Anyone who has been gaslit knows it feels like hell on earth. We might as well be soldiers in a foreign war. When we return from the war of gaslighting, we deal with PTSD. Eventually, we feel the healing of the wounds.
I am one of thousands of victims of gaslighting in Colorado. All victims have unique stories. In pursuing justice for many of these victims, I’ve learned that lawyers, judges, …
When a divorce ends a physician’s career
For the first time in American history, more than 100,000 babies were born through in vitro fertilization (IVF) in a single year.
According to data released in March 2026 by the Society for Assisted Reproductive Technology (SART), 100,158 IVF babies were born in the United States in 2024, across 449,772 reported treatment cycles at 364 fertility clinics nationwide. Behind each of those births is a patient who faced uncertainty, made …
How to read IVF success rates before choosing a clinic
The growing scrutiny of applied behavior analysis (ABA) within Medicaid is widely misunderstood within the behavior analytic community as an attack on the profession or its science. It is neither. The root cause is structural. Medicaid programs, whether state-managed or administered through managed care organizations, operate on fixed annual allocations called “premiums,” funded by a blend of federal and state dollars. Each child’s premium is essentially a predetermined budget meant …
The Medicaid reckoning for applied behavior analysis
A physician in our network was having dinner with a group of entrepreneurs. None of them worked in health care. But one mentioned a former health IT executive who had built a technology platform for hospital operations. The physician, who spent his days inside hospitals and immediately recognized the problem the product was solving, picked up his phone, called me, and said, “You need to look at this.”
That call led …
Why physician-led deal sourcing beats traditional VC
The number was wrong for twenty years. Nobody could see it.
For more than twenty years, a number quietly shaped the care of millions of patients. It told nephrologists when to refer. It told transplant committees who qualified for the waitlist. It told primary care physicians which patients were stable, and which were declining.
For Black patients, the number was wrong. By design.
The number was eGFR, and the formula behind it included …
What the eGFR race correction teaches us about AI
Technological and biomedical advancements are undeniable blessings in today’s health sector. These advancements have improved life-prolonging technologies. So, clinicians can often sustain biological life long after meaningful recovery is unlikely. Consequently, there is a subtle shift happening in modern medicine, where we are no longer asking whether we can keep people alive but who gets to decide when not to.
This shift becomes clearer when viewed through Ronald Dworkin’s distinction between …
End-of-life decision-making is never a solo act
You might recall when patients arrived with a blank slate of symptoms, and diagnosis began with your clinical judgment. That blank slate is now a distant memory. Before your patient meets you, they have already spent weeks or months scrolling through a digital universe that is actively changing how they understand and interpret their own symptoms. The influence of digital media on all aspects of health care is here to …
Why health influencers shape patients, not prescriptions
I recently worked with a medical student who had spent weeks writing and revising her residency personal statement. Her essay was layered and thoughtful, tracing the arc of her experiences and establishing a clear through-line for why she wanted to pursue palliative care medicine. Most importantly, the narrative sounded like her. It was honest. She was proud of it.
Then she showed it to a resident on a rotation. The resident …
Why ChatGPT can’t write your residency personal statement
I came to military medicine as a sports medicine physician. At first, it seemed like an unexpected place for that training. But the more soldiers I treated, the more obvious it became: What better place for sports medicine than the military?
Sports medicine is built around performance, load, recovery, rehabilitation, and preserving function over time. In military medicine, the language changes but the principles are the same. Return to sport becomes …
Military sports medicine and the cost of readiness
A 22-year-old came to my office because he wanted to “get on track” with his health.
He was not in crisis. He did not feel sick. His labs were concerning, but not unusual for primary care: triglycerides in the 250s, a hemoglobin A1C near the diabetic range, elevated blood pressure and central obesity.
Then I reviewed his liver stiffness measurement. F3 fibrosis.
That result was hard to believe. Over time, it prompted me …
The liver should play a larger role in managing metabolic disease
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Medical AI is evolving faster than the legal system can regulate it. Richard E. Anderson, CEO of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, argues that the gap between what AI can do clinically and what courts are ready …
Why AI has outpaced medical malpractice law, and what to do about it [PODCAST]
Neonatal survival depends on continuity that modern health systems often assume as stable. Thermoregulation, oxygen delivery, infection control, trained clinical staffing, and reliable electricity must function together as an integrated system. When that system is intact, care follows a predictable sequence from delivery through stabilization and escalation when needed. When it is disrupted, survival becomes conditional rather than assured.
In Gaza and Lebanon, ongoing humanitarian conditions have placed neonatal services under …
Neonatal care in humanitarian crises is conditional
Medicine changes in many ways. Some changes arrive with public debate, policy announcements, and formal declarations of progress. Others arrive more quietly, through repetition, habit, and the slow accumulation of what becomes normal. In my experience, the most consequential changes in professional life often come that second way. They are absorbed long before they are named.
We speak often of the hidden curriculum in training. Young physicians learn not only science …
When medicine confuses professionalism vs. compliance
Imagine a physician who has been practicing anesthesiology for 20 years. She is skilled, board-certified, well-liked, and respected by her team. She now works more hours than she did 10 years ago, covers more call, cares for sicker patients, and manages an …
Insurance consolidation is a patient safety problem
An older patient tells the health care team that swallowing medications is difficult. Pills get stuck in the throat. Some trigger gagging. Others are skipped altogether because taking them has become an ordeal. The concern is documented, the difficulty is acknowledged, and in some cases, a swallowing assessment is even performed. Yet the prescription remains unchanged.
Weeks later, the patient has missed doses or stopped the medication altogether. The medical record …
When difficulty swallowing pills looks like noncompliance
Physicians tend to view conditions affecting mental health as entirely different from those affecting the digestive system. Depression is managed in one clinic, irritability and constipation in another, and chronic fatigue somewhere in between. However, mounting evidence indicates that these conditions are potentially interconnected. The connection might start in the gut.
Human intestines are host to trillions of microorganisms collectively referred to as the gut microbiota. They are involved in a …
The gut microbiome and mental health are interconnected
As a prominent health care educator and advocate for chronic pain patients and their clinicians, I receive a large number of emails and potential papers in venues where I am active. Every week, I hear from people who have been harmed by U.S. government misdirection and outright health care fraud. Increasing numbers of those who come to me are doctors who have been railroaded into prison and had their lives …
Why are doctors prosecuted for prescribing opioids?
During and after the pandemic, I was actively looking for a non-clinical position. Despite my love of medicine and two decades as a partner in a busy, prestigious OB/GYN private practice, I would have left clinical medicine entirely if the right opportunity had come along. That is how depleted I was. That is how broken the system had become for me.
It didn’t come along. Eventually, I stopped waiting for an …
Leaving insurance-based practice while burned out is a trap
“If gravity pulls everything down, why are my health insurance premiums and co-payments skyrocketing?”
The question sounds humorous, but beneath the humor lies frustration shared by millions of Americans. Health care spending in the United States continues to rise year after year. Medical technology has advanced dramatically. We have better imaging, more sophisticated procedures, and an ever-expanding list of medications. Yet many patients are finding health care increasingly difficult to afford. …
Health care affordability is now a moral crisis
The third pharmacy turned him away. My patient had already driven across Northern Michigan in search of his life-saving cancer medication. The first pharmacy was out of stock. The second was out too. At the third, he was told they hadn’t received a shipment in weeks.
On the other end of this crisis are the physicians. We spend our late evening hours calling store after store, a desperate game of pharmacy …
U.S. drug shortages threaten national health security
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