There is a moment in the operating room so brief it almost disappears.
Names are spoken. Roles clarified. A question offered into the air: Does anyone see something we don’t?
For a heartbeat, hierarchy loosens. For a breath, the room remembers it is made of humans. That is the moment the checklist was built for. Not because surgeons forget steps, but because under pressure, even the best of us forget how to …
Eighteen months ago, I learned something every patient hopes never to hear: that my cancer had returned. Years earlier, I had been treated successfully for prostate cancer. When my PSA began to rise again, I knew something was wrong. It took persistence and more than a few second opinions to confirm what my instincts already told me.
That journey eventually led me to a leading cancer center. I had already seen …
We repeat the phrase “an ounce of prevention is worth a pound of cure” as if it were a folksy reminder to eat better or get a flu shot. But taken seriously, it is not a medical cliché. It is an economic law. And it exposes a devastating flaw in how modern societies choose to spend money.
Prevention is not the opposite of cure. Cure is essential, lifesaving, and often extraordinary. …
When I began my surgical training in the 1990s, vascular surgery looked very different than what it does today. At that time, only a small number of physicians specialized in treating blood vessel diseases, and even fewer practiced in Brooklyn. I chose to complete my education and surgical training here in New York so I could stay rooted in the community I care most about. As the second board-certified vascular …
Most physicians sense it, even if they struggle to name it.
Something fundamental has changed in medicine. Not the science. Not the patients. Not even, at root, the doctors themselves. What has changed is the status of medicine as a profession, and with it, the psychological footing that once made the work bearable.
For much of the last century, medicine functioned as a profession in the classical sense. That meant more than …
“If you ask what they like about their surgeon and they only say they are nice? I don’t want a nice person.” This sentiment comes from Dr. Oz, a boarded and licensed thoracic surgeon, and was posed to the house of medicine at the 2025 House of Delegates Interim Meeting.
I have grappled with what being a good surgeon means to me. Our training would have us believe that a good …
Every now and then I go back to a book I read decades ago. Sometimes it feels dated, a period piece. Sometimes it sounds uncannily current, as if it has been waiting. And sometimes it does both at once, which is more unsettling.
Recently I reread Moral Dilemmas in Medicine, first published in 1975. I read it as a younger physician, still believing that if you learned enough and tried …
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Vascular surgeon Xzabia Caliste discusses her article, “The silent disease causing 400 amputations daily.” She shares the heartbreaking personal story of witnessing both her aunt and uncle lose their limbs to peripheral …
You just saved a patient an emergency room visit with a three-minute portal message. You reviewed their connected blood pressure cuff data, saw a concerning trend, and tweaked their medication. It was efficient, high-quality, proactive care.
Your reward? Zero dollars.
Worse than that, your contribution was invisible. It didn’t count toward your productivity. It didn’t show up on a dashboard. In the eyes of our current health care system, that high-value interaction …
The medical profession has gone through major changes from the days-past to present days. The transition from quackery to science, and from role assuming or inheriting to regulated graduate and postgraduate education.
The changes took place over centuries, but the most notable evolution in medical knowledge and training took place in the last couple of centuries and continues to evolve. Evolves may be used to describe positive as well as negative …
My journey to medicine was a little bit different than most. Prior to beginning my academic career, I had the fortune of being a second-round NHL draft pick and enjoyed a career as a professional hockey player.
When I went through my CaRMS interviews, I was often asked about my previous experience and how that would help me in residency. I would give the typical answer: “Teamwork makes the dream work,” …
In medicine, we are trained to act decisively in moments of crisis. We respond to hemorrhage, cardiac arrest, and trauma with clarity and speed. Yet when the crisis is internal (when the dysfunction lies within our teams, our leadership structures, or ourselves) many of us hesitate. We tolerate misalignment because it is familiar. We fear change more than we fear staying stuck.
This fear is not benign. It erodes morale, fractures …
For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then …
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When I was a resident, the trauma surgeon was the go-to person for anything complicated. It seemed like they could do everything, and do it well. That’s what drew me to the field. There was a confidence, decisiveness, and scope that made trauma surgery feel like the pinnacle of surgical mastery.
For most of my career, I’ve worked as a trauma and critical care surgeon, from busy academic Level I trauma …
The creed of compliance
In every hospital, a grotesque comedy unfolds: Poor Sod, our hapless patient, lies gut-shot, aorta spewing like a B-movie fountain. Clinicians, faces blank as overcooked porridge, scurry in a choreographed panic, clutching flowcharts like sacred scrolls. Monitors bleep like a chorus of lobotomised parrots. A registrar, mad enough to trust his gut, tries a life-saving stunt not in the Holy Manual. A nurse, eyes glinting with the …
Imagine having to ask your competitors for permission to open a new business: a corner café, a diagnostic clinic, or a surgical center. For decades, that was the reality in South Carolina health care. Certificate of Need (CON) laws gave entrenched hospital systems the power to contest new outpatient facilities, imaging centers, and physician-led ventures. It stifled competition, raised costs, and preserved the status quo.
That era is ending. In 2023, …
Peace in the Middle East was once considered impossible until someone had the courage to take a stand and chart a new course. Mr. President, we need that same clarity and boldness now in health care.
The government shutdown over health care isn’t about medicine, it’s about money. Costs have exploded while premiums skyrocket. Paradoxically, doctors earn less, hospitals consolidate, and patients wait longer. The focus has shifted from healing to …
In mid-November, thousands of junior doctors in Britain will again step away from their posts. Not for comfort. Not for gain. For something harder to name.
They have been praised as heroes and treated as expendable, thanked in speeches while their pay erodes and their patience thins. I heard one young doctor say she still loves medicine, but cannot serve a system that sees her as replaceable. She stayed through staff …
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Neurosurgeon Jeffrey Hatef, Jr. discusses his article “Guilty until proven innocent? My experience with a state medical board.” In this episode, Jeffrey shares the shocking story of how his medical license was …
For over forty years, I worked as a general and vascular surgeon. For the last ten of those years, I was employed under an RVU-based compensation model. That period is when my dissatisfaction with medicine truly began. Complex, life-saving operations were reduced to “productivity units.” The pressure was relentless, the system unforgiving.
And unlike primary care physicians, surgeons do not have the option of concierge or direct-pay models. We are necessarily …
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