I retired from my pediatric cardiology practice almost two years ago, and I keep circling back to one of the final days of my career. For a long time, I told myself I had simply burned out, worn thin by the pace and the paperwork. Only with time and reflection have I realized I didn’t step away because I was tired, I stepped away because of deep moral injury.
I remember …
Why I left pediatric cardiology: a story of moral injury
It was Christmas Eve 2005, and the health plan was closing at 3 p.m. By 4 p.m., the nurses, doctors, pharmacists, and support staff who handled utilization management for HIP Health Plan were already on their way home. My usual role at the health insurance company involved creating quality profiles for physicians caring for our roughly 1 million members. But that afternoon, I was covering hospital admissions so colleagues could …
Home for Christmas: a physician’s tale of prior authorization
It is beyond a doubt that, in many states, including the state of Maryland in which I am licensed, tort reforms for medical malpractice occupy a good part of the legislative agenda. In Maryland, tort reforms bring:
Why current medical malpractice tort reforms fail
The news headlines and the online chatter are full of chest-thumping claims from both political parties about saving democracy, scandalous finger-pointing at the other guys, battles over sound bites, and circus antics to grab the attention of the media. It is easy to get distracted by all the political drama and lose sight of important facts.
When it comes to health outcomes, the U.S. is leading the world in the amount …
Why U.S. health care outcomes lag behind other nations
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Psychiatrist Farid Sabet-Sharghi discusses his article, “The psychological trauma of polarization.” Farid explains how the human psyche is evolutionarily wired for connection, making the current climate of hostility and division deeply traumatic. …
How political polarization causes real psychological trauma [PODCAST]
There is a stillness in the waiting room,
not exactly silence,
but a quiet that settles over chairs,
minds diverted elsewhere.
Here, women sit in chairs
with their thoughts
floating in opposing directions,
pretending to read magazines,
while their minds
wander hallways
they would rather not travel.
My name is called softly,
and my heart skips a beat,
the time has come.
I follow the routine,
changing from street clothes
into bare arms and a borrowed gown
that never seems to fit properly.
I take a deep breath,
trying …
The quiet bravery of breast cancer screening
With an overwhelming role of automation in modern health care industry, the concept of medical ethics seems to be fading away in the waves of murky economic profiting from value-based bundles meant for pure revenue generation. The commercialized approach towards practice of medicine requires readdressing the core ethical framework which lies at the hearth of patient-doctor relationship. Being innate and inextricable part of clinical medicine, ethical responsibility is meant for …
How automation threatens medical ethics principles
With the onset of fall and winter season, my clinic in the Bronx braces for a flood of worried parents. A toddler coming in with itchy, watery eyes and a runny nose becomes a far too common sight. Parents share of their battles against poorly ventilated apartments, mould and cockroach infestations, housing insecurities; adding to this, the threat of RSV, flu, and COVID-19 exposures in day care and school causes …
When to test for pediatric seasonal allergies
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Interventional physiatrist Francisco M. Torres discusses his article, “A doctor’s own prostate cancer recovery.” He shares his vulnerable story of undergoing a robot-assisted radical prostatectomy and the unexpected shame and “erosion of …
A doctor’s humbling journey through prostate cancer recovery [PODCAST]
Laura, my department chair, is relentless in her enthusiasm for ambient AI systems in clinical care. Daily emails, weekly reminders, and even personal demonstrations; she’s convinced this is the future of medicine. Watching her, I can’t help but feel both admiration and unease. Her excitement is genuine, but I wonder if we’re rushing toward something we don’t fully understand.
And in many ways, she’s right. There’s a quiet joy in having …
The loss of storytelling with ambient AI systems
I used to think the hardest part of building better health care was securing funding.
Then I watched the same cycle repeat itself: A promising pilot launches, early outcomes are celebrated, a report is written, and when the funding period ends, the program quietly disappears. The idea did not fail. It simply could not survive.
