Anonymous

October 25, 2026Oct 25, 2026

For anyone with their finger on the pulse of American medicine, it is clear that referrals to see specialists as required by many health insurance plans have become a serious problem for doctors and patients alike. Primary care physicians often resent the time that these referrals take out of their day. Many also resent the fact that patients sometimes make appointments for no other reason than to …

Medical satire: A wolf can pass as your doctor now

August 27, 2026Aug 27, 2026

When I was just a Medium-Sized Bad Wolf loping through the forest, I stumbled upon a doctor in a white coat, carrying a bag of supplies. It was Sunday night, and dinner options were scarce, since most other humans were…

“Where are you going so late, Doctor?”

She sighed. “Another patient who refused the flu vaccine is sick with the flu, so I’m bringing them Tamiflu.”

I tricked her …

Becoming a physician mother changed how I practice

July 26, 2026Jul 26, 2026

As pediatricians, we enter patients' lives at moments of uncertainty. You learn how to listen for what is said and what is not said. You walk guardians through fevers, developmental milestones, and the thousand small worries that come with raising…

As pediatricians, we enter patients’ lives at moments of uncertainty. You learn how to listen for what is said and what is not said. You walk guardians through fevers, developmental milestones, and the thousand small worries that come with raising a child. Over time it all feels comfortable. Routine.

Then you become the parent. The questions you have answered so many times drip with new urgency, and your own uncertainty. Sleep, …

Physician moral injury and the doctors trying to stay

June 23, 2026Jun 23, 2026

My wife did not want to leave. That is the part that matters most. After residency, this was the only hospital she had ever known as an attending physician. It was where she became a doctor in the fullest sense…

My wife did not want to leave. That is the part that matters most.

After residency, this was the only hospital she had ever known as an attending physician. It was where she became a doctor in the fullest sense of the word: not the title earned at graduation, but the identity built over years of showing up for patients, colleagues, emergencies, births, losses, complications, and ordinary days that were not …

Why resident mistreatment puts patient care at risk

June 19, 2026Jun 19, 2026

After 20 years in medical practice, I made the decision to return to training for six months as a neonatology fellow to regain my neonatology board eligibility. At 54 years old, I did not come in with illusions. I expected long hours, academic rigor, and the challenge of re-entering a structured training environment after decades of independence.

What I did not expect was to witness, so clearly and so persistently, a …

Institutional betrayal in medicine nearly broke me

June 16, 2026Jun 16, 2026

The morning it happened, I had just come back from a run. It was a beautiful day. I was training for a marathon, grateful for my life. I came home and stepped into the shower. A family member I had…

The morning it happened, I had just come back from a run. It was a beautiful day. I was training for a marathon, grateful for my life. I came home and stepped into the shower.

A family member I had welcomed in my home had a psychotic break and violently assaulted me with a kettlebell. The surgeon offered to schedule the repair of my severed tendon for the following morning. I …

Pregnant resident discrimination nearly cost me everything

June 1, 2026Jun 1, 2026

I have delivered hundreds of babies. I have held the hands of women in their most terrifying and most joyful moments. I have spent my entire adult life becoming the kind of doctor who shows up, completely, compassionately, and without hesitation, for my patients. What I never imagined was that one day, bleeding and pregnant and alone in a call room at 21 weeks, I would be the one who …

The recovery no one schedules after maternity leave

May 30, 2026May 30, 2026

As a doctor, I often explain to patients how long recovery is likely to take. We offer timelines because uncertainty is often the hardest symptom to bear. I know this from the other side too. Four weeks after giving birth,…

As a doctor, I often explain to patients how long recovery is likely to take. We offer timelines because uncertainty is often the hardest symptom to bear.

I know this from the other side too. Four weeks after giving birth, I found myself jogging outside at 11 p.m., with an app counting my steps. I was 12 kilograms heavier than before pregnancy and could barely look at myself in the mirror. …

Why bipolar II is not just a milder version of bipolar I

May 10, 2026May 10, 2026

When I graduated from medical school, I carried an assumption I suspect many of us do: Bipolar II disorder is a "milder" version of bipolar I. After all, mania is dramatic. It is disruptive. It can involve psychosis, hospitalization, legal…

When I graduated from medical school, I carried an assumption I suspect many of us do: Bipolar II disorder is a “milder” version of bipolar I. After all, mania is dramatic. It is disruptive. It can involve psychosis, hospitalization, legal consequences, and financial devastation. Hypomania, by comparison, seems restrained: more energy, less sleep, no involuntary admission. The hierarchy seemed obvious. Mania is more severe than hypomania. Therefore bipolar I must …

Medical education

A medical school dismissal highlights disability discrimination

May 2, 2026May 2, 2026

Meet the standards. Demonstrate competence. Move forward. That is the promise medical students are told to trust. But a federal lawsuit filed against a private medical school puts that promise to the test. What happens when academic standards, professionalism judgments,…

Meet the standards. Demonstrate competence. Move forward. That is the promise medical students are told to trust.

But a federal lawsuit filed against a private medical school puts that promise to the test. What happens when academic standards, professionalism judgments, and disability accommodations collide?

