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Developmental behavioral pediatrician Roxanne Almas discusses her article “The making of a rested healer.” Roxanne shares her deeply personal journey through the “quiet unraveling” of burnout and the profound grief of losing …
Rest is a holy practice: Reclaiming the soul of medicine [PODCAST]
After working close to 20 years in this medical-surgical ICU, I thought I was an expert. Infallible. I could do it all.
I left my ICU comfort zone, my lifelong nurse friends, and ventured out. Nothing could stop me.
For a different hospital system, I became a critical care resource nurse.
This very large hospital system would dictate what unit I would go to and for how long. I truly thought I could …
Why I left the surgical-trauma ICU: a nurse’s story of burnout
America is ready for an honest conversation about health care policy before more people suffer and we go broke waiting for it to happen. Fully one-third of Americans report that in the past 12 months they have skipped or postponed getting needed health care because of the cost. Thirty percent say that they or a family member had problems paying for health care in the past year, and 41 …
American health care policy reform: Why we need a bipartisan commission
How one reframing changed the way my patients think about me, and their health.
Every day, a patient sits across from me, arms crossed, waiting for me to tell them what pill to take. Or worse, waiting for confirmation of what they already believe: that the medical system has nothing real to offer, their doctor is just a middleman for pharma companies or an insurance shill, and that the answer to …
Rebuilding patient trust through the evolutionary mismatch framework
There are moments when professional boundaries collapse under the weight of something more fundamental: our shared humanity.
You do not have to be a physician to recognize when a system has failed at its most basic level. You only have to be human.
What happened to Alex Pretti is not solely a tragedy confined to one profession, one agency, or one moment. It is a systemic rupture, one that exposes a dangerous …
Systemic failure in professional environments: the myth of protection
Recently, my husband and I passed through Eureka, IL (pop. 5,200). We stopped at Eureka College, which is President Ronald Reagan’s alma mater and the host of the Ronald Reagan Museum. As visitors to many presidential libraries, we …
The service of humanity: Recommitting to physicians’ ethical duties
Stopping a GLP-1 abruptly and expecting maintenance of weight loss is not realistic. Even replacing it with a standard “eat less, move more” plan is not sufficient as it ignores what we know about hunger regulation and metabolic adaptation. A reduced-calorie diet and 30 minutes of daily walking, while helpful, are rarely sufficient to overcome the physiological forces defending prior weight.
Weight maintenance after significant loss requires managing cravings, psychological hunger …
GLP-1 weight regain: Why stopping medication leads to weight return
It is honestly impressive the lengths people will go to cure their illnesses, or, alternatively, to lovingly nurture their favorite delusions. And to be fair, I get it. We have all been sick. I am a doctor and I have still Googled home remedies for canker sores, tooth pain, and ingrown toenails. The difference is that experimenting with saltwater rinses is unlikely to end your life.
When it comes to actual, …
The Blanket Sign: Recognizing difficult patient encounters in the ER
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Physician and health care reform advocate David K. Cundiff discusses his article “Ecovillages and organic agriculture: a scenario for global climate restoration.” David challenges the IPCC’s failure to model a fully organic …
Ecovillages and organic farming could reverse global warming [PODCAST]
In engineering, a feedback loop is meant to stabilize a system. In medicine, feedback guides us toward better outcomes. But in applied behavior analysis (ABA), feedback has become a trap, recycling failure under the guise of science, and leaving children and families caught in its circuitry.
The closed circuit
Stevens’ feedback loop diagrams are elegant in their simplicity: arrows circling back, showing how inputs and outputs can stabilize a system. In healthy …
Applied behavior analysis criticism: the closed feedback loop
A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional complexity, answerable to no one but their patients.
It is a satisfying idea. It is also an empirically untested one.
The history of DPC is built on physicians willing to challenge entrenched …
The future of employer-aligned DPC and physician autonomy
The moment I decided to become an American-trained dentist, I was holding a textbook in India. I was a first-year dental student in India when it happened. I had just bought my textbooks for the semester, the thick, heavy kind that feel important in your hands, and I started flipping through them.
Page after page, I kept noticing something. The authors. Their names. Their affiliations. Almost all of them were from …
Navigating the international dentist U.S. pathway
When someone you love is in a different location and suffering while you are safe, a heavy silence begins to fill the room. This survivor guilt is one of the most difficult burdens to carry because it turns even the smallest joys, a hot cup of tea, a peaceful morning, or a moment of laughter, into something that feels like a betrayal. The heart constantly asks: Why them and not …
Coping with survivor guilt: wisdom from Saadi Shirazi and Viktor Frankl
At the end of December 2025, the American Medical Association (AMA) Journal of Ethics ceased its operations, now just a relic of the past. Its inception began in September 1999 with a journal theme entitled “Virtual Mentor Launches with a Nod to William Osler.” It references ethical decision-making, praise for Sir William Osler’s Aequanimitas, and the experience of the spoken word from a doctor to a patient’s ears. Its …
Medical ethics and AI: Why losing oversight endangers patients
When my small-group facilitator asked whether withdrawing life support is morally different from withholding it, my classmates offered the usual responses: autonomy, prognosis, and suffering. My mind was somewhere else entirely. It was the first time I had understood something that I had never questioned.
In medicine, categories exist to serve people; in Jewish law (Halakha), people often exist to serve categories. For years I never saw the cost until we …
End-of-life care and religion: Reconciling Jewish law and medicine
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Pediatrician and certified coach Jessie Mahoney discusses her article “Disruptive physician labeling: a symptom of systemic burnout.” Jessie argues that the rising number of “disruptive” labels slapped on highly skilled doctors is …
“Disruptive” behavior is often a cry for help from depleted doctors [PODCAST]
During a busy morning, a junior nurse notices a discrepancy between a patient’s medication order and the usual dosing protocol. The unit is short-staffed, rounds are running behind, and the attending physician appears visibly rushed. The nurse hesitates, worried about slowing the team down or appearing inexperienced.
The unit manager who is present during rounds, notices the nurse’s hesitation and pauses the discussion. Rather than pushing forward, the manager says, “Before …
Psychological safety in health care: Why speaking up saves lives
The single scariest moment in my medical career was not as a student, or a resident with the first dying trauma patient in front of me. Nor was it in Iraq on November 2, 2003, when two Chinooks were shot down and my ER was overwhelmed with trauma after trauma. It was the very first day as an attending in the ER. Up until then, in every single case in …
Evaluating the U.S. Surgeon General nominee: Why clinical experience matters
My wife is dying.
The day has yet to be determined, but the causes are certain. Stage 4 metastatic pancreatic and liver cancers will allow her a few weeks more in which to say goodbye to a large circle of family and friends. She has decided not to undergo chemotherapy or radiation that at best might extend her life by a few weeks, at the cost of the quality of whatever …
Lessons from 47 years: long-term marriage and palliative care
Imagine a world-class anesthesiologist at a major hospital in Manhattan. She is fully credentialed, board-certified, and has been saving lives at that facility for 5 years. On her day off, she wants to pick up an extra shift at a surgery center 3 blocks away that is currently short-staffed and desperate for help. Logic says she should be able to walk in, show her “Ready-to-Work” status, and start. Instead, she …
Health care credentialing is broken: How to fix the staffing crisis
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