A few years ago, I met a talented internist who had been practicing for 15 years. She owned a small clinic, worked long hours, and ran a thriving patient base, but when we reviewed her financials, I realized she’d been paying far more in taxes and taking far more risk than she needed to.
Her response was one I hear often: “Clint, I’m not a businessperson; I’m a doctor.”
It’s a mindset …
Physician asset protection: a guide to entity strategy
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs. The child suffers not only from the caregiver’s direct …
Understanding factitious disorder imposed on another and child safety
“Doc, I’ve seen enough doctors. I only trust you. I want you to do my knee replacement and fix my heart.”
I heard the conviction in his voice when I heard these words from this patient. Sitting across from me was a 76-year-old army veteran I had cared for over two decades. He had seen multiple specialists, endured countless consultations, and, in the end, he wanted me, the physician who had …
Physician grief and patient loss: Navigating the emotional toll of medicine
Kelly D. Holder, PhD, and I first met at the Dr. Lorna Breen Heroes Foundation Health Care Worker Well-Being Day in Washington, D.C., where she was a presenter. I was impressed with Kelly’s work, focusing on helping health care professionals and leaders co-create a culture of well-being, which is so critical in medicine today.
This resonates deeply with Sarah Hollander, MD’s belief that the culture of medicine must change, starting in …
Joy in medicine: a new culture
Medscape recently released a report entitled, “A Constant Evolution: The Unique Culture of Medical School: Medscape 2025 Report.” The report’s underlying premise is that a warm, welcoming, and supportive culture in medical school allows students to not only “survive” their training, but to truly “thrive” in their educational journey.
What defines medical education today
Yet, reading between the lines, this emphasis on “culture” and environment also poses a very different question: …
Is medical school culture replacing academic rigor?
As elected officials and citizens brace for the possible expiration of federal subsidies for health insurance premiums, many wonder if there are alternatives to the confusing rebate/copay/deductible/premium drug coverage word salad (see: PSAOs, GPOs, NADACs, ASOs, MLRs, AWPs, WACs, U&Cs, MACs, BERs, GERs, DFERs, GDRs, NDCs, DIRs, and ERISAs).
Just because patients don’t understand the opaque layers/players behind the drug procurement affordability crisis, doesn’t mean that lawmakers do, say experts (which …
Understanding alternative drug funding programs
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Developmental-behavioral pediatrician Ronald L. Lindsay discusses his article, “A pediatrician’s reckoning with behavior therapy.” He shares his profound professional and personal pivot, …
A pediatrician’s reckoning with applied behavior analysis [PODCAST]
Let’s discuss primary care. That’s primary care, as in P-R-I-M-A-R-Y C-A-R-E.
Why the emphasis?
Sadly, I don’t …
Is primary care becoming a triage station?
It was past 7 p.m. when I finally reached home after another long day in the outpatient oncology clinic. My mind still echoed with the day’s stories: patients fighting pain, families clinging to hope, and the small victories that made the exhaustion feel almost worthwhile. There was emotional fatigue, but also peace.
Then I opened WhatsApp. The headline jolted me: “Doctor in Chennai stabbed by patient’s son after mother’s death.” He …
Violence against physicians and the role of empathy
I am a disabled doctor. Being in residency, where many of my peers are young and able-bodied, I entered medicine with extensive experience on the other side of the examination table. I also entered medicine wanting to emulate the best of the care I received, and minimize the worst.
Over time, I have met more and more doctors like me who struggle with temporary or permanent disability. I see how systems …
The impact of policy cuts on ableism in health care
America learned to add medications. Add one for sleep. Add one for nausea from the first. Add one for weight gain from the second. Add a second antidepressant when the first loses effect. Add a stimulant when a mood stabilizer slows a teenager down. Add an antipsychotic when anxiety erupts in the clinic room. Add a statin because a lab number sits outside a guideline range. Patients, however, feel the …
How deprescribing in psychiatry offers a path to safer care
The denial came back in less than three seconds.
A physician had just submitted a renewal for a medication her patient had taken for years, one that kept her stable, out of the hospital, and able to function. She expected the usual wait time. Maybe an hour. Maybe a day.
Instead, an automated message appeared: “Denied: automated appropriateness determination.”
No reviewer. No rationale. No path for appeal. Only an algorithm, silent, opaque, and …
AI in prior authorization: the new gatekeeper
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Assistant professor of professional practice Adrian Reynolds discusses his article, “What is professional identity formation in medicine?” He explores how a student’s frustrated question, “Did I get dumber?” reveals the deep crisis …
Why learning specialists are central to medical education [PODCAST]
“Once in a while you get shown the light
In the strangest of places if you look at it right.”
That line from Scarlet Begonias (lyrics by Robert Hunter, melody by Jerry Garcia) has followed generations like a benediction disguised as a song lyric. Released in 1974 on the Grateful Dead album From the Mars Hotel, it has become something more than poetry. It is a philosophy of attention, a reminder that …
Finding meaning in medicine through the lens of Scarlet Begonias
Illness is inevitable, and medical care can be expensive. The U.S. is the only developed nation without some form of universal health care. Instead, it relies on a for-profit system in which insurance companies often seek ways to reduce costs, sometimes by delaying or denying coverage for services. These delays can include requirements such as prior authorization or peer-to-peer reviews for standard, guideline-directed treatments. This process takes up health care …
Profit vs. patients in the U.S. health care system
Medicine is getting faster, louder, and more efficient, and many of us feel something quietly slipping away. We talk about burnout, moral injury, and depersonalized care, but the deeper question is often left untouched: How do we keep the soul of medicine alive while building systems that must scale?
I encountered that question in an unexpected place, not in a policy meeting, not in a spreadsheet, and not in an architectural …
How to keep the soul of medicine alive in a scaling system
Robert E. Lee did not lose Gettysburg because he lacked courage or troops. He lost because he was blind. His cavalry commander, J.E.B. Stuart, galloped off on his own, leaving Lee without reconnaissance. By the time Stuart returned, George Custer cut him to pieces. Leadership without recon is leadership without eyes.
Screening tests are the point in a military formation. They provide the initial lay of the land. In medicine, they …
Why medicine needs military-style leadership and reconnaissance
You are the expert of your body. You know when something isn’t right.
Yet many patients leave an exam room feeling worse than when they came in, not because of their illness, but because they were told, directly or indirectly, that nothing is wrong. Their symptoms are minimized, reframed, dismissed, or worse, attributed to anxiety, stress, age, or weight. They are left questioning their own experience and perception of reality.
This is …
How to handle medical gaslighting
The nurse adjusted my father’s blanket for the third time that hour, her voice soft as velvet. “We just hate to see him suffer like this,” she whispered. My mom and I watched her check his IV with the tenderness reserved for wounded pups.
Three floors down, four years earlier, this same hospital discharged me mid-vomit with a gastric outlet obstruction and a white blood cell count that screamed infection. “Go …
Gender bias in medicine: Who deserves to be saved?
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Otolaryngologist Brian F. Worden discusses his article, “The surprising link between migraine and tinnitus.” He reveals that for the 26-47 percent of tinnitus patients who also report migraines, the tinnitus may actually …
Why your migraine might be causing your tinnitus [PODCAST]
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