When I wrote my first novel last year, I grappled with the ethical implications of using a large language model to guide my writing process (one I have been carefully refining for decades). Prompt after prompt, my mind became inundated with the notions of how every query consumed a not insignificant amount of energy and the black box of the generated text’s origins. “Am I relying too heavily on this …
How an AI medical scribe saved my practice
I used to believe that being a good physician meant being generous, flexible, and willing to bend the rules if it helped a patient. I don’t believe that anymore.
The lesson came from a young patient who walked into my traditional Chinese medicine (TCM) clinic one afternoon, looking exhausted, embarrassed, and desperate.
He needed a powdered herbal preparation that cost around NT$7,500 (about $230). He stared at the ground and whispered, “Doctor, …
Physician boundaries: When compassion causes harm
In Japan’s far north, Hokkaido stretches across mountains, forests, and endless snow. For months each year, the landscape turns white, and travel slows to a crawl. This vast and beautiful region (known for dairy farms, fishing towns, and open space) is also one of the most sparsely populated parts of the country.
For people living here, health care access depends not only on medicine, but on geography, infrastructure, and weather. It’s …
Rural health care access: Japan vs. U.S.
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Licensed attorney Anu Murthy discusses her article, “A lawyer’s guide to physician side gigs.” Anu details why the pandemic caused an explosion in physician side gigs (from telehealth to passion projects) and …
A lawyer’s essential checklist for physician side hustles [PODCAST]
As the holiday season approaches, many people look forward to gatherings, travel, and celebrations centered around food. For those living with food allergies, however, this time of year brings a different reality. It means navigating crowded parties where allergens are everywhere, traveling on airlines that may or may not honor allergy precautions, and repeatedly encountering people who still do not fully believe that food allergy is real or life-threatening. The …
When TV shows use food allergy as murder
It is remarkable that treatises, white papers, editorials, and articles on the cost of health care are consistent with ignoring the essence of care, and they are lacking in physician commentary. Insurance is not health care, and there can be no health care without doctors. Simply stated, in the end after all the intermediaries have claimed their pound of flesh for myriad services that most often provide little to no …
The devaluation of physicians in health care
Developmental-behavioral pediatrics (DBP) was once defined by giants, leaders who authored textbooks, set standards, and gave the specialty a clear identity. Today, the field is fragmented, misunderstood, and too often hostile to new ideas. My own career arc illustrates how inbreeding and isolation have hollowed out DBP, leaving children without advocates and institutions without direction.
At a major military medical center, retired military DBPs replaced me. All were trained at that …
Institutional inbreeding in developmental-behavioral pediatrics
Ten years ago, I quit my job and started a solo office-based practice in rural Washington. I serve patients like Mr. G, an elderly gentleman who drove over 70 miles through mountain passes and rural highways to receive care for gangrene of his foot, as nearby hospitals were either too full or too far away. But Medicare’s broken payment system is endangering practices like mine, quietly dismantling access to affordable …
Medicare payment is failing rural health
I live across the street from a funeral home. Each day as I see the cars begin to line up and the people in dark clothes gather to say goodbye, I can’t help but wonder about the stories inside. Who were they coming to honor? What kind of life had just ended? So, most mornings, before I check my email or the hospital census, I read the obituaries.
As a child, …
A doctor’s ritual: Reading obituaries
When an attending doctor recently took me aside after a particularly hard clinical case with a first-year resident, she made pains to point out to me that the resident felt she wasn’t being treated fairly by nurses, because she was a woman. The physician went on to describe the difficulty of being a woman in a professional world where male colleagues are taken more seriously and treated with more respect, …
The physician-nurse hierarchy in medicine
Researchers at Sichuan University in China have developed a laser therapy that selectively kills pancreatic ductal adenocarcinoma (PDAC) tumors while preserving the surrounding healthy tissue. The technology, built around a 6.1-micron laser, takes advantage of the characteristic collagen fingerprint within PDAC tumors to focus the laser energy where it is needed the most.
The technology has received full approval from the Chinese National Medical Products Administration and will be developed …
How new pancreatic cancer laser therapy works
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Pediatric emergency medicine physician Bronwen Carroll discusses her article, “The childhood risk we never talk about.” Bronwen explains the staggering data showing child sexual abuse is far more common than many other …
How to prevent child sexual abuse [PODCAST]
Innovation in health care is often described in technological terms (new devices, advanced imaging, digital platforms). But some of the most meaningful forms of innovation happen quietly, inside small hospitals struggling to survive.
This is the story of a community hospital in Taiwan that once faced collapse, and the unexpected lessons it offers to health care leaders everywhere.
Looking for a way forward
In the late 1990s, the hospital was in serious decline. …
Community hospital innovation: a survival story
California’s opioid policies reveal a stark hypocrisy, imposing draconian restrictions on prescriptions for chronic pain patients (leaving wildfire survivors and others in unrelenting agony) while allocating over $100 million annually through initiatives like the California Harm Reduction Initiative (CHRI) and Proposition 36 to provide free needles, pipes, and fentanyl test strips to addicts with minimal oversight. This disparity is compounded by the Medical Board of California’s (MBC) overreach, where physicians …
California’s opioid policy hypocrisy
In medicine, we are trained to act decisively in moments of crisis. We respond to hemorrhage, cardiac arrest, and trauma with clarity and speed. Yet when the crisis is internal (when the dysfunction lies within our teams, our leadership structures, or ourselves) many of us hesitate. We tolerate misalignment because it is familiar. We fear change more than we fear staying stuck.
This fear is not benign. It erodes morale, fractures …
The physician’s change cycle: Why doctors stay stuck
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Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article, “The rise of digital therapeutics in medicine.” Muhamad explains what prescription digital therapeutics (PDTs) are, emphasizing they are …
A psychiatrist explains the new frontier of prescribed software treatments [PODCAST]
As a psychiatrist, I often find myself confronting not only the symptoms of mental illness but also the deep scars left by stigma. Even in 2025, despite advances in neuroscience and a growing cultural focus on mental health, stigma remains one of the greatest barriers to healing. It manifests in silence, shame, and misunderstanding, and it affects patients, families, and even those of us within the psychiatric profession. Addressing stigma …
How stigma in psychiatry affects patients
Developmental-behavioral pediatrics (DBP) has lost its identity, and my career shows what happens when leadership retreats.
When I applied for positions in Tucson and Jacksonville, I was not seen as a developmental pediatrician with expertise in neurodevelopmental disabilities. Instead, I became the dumping ground for “Stranger Things” (children whose needs were psychiatric, not developmental). Administrators and chiefs, lacking even a basic understanding of DBP, misrouted cases into my lap. The result …
Developmental-behavioral pediatrics: the lost identity
We put on that strong face. Resilience. We learn to handle anything. But our outside appearance can fool you as our inner turmoil plays havoc emotionally.
I learned quickly that nursing was not all about holding hands with a sick child in the emergency room or fluffing up a pillow for a dying grandma. My initiation into the dark side of nursing began in the emergency department. I was fresh out …
The haunting trauma of nursing
There was a time when I thought burnout was easy to recognize, that it came with flashing red lights and emotional breakdowns. I imagined it as the dramatic kind of collapse you see in movies: a physician walking out mid-shift, tears in their eyes, leaving their stethoscope behind.
In those days, I didn’t really think about burnout. I believed burnout happened to other people, the ones who hadn’t mastered time management …
Physician emotional fatigue: When burnout becomes a blind spot
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