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Nephrologist Timothy Pflederer discusses his article “How value-based care transforms chronic kidney disease management,” highlighting how value-based care (VBC) is reshaping the treatment of chronic kidney disease and end-stage kidney disease. Timothy …
In medical training, there are moments when the question quietly shows up. It might be during a night shift, after a long stretch without sleep, or while catching up on charting. The thought is simple, but heavy: What if I had chosen something else? What if I had gone into engineering, or business, or any path that didn’t ask quite so much?
This reflection started as an assignment for a medical …
“Did I get dumber?” This poignant question from a medical student, asked in frustration after receiving a lower-than-expected grade, became the focus of a forty-five-minute academic coaching session. Simply put, my role as a learning specialist was to foster a mindset shift: from “my grade determines my self-worth” to “my grade reflects where I am in my learning right now and guides my next steps.” Helping the student build this …
An excerpt from The Clinical Research Handbook: A Practical Guide to Designing, Conducting and Publishing Clinical Research.
Research is a powerful force for change. Whether addressing global health care disparities, improving local community services, advancing technology, or exploring the frontiers of science, well-chosen research projects can solve practical problems and expand our understanding of the world. However, identifying the “right” question is often the hardest—and most critical—step in this journey.
This …
As a urologist, I see recurrent UTI patients nearly every day, and most cases are routine: nasty bacterial infections that appear in the bladder every few months. However, a recent patient turned out to be the zebra rather than the horse. This particularly lovely woman was 91, an Italian immigrant, and was accompanied by her adult son, who helped provide history and translate as needed. She sat calmly on the …
The ongoing opioid crisis, claiming over 70,000 lives annually in the U.S. according to the CDC’s 2023 data, presents a perplexing scenario where regulatory bodies, in their attempt to curb misuse, have inadvertently intensified challenges for health care providers and patients. The Centers for Disease Control and Prevention (CDC) issued its 2016 guideline for prescribing opioids for chronic pain, with revisions in 2022 to address misapplications, yet these efforts have …
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Attorney and wealth manager David B. Mandell discusses his article “Why physicians are unlike the ‘average’ investor,” highlighting why doctors face unique financial challenges compared to most U.S. investors. David explains the …
As a cardiologist in New York City who treats a sizable Bangladeshi‑American community, I have witnessed otherwise healthy individuals exhibit concerning cardiovascular events, frequently in the absence of conventional risk markers. What unites them? Severe, protracted psychological stress brought on by prejudice, family court disputes, immigration problems, or financial instability.
The mechanisms of prolonged stress
Prolonged stress raises cortisol, adrenaline, and inflammatory cytokines via activating the sympathetic nervous system and hypothalamic‑pituitary‑adrenal (HPA) …
Coronary artery disease is still the world’s number-one killer.
That’s despite statins, PCSK9 inhibitors, stents, bypasses, and decades of lifestyle messaging.
We’ve gotten better at managing heart attacks, but we haven’t cured heart disease. Or prevented it. Or even figured out exactly what causes it.
As an internist and lipidologist (in recovery), I spent years chasing cholesterol numbers, especially HDL. I gave talks for Abbott. I pushed niacin like it was salvation. Then …
Today for the first time, I got flowers from a grateful patient.
And I reflect on how rough the week has been, all the things that seemed impossible and insurmountable, and everything that has brought me to this point. The patient is going on hospice, he’s going to die, yet he felt that I made a significant impact that he wanted to show his gratitude. And that almost brought me to …
American medical schools and universities once led the world in biomedical discovery, in large part due to federal funding. Public investment in science helped eradicate polio, unlock the human genome, and develop life-saving treatments for diseases once considered death sentences. But that era of reliable federal funding is ending under the current White House administration – and America’s research enterprise is at risk of going with it.
Over the past decade, …
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Physician Jessie Mahoney discusses her article “Ending burnout through structure, not gimmicks,” making the case that the most effective remedies for physician burnout are systemic changes—reasonable patient loads, thoughtful schedules, supportive leadership, …
I’ve worn many hats in my medical career—lab technician, Physician Assistant, Army Captain, and teacher. But no matter where I’ve served, one truth has followed me like a shadow: The most effective medical learning doesn’t happen in a classroom. It happens beside a patient, with blood pressure cuff in hand, chart under arm, and a mentor who knows when to step back and let you try.
The most powerful educational model …
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American medicine has mastered a perverse art: paying more to achieve less.
We call it “cost-cutting,” but it is a system of engineered backwardness. We underfund clinical staff, then spend fortunes on lawyers to defend the inevitable errors. We employ armies to process bills while insurers employ armies to deny them. We treat the eyes, the teeth, and the mind as optional accessories, as if they could be unbolted from the …
This first decade of my career as a millennial physician is starting to look as fragmented on my CV as it has felt in reality, chasing even a modicum of the stability that the physicians of my father’s generation took for granted. Meanwhile, the chaos engendered by market forces like vertical and horizontal integration across insurance and hospital systems, private-equity-backed buyouts of physician practices and surgery centers, and now just …
Before I started medical school, I used to pass the same government hospital every day on my way to school. It was one of those places that offered “free treatment,” but even as a teenager, I could sense that the care was often just for the name. I remember going to school the next day at around 6:30 a.m., I saw a man sitting outside the hospital, the same man …
As doctors, we often tend to focus on solving the problem at hand. We identify the issue, make a diagnosis, and try to treat the condition to the best of our capabilities. And in this pursuit to achieve our textbook level of homeostasis, we often forget that it is the patient who requires us. As rightfully pointed out in the posters outside the palliative care center, sometimes we may encounter …
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Public health advocate Kathleen Muldoon discusses her article “Why congenital CMV should be on every parent and doctor’s radar,” revealing how congenital cytomegalovirus (cCMV) remains the most common viral cause of disability …
In today’s health care system, primary care is stretched thin. Patients face longer wait times, providers are burned out, and practices are under constant pressure to do more with less time in their hands. In the middle of this strain, I have noticed a troubling trend, divisions between physicians (MDs, DOs) and nurse practitioners (NPs) or physician assistants (PAs).
I strongly believe that …
I have always despised the trope of the patient who pulls through against all odds, despite all evidence to the contrary. Yes, diagnoses can shift and treatment plans evolve, but the ultimate trajectory rarely strays far from the original suspicion. Still, I understand why those stories resonate.
As a resident, I cared for a teen who got a night off from treatment to get married, and another who went to prom …
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