I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.
How it works
The cycle is simple:
The weight of a number
Three years ago, I sat in my car during a work break, hands trembling as I opened my MCAT score report. The number stared back at me: 494. My heart sank. As a husband and father of two young girls, I had poured five months into prep courses, question banks, and late-night study sessions, all while balancing family and work. I walked out of that eight-hour …
As a physician provider in my State Physicians Health Program, I have watched brilliant colleagues flicker out. Not because they lacked skill or grit, but because the system treated their humanity like an optional feature. We train physicians to master physiology, not how to metabolize grief. We celebrate heroics, not healing. Then September arrives, Suicide Prevention Month, and we draft statements. The statements are sincere. They are not sufficient. It …
I have spent decades learning about how bodies and brains work, but nothing has taught me more about complexity than raising my autistic son. He is nine, curious, brilliant, and completely captivated by chemistry. He can explain the structure of an atom with more clarity than most high school students.
But when we step into the real world (classrooms, stores, even family gatherings), sometimes his brain does not get to shine. …
“I was excited to see you today because I thought you were going to answer all my questions,” a patient once told me. I smiled, masking the insecurity. “I wish I could.”
The truth is, I often cannot (at least not in a single visit). Medicine is rooted in curiosity and lifelong learning. Patients expect certainty, but doctors live with uncertainty. We know enough to know how much we do not …
In my years as a physician on the front lines of addiction and pain medicine, I have never encountered a medication as transformative as buprenorphine (Suboxone). I have seen patients, broken by years of opioid addiction, have their lives change within an hour of their first dose, ready to reclaim a life they thought was lost. For these patients, buprenorphine is as essential as insulin is for a person with …
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Health care executive Ashish Mandavia discusses his article “Why U.S. health care pricing is so confusing—and how to fix it.” Ashish explains how systemic misaligned incentives, opaque insurance practices, and weak enforcement …
I never expected that iron deficiency anemia would change the course of my life. I felt off. Tired in a way that sleep could not fix. Foggy, weak, emotionally distant. At first, I thought I was just worn down from work and the daily grind. I was not myself, physically, mentally, or emotionally.
Eventually, I was diagnosed with iron deficiency anemia, a condition many associate with mild fatigue or simply “not …
Kidney stones are not only about what you eat or the genes you inherit. They are also about where you live and how hot it gets. Every summer, urologists notice the same pattern: as the temperature climbs, so do the visits for kidney stones. Because heat and humidity do not just make us sweat, they change how our bodies handle water and minerals. Dehydration concentrates the urine, crystals form more …
Let me just start by saying: If you are reading this and thinking, “Who voluntarily takes medical board exams at 63?” You are absolutely right. Normal people do not do that. They take up golf from the Green tees, try to marry off their kids, and complain that the younger generation cannot drive. But me? I spent four precious months of my remaining life cramming for the ABIM boards like …
The night shift was unusually calm. Mr. T, a 74-year-old admitted for pneumonia, had completed his evening antibiotics and was resting quietly. His blood pressure, heart rate, temperature, and oxygen saturation were all within normal limits. The nurse’s 2 a.m. note was brief but telling: “Less talkative tonight,” “Needed encouragement to walk to the bathroom,” “Left most of his dinner untouched.”
By morning, Mr. T was febrile, hypotensive, and confused. Within …
Appointments booked months out. Overwhelmed specialists. ERs struggling to stay staffed. The physician shortage is not coming. It is already here.
The Association of American Medical Colleges projects a shortfall of more than 124,000 physicians by 2034. But that number does not capture the reality that doctors are leaving medicine quietly, every single day. Some retire early. Others step into nonclinical roles. Many more are simply trying to find a better …
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Pediatrician and certified coach Jessie Mahoney discusses her article “Why so many physicians struggle to feel proud—even when they should.” Jessie explains how medical training conditions doctors to downplay success, deflect compliments, …
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As physicians, we are trained to prescribe, to fix, to optimize. Our patients expect it, and frankly, so do we. I built a career around lipid panels, trial data, and prescriptions meant to shave percentage points off cardiovascular risk. But lately, I find myself offering something far less high-tech and far more radical: a walk.
Walking is slow. Impractical. Rarely the efficient choice. Which is exactly why it matters.
Everywhere around us, …
An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
What is a high-risk pregnancy?
You may find it strange that there is no single accepted definition of what constitutes a high-risk pregnancy. Probably more than half of women will have at least one risk factor that could be an issue, but for most of these women it will minimally affect their pregnancy care or the outcome. For other …
In recent years, American politics has witnessed a disturbing rise in conspiracy-driven health narratives that undermine science and public safety. Among the most vocal proponents of anti-vaccine rhetoric has been Robert F. Kennedy Jr., whose campaign of misinformation poses a clear threat not only to childhood immunization but to medical research more broadly. One might assume that the nation’s leading physician organizations, particularly major medical and pediatric associations, would respond …
When I am sued by a prominent medical malpractice plaintiff attorney, I open the firm’s website. Despite the lawyer’s prominence, the website uncharacteristically solicits for medical malpractice, claiming, “If you have a phone, you have a lawyer.” We all know that it takes more than a phone; it takes a case. What I have learned since that day is a lesson for every physician practicing medicine because each, like it …
A dangerous truth is hidden behind the winning smiles and cartoon-adorned walls at pediatric dental offices: Children are dying or suffering from debilitating neurologic injury during routine care, and few are paying attention. This glaring oversight in ambulatory pediatric dental care is concerning not only for the potential harm to vulnerable, unknowing families but also to the medical community at large. Now more than ever, pediatric dental care is being …
In the hierarchy of health care professionals, I supposedly stand on one of the lowest steps of that ladder. Some say I am just a CNA. Some say I am the backbone of nurses and physicians. I say: I am a strategic part of this ladder. I do not have the medical knowledge or skills of a physician nor of a nurse. But what I do have is a heart …
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Why kratom addiction is the next public health crisis.” Muhamad explains how kratom, a botanical imported from Southeast Asia, has …
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