What do old people die from?
Ella passed away last week at age 84. I have cared for her since she was admitted to the nursing home two years ago. Her granddaughter called me wanting to know the cause of death. In old age, the cause of death is often the wrong question, as the end is usually not a single cause but a slow convergence of many.
Ella had a list …
Why death certificates fail to capture the reality of aging
Artificial intelligence is no longer approaching medicine. It is already embedded inside it. It drafts our notes. It summarizes research. It suggests differentials. It triages messages. It promises efficiency, scale, and relief from burnout. Physicians are adopting it quickly. That speed should give us pause.
The greatest threat facing physicians in 2026 is not resisting artificial intelligence. It is allowing artificial intelligence in health care to be designed without us. Every …
AI governance in health care: Why physicians must lead the design
After I got diagnosed with celiac disease when I was 19, I faced a difficult choice every time friends invited me out: I could either stay home, or I could risk getting terribly sick.
I was a college volleyball player at West Virginia University when I started experiencing severe migraines and stomach issues. I could not eat anything without getting sick, which resulted in me losing 40 pounds in just two …
Managing celiac disease: Overcoming the hidden social burden
It is said that we live in difficult times, and that reality is unavoidable for anyone who does not live as a hermit in a cave somewhere. For patients and their doctors, the signs of impending failure are equally unavoidable.
Health care consumes 18 percent of U.S. gross domestic product and continues to rise faster than the rate of inflation. Consumer confidence in the goodwill and scientific integrity of U.S. health …
Military leadership lessons for the U.S. health care crisis
For years, patients did not complain about their surgical care. They complained about not getting calls back.
The frustrating part was that my staff was calling them back. Messages were left. Voicemails filled up. Phone trees were in place. And still, patients felt ignored, staff felt defensive, and I found myself on a constant apology tour.
I assumed this was just how modern medical offices worked.
We had three people answering phones. We …
Surgical practice efficiency: How to fix a broken system
Health care is rapidly transitioning toward value-based care, yet many clinicians remain uncertain about what it actually means for their daily work. Despite widespread discussion of quality metrics, cost containment, and population health, clinicians are increasingly expected to deliver system-level outcomes without structured preparation to function within the systems that demand them.
If health care seeks to improve the lives of clinicians and patients while strengthening continuity of care, it must …
Value-based care workforce: Bridging the gap in clinical education
American health care has changed so profoundly in the last three to four decades that it is all but unrecognizable to those of us spending our careers in private practice. In my opinion, the root causes are not that complex. Foremost among them is the unconscionable disparity between the remuneration received by hospital-employed physicians and that of their counterparts in private practice for the same service or procedure.
This is abetted …
The death of private practice: unequal pay and hospital power
The veil of pretense was snatched long ago. So, politicians dare not brazenly declare that the U.S. has the greatest health care in the world. The system is broken. Neither Republicans nor Democrats have a remedy. It is a perverted Robin Hood system, where the rich are robbed to serve the poor poorly.
The exorbitant insurance premiums are unaffordable for many, and for others, it is as if it were a …
Curing U.S. health care: Why a fair health tax is the answer
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Fertility specialist Oluyemisi Famuyiwa discusses her article “Uterine aging in IVF: Why the ‘soil’ matters as much as the seed.” Oluyemisi explains that while clinicians often focus on egg quality, the aging …
Uterine aging plays a critical hidden role in IVF outcomes [PODCAST]
Yesterday morning, I learned that one of my teachers had passed away. He was only 63, a devoted, tireless oncologist who spent his life teaching and training many oncologists across Pakistan. Many of his students went on to work abroad as senior oncologists and professors, carrying his legacy far beyond borders.
