“I have a form of genetic primary immunodeficiency and several heart issues, among other things. I know that I need to be far more vigilant than someone with a fully armed and operational immune system, so I try to take as much responsibility for that as I can.
First tactic: Not going out …
Medical facilities: Please keep your immune-deficient patients safe [PODCAST]
When plastic surgeon Dr. Robert Pearl published his Los Angeles Times op-ed, “How Doctor Culture Sinks U.S. Healthcare,” a polemic essay critical of primary care physicians like me, he set off a firestorm. While he made some valid points, Dr. Pearl also blamed many of the preventative health failures in the U.S. squarely on the shoulders of primary care physicians without acknowledging that our health care …
The unfair blame on primary care physicians
My phone rings.
“Namaskar! My cough is really bothering me. What should I do?” says a middle-aged man.
“Namaskar! I am Astha Prasai. I am here to help you. Please bear with me while I ask you your problem in detail,” I answer.
Mr. Kafle from Kathmandu is worried about this nagging cough he has, and it has been a month since he has tested positive for COVID- 19. After talking to him …
Telemedicine in Nepal during COVID-19
“For thousands of generations, parents, relatives, and the extended community raised and prepared children to become successful adults, to acquire knowledge, and strengthen the abilities needed to meet the challenges of their time. How did they do it? Until relatively recent times in human history there were no schools or organized institutions, …
How to raise tenacious and resilient children [PODCAST]
“When I was diagnosed as gene-positive for HD, just over ten years ago, there wasn’t anything promising on the horizon in terms of a cure. It has only been since new clinical trials were announced in the past few years that I have allowed myself to feel a tiny bit of …
Huntington’s disease and a patient’s perspective on genetic testing [PODCAST]
Even though I completed residency almost 15 years ago, it is easy to remember the dread I experienced before taking hospital call. The sinking feeling in my stomach as the call date loomed near, the hypervigilance and terror every time my beeper went off in the middle of the night, the fear of imagined catastrophes that would by necessity be my fault.
My anticipation of call was usually worse than reality. …
Physicians: Stop dreading call
July 1 is a day that marks the new era when student truly becomes doctor, where hundreds of residency programs start day one of the three-year or longer residency, a life-changing rite of passage. Where the initial hours start the tens of thousands of hours of experiential full immersion training. Looking back, intern year was one of the hardest years of my training and definitely one of the hardest years …
Reflections from a former intern
Value-based care (VBC) continues to be a popular expression across the health care landscape, but the challenges and opportunities it offers are quite different across specialties. Behavioral health (BH) providers are an important case in point. The opioid epidemic combined with increased recognition and prevalence of mental illness secondary to the pandemic has brought behavioral health to the forefront, but for BH providers, the transition to VBC continues to present …
Behavioral health providers face challenges in value-based care
“I’ve been semi-retired in clinical medicine for almost four years now. Initially, I found myself coaching burned out physicians: Helping them recover, finding careers they love, and even starting their own businesses outside the box. However, as I listened to my inner voice, I was led back to my healing roots, and …
How deep mindset work helped me find the courage to make my career transition [PODCAST]
I’m not an organizational leader, a member of the C-suite, a department chair, or a VP of anything. I’m a coach who guides physicians as they try to provide exceptional care and actually have a life. But I know a lot about setting goals, executing on priorities, and inspiring through vision statements.
Here’s the thing. This is not a successful long-term strategy:
Hello, health care organization leader, are you listening?
I am a first-generation Chinese American. And amidst the complexity of the pieces that form my identity (mom, wife, daughter, woman, doctor), it is the piece I have often prized the least.
In one of my earliest memories, I am riding a crowded bus in Beijing. My aunt and cousin are pointing out the American tourists as we pass, commenting on their high nose bridges and round eyes and how these …
It’s time to rethink the model minority
“This plea for help is on behalf of every hospital worker who has been on the front lines of the COVID-19 pandemic — from the environmental services staff and medical assistants who are often not recognized, to the social workers and chaplains who are surrounded by distress, to the physicians and …
A plea for help from the front lines of the COVID-19 pandemic [PODCAST]
Most physicians have been defendants in lawsuits. Plaintiff experts almost always have a feeding frenzy. In truth, expert witnesses are held to codes of conduct about remaining objective and avoiding partisanship or advocacy. Yet, should the verdict favor defendants, these experts, except for deserving the term “hired guns,” are rarely, if ever, held accountable for their feeding frenzy, which conflicts with their ethical obligations.
I want to share my experience. I independently …
A counterintuitive strategy when you are sued for medical malpractice
The Food and Drug Administration (FDA) negated the recommendation of its expert panel and approved Aduhelm to treat Alzheimer’s dementia (AD), contending that the possible benefit trumped the lack of evidence of efficacy. The FDA was inexcusably in error in making this decision. Aside from the likely lack of benefit, the use of this drug can result in many negative consequences that make its use ethically questionable.
The manufacturer submitted two …
The FDA was wrong about Aduhelm
“The right choice of words, at the right time, can lift a person out of despair and literally save a person’s life, while an ill-chosen word, or worse, a purposely harsh one, can scar a person. The entire field of narrative medicine is formed around the principle of reviving empathy in doctors …
COVID in Pakistan: a physician’s story [PODCAST]
A rough career transition in 2019 followed by the pandemic highlighted how I was still financially tethered to my job — after 10 years of practicing as a subspecialty trained radiologist, saving, maxing out my retirement accounts, and investing in the stock market and in real estate. Looking around, I saw other physicians in a similar predicament. After years dedicated to rigorous training, we were still trapped by “golden handcuffs.” …
How doctors think about financial independence is dead wrong
Nurses are an essential component of the American health care system and are continually in high demand nationwide. For years, nurses have elected to leave the field or have sought alternative professions instead of working in a traditional nursing role full-time. The pandemic brought into focus the need for work-life balance across professions. Whether strained from high-stress levels, financial upset, demanding hours or an overwhelming workload, nursing …
The rise of non-traditional nursing
Amidst beeping monitors, I sat holding my mother’s frail hand in mine with tears rolling down my face and an eerie silence within my soul. I was trying to make sense of the last 24 hours.
My mother had migrated to Houston after an early retirement at 55 to spend time with her granddaughter and me. But life had other plans, as she was diagnosed with breast cancer a year into …
Culture and end-of-life caretaking
“‘That’s great. You want to start a women in medicine program! How are you going to pay for it?’
This is the most common question and potential barrier from colleagues, leaders, and those who understand the value of these programs. We found that our two-year Women Leaders in Medicine program improved burnout, retention, …
How to pay for women in medicine programs [PODCAST]
Photography
A person’s lifetime medication consumption has a familiar and predictable pattern. The more a person ages, the greater their number of taken medication. However, the public behavior in initiating medication has been changed compared to thirty years ago.
Nowadays, parents demand to get their hands on OTC meds for their infants and toddlers.
In this piece, I am interested …
The life cycle of medication consumption
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