5 questions in mental health counseling – and life
Dedicated to my friend and colleague Pat Irving to whom I first told the story.
I’m 80 years old and I’ve been writing for over 60 years—first in systems engineering, later in advanced technology, and more recently in public health policy for the regulation of pain medicine. At this stage of my life, some of my writing is introspective, in an attempt to extract and share “lessons learned” with others. Thus, …
The hidden $935 billion problem in U.S. health care no one is talking about—and how to solve it
“Waste is worse than loss. The time is coming when every person who lays claim to ability will keep the question of waste before him constantly.”
– Thomas Edison
The escalating challenge of waste in U.S. medicine
The U.S. health care system is struggling with inefficiencies and waste that weaken its effectiveness, thus reducing accessibility and sustainability as a whole. According to a study by JAMA, between $760 and $935 billion is wasted …
Health care reform requires better access and quality: dialysis as an example
Having spent two years in Oxford as a Marshall Scholar in the mid-1970s, I came back to medical school believing in a national health service—i.e., Medicare for all. But I learned firsthand that a monopoly can provide access without ensuring quality. When quality isn’t the priority, there’s no hope for lowering costs or alleviating suffering.
Medicare is already the single payer for dialysis and has failed patients miserably. As a result, …
Why are hospitals cornering doctors with this legal trap? [PODCAST]
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We sit down with Dennis Hursh, a health law attorney with decades of experience representing physicians in their interactions with hospitals. Dennis shares eye-opening stories of how hospitals use restrictive contracts and aggressive …
The widow’s walk: a poignant tale of loss, love, and recovery
A widow’s walk, also known as a widow’s watch or roof walk, is a railed rooftop platform often having an inner cupola or turret, frequently found on 19th-century North American coastal houses. The name is said to come from the wives of mariners, who would watch for their spouses’ return, often in vain, as the ocean took their lives, leaving the women widows. In other coastal communities, the platforms were …
To avoid unwanted medical treatment: Choose a bulldog surrogate to fight for you
“Health is a matter of choice, not a mystery of chance.”
—Aristotle
As an end-of-life (EOL) consultant, one aspect of my job is advance care planning, which involves helping people create an advance directive. An advance directive (AD) has two components. The living will portion lists the treatment options and choices you want or don’t want if you become incapacitated due to an accident or a medical crisis. In the second portion, …
The maternal and child health crisis in Sudan: a call to action
The war in Sudan, which began in April 2023, has created one of the world’s largest displacement crises, forcing more than 10 million people to flee their homes. The warring sides, the Sudanese Armed Forces and the Rapid Support Forces, are inflicting horrendous violence on people across the country. Hospitals have been attacked, markets bombed, and houses razed to the ground, leading to a catastrophic toll on the health of …
Controversies surrounding transgender athletes and competitive fairness [PODCAST]
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We sit down with William Lynes, a urologist, to discuss the complexities surrounding the inclusion of SGID athletes in female sports. William explores the impact of biology on performance, the potential risks for female athletes, …
How flawed legal reasoning can tilt medical malpractice cases
A quote by Sir Winston Churchill: “However beautiful the strategy, you should occasionally look at the results.”
Actually, Churchill never said this. It may have been Ian Gilmour, a member of Margaret Thatcher’s Cabinet, years after Churchill’s death. Nevertheless, this quote is often cited in the context of risk management. It is as relevant in a medical malpractice lawsuit as it is a warning to malpractice attorneys. No matter how elegant …
As a doctor, what I learned from knocking on doors for the presidential election
When I’m not knocking on exam-room doors as a pediatrician in New York City, I’m knocking on voters’ doors in Northampton, Pennsylvania—a small county that could determine the outcome of this year’s nail-biting presidential election.
