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Internal medicine physician Earl Stewart, Jr. discusses his article “Pancreatic cancer racial disparities.” Earl examines the devastating pattern of pancreatic cancer claiming Black cultural icons like John Lewis and Aretha Franklin while …
Once a year,
I return to two quiet organs
I once carried without thought,
working faithfully in the dark,
asking for nothing,
until one day they asked to be seen.
Cysts.
Small moons of fluid,
bubbles scattered like careless stars
throughout the geography of me.
Harmless, they said.
Mostly.
Until one was not.
That year,
a word entered my body:
cancer.
A word that knows how to make itself at home
in every corner of thought.
A specialist explained
how light and force could be aimed,
how the invader could …
I’ve spent more than 30 years in nursing, and in recent years my work has shifted to something most people never think about: clinical data abstraction. My job is to review the medical record and extract the pieces of information that clinical registries rely on for research, quality reporting, regulatory requirements, and everyday decision-making. It’s specialized work that depends on clinical judgment, a deep understanding of clinical documentation in the …
Most physicians begin their careers with a deeply held belief: If treatment is good, patients will come. It feels intuitively correct, and early in practice it often appears to be true. Clinical outcomes build trust, trust brings patients, and for a time the system seems to sustain itself. Yet after years of working inside physician-owned hospitals, group practices, and large corporate health systems, I have learned an uncomfortable truth. Good …
The emergency department didn’t suddenly get worse.
The numbers did.
Every shift, emergency clinicians are measured by dashboards that insist on telling a familiar story: Door-to-provider times are too long, length of stay is unacceptable, left-without-being-seen rates are creeping up. The implication is clear. We’re slow. We’re inefficient. We’re failing.
But those numbers are no longer describing clinical performance. They’re describing system saturation.
Emergency departments today operate in conditions that were once considered temporary …
Hashimoto’s disease is the most common cause of hypothyroidism in children and adolescents, yet it remains frequently overlooked, particularly in adolescent girls. Fatigue, mood changes, weight gain, and cognitive slowing are often attributed to mental health conditions or dismissed as normal features of puberty, delaying diagnosis and treatment. This pattern reflects a broader failure to recognize how autoimmune thyroid disease presents during adolescence, and how gendered assumptions shape clinical interpretation …
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Health care attorney Dennis Hursh discusses his article “wRVU threshold risks in physician contracts.” Dennis explains the critical distinction between a guaranteed salary and a draw against future earnings where failure to …
In medicine, we are trained to lead with logic. To analyze, evaluate, and act. We are praised for decisive thinking, efficiency, and evidence-based decisions. In the hardest moments of my life, career, and leadership, none of those tools brought me clarity.
Ten years ago, as a practicing pediatrician and physician leader, my personal life began to fall apart. My husband, who had always been steady and supportive, began to slide into …
“I’m surprised I haven’t had a kidney stone.”
It’s a running joke among my co-residents, when it’s 3 o’clock in the morning, with over 20 patients in the waiting room, and nobody can remember the last time they had water. Most days, my fluid intake is limited to the sips needed to swallow my antidepressants (to quote my parents, “you can’t just take them whenever you feel sad,” and “it’s not …
A man in his late 40s sits down in my office and says, “Doctor, I think my testosterone is low.”
Sometimes he is already holding lab results. Sometimes he is coming from a gym forum, a friend’s recommendation, or a late-night Google search. But almost always, the story sounds familiar: lower sex drive, fewer morning erections, weaker erections, fatigue, brain fog, mood changes, and that stubborn belly fat that seems to …
“Can AI scale in medicine?” is the wrong question.
The real question is: Can AI protect the soul of medicine while people who have never sat with our patients decide their fate?
The ADVOCATE program: an overview
The Trump administration recently launched the ADVOCATE program: Agentic AI-Enabled Cardiovascular Care Transformation. Run by ARPA-H, this initiative aims to build and deploy autonomous “clinical AI agents” for cardiovascular disease, with an FDA authorization pathway of …
Most clinicians know that eggs age. Fewer acknowledge that the uterus ages too.
In reproductive medicine, we often rely on the seed-and-soil analogy. The seed is the embryo. The soil is the endometrium, the inner lining of the uterus where implantation occurs.
Here is the part that deserves more explicit counseling and strategic planning: Even when embryo quality is controlled, uterine age can independently influence implantation, miscarriage risk, and live birth rates. …
Patient frustration is something many of us carry home at the end of the day. Much of that frustration, however, isn’t personal; it’s structural.
Many patients don’t realize that different primary care models are designed to deliver fundamentally different experiences. They expect concierge-level access and time within insurance-based practices. They want same-day appointments, unhurried visits, and immediate physician availability, regardless of the model they’re in. And when we can’t deliver what …
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I learned medicine in hallways, in the classroom, and outside.
I learned how to apologize to a patient by watching my attending pull up a chair and say, “I should have done better.” I learned how teams actually work by overhearing tense but respectful disagreements during sign-out. I learned what it meant to belong by being given responsibility before I felt ready. None of those lessons happened on Zoom or Teams.
In …
Across my career, including as CMIO of Kaiser Permanente’s Colorado medical group, I’ve had a front-row seat to how remote care and technology are reshaping clinical practice. I’ve also watched many colleagues make the shift to telehealth positions seeking flexibility and an escape from hospital and clinic burnout. These siloed jobs often lead to a different kind of burnout because they can be isolating, rote, and disconnected from actual systems …
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Internal medicine and functional medicine physician Shiv K. Goel discusses his article “Mind-body connection in chronic disease: Why traditional medicine falls short.” Shiv explores the limitations of conventional medical models that focus …
My great-grandfather was a small-town doctor in the early 1900s.
It was a different time. A different place. A very different pace.
He knew his patients. He knew their families. He understood their lives, not just their symptoms. Care happened in the context of relationship because that was simply how medicine worked.
Today, health care looks very different. The science is better. The technology is stronger. We can do things now that would …
The number was specific: 18,000 steps.
It came from a retired hospital director in Taipei, a physician-administrator who spent four decades building services, negotiating budgets, and managing crises across a health care system that now treats an aging society as its primary patient.
Most physicians retire into silence. He retired into data.
But the more interesting revelation did not come from his smartwatch. It came from the dinner table.
A shift in governance
In Western …
As a psychiatrist, I increasingly meet patients who come in convinced they have attention-deficit/hyperactivity disorder (ADHD). They arrive prepared: an online screening test, a list of symptoms (poor concentration, low motivation, distractibility) and often a quiet sense of relief at finally having an explanation. Then I do what physicians are trained to do. I take a careful history. I review medications. I ask about sleep, mood, anxiety, substance use, and …
The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …
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