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Physician

Why physician outsourcing is a warning sign for hospitals

History has taught medicine some brutal lessons. Nearly two centuries ago, Ignaz Semmelweis noted a disturbing pattern in the maternity wards of Vienna, Austria. Women cared for by physicians were dying of puerperal fever at dramatically higher rates than those…

History has taught medicine some brutal lessons. Nearly two centuries ago, Ignaz Semmelweis noted a disturbing pattern in the maternity wards of Vienna, Austria. Women cared for by physicians were dying of puerperal fever at dramatically higher rates than those cared for by midwives. The hospital still looked functional, the wards remained open, physicians continued working, and the institution carried on. But something inside the system was profoundly wrong. Semmelweis …

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Why physician outsourcing is a warning sign for hospitals

Conditions and Diseases

12 psychiatrists missed my medication-induced psychosis

During deliberations in the recent murder trial of Lindsay Clancy, jurors made an unusual request. They asked to see the bags of prescription medication bottles that had been introduced into evidence. Clancy's defense had argued that she was suffering from…

During deliberations in the recent murder trial of Lindsay Clancy, jurors made an unusual request. They asked to see the bags of prescription medication bottles that had been introduced into evidence.

Clancy’s defense had argued that she was suffering from postpartum psychosis when she killed her three young children in 2023, and that her condition had been compounded by overmedication and inadequate psychiatric care. Prosecutors disputed that account. After weeks of …

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12 psychiatrists missed my medication-induced psychosis

Conditions and Diseases

The Pennsylvania measles outbreak and the cost of forgetting

On Saturday, August 29, 2026, a headline in my local paper caught my eye. There were 460 confirmed measles cases in Pennsylvania as of Friday, August 28, according to the Pittsburgh Tribune-Review. As of Wednesday, September 16, there are 731…

On Saturday, August 29, 2026, a headline in my local paper caught my eye. There were 460 confirmed measles cases in Pennsylvania as of Friday, August 28, according to the Pittsburgh Tribune-Review. As of Wednesday, September 16, there are 731 cases in 38 of Pennsylvania’s 67 counties, and over 120 hospitalizations.

A brief search of the CDC website shows that since 1991, the number of measles cases nationwide has been in …

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The Pennsylvania measles outbreak and the cost of forgetting

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Health Technology

AI governance in health care has to reach the exam room

Hospitals and health systems have spent the past several years building AI governance programs. They have formed committees, written policies, reviewed vendors, and debated where these tools belong in clinical care. That work matters. But as a physician, I worry…

Hospitals and health systems have spent the past several years building AI governance programs. They have formed committees, written policies, reviewed vendors, and debated where these tools belong in clinical care. That work matters.

But as a physician, I worry that too much of the conversation still stops short of the exam room. A health system can approve a tool, complete a compliance review, and satisfy a governance checklist while …

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AI governance in health care has to reach the exam room

Physician Finance

Why physician financial freedom matters more than salary

An excerpt from Essays and Echoes: Reflections from a Life in Medicine. In the CBS series Blue Bloods, the 2014 episode "Most Wanted" finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm.…

An excerpt from Essays and Echoes: Reflections from a Life in Medicine.

In the CBS series Blue Bloods, the 2014 episode “Most Wanted” finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm. The appeal is clear. The new job would pay much more, and her daughter is nearing college age. Erin is not choosing between good and greed. She is …

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Why physician financial freedom matters more than salary

Conditions and Diseases

4 fibromyalgia myths the current evidence doesn’t support

Fibromyalgia is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive difficulties (often called "fibro fog"), frequently accompanied by other symptoms such as mood changes or overlapping conditions like irritable bowel syndrome. It arises…

Fibromyalgia is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive difficulties (often called “fibro fog”), frequently accompanied by other symptoms such as mood changes or overlapping conditions like irritable bowel syndrome. It arises primarily from altered central nervous system pain processing rather than peripheral tissue damage or inflammation.

Myth: Fibromyalgia is “all in the head” or purely psychological

Fact: While psychological factors and stress …

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4 fibromyalgia myths the current evidence doesn’t support

Physician

Physician mental health and the shame of asking for help

I have intubated people who intentionally overdosed on many things they could find. I have sat with families in the minutes after we lost someone who didn't have to be lost. I have written discharge summaries for patients I worried…

I have intubated people who intentionally overdosed on many things they could find. I have sat with families in the minutes after we lost someone who didn’t have to be lost. I have written discharge summaries for patients I worried about the moment they walked out the door.

