Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left Kaiser after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in Silicon Valley: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor.
I saw this problem firsthand before I retired from …
The Silicon Valley primary care doctor shortage
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Counselor and certified coach Mary Remón and oncologist Tiffany Troso-Sandoval discuss their article, “Clear communication is kind patient care.” They explore the common scenario of patients leaving the office more confused and …
Transforming patient fear into understanding through clear communication [PODCAST]
Most people exercise to improve cardiovascular fitness, metabolic health, or mood, but regular physical activity also plays a significant role in sexual and urinary function. As a urologist, I routinely see how movement influences two intimate yet essential systems: the reproductive system and the lower urinary tract.
When patients present with urinary leakage, erectile changes, or reduced libido, they often expect a prescription or procedure. Yet for many, measurable improvement begins …
How movement improves pelvic floor function
Adapted from The Care of Foreigners: How Immigrant Physicians Changed US Healthcare. Copyright 2025. Published with permission of Johns Hopkins University Press.
In the decades following the passage of the Hart-Celler Immigration and Nationality Act of 1965, the face of American medicine irrevocably changed. This bill expedited the rapid entry of physicians from post-colonial Asian nations into the U.S. in significant numbers. In this migratory flow, South Asian physicians, in …
How immigrant physicians solved a U.S. crisis
“The FDA has issued a nationwide recall of lisdexamfetamine capsules.”
That sentence in Newsweek magazine should have triggered alerts, guidance, and coordinated response. Instead, the silence from pediatric leadership has been deafening. Newsweek turned to the FDA and the American Academy of Family Physicians. Where are the leadership of the American Academy of Pediatrics (AAP) and the Society for Developmental and Behavioral Pediatrics? Silent. Why?
The recall that should have sparked action
In …
Pediatric leadership silence on FDA ADHD recall
We entered medicine with a shared calling (to heal, to serve, and to make a difference). Yet somewhere along the journey, between the never-ending charting, late-night calls, and invisible emotional burdens, many of us forgot how to heal ourselves.
Every few months, another survey or report confirms what so many of us already sense in our bones: physicians are burning out at staggering rates. But what remains under-discussed, and perhaps even …
How relationships predict physician burnout risk
Some cases linger in our memory because of the humanity at their center. The case of Charlie Gard, which unfolded in England in 2017, is one of those. It took place within the National Health Service and under a legal framework in which courts decide a child’s treatment when parents and clinicians cannot agree. Before it became a global controversy, before it drew international headlines, it began as something far …
The ethical conflict of the Charlie Gard case
My fourth year of OB/GYN residency there was an essay contest about what it meant to be an advocate for women’s health while preserving your sense of self. I sent a screenshot of the contest to my then-boyfriend, now-husband. He replied, “You want to add something else to your to-do list?” He was joking, but he wasn’t wrong. Just a few days prior, I was hyperventilating from all the things …
Preserving your sense of self as a doctor
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Registered nurse June Pomeroy discusses her article, “How physician obesity affects patient care.” June explores the complex realities of weight bias within the medical field, examining how a physician’s own struggle with …
Understanding the hidden weight bias that harms patient care [PODCAST]
Introduction
Tay-Sachs disease is a devastating genetic disorder that primarily affects individuals of Ashkenazi Jewish descent, though it is also found among Cajuns in Louisiana and French-Canadians. This fatal condition typically manifests within the first six months of life and leads to progressive neurological deterioration, often resulting in death by age five. As medical science advances, the question arises: Should genetic testing for Tay-Sachs be mandatory for all individuals of reproductive …
The ethics of mandatory Tay-Sachs testing
For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then …
The geometry of communication in medicine
One of the first questions you’re asked when applying to medical school is: Why do you want to be a doctor? For most, the answer is some version of “I want to help people.” But for me, that was never the real question. It was always “Why do you want to be a pediatrician?”
I’ve known since I was very young that I wanted to work with children. I’ve always loved …
Why I became a pediatrician: a doctor’s story
Children often surprise us with the seriousness they bring to a clinic visit. Every so often, when the room feels tense, I turn to a simple question and ask what their favorite toy is. Caregivers smile, and children lean forward with the kind of excitement that only play can spark. In a moment, the atmosphere changes. The room feels lighter, the conversation easier, and the visit begins to unfold with …
Why toys matter in the exam room
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Health care strategist Dana Y. Lujan discusses her article “Why direct primary care (DPC) models fail.” Dana argues that the DPC community’s obsession with “purity” is missing the point, stating that these …
Why bad math (not ideology) is killing DPC clinics [PODCAST]
All clinical trials are fueled, in part, by optimism. A trial currently underway in California is fueled by the optimism of one patient in particular, Kayvon Goodarzy.
Despite decades of effort, there has been an abject lack of new approved therapies for glioblastoma (GBM). The standard of care for this deadly brain tumor has been chemotherapy and radiation, to less-than-ideal results. But that might be changing, and it’s all thanks …
Glioblastoma immunotherapy trial: a new breakthrough
“Vaccines do not cause autism.” That statement once anchored public health. The CDC just dismantled it, quietly, strategically, and dangerously.
Presumption reversed, justice subverted
Attorney Lindsey Halligan didn’t misspeak when she claimed James Comey must prove his innocence beyond a reasonable doubt to a Virginia grand jury. She exposed the new doctrine: guilt by accusation, innocence by loyalty. Then she staged a procedural ambush. She bypassed the full grand jury entirely. She …
Did the CDC just dismantle vaccine safety clarity?
When the American Academy of Child and Adolescent Psychiatry released its October 2025 policy statement expanding what counts as valid, evidence-supported autism treatment, it marked a turning point that has been needed for years. For more than a decade, insurance companies pushed a narrow, outdated narrative that applied behavior analysis was the only evidence-based intervention for autism. That narrative was not accurate. It shaped policy, and it left families with …
New autism treatment guidelines expand options for families
When the first pandemic lockdowns swept through hospitals, our hallways went silent. The absence of visitors felt practical at first, a necessary shield against viral spread. But weeks turned into months, and that silence began to echo with something deeper: distrust.
I remember walking into a patient’s room to find her eyes fixed on the door. She wasn’t waiting for the nurse. She was waiting for her daughter, the daughter she …
Why visitor bans hurt patient care
Even the most “affordable” DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into higher-income neighborhoods. Without understanding these behavioral and economic realities, physicians risk building a model the community cannot sustain long-term.
I previously argued that physicians must answer five market questions before …
Direct primary care in low-income markets
It happens almost every clinic day. A patient walks in, sits down for their vital signs, and their blood pressure reads higher than expected. Sometimes much higher. Moments later, when I retake it myself after we’ve talked for a few minutes, it’s 20 or 30 points lower.
“But, doctor, I check it at home and it’s never this high!”
They are right. This is the phenomenon of white coat hypertension, blood pressure …
Is white coat hypertension harmless?
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