Imagine a physician who has been practicing anesthesiology for 20 years. She is skilled, board-certified, well-liked, and respected by her team. She now works more hours than she did 10 years ago, covers more call, cares for sicker patients, and manages an …
Insurance consolidation is a patient safety problem
An older patient tells the health care team that swallowing medications is difficult. Pills get stuck in the throat. Some trigger gagging. Others are skipped altogether because taking them has become an ordeal. The concern is documented, the difficulty is acknowledged, and in some cases, a swallowing assessment is even performed. Yet the prescription remains unchanged.
Weeks later, the patient has missed doses or stopped the medication altogether. The medical record …
When difficulty swallowing pills looks like noncompliance
Physicians tend to view conditions affecting mental health as entirely different from those affecting the digestive system. Depression is managed in one clinic, irritability and constipation in another, and chronic fatigue somewhere in between. However, mounting evidence indicates that these conditions are potentially interconnected. The connection might start in the gut.
Human intestines are host to trillions of microorganisms collectively referred to as the gut microbiota. They are involved in a …
The gut microbiome and mental health are interconnected
As a prominent health care educator and advocate for chronic pain patients and their clinicians, I receive a large number of emails and potential papers in venues where I am active. Every week, I hear from people who have been harmed by U.S. government misdirection and outright health care fraud. Increasing numbers of those who come to me are doctors who have been railroaded into prison and had their lives …
Why are doctors prosecuted for prescribing opioids?
During and after the pandemic, I was actively looking for a non-clinical position. Despite my love of medicine and two decades as a partner in a busy, prestigious OB/GYN private practice, I would have left clinical medicine entirely if the right opportunity had come along. That is how depleted I was. That is how broken the system had become for me.
It didn’t come along. Eventually, I stopped waiting for an …
Leaving insurance-based practice while burned out is a trap
“If gravity pulls everything down, why are my health insurance premiums and co-payments skyrocketing?”
The question sounds humorous, but beneath the humor lies frustration shared by millions of Americans. Health care spending in the United States continues to rise year after year. Medical technology has advanced dramatically. We have better imaging, more sophisticated procedures, and an ever-expanding list of medications. Yet many patients are finding health care increasingly difficult to afford. …
Health care affordability is now a moral crisis
The third pharmacy turned him away. My patient had already driven across Northern Michigan in search of his life-saving cancer medication. The first pharmacy was out of stock. The second was out too. At the third, he was told they hadn’t received a shipment in weeks.
On the other end of this crisis are the physicians. We spend our late evening hours calling store after store, a desperate game of pharmacy …
U.S. drug shortages threaten national health security
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Rural doctors hit a ceiling around 35 patients a day, and hiring more clinicians will not move it. Tod Stillson, a family physician, medical device inventor, and health care entrepreneur, argues that the …
What happens when physicians cede AI to direct-to-consumer startups [PODCAST]
Ensuring a patient escort has long been a standard safety requirement for discharge after outpatient anesthesia. The rule is increasingly difficult to satisfy for patients who live alone. Even when a loner patient can arrange for someone to closely oversee them at home until the effects of anesthesia have completely worn off, which is generally presumed to be a 24-hour period after administration, they cannot always ensure someone to physically …
How a self-driving car medical escort could work
The emergence of artificial intelligence (AI) in health care is reshaping how clinical teams diagnose, document, and deliver care. Adoption is rising quickly, with the American Medical Association reporting that two in three U.S. physicians already use AI tools in practice, a 78 percent increase in just one year. To keep pace with this acceleration, health care organizations must focus on building and maintaining clinical trust in the technology before …
Clinician trust in AI is not a one-time milestone
It has been 20 years since the term “value-based care” (VBC) entered the health care lexicon.
VBC was supposed to transform health care. It promised to move the system away from fee-for-service (FFS), a model that rewards volume over outcomes, toward a future defined by prevention, efficiency, better patient results, reduced waste, and lower costs. Two decades later, that promise remains largely unfulfilled. Despite years of pilots, policy pushes, and payment …
The real reason value-based care has not delivered
Mental health is often discussed as if it belongs to a certain kind of person. Someone who can articulate their feelings clearly. Someone who can describe anxiety, name sadness, or explain what feels off. But this way of thinking leaves out an entire group of people whose emotional lives are just as real, even if they are expressed differently.
People with intellectual disabilities experience stress, frustration, loneliness, and joy in deeply …
Mental health in intellectual disability is real, not less
The history of psychiatry is often a story of our own impatience. When we look back at the era of the ice-pick lobotomy, we tend to view it as a distant, primitive horror. But if we look closer, the impulse behind it remains very much alive. It was the dream of the “quick fix,” the belief that if we could just physically alter the brain, we could bypass the messy, …
Psychedelics in psychiatry are not a neural reset
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If GLP-1 drugs are the breakthrough of this decade, diet may be the most overlooked way to enhance their effect.
These medications have transformed the treatment of obesity and type 2 diabetes, delivering levels of weight loss and glycemic control that were once unimaginable. They are, without question, one of the most important pharmacologic advances in modern medicine.
But amid this progress, we are overlooking a simpler and more fundamental question. Have …
Diet and GLP-1 drugs work better together
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Most physicians spend more time fighting their software than seeing patients, and piling on new tools has not fixed it. Grace E. Terrell, a physician executive, argues that decades of layering electronic health …
Why every new health care tool keeps making the job harder [PODCAST]
There are experiences that do not ask to be understood right away. They ask to be felt.
On Teshima Island in the Seto Inland Sea of Japan, tucked quietly away from the rhythm of daily life, sits Les Archives du Cœur, The Heart Archive, by Christian Boltanski. It is, in essence, a collection of heartbeats. Thousands of them, recorded, stored, and offered back into the world as sound, light, and memory. …
Finding meaning in medicine at a career’s quiet edge
There is a topic that has been avoided since the beginning of the Age of Enlightenment in medical discourse. Nothing to do with diagnosis, prognosis, or treatment protocols, but about the invisible human nature that holds patients together when science runs out of answers. That conversation is about faith.
I personally did not have it for a long time. For most of my thirty-five years in medicine, I kept faith neatly …
What happened when I brought faith into medicine
I remember the moment I understood I would have to write this story.
I was in Berlin with my girlfriend, wandering the city hand in hand, stopping for coffee near the Tiergarten with no real plan. We decided to visit the Jewish Hospital, the Jüdisches Krankenhaus. I had heard the name so many times in my family, and now I was just a few metro stops away.
We entered beneath the old …
Why do physicians write fiction?
While protein has dominated the nutrition conversation over the past decade, fiber is rapidly gaining ground as more consumers recognize its role in preventing disease and promoting overall well-being. From digestive health and weight management to heart health, blood sugar control, colon cancer prevention, and even reducing inflammation, the benefits are hard to ignore.
Yet most Americans average only 50 percent of optimal fiber requirements, with most consuming just 15 grams …
How to eat more fiber without the bloating
Whether the spread of bird flu to dairy cows, pigs, cats, dogs and seals or the spread of COVID-19 to deer, minks and zoo animals, the press is often mum about zoonotic viruses when they jump species.
Who, for example, knows that Ebola can spread to dogs, pigs and antelopes? Is non-reporting of virus activity to forestall panic or protect commercial markets?
The spread of animal viruses is caused by domestication, warfare, …
Why the press stays silent on zoonotic viruses
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