I read Zoe Crawford’s thoughtful KevinMD essay on the limitations of direct primary care (DPC) with great interest. Her frustration as a medically complex patient navigating a fragmented health care system will resonate with anyone who has struggled to obtain timely imaging, referrals, or specialty care. As a clinician who has spent a career thinking and writing about how health systems fail both patients and physicians, I agree with …
Read more…
I’ve been thinking about “choice” a lot lately, not the rich, ethically grounded version we teach in medical school, rooted in autonomy, informed consent, and shared decision-making, but a thinner, more selective version now circulating in political and legal discourse. The kind that sounds principled until you read the fine print.
The message goes like this: You may choose, just make sure you choose correctly.
It’s the literary equivalent of Animal Farm: …
Read more…
“Once in a while you get shown the light
In the strangest of places if you look at it right.”
That line from Scarlet Begonias (lyrics by Robert Hunter, melody by Jerry Garcia) has followed generations like a benediction disguised as a song lyric. Released in 1974 on the Grateful Dead album From the Mars Hotel, it has become something more than poetry. It is a philosophy of attention, a reminder that …
Read more…
Something very distinctive happens once students complete medical school and residency: some of them start acting like excrement. Not all, but enough that most of us have witnessed the transformation. Maybe you’ve noticed it in your mentees, or in the children of friends and colleagues who went into medicine. Maybe, uncomfortably, you’ve wondered if it happened to your own children. And, if you’re like me, reflecting at the tail end …
Read more…
I’m not paranoid. And I don’t believe in conspiracy theories. But as a physician who has spent decades watching the pendulum of medical ethics swing back and forth, I can’t ignore the pattern emerging across public health and politics today. Some of what I’m seeing looks uncomfortably familiar. It looks like eugenics, not the caricature of white coats and calipers, but the quieter, policy-driven, values-encoded version that shaped America a …
Read more…
An excerpt from Real Medicine, Unreal Stories, Volume 3.
The café was quiet, tucked between a shuttered bookstore and a yoga studio that only seemed to open during Mercury retrograde. It was the kind of place that didn’t advertise, which made it perfect for writers, wanderers, and today, two physicians who had long since discovered that stories, not stethoscopes, were the truest diagnostic tools.
Dr. Gary Handler stirred his coffee absentmindedly, …
Read more…
I won’t be using CVS pharmacies anymore. Sure, I may still need to send prescriptions their way as a physician—but as a consumer, I’m done.
Why?
CVS has recently implemented a new phone system that forces callers to leave a voicemail instead of waiting on hold. The idea is to streamline operations, letting pharmacy staff return calls when they have time. It’s supposed to manage call volume, reduce wait times, and shield …
Read more…
This story is fiction but inspired by the real and worsening challenges faced by international medical graduates navigating U.S. immigration policy.
The acceptance letter sat printed on top of Nabeel Khan’s passport, still warm from the old inkjet printer in his family’s living room in Lahore. The words glowed like prophecy: “Congratulations! We are thrilled to welcome you to our Internal Medicine Residency Program at St. Julian’s Hospital, Topeka, Kansas, …
Read more…
In memory of Brian Wilson (1942–2025).
In a world increasingly marked by fracture and fear, it is hard not to return to the quiet, aching clarity of Brian Wilson’s song Love and Mercy. Originally released in 1988, the song was not a protest anthem or a sweeping political critique. Instead, it was a simple, open-hearted wish: “Love and mercy, that’s what you need tonight. So, love and mercy to you and …
Read more…
An excerpt from Real Medicine, Unreal Stories: Lessons and Insights from Clinical Practice.
The magnolias were blooming early this spring, their pale pink petals fluttering down onto the worn brick pathway outside the hospital courtyard. Dr. Eva Cardenas wrapped her thin white coat tighter as she waited on a bench, the same one she used to eat lunch on during the worst months of 2020, six feet apart from everyone …
Read more…
This article is satire.
Dr. Donovan Trumble was not your average internist.
In fact, if you asked him, he wasn’t your average anything.
He called himself “the most successful physician-researcher in America—maybe ever,” and once declared during grand rounds, “If Sir William Osler were alive today, he’d be my opening act.”
To the faculty at the Ivy League medical school where Trumble had once chaired the Department of Clinical Egotism (officially “Translational Medicine,” but …
Read more…
An excerpt from Narrative Medicine: New and Selected Essays.
One of my adult daughters recently reminded me of a cherished memory. When she was about four years old, we spent a few hours together at a small, independently owned bookstore. I selected books straight off the shelves and read to her, and later we joined a circle of children and parents to …
Read more…
The term “core competency” was coined by management experts C.K. Prahalad and Gary Hamel in their influential 1990 article titled “The core competence of the corporation,” published in the Harvard Business Review. Prahalad and Hamel defined core competencies as the unique capabilities or advantages that a company possesses, which are critical to its ability to achieve competitive advantage and long-term success. These competencies are not just about the skills or …
Read more…
Federal downsizing, while touted as a means to streamline operations and eliminate bureaucratic waste, has significant and often detrimental consequences for the U.S. health care system. Two documents shed light on this issue from complementary perspectives. The first, a U.S. Office of Management and Budget-Office of Personnel Management (OMB-OPM) memorandum outlines an aggressive workforce optimization initiative designed to reduce federal staffing and cut costs. The …
Read more…
The recent decision by the University of Pennsylvania (Penn) to remove diversity, equity, and inclusion (DEI) initiatives from its website has sparked a significant debate within the academic community. This move, aimed at complying with an executive order from President Donald Trump, highlights the tension between institutional values and political mandates. This essay explores the implications of Penn’s actions, contrasting …
Read more…
The Hippocratic Oath does not require citizenship as a condition of treatment. The oath, which serves as a foundational ethical guideline for physicians, emphasizes principles such as doing no harm, maintaining patient confidentiality, and practicing medicine ethically and with integrity. It focuses on the physician’s responsibilities to patients and the ethical practice of medicine rather than any conditions related to a patient’s citizenship or nationality.
So, why did this issue surface …
Read more…
The peaceful transition of power to the 47th president of the U.S. occurred January 6, 2025. It was the loser of the presidential election who ensured an orderly process and ironically certified the results.
In medicine, transitions of care – whether from inpatient to skilled nursing facility, from hospital to home, or during the passing of responsibility from one practitioner to another – represent pivotal moments in the continuity of patient …
Read more…
