We were walking up the fairway on the ninth hole when one of my patients asked, “Larry, when should I come in for my annual?” I had a seven-iron in hand, breeze at my back, and I answered without thinking: “Doesn’t matter.” He looked at me like I had just duffed a wedge. To him, it sounded like I did not care. In a way, I suppose I mishit that …
Rethinking the value of the annual physical
Health care often talks about burnout as if it were a recent discovery. But for many clinicians, the exhaustion they feel did not begin with them. It was inherited, passed down through a system that normalizes overwork, silence, and sacrifice as the price of practicing medicine.
Every generation of providers has heard the same message: This is just how it is. Long shifts, missed meals, unsafe staffing ratios, and silence in …
The generational trauma of the health care system
Burnout isn’t a personal shortcoming; it’s a system warning. A peer-reviewed Annals of Internal Medicine cost estimate pegs the annual bill for physician burnout near $4.6 billion in turnover and reduced clinical time, an operational risk with human consequences. As an executive who works across clinical and administrative teams, I see this as both a human tragedy and an operational failure that demands leadership attention. The good news: There …
Leadership levers to reduce burnout
I am the mother of a 37-year-old son diagnosed with autism and Crohn’s disease. He also has serious intellectual and developmental disabilities (IDD), requiring round-the-clock care and support. I also have a medical history of PCOS (polycystic ovary syndrome) and took fertility medication to conceive him. For years, I have watched the autism diagnosis rate climb while public discourse remained fixated on single causes or stigmatizing narratives. But we are …
A mother’s question about PCOS and her son’s autism
As a pharmacist, I have spent years behind the counter filling prescriptions, answering questions, and giving quick consultations. Most of my days felt routine: scanning barcodes, checking drug interactions, and moving from one patient to the next. But one encounter changed the way I saw my profession forever.
It was a quiet afternoon when an elderly woman walked into the pharmacy. She handed me a prescription for blood pressure medication, but …
A pharmacist’s lesson in patient care
When a teenage boy develops sudden testicular pain, it should always be treated as an emergency. The most urgent concern is testicular torsion, where the spermatic cord twists and cuts off blood supply to the testicle. In these cases, every hour counts; waiting too long can mean permanent damage, loss of the testicle, and even future fertility problems.
Torsion happens most often in boys and adolescents because the testicles grow …
Why sudden testicular pain is an emergency
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Pediatrician Kelly Curtin-Hallinan discusses her article “My improbable survival of stage 4 cancer.” Kelly shares her year-long journey of facing a dire diagnosis, enduring rounds of tests, managing the anxiety of waiting …
Living with the uncertainty of surviving stage 4 cancer [PODCAST]
During the COVID-19 pandemic, I cared for a patient in the intensive care unit whose condition was critical. When I asked how he was feeling, he said, “Doctor, I am not afraid. My family is praying for me, and I believe God will give me strength.” Despite receiving the best medical interventions available, it was clear that his faith, cultural practices, and the support of his family played an undeniable …
The role of faith and culture in patient recovery
Kratom (Mitragyna speciosa) has become a topic of significant debate among clinicians, policymakers, and the public due to differing views on its safety, pharmacology, and regulatory requirements. A recent article raises important concerns about kratom’s pharmacological actions, potential for addiction, psychiatric risks, and regulatory challenges. Although the goal of protecting public health is admirable, it is crucial that discussions around kratom are rooted in current scientific evidence and avoid …
The case for regulating, not banning, kratom
In the late 1990s, Yahoo dominated the internet by organizing websites. Human editors manually reviewed, categorized, and arranged them into a hierarchical directory, essentially a digital Yellow Pages. This worked while the web was small, but the approach couldn’t scale. Google took a radically different path. Instead of relying on human judgment, they built algorithms to crawl, index, and rank pages based on links and relevance. This allowed them to …
Health care is having its Yahoo moment
In the grand edifice of American medicine, where the Enlightenment’s promise of rational progress once shone brightly, a shadow now lengthens across the corridors: the tyranny of the metric. Conceived in the spirit of Taylorism’s efficiency and Deming’s quality control, these numerical arbiters were meant to elevate the healer’s art, transforming subjective judgment into objective excellence. Yet, as with so many well-intentioned intrusions of bureaucracy into human affairs, they have …
The measure of a doctor, the misery of a patient
My mind became the centerpiece of my identity early on in life. I lived so intimately with my thoughts that I came to believe this is who I was. As academic success and the praise of being “the smart one” set me apart, I internalized a sense of uniqueness. Others saw it too, which created early recognition… and isolation.
And here lies the hidden cost:
The hidden cost of a physician’s intellectual identity
An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
If you are 35 or older and either pregnant or thinking about having a baby, you are not alone. The average age for women having babies in this country and around the developed world has increased significantly over the past two decades, and the percentage of women having children after age 35 has increased as well. The teenage …
Pregnancy after age 35: What are the real risks?
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Patient advocate Timothy Thomas discusses his article “The Cap’n Crunch philosophy of medicine.” Timothy shares his personal experiences with gaps in primary care, from learning of his diabetes diagnosis at a Walmart …
Why the “Cap’n Crunch” approach to medicine puts patients at risk [PODCAST]
Cap’n Crunch never held a true naval rank; he was called “Cap’n” because he was the highest-ranking person present, not because he replaced someone more qualified. In some clinics, it is the same: the system is built so you rarely, if ever, see a real doctor. Whoever is around with the right badge simply gets the title and responsibility by default. This “Cap’n Crunch” phenomenon is not limited to one …
The Cap’n Crunch philosophy of medicine
In the early 1990s, while the American Academy of Pediatrics was formalizing its vision of the “medical home,” we were already living it, without a name, without a policy statement, and without institutional applause. At Minot Air Force Base in North Dakota, our pediatric team operationalized what would later be codified: interdisciplinary care, family partnership, coordinated services, and continuity across settings. We did not call it a medical home. We …
Building the medical home before it had a name
For years, concierge medicine and direct primary care (DPC) were viewed as fringe alternatives, reserved for affluent patients or entrepreneurial physicians willing to step outside the insurance system. But in my opinion, these models are no longer “nice-to-have” side projects. They’re becoming essential pathways for physicians to reclaim careers, reduce burnout, and meet patient expectations in an evolving health care landscape.
Burnout is pushing physicians to the edge.
The pandemic only magnified …
Why doctors are leaving insurance-based care
Recent research has revealed that atypical migraine can influence tinnitus in some individuals. Some patients report significant improvement in tinnitus when treated with migraine-specific therapies. But how can someone know whether migraine is a factor in their tinnitus, and what treatments might help?
Understanding migraine beyond headaches
Migraine is a complex neurological disorder, not just a severe headache. Some people experience migraine without ever having a headache. It is thought that inherited …
The surprising link between migraine and tinnitus
We have all been told the story: High cholesterol leads to heart disease, and statins are the magic bullet. The JUPITER trial, published in The New England Journal of Medicine in 2008, became one of the most heavily publicized pieces of “proof” supporting that belief. It claimed that rosuvastatin significantly reduced heart attacks, strokes, and cardiovascular events, even in people with normal LDL cholesterol levels.
But what if I told you …
Rethinking the JUPITER trial and statin safety
South Asians are one of the fastest-growing immigrant populations in the United States, yet their health experiences remain poorly understood, often falling into broad “Asian American” categories that erase unique needs. The result is persistent inequities: South Asians face disproportionately high rates of conditions like diabetes, heart disease, and PCOS, while also contending with cultural stigma, language barriers, and limited representation in the health system.
As a public health professional and …
Why culturally compassionate care matters for South Asian communities
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