Nothing was wrong with the clinicians involved.
Nothing was wrong with the intention.
What was missing was a system.
Health …
Sustainable health care innovation: Why pilot programs fail
Walk into a convenience store. You will see sleek bottles, gummies, shots, and powders in bright wrappers. Companies market them as calm, focus, energy, sleep, pain relief. People treat them like upgraded vitamins. They swipe a card and head home. Nobody runs a checklist on dose, interactions, tolerance, withdrawal, or contamination.
This culture runs on a simple story. Natural means safe and plant means gentle. Legal means regulated while a label …
Unregulated botanical products: the hidden risks of convenience store supplements
Medicine teaches us to recognize disease, to listen for the subtle signs of pathology, to read lab values and imaging scans as if they are languages unto themselves. Yet what many of us were never taught is how to interpret the quiet, internal signals of our own humanity. We can identify cardiac murmurs with precision, but we often miss the whispers of our own exhaustion.
As physicians, we spend years mastering …
The 3 E’s: a physician-created framework for healing burnout
This is a work of fiction.
I directed Mrs. Powell to sit and make herself comfortable. She lowered herself into the chair at the round table in the lobby of my office slowly, her frail, 90-year-old frame eventually settling into it.
“How’s your health, Mrs. Powell?” I asked. This is how I approached most conversations in which a client asked if they could meet suddenly. Usually, it meant they had gotten some …
How end-of-life planning can be a gift
“The meds made me do it” has become a familiar refrain whenever psychiatric treatment intersects with tragedy. It is a phrase heavy with implication, suggesting loss of control, a sense of medical betrayal, and a system that failed at its most basic task: keeping people safe. When cases like the Nick Reiner tragedy enter the public consciousness, that phrase resurfaces almost reflexively, offering a deceptively simple explanation for something incredibly …
“The meds made me do it”: Unpacking the Nick Reiner tragedy
Linda had seen seven physicians in three years. She was on five medications. And she was exhausted, not just physically, but existentially.
“Dr. Goel,” Linda said quietly, “I’ve done everything they told me. The diets. The pills. The exercise programs. Why isn’t anything working?”
At 54, Linda was a meticulous accountant living with hypertension, type 2 diabetes, obesity, chronic fatigue, and generalized anxiety disorder. Her lab results painted a picture of metabolic …
Mind-body connection in chronic disease: Why traditional medicine falls short
“I’m here (cough) to pick up (cough) the steroid,” says the visibly sick patient at the pharmacy. The pharmacist tries not to breathe in too deeply to catch the contagion as she hands over the box of pills. The patient has no idea that others have nicknamed it “poison” or “the Devil’s drug,” because it’s not worth it. The risks of casually prescribing prednisone or Medrol Dosepaks for seasonal illnesses …
The dangers of oral steroids for seasonal illness
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Vascular surgeon Xzabia Caliste discusses her article, “The silent disease causing 400 amputations daily.” She shares the heartbreaking personal story of witnessing both her aunt and uncle lose their limbs to peripheral …
Saving limbs from the silent threat of peripheral artery disease [PODCAST]
During one of my junior internships, I met a patient whose care challenged not so much my medical knowledge as my understanding of culture. Mr. L., a 20-year-old university student originally from China, presented to the clinic with complaints of low back pain. He firmly believed his back pain was caused by an “improper” posture. During our discussion aimed at clarifying this misconception, I encountered considerable resistance. After speaking with …
Why intercultural competence matters in health care
“Doctors need to develop resilience against burnout!”
After 20 years in medicine, every time I hear this, my jaw tightens, and my TMJ reminds me I have a very limited tolerance for nonsense.
Let’s call this what it is: not burnout, exploitation.
You cannot “resilience” your way out of systemic extraction. You cannot mindfulness your way out of an industry built on squeezing more and more labor out of you for less and …
Physician exploitation: Why burnout is the wrong diagnosis
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