Ask any clinician about the drive home after a case goes bad and the patient outcome is tragic. It is a specific kind of heavy silence. We have all had the experience. You do not forget it. You replay the tape in your head dissecting every move, carrying a stain that does not wash off or show mercy. It owns you.
We have had a name for this for 20 years: …
The second victim label ignores patient safety reality
An excerpt from The Hidden War in Medicine: The Fight No One Warned Us About.
We entered medicine believing something many young doctors believe. That medicine was a noble profession built on collaboration, compassion, and a shared mission: fighting disease! We had many glorious moments that make you cry tears of joy when a patient had been finally healed. From the outside, that is the image everyone sees. Doctors working …
How the hidden war in medicine affects young doctors
Cortisol. Almost always cortisol. I say this to patients more than almost anything else. And I say it having lived it myself, years of high-output clinical work, late nights, early mornings, and the particular exhaustion of lying in bed completely depleted but unable to actually fall asleep. Tired but wired. It is a real physiological state, and it has a name: hypothalamic-pituitary-adrenal (HPA) axis dysregulation. It is not insomnia in …
Is HPA axis dysregulation causing your chronic insomnia?
I have treated over 10,000 bariatric patients across my career, and if there is one issue that comes up more than almost anything else, it is protein. Specifically, patients not getting enough of it. The research confirms what I see every day in practice. Only a minority of bariatric patients reach the recommended minimum of 60 grams per day, resulting in the loss of fat-free mass rather than the …
The hidden risk of protein deficiency in bariatric surgery
Knee osteoarthritis (OA) remains a leading cause of chronic pain and reduced mobility, affecting millions of adults worldwide, particularly those over age 50. As cartilage deteriorates and inflammation increases, patients often face pain, stiffness, swelling, and limitations in daily activities. Although no cure exists, a structured, escalating treatment plan can significantly alleviate symptoms, preserve function, delay disease progression, and help many individuals avoid or postpone surgery. Current guidelines from the …
Knee osteoarthritis demands layered pain management
In an era of unprecedented technological adoption, it feels almost unfashionable to talk about listening. Artificial intelligence is advancing at breakneck speed. Clinical decision support tools grow more sophisticated every year. And yet, in examining the results of a new national survey from Littmann Stethoscopes, I’m struck by a simple truth that every clinician recognizes, but our system increasingly obscures: The most essential diagnostic tool in medicine is still the …
Why clinical listening skills outpace artificial intelligence
Last year, a startup pitched me a device designed to improve endoscopic procedures in gastroenterology. Slick deck. Strong team. Blue-chip venture capital (VC) backing. One problem: The device added three extra steps to a workflow that gastroenterologists have spent decades optimizing for speed. Any gastrointestinal (GI) physician would have flagged this in the first five minutes. But the investors who wrote the check? None of them had ever held a …
Health care startups desperately need clinical expertise
I’ve recently been forced to make painful and difficult choices that impact my personal life as well as my small business because this Congress has been unwilling to renew tax credits that used to significantly lower the cost of my health insurance. My husband and I are both self-employed entrepreneurs. We don’t have access to corporate health plans and the substantial cost sharing that employers typically …
How expiring ACA enhanced premium tax credits hurt business
I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work shows a steep drop in her blood count. We are working together to understand what is going on. As I prepare to enter orders in the electronic health record (EHR), …
The hidden clinical cost of HCC coding in primary care
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Physician wellness coach Jessica Singh discusses the article “Physician burnout: Finding peace in a broken health care system.” Jessica shares a powerful narrative of a grueling swing shift in a rural emergency …
Finding peace and reclaiming humanity within a broken health care system [PODCAST]
One of the most common questions I hear in rehabilitation is not asked during therapy sessions. It is usually asked quietly by a family member after the session ends. “Will my mother walk again?” Families rarely ask about therapy intensity or functional scoring systems. They do not ask how many minutes of treatment occurred that day. They ask about walking. Walking represents independence. It represents the possibility of returning home. …
Why walking matters most in post-acute rehabilitation
In medicine, we are trained to recognize risk in our patients. But we often overlook those same risks in ourselves. Sometimes, the system overlooks them, too. During residency, performance is expected and endurance assumed. Health often declines quietly and almost invisibly. We label it “dedication”; we claim “resilience.” In reality, it is often neither. I learned this lesson over 48 hours, two days that would reshape both my career and …
The hidden crisis of trainee health during medical residency
In modern times, we frequently encounter messes in our public life. This seems particularly true in American health care, and it is certainly true in our politics. But few citizens seem to put the two issues together sufficiently to effectively demand change. Putting them together is what this article is about.
According to the nonprofit public interest group Open Secrets, individuals and political action committees spent a record $4.5 billion in …
Health care lobbying is destroying the U.S. system
A patient in his 20s recently came to see me in a state of severe distress. He described feeling consumed by his thoughts, constantly anxious, unable to function, and deeply exhausted. His sleep had collapsed. His sense of identity felt lost. He was experiencing persistent passive suicidal thoughts, not because he wanted to die, but because everything felt overwhelming and unrelenting.
Within three days of starting low-dose lithium at 150 milligrams …
Low-dose lithium treats suicidal ideation safely
I decided to be a physician because my mother died from tuberculosis, after quite a struggle, including with not only tuberculosis, but also with the United States Public Health System, when I was 15 years old. I got an academic scholarship to college and then put myself through medical school.
I did an internal medicine residency at Washington University and Barnes Hospital and was an emergency room physician for about seven …
Why Florida physician background checks are driving doctors away
There are moments in life when the identity you have carefully built over decades is interrupted so abruptly that you are forced to ask who you are when the familiar parts no longer function the way they once did.
For physicians, identity often begins early. We learn to attach meaning to competence, endurance, reliability, and service. We become the person others call when decisions must be made, when systems feel uncertain, …
Redefining physician leadership and adversity after a life-changing illness
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Physician and tax specialist Logan Foltz discusses the article “Physician tax strategies: Why your tax bill is so high and how to fix it.” Logan explains why the Internal Revenue Code patterns …
Why physicians pay more in taxes and how to reclaim your income [PODCAST]
The treatment of cardiovascular diseases has advanced at an extraordinary pace over the past half-century resulting in an age-adjusted 60 percent reduction in heart disease death rates. This dramatic decline is directly attributable to primary and secondary preventive therapies such as statins and small interfering messenger RNAs along with disruptive technologic advances in procedural techniques. New pharmacologic options for thromboprophylaxis and novel therapies for heart failure …
Why cardiovascular medicine should focus on patients, not environmental advocacy
One prominent characteristic of medicine is its ability to repeatedly remind you to be humble. There is always something new to learn about it, and in real life patients rarely present exactly as they do in the textbook. On top of that, health care workers commonly feel pressure to be perfect due to the potentially serious consequences of many medical mistakes. Of course, since we are human, we are bound …
Medical mistakes happen and you are still enough
Every week in the pediatric emergency department, I see the consequences of adolescent substance use that started too early and went unaddressed for too long. A teenager in crisis. A family blindsided. A window of prevention that closed long before anyone realized it was open.
We keep asking the same question: How do we reach kids before it gets to this point?
The answer, it turns out, might already be sitting in …
Peer-led storytelling in adolescent substance use prevention
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