Why direct primary care (DPC) models fail

Policy
October 13, 2025

I’m going to say something controversial: the DPC community’s obsession with “purity” is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I’ve learned that most alternative payment models don’t fail because they’re impure. They fail because someone forgot to do the math.

When $1 million can’t save a bad idea

The University of Houston medical school launched a direct primary …

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The silent victories of medicine

Physician
October 13, 2025

Some battles announce themselves with trumpets; others creep in silently, spreading their fire unseen. His battle was the latter. What began as a hidden spark in his muscles had grown into an inferno consuming his young body from within.

He was barely thirteen, a boy from Bihar, when fate dragged him into this fight. By the time he reached us, fever had bound him for three relentless weeks. His pulse was …

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How timing affects chemical exposure risks

Conditions
October 13, 2025

As physicians, we’re used to thinking about dose (how much medication, how often, and for how long). But there’s another dimension that’s often overlooked: time. For decades, we’ve known that the body processes medicines differently depending on the time of day. A blood pressure pill or chemotherapy drug can have markedly different effects depending on when it’s taken. This field, known as chronopharmacology, has transformed how we think about drug …

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A physician’s tribute to respiratory therapists

Conditions
October 13, 2025

Larry is a friend. We are not besties. He is a neighbor, a few miles down the road from our forty-eight-acre hobby farm in our quaint little town, surrounded by farmland, generational farmers, rusted old tractors, cornfields, livestock, and a few homes interspersed in between. He is a neighbor, nonetheless. And a friend.

I first met Larry when we were building our country home, where my wife dreamt of raising a …

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A cancer doctor’s warning about the future of medicine

Physician
October 13, 2025

I am a cancer doctor.

It took me many years to become one and while I paid for my medical school tuition, my residency and fellowship training was partially subsidized by government funds for general medical education. Every residency and fellowship is partially funded this way because the government recognizes the need for doctors. I have also had an NIH funded basic research lab where I did research that has contributed …

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How to protect your voice like a professional

Conditions
October 13, 2025

California Governor Gavin Newsom recently made headlines for his marathon public appearances, speeches, and press briefings. Watching him, I could not help but wonder what his voice coach or speech-language pathologist might say. As a clinician who specializes in voice therapy, I see teachers, pastors, lawyers, and health care providers (people who depend on their voices every day). Politicians are no different.

Our voices are often our most valuable tool, yet …

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How physicians can use faith, family, friendship, and fulfillment to combat burnout [PODCAST]

Podcast
October 12, 2025
YouTube video

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Rheumatologist Ananta Subedi discusses his article “The 4 foundations that sustain physicians through burnout and balance.” Ananta reflects on his journey from medical education in Nepal to building a rheumatology practice in …

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Is Alzheimer’s an infectious disease?

Conditions
October 12, 2025

For decades, neurology has told us that Alzheimer’s disease is caused by toxic proteins (amyloid plaques and tau tangles) that clog the brain. Pharmaceutical companies have poured billions into anti-amyloid drugs designed to wash them away. The results? Repeated failures, high-profile disappointments, and a handful of marginal approvals with no meaningful improvement in patients’ lives. Sound familiar? In cardiology, we’ve built an entire industry on lowering LDL cholesterol. Statins move …

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Life after GLP-1s: How to sustain weight loss

Conditions
October 12, 2025

It should come as no surprise that GLP-1 receptor agonists have revolutionized the management of obesity and metabolic syndrome. These drugs have shown extraordinary promise in regulating appetite, promoting weight loss, and improving blood sugar control. Nearly one in eight adults (twelve percent) have taken a GLP-1 agonist, and forty-three percent of adults diagnosed with diabetes have used these therapies, numbers likely to have increased further in the last year …

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Teaching medical students what it is really like to be a physician

Physician
October 12, 2025

Physician burnout and physician suicide continue to plague the medical profession. Everyone knows the tragic statistic: one U.S. physician commits suicide each day. While some statistics report a decrease in the problem over time, the accuracy of these reports is questionable. The reality is that it is far too common.

