The collapse of developmental pediatrics

Physician
November 7, 2025

The terrain I refused to leave

At Madigan Army Medical Center, I built a diagnostic model that delivered autism answers in under 30 minutes. No shortcuts, just smarter care. A Ph.D. pediatric nurse practitioner performed triage. I conducted the Screening Tool for Autism in Toddlers (STAT-MD), a targeted autism screening protocol developed at Vanderbilt, confirmed criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and families left …

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Why the U.K. junior doctor strike matters

Physician
November 7, 2025

In mid-November, thousands of junior doctors in Britain will again step away from their posts. Not for comfort. Not for gain. For something harder to name.

They have been praised as heroes and treated as expendable, thanked in speeches while their pay erodes and their patience thins. I heard one young doctor say she still loves medicine, but cannot serve a system that sees her as replaceable. She stayed through staff …

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How to adopt AI in health care responsibly

Tech
November 7, 2025

To give you an idea of how rapidly AI adoption has occurred, I recently reviewed the minutes of a company leadership meeting from last year. The topic of AI was almost entirely absent, receiving only minimal discussion. Compare that activity to today, where we’ve developed dozens of applications that actively utilize some form of AI, and hold daily meetings where it is the sole topic of discussion.

If your organization’s experience …

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Why physicians must not suffer in silence [PODCAST]

Podcast
November 6, 2025
YouTube video

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Neurologist Scott Abramson discusses his article “Why ‘the best physicians’ risk burnout and isolation.” In this YouTube-optimized episode, Scott reflects on the ancient Talmudic teaching that warns how pride and perfectionism can …

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Is Lp(a) testing the new messiah?

Conditions
November 6, 2025

I just read yet another article praising the new messiah of cardiology (Lipoprotein(a)) and urging every physician in America to start testing for it. The tone was familiar: solemn, scientific, and a little evangelical.

The message? “Measure Lp(a) once in every patient.”

The subtext? “Because we finally found the missing piece.”

If this feels like déjà vu, that’s because it is. We’ve been here before: first with total cholesterol, then LDL, then HDL …

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Is it time for the VA to embrace virtual care?

Tech
November 6, 2025

Is it time for the Department of Veterans Affairs (VA) to fully embrace virtual care?

The VA has long been one of America’s great health care innovators. From pioneering electronic health records to building one of the first truly integrated care systems, the VA has often been decades ahead of the private sector.

But today, the system is straining. Nearly 94 percent of VA facilities face physician shortages, and 79 …

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Pharmacy benefit manager reform vs. direct drug plans

Meds
November 6, 2025

Much has been made of the move by President Donald Trump and the pharmaceutical industry to offer direct-purchase drug programs at heavily discounted rates. Following the announcement of these new programs and TrumpRx, we’ve heard news and opinion pieces from every major outlet, but missing in the conversation is one of the most important voices: the patient. Key questions remained unanswered:

“What does this mean for my care?”

“Does this work with …

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The psychological trauma of polarization

Physician
November 6, 2025

The human psyche is built for connection. Our evolutionary history, our families, and our communities shape us to seek cooperation, mutual respect, and shared purpose. We are, by design, social beings whose sense of safety depends on trust and belonging.

When that natural orientation toward unity is fractured; when instead we encounter hostility, harsh language, or dehumanization, it cuts against the grain of who we are. What might once have been …

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Quality metrics in medicine vs. patient trust

Physician
November 6, 2025

The woman sits across from me, hands folded around a list of her medications.

We review the cholesterol guidelines. I explain the evidence. She listens carefully, then says, almost apologetically, “Doctor, I know what the data says. I just don’t want to take another pill.”

There is no anger in her voice, only fatigue, the quiet exhaustion of someone who has lived long enough to know her own limits.

I pause, because this …

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My journey to a type 1 diabetes diagnosis

Conditions
November 6, 2025

I was diagnosed with type 1 diabetes mellitus in February 2024. Now it all made sense.

It all started in October 2020 when I passed out cold. I was rushed to the emergency room and 3 days later woke up to find I had a thyroid issue and lost 2 pints of blood. Four days later, after a blood transfusion, I was sent home. At that point, I thought I was …

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Understanding post-vaccination syndrome in real-world medicine [PODCAST]

Podcast
November 5, 2025
YouTube video

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Internal medicine physician Harry Oken discusses his article “mRNA post vaccination syndrome: Is it real?” In this episode, Harry explores the science, uncertainty, and human stories surrounding post-vaccination syndrome (PVS) linked to …

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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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