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A car shows up when you click a button and groceries arrive by tonight, but a doctor’s appointment takes weeks. Payam Zamani started MY DR NOW while he was …
Amazon and Uber set the bar that primary care is judged against [PODCAST]
A new kind of capital
For decades, we have treated brain health solely as a medical issue, something to address only when it begins to fail. That’s beginning to change, as more experts recognize that the capabilities of the human mind (our ability to think, adapt, learn, and make decisions) impact more than just the day-to-day lives of individuals. They influence the well-being and stability of families, workplaces, populations, and society …
Brain capital: the $11.7 trillion case for brain health
A meaningful portion of my practice involves reconstructive work, not the kind that follows trauma or cancer, but the kind that follows cosmetic procedures that went wrong. Patients come to me after abdominoplasties that developed into sepsis, after injections administered by unlicensed individuals, after hair transplants that left permanent scarring. Much of what I do in the consultation room is assess what can be improved, what cannot be reversed, and …
The real risk of medical tourism complications is distance
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Medical education has always carried an enormous responsibility: deciding what a future physician needs to know.
For generations, the answer seemed relatively straightforward. Give medical students a rigorous foundation in anatomy, physiology, biochemistry, pathology, pharmacology, microbiology, and other basic sciences. Build clinical knowledge upon that foundation. Then provide supervised clinical experience until the student becomes capable of practicing medicine. That model has served medicine extraordinarily well.
But the world in which today’s …
5 competencies the future of medical education requires
A new scoping review in npj Digital Medicine should be read by every clinician who treats serious mental illness. Diel, Torous, and colleagues reviewed 119 articles on the mental health harms of large language model chatbots. They sorted the harms into five categories: direct psychiatric harm, behavioral and relational harm, cognitive harm, safety failures, and governance risks. Psychosis and severe mental illness came up again and again as the …
AI chatbots and psychosis: Families see the harm first
We measure blood pressure before a patient has a stroke. We check cholesterol before a coronary event. We evaluate vision before impairment interferes with driving or reading.
So why is hearing treated differently? For many people, the last routine hearing test they remember was in elementary school. Decades pass before anyone checks again, often after the problem has become impossible to ignore. Conversations are frustrating, family members are repeating themselves, and …
Hearing screening in primary care is a single question
The last patient leaves around six. Dinner happens, eventually, and the kids go down around eight. The laptop comes back out after that, open to a stack of notes from a day that had exactly zero room in it for finishing them.
Two-fifteen was the closest thing to a gap today, and a nurse used it to grab labs. Four-thirty had five minutes, spent walking a worried mother back to the …
After-hours charting isn’t a backlog. It’s a team problem.
This month, the Centers for Medicare and Medicaid Services (CMS) announced a new 173-page toolkit to help states ensure more effective and less costly autism care for children. The launch came as government data shows spending on care increased by 421 percent between 2021 and 2025, far outpacing the 67 percent growth in the number of children receiving services. It also followed recent investigations by the New York …
Autism behavior therapy needs a physician in the room
For many physicians, the first truly useful encounter with generative AI has been remarkably mundane. It takes notes.
Ambient AI listens to the encounter, organizes the conversation, drafts the clinical note, and gives the physician something increasingly scarce in medicine: time. That is a genuine accomplishment. But it may also have created a misleading picture of where clinical AI is headed.
The next generation of AI will not simply document what the …
AI and physician judgment: the risk when AI is mostly right
“Do No Harm” is perhaps the most famous medical maxim. But reciting it is one thing; living by it is another. Sometimes, the question of “harm” is up for debate. Throughout history, physicians have lent their knowledge to all manner of atrocities, warfare, torture, and mass sterilization, often justified under the supposedly noble pursuit of “reducing harm.”
Capital punishment or the death penalty is another instance of this dilemma. Doctors shouldn’t …
Physicians and the death penalty: There is no humane way
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A patient says her hip has hurt for a while. Whether she leaves trusting her doctor depends on what happens next. Alan P. Feren, a retired surgeon, health care …
Why patients stop trusting doctors who listened to them [PODCAST]
Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years. What most of us, myself included, haven’t been saying nearly often enough is anything about the brain, and a study published this summer in Molecular Psychiatry is a good reason …
Blood sugar and brain aging start long before diabetes
If you take Ozempic, Wegovy, Mounjaro, or Zepbound, or you are simply trying to make sense of GLP-1s (glucagon-like peptide-1) and GIPs (glucose-dependent insulinotropic polypeptide), you may have seen a recent Medscape article asking whether GIP really adds any benefit in type 2 diabetes. It is a fair scientific question. The problem is that the headline makes the answer sound much clearer than it is.
The study behind the article, …
What did the tirzepatide study actually test?
There is a conceptual inconsistency in contemporary medicine that I have become increasingly unable to reconcile. Psychiatry recognizes psychic pain as a genuine clinical phenomenon, and suicidology has long recognized unbearable psychological pain as integral to suicidal states. Neuroscience has simultaneously demonstrated that nociception, affective pain, reward, motivation, salience, stress responsivity, and emotional regulation are interconnected biological processes.
Yet when psychic pain becomes intolerable, psychiatry has remarkably little therapeutic infrastructure directed …
Why is psychic pain treated as a symptom instead of pain?
The referral came from a mental health clinic. A woman had been putting the hose of a handheld vacuum cleaner into her mouth, pushing the nozzle toward the back of her throat, and turning it on. She had done this more than once a day for several days. The clinician who examined her found bruising and abrasions throughout her mouth. She was referred to me because her mouth and throat …
Diagnostic overshadowing and the war in her throat
Every night on mainstream streaming platforms, I see the same rotation of charity commercials: protect dogs, save Syrian children, shelter American runaways, support childhood cancer care, preserve wildlife. Each one asks for a small monthly donation (99 cents, $5, $19), and each one insists that without your contribution, the suffering continues.
As a physician, I don’t respond to the emotional script. I respond to the ethical one. And the ethical script …
Why do charity commercials leave clinicians uneasy?
Ask an independent practice owner who handles the revenue cycle and the answer is usually the name of a billing company. Ask what that company actually does each month and the answer gets shorter. Claims go out. Payments get posted. Denials get worked. Statements get mailed. That is medical billing, and it is valuable work. It is not the same thing as managing the revenue cycle, and the space …
Revenue cycle management is more than medical billing
Health care has never had more data. The industry generates approximately 30 percent of the world’s data volume, and that share continues to grow faster than nearly every other industry. Electronic health records, claims systems, pharmacy records, lab results, care management notes, social determinants of health data, wearable devices, and patient-generated information are producing an unprecedented volume of information about the patients we serve.
At the same time, health care …
Why AI fails in health care: Your data is the problem
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A patient came in with weight gain nobody could explain. Every test came back fine. Shiv K. Goel is a board-certified internal medicine and functional medicine physician. This episode …
Some relationships work like medicine. Others work like a diagnosis. [PODCAST]
As an incoming fifth-year dental student beginning my clinical internship at Tamale Teaching Hospital, the major tertiary referral center for northern Ghana, I expected to refine my surgical hand and master diagnostic pathology. The fine instructors at the department made this possible, but I also got to witness firsthand the brutal arithmetic of health care access in the northern parts of Ghana.
She first presented to our oral and maxillofacial …
Cancer care in Ghana: Poverty is the true malignancy
