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Obesity medicine physician Jessica Duncan discusses the article “GLP-1 weight regain: Why stopping medication leads to weight return.” Jessica explains that expecting to maintain weight loss after abruptly stopping GLP-1 therapy is …
Why weight regain is a predictable biological response after stopping GLP-1s [PODCAST]
On October 20, 2015, I did something unremarkable: I turned on the GPS app on my Android phone before driving to work. I had no idea that routine act would one day save my career and expose a pattern of institutional behavior that every academic physician needs to understand.
I was an assistant professor of oral and maxillofacial surgery at a major academic medical center. Two days after a high-risk patient …
Physician legal protection: Surviving academic medical center blame
What happens when the doctor becomes the patient? Is there anything learned or reinforced? For me, it was a life-changing experience both personally and professionally when I became the patient.
My story began on New Year’s Eve. I had been feeling dizzy associated with some chest pain and was scheduled to have a stress echo at my local hospital to make sure all was OK (of course it would be OK, …
Surviving ventricular tachycardia: What I learned as a patient
Imagine a healthy eight-year-old boy going under general anesthesia for a routine procedure. His preanesthetic workup is unremarkable. His family history raises no flags. He receives sevoflurane, the most commonly used inhaled anesthetic in pediatric practice worldwide, and he does not wake up the same.
This is not a theoretical scenario. It has happened to families of Venezuelan ancestry on multiple continents, across multiple decades, and no one connected the dots. …
How a hidden genetic mutation creates a severe pediatric anesthesia risk
They tell us doctors
to practice self-care,
as if grief were a muscle
that loosens with stretching.
But no one teaches
how to set down
a conversation about dying
and pick up
the rhythm of living.
At the end of the work day,
the questions still echo,
How much time do I have?
What would you do, doc?
The charts are closed,
but the questions remain open.
Burnout does not arrive
as flames.
It seeps,
through the small cracks
between hope and reality,
between doing everything possible
and knowing we have …
A physician’s poem on burnout and end-of-life care
A publication in Nature in April 2026 reports that N-desethyl-fluornitrazene (DFNZ), a modified nitazene and µ-opioid receptor (MOR) superagonist, produced potent analgesia in rodents with less respiratory depression, weaker dopamine-linked reward signaling, lower withdrawal burden, and no clear tolerance or MOR downregulation. The study challenges the usual assumption that very high MOR efficacy must inevitably produce the full adverse-effect profile seen with conventional opioids. Opioid pharmacology has long been …
How the opioid superagonist DFNZ challenges pain medicine
In the operating room, precision has never been greater. Modern surgery now relies on navigation systems, artificial intelligence, robotic assistance, digital planning platforms, and predictive analytics capable of modeling outcomes before the first incision is made. For the first time in medical history, technology allows surgeons to simulate procedures, optimize implant positioning, and reduce technical variability to levels once unimaginable.
Yet many surgeons recognize an uncomfortable paradox emerging beneath this progress: …
Artificial intelligence in surgery: Balancing precision with clinical wisdom
I still remember the first time I saw what bullying in medicine could do to a physician in training. It was not loud at first. It was not always obvious. It came wrapped in authority, tone, pressure, and the quiet threat that a career could be damaged by people in power. A resident nearing her final year of dermatology training was being bullied by program leadership and others in the …
Confronting the reality of bullying in medicine today
For years, I have heard breast cancer survivors share a common refrain: “I expected to lose my breasts. I did not expect to lose the ability to feel.”
Yet in exam rooms across the country, persistent numbness after mastectomy remains underdiscussed and poorly understood in routine care. It is often framed as an inevitable side effect rather than a life-altering outcome that impacts quality of life after cancer.
We have made tremendous …
Living with numbness after mastectomy: the unseen impact on survivorship
There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced inside for over two decades, saying you believe something that the evidence has not yet fully validated carries consequences. Raised eyebrows at conferences. The careful distance of colleagues. The quiet …
The clinical evidence and reality of peptide therapy
Most emergency departments feel perpetually behind. The waiting room fills, ambulances stack, and staff move quickly yet still feel behind. The reflex explanation everyone gives is capacity. We need more beds, more rooms, more space. That explanation is intuitive. It is also often incomplete.
In many departments, nothing meaningful happens after triage until a patient is placed in a permanent treatment room. No bed means no provider evaluation. No provider evaluation …
The physician-in-triage model and rapid evaluation in emergency medicine
I have treated over 10,000 bariatric patients across my career, and if there is one issue that comes up more than almost anything else, it is protein. Specifically, patients not getting enough of it. The research confirms what I see every day in practice. Only a minority of bariatric patients reach the recommended minimum of 60 grams per day, resulting in the loss of fat-free mass rather than the …
Why bariatric patients struggle with protein and how to fix it
Most internal medicine physicians assume that when they sit for a board examination, their answers determine one thing: whether they pass. Few realize that their exam performance has been linked to federal Medicare claims data and used in research, without their knowledge or consent.
The American Board of Internal Medicine (ABIM) has published studies linking board scores to clinical outcomes derived from Medicare claims. ABIM presents these analyses as quality research …
Why ABIM’s use of Medicare claims data violates physician autonomy
The stethoscope has always been more than a tool for auscultation; it is a physical bond between two human beings that no government has the authority to sever. In early 2026, as the Iranian regime launched a brutal crackdown on its own citizens, we witnessed the most extreme test of this bond. When the state demanded that physicians become extensions of the secret police, our colleagues in Iran chose the …
Iranian physicians in 2026: a testament to medical courage
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Patient advocate Eric Goldfarb discusses the article “How a pregnancy test on a male patient revealed health care flaws.” Eric shares the absurd and heartbreaking story of finding a pregnancy test charge …
Why hospital systems fail to notice the human behind the bill [PODCAST]
You tell me it is all in my head.
As though my head were a small room where false alarms
ring for sport,
like I have no better way to spend my time and life.
You hold films up to the light,
of bones and blood,
nothing cracked or out of place,
or a catastrophe waiting in the wings
that has earned a name in your stack of books.
My blood you have drawn
has traveled through your machines
and has …
A patient’s poem on invisible illness and trauma-informed care
A dry cough can be one of the most misleading symptoms in medicine. At home, it can dominate the emotional climate of an entire household. It interrupts sleep, breaks conversations, unsettles meals, and keeps caregivers in a state of low-grade vigilance. It appears in cold air, at the beginning of a speech, during the first few sentences of a phone call, or in the quiet moment when everyone is finally …
How a minor dry cough amplifies caregiver burden in home health care
If you have nagging pain deep in your lower back or one buttock that never seems to settle, you are not alone. Many people chase answers through discs, nerves, or muscles, yet the real source turns out to be the sacroiliac (SI) joint. This connection between the base of your spine and your pelvis is built for stability with just a hint of motion. When it becomes irritated or unstable, …
How to treat sacroiliac joint pain effectively today
I want to tell you something attorneys already know but will never say to your face. When your expert report lands in their inbox and they read it, I mean really read it, they know within the first two paragraphs whether they are calling you again. Not after the case. Right then. And if the answer is no, they do not tell you. They do not give feedback. They do …
Why clinicians fail at writing expert reports
In September 2025, The Atlantic reported on a frenzy surrounding leucovorin, a folate derivative long used in oncology and rheumatology. Families desperate for answers were suddenly told it might be a miracle therapy for autism. Waitlists stretched years, clinics were overwhelmed, and hope surged. The problem was not just scientific, it was political. When President Trump and HHS Secretary Robert F. Kennedy Jr. endorsed leucovorin, they amplified demand …
Leucovorin for autism: Why physicians must protect hope from hype
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