The heaviest things we carry are rarely the tasks. They are the standards we never thought to question.
My morning mental routine: Who is picking the kids up? What are we having for dinner? What time do I need to be at work, and how much is on my plate there? What time do I need to pick the kids up in time to make dinner? Maybe we will just eat …
How to lighten your mental load by asking better questions
The cold coffee cups are the least of it. They sit abandoned on desks and in reporting rooms, small monuments to interruptions, unfinished tasks, and priorities that shift by the minute. Beside them stands the inevitable glass of lukewarm water, another reminder that even the most basic needs are often postponed in the service of someone else’s urgency.
What is far more difficult to ignore are the sleepless nights. The anxiety …
Health care burnout is a structural problem, not resilience
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Most women lose feeling in their chest after a mastectomy, and almost no one warns them ahead of time. Emily Hansen, a patient advocate who has spent nearly two decades in health care …
Numbness after a mastectomy no one warns you about [PODCAST]
Recently, I called the office of my primary care physician. I asked the person who answered the phone, “Will the doctor sign an FAA BasicMed form?” The person said, “Let me check,” and returned a minute later. “She cannot. You need to see an FAA doctor.” I tried to explain that she could, but I could not convince the desk person.
The following explains BasicMed, the Federal Aviation Administration (FAA) program …
What every primary care physician should know about BasicMed
We have spent years talking about what is wrong with nursing culture. “Nurses eat their young.” New nurses leave too soon. Burnout is everywhere. Tension on the floor feels almost expected. We have named it. We have seen it. Most of us have lived it.
But naming it hasn’t fixed it. If anything, the conversation keeps circling the same territory without getting any closer to the root of it. And I …
What happened to teamwork in nursing?
Medicine likes to imagine that leadership follows predictable paths. We talk about “career tracks,” “pipelines,” and “development pathways” as if the profession reliably produces clinicians who can lead research, deliver complex care, build systems, and teach the next generation. But anyone who has spent a lifetime inside the machinery knows this is a myth. These domains rarely overlap. In fact, they often conflict.
And yet, every so often, a career emerges …
Why ethical leadership in medicine is so rare
A Black medical student with top board scores applies to cardiology fellowship. She has no research mentor, no letter from a famous cardiologist, and no one to tell her which programs to target. She does not match. The system calls it merit. But was it?
Health inequity is often discussed at the bedside, focusing on access to care, treatment decisions, and clinical outcomes. Yet by the time a patient reaches the …
Diversity in cardiology is a power problem, not a pipeline
An excerpt from I Left Anyway: The Life I Was Supposed to Want.
The schedule looked ordinary, which almost made it harder to explain. The fluorescent lights hummed overhead. The computer screen asked me to log in again because five minutes of stillness was enough for it to decide I had disappeared. There was no collapse that day, no scandal, no final straw that would make the story easy.
I washed …
“Are you still practicing?” is the wrong question
There is a fifth pillar of American medical ethics. It was never voted on, never formally adopted, and never appears in Beauchamp and Childress. It governs clinical conduct more reliably than the other four combined. It is called compliance.
What the compliance framework has accomplished is not the erosion of beneficence, non-maleficence, autonomy, and fidelity. It is their capture. Each pillar has been quietly redefined until it means something closer to …
How compliance quietly captured medical ethics
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Most doctor visits do not fail in the room. They fail after you walk out, holding a plan and no clear idea of when something has gone wrong enough to call back. In this episode, retired surgeon and patient advocate Alan P. …
Why your treatment plan falls apart after you leave the doctor [PODCAST]
Marc Stone, MD served as deputy director for safety in the FDA Center for Drug Evaluation and Research’s Division of Psychiatry until 2024.
Martha Rosenberg: Recently, in the Cato Institute journal Regulation you and co-authors Andrew Mosholder, MD and Tarek Hammad, MD wrote that the FDA’s antidepressant warning did not kill American children through discouraging prescriptions as alleged in an earlier story. What did yours and Dr. Hammad’s earlier research on …
A former FDA official on antidepressants and suicide risk
We are exquisitely good at managing the aging emergency and strikingly bad at preventing it. That is a system design choice, not a clinical inevitability.
Every physician who cares for older adults knows the pattern. A patient we have seen for years, stable, independent, managing, arrives one day transformed by a single event: a fall, a hospitalization, a stroke, an acute delirium. And in the seventy-two hours that follow, a family …
The advance care planning conversation nobody starts
When the president announced that Tylenol caused autism (it does not), he commented that leucovorin, a cancer medication, treated the condition. His remark had an outsized impact on the public, despite counter-statements by autism specialists. I can understand the response. What mother-to-be would take the chance, even if untrue, that Tylenol may cause autism? Or if parents have a child with this condition, would they not be willing to try …
Should the law force doctors to prescribe on demand?
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Here is a question I have never been able to get comfortable with: How did we build an entire prescribing system for one of the most common infections in America without ever confirming what we are treating?
Acute sinusitis generates more than 30 million patient encounters a year in the United States. Antibiotics are prescribed at 84 to 91 percent of those visits. And at virtually none of them does anyone …
We prescribe antibiotics for sinusitis without a diagnosis
Medicine tells itself a reassuring story: Excellence is rewarded, integrity is recognized, and systems ultimately support the clinicians who work to make them better. But anyone who has spent a career inside the machinery knows the truth is more complicated. In systems without explicit ethical goals, achievement is not celebrated. It is punished.
Across decades in developmental-behavioral pediatrics, disability advocacy, and hospital leadership, I have watched a quiet, corrosive pattern repeat …
Good doctors leave medicine when integrity costs them
When Alexander Zverev lost to Taylor Fritz in the Halle semifinal tennis tournament, he didn’t blame his pancreas. He did the professional thing: He admitted Fritz outplayed him. But Zverev also let slip a detail that deserves more than a post-match shrug. Before the match, his glucose sensor decided to go rogue. Based on its creative interpretation of his blood sugar, Zverev injected a dose of insulin better suited for …
Type 1 diabetes and the tennis match you cannot see
Tooth decay is one of the most common chronic diseases of childhood, yet it is almost entirely preventable. Despite advances in dental care, millions of children continue to experience cavities that affect their ability to eat, sleep, concentrate in school, and thrive.
Much of our current approach focuses on treatment rather than prevention. Even when we promote prevention, we often rely on ideal routines that are not consistently achievable for many …
Xylitol for cavity prevention belongs in schools
Most independent practices treat HIPAA as a documentation exercise. The policy binder sits on a shelf, the privacy notice is posted, the staff training certificate is in the file, and the assumption is that the practice is covered. Enforcement patterns over the last several years suggest a different exposure model. The settlements that reach small practices are rarely about the policies that were missing on paper. They are about the …
HIPAA compliance for small practices is not paperwork
We discuss quite a bit in clinical practice about why we have mental health issues, and how a feeling of anxiety often has significant nuance in terms of diagnosis. Let’s start with good old-fashioned anxiety. Anxiety is the feeling of being in danger or there being some sort of threat when one is not present, and this comes down to how our brains are wired for survival.
First and foremost, our …
How social media affects the brain’s survival wiring
For most of human history, medicine and metaphysics were inseparable. Physicians sought not only to understand the body but to understand the meaning of illness, the purpose of suffering, and the relationship between healer and patient. Healing was more than the manipulation of physical matter. It engaged the whole person.
That began to change in the late nineteenth and early twentieth centuries. The remarkable successes of scientific medicine, driven by advances …
Medicine and metaphysics belong together again
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