For twenty-three years, I was the doctor on the other side of the crisis. Then I wasn’t.

It didn’t arrive the way emergencies do: …

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Physician mental health and the shame of asking for help

Health Technology

Why haven’t ambient AI scribes boosted productivity?

A physician finishes today's note noticeably faster than they used to. The AI scribe listened, drafted, and closed most of the gap between seeing the patient and finishing the paperwork. At the end of the day? That's less time hunched…

A physician finishes today’s note noticeably faster than they used to. The AI scribe listened, drafted, and closed most of the gap between seeing the patient and finishing the paperwork. At the end of the day? That’s less time hunched over a keyboard once the last patient leaves.

But ask, three months in, whether the practice is seeing more patients or capturing more revenue because of it. What comes back is …

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Why haven’t ambient AI scribes boosted productivity?

Podcast

Burnout isn’t only about autonomy, it’s about your bank account [PODCAST]

Physicians stay in jobs they cannot afford to leave. The wellness conversation talks about resilience and meaning, and never about what is in your bank account. Stanley Liu, cardiologist, financial planner, and founder of DocEmpowered, returns with a concept traditional…

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Youtube video

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Physicians stay in jobs they cannot afford to leave. The wellness conversation talks about resilience and meaning, and never about what is in your bank account. Stanley Liu, cardiologist, financial planner, and founder of DocEmpowered, returns with a concept traditional financial planning does not have. This episode is based on his …

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Burnout isn’t only about autonomy, it’s about your bank account [PODCAST]

Conditions and Diseases

Physician well-being is not an individual problem

The effectiveness of a health care system is routinely judged by the care patients receive. Far less attention is given to the conditions under which that care is delivered. Health care policy continues to emphasize insurance coverage, access to care,…

The effectiveness of a health care system is routinely judged by the care patients receive. Far less attention is given to the conditions under which that care is delivered. Health care policy continues to emphasize insurance coverage, access to care, rising costs, workforce shortages, and health outcomes. Yet one question remains largely unaddressed: Who is caring for our physicians?

Physician well-being has traditionally been viewed as an individual concern. Current evidence …

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Physician well-being is not an individual problem

Health Technology

Hospital IT approval has no path for clinician-built tools

Six years ago, a man pulled off a highway in rural Washington because his chest hurt. The ER physician called Gautam, the cardiologist on call, 120 miles away. Nearly twenty minutes passed before he had the ECG. In rural Washington…

Six years ago, a man pulled off a highway in rural Washington because his chest hurt. The ER physician called Gautam, the cardiologist on call, 120 miles away. Nearly twenty minutes passed before he had the ECG. In rural Washington in 2019, you send an ECG by fax. By the time Gautam reviewed it and called back, the patient was coding. He died.

That story is about a fax machine. It …

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Hospital IT approval has no path for clinician-built tools

Physician

Surgical judgment: the skill no one sees from the gallery

When I was younger in surgery, I watched hands. I watched how senior surgeons held an instrument, how little unnecessary movement they made, how calmly they worked around a vessel that could turn an orderly operation into an emergency within…

When I was younger in surgery, I watched hands. I watched how senior surgeons held an instrument, how little unnecessary movement they made, how calmly they worked around a vessel that could turn an orderly operation into an emergency within seconds. Technical mastery was visible. You could stand across the operating table and recognize it.

I wanted that kind of control. Most young surgeons do.

In my first year of cardiovascular surgery …

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Surgical judgment: the skill no one sees from the gallery

Medications

How fentanyl misinformation turns suspicion into fact

Numbers do not have to be fabricated to mislead. They can be technically accurate and still create a false story when "detected" becomes "caused," "involved" becomes "alone," and a preliminary suspicion becomes a headline. This dynamic played out following a…

Numbers do not have to be fabricated to mislead. They can be technically accurate and still create a false story when “detected” becomes “caused,” “involved” becomes “alone,” and a preliminary suspicion becomes a headline.

This dynamic played out following a May 2026 emergency in Mountainair, New Mexico. Three people died in a home where investigators found fentanyl, para-fluorofentanyl, and methamphetamine, while eighteen first responders later reported symptoms such as nausea, …

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How fentanyl misinformation turns suspicion into fact

Health Technology

Patient-centered device design is not bedside manner

This year I interned at Dr. Ziauddin Hospital during my biomedical engineering studies. Much of what I learned there was not to be found in books. At the moment it was standing next to a machine, doing its job perfectly,…

This year I interned at Dr. Ziauddin Hospital during my biomedical engineering studies. Much of what I learned there was not to be found in books. At the moment it was standing next to a machine, doing its job perfectly, and the patient attached to it, looking totally lost.

