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Women doctors joke about being cursed with every complication, but what if the job itself is quietly damaging their health? Jessie Mahoney, a pediatrician and certified coach, returns to share her own story …
Why women doctors get sick and blame themselves for it [PODCAST]
When I served as chair of the Board of Registration for Physician Assistants in Massachusetts, every decision carried a weight that extended far beyond the immediate case in front of us. Whether we were reviewing a licensing violation, addressing unprofessional conduct, or weighing in on a practice standard, we were always, whether we named it or not, making decisions about what kind of profession we wanted PA practice to be …
What generative AI in health care makes newly possible
A colleague recently recommended licensed clinical social worker Terri Cole’s book Too Much after seeing a quote I shared on social media about no longer accommodating people who refuse to take responsibility for their own emotional work. Her timing was remarkable.
As I read, I felt as though Cole had somehow studied the way I lived for much of my life. I recognized the constant monitoring of other people’s emotions, …
High-functioning codependency is quietly draining doctors
Most independent practices renew payer contracts the same way they sign them: the renewal letter arrives, the practice manager forwards it to the physician owner, and either someone signs it or no one does. The contracts that escape renegotiation for three or four cycles are the ones quietly anchoring 20 to 35 percent of commercial volume at fee schedules that lag the practice’s best contract by 15 to 25 percent.
The …
Run a payer panel audit before renewal season
Recently, controversy emerged at the American Diabetes Association (ADA) annual meeting after several researchers were removed for distributing copies of an editorial concerning proposed federal funding cuts to biomedical research. The incident generated debate across the medical community. Some viewed the removal as an appropriate enforcement of conference policies and codes of conduct. Others questioned whether restricting the distribution of scientific perspectives at a professional meeting risks undermining the very …
Why scientific dissent is a test of institutional trust
“Have you seen The Pitt?”
This question has become commonplace; patients want to know if it is realistic, colleagues want to compare reactions, and many of us find ourselves dissecting the commentary on an imperfect health care system captured in weekly, one-hour installments that mirror physicians’ everyday reality.
The show does many things well: It is medically accurate, faithfully depicts interdisciplinary teamwork, and reveals the humanity and vulnerability of health care workers. …
Physician moral injury, not burnout, is the real wound
For decades, the digital rectal exam (DRE), the traditional “finger test,” has been a routine component of prostate screening. It is quick, inexpensive, and engrained in medical culture. But the question is no longer whether we can do it. It is whether we should. With PSA testing, advanced imaging, and refined risk stratification, routine DRE in asymptomatic men is increasingly indefensible.
Low sensitivity and limited value
Recent studies show that DRE has …
Why the digital rectal exam fails prostate cancer screening
Needle exchange programs are one of the most well-known, and subsequently most controversial, forms of harm reduction in addiction medicine. These programs provide clean needles and/or syringes for drug users, often in exchange for used needles, in efforts to curb the unsanitary reuse of needles and subsequently decrease the spread of infectious diseases such as hepatitis and HIV. Needle exchange programs, on their own, have been shown to decrease …
The harm reduction debate isn’t exchange or nothing
“Guess what? I have PCOS,” was not what I expected to hear over the phone when catching up with a college friend the summer before my second year of medical school. Even more puzzling to me was the story of how she got her diagnosis. She relayed the saga of an intrauterine device placement gone wrong, infection-induced psychosis, and severe menstrual bleeding and pain. Following an extensive workup, she was …
The PCOS diagnosis gap medical schools must close
I did not encounter Norman Schwarzkopf’s leadership doctrine until long after I had already been living it. When I finally read his words about sweat, preparation, and the courage to act despite uncertainty, I felt an immediate jolt of recognition. It wasn’t admiration. It was recognition. I realized I had been following the same principles instinctively throughout my medical and institutional life, especially in the moments when leadership and command …
What quiet leadership looks like in a broken system
A medication was recommended to me a week ago. It still has not reached me. I prescribe medications for a living. I know where an order can stall: awaiting a signature, sent but never received, delayed by an authorization, or routed to a pharmacy without stock. I know whom to call and what to ask.
None of that has moved my prescription. There is no one covering the service, so it …
Why medication access fails even the best-case patient
I spent thirty years in academic medicine as a dean for faculty affairs and development, training physicians to be not just clinically competent but genuinely patient-centered and thorough. I believed in the system I helped build. I still do, mostly. But I am also a patient. And as a patient, the system failed me for fifteen years, not through negligence, but through something quieter and harder to fix.
Fragmentation.
The history
In 2005 …
When fragmented care misses pancreatic enzyme insufficiency
It was our first night at a bull riding event, Shoot Out Arena in Tombstone, Arizona, an August night, and I had no idea yet what any of this actually looked like up close.
We were sitting beside the chutes in the VIP section. The rider gave the nod, the gate swung open, and the clock started. Bull and rider came out together …
What bull riding taught me about sports medicine gaps
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Picture a health system where family medicine and emergency medicine physicians work together as true partners within the same emergency department. Both specialties share responsibility for the same patients by providing comprehensive and coordinated care. This is probably how the founders of emergency medicine, many of whom were family physicians, imagined the future when they started this specialty.
Although this collaborative approach may seem new to some, it has been …
The case for family physicians in emergency medicine
I remember medical school orientation clearly. I was excited, nervous, confident, and full of self-doubt, all of it wrapped up in a kind of nervous energy. I had a clear vision of what my life would look like. I would finish medical school, complete residency, and practice primary care back in my hometown. The white coat they draped over me at the ceremony did not sit comfortably on my shoulders, …
Reclaiming physician career meaning before you retire
A recent paradigm shift in software engineering, where developers build complex applications using pure natural language, intuition, and high-level architectural oversight rather than writing manual syntax, unlocked a radical new relationship between humans and machines. It is time for clinical medicine to experience its equivalent. We propose a clinical care model in which a physician directs a multimodal AI assistant in real time at the patient’s bedside through speech, vision, …
Can AI at the bedside finally ease clinician burnout?
A patient came to me worried she was going to lose twenty-five pounds in the next month.
Even on tirzepatide, what would make her think that? She’d only lost five pounds in the first two months.
She said the marketing that brought her in had promised her thirty pounds in three months.
So I explained the truth: the body does not save up its losses and then spend them in a lump sum. …
Why doctors need to be in the marketing room
When Neil H. Shubin assumed the presidency of the National Academy of Sciences, he called for the NAS to speak with greater speed and reach at a time when science is increasingly contested in public life.
That call is timely. But even the clearest scientific advice can be ignored when too few people trained in science and medicine take part in making laws and setting national priorities.
Scientific advice is essential. …
Why so few scientists serve in Congress
It has been almost 1.5 months since Dr. A. was assigned to me as one of the two junior doctors working with me. Both of them are first-year residents.
Dr. S. is very sweet, hardworking, and eager to learn. Most of the time, she is the one doing all the work. Dr. A. is a first-year resident too, but S., being a fresh graduate, is more junior, and maybe that is …
Why I cried with a colleague I did not even like
Institutional credibility and clinical excellence are not synonymous. One is conferred by reputation; the other is earned through knowledge, compassion, judgment, and the trust of patients.
Hospitals, academic centers, and large physician groups have earned tremendous respect, and rightly so. But excellent medicine is also practiced every day in independent clinics, private practices, and community-based settings that exist outside traditional health care systems.
My own journey through medicine has given me a …
The measure of medicine is outcomes, not prestige
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