I’ve seen clients start GLP-1 medications full of hope, and stop them feeling betrayed by their own biology. Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way: one step forward, five steps back.
We …
Why you need a GLP-1 exit plan
Most midlife men don’t walk into our clinics asking for help. They walk in asking for labs.
They’ll tell us they’re “just tired,” “not as sharp,” or “feeling off.” They’ll blame work or age. They’ll ask for hormone testing or a quick fix. What they rarely say (and what most of us rarely ask about) is the deeper truth underneath the symptoms.
There is a silent crisis unfolding in midlife men, and …
Why midlife men feel unanchored and exhausted
My mother’s life was defined by silence. She was born in India. In a world where a woman’s worth was measured in duty: how well she cared for others, how quietly she endured. She was obedient. Her dreams were practical, her voice gentle. Never shared an opinion.
I used to think that by becoming a doctor (a woman with a career, a passport, a voice) I had escaped that silence for …
How medicine reflects women’s silence
A 2022 KevinMD article raised concerns about generic formulations of ADHD medications. The author described what many patients and families had already discovered: Not all generics are created equal. For those of us who lived through the substitutions, the difference was not abstract. It was a roller coaster that intruded on daily life, even on vacation.
The generic in question was manufactured by Mallinckrodt. Unlike Concerta, which uses an osmotic-controlled …
Why not all ADHD generics are created equal
In May, a published report indicated that changes indicative of Alzheimer’s disease (AD) were detected at age 24 via a blood test, which is increasingly available. These changes may begin earlier, but these were the study’s youngest participants. There are no medical treatments for these early manifestations, and aside from providing knowledge of a possible future and potentially causing anxiety, what value does the test hold? Unless a person has …
Early Alzheimer’s blood test: Is it useful?
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Neurologist Carolyn Larkin Taylor discusses her article, “How medical gaslighting almost cost me my life.” Carolyn shares her terrifying personal story of being dismissed by her long-time gynecologist, who labeled her cancer …
How medical gaslighting almost cost a neurologist her life [PODCAST]
During health care encounters with patients from diverse linguistic and cultural backgrounds, there is always a concern about information getting lost in translation between health care providers and their patients. Language and cultural concordance significantly affect the quality and effectiveness of health care delivery. Although phone-in interpreters, with or without video capabilities, are accessible online, none can match in-person interpretation. Even if high-profile political conversations have adapted to artificially intelligent …
Language doulas bridge care gaps
I still remember the feeling of relief standing by my uncle’s bedside. The monitors were humming with steady rhythms; the surgical team was congratulating themselves on a textbook procedure. By all clinical metrics, he was a success story. The intervention worked. The pathology was addressed. He was “stable.”
We celebrated his discharge as a victory lap. We trusted that the packet of papers in his hand (filled with appointments, medication schedules, …
The patient carryover crisis: Why discharge education fails
The National Academy of Medicine defines diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” Office-based practices are the predominant setting for malpractice claims related to diagnostic error.
Yes, office-based care settings.
Fast-paced, high-acuity emergency departments (EDs) have fewer malpractice claims related to diagnostic error than physician offices, according to recent research. Furthermore, 53 …
Why diagnostic error is high in offices
“No medical malpractice lawsuit is frivolous,” is the narrative echoed by plaintiff attorneys. Medical malpractice lawsuits are vastly underrepresented. Also, because frivolous lawsuits are too expensive to litigate, expense is a natural deterrent for filing one. Plaintiff attorneys have controlled this narrative for as long as I’ve been in practice since 1972.
Recently, I examined the veracity of this claim. Indeed, there are 66 million civil lawsuits filed in the …
The myth of no frivolous medical lawsuits
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Pediatrician Wendy Schofer discusses her article, “Why food perfectionism harms parents.” Wendy explains how the intense worry over family eating habits and ultraprocessed foods is often a symptom of a deeper issue: …
A pediatrician explains the real danger of food perfectionism [PODCAST]
Keeping my head down and working through intern year was all I had known. My days blurred into nights, and my weeks into months. The dreary Pacific Northwest winters had only compounded this. Despite a quiet yearning for connection and community, I declined most social invitations. My sense of obligation did not end at the hospital doors. It followed me home, where expectations and emotional responsibilities lingered. I often felt …
Divorced during residency: a story of clarity
Last winter, a senior nurse in our psychiatric unit told me, “The dashboard says we’re low-risk. But during night shifts, I don’t even feel safe walking to the bathroom.”
The monthly quality report on her desk said the same thing it had said for nearly a year: “Violence incidents: no significant difference among the three wards (p > .05).”
On paper, her ward looked normal. At the bedside, it was anything but.
Her …
Medical statistics errors: How bad data hurts clinicians
The recent Atlantic article by Olga Khazan, “Avoiding Ultraprocessed Foods is Completely Unrealistic. Especially if you have kids,” brought a concern that I’ve carried for a long time into full clarity: Our worries about family weight and eating habits aren’t actually about the physical body. They’re about perfection. And they are a call to approach health completely differently.
I am a pediatrician working at the intersection of family stress, emotional …
Why food perfectionism harms parents
The British tend to use the term “carer” for the people who help other persons with needs. It seems to emphasize its root word, care, with implications for family members, volunteer helpers, and professionals who fill that role. The American term tends to be “caregiver;” its usage has become more common.
Even when I worked in health care, I had never used either of those terms. But over the last fifteen …
A husband’s story of end-of-life care at home
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Certified financial planner Michelle Neiswender discusses her article, “Why physicians should not be their own financial planner.” Michelle explains why physicians, despite being brilliant, often make costly financial mistakes when managing their …
Why being your own financial planner is costing you millions [PODCAST]
In the vast, undulating expanse of rural America (those counties where the horizon stretches like a taut bowstring, evoking the stoic endurance of Steinbeck’s Joads) one might expect the pulse of health care to beat with the resilient rhythm of native ingenuity. Yet, as a recent study in the Journal of the American Medical Association reveals, physicians sponsored under the H-1B visa program are twice as prevalent in these bucolic …
The H-1B crutch in rural health care
A recent Wall Street Journal graphic traces the rise in autism prevalence among eight-year-olds from 2000 to 2020. The slope is unmistakable, upward, steady, and steep. But it’s not a crisis. It’s a reckoning.
Each inflection point on that chart marks a milestone in institutional clarity:
Autism prevalence surveillance: a reckoning, not a crisis
I strongly believe that working harder in medicine is making us as doctors poorer, and it’s quietly harming patients too. Not because we don’t care, but because rushing destroys the very thing patients need most: Time, attention, and real care.
Let me explain.
If you’re a medical doctor or another primary care clinician, you’ve probably heard this your whole career: “Work harder. Work faster. See more patients. Push more. Do more.” And …
Physician income vs. burnout: Why working harder fails
Take a look in your medicine cabinet. What you see isn’t a sign of weakness; it’s a testament to one of the greatest partnerships in modern life: the one between your body and medical science. From the vaccine you got as a kid to the pill that keeps your blood pressure in check, these interventions aren’t just treating sickness. They are part of who you are. In a world still …
Our relationship with medicine: a triumph
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