The term burnout, while a necessary label, implies that a single factor causes it. In reality, each burned-out physician is different. …

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A new framework for depression recovery

Conditions
October 12, 2025

What if recovery from depression was not only about reducing symptoms, but about rekindling a person’s inner spark?

During my years as a Navy nurse in mental health, I witnessed countless people navigating the heavy fog of depression. Many were offered medication, therapy, or structured activity schedules. These approaches saved lives and improved outcomes. Yet sometimes, despite best efforts, patients still felt like they were going through the motions, managing symptoms …

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Why doctors are losing the health care culture war

Policy
October 12, 2025

The interview ends. The line goes dead. A senior CDC official has resigned, not because the science changed, but because the room did. Within forty-eight hours, CDC Director Monarez is fired by tweet, three senior leaders walk out, and a deputy from HHS (Jim O’Neill, a Silicon Valley investor turned political enforcer) is slotted in as acting CDC chief.

The headlines say turmoil. That is the polite word for capture.

Meanwhile, the …

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Innovations and barriers in colorectal cancer screening strategies [PODCAST]

Podcast
October 11, 2025
YouTube video

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Nurse practitioner Elisabeth Evans discusses her article “The critical role of nurse practitioners in colorectal cancer screening.” Elisabeth shares why colorectal cancer is the second-deadliest cancer in the U.S. yet remains under-screened, …

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Global surgery needs advocates, not just evidence

Education
October 11, 2025

In the world of global surgery, progress is a word we love to repeat. Since 2015, we have celebrated the drafting of National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs), applauded World Health Assembly resolutions, and cited countless academic papers. But walk into a district hospital in a low- or middle-income country, and the patient waiting for a life-saving operation will not feel that progress. For them, the promises of global …

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The hypocrisy of insurance referral mandates

Physician
October 11, 2025

Every week, I see patients not because they need to, but because their insurance company says they must. A patient came in recently for one reason only: Her insurer required a referral before she could see a specialist. She didn’t want to. I didn’t need her to. But we both had no choice. After a 20-minute visit neither of us needed, I did what the insurer required: document, click, submit. …

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The timeless art of diagnostic reasoning

Physician
October 11, 2025

The patient was in her forties. She experienced chest pain, but it did not appear to be “classic.” Her ECG was normal. Her labs did not raise alarms. The team leaned toward anxiety. Hours later, she went into cardiac arrest from a heart attack. That silence after the code still stays with me. We anchored on the first test. We closed the case too early. We stopped listening to her …

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Why health self-advocacy is an essential life skill

Conditions
October 11, 2025

Money management and career planning are considered life skills (but the skill that shapes health self-advocacy) deserves the same status. Without it, care suffers. My family member was recovering from surgery, facing medication safety concerns, severe anxiety, and the need for constant care. At the same time, I was managing my own records and preventive health. Like so many women, I had become the family’s chief health executive, carrying responsibilities …

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How functional medicine helps where conventional care falls short [PODCAST]

Podcast
October 10, 2025
YouTube video

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Internal medicine physician Sally Daganzo discusses her article “How functional medicine fills the gaps left by conventional care.” Sally explains how a systems-based, evidence-informed approach can uncover root causes of complex conditions …

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What MS can teach cardiologists about disease

Physician
October 10, 2025

At the recent ECTRIMS Congress in Barcelona, researchers presented data that should make every specialist pause. In a claims analysis of nearly 70,000 patients with multiple sclerosis (MS), 98 percent of infections were first detected not in neurology clinics, but in primary care and other non-neurology practices. Even “serious” infections requiring hospitalization were almost entirely picked up elsewhere. The message was clear: Specialists, by design, often miss the forest for …

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What an active shooter taught me about being a doctor

Physician
October 10, 2025

“Do you know what it feels like, to know you could die at any moment?” His words linger in the air, heavy, long after the threat of violence has passed, long after our team has calmed him with words and soft gestures. It is not the first time a patient’s family member has swung at me, nor will it be the last. But it is the first time with a …

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