He was not my direct teacher, but rather the teacher of my supervisor, a teacher of a teacher. Yet distance …
A tribute to an oncologist: the power of mentorship in medicine
By presidential order, marijuana has been rescheduled from Schedule I to Schedule III. This is not a subtle bureaucratic shift. It is a historic decision with major medical, regulatory, and cultural implications. Yet, astonishingly, much of the medical community has responded with near silence. There has been little serious discussion, no broad professional debate, and minimal effort to educate clinicians or the public about what this change does, and does …
Marijuana rescheduling: Why the medical community’s silence is dangerous
I recently wrote a four-part series examining AI and the future of medicine. The response confirmed something important. Physicians are not merely curious about artificial intelligence. They are unsettled. The headlines are loud. Automation. Disruption. Replacement. It is reasonable to ask whether doctors will lose jobs, whether surgeons will be replaced, whether this is the beginning of a profession fundamentally reshaped.
The answers are neither triumphalist nor catastrophic. AI replaces tasks. …
Future of AI in medicine: Will algorithms replace doctors?
As my first rotation in surgery draws to a close, I’ve been reflecting not only on anatomy and technique, but on the structure of medicine itself. Surgery teaches hierarchy not as an obstacle but as a rhythm, one that protects patients and preserves excellence. In that rhythm, I found clarity about my role as a PA student: to learn medicine deeply while honoring the lineage of those who have mastered …
Why PAs are masters in medicine, not competitors to MDs
Reflection has become one of the core virtues of contemporary health professional education. From journaling assignments to mindfulness prompts to competency-based portfolios, students are repeatedly asked to look inward. Reflection is framed as the doorway to insight, empathy, and professional identity formation. But an uncomfortable question is beginning to surface in hallway conversations and faculty retreats: Can too much reflection, or reflection done poorly, actually harm our learners?
At first glance, …
Reflection vs. rumination: Is medical education harming students?
Close your eyes and imagine a health care system that truly prioritizes patients above all else, one that is free from political interference, financial incentives, or secondary gains that distort decision-making. In this ideal framework, regulatory bodies such as the Medical Board, Centers for Disease Control and Prevention (CDC), and Drug Enforcement Administration (DEA) would enforce guidelines uniformly and based on evidence, without inadvertently inflating costs or compromising care quality …
The hidden cost of medical board regulation and prosecutorial overreach
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Pediatrician and certified coach Jessie Mahoney discusses her article “Leading with love: a physician’s guide to clarity and compassion.” Jessie shares how a personal crisis involving her husband’s severe depression forced her …
Asking what love would do transforms leadership [PODCAST]
I have so many patients struggling with horrible arthritis pain! All the treatments we have either really don’t work well or have side effects, and many times cause more harm than good. I found myself having a risk-benefit discussion with every single patient with chronic pain, and at times, feeling like I was doing more harm than good when trying to help treat the pain.
Patients are taking NSAIDs, and I …
Peptides for chronic pain: Navigating safety and regulations
She arrived exhausted, a shadow of the lively 31-year-old she once was.
She was diagnosed with leukemia in January 2023, underwent intensive IV chemotherapy, and was now on maintenance oral therapy. When I met her in July 2025, survival was no longer a question. It was about quality of life.
Fatigue consumed her days. Digestive discomfort disrupted her nights. Recurrent infections kept her in constant vigilance. Her laboratory values reflected a body …
Integrative oncology nutrition: a case study in leukemia recovery
As physicians, we pride ourselves on following the evidence. We weigh risks and benefits, assess data, and trust science to guide decisions about patient care. Yet, when it comes to reproductive health, lawmakers and courts too often override scientific consensus. Nowhere is that clearer than in the debate over mifepristone.
Patients deserve care rooted in evidence and science, not ideology. To provide safe and best-practice medical care, physicians need the ability …
Mifepristone safety: Comparing the data to Viagra and penicillin
Annual preventive exams have been a staple of American medicine for decades. Yet despite their importance, preventive visits remain underutilized in American health care, which is no surprise in a system that centers sick care and incentivizes churning out services instead of improving outcomes.
In fact, only 60% of Medicare beneficiaries complete their annual well visits, and less than 65% of children under 19 complete their well-child check-ups. When …
Agentic AI: the key to saving annual preventive exams
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