Each time I walk up to a voter’s front door, my heartbeat quickens. You would think a doctor who talks to total strangers every day would be immune to such jitters. But even with a door-knocking …
From darkness to empathy: How one ICU patient transformed my perspective
My first ICU rotation of intern year was filled with great darkness. It was dark outside as I walked from my car into the hospital each morning before sunrise, and it was again dark when I walked to my car at the end of the day. Less than one hour into my first day in the ICU, a patient’s weak and ineffectual heart stopped beating, and CPR was swiftly initiated. …
How technology can support nurses and improve patient safety [PODCAST]
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Voting as a physician: How my parents’ story inspired me to advocate
My parents, both physicians, embody the American story. After completing medical school in Iran, they were recruited to the U.S. in 1968 to fill the gap left by doctors sent to Vietnam. Building a life from the ground up, they became pillars of their patients and communities — and our family, too. In 1992, they became citizens, finally gaining the right to vote, and they’ve never missed an election since, …
It’s not a normal job, folks: How 3 elemental forces of reality shape the profession of medicine
Introduction
In the book Ender’s Game, humans face a time-dilation war in which they must travel light-years into the future to face an enemy of unknown strength and scale. The weapons and technology they possess for the journey may be outdated by their arrival, because relativity minimizes the passage of time. The same dilemma is true for medical and premedical students who can spend decades in training, only to emerge without …
How financial incentives transform health care [PODCAST]
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We sit down with Taylor J. Christensen, an internal medicine physician and health policy researcher, to discuss his health care incentives framework. Taylor explains how restructuring financial incentives can encourage providers and insurers …
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Nurses sue over trans colleague’s actions
Eight female nurses at a United Kingdom hospital are suing their employer for not assuring their psychological and physical safety. The nurses work in specialized areas that require their changing uniforms once daily. There is a trans-female nurse, similarly specialized, who changes with them. He wanders about the locker room in briefs or nude, the women report, ogling them as they exchange clothing. It has also been related that he …
A prescription from the next generation of doctors: Vote early
As future medical professionals, we see the real-life consequences of political decisions in emergency rooms, hospitals, and clinics. Despite a growing recognition that voting is directly linked to better health outcomes, however, health professionals are voting at lower rates than the national average. It’s time that we make a change this election.
We see patients denied essential services due to bureaucratic hurdles, such as insurance coverage gaps for life-saving medications …
Physician gaslighting looks like this
As physicians, we are often collectively gaslit—made to believe that somehow, we are responsible for system failures. Many physicians are brainwashed to “drink the Kool-Aid” and accept phrases like, “This is the way things have always been done.” We are made to feel inhuman when we advocate for ourselves as if we are somehow to blame. The system uses terms like “unprofessional,” “unable to cope with the rigors of being …
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Embracing the advantages of digitization in health care
Due to rising rates of burnout and depression among health care providers, the U.S. is looking at a projected shortfall of over 3.2 million health care workers by 2026. In parallel, the health care industry is grappling with a 13 percent decline in provider productivity that is directly correlated with the increased adoption of electronic medical records (EMRs). This raises a critical question on …
Past Week
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How smartphones are stealing your focus—and what you can do about it
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Learning to trust your body again: Healing the hidden wounds of medical training
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Are quotas a solution to physician shortages?
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Why patients and doctors are ditching insurance for personalized care
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Internal Medicine 2025: inspiration at the annual meeting
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When grief hits all at once: a morning of heartbreak and love
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Past 6 Months
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How trade wars could destroy the U.S. health care system
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How hospitals are quietly taking control of physicians
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What happened to real care in health care?
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The silent crisis hurting pain patients and their doctors
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Doctors don’t need yoga, they need time to smoke
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Academic medical centers under threat: the impact of funding cuts
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The origin of medical licensing exams
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Focusing on medicine’s core, not administrative chores [PODCAST]
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When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding
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Burnout isn’t ironclad—and neither are we
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Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies
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Clinicians must be scrupulously honest in and out of work
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Past Week
-
How smartphones are stealing your focus—and what you can do about it
-
Learning to trust your body again: Healing the hidden wounds of medical training
-
Are quotas a solution to physician shortages?
-
Why patients and doctors are ditching insurance for personalized care
-
Internal Medicine 2025: inspiration at the annual meeting
-
When grief hits all at once: a morning of heartbreak and love
-
Past 6 Months
-
How trade wars could destroy the U.S. health care system
-
How hospitals are quietly taking control of physicians
-
What happened to real care in health care?
-
The silent crisis hurting pain patients and their doctors
-
Doctors don’t need yoga, they need time to smoke
-
Academic medical centers under threat: the impact of funding cuts
-
Recent Posts
-
The origin of medical licensing exams
-
Focusing on medicine’s core, not administrative chores [PODCAST]
-
When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding
-
Burnout isn’t ironclad—and neither are we
-
Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies
-
Clinicians must be scrupulously honest in and out of work
-
