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This episode is sponsored by Novartis Pharmaceuticals Corporation.
In this sponsored episode from Novartis Pharmaceuticals Corporation, a leading preventive cardiologist walks through the 2026 cholesterol …
2026 cholesterol guidelines: LDL goals, Lp(a), and coronary calcium scoring [PODCAST]
I have watched the U.S. News & World Report “Best Medical Schools” rankings shape behavior in American medicine for decades. As a physician, educator, and someone who has mentored trainees at different stages of their careers, I have seen the rankings function both as a compass and as a distortion. They promise clarity in a complex landscape. Too often, they deliver something closer to a mirage.
The appeal is obvious. Medical …
Medical school rankings reshape what they measure
An excerpt from Before and Beyond the Scalpel: Prehabilitation and Pelvic Floor Recovery After Prostate Cancer.
When I heard the word “cancer,” I was not prepared, and I am a physician with more than 35 years of experience.
Intellectually, I knew prostate cancer carries a high cure rate when caught early, as mine was. I understood the staging, the options, and the survival statistics. I had counseled patients through diagnoses far …
The prostate cancer recovery few men are warned about
Suppose you were offered the following two work opportunities. Which would you choose?
Career A: an acceptable opportunity that pays slightly more than your current job; you’re guaranteed never to make less than you do today.
Career B: a dream opportunity that sings to your soul but comes with no guarantees. While you may make much more than you do today, you could also potentially take a six-figure pay cut.
In other words, …
Physician career choices come down to risk tolerance
At the end of a visit, it is common to say: “Call if things get worse.” It sounds supportive. It sounds open-ended. It sounds safe. But what does “worse” mean? More frequent pain? More intense pain? Pain that wakes the patient at night? Pain that interferes with work? Without definition, responsibility shifts quietly.
Modern care depends on patients, not simply to follow instructions, but to understand the treatment plan, to carry …
Shared responsibility in patient care needs boundaries
I remember the first time a resident came to me with a clinical question she had already answered, using ChatGPT. She was not asking for confirmation. She wanted to know if the answer was right. That moment changed how I think about artificial intelligence in residency education. I am a family medicine physician and associate program director. For years, I have been building what we call the Junior Preceptorship model, …
Artificial intelligence in residency education and family medicine
Clinical training does not teach operational survival
Clinical training prepares physicians for clinical decisions. It rarely prepares them for the operational decisions that determine whether an independent practice survives the first three years.
A new practice owner may understand diagnosis, treatment, documentation, and patient communication, yet still be unready for payer enrollment, days to get paid, denial management, lease math, compliance deadlines, electronic health record (EHR) tradeoffs, and vendor evaluation. These decisions …
Independent medical practice runs on operations
Chronic disease is rising. Our system is not designed for it. This is not a controversial observation. Across clinical practice, research, and health system leadership, there is growing recognition that the burden of chronic illness is increasing and beginning earlier in life. What is less often acknowledged is that the structure of our health care system has not evolved at the same pace. In clinical settings, this shift is already …
Why our health care system is failing chronic disease patients
I was watching a medical drama recently when a physician identified a patient’s age, not from a chart, but from their teeth. The logic was simple. Worn enamel. Coffee staining. Fully erupted molars. It made for good television. But it also revealed something much bigger, something we rarely talk about in medicine, and almost never teach outside of it: The body is always leaving clues. We just do not know …
Pediatric airway health and early childhood development clues
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What happens when a woman is diagnosed with a rare, estrogen-sensitive lung disease at 28, in her first week of residency, with no roadmap for whether she can safely …
She was learning to keep others breathing while losing her own air [PODCAST]
If anything represents the economic effects of medical malpractice, it is the following two cases. One involves a teenage mother and a major academic medical center. According to attorneys on both sides, the lawsuit is legitimate. However, its underlying merit is described as only 25.3 percent. Nevertheless, a legal strategy obscures this. The mother is 16 years old when she conceives and lives in a West African country until 17 …
The cost of chaos in medical malpractice litigation
For three months, I searched for a preceptor. I reached out to clinics, private practices, and community providers. I emailed offices, followed up, and posted in professional forums and Facebook groups. I approached the process with persistence and respect for the clinicians whose time I was requesting. Most of the time, I received no response. When I did, the answer was typically the same: not accepting students, already at capacity, …
The rising cost of clinical placements for nursing students
As a practicing pain management physician in good standing in California, I’ve observed how accusations against physicians are actively encouraged, while meaningful accountability for false or exaggerated claims is largely ignored. This creates a system that rewards a “throw mud until something sticks” strategy for financial gain by patients, insurers, and other parties. This is precisely why I wrote the book Legal Mind in Medicine to highlight the legal …
Doctors leave California over a tilted legal system
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There is a sentence physicians have said for generations: “We’ll take good care of you.” It is a good sentence. Patients need to hear it, and most of the time it is said with sincerity. Yet there are moments, more now than before, when that sentence carries a second awareness alongside it. The emergency department is boarding. There may not be an inpatient bed for hours, sometimes longer. Tests, consults, …
Integrity in medicine is quietly under strain
I was eight months old when I was diagnosed with cystic fibrosis, a genetic illness that slowly damages the lungs and can affect digestion and other organs. My parents quickly learned the rhythms of it all: treatments, medications, and constant vigilance.
But here is the part people do not always expect: I still got to be a kid. I rode horses. I ran cross country. I went to college. I fell …
Surviving cystic fibrosis: a double lung transplant journey
This month, 53 medical schools committed to requiring 40 hours of nutrition education. As the physician who co-taught the first U.S. medical school class in culinary medicine, with Mike Roizen, MD, founding director of the Cleveland Clinic Wellness Institute, I am proud that culinary medicine is now taught in roughly 80 percent of U.S. medical schools. I recognize this as a genuine win. But I have watched this story before, …
Why nature-based medicine is the future of health care
When I tell other physicians that I negotiated a sabbatical from private practice, a full semester abroad with my family, followed by months of extended travel, the reaction is almost always the same. It starts with disbelief, moves quickly to calculation (“But who covered you? What happened to your income?”), and ends, more often than not, with a version of: “I could never do that.” I understand the reaction because …
How to negotiate a physician sabbatical in private practice
A patient arrives in the emergency department vomiting. Not once or twice, but repeatedly, leaning over the bedside basin, pale and sweating, clearly miserable. Between episodes, he tries to explain what happened. Earlier in the day he felt completely fine. Then the nausea started suddenly, followed by vomiting, cramping, and a cold sweat that made his shirt cling to his back. By the time he arrived in the emergency room, …
When a stomach bug is actually an atypical heart attack
The student sitting across from me didn’t think she was burned out. She had just made the dean’s list, locked in a competitive summer internship, and was running two clubs. She was sleeping four hours a night, had stopped texting friends back, and described feeling “nothing” when she opened her acceptance letter to a graduate program she had spent two years working toward. “This is just what college is supposed …
6 signs of burnout in high-achieving students
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What happens when a patient makes a reasonable, informed decision to skip a non-mandatory test and the system simply stops? Patient advocate Aaron S. Rosenberg shares how a routine dental visit became a …
He declined routine X-rays and was denied a dental cleaning [PODCAST]
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