“The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter out loud: this is the meaning of the word unspeakable. Trauma survivors want to forget, observers want to forget, and society as a whole wants to forget. It is too painful to do otherwise. We push trauma away and it rears up in other ways: Atrocities, however, …
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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article “The burden of the eldest daughter.” Jessie explores the unique psychological weight carried by firstborn women who are taught early on to …
In July, I wrote about the importance of end-of-life planning (EOL). Shortly after, I read a study that examined physicians’ EOL plans with advanced cancer and Alzheimer’s disease (stage unspecified). The study encompassed nations with different forms of aid in dying, from the U.S., where a terminal coma is the only option most states allow, to Belgium, where physician-assisted dying (PAD) and euthanasia are available. Although the term suicide …
At its best, the doctor-patient relationship is an intimate one. Often, our patients appear before us in the most vulnerable moments of their lives. We treat their diseases, but we also tend to their emotional and spiritual well-being. That kind of intimacy can be meaningful and rewarding, but it can also breed awkward and even potentially compromising interactions. That is particularly true when money gets involved.
Despite widespread dissatisfaction with the …
I’ve recently been intrigued by this question: Are you giving from extra or essence?
In many respects, giving from one’s essence is what burnout is all about. Your energy reserves (emotional, physical, mental, cognitive) are heading rapidly toward empty. Because of a mismatch between the energy drain from internal and external stressors and the ability to replenish your energy, you are left depleted.
I see this mismatch daily in the physicians whom …
At this point, numerous individuals have become engaged with ChatGPT. We’ve asked it to summarize a complex patient history and draft a discharge summary or explanation of a rare clinical concept. At first, it feels like magic. However, after several weeks, that same old feeling of frustration returns. Why does this still feel like more work?
The problem is not that technology is lacking. The problem is that ChatGPT was never …
The cabin was quiet in that familiar, suspended way airplanes always are with a steady engine hum, passengers absorbed in movies, sleep, and anticipation with the intermittent crying child. It was an ordinary flight. Until it wasn’t. The overhead speaker crackled without warning. “If there is a doctor on board, please identify yourself.”
The voice was calm. The effect was not. Just a row behind me, a child no more than …
Wellness programming must evolve beyond institutions if we are serious about supporting physicians, especially women physicians.
For wellness to be taken seriously, it had to begin within institutions. Those efforts offered visibility and legitimacy. But institutional wellness is not the whole answer.
For 17 years, I led wellness initiatives inside a large medical organization. I saw the value of bringing attention to physician well-being. I also saw the limitations. Six years ago, …
For the past several decades, Western spiritual culture has been profoundly shaped by the rebranding of Buddhist contemplative practices (mindfulness, presence, and the exaltation of “the now”). As a psychiatrist, I have witnessed the arrival of this movement inside the consultation room. Patients arrive quoting teachers, apps, and books urging them to stay present, to watch their breath, to release attachment to the future or past. Many have tried, often …
An excerpt from Pandemics, Poverty, and Politics: Decoding the Social and Political Drivers of Pandemics from Plague to COVID-19.
We talk about health as if it were an individual act of will, a matter of personal choice or risk tolerance. But anyone who has walked alongside people living in poverty, in refugee settlements, in overcrowded housing, or on the street knows that illness does …
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Internal medicine and pulmonary physician Bharat Desai discusses his article “How Acthar Gel became a $250,000 drug.” Bharat shares the shocking moment he realized an obsolete pituitary extract from 1952 was being …
For decades, many have documented the decline of the physical exam. As imaging grew more powerful, labs more precise, and algorithms more accurate, the stethoscope and reflex hammer faded in importance. Some even speculated that technology would eventually make hands-on diagnostic skills obsolete.
But the next era of medicine may flip that prediction on its head.
Picture a future where artificial intelligence participates in nearly all patient management decisions. This seems inevitable …
America’s physician shortage is no longer a distant projection. It is happening now, steadily, one resignation, early retirement, and practice closure at a time.
A nationwide, longitudinal analysis published in Annals of Internal Medicine tracked more than 712,000 physicians caring for Medicare patients over a decade and found a troubling trend: Physician attrition from clinical practice rose from 3.5 percent in 2013 to 4.9 percent in 2019, across every specialty, …
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A recent Johns Hopkins study has reignited that debate. The research documents rapid growth in concierge and direct primary care practices and warns that these models may worsen access to care.
That framing feels intuitive. It is also incomplete.
It assumes that traditional primary care access was functioning before physicians began moving into fee-based models. It was not.
Long before concierge and direct primary care gained traction, primary care access had already …
Frivolous medical malpractice lawsuits are endemic and infect everyone whether they realize it or not. The greed of plaintiffs, attorneys, medical experts, and malpractice carriers, coupled with the ineptitude of the tort system, causes avoidable costs. Everyone pays the price.
Some plaintiffs sue for medical malpractice just because they harbor a grievance against a doctor and their claim has no attributable merit. Plaintiff attorneys, who are looking for business, advertise …
The discomfort I felt around supervising did not arise in the clinic. It arose while reading the agreements meant to define it.
Supervisory agreements. Collaborative designations. Regulatory language that needed to be reconciled (carefully, deliberately) because names, roles, and obligations matter. Like many physicians, I have signed these documents countless times. But reading them slowly, rather than reflexively, produced an unexpected unease, one that felt structural rather than personal.
The language was …
I wanted to be at the top. Clinical ladder 4 was the top. You couldn’t get any higher achievement as an ICU nurse than this.
There were many requirements to obtain this:
I checked all the boxes, every year. It was hard work. And tiresome. The compensation for …
When we think of peacekeeping missions, images of armored vehicles and blue helmets often dominate the narrative. Rarely do we picture the quiet, relentless battle fought within the walls of a makeshift hospital, where saving lives becomes an act of defiance against chaos. Yet, in Abyei, Sudan, that was our reality. We arrived expecting logistical challenges, but nothing prepared us for the disarray that greeted us at the UN Level …
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Certified coach and professor Kathleen Muldoon and co-founder of Ryan House and Children’s Respite Homes of America Jonathan Cottor discuss the article “The need for pediatric respite care.” Kathleen shares the personal …
At the height of the COVID-19 surge, many hospital leaders faced moments they will never forget. Beds were nearly full. Staff were exhausted. Supplies that once felt routine suddenly became scarce. In those moments, decisions had to be made quickly, often based on experience, instinct, and whatever information was available at the time.
We like to believe that good leadership means trusting our gut. In clinical medicine, intuition matters. Years of …
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