Primary care

When the patient portal is the only way to reach your doctor

Arthur Lazarus, MD, MBA

November 8, 2026Nov 8, 2026

An excerpt from METACINE: Essays on Health Care in a Changing World. Primary care is meant to be medicine's front door: the familiar place where a patient can discuss a new symptom, a lingering worry, a medication question, or simply…

An excerpt from METACINE: Essays on Health Care in a Changing World.

Primary care is meant to be medicine’s front door: the familiar place where a patient can discuss a new symptom, a lingering worry, a medication question, or simply the uneasy sense that something is not right. It is meant to be a relationship, not merely a point of entry into a larger system.

Yet as hospital chains acquire more …

American Medical Women's Association

COPD in women starts with subtle signs physicians can miss

November 7, 2026Nov 7, 2026

In my teens, I watched my grandmother slowly change and wither away. I can still remember the feel of her bones under my arms as I advanced through my teen years as her already slim frame became slimmer. I watched as her breathing became more labored, there were more trips to the hospital, and she eventually became tethered to oxygen at ever-increasing flow rates. The sound of the portable concentrator …

Clinical trials answer drug questions. Health questions need other tools. [PODCAST]

November 6, 2026Nov 6, 2026

No one ever ran a blinded trial on handwashing. It became standard practice around the world anyway. Narinder Singh Parhar, an internal medicine, hospital medicine, and critical care physician, calls evidence-based medicine one of the field's great achievements and credits…

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Will AI replace doctors? I’m not worried for 7 more years.

Larry Kaskel, MD

November 6, 2026Nov 6, 2026

I'm sixty-four years old. I've practiced internal medicine for more than thirty-five years, and I figure I've got another seven good years left. And I'm not particularly worried about artificial intelligence replacing me. That doesn't mean I think AI is…

I’m sixty-four years old. I’ve practiced internal medicine for more than thirty-five years, and I figure I’ve got another seven good years left. And I’m not particularly worried about artificial intelligence replacing me.

That doesn’t mean I think AI is overhyped. Quite the opposite. I suspect it’s going to transform primary care faster than most physicians appreciate. Some of what we do today will look positively antiquated by the time I …

Physician work-life balance starts with a better structure

Jerina Gani, MD, MPH

October 30, 2026Oct 30, 20262

It's 5:30 in the afternoon. The last patient has left. The waiting room is quiet. The medical assistants are finishing their work, and the exam rooms are empty. But the physician is still sitting in front of the computer. There…

It’s 5:30 in the afternoon. The last patient has left. The waiting room is quiet. The medical assistants are finishing their work, and the exam rooms are empty.

But the physician is still sitting in front of the computer. There are unfinished notes, laboratory results to review, medication refills waiting for approval, and patient messages that require careful clinical judgment.

The physician looks at the clock. There was a promise to be …

Doctor-patient communication ends with the wrong question

Dr. Gurdev Singh

October 27, 2026Oct 27, 2026

The plan is made. The chart is closed. The doctor's voice has already changed. "Anything else?" Most physicians have asked that question thousands of times. I have asked it more times than I can count, and often at precisely the…

The plan is made. The chart is closed. The doctor’s voice has already changed. “Anything else?”

Most physicians have asked that question thousands of times. I have asked it more times than I can count, and often at precisely the moment I was ready for the visit to end.

Nearly every clinician says it, and most say it the same way. “Anything else?” sounds like an invitation. It functions as a closing. …

Concierge medicine gave this family doctor his time back

Michael C. Luciano, DO

October 27, 2026Oct 27, 2026

Seventeen years ago, I opened a family medicine practice with a simple goal: take care of my community. I am board-certified in family medicine and obesity medicine, and I loved the work. What I did not love was what the…

Like many of you, I spent my days racing a clock I didn’t set. Short visits. Prior authorizations stacked on my desk. Evenings spent finishing notes while my …

Why storytelling in health care outlasts the algorithm

Ryan McCarthy, MD

October 24, 2026Oct 24, 2026

On Friday, March 13, 2020, Governor Jim Justice held a press conference, one I watched virtually, and, as I ate cheddar cheese and Triscuits and put my feet on my desk, I felt unwell. The previous weekend had been the last “normal” thing my son, Isaac, would do in high school, the West Virginia All-State High School Band. And by “normal” I mean a superspreader event where my entire family …

Disability claim denied? Your chart notes may be why. [PODCAST]

