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Internal medicine and functional medicine physician Shiv K. Goel discusses his article “Agentic AI in medicine: the danger of automating the doctor.” Shiv analyzes the new ARPA-H “ADVOCATE” program which aims to …
Autonomous AI agents could strip the soul from medicine [PODCAST]
Modern health care works tirelessly to treat illness and save lives, yet it often intervenes after disease has already taken hold. The system prioritizes acute treatment over prevention, despite overwhelming evidence that early intervention and public health strategies save more lives, earlier, and at far lower cost. While dramatic rescues capture attention, the quieter work that could prevent disease is often underappreciated, leaving patients and communities to face preventable health …
The hidden cost of ignoring public health infrastructure
Patients ask me about supplements every week. They bring bottles from Amazon, health food stores, podcasts, and social media. They want something natural. They want something gentler. They want something they can buy without asking permission. I understand the instinct. Psychiatric medications have side effects, cost, stigma, and disappointment. But the supplement aisle is not a sanctuary. It is a marketplace that could turn dangerous.
That matters because supplements in the …
The truth about psychiatric supplements and mental health
Every year on March 14, mathematicians celebrate Pi Day. The constant π (approximately 3.14) describes the ratio between a circle’s circumference and its diameter. It represents perfection in geometry. But in clinical life, health rarely looks like a perfect circle. I was reminded of this while speaking with Mrs. Chen at a community health program. She was 78 years old. By most medical standards, she was doing well. Her blood …
Rethinking health care for older adults beyond lab results
A false accusation or unfair allegation can destroy a doctor long before any court delivers a verdict. That is the part the public rarely sees. A charge alone can shatter a medical career. It can trigger suspension, isolation, gossip, media exposure, loss of referrals, financial collapse, and permanent reputational injury. In many cases, the accusation becomes the punishment. The acquittal verdict arrives later. By then, the damage is already carved …
Why false accusations against doctors destroy careers
Despite an ongoing shift in medical training across the country to enhance physician communication skills, there remains limited formal training communicating with patients who have tracheostomies. With over 100,000 tracheostomies performed every year in the United States, clinicians in every field will encounter patients who have individualized communication needs. These patients often experience isolation, depression, and anxiety due to an inability to interact and communicate with others. Clinicians can and …
Tracheostomy communication barriers: a gap in medical training
Dental anxiety remains one of the most common yet overlooked barriers to oral health care. Despite advances in modern dentistry (painless techniques, improved anesthetics, and patient-centered care), millions of people continue to delay or completely avoid dental visits because of fear. The consequences extend far beyond oral health; untreated dental disease can significantly affect overall health, confidence, and quality of life. For many patients, dental anxiety begins early in life. …
Overcoming dental anxiety for better oral health care
“Oh, poor thing!” exclaimed Dr. S, shaking her head in empathy.
“It is very sad,” I chimed in.
Lalita lay on the operating table. A sterile green cloth hung perpendicularly, separating her, the patient, from Dr. S and me, the operating surgeons.
She was undergoing her first cesarean section in view of fetal distress.
It was indeed very sad. Not the cesarean part, but the fact that her husband had passed away when she …
Tubal ligation and widowhood: Navigating toxic requests
An excerpt from Lessons Learned: Stories from Dual Physician Marriages, published by the American Association for Physician Leadership (AAPL), is available in print and eBook at Amazon and the AAPL bookstore.
How do two people build a strong marriage while both are practicing physicians? Medicine is demanding, and marriage can be too. Plenty has been written about how those pressures can strain relationships, but far less …
Dual physician marriage: stories of love and partnership in medicine
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Pediatrician and certified coach Jessie Mahoney discusses her article “Why physician wellness programs must evolve beyond institutions.” Jessie reflects on her seventeen years leading in-house wellness initiatives and argues that while institutional …
Wellness requires safe spaces outside the medical system [PODCAST]
I just signed my first attending contract.
