I started volunteering on Saturday mornings out of a feeling of restlessness. Having been in primary care for several years, I was looking for something new, to break from routine, and to feel like I was doing real good. Which is how I ended up at our medical student-run free clinic, and have been blessed with an opportunity that has grown into a primary passion of mine. We see mostly …
Why relationship-centered care matters in medicine
Doctor, you see only the faint visible smile
on my exterior, my hand reaches out to shake yours
as you enter the space.
But you cannot see the “me” within,
the fear, the stress, the anxiety
that circulates inside me.
These emotions swirl within,
poking and prodding,
they hang like a weighted chain
about my heart.
I guess one could say
I am an imposter,
a person in disguise.
But couldn’t the same be said of you?
I guess you were trained
to keep your …
The silent patient experience in the exam room
The recent record snowstorm in New England got me all in a deep wintery nostalgia. I contacted my friends back in Boston who have been living there for well over 40 years to get their perspectives, and it brought back memories of living on the East Coast and surviving the seemingly interminable long winters there before I moved to California in the late 1980s. Most prominently in my memory is …
Surviving a hospital blizzard as a physician on call
Calls to declare family physicians the “backbone of health care” are emotionally appealing, but they do not withstand scrutiny. When we examine training pathways, cost structures, insurer incentives, and real-world performance, a different picture emerges, one in which many other clinicians are better trained for the populations they serve and, critically for insurers, far cheaper. This is not an attack on family physicians. It is a call for accuracy in …
Rethinking the role of family physicians vs. specialists
I have practiced medicine for 45 years. In that time I have learned that the biggest threat to a patient is not a missed diagnosis. It is a missed owner. Every patient has a story. Most of them have a complicated one. Multiple doctors, multiple medications, multiple specialists, multiple systems. And in all of that complexity, nobody steps forward and says: I own this patient. I will follow the thread …
Patient ownership is the key to a better health care system
I grew up in a family of nine in New Delhi, where scarcity was our daily companion. We had no processed food, no artificial dyes, no glyphosate-laced cereal aisles stretching into infinity. We ate whole foods, not by philosophy, but by necessity. We moved our bodies, not by gym membership, but because life demanded it. We slept when the sun went down and woke when it rose. Circadian rhythm was …
Make America Healthy Again fails true functional medicine
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Clinical director at Franklin Park Family Dental in Dorchester and Tremont Family Dentistry in Boston, Charan Teja Bobba, discusses his article “Treating methamphetamine-associated dental disease in safety-net clinics.” Charan reflects on the …
Safety-net dentistry restores human dignity for patients recovering from severe addiction [PODCAST]
A patient sends a portal message at 9:17 p.m. on a Tuesday. “Hey, I’ve been having some chest tightness when I climb stairs. It comes and goes. Also can you refill my metformin and check if my last A1C was OK? I don’t want to come in if I don’t have to.” This message requires clinical triage. It requires chart review. It requires a decision about whether to initiate a …
How patient portal message volume drives physician burnout
I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work shows a steep drop in her blood count. We are working together to understand what is going on. As I prepare to enter orders in the electronic health record (EHR), …
The hidden clinical cost of HCC coding in primary care
One prominent characteristic of medicine is its ability to repeatedly remind you to be humble. There is always something new to learn about it, and in real life patients rarely present exactly as they do in the textbook. On top of that, health care workers commonly feel pressure to be perfect due to the potentially serious consequences of many medical mistakes. Of course, since we are human, we are bound …
Medical mistakes happen and you are still enough
It was a typical weekday morning. I woke up at 5:20, started a load of laundry, showered, dressed, unloaded the dishwasher, got the kids breakfast and lunch together, fed the pets, etc. After sending my husband off to work, I got the kids up and ready for the day. Things were going smoothly. I got my kids to school on time, and got into work early enough to go through …
Balancing part-time clinical work and motherhood
There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced inside for over two decades, saying you believe something that the evidence has not yet fully validated carries consequences. Raised eyebrows at conferences. The careful distance of colleagues. The quiet …
The clinical evidence and reality of peptide therapy
Most internal medicine physicians assume that when they sit for a board examination, their answers determine one thing: whether they pass. Few realize that their exam performance has been linked to federal Medicare claims data and used in research, without their knowledge or consent.
The American Board of Internal Medicine (ABIM) has published studies linking board scores to clinical outcomes derived from Medicare claims. ABIM presents these analyses as quality research …
Why ABIM’s use of Medicare claims data violates physician autonomy
The internet has made patients more informed. It has also made some patients more misled. A small but growing body of medical commentary has used the provocative label “internet-derived information obstruction treatment (IDIOT)” syndrome to describe what happens when people trust online medical content so blindly that they delay care, stop treatment, self-medicate, or resist sound clinical judgment. The term appears in published reviews and commentaries, but it is not …
How IDIOT syndrome threatens value-based health care
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Internal medicine and functional medicine physician Shiv K. Goel discusses the article “Why lifestyle matters more than BPC-157 and semaglutide.” Shiv explains how the modern longevity boom has trained patients to seek …
True metabolic healing requires more than just prescribing expensive peptides [PODCAST]
The day I handed in my credentials as medical director, I sat in my car in the parking lot for a long time. I had held that role at Methodist Specialty and Transplant Hospital in San Antonio for years. I had built protocols, chaired committees, mentored residents, and managed crises at hours when the rest of the city slept. I was, by every conventional metric, succeeding. And yet there was …
Why leaving hospital medicine for private practice was worth the risk
In clinical practice, reassurance is both necessary and responsible. When a clinician says “nothing concerning,” it is rarely casual. It reflects a judgment: no immediate danger, no clear evidence of serious disease, no indication for urgent intervention. It is often the appropriate conclusion at that moment in time. But what happens to that statement after the visit ends is less often considered. Because outside the clinical context in which it …
How clinical reassurance impacts patient communication
As physicians, we rarely disagree about first principles. Nutrition, physical activity, sleep, stress, and behavioral patterns sit at the foundation of nearly every chronic disease conversation. We counsel patients on these topics every day, sometimes passionately, sometimes hurriedly, often within the narrow time constraints of a packed clinic schedule.
Yet an uncomfortable gap persists between what we know drives long-term outcomes and what we are realistically able to deliver in routine …
Lifestyle medicine support: Bridging the gap in patient care
Your patient stops showing up for follow-ups. They are rationing medications you prescribed. They cannot afford the specialist you referred them to.
You assume it is financial stress or insurance issues, but it could simply be due to what is missing from your chart notes, a pattern that is especially common among military veterans navigating disability benefits.
After more than 20 years in clinical practice serving patients with disabilities, including many military …
How your clinical notes impact military veterans’ disability benefits
I really tried to have AI come up with an innocuous-sounding title for this piece: “Caring Hearts, Lighter Wallets: The Financial Reality of Primary Care.” But my poor judgment prevailed so I just decided to insult all of my colleagues right from the start. I assure you, for better or worse, that this article is my original opinion although with AI editing for grammar and clarity (but unfortunately not brevity). …
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