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Physical therapist and physician advocate Kim Downey, mental health counselor Nikolai Blinow, and family physician and physician coach Tonya Caylor discuss their article “Focusing on well-being versus wellness: What it means for …
Why shifting from wellness to well-being matters for physicians and patients [PODCAST]
I began my career as a nurse practitioner in primary care, where patient visits are often limited to 15 or 20 minutes to manage complex conditions like hypertension, diabetes, and COPD. What struck me was how often these medical issues came with a psychological overlay like depression, anxiety, panic attacks, and trauma. That shaped the course of treatment as much as lab results or medications. The pace of primary care …
A nurse practitioner on leaving the medical machine
In the ER, we ask, Was he wearing a seatbelt
Partly for the note, but partly so we can remove ourselves
From exploded flesh, splintered bones,
Not sure if we can save that eye.
Something in us says, that will not be me;
I take precautions. We live on,
On the strength of the stories we tell ourselves.
But in the ICU, when one of our own has come in,
After a well-informed try at smothering the spark,
There …
A poem for a physician in the ICU
A system hemorrhaging talent: the scale of the crisis
The global health care system is teetering on the edge of a catastrophic workforce deficit, with the World Health Organization projecting a shortfall of 11 million health workers by 2030. Nowhere is this crisis more acute than in the behavioral health sector, which is not merely losing talent but hemorrhaging it. The time for action is not just now, it’s yesterday.
Community …
The mental health workforce is collapsing
Our one and only daughter has gone off to college. My wife and I dropped her off the weekend before. As we made the four-hour drive from Houston to Baton Rouge along I-10, the road stretched ahead, both endless and fleeting, as if time itself were torn between holding on and letting go. Between bursts of laughter and quiet silences, we spoke of classes, friendships, boys, the discipline of focus, …
The stoic cure for modern anxiety
When most people talk about obesity, the blame often falls on donuts, McDonald’s, fast food, lack of exercise, or lack of willpower.
But as a primary care physician, I see a different reality. Obesity is not always born from a donut, and it is not always caused by time poverty. Yet in many cases, it grows out of time poverty, a system that robs people of the space to think, to …
Obesity is the infant of time poverty
The gimmick of the day is to make -preneur the suffix of the year. Solopreneurs. Doctorpreneurs. Digipreneurs. Trumpreneurs. It should come as no surprise then, that leaderpreneur has appeared in your latest Google search. What is a leaderpreneur, anyway, and why should anyone care? Recognizing that there are as many definitions of leadership, entrepreneurship, and innovation as there are practitioners of those arts, here is my take:
Entrepreneurship is the pursuit …
The difference between a leader, a manager, and an innovator
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Orthopedic surgeon Michael Day discusses his article “Why it’s time for doctors to become performance coaches.” Michael explains why public trust in U.S. health care is declining and how patients are increasingly …
Why physicians should embrace the role of performance coaches in health care [PODCAST]
When the FDA put a black box warning on tofacitinib in 2021, the message was blunt: more heart attacks, more cancers, and more blood clots. The warning came from the ORAL Surveillance trial, which followed over 4,000 patients with rheumatoid arthritis already at high cardiovascular risk. Compared to TNF blockers, patients on tofacitinib had:
…
Tofacitinib: a lesson in heart-immune health
Physicians tell me they want out of the insurance grind, but they’re terrified to actually do it. That fear is costing them years of autonomy they could already have.
As someone who supports both DPC and concierge physicians, I believe in the purity of the DPC model, but I also believe in practical pathways to get there. Hybrid models aren’t the compromise position; they’re the strategic bridge that makes the transition …
The smart way to transition to direct care
Caring for someone with Alzheimer’s is not just exhausting; it is emotionally disorienting. You lose pieces of someone you love, slowly, in a thousand small ways. And while books, doctors, and websites talk about the medical side of Alzheimer’s, there are things they do not prepare you for like the guilt, the grief, the unexpected laughter, and how much it can break your heart. If you are in this role …
7 things no one tells you about being a caregiver for someone with Alzheimer’s
I stare down at the ground below me, closing my eyes tight, trying to hold back the tears. “Push it down. Deep breath in. Breathe it out … slowly … again …” The mantra I say in my head whenever it suddenly becomes too much.
I open my eyes to the view of the ground, unwillingly taking a snapshot of the view that surrounds me. Like the slow click of a …
Bearing witness to the gun violence epidemic
I had been hearing so much about burnout in medicine; and one day, I realized it had crept up on me. It began at my mother’s funeral, when an acquaintance, a former family friend, approached me asking me to examine her painful toe. I tried to avoid her, yet I could not say no. Through my grief and exhaustion, conditioned by years of striving to live a life of purpose, …
A doctor’s struggle with burnout and boundaries
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Certified coach Michael Carlini discusses his article “Why physicians with ADHD are burning out.” Michael explains how high-IQ physicians often mask their ADHD symptoms through hyper-organization, perfectionism, and hyperfocus, which allows them …
Why physicians with ADHD are struggling with burnout despite success [PODCAST]
These days, getting spun out into a state of worry and panic is just a click away: Turn on any device for constant updates on the chaos around us.
Adding to this, on a personal level, the last six years have been the most difficult and transformative period of my life. I had never imagined that I would experience and recover from the darkness of depression and suicidality six years ago, …
Unhooking from the ego in medicine
Behind every prescription safely dispensed stands a pharmacist making dozens of clinical decisions under mounting pressure. What happens when that pressure becomes unbearable? When the professionals who are the last line of defense against medication harm are pushed to their breaking point, patient safety breaks with them. This crisis is real and it is often invisible.
The invisible epidemic
Surveys and workplace reports repeatedly show that large numbers of pharmacists experience burnout …
Why pharmacist burnout is a patient safety issue
Ever been so tired you forgot your own name? I remember a junior doctor on strike in London who told me exactly that. Thirty-six hours awake, stumbling into the children’s ward, staring at a prescription pad. “I couldn’t even remember my own name,” he said, “let alone the right antibiotic dose.”
That was not about wages. That was about survival, his and the children’s.
Yet the story always gets told the same …
Why doctors strike: a matter of survival
Everywhere in American medicine today, you hear the word leadership. Hospitals advertise leadership programs. AMCs hold leadership retreats. Colleagues are urged to “develop as leaders.” Yet when you talk to practicing doctors (the ones actually seeing patients), most will tell you all they want is to do their work, fairly scheduled, with decent colleagues, and without interference.
That is the paradox of the physician leader. Everyone talks about leadership, but almost …
Stop trying to lead doctors like corporate employees
The 9/22 White House press conference regarding acetaminophen raises two serious concerns. First, the scientific accuracy of the purported link between acetaminophen and Autism Spectrum Disorder (ASD) is dubious. Additionally, the norms of public communication concerning whether a President should offer medical advice existed for good reason. The heads of CMS, NIH, and FDA were present, but did not dispute in real time the essential claim that Tylenol causes autism.
Second, …
The false link between Tylenol and autism
I am writing this on a flight, somewhere between Los Angeles and Boston. Next to me, a young couple is tending to their ten-month-old baby: passing a bottle, bouncing her when she fusses, trading weary but tender smiles. Their world is diapers and nap schedules, the endless rhythm of caregiving.
My world today looks very different. I am taking my youngest child to college. With this trip, all three of my …
The paradox of letting your children go
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