“I don’t know” may be one of the most difficult phrases to both hear and admit. As a patient, fewer words can make you more anxious, and as a health care provider, fewer words can make you feel more powerless. As a whole, the medical community has fostered and embraced a culture of certainty, discouraging the phrase “I don’t know” because of the helplessness it can instill in patients and …
The cost of certainty in modern medicine
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Palliative care physician and certified physician development coach Christie Mulholland discusses her article “5 things health care must stop doing to improve physician well-being.” Christie challenges the pervasive narrative that younger physicians …
Blaming younger doctors for setting boundaries ignores the broken system [PODCAST]
During the COVID-19 pandemic, conversations about burnout and stress exploded, particularly among health care workers. Much of the advice centered on self-care practices: taking time off, scheduling massages and spa days, practicing mindfulness, protecting your evenings, using your PTO. While these strategies are valuable, they are not the full story.
Positioning self-care as the solution to stress oversimplifies a much deeper physiological process. For many patients (and clinicians) stress is not …
Nervous system dysregulation vs. stress: Why “just relaxing” doesn’t work
Based on our combined experience of over 70 years in patient advocacy, pain management, and behavioral neurology, we are convinced that U.S. public perception and public policy on treatment of pain have been driven almost entirely by sociopolitical and legal factors. Seldom in recent years has policy been significantly influenced by science.
The U.S. enjoyed a brief period of scientifically enlightened policy in the late 1990s through 2008. A large number …
U.S. opioid policy history: How politics replaced science in pain care
Emergency medicine trains clinicians to recognize patterns early, anticipate deterioration, and intervene before outcomes become irreversible. We pride ourselves on seeing what others miss. Yet we are repeatedly instructed, explicitly or implicitly, to ignore the largest pattern of all. Political decisions consistently and predictably shape who arrives in our emergency departments, how sick they are, and how unsafe the environment becomes for the people expected to care for them.
If political …
Alex Pretti’s death: Why politics belongs in emergency medicine
In recent years, medicine has become more open about burnout, workforce shortages, and the challenges facing women in health care leadership. We write about mentorship programs, leadership pipelines, and the need to bring more women into ownership and executive roles. We celebrate women who build clinics, lead departments, and create space for others to rise.
What we talk about far less is what happens when women actually meet each other in …
Women in health care leadership: Navigating competition and mentorship
In an increasingly digital world, older adults are often viewed as prime targets for financial scams. These malicious schemes exploit vulnerabilities inherent in aging, such as social isolation, cognitive decline, and trustfulness. As primary care physicians, we are in a unique position to recognize the signs of vulnerability in our older patients. Understanding the methods employed by fraudsters, the impact on victims, and how to educate them on preventative measures …
Senior financial scams: a guide for primary care physicians
I have the great honor and privilege of coaching medical students throughout their training. In the past week, several students have shared experiences that have stayed with me: On clinical rotations, some shared stories of being referred to only as “student one” or “student two,” their humanity quietly erased. Others described managing food and housing insecurity while carrying the financial burden of medical education. Still others, particularly students with darker …
Moral courage in medical training: the power of the powerless
The false promise of efficiency
The latest punditry calls for three-year medical schools, stripped of ethics and other vital subjects, with less clinical training. The rationale? Efficiency. The result? A generation of physicians unprepared for the complexity of children’s lives.
General pediatricians themselves admit in published surveys that they “know squat” about developmental-behavioral pediatrics (DBP) after residency. Yet the proposed solution is to shorten training further. That is not reform; it is …
A blueprint for pediatric residency training reform
The story of gastroenterology in 2025 is no longer about productivity or reimbursement, it’s about manpower. Hospitals and practices across the U.S. are struggling to recruit, retain, or even temporarily staff the specialists who manage digestive diseases, perform colon cancer screening, and handle emergency procedures like ERCP. What we’re facing isn’t simply a staffing issue; it’s a structural shortage decades in the making.
