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What happens when a doctor closes the chart but the patient leaves without understanding what was actually said? Retired surgeon, independent physician, health care consultant, and patient advocate Alan …
His mother-in-law heard “cancer,” went home, and was dead within a year [PODCAST]
In one health care organization, a provider was reviewed and cleared through routine payment integrity processes. Months later, that same provider became the subject of a fraud investigation, based on patterns that had been present all along. Both reviews were technically correct within their scope. But together, they revealed something more concerning: The system itself was not aligned. Health care organizations invest heavily in payment integrity (PI) and special investigations …
Why health care fraud detection requires payment integrity alignment
A healthy, 4-year-old girl was brought to the pediatric dental office for treatment of several cavities. The parents were told their child would be given medication to help her “sleep” through the procedure. Easier and quicker than going to a hospital, office-based dental sedation was presented as a safe, routine option for children.
After the sleeping medication was administered, the child grew quiet and became still. The dental work began. At …
The hidden dangers of dental sedation and dental anesthesia in kids
Bree is an 11 1/2 year-old, 4.2-pound micro mutt who once lived on the streets of Long Beach. She eventually wound up at Long Beach Animal Care Services, where she sat in a crowded cold cement kennel with no bed, no blanket, no toys, and one very sick basset hound with parvovirus. Every dog in that kennel was scheduled to be euthanized on Christmas Eve 2014. If it weren’t for …
What a tiny dog taught me about the nervous system
Most health care startups don’t fail because the technology is bad. They fail because of mistakes that happen long before the product ever reaches a clinical setting. After seven years of evaluating health care companies as a physician-scientist turned venture investor (and making over 20 investments across digital health, biotech, medical devices, and therapeutics), I’ve started to see the same patterns repeat.
These aren’t obscure business school failures. They’re patterns that …
5 patterns behind health care startups that fail
For more than a decade, the phrase “ultra-processed food” has functioned as nutritional shorthand for danger, a dietary villain blamed for rising rates of obesity, diabetes, and heart disease. The public message has been simple: If it is ultra-processed, avoid it. But science is rarely that simple.
My colleagues and I recently reviewed the growing body of research examining ultra-processed foods, not as a single monolithic category, but as distinct …
Rethinking nutrition policy on ultra-processed food
I first met Ramon in the aftermath of Hurricane Katrina when I was moonlighting in local ERs and assisting wherever needed. New Orleans has a long-standing historical and economic connection to Honduras, primarily through the banana trade and shipping routes linking Honduran ports to New Orleans. These routes facilitated both commerce and migration between the two. Ramon, whose family has deep roots in both Honduras and New Orleans, arrived here …
Preparing for Medicaid cuts and the imperial health boomerang
Late at night, after basketball games or practices, with the physical exhaustion of the court still settling in, I often find myself staring at my laptop. I am watching how long it takes to complete something that has nothing to do with sports, or even actual patient care. It is documentation. Coding. Forms. Insurance language that seems designed less for clinical clarity than for mere survival within a bureaucratic system.
In …
Why accountability in medicine must guide health care AI
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When is the most powerful thing a medical student can do in a patient’s room simply to stop talking? Medical students Jay Pendyala and Jonathan Berg draw on years …
Silence at the chessboard changed how I talk to patients [PODCAST]
Imagine sitting in a witness box while a plaintiff attorney holds up your drafted, 15th-grade surgical consent form. You know the patient signed it. You know you spent 10 minutes explaining the risks. But then the attorney asks the patient: “When the doctor warned you about positive dysphotopsia, did you know it meant you wouldn’t be able to drive your grandchildren home at night?” The patient cries. The jury glares …
Why experiential consent is replacing traditional medical consent forms
The medical students I work with are already starting to close doors. They are in their twenties, still in training, and they are already narrowing, already deciding which parts of themselves fit inside the life they are building toward. I recognize it because I did the same thing. I just did not realize it until much later. And no one told me there was another way to look at it. …
Why career pivots are a valid path in medical training
As a physician who has spent years managing patients with persistent pain, I often encounter the same frustrating cycle. A patient arrives with unrelenting back pain that has lasted for months. They describe not just physical discomfort but a deepening sense of hopelessness, fatigue, and withdrawal from life. Is the pain causing the depression, or did underlying depressive symptoms amplify an initially manageable ache into something chronic and debilitating? It …
How to treat chronic pain and depression together
In busy emergency departments, sepsis is often discussed as something we “cannot miss” rather than a diagnosis we can confidently make. Patients may arrive with signs of an infection and physiologic abnormalities, yet fall into the gray zone where sepsis is possible, but far from certain. Over the last decade our definition of sepsis has evolved to recognize that sepsis is more than an infection and …
Transforming sepsis care with rapid host response diagnostics
Every research mentor eventually faces a difficult question: What, and who, will continue when the work is no longer theirs to carry forward?
We often speak about mentoring, yet the dilemma of mentorship is rarely addressed directly. Perhaps it lies at the intersection of responsibility and uncertainty. Mentorship is often imagined as guidance freely given, with apprenticeship unfolding naturally. In modern academic life, however, the laboratory is shaped not only by …
How research laboratory culture shapes mentorship in academic life
The tools to detect serious disease years before symptoms appear already exist. What we are waiting on is a health care system structured to use them. Early in my career in primary care, I watched patients with vague symptoms and normal lab results get dismissed as anxious or mildly depressed. While some were, others were experiencing the very earliest stages of disease. Signals that more advanced diagnostics would have caught, …
Why early detection technology and precision medicine are failing patients
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What if the biggest problem with electronic health records was not the technology itself, but that we expected it to transform medicine when it could only lay the foundation? …
Gradually, then suddenly: Dr. Robert Wachter on health care’s giant AI leap [PODCAST]
At a time when one in five married American couples experience infertility, and one in three American men have a low sperm count, concerns around fertility and conception have led millions to seek solutions. But family building is rarely a linear process, and for every individual or couple able to successfully conceive on the first try, there are just as many who may seem to be doing everything right without …
The continuum of fertility care: Why IVF is not the only option
Recently, I came across the Charter of the Soignés (“those being cared for”) by French physician and writer Martin Winckler from The School of Caregivers (2019).
This is not a legal document, but an ethical framework. It outlines 10 principles centered on dignity, autonomy, and the humanity of the patient.
The first nine principles focus on what we would hope our patients experience. The recognition that a person is more than a …
Physician autonomy is not separate from patient care
It is 4:50 p.m. on a Thursday. Your last patient is a 67-year-old with heart failure with reduced ejection fraction. He has been hospitalized twice this year. His medications look familiar. A beta-blocker. An ACE inhibitor. A loop diuretic. But something is missing. You scroll through the chart. No mineralocorticoid receptor antagonist. No SGLT2 inhibitor. No ARNI. You pause. You know the guidelines. You have heard the talks. You have …
Why heart failure care requires spaced repetition for doctors
A patient walks into my office. She is 52, exhausted, brain-fogged, gaining weight, and six years into sertraline 100 mg. I mention methylene blue as a mitochondrial support at 10 mg orally.
She looks at me like I just suggested arsenic.
“My pharmacist said I can never take methylene blue because I am on an antidepressant. He said it causes serotonin syndrome.”
I hear this every week. And every week I have to …
51 cases that reframe methylene blue serotonin syndrome
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