At the center of that lawsuit is a fourth-year medical student who, according to public court filings, was dismissed amid allegations of disability discrimination, failure to accommodate, …

A physician’s journey with a hidden CSF leak and delayed diagnosis

April 27, 2026Apr 27, 2026

In 2023, I was in a serious motor vehicle collision. The injury that followed, a vertebral artery dissection, required real recovery. I did the work and thought I had come out the other side. I was looking forward to celebrating my three-year anniversary since the accident. I was feeling grateful. I was not expecting what came next.

The bike

I love spinning. The bike was the first thing I reclaimed after the …

Trusting clinical intuition to spot an atypical heart attack

April 19, 2026Apr 19, 2026

An excerpt from Those Shoes: A Physician's Reckoning with Life, Death and the Medical Machine. The nurse caught me before I walked in the room, "This next patient says he knows you." I looked in the room and saw Jim,…

An excerpt from Those Shoes: A Physician’s Reckoning with Life, Death and the Medical Machine.

The nurse caught me before I walked in the room, “This next patient says he knows you.” I looked in the room and saw Jim, the gate guard in my neighborhood. “What’s he here for?” “Back pain,” she said, with a look I recognized. “You know what he wants.” I knew what she meant. Back …

Why self-care alone cannot cure systemic nursing burnout

April 11, 2026Apr 11, 2026

Nurses are constantly told that burnout can be prevented through self-care: rest, nutrition, mindfulness, and learning to assert healthy boundaries. I followed that advice. I asserted professional boundaries. I tried to maintain reasonable limits around my time and energy. I attempted to follow the guidance nurses are routinely given about protecting our well-being. Within one year, I was fired from three jobs. This is the contradiction at the center of …

How to win peer-to-peer calls: a medical director’s guide

April 7, 2026Apr 7, 2026

I review your peer-to-peer calls. Here is why you keep losing. I sit on the other side of your peer-to-peer call. I am a physician medical director in utilization management. When you call to overturn a denial, I am the…

I review your peer-to-peer calls. Here is why you keep losing.

I sit on the other side of your peer-to-peer call.

I am a physician medical director in utilization management. When you call to overturn a denial, I am the one listening. I have taken thousands of these calls over the past decade. I can tell within the first 30 seconds whether you are going to win.

Most of you lose. Not because …

“The only thing that will change will be our name”: a private equity cautionary tale

February 25, 2026Feb 25, 2026

"The only thing that will change will be our name." These were the words shared by a senior partner when our staff was informed that the partnership had decided to sell the practice to a private equity firm. Unfortunately, as…

“The only thing that will change will be our name.”

These were the words shared by a senior partner when our staff was informed that the partnership had decided to sell the practice to a private equity firm. Unfortunately, as the story unfolded, that was also the moment that my future changed.

I was an associate when those now infamous words were uttered. While I was wary of this transition, it was …

When racism findings challenge institutional narratives

December 31, 2025Dec 31, 2025

In the annals of social science, few imperatives are more solemnly intoned than the necessity of measuring racism with the cold precision that only quantification can provide. Only when bias is reduced to p-values and effect sizes may one confidently proclaim, “Behold, the incontrovertible evidence of racism,” secure in the knowledge that no reasonable interlocutor can wriggle free on the strength of anecdote or wounded sentiment. Yet such measurements, to …

Restoring clinical judgment through medical education reform

December 28, 2025Dec 28, 2025

A modest proposal for the reform of American medicine might begin, improbably enough, in a suburban pediatrician's office where, last week, a physician of evident earnestness instructed my adolescent son to sleep until noon whenever possible, on the theory that…

A modest proposal for the reform of American medicine might begin, improbably enough, in a suburban pediatrician’s office where, last week, a physician of evident earnestness instructed my adolescent son to sleep until noon whenever possible, on the theory that tardy rising is the royal road to superior intelligence. The authority cited was a single paper (published, with all due respect, in the journal Personality and Individual Differences) bearing the …

Gender bias in medicine: Who deserves to be saved?

December 18, 2025Dec 18, 2025

The nurse adjusted my father's blanket for the third time that hour, her voice soft as velvet. "We just hate to see him suffer like this," she whispered. My mom and I watched her check his IV with the tenderness…

The nurse adjusted my father’s blanket for the third time that hour, her voice soft as velvet. “We just hate to see him suffer like this,” she whispered. My mom and I watched her check his IV with the tenderness reserved for wounded pups.

Three floors down, four years earlier, this same hospital discharged me mid-vomit with a gastric outlet obstruction and a white blood cell count that screamed infection. “Go …

The H-1B crutch in rural health care

The H-1B crutch in rural health care

November 26, 2025Nov 26, 2025

In the vast, undulating expanse of rural America (those counties where the horizon stretches like a taut bowstring, evoking the stoic endurance of Steinbeck's Joads) one might expect the pulse of health care to beat with the resilient rhythm of…

In the vast, undulating expanse of rural America (those counties where the horizon stretches like a taut bowstring, evoking the stoic endurance of Steinbeck’s Joads) one might expect the pulse of health care to beat with the resilient rhythm of native ingenuity. Yet, as a recent study in the Journal of the American Medical Association reveals, physicians sponsored under the H-1B visa program are twice as prevalent in these bucolic …

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Drugs and prescribing

A cautionary tale about pramipexole