Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
Most physicians know what they earn. Far fewer know what it costs to hire them or replace them. A colleague once told me in frustration, “It takes me two years to get my money back on a new hire.” I understood the frustration, but not the math. I thought of hiring the way many physicians do: salary, benefits, maybe a signing bonus. It seemed straightforward. It is not. Hiring a …
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The hidden math behind physician hiring costs and recruitment
Physicians are trained, above all, to project steadiness. Long before we feel it, we learn to perform it. The lesson begins early in training. The pager goes off, a room fills with urgency, and the expectation is unspoken but unmistakable: Remain calm. Do not let uncertainty show. Do not let fear show. Patients need confidence. Teams need direction. Over time, the composure stops feeling like a performance. It becomes a …
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The quiet paradox of physician mental health and medication
A pharmaceutical representative recently brought lunch to my office to present a new drug. The drug may help some patients. The food was abundant. The room was full, with excess all around, including leftovers that were eventually thrown away. None of that is unusual in American medicine.
What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the …
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Why I stopped accepting pharmaceutical-sponsored lunches
We are taught to watch for conflicts of interest in the form of pharmaceutical pens and consulting checks, yet we often overlook the most pervasive corruption of all: the ticking of the clock.
We traditionally describe medical conflicts of interest in corporate terms: free dinners, speaking fees, and consulting arrangements. These temptations are real, and they deserve the scrutiny and rules we apply to them. But they are external distractions. The …
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The ticking clock: How time constraints in medicine hurt patient care
On January 29, 2026, the European Journal of Pediatrics formally retracted what had been the largest randomized clinical trial examining folinic acid as an intervention for autism. The reason, according to the journal’s notice, was direct: The study’s data did not support its published conclusions.
Originally released in 2024, the trial reported that 24 weeks of oral folinic acid therapy produced a “significant reduction” in autism symptoms among 77 children. In …
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What the folinic acid retraction means for autism treatment
Egregious ethical failures in health care almost always gain attention. Less visible, but no less consequential, are the systemic ones that are often overlooked: routine acts that present themselves as morally neutral, procedural, and unremarkable. They usually do not provoke outrage and are not experienced as trauma. Yet over time, one must be concerned about how they quietly reshape our well-being and our professional identities.
The effect of these acts does …
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Moral injury in medicine: When silence becomes a survival strategy
Human rights are understood to be universal and egalitarian. They are inalienable, indivisible, and grounded in a shared moral intuition: that human dignity deserves protection. One of the most widely accepted expressions of that intuition is the obligation to care for those who are physically or emotionally ill. Yet despite this near-universal belief, modern health care systems continue to struggle with a fundamental question: Is health care a human right, …
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Health care as a human right vs. commodity: Resolving the paradox
Most of us don’t notice moral development happening while it is happening. Moral character forms quietly, through repetition, through what we get used to doing and through what we slowly stop doing without much forethought.
Artificial intelligence matters from a moral perspective long before it ever potentially becomes conscious or autonomous. Although AI may or may not confront us with dramatic ethical dilemmas, it does change our moral lives in a …
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AI and moral development: How algorithms shape human character
For years we have told patients the same thing when they have trouble finding a doctor: Go to your insurance directory, look it up, they can help you.
And despite saying that, many of us have quietly known for a long time that this advice is broken. We still give it. We give it hoping for the best, knowing there really are not many other useful options to offer at this …
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Ghost networks in health care: Why physicians are suing insurers
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 …
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The shifting meaning of supervision in modern health care
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs. The child suffers not only from the caregiver’s direct …
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Understanding factitious disorder imposed on another and child safety
The recent federal conviction of Done Global’s CEO, Ruthia He, and its clinical president, psychiatrist David Brody, on November 20, 2025, has brought long-standing concerns about virtual ADHD prescribing into undeniable focus. A San Francisco jury found both executives guilty of conspiring to distribute Adderall and other Schedule II stimulants, along with health care fraud and (for He) obstruction of justice. According to the Department of Justice, Done Global generated …
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Telehealth stimulant conviction: lessons from the Done Global case
Have you ever wondered how a single online comment might shape your reputation as a physician? I have, especially after reading a review that sardonically suggested I had earned my medical degree from Amazon (the company, not the rainforest). The jab was clearly meant to sting. Although I regret the dissatisfaction behind it, it gave me pause. How much weight do we give these offhand remarks, and what do they …
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How online physician reviews impact your medical career
Some cases linger in our memory because of the humanity at their center. The case of Charlie Gard, which unfolded in England in 2017, is one of those. It took place within the National Health Service and under a legal framework in which courts decide a child’s treatment when parents and clinicians cannot agree. Before it became a global controversy, before it drew international headlines, it began as something far …
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The ethical conflict of the Charlie Gard case
