When most of us as providers think about success in primary care, we focus on patient volume, quality of care, or time management. But in my opinion, there is a less glamorous (yet absolutely vital) area that can determine both our income and our liability: billing accuracy.
Billing is not just about codes and claims. It is the foundation of our financial health and a critical layer of legal protection. When …
Sepsis, multi-organ failure, near death
I fought back to the work I loved.
Life shifted; teaching’s call opened another door.
Not time yet.
The student clinic, a rebirth at the bedside,
Watching timid M1s bloom into confident, caring M3s: pure joy.
Being a doctor, teaching, healing, helping those in need.
Not time yet.
The pure fun of light bulbs igniting in small groups,
Connecting with so many bright, caring young minds,
Knowing medicine’s future is secure through them.
Not time yet.
Another …
We often sign extensive contracts when entering long-term commitments — think of the fine print in a mortgage, a car loan, or a new job offer.
While there are privacy forms and acknowledgments of office policies, the expectations of the physician-patient relationship are often assumed rather than explicitly stated. Some providers do outline expectations, and in today’s medicolegal environment, HIPAA notices are always signed — but that’s not the same as …
Being a doctor is about more than diagnosing illnesses or prescribing medications. It is about more than knowing the latest research, the right drug dose, or the most effective treatment plan. Those things matter (of course they do), but they are just part of the job description.
The reality is more human, more vulnerable, and more complex.
Imagine what it is like to sit in the waiting room before your appointment. You …
I got into the car outside the bus station in Lowell, Massachusetts, where my father was waiting to pick me up. He looked nervous when he handed me an envelope. Inside was my medical school decision letter. I was accepted. We let out a cheer.
Along with the acceptance letter was the projected cost of attendance: around $70,000 for the first year, climbing to nearly $90,000 by the fourth. I would …
The culture of medicine is shaped in quiet ways, by the way meetings begin, the pregnant pauses before a response, and the energy transmitted in emails sent and received. These seemingly insignificant experiences ripple outward, setting the tone for entire teams, shaping what is spoken and what is not, shaping what feels possible and what feels unsafe.
The culture of medicine is not an abstract force. It is built moment by …
I knew there was a cost when I chose to become a physician: The long hours, delayed gratification, the strained relationships. I could understand these things as familiar from my lived experiences. I knew there would be a financial burden, and having been raised by two immigrant parents, an electrician and a nurse, I was no stranger to the pressures of financial insecurity. I was fortunate too: my parents did …
A few weeks ago, I heard Michelle Obama say something that stopped me in my tracks:
“We have to learn to be OK with the regular days. The in-between. The parts of life that aren’t exciting.”
I thought of my kids in the back seat during a long car ride, sighing dramatically, claiming they were “literally dying” of boredom. I thought of patients sitting in a waiting room with nothing but their …
We’re often told that the key to financial success in medicine is volume—more patients, more visits, more hustle. But after two decades in primary care, I’ve learned something different:
The most powerful asset in your practice isn’t speed. It’s trust.
And trust starts with one of the most human (and most overlooked) elements of medicine: the doctor-patient relationship.
Why relationships matter more than ever
Primary care isn’t just about diagnoses or prescriptions. It’s about …
Recently, researchers examined whether there had been any changes in the way terminal cancer patients died from 2014 to 2019, given the increased information available on hospice, palliative care, and advanced end-of-life planning (EOLP). They asked whether those who were terminal continued aggressive treatment until their demise. The authors anticipated a decrease in this, but found that the frequency of cancer patients who continued aggressive therapy had not declined. The …
I am a physician-scientist, a title earned through decades of toil in laboratories and hospital wards, where the twin pursuits of truth and healing once reigned supreme. Yet, at the flagship academic hospital of this self-proclaimed “sanctuary state,” I conceal my credentials—not out of humility, but from a grim desire to witness the system unadorned, as it reveals itself to the ordinary patient. What I have beheld is a travesty: …
A man sat in my waiting room, heart racing—not from chest pain, but from panic. He’d been Googling his symptoms all night. Not afraid of what is—terrified of what might be. This is the anticipatory anxiety of modern medicine—a silent epidemic that strikes before any diagnosis ever does.
Patients no longer arrive with just symptoms. They bring stories already constructed. Hours of scrolling. Threads of worst-case scenarios. Algorithms feeding fear. By …
There was a time — not too long ago — when I dreaded the start of each workweek.
I had spent years studying, training, and sacrificing sleep, time with family, and even my health to become a physician. I believed in the value of primary care and the importance of relationships with my patients. But somewhere along the way, the dream started slipping through my fingers. I wasn’t unhappy because of …
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In medicine, one surprisingly heated debate doesn’t get much airtime: Should patients call their doctors by their first name?
It pops up often on medical forums. I’ve seen long threads dissect whether it’s disrespectful, whether it undermines authority, or whether it reflects a cultural shift in how we view physicians. Some doctors insist on “Doctor” as a matter of principle—status, respect, professionalism. Me? I appreciate being called Dr. Nadelson. It reflects the …
In the once-venerable corridors of our state’s flagship academic hospital, a slow-motion disaster is unfolding. White patients — yes, white patients, because that’s who’s leaving — are abandoning ship, hightailing it to the quieter, politer hospitals in “white” suburbs. Why? Because the “uniformly Mexican” staff — medical assistants, front desk drones, and nursing staff — treat customer service like it’s a foreign concept. And frankly, it is. Mexico isn’t exactly …
She works for a not-for-profit health system, but nothing about what she described to me felt charitable. A young physician, just a few years into her career, she’s already facing a choice that no doctor should ever have to make: protect her patients or protect the metrics that determine her employer’s paycheck.
The heart of the problem
This physician works under a value-based payment model. On paper, it sounds great: Pay doctors …
We often hear the phrase “practice what you preach.” As both a physician and a patient, I’ve learned that nowhere is this more important than in how we navigate health care.
Over the years, I’ve written about the importance of collaboration between physicians and patients. But as I’ve grown older and more frequently interact with the health care system, I’ve come to believe that good care rests on four essential elements:
WeightWatchers (WW) recently completed a broader financial reorganization, realigning leadership with a sharper focus on clinical innovation and women’s health, including menopause support. The reorganization includes appointing a chief medical officer to lead a more integrated, medically informed approach.
WW’s reorganization bankruptcy was driven by mounting debt and pressure from newer weight-loss therapy products, namely GLP-1 drugs like Ozempic and Wegovy. It was also impacted by a shifting landscape where traditional …
One of the most important—and least discussed—truths in medicine is this:
Feeling inadequate in medicine isn’t rare. It’s everywhere—quiet, lingering, relentless.
I remember starting my outpatient practice right out of residency. I had joined a large multispecialty group filled with physicians trained at top-tier institutions. Many had been practicing for decades. They were confident. Efficient. Experienced. I was still waiting on my board scores—unsure if I was even certified yet. And yet—there …
An excerpt from Tales from the Trenches: A life in Primary Care.
For nearly four decades in medical practice, I’ve been asked countless times about the best supplements or vitamins for improving health. Despite widespread hopes that pills can unlock vitality and longevity, the truth is less glamorous and far more powerful: The single best prescription for health is regular physical activity. Exercise, not supplements or medications, is the most …
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