Early in the pandemic, we began using yellow cloth isolation gowns, environmentally superior, perhaps, to the paper gowns that preceded them, but not without complications. The strings at the neck were invariably tied and tightly knotted after going through the wash. If you’re a smallish doctor or nurse, the pre-tied neckline hung down around the tip of the xiphoid. I stood outside my patients’ rooms on long, weary days and …
Two years ago, Drs. Aaron Morgenstein, Corinne Sundar Rao, and Shreekant Vasudhev drew a compelling parallel between the Titanic’s tragic voyage and the looming crisis in U.S. health care. They highlighted systemic issues such as administrative egotism, outdated practices, and substandard resources, warning that without significant course corrections, the health care system was on a collision path with disaster.
Today, in 2025, the iceberg has struck, and the cracks are …
In aviation, the right seat is typically reserved for the instructor. In medicine, it’s the role of the diagnostician, the mentor, the gatekeeper. I once piloted a T-37B “Tweet” trainer from the right seat, not as a student, but as someone trusted to guide. That experience shaped how I approach clinical decision-making, interdisciplinary fluency, and the choreography of care.
During a military training program, our squad faced a simulated obstacle: an …
It started with a phone call.
“Doc,” my CEO said, “do you know this doctor?”
I asked why.
“He wrote a prescription for a drug that cost $250,000 for one course.”
“You must mean $25,000,” I said.
“No,” she replied. “The insurer already paid two hundred fifty thousand dollars.”
I assumed it had to be a miracle therapy, some one-in-a-million life-saving treatment. Then she told me the name: Acthar Gel. I nearly fell out of my …
An excerpt from Doctor Not Guilty.
The Fifth Amendment of the United States Constitution exists for a reason. It protects you from self-incrimination. If you remember one rule from this book, hold on to this: Never talk to the police.
By “police,” I mean every investigative agent: FBI, DEA, OIG, HHS, state boards of medicine, and investigators from the attorney general’s office. Not with a lawyer. Not without one. Not ever.
Silence …
I learned the forbidden truth by searching “how many medical malpractice lawsuits are filed per year and how many are frivolous?” The answer is “17,000-20,000 and all are legitimate.” This answer is incongruous with seven facts.
The facts are: First, a complication causes a medical malpractice lawsuit. Some are medical errors; some are random errors-of-nature. Since an error-of-nature is not caused by negligence, a resulting lawsuit is frivolous. Second, …
I am a gastrointestinal medical oncologist. I am also a Black woman. When people ask me how I got here, this is the story I share. In 2011, while sitting in a medical school lecture I received an email from a classmate that read: “Open this, you should apply.” It described a program for students who are underrepresented in medicine and interested in pursuing a career in oncology. Without hesitation, …
I thought that’s what I had to do to be successful: Wake up at 4 a.m., get after it, hustle before the world wakes up, and join the club of high performers who swear by their pre-dawn routines. So I tried it. And I was miserable. I’m talking dragging-myself-out-of-bed, foggy-brain, counting-down-the-hours-until-I-could-go-back-to-sleep kind of miserable.
As a brand-new full-time entrepreneur, I was forcing myself into a routine that felt like punishment, all …
The greatest challenge for all who practice geriatrics is reducing polypharmacy, the addition of medications that either provide no benefit or cause harm to seniors. Millions of seniors end up on many medications that are not helping them and could be causing side effects. Geriatricians are the experts in what we call de-prescribing, cutting down on unnecessary medications.
The key reasons seniors end up on too many medications are the following. …
I recently published a reflection on KevinMD, “A doctor’s duty on 9/11 in a small town,” a piece about clinical duty, quiet advocacy, and legacy. Boston University included it in my nomination for their Advocacy, Equity & Social Justice Alumni Award. I sent it to every major news outlet in my region. No one responded. One station asked if I’d go on camera. I agreed. Then, silence. This is …
For the past century, physicians have practiced within the framework of materialism: the belief that everything real can be measured, and everything measurable is real. But that worldview has been quietly eroded by physics itself. In the double-slit experiment, particles behave as waves of probability until observed, at which point they collapse into definite form. Later variations (such as Wheeler’s delayed-choice experiments) demonstrated that observation seems to determine not only …
This is an invitation to clinicians and health leaders to shape the next decade of care: more precise, more connected, more human. The tools are here. The leadership is you.
The quiet nudge
If you’ve felt that steady tug that health care could be so much better, you’re not alone, and you’re not wrong. We’re investing more than ever, but patients still meet friction at the exact moment they need ease. That …
There’s a quiet heaviness that has settled over medicine, not always visible, but deeply felt. It lingers in hospital corridors and hovers over clinic desks cluttered with charts and cold coffee cups. You can see it in the nurse scrolling through yet another new policy update, her shoulders sagging under invisible weight. You can hear it in the tired sigh of a physician glancing at the clock at 9 p.m., …
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Medicine is more than biology; it is organization. Every country builds its system of care according to its culture, economy, and priorities. In Japan, where I have spent the past few years, health care feels like an extension of social rhythm: precise, deliberate, quietly humane. In the United States, where I trained, the emphasis is on innovation and specialization, but often at the cost of coordination. Now, as I prepare …
You notice them wherever they go. The new titans of industry dressed like college kids on their way to class. Recently, I saw a picture of Jack Dorsey, the founder of Twitter, in a plain cotton T-shirt and nerdy trousers. With his overgrown beard completing the look, he resembled a man emerging from months deep in the jungle after a survivalist contest. Then there is Mark Zuckerberg, perpetually clad in …
“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.
By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership …
We talk about burnout like it’s just being “tired” or “stressed.” However, it is not. It is a fundamental breakdown of the operating system: your brain. I know, because I’ve been there. I was the high-performer, the one who “got things done,” until my executive function packed its bags and left the building. If you’re feeling this way, you’re not weak; your system is simply overloaded. You have entered the …
In medicine, we are taught to care deeply.
When criticism arrives, whether from a patient, a colleague, an administrator, or an anonymous review, it stings. A lot. The sting usually lasts long after we read the words. It usually leads to rumination, self-doubt, and often even poor sleep, a questioning of our career choice, and our abilities.
Even with years of mindfulness, self-compassion, and coaching, I still feel upset when it happens …
Current Procedural Terminology (CPT) is the billing language of American medicine. The health care system established the CPT code that was created by The American Medical Association (AMA) in 1966 and updated yearly, as the national common language used by federal, public, and private plans.
Evaluation and Management (E/M) codes are the CPT section used for office and telehealth visits. In 2021, E/M rules changed. You select the visit level by …
The recent inclusion of moral injury as a Z code in the DSM marks a moment for mental health. Z codes place a diagnosis in an environmental or psychosocial context. After years of advocacy from clinicians and veterans, moral injury has entered our clinical lexicon. This action validates the linkage between our embeddedness in the world and our individual struggles, from soldiers and first responders to physicians navigating a broken …
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