The shrinking pipeline of gastroenterologists
In the mid-1990s, roughly …
The gastroenterologist shortage: Why supply is falling behind demand
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Physician, former health care executive, certified coach, speaker, and organizational consultant Laura Suttin discusses her article “Why the 4 a.m. wake-up call isn’t for everyone.” Laura shares her personal struggle with the …
Waking up at 4 a.m. is not required for success [PODCAST]
Medical education has a blind spot.
We spend years teaching students to identify diseases. We drill them on symptoms, pathophysiology, and treatment algorithms. By the time they reach clinical rotations, most can rattle off the differential diagnosis for chest pain or abdominal discomfort without hesitation.
But ask a third-year student how much a CT scan costs, or whether an MRI is worth the added expense over an ultrasound, and you’ll often get …
Medical education’s blind spot: the cost of diagnostic testing
More physicians than ever are reaching out for support after being labeled disruptive, inefficient, delinquent, reactive, or poor communicators.
These are highly skilled, deeply committed professionals being written up for professionalism concerns, communication issues, behavior, and “reactivity.” These cases span every specialty, gender, and stage of career.
This is not a reflection of declining professionalism. It is a predictable outcome of practicing in an untenable and broken system. It is an expected …
Disruptive physician labeling: a symptom of systemic burnout
I used to think medicine would change me by adding things. Knowledge. Confidence. Authority. Certainty. I assumed growth would look like accumulation, more skills, more answers, more control. What actually happened was the opposite. Medicine changed me by subtraction.
When I started writing as a medical student, everything felt sharp and exposed. The hospital was loud, inefficient, and often cruel in ways no one named out loud. I wrote about scut …
Medicine changed me by subtraction: a physician’s evolution
Throughout contemporary medical discourse, health disparities among racial and ethnic groups are often attributed to systemic and structural racism. Furthermore, organizations such as the American Medical Association assert that race itself is a social construct and urge a shift away from viewing race as a “biological risk factor” toward a “deeper understanding of racism as a determinant of health.” Unfortunately, this framing rings hollow and obscures an important …
Genetic mutations and racial disparities in leukemia survival
I entered medicine believing (perhaps naïvely) that experience mattered. Triple board certification, years of clinical practice across three specialties, and working in New York City felt like assets that would translate beyond the bedside. Like many burned-out physicians, I assumed that transitioning into a non-clinical role would be difficult, but not absurdly so.
I was wrong.
Over several years, I applied to what felt like thousands of positions in pharmaceutical companies, utilization …
The hidden costs of the physician non-clinical career transition
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Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician legal rights: What to do when agents knock.” Muhamad shares a terrifying but essential guide for any …
Invoking your rights is the only way to survive a federal investigation [PODCAST]
As a longtime writer and health care educator, I am sometimes approached by media reporters to discuss multiple fields. Despite the breadth of my publications in U.S. and Canadian health care, my original academic degrees (45 years ago) were in engineering subjects. Among my other hobbies, I have at times contributed as a peer reviewer in advanced science and technology journals.
Thus, it came as no surprise when I received the …
Why almost nobody needs a PhD anymore: an educator’s perspective
We are currently living through the greatest democratization of health information in history. You no longer need a library card or a medical degree to learn about physiology, nutrition, or disease prevention. We carry the world’s medical knowledge in our pockets, accessible with a single tap.
On the surface, this is a victory for public health. People are more aware of the importance of sleep, the risks of processed foods, and …
Health advice vs. medical advice: Why the difference matters
Elevance Health recently reported that it expects to lose more than 180,000 fully insured group plan enrollees in 2026, with its CFO describing the strategy as “prioritizing disciplined pricing and margin integrity over volume.” UnitedHealth has made similar statements. Both are effectively walking away from the fully insured employer market, where administrative complexity no longer justifies the economics.
At the same time, private equity is pouring capital into …
Why private equity is betting on employer DPC over retail
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