In medicine, self-sacrifice is praised. We call it dedication. We call it loyalty. However, sometimes it is just exhaustion wearing a badge of honor, and it keeps us complicit in systems that harm us and our patients.
Burnout does not kick the door in. It just shows up quietly. One day you notice you have not called a friend back in weeks. Lunch, if you can call it that, is an …
Well, that didn’t take long, did it?
Today’s “controversy du jour” is prevention in health care. More specifically, vaccines and their role in preventing disease, disability, and death while promoting health and lifespan.
Prevention is the mother’s milk of health care. It is core to reducing illness and disease. Sadly, the udders producing that milk are drying up quicker than you can shake a fist at what is happening before our very …
Over the past several years, each time a periodic U.S. hospital closures report is released, the number failing financial stress tests and at extreme risk of closing rises. The number now approaches 800 nationwide.
Meanwhile, many project that the just-passed One Big Beautiful Bill will rapidly increase these closures and further degrade health care access for American citizens.
Touted reasons for accelerating hospital closures, especially impacting …
The message came through before dawn: “Our EHR is down. No access to patient charts.”
In a rural clinic, that is not just a technical inconvenience. It is the mother who drove forty miles before sunrise to get her child’s asthma medication, the farmer who left the fields to review his lab results, the elderly patient who cannot make another trip for months. When systems go dark, there is no backup …
History has a habit of repeating itself.
Just prior to the 1929 crash, ads supporting the presidential candidacy of Herbert Hoover promoted a tag line promoting prosperity that has lived in infamy: “A chicken for every pot and a car in every garage.”
Now we have Robert Kennedy—our Secretary of Health and Human Services, the cheerleader for the “Make America Healthy Again” movement—promoting another grand idea to solve our nation’s …
The U.S. health care system is a paradox. It’s the most expensive in the world—costing over $4.5 trillion annually—yet produces some of the worst health outcomes among developed nations. Fragmentation is at the core of this crisis. Patients bounce between primary care doctors, specialists, emergency rooms, and insurers, often with no single point of coordination. The result? Redundant tests, misdiagnoses, delayed care, and frustrated clinicians.
Enter artificial intelligence—not as a silver …
I recently spoke with close friends—both physicians—who admitted something quietly alarming: They’re not resisting change in health care. They’re just tired of constantly adapting while losing the essence of what brought them into medicine in the first place.
“I spend more time documenting than actually caring for my patients.”
“Every time I adjust to one system, a new one replaces it.”
These comments stayed with me—not as complaints, but as confessions. As a …
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Certified coach Kathleen Muldoon discusses her article, “Choosing between care and country: a dual citizen’s Independence Day reflection.” As a dual U.S. and Canadian citizen and mother to a child with complex …
Well before I was a physician, I was an art history major at Bowdoin College. Beneath towering pine trees, I spent much of my time in dim lecture rooms off the quad and in the quiet galleries of Maine’s art museums, studying paintings, sculptures, and photographs to understand not just what was being portrayed, but also what they revealed about the people, places, ideas, and defining events of their time. …
As yet another tragic chapter unfolded in the intractable and ever-escalating Iran-Israel conflict, I found myself in the midst of conversations, intense, impassioned, and sometimes uncomfortably raw. The participants weren’t diplomats or scholars. They were ordinary people, men and women, brown and white, Jews and Arabs, Muslims and Christians, all fiercely devoted to their own perspectives, each convinced they were defending not merely an opinion but the truth.
One particularly striking …
Rising costs are dominating kitchen table conversations across the country, and health care is no exception. In response, federal and state regulators have introduced a range of proposals to curb spending and improve efficiencies—some thoughtful, others deeply flawed. As a former emergency medicine physician and now a health care executive with over three decades of experience, I’ve seen what works and what doesn’t. If we’re serious about cost control, we …
Imagine going to a restaurant where, instead of being charged separately for your appetizer, main course, and dessert, you pay a fixed price for the entire meal. That’s the idea behind a bundled payment plan in health care. Instead of billing patients and insurers for every individual test, treatment, or doctor’s visit during a medical episode—like a knee replacement—providers receive a single, comprehensive payment for all services related to a …
As lawmakers debate cuts to Medicaid and restrictions on care for undocumented immigrants, the question isn’t just what America covers—it’s who.
Proposals like the No Medicaid for Illegal Immigrants Act of 2025, and related attempts to embed its provisions in the One Big Beautiful Bill Act, aim to block federal funding for Medicaid services to undocumented families. Some state plans go further, threatening to remove children from CHIP if …
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President Trump signed into law the One Big Beautiful Bill Act (H.R. 1)—a 1,000+ page legislative thunderclap that had just cleared Congress, reshaping the landscape of American domestic policy as fireworks lit the sky. Branded as a domestic reset—heavy on tax cuts, defense expansion, and deregulation—it was not sold as a health care bill. But for those of us on the front lines of medicine, particularly in rural America, make …
Veterans deserve the highest-quality health care our nation can offer, but fulfilling this promise often means overcoming major challenges. About 9 million veterans receive care through the VA, with a third living in rural areas far from VA facilities. Meeting their needs requires innovative solutions that combine expertise, technology, and strategic partnerships.
Why VA’s holistic model outpaces traditional care
The VA stands apart with its integrated, long-term approach to care. Unlike the …
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article, “Physician patriots: the forgotten founders who lit the torch of liberty.” Muhamad calls for a remembrance of the five physician-patriots—Dr. …
In an age where bold language dominates headlines, it can be easy to overlook the real-world effects of complex legislation. But this is not just a matter of political branding. The proposed One Big Beautiful Bill Act has implications that, based on current research, could lead to substantial and preventable harm to public health.
As a fourth-year medical student with a background in public health, I’ve spent years studying how health …
As a surgery resident, I see the long shadow of poor public health every day — whether it’s a diabetic foot infection that’s gone too long without care or a hypertensive crisis that never should’ve happened. That’s why the proposed restructuring of the CDC and other federal health agencies is not just administrative news to me — it’s personal.
The argument for reform often leans on efficiency: Reduce bureaucracy, streamline oversight, …
There’s a stretch of days at the beginning of July, between Canada Day and Independence Day, when I find myself holding my breath. It’s a liminal space that I know intimately as a professional, a mother, and a dual citizen. Born Canadian and naturalized American. Over the past several years, as I have come into the full realization of who I am as a parent of a child with complex …
Medicine today is single-encounter oriented with documentation largely tailored for legal purposes rather than medical care. When an encounter ends, the physician must sign off the documentation and no further changes can be made; any corrections require another document that must also be signed off, but this is seldom done.
A further problem with current medicine is that many diagnoses are differential diagnoses instead of confirmed ones, which may be OK …
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