We talk about burnout like it’s just being “tired” or “stressed.” However, it is not. It is a fundamental breakdown of the operating system: your brain. I know, because I’ve been there. I was the high-performer, the one who “got things done,” until my executive function packed its bags and left the building. If you’re feeling this way, you’re not weak; your system is simply overloaded. You have entered the …
In medicine, we are taught to care deeply.
When criticism arrives, whether from a patient, a colleague, an administrator, or an anonymous review, it stings. A lot. The sting usually lasts long after we read the words. It usually leads to rumination, self-doubt, and often even poor sleep, a questioning of our career choice, and our abilities.
Even with years of mindfulness, self-compassion, and coaching, I still feel upset when it happens …
Current Procedural Terminology (CPT) is the billing language of American medicine. The health care system established the CPT code that was created by The American Medical Association (AMA) in 1966 and updated yearly, as the national common language used by federal, public, and private plans.
Evaluation and Management (E/M) codes are the CPT section used for office and telehealth visits. In 2021, E/M rules changed. You select the visit level by …
The recent inclusion of moral injury as a Z code in the DSM marks a moment for mental health. Z codes place a diagnosis in an environmental or psychosocial context. After years of advocacy from clinicians and veterans, moral injury has entered our clinical lexicon. This action validates the linkage between our embeddedness in the world and our individual struggles, from soldiers and first responders to physicians navigating a broken …
You arrive on time: 8:20 a.m. for your 8:30 appointment. You’ve done your part; you showed up early, brought your insurance card, and maybe even filled out the forms online. You expect to see your doctor at 8:30. After all, that’s what the schedule says. But the clock, like the system, runs on its own rules. At 8:35, you’re still at the front desk. They’re scanning your card, verifying your …
This past August, our local hospital celebrated its 50th anniversary. The media published photos from 1975 of the ceremonial groundbreaking with hospital officials, including future Chief of Staff, Dr. David Mysko.
Dr. Mysko was the first doctor I met when I joined the staff in 1987. We played on “The Hospital Mashers,” competing with other community softball teams in a city league. As a family practitioner, he probably delivered many readers …
As a psychiatry resident, I have been closely monitoring developments in the proliferation of AI chatbots for therapy. The moment feels like the ground shifting below my feet, and I have just started my career. In my clinical practice I feel unprepared to discuss how these new technologies are impacting my patients’ lives, but from my digest of national media, I am certain that a substantial number of my patients …
“Why don’t they see?” “Why can’t they understand?” “Why are they doing this to us?”
These questions echo in exam rooms, in meetings, in the hallways of hospitals and clinics across the country. They are often sparked by policy changes, institutional decisions, or administrative mandates that feel disconnected from the physicians providing the care. Underneath the questions is the hope that the reality in front of us isn’t actually true. That …
For the longest time, I believed that if I gave myself fully, 24/7, to work, to my son, to my marriage, to my friends, then eventually, everything would fall into place. That maybe, just maybe, I would finally be able to answer every message, refill every prescription, kiss every scraped knee, and fix all the things.
But what I’ve come to understand is that we, especially women, though not exclusively, often …
This past summer, I was diagnosed with prostate cancer. For more than three decades, I have taught, examined, and guided patients through various types of illnesses. However, nothing prepared me for the disorienting effect of becoming a patient myself. The diagnosis itself (a less aggressive prostate cancer amenable to robot-assisted radical prostatectomy) felt, at first, like a technical problem with a straightforward surgical solution. But what I did not fully …
It’s no secret, is it? Health care organizations and institutions are struggling, some more than others. However, all are faced with seemingly insurmountable challenges. Demand outstripping resources, failing cultures and disengaged staff, and everywhere blockages and lack of flow are but a few of the common themes.
Big money, large initiatives, and great minds have all been thrown at the problem. The result? Well, if there was an answer we would …
Peace in the Middle East was once considered impossible until someone had the courage to take a stand and chart a new course. Mr. President, we need that same clarity and boldness now in health care.
The government shutdown over health care isn’t about medicine, it’s about money. Costs have exploded while premiums skyrocket. Paradoxically, doctors earn less, hospitals consolidate, and patients wait longer. The focus has shifted from healing to …
The Trump administration recently released a long-promised report decrying the sorry state of the health of American children and saying how it planned to change this.
They correctly begin by noting that “Despite outspending peer nations by more than double per capita on health care, the United States ranks last in life expectancy among high-income countries and suffers higher rates of obesity, heart disease, and diabetes.” Unfortunately, they then largely focus …
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I spent 11 years becoming a family physician.
Four years in undergrad, four in medical school, three more in residency.
That’s a decade of delayed income and about $300,000 in debt, all for the privilege of practicing in one of the most critical, underappreciated corners of medicine: primary care.
I came out idealistic. I wanted to build relationships, prevent disease, and guide people through the chaos of a broken system. But I quickly …
AI is rolling out in medicine faster than most of us can process. Ambient scribes documenting visits. Clinical decision support algorithms. Automated prior authorizations. The promises are compelling: reduced clerical burden, more face-time with patients, less burnout.
I wanted this. As a palliative care doctor and director of physician well-being at my institution, I’ve spent years watching colleagues drown in documentation and burn out from relentless task loads. When AI tools …
For decades, I practiced developmental-behavioral pediatrics with a focus on coordinated care, measurable goals, and clinical accountability. I believed that if we could define a child’s needs clearly and track progress with integrity, we could build systems that honored both science and dignity.
But I now realize I missed something critical.
After reviewing the #BanABA initiative and speaking with Dr. Henny Kupferstein, I’ve come to understand the full scope of harm linked …
The terrain I refused to leave
At Madigan Army Medical Center, I built a diagnostic model that delivered autism answers in under 30 minutes. No shortcuts, just smarter care. A Ph.D. pediatric nurse practitioner performed triage. I conducted the Screening Tool for Autism in Toddlers (STAT-MD), a targeted autism screening protocol developed at Vanderbilt, confirmed criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and families left …
In mid-November, thousands of junior doctors in Britain will again step away from their posts. Not for comfort. Not for gain. For something harder to name.
They have been praised as heroes and treated as expendable, thanked in speeches while their pay erodes and their patience thins. I heard one young doctor say she still loves medicine, but cannot serve a system that sees her as replaceable. She stayed through staff …
The human psyche is built for connection. Our evolutionary history, our families, and our communities shape us to seek cooperation, mutual respect, and shared purpose. We are, by design, social beings whose sense of safety depends on trust and belonging.
When that natural orientation toward unity is fractured; when instead we encounter hostility, harsh language, or dehumanization, it cuts against the grain of who we are. What might once have been …
The woman sits across from me, hands folded around a list of her medications.
We review the cholesterol guidelines. I explain the evidence. She listens carefully, then says, almost apologetically, “Doctor, I know what the data says. I just don’t want to take another pill.”
There is no anger in her voice, only fatigue, the quiet exhaustion of someone who has lived long enough to know her own limits.
I pause, because this …
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