A few days ago, I was speaking with a high-achieving, articulate, brilliant friend, someone always up and doing, super-expressive. During our conversation, I noticed her stumbling over her words, which was quite unusual, and her fidgety hands. She was narrating a traumatic incident that had occurred to her and how it tore her apart and made her simply give up on everything, in her words, “she was done.” Throughout the …
Trauma in high-functioning adults
It started with a phone call.
“Doc,” my CEO said, “do you know this doctor?”
I asked why.
“He wrote a prescription for a drug that cost $250,000 for one course.”
“You must mean $25,000,” I said.
“No,” she replied. “The insurer already paid two hundred fifty thousand dollars.”
I assumed it had to be a miracle therapy, some one-in-a-million life-saving treatment. Then she told me the name: Acthar Gel. I nearly fell out of my …
How Acthar Gel became a $250,000 drug
An excerpt from Doctor Not Guilty.
The Fifth Amendment of the United States Constitution exists for a reason. It protects you from self-incrimination. If you remember one rule from this book, hold on to this: Never talk to the police.
By “police,” I mean every investigative agent: FBI, DEA, OIG, HHS, state boards of medicine, and investigators from the attorney general’s office. Not with a lawyer. Not without one. Not ever.
Silence …
Physician legal rights: What to do when agents knock
The practice of medicine is fundamentally different from the study of medicine. Right now, you’re being rewarded for memorizing and test-taking. But being a good doctor is about communication, clinical judgment under uncertainty, and treating whole humans in context. The skills that get you through preclinical years aren’t the ones that make you excellent at the bedside. Start developing those now: learn to really listen, to tolerate ambiguity, and to …
How to succeed in your medical training
I learned the forbidden truth by searching “how many medical malpractice lawsuits are filed per year and how many are frivolous?” The answer is “17,000-20,000 and all are legitimate.” This answer is incongruous with seven facts.
The facts are: First, a complication causes a medical malpractice lawsuit. Some are medical errors; some are random errors-of-nature. Since an error-of-nature is not caused by negligence, a resulting lawsuit is frivolous. Second, …
Why medical malpractice data is hidden
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Certified financial planners Michael Lynch and Alisa Olsen discuss their article “Create your own financial vision for independence,” an excerpt from their book Taking Care of Your Future: Your Simple System for …
A financial vision to define your retirement [PODCAST]
He spent his youth memorizing lungs. That was how he learned chest X-rays, not by chasing abnormalities, but by studying thousands of perfectly normal films until his eyes could sense when something was ever so slightly wrong. “If you don’t know normal,” he would tell residents, “you’ll never understand abnormal.”
He was a chest physician, not a radiologist, yet his skill with chest imaging became legendary. At Taipei Veterans General Hospital, …
AI in medical imaging: When algorithms block the view
I am a gastrointestinal medical oncologist. I am also a Black woman. When people ask me how I got here, this is the story I share. In 2011, while sitting in a medical school lecture I received an email from a classmate that read: “Open this, you should apply.” It described a program for students who are underrepresented in medicine and interested in pursuing a career in oncology. Without hesitation, …
The danger of dismantling DEI in medicine
Female athletes have redefined strength and endurance, but one common issue still hides in silence: urine leakage during training or competition.
It’s more common than most realize. In certain sports like gymnastics, trampolining, and CrossFit, the rates are particularly high. Still, many women keep silent, assuming it’s a normal side effect of being active or that nothing can be done.
As a urologist, I often meet women who are in top physical …
Female athlete urine leakage: A urologist explains
I thought that’s what I had to do to be successful: Wake up at 4 a.m., get after it, hustle before the world wakes up, and join the club of high performers who swear by their pre-dawn routines. So I tried it. And I was miserable. I’m talking dragging-myself-out-of-bed, foggy-brain, counting-down-the-hours-until-I-could-go-back-to-sleep kind of miserable.
As a brand-new full-time entrepreneur, I was forcing myself into a routine that felt like punishment, all …
Why the 4 a.m. wake-up call isn’t for everyone
Do you get bored when reading a boring book? Do you struggle to concentrate when you haven’t had enough sleep? Do you have difficulty following instructions, make careless mistakes and forget to return calls? Are you sometimes the last one to “get” a joke?
You may be “suffering from” with Autism Spectrum Disorder (ASD) and are “neurodivergent” and “on the spectrum.”
Today’s ASD “neurodivergence” craze has spawned at least two lucrative and …
Are you neurodivergent or just bored?
Applied Behavior Analysis (ABA) has become the default therapy for autism in the U.S., not because it’s the most effective, but because it’s the most entrenched. Mandated by insurers, funded by Medicaid, and marketed as “medically necessary,” ABA now consumes hundreds of millions of dollars annually. But here’s the truth: ABA is unproven, ethically fraught, and fiscally unsustainable.
As a developmental-behavioral pediatrician and lead investigator for the NIH-funded RUPP trials, I …
Funding autism treatments that actually work
The greatest challenge for all who practice geriatrics is reducing polypharmacy, the addition of medications that either provide no benefit or cause harm to seniors. Millions of seniors end up on many medications that are not helping them and could be causing side effects. Geriatricians are the experts in what we call de-prescribing, cutting down on unnecessary medications.
The key reasons seniors end up on too many medications are the following. …
How to reduce unnecessary medications
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Certified financial planner Paul Morton discusses his article “Physician practice ownership: risks, rewards, and reality.” Paul breaks down the massive differences between an employed physician’s financial journey and that of an equity …
Is owning a medical practice worth the ultimate financial risk? [PODCAST]
I recently published a reflection on KevinMD, “A doctor’s duty on 9/11 in a small town,” a piece about clinical duty, quiet advocacy, and legacy. Boston University included it in my nomination for their Advocacy, Equity & Social Justice Alumni Award. I sent it to every major news outlet in my region. No one responded. One station asked if I’d go on camera. I agreed. Then, silence. This is …
Why the media ignores healing and science
Every clinic has moments that stick with you. They aren’t always dramatic, but they show why some people end up suffering longer than they should. During my time working as a medical office assistant, I observed a recurring pattern that spanned across various age groups, backgrounds, and diagnoses. Patients didn’t delay care because they were careless. They delayed because the system had quietly taught them to.
One afternoon, a middle-aged woman …
Why patients delay seeking care
Canada’s primary health care crisis has garnered news headlines and political attention, but an equally alarming crisis is ongoing in long-term care (LTC). More than five years after COVID-19’s deadly sweep through LTC homes, exposing long-standing deficiencies in funding, infrastructure, infection control, staffing and working conditions, many problems remain, driving a critical staffing shortage, burning out workers and impacting resident care. With the need for LTC …
The burnout crisis in long-term care
Since a diagnosis of colon and rectal cancer in 1993, I have had a number of serious complications and a recurrence. Some, if not most of what occurred could have been avoided. My experience points to some gaps in my health care that providers and patients might want to consider.
I was given the option to choose a cancer treatment and made the wrong choice. As a busy university administrator, I …
A story of gaps in cancer care
For the past century, physicians have practiced within the framework of materialism: the belief that everything real can be measured, and everything measurable is real. But that worldview has been quietly eroded by physics itself. In the double-slit experiment, particles behave as waves of probability until observed, at which point they collapse into definite form. Later variations (such as Wheeler’s delayed-choice experiments) demonstrated that observation seems to determine not only …
The role of meaning in modern medicine
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Diagnostic radiologist Rakesh A. Shah discusses his article “A critique of medicine’s response to RFK Jr.” Rakesh argues that major physician organizations have failed in their duty to protect public health by …
Medicine’s silence on RFK Jr. [PODCAST]
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