It should feel like pure celebration. Mostly, it does. But it is also a moment that forces reflection. For first-generation physicians, the hardest part of the journey often is not medical school or residency. It is learning how to navigate what comes after, inside systems we were never born into.
You are just as capable, compassionate, and prepared as anyone else. You have worked harder …
First-generation physician: Navigating the first attending contract
An excerpt from NOMERGENCY: Reclaiming Focus and Calm from False Urgency.
Your heart plummets.
It’s 4:55 p.m., five minutes until freedom, five minutes until you’re finally out the door to go and try that restaurant your friends have been raving about for months. But you’ve already caught a glimpse of the new e-mail from your boss, and it cannot be unseen.
The subject line reads: “Take a quick look?”
Your stomach twists.
Maybe I …
Workplace boundaries: How to stop answering e-mails at 5 p.m.
In the emergency department, you learn to function under pressure. You compartmentalize. You prioritize. You override your own nervous system in order to keep someone else alive.
During COVID, that skill became oxygen.
We worked in zones of four to eight critical patients, all unstable, all needing constant vigilance, or we were assigned to the lobby and hallways, managing 50 or 60 patients triaged as “non-critical,” knowing any one of them could …
Lowercase PTSD: Why emergency staff are still hypervigilant
Modern medicine can transplant organs, cure hepatitis C, and deploy artificial intelligence to read radiology scans. Yet one of the most effective life-saving interventions in clinical medicine, treatment for tobacco dependence, is still delivered inconsistently. More than 28 million Americans continue to smoke cigarettes. Evidence-based treatments are widely available, inexpensive, and highly cost-effective. But across health systems, physicians rarely deliver them in a systematic way. By every measure, physicians are …
Improving tobacco treatment in clinical practice
One of us (NB) has been reasonably conscientious about his health for the past 50 years. He sees his PCP twice a year and has tried to set an example for his patients by focusing on diet and exercise. I have done well, except I need a little work on stress reduction and sleep hygiene. Curiously, in 50 years and more than 100 office visits to health care providers, no …
The mouth as a gateway: Why oral health matters for physicians
In today’s clinical oncology practice, the saying “no two cancers are alike” is more relevant than ever. I recently treated two patients with very similar advanced non-small cell lung cancer (NSCLC) who were both critically ill. However, molecular profiling revealed distinct genetic drivers for each case, leading to very different, highly customized treatment plans.
Patient presentation and initial assessment
Both patients, in their late 60s and never-smokers, presented with weight loss, worsening …
EGFR vs. ALK: How molecular profiling defines lung cancer treatment
I called my old professor the other day to ask a very specific question about the Geriatric Depression Scale and expressed to him a big frustration on my end on how we are no longer able to perform such complex assessments among our patients, especially in primary care. During residency, we are taught to take thorough histories and perform physical exams by the book, but in reality, it is very …
The lost art of connection: Why medicine needs to slow down
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Occupational medicine physician and life coach Claudine Holt discusses her article “Nervous system dysregulation vs. stress: Why ‘just relaxing’ doesn’t work.” Claudine challenges the common advice to treat burnout with self-care like …
Why “just relaxing” fails when your nervous system is stuck in survival mode [PODCAST]
For years, the U.S. has felt the impact of ever-rising health care costs while facing decreasing access, affordability, and worsening clinical outcomes, as compared to other countries. Multiple disruptive forces increasingly plague our health care system, our workforce and workplaces, health care facilities, health care consumers, …
The health care economic crisis: Why the system is failing in 2026
Consider a common scenario. A 65-year-old patient presents with intermittent chest discomfort present for several days and no prior history of heart disease, including among family members. The physical exam is unrevealing. An EKG and cardiac enzymes are negative. The clinician explains, “I do not see anything concerning. Given your age and symptoms, this is likely reflux. Let us have you wait three hours after eating before retiring for the …
Clinical communication skills: the power of structured language
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