“Do you have a key?” my grandma asks me. I hesitate and she repeats herself, “Do you have a key to this place?” She is sitting in a hospital chair behind one of those hospital tables with a tray full of hospital food in front of her. She is practically skin and bones; her shirt and pajama pants are hanging off of her. My mom is sitting on the bed, …
The art of pretending in medicine and family
As a founder in digital mental health, I’ve watched our industry celebrate reaching $8.34 billion in valuation while systematically failing 40 percent of the population. This isn’t just a moral failure, it’s a $20 billion market opportunity that’s being ignored because of cultural blindness. For physicians trying to refer diverse patients to digital mental health resources, the options are frustratingly inadequate. With the total U.S. behavioral health market valued …
Digital mental health’s $20 billion blind spot
The vow was not ceremonial. It was lived.
We were in Waverly, Ohio on 9/11, a town that did not make headlines, but held its own kind of gravity. The clinic was open. Kathy was chasing after Robert, age 8, who had darted toward the library at the end of the street, eager to explore its corners before school resumed. She did not call him back. She followed. That was the …
A doctor’s duty on 9/11 in a small town
With over 270 active drug shortages and growing global instability, the United States must protect itself from a worsening crisis in cancer care. The fragile supply of generic chemotherapy drugs like cisplatin, which is important for treating bladder, lung, and testicular cancer, could collapse if geopolitical tensions between India and Pakistan escalate further. To preserve this diminishing supply, the U.S. must reduce its overreliance on Indian pharmaceutical manufacturing and …
How India-Pakistan tensions could break America’s generic drug pipeline
I see it every week in my practice: Patients obsessed with their cholesterol numbers. LDL, HDL, triglycerides, the full alphabet soup. They have been trained to believe these numbers hold the keys to life and death.
But here is something I cannot stop thinking about: When you look under the microscope, an atherosclerotic plaque (the thing that clogs arteries and leads to heart attacks) looks an awful lot like a tuberculosis …
Why we may be fighting the wrong enemy in heart disease
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Physician leader Janet A. Jokela discusses its article “Collective action as a path to patient-centered care.” The piece reflects on the evolution of physician unions since the 1980s, beginning with housestaff associations …
How collective action is shaping physician empowerment and patient care [PODCAST]
As an academic trauma surgeon and intensive care physician, I have spent decades honing my clinical skills and teaching them to others. The recent milestone reached by Microsoft’s new AI system, the MAI Diagnostic Orchestrator (MAI-DxO), is a reminder that the cognitive frontier of medicine is shifting, not gradually, but in leaps. MAI-DxO reportedly diagnosed complex cases from the New England Journal of Medicine with eighty percent accuracy, compared to …
Most of us have done it: a new symptom pops up, and instead of calling a doctor, we type it into Google. In that moment, the internet feels like the fastest way to get answers. But when it comes to urology, a field where stigma, fear, and embarrassment often hold people back, the flood of conflicting or misleading information online can do more harm than good. That’s where digital health …
How digital health is changing urology
Emergency medicine has evolved far beyond what its founders envisioned. Once an afterthought of the health care system, it is now the gateway to care for millions. Every day, our emergency departments serve as the front door of the hospital and, for many, the only door into health care.
This is why I argue that emergency medicine safeguards human rights.
Consider the patient mix of any emergency department: we care for the …
Why emergency medicine is a human rights specialty
Back-to-school season is one of the busiest times of the year for health care providers (HCPs). Doctors’ offices are full of young patients and families preparing for the year ahead, checking off physical exams, immunization forms, and age-based screenings. These visits are more than just routine; they are critical opportunities to talk about risk factors and catch early signs of health issues. Yet too often, one disease slips through the …
Why type 1 diabetes screening should be part of back-to-school
Before venturing into medicine, I was focused on aviation, training as a pilot at age 15. To this day, I can still recite every step of the engine-failure sequence from memory. Pilots are trained this way for a reason: They spend hours in simulators practicing under duress, so that when something goes wrong in the real world, they respond instinctively. By the time they are in the cockpit with passengers …
How cloud-based simulation training is revolutionizing dentistry
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Urologist Fara Bellows discusses her article “When recurrent UTIs might actually be bladder cancer.” Fara shares the story of a 91-year-old patient whose recurrent urinary infections masked an underlying bladder cancer diagnosis, …
When recurrent UTIs mask the warning signs of bladder cancer [PODCAST]
I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.
How it works
The cycle is simple:
What is guideline creep in medicine?
The weight of a number
Three years ago, I sat in my car during a work break, hands trembling as I opened my MCAT score report. The number stared back at me: 494. My heart sank. As a husband and father of two young girls, I had poured five months into prep courses, question banks, and late-night study sessions, all while balancing family and work. I walked out of that eight-hour …
From a 494 MCAT to medical school success
As a physician provider in my State Physicians Health Program, I have watched brilliant colleagues flicker out. Not because they lacked skill or grit, but because the system treated their humanity like an optional feature. We train physicians to master physiology, not how to metabolize grief. We celebrate heroics, not healing. Then September arrives, Suicide Prevention Month, and we draft statements. The statements are sincere. They are not sufficient. It …
It’s time to operationalize physician wellness
I have spent decades learning about how bodies and brains work, but nothing has taught me more about complexity than raising my autistic son. He is nine, curious, brilliant, and completely captivated by chemistry. He can explain the structure of an atom with more clarity than most high school students.
But when we step into the real world (classrooms, stores, even family gatherings), sometimes his brain does not get to shine. …
The science behind my son’s sensory overload
“I was excited to see you today because I thought you were going to answer all my questions,” a patient once told me. I smiled, masking the insecurity. “I wish I could.”
The truth is, I often cannot (at least not in a single visit). Medicine is rooted in curiosity and lifelong learning. Patients expect certainty, but doctors live with uncertainty. We know enough to know how much we do not …
What patients do not see behind the white coat
In my years as a physician on the front lines of addiction and pain medicine, I have never encountered a medication as transformative as buprenorphine (Suboxone). I have seen patients, broken by years of opioid addiction, have their lives change within an hour of their first dose, ready to reclaim a life they thought was lost. For these patients, buprenorphine is as essential as insulin is for a person with …
The unfair war on buprenorphine
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Health care executive Ashish Mandavia discusses his article “Why U.S. health care pricing is so confusing—and how to fix it.” Ashish explains how systemic misaligned incentives, opaque insurance practices, and weak enforcement …
Why U.S. health care pricing confusion demands bold solutions [PODCAST]
I never expected that iron deficiency anemia would change the course of my life. I felt off. Tired in a way that sleep could not fix. Foggy, weak, emotionally distant. At first, I thought I was just worn down from work and the daily grind. I was not myself, physically, mentally, or emotionally.
Eventually, I was diagnosed with iron deficiency anemia, a condition many associate with mild fatigue or simply “not …
My invisible illness destroyed my marriage
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