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What happens when a physician who spent decades treating patients suddenly finds himself on the other side of the exam table, unable to get a simple answer about his own aneurysm? Jeffrey Junig, …
Your doctor saved your life but won’t return your call [PODCAST]
Again, I must discuss two cases of medical malpractice which I feel best demonstrate the quagmire our health care system finds itself in. One is a medical malpractice case against a hospital. It follows that this case also has a merit of only 33.48 percent. Nevertheless, there is a legal strategy that tips the scale by not permitting testimony discussing conditions occurring in another country, where the first 17 …
How medical malpractice cases reveal health care system flaws
Last year I watched a patient of mine, I will call him Raymond, navigate what should have been a straightforward referral to cardiology. He had insurance. Good insurance. The kind politicians point to when they say the system is working. It took 11 weeks, four phone calls, two prior authorizations, and one emergency department (ED) visit to get him seen. He was not uninsured. He was not poor. He was …
Why we must fix our fragmented health care system architecture
Credentialing mistakes are expensive before they are visible
Credentialing problems usually look administrative until the revenue gap appears. A new practice may be open, staffed, leased, insured, and ready for patients, but one missing payer panel can cut off a revenue stream for a quarter or more.
The timeline is not small. Payer enrollment commonly takes 90 to 180 days. For a practice carrying rent, software, payroll, malpractice coverage, phones, internet, marketing, …
5 questions to ask before you choose a credentialing service
She was forty-eight years old and had already been through enough.
Her uterus had prolapsed. If you have not heard the term, let me be plain. The uterus had descended through the vaginal opening. It was outside her body. This is not a metaphor and it is not a minor complaint. It is a complete structural failure of the pelvic floor that turns walking, sitting, and basic dignity into a daily …
Prior authorization during surgery is not oversight
As California gears up for its gubernatorial primaries and debates, the familiar issues dominate the conversation: housing affordability, crime, taxes, and economic pressures. Health care surfaces, but rarely as a central priority with concrete, actionable solutions. Candidates offer broad strokes on affordability or protecting programs from federal changes, yet the crushing realities of escalating costs, physician shortages, regulatory burdens, and a system skewed against preventive, relationship-centered care receive little more …
California’s governor race is missing a health care plan
For years, the conversation around burnout has centered on physicians, and more recently, ambient artificial intelligence (AI) has been positioned as a solution to reduce after-hours charting and reclaim time from the electronic health record (EHR). But as these tools gain traction, a gap is becoming harder to ignore: Many are designed for a single user, even as care is delivered across teams and workflows that extend well beyond the …
How ambient artificial intelligence can transform team-based care
Long before in vitro fertilization (IVF) clinics, fertility apps, hormone testing, or egg freezing, women understood that fertility carried social meaning far beyond biology.
In 19th-century Yorubaland, a woman named Efunsetan Aniwura rose to become one of the most powerful figures in Ibadan history. She was wealthy, influential, politically connected, and held the prestigious title of Iyalode, a leadership position reserved for prominent women in society. Yet historical accounts and Yoruba …
The emotional impact of infertility is grief unspoken
In the past, women in menopause were brushed aside and told that their symptoms were “just stress” or a “natural part of aging.” Implicit in this message was the expectation that women were to push through this transition and endure its symptoms on their own without support. Now, the pendulum has swung and this midlife transition is finally getting some attention. The problem now is that this newfound medical attention …
Why individualized menopause care matters today
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What if the biggest driver of unnecessary ER visits, malpractice claims, and patient anxiety isn’t a missed diagnosis but a missed sentence? Alan P. Feren, a retired surgeon, independent physician, health care consultant, …
Patients don’t need certainty, they need your reasoning out loud [PODCAST]
Early detection has always been one of medicine’s most powerful tools. The sooner we can identify cognitive, behavioral, or neurological conditions, the greater the potential benefit for patients, their caregivers, and their providers. That truth is even more pressing today. Thanks to rapid advances in artificial intelligence and speech analysis, vocal biomarkers have emerged as a fast, accurate, and non-invasive way to screen for a growing range of conditions. The …
How vocal biomarkers are revolutionizing early detection
One of my patients, K, arrived in the United States in florid psychosis. Back in China, she worked as a housekeeper and lived independently. She took her medications reluctantly but consistently, forced upon her by her parents. After her parents passed away, she stopped her medications. She became convinced her life was being controlled by the Chinese government. In terror, she booked a ticket to the land of freedom, America. …
Patient autonomy in psychiatry and the ethics of care
What if the biggest problem in medicine isn’t bad decisions but rather the decisions we cannot even consider?
Clinical decisions unfold through processes shaped by the environment, which determine what clinicians can notice, consider, and act on. What seems like individual reasoning is structured in advance by systemic and environmental forces.
Within this context, this paper introduces a concept that I call “invisible triage,” a preconscious process that restricts which options are …
What hidden constraints shape clinical decisions?
As a board-certified physical medicine and rehabilitation (PM&R) physician, I have guided patients through musculoskeletal care. Recently, my focus has shifted toward regenerative medicine, particularly platelet-rich plasma (PRP) therapy. What began as curiosity is now a strong commitment to understanding these therapies for patients who have exhausted conventional treatments.
This new focus led me to attend an intensive weekend course with experts from orthopedics, sports medicine, PM&R, rheumatology, and pain medicine. …
PRP therapy protocols lack expert consensus
In my years as an ICU nurse, I learned to recognize a pattern. The patients I cared for in trauma surgical intensive care often arrived after a cascade of preventable events. A missed medication. A symptom that went unaddressed. A follow-up appointment that never happened. By the time they reached my unit, the question was no longer how to keep them well at home. It was how to bring them …
Patients pay when Medicare care coordination codes go unused
The life of a physician is often viewed as a linear climb, a constant upward trajectory of achievement, responsibility, and endurance. But after decades in the field, I have come to realize that medicine is not a straight line. It is a series of seasons. If we fail to recognize the changing weather of our own lives, we risk arriving at the final season with broken bodies and weary minds. …
Why physician well-being matters at every career stage
Recently, I found myself in a place many physicians know professionally but dread personally: the waiting area outside a procedure room, this time as a mother. My six-year-old underwent what was supposed to be a simple elective procedure under general anesthesia at a day surgery center. He walked in smiling. He was put to sleep by using inhalational anesthesia through a mask. We were debriefed briefly by the ear, nose, …
How implicit bias in health care impacts patient safety
If you have just matched into residency, the profession is about to begin shaping you in ways that are not always visible at first. You have made the right decision and chosen a life of service, one whose rewards are far greater than a bank account will ever reflect. What follows is not part of a curriculum, and it will not be captured on a slide. It is learned more …
Finding meaning and purpose in medical residency training
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What happens when patients from opposite ends of the political spectrum sit together in your waiting room and start talking like neighbors? Psychiatrist Farid Sabet-Sharghi explores why the medical …
Your waiting room does what social media cannot [PODCAST]
Tickborne diseases are the most common vector-borne infections in the U.S., and for decades Lyme disease has dominated the conversation in endemic regions. But ticks are carrying more than Lyme alone and co-infections are becoming harder to ignore. New research suggests ticks are harboring a wider mix of pathogens than previously recognized, and that co-infections are becoming an increasingly important part of the clinical picture.
A recent study published in Ecosphere …
Why tickborne co-infections are changing Lyme disease care
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