Medical devices are manufactured to perform accurately. They have to be quick, believable to the physician that reads the number, fail-safe, and …

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Patient-centered device design is not bedside manner

Podcast

Genetic test results, social media advice, and an irreversible choice [PODCAST]

Your genetic test results now arrive on your phone before anyone is available to explain them. So the questions go to an online mom group, or to ChatGPT, and strangers answer first. Stephanie Waggel, physician and founder of Improve Medical…

Listen on Apple Podcasts · Spotify

Youtube video

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Your genetic test results now arrive on your phone before anyone is available to explain them. So the questions go to an online mom group, or to ChatGPT, and strangers answer first. Stephanie Waggel, physician and founder of Improve Medical Culture, has been watching that happen in real time. This …

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Genetic test results, social media advice, and an irreversible choice [PODCAST]

Conditions and Diseases

AI in dementia care could give doctors time to listen

The questions a doctor asks a patient and their family are particularly important for a diagnosis in Alzheimer's disease and related dementias, but the demand for care is rapidly outpacing the supply of clinicians, and the time to truly listen…

The questions a doctor asks a patient and their family are particularly important for a diagnosis in Alzheimer’s disease and related dementias, but the demand for care is rapidly outpacing the supply of clinicians, and the time to truly listen keeps shrinking. My colleagues and I have been testing a possible way to protect that conversation: a voice-based artificial intelligence “agent” that interviews patients before they ever see a clinician, …

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AI in dementia care could give doctors time to listen

Physician

Physician burnout often begins with self-abandonment

The room was still dark, my cat curled next to me, when I looked at the clock: 4:18 a.m. It was well before my alarm was set to go off, but I knew I wasn't going to fall back asleep.…

The room was still dark, my cat curled next to me, when I looked at the clock: 4:18 a.m. It was well before my alarm was set to go off, but I knew I wasn’t going to fall back asleep. Reluctantly, I grabbed my phone, put on my slippers, and shuffled downstairs to the coffee maker. While the coffee brewed, I skimmed my email and read the news headlines. Coffee …

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Physician burnout often begins with self-abandonment

Conditions and Diseases

Barriers to yoga practice, and how to lower them

Musculoskeletal and mental-health conditions are among the most consequential and costly health challenges in the United States. Musculoskeletal conditions affect more than one-third of U.S. adults and account for more than $300 billion in medical spending, while mental illness is…

Musculoskeletal and mental-health conditions are among the most consequential and costly health challenges in the United States. Musculoskeletal conditions affect more than one-third of U.S. adults and account for more than $300 billion in medical spending, while mental illness is estimated to cost the broader U.S. economy approximately $282 billion annually. Although many of these conditions are chronic and cannot be addressed through a single universally effective intervention, …

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Barriers to yoga practice, and how to lower them

Medications

The nociplastic pain question new pain therapies avoid

Systematic review data puts the prevalence of central sensitization features among knee osteoarthritis patients at approximately 36 percent by validated instrument. More than one in three patients carrying an orthopedic diagnosis you trust, presenting with pain that structural intervention may…

Systematic review data puts the prevalence of central sensitization features among knee osteoarthritis patients at approximately 36 percent by validated instrument. More than one in three patients carrying an orthopedic diagnosis you trust, presenting with pain that structural intervention may only partially address. The joint pathology on the imaging is real. The dominant pain mechanism is incompletely characterized.

In my last piece, I argued that glucagon-like peptide-1 (GLP-1) pharmacology and neurotechnology …

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The nociplastic pain question new pain therapies avoid

Physician

Can physicians and organized labor stand together?

Our cultural ethos has revolved around the paragons of "hard work" and so much so that now our health leaders are suggesting that "healthy" Americans work longer to delay retirement to stimulate the economy. In the words of Dr. Oz,…

Our cultural ethos has revolved around the paragons of “hard work” and so much so that now our health leaders are suggesting that “healthy” Americans work longer to delay retirement to stimulate the economy. In the words of Dr. Oz, “If Americans could stay healthy enough to work just one additional year or start working earlier in their lives, it would increase the GDP of our nation by trillions …

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Can physicians and organized labor stand together?

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