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Professor of clinical psychiatry Michael F. Myers discusses his book Physicians With Lived Experience: How Their Stories Offer Clinical Guidance and the article “Breaking the silence: mental health and racism in medical …
Physician vulnerability and authenticity: How shared stories heal [PODCAST]
In Northern California and beyond, health care systems are rapidly integrating artificial intelligence (AI) and digital tools to transform how pain is recognized, measured, and managed. From algorithm-guided assessments to wearable sensors and predictive analytics, these tools promise to augment clinical decision-making and improve patient outcomes. Yet significant controversies remain, including concerns over algorithmic accuracy, bias, data privacy, and the extent to which technology should complement or potentially displace human …
AI in pain assessment: Balancing innovation with patient safety
This article is sponsored by InCrowd.
Health care professionals are constantly navigating changes in policy, clinical evidence and practice expectations all while delivering patient care. Over the past several months, InCrowd has been asking health care professionals across the United States to share their perspectives on three major developments: changes to nursing degree classifications, a state-level bill in Massachusetts that …
It is very cold in Islamabad. These days, I feel overwhelmed by joblessness, the constant lack of money, an upcoming medical exam, and the slow progress I am making in life. Apart from studying for my upcoming medical exam, the most consistent part of my routine has become counting money. I check all my bank accounts, calculate every remaining rupee, and make small, anxious plans about how I will manage …
Winter in Islamabad: Finding hope in the daily struggle
Physicians are renowned for their dedication to helping others. The problem is that their dedication has become synonymous with self-sacrifice and working for free.
Giving away time, energy, and expertise is simply “what good doctors are supposed to do.”
We work through lunch. We attend meetings during lunch. We respond to patient messages on our days off. We prepare lectures and teach without compensation. Leaders hold space for complaints and conflict and …
The hidden cost of uncompensated work on physician burnout
When I experienced burnout as a young primary care physician, I thought it was my fault. Actually, I didn’t know it was burnout; I had never heard the word. But I believed whatever was causing the deep exhaustion, lack of empathy, and feelings of uselessness were surely due to a flaw or weakness in me.
Eventually, I stumbled across the definition of professional burnout. I was so curious to understand what …
Physician burnout solutions: Why system change isn’t enough
For years, the conversation about board certification has centered on fairness, cost, and evidence. But there is another consequence that gets far less attention: how these systems affect the supply of practicing physicians.
America’s physician shortage isn’t theoretical anymore. It is here. Hospitals are scrambling to fill call schedules, rural communities are waiting months for specialist appointments, and medical groups are watching senior clinicians retire earlier than planned. Among the many …
How board certification fuels the physician shortage crisis
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Developmental behavioral pediatrician Roxanne Almas discusses her article “The making of a rested healer.” Roxanne shares her deeply personal journey through the “quiet unraveling” of burnout and the profound grief of losing …
Rest is a holy practice: Reclaiming the soul of medicine [PODCAST]
After working close to 20 years in this medical-surgical ICU, I thought I was an expert. Infallible. I could do it all.
I left my ICU comfort zone, my lifelong nurse friends, and ventured out. Nothing could stop me.
For a different hospital system, I became a critical care resource nurse.
This very large hospital system would dictate what unit I would go to and for how long. I truly thought I could …
Why I left the surgical-trauma ICU: a nurse’s story of burnout
America is ready for an honest conversation about health care policy before more people suffer and we go broke waiting for it to happen. Fully one-third of Americans report that in the past 12 months they have skipped or postponed getting needed health care because of the cost. Thirty percent say that they or a family member had problems paying for health care in the past year, and 41 …
American health care policy reform: Why we need a bipartisan commission
How one reframing changed the way my patients think about me, and their health.
Every day, a patient sits across from me, arms crossed, waiting for me to tell them what pill to take. Or worse, waiting for confirmation of what they already believe: that the medical system has nothing real to offer, their doctor is just a middleman for pharma companies or an insurance shill, and that the answer to …
Rebuilding patient trust through the evolutionary mismatch framework
There are moments when professional boundaries collapse under the weight of something more fundamental: our shared humanity.
You do not have to be a physician to recognize when a system has failed at its most basic level. You only have to be human.
What happened to Alex Pretti is not solely a tragedy confined to one profession, one agency, or one moment. It is a systemic rupture, one that exposes a dangerous …
Systemic failure in professional environments: the myth of protection
Recently, my husband and I passed through Eureka, IL (pop. 5,200). We stopped at Eureka College, which is President Ronald Reagan’s alma mater and the host of the Ronald Reagan Museum. As visitors to many presidential libraries, we …
The service of humanity: Recommitting to physicians’ ethical duties
Stopping a GLP-1 abruptly and expecting maintenance of weight loss is not realistic. Even replacing it with a standard “eat less, move more” plan is not sufficient as it ignores what we know about hunger regulation and metabolic adaptation. A reduced-calorie diet and 30 minutes of daily walking, while helpful, are rarely sufficient to overcome the physiological forces defending prior weight.
Weight maintenance after significant loss requires managing cravings, psychological hunger …
GLP-1 weight regain: Why stopping medication leads to weight return
It is honestly impressive the lengths people will go to cure their illnesses, or, alternatively, to lovingly nurture their favorite delusions. And to be fair, I get it. We have all been sick. I am a doctor and I have still Googled home remedies for canker sores, tooth pain, and ingrown toenails. The difference is that experimenting with saltwater rinses is unlikely to end your life.
When it comes to actual, …
The Blanket Sign: Recognizing difficult patient encounters in the ER
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Physician and health care reform advocate David K. Cundiff discusses his article “Ecovillages and organic agriculture: a scenario for global climate restoration.” David challenges the IPCC’s failure to model a fully organic …
Ecovillages and organic farming could reverse global warming [PODCAST]
In engineering, a feedback loop is meant to stabilize a system. In medicine, feedback guides us toward better outcomes. But in applied behavior analysis (ABA), feedback has become a trap, recycling failure under the guise of science, and leaving children and families caught in its circuitry.
The closed circuit
Stevens’ feedback loop diagrams are elegant in their simplicity: arrows circling back, showing how inputs and outputs can stabilize a system. In healthy …
Applied behavior analysis criticism: the closed feedback loop
A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional complexity, answerable to no one but their patients.
It is a satisfying idea. It is also an empirically untested one.
The history of DPC is built on physicians willing to challenge entrenched …
The future of employer-aligned DPC and physician autonomy
The moment I decided to become an American-trained dentist, I was holding a textbook in India. I was a first-year dental student in India when it happened. I had just bought my textbooks for the semester, the thick, heavy kind that feel important in your hands, and I started flipping through them.
Page after page, I kept noticing something. The authors. Their names. Their affiliations. Almost all of them were from …
Navigating the international dentist U.S. pathway
When someone you love is in a different location and suffering while you are safe, a heavy silence begins to fill the room. This survivor guilt is one of the most difficult burdens to carry because it turns even the smallest joys, a hot cup of tea, a peaceful morning, or a moment of laughter, into something that feels like a betrayal. The heart constantly asks: Why them and not …
Coping with survivor guilt: wisdom from Saadi Shirazi and Viktor Frankl
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