusual ways. The signs were classic. The diagnosis was clear. I spoke the “A” …

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How misinformation endangers our progress against preventable diseases [PODCAST]

Podcast
November 3, 2025
YouTube video

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Emergency physician Drew Remignanti discusses his article “A world without vaccines: What history teaches us about public health.” In this conversation, Drew reflects on historical lessons from smallpox, polio, and measles to …

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The rise of digital therapeutics in medicine

Physician
November 3, 2025

Most people now manage pieces of their health on a phone, from steps to sleep to blood pressure cuffs that talk to the cloud. Digital therapeutics go a step further. They are not wellness trackers or meditation apps. They are medical treatments delivered by software, built on clinical evidence, cleared by regulators, and prescribed or recommended by clinicians to prevent, manage, or treat a diagnosis. That is the core idea, …

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Lipoprotein(a): the hidden cardiovascular risk factor

Conditions
November 3, 2025

Lipoprotein(a) [Lp(a)] was, until recently, an underrecognized cardiovascular risk factor. However, extensive research over the last 15 years (including vast genome-wide association studies) has confirmed an independent, causal link between elevated lipoprotein(a) levels and atherosclerotic cardiovascular disease (ASCVD). The science has shown that, despite their small size, Lp(a) particles can have a substantial health impact, and as many as one in every five individuals worldwide has elevated levels (defined as …

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Systematic neglect of mental health

Tech
November 3, 2025

For the third time in six weeks, a 34-year-old woman sat in an emergency room, desperate for help, and for the third time, the system failed to see her. It saw her dehydration, severe enough to require IV fluids. It saw her malnutrition, with electrolyte imbalances that required correction. It saw her vision problems, concerning enough for an ophthalmologic consultation. It saw everything except the person suffering. Each time, the …

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What teen girls ask chatbots in secret

Conditions
November 3, 2025

Teen girls are turning to chatbots, not for homework help, but for the questions they’re too afraid to ask anyone else. Not their parents. Not their teachers. Sometimes not even their closest friends. Instead, they whisper their fears into an empty chat box late at night, hoping the words land softly somewhere.

These aren’t silly or shallow questions. They’re small windows into a generation growing up online, trying to feel safe …

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Paraphimosis and diabetes: the hidden link

Physician
November 3, 2025

Paraphimosis is a urological emergency characterized by the inability to reduce a retracted foreskin over the glans penis, leading to vascular congestion, edema, and potential tissue necrosis. While paraphimosis can result from local trauma, poor hygiene, or iatrogenic causes, it is increasingly recognized as a clinical manifestation associated with underlying systemic disease, particularly diabetes mellitus.

Diabetes mellitus, especially when undiagnosed or poorly controlled, exerts profound effects on local tissue immunity, wound …

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Silicon Valley’s primary care doctor shortage

Physician
November 3, 2025

Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left a leading integrated health plan after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in an affluent U.S. region: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor.

I saw this …

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Why women in medicine need to lift each other up [PODCAST]

Podcast
November 2, 2025
YouTube video

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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article, “Why don’t women in medicine support each other?” She explores how scarcity, competition, and cultural conditioning have discouraged women physicians from advocating …

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The problem with laboratory reference ranges

Conditions
November 2, 2025

Tonight, my lab quietly changed what it considers a “normal” ApoB. On Monday, my patient’s ApoB of 98 mg/dL was comfortably green. On Tuesday, that same number was flagged high, a 30-point swing in the normal range overnight. No new evidence. No new trial. No public health crisis. Just a reference-range recalibration. And with that one quiet adjustment, millions of people who went to bed “normal” may wake up “abnormal.”

Reference …

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My persistent adverse reaction to an SSRI

Meds
November 2, 2025

Two years ago, I took a single 20 mg dose of escitalopram. Like millions of others, I was prescribed this antidepressant with the expectation that it would help, or at worst, have mild side effects that would pass. Instead, I experienced an immediate and severe adverse reaction. What I could not have imagined then was that the symptoms would not resolve; they have persisted and, over time, have only worsened.

Since …

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Why carrier screening results are complex

Conditions
November 2, 2025

Carrier screening has outgrown the language we still use to explain it. The rapid expansion of genetic testing has uncovered new layers of complexity in how conditions present, how results should be interpreted, and how patients experience and act on genetic information. To practice responsibly in this era of Genetic Carrier Screening 3.0, clinicians must understand not only what we are testing for, but how and why the results look …

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