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Developmental-behavioral pediatrician Ronald L. Lindsay discusses his article, “A pediatrician’s reckoning with behavior therapy.” He shares his profound professional and personal pivot, …
A pediatrician’s reckoning with applied behavior analysis [PODCAST]
Let’s discuss primary care. That’s primary care, as in P-R-I-M-A-R-Y C-A-R-E.
Why the emphasis?
Sadly, I don’t …
Is primary care becoming a triage station?
It was past 7 p.m. when I finally reached home after another long day in the outpatient oncology clinic. My mind still echoed with the day’s stories: patients fighting pain, families clinging to hope, and the small victories that made the exhaustion feel almost worthwhile. There was emotional fatigue, but also peace.
Then I opened WhatsApp. The headline jolted me: “Doctor in Chennai stabbed by patient’s son after mother’s death.” He …
Violence against physicians and the role of empathy
I am a disabled doctor. Being in residency, where many of my peers are young and able-bodied, I entered medicine with extensive experience on the other side of the examination table. I also entered medicine wanting to emulate the best of the care I received, and minimize the worst.
Over time, I have met more and more doctors like me who struggle with temporary or permanent disability. I see how systems …
The impact of policy cuts on ableism in health care
America learned to add medications. Add one for sleep. Add one for nausea from the first. Add one for weight gain from the second. Add a second antidepressant when the first loses effect. Add a stimulant when a mood stabilizer slows a teenager down. Add an antipsychotic when anxiety erupts in the clinic room. Add a statin because a lab number sits outside a guideline range. Patients, however, feel the …
How deprescribing in psychiatry offers a path to safer care
The denial came back in less than three seconds.
A physician had just submitted a renewal for a medication her patient had taken for years, one that kept her stable, out of the hospital, and able to function. She expected the usual wait time. Maybe an hour. Maybe a day.
Instead, an automated message appeared: “Denied: automated appropriateness determination.”
No reviewer. No rationale. No path for appeal. Only an algorithm, silent, opaque, and …
AI in prior authorization: the new gatekeeper
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Assistant professor of professional practice Adrian Reynolds discusses his article, “What is professional identity formation in medicine?” He explores how a student’s frustrated question, “Did I get dumber?” reveals the deep crisis …
Why learning specialists are central to medical education [PODCAST]
“Once in a while you get shown the light
In the strangest of places if you look at it right.”
That line from Scarlet Begonias (lyrics by Robert Hunter, melody by Jerry Garcia) has followed generations like a benediction disguised as a song lyric. Released in 1974 on the Grateful Dead album From the Mars Hotel, it has become something more than poetry. It is a philosophy of attention, a reminder that …
Finding meaning in medicine through the lens of Scarlet Begonias
Illness is inevitable, and medical care can be expensive. The U.S. is the only developed nation without some form of universal health care. Instead, it relies on a for-profit system in which insurance companies often seek ways to reduce costs, sometimes by delaying or denying coverage for services. These delays can include requirements such as prior authorization or peer-to-peer reviews for standard, guideline-directed treatments. This process takes up health care …
Profit vs. patients in the U.S. health care system
Medicine is getting faster, louder, and more efficient, and many of us feel something quietly slipping away. We talk about burnout, moral injury, and depersonalized care, but the deeper question is often left untouched: How do we keep the soul of medicine alive while building systems that must scale?
I encountered that question in an unexpected place, not in a policy meeting, not in a spreadsheet, and not in an architectural …
How to keep the soul of medicine alive in a scaling system
Robert E. Lee did not lose Gettysburg because he lacked courage or troops. He lost because he was blind. His cavalry commander, J.E.B. Stuart, galloped off on his own, leaving Lee without reconnaissance. By the time Stuart returned, George Custer cut him to pieces. Leadership without recon is leadership without eyes.
Screening tests are the point in a military formation. They provide the initial lay of the land. In medicine, they …
Why medicine needs military-style leadership and reconnaissance
You are the expert of your body. You know when something isn’t right.
Yet many patients leave an exam room feeling worse than when they came in, not because of their illness, but because they were told, directly or indirectly, that nothing is wrong. Their symptoms are minimized, reframed, dismissed, or worse, attributed to anxiety, stress, age, or weight. They are left questioning their own experience and perception of reality.
This is …
How to handle medical gaslighting
The nurse adjusted my father’s blanket for the third time that hour, her voice soft as velvet. “We just hate to see him suffer like this,” she whispered. My mom and I watched her check his IV with the tenderness reserved for wounded pups.
Three floors down, four years earlier, this same hospital discharged me mid-vomit with a gastric outlet obstruction and a white blood cell count that screamed infection. “Go …
Gender bias in medicine: Who deserves to be saved?
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Otolaryngologist Brian F. Worden discusses his article, “The surprising link between migraine and tinnitus.” He reveals that for the 26-47 percent of tinnitus patients who also report migraines, the tinnitus may actually …
Why your migraine might be causing your tinnitus [PODCAST]
A new patient recently told me, “I’ve already seen two doctors about this.” She meant a life coach with an online certificate and a therapist with a doctorate in education. Neither was a physician. Neither had examined her, ordered labs, or considered medical causes for her rapid cognitive decline.
When I evaluated her, it was immediately clear she needed urgent neurological workup. She wasn’t suffering from “stress.” She had an early …
Psychiatrists are physicians: a key distinction
Tick-borne illnesses continue to rise across the U.S. and Europe, and clinicians are feeling the impact. More patients are showing up with early Lyme disease, more are asking about prophylaxis, and more travelers want advice about tick-borne encephalitis (TBE). At the same time, vaccine development is finally accelerating after years of stagnation. For busy clinicians, here is a concise update on what’s new and what to tell patients in 2025.
Lyme …
Tick-borne disease vaccines: a 2025 update
Causing quite a stir, Mark Zuckerberg (Meta’s CEO) recently proposed Artificial Intelligence (AI) companionship for those suffering from social isolation. All of this unfolds amid a climate of epidemic-levels of loneliness, as declared by the Surgeon General, and the storms it has unleashed upon the edifices of our personal and collective health. The irony, even horror, was not lost on many: The very tools and companies, in …
AI and human connection: an ethical crisis
Being a family physician and geriatrician for more than 38 years, I’m trying to better understand why our elderly patients, and in general, elderly people, suffer from dehydration. For sure, there are many reasons. Some of those are simple, but some of the hidden ones we don’t think about. For example, just by getting older, we end up having less water in our bodies. Living in a humid area and …
Why are elderly patients dehydrated?
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Urologist William Lynes discusses his article, “Teaching medical students what it is really like to be a physician.” He confronts the tragic reality of physician burnout and suicide, arguing the culture of …
Preventing physician burnout before it begins in med school [PODCAST]
Standing in the middle of the parking lot of the Berkeley 2000 Recreation Center in February 2021, Molly Humphreys, in a single frame, captures an important moment in the public’s collective health, though it can be easily missed if we don’t pause and absorb its significance. In the chaos of 2025, it would be careless to not linger on this image.
A masked …
Why we can’t forget public health
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