October 23, 2026Oct 23, 2026

The words you put in a patient's chart can be used to deny their disability claim. A note that says "stable" or "improved" can mean one thing to you and another to the insurer. Jennifer Hess, an ERISA disability attorney…

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The words you put in a patient’s chart can be used to deny their disability claim. A note that says “stable” or “improved” can mean one thing to you and another to the insurer. Jennifer Hess, an ERISA disability attorney and Riemer Hess partner, represents physicians and other professionals in …

Parental instincts caught what normal tests missed

Jayme Higgins, RN

October 22, 2026Oct 22, 20264

As a nurse, I understand why medicine depends on objective data. We rely on lab results, imaging studies, vital signs, and physical examinations to help guide decisions. We are trained to avoid unnecessary testing, unnecessary radiation, and unnecessary interventions. I fully understand the risks of overdiagnosis, radiation exposure, and the reality that many childhood illnesses improve with time and supportive care.

But recently, I learned a lesson from the other side …

Narinder Singh Parhar, MD

Health care innovation is more than a new drug or device

October 22, 2026Oct 22, 20262

For many people working in health care, the problems have become painfully familiar: the growing burden of chronic disease, physician and nurse burnout, shortages of adequately trained clinicians, rising costs, and dissatisfaction among patients and professionals alike. Together, these pressures can create a frustrating feeling that we have reached the end of the road. I believe we have reached a point that demands a change in direction.

We have extraordinary scientific …

Losing health insurance should not mean losing dignity

Katie Abbott, MHA

October 21, 2026Oct 21, 2026

At a recent health care conference, a panel of leaders gathered to talk about financial resilience. The framing was intentionally designed. The question wasn't "How do we save money?" It was "how to deliver the right care, at the right…

At a recent health care conference, a panel of leaders gathered to talk about financial resilience. The framing was intentionally designed. The question wasn’t “How do we save money?” It was “how to deliver the right care, at the right time, in the way that is most meaningful, so that outcomes change, health improves, and the total cost of care comes down.”

When the audience asked how social and structural drivers …

A diagnosis no one authored can follow your patient from visit to visit [PODCAST]

October 19, 2026Oct 19, 2026

A patient arrives already sure of what is wrong with them. The words they use came from somewhere else. Alan P. Feren is a retired surgeon, health care consultant, and patient advocate. This episode is based on his article "Clinical…

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Narinder Singh Parhar, MD

Corporate greed in health care puts profit over patients

October 19, 2026Oct 19, 2026

Money has become an increasingly dominant measure of success in modern society. Wealth, once considered a means of achieving security, independence, and a comfortable life, is too often treated as an end in itself. Nowhere is this transformation more troubling…

Over the past two decades, health care has attracted unprecedented interest from investors, private equity firms, corporate executives, and other nonmedical stakeholders. Some have brought valuable …

Esketamine vs. ketamine: what to ask before you refer

Ravi Singareddy, MD

October 19, 2026Oct 19, 20263

In my practice, more and more patients arrive with a ketamine clinic advertisement in hand. Many have already asked their primary care physician, "Should I try this?" The honest answer depends on a distinction those advertisements routinely blur: The "ketamine"…

In my practice, more and more patients arrive with a ketamine clinic advertisement in hand. Many have already asked their primary care physician, “Should I try this?” The honest answer depends on a distinction those advertisements routinely blur: The “ketamine” offered for depression is not a single, standardized therapy.

On one side is intranasal esketamine (Spravato), the S-enantiomer of ketamine. The FDA approved it in 2019 for treatment-resistant depression (TRD) …

Why the annual physical shortchanges patients and doctors

Acey Albert, MD

October 17, 2026Oct 17, 20263

A patient called my office last month asking if she could "just get her labs done" without coming in. She wasn't being difficult. She'd had the same panel run every year for a decade, felt fine, and didn't see why…

A patient called my office last month asking if she could “just get her labs done” without coming in. She wasn’t being difficult. She’d had the same panel run every year for a decade, felt fine, and didn’t see why a 15-minute conversation needed to precede a blood draw. Another patient, a few weeks later, arrived for his physical with a list of eleven things he wanted addressed: three medication …

Heart and brain got the investment; the musculoskeletal system did not [PODCAST]

October 16, 2026Oct 16, 2026

You can learn more from watching a patient walk down the hallway than from the rest of the exam. Most exams happen sitting or lying down. Narinder Singh Parhar is an internal medicine physician and founder of Jeeva Health Systems.…

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A plan to save primary care that puts doctors in charge

Ken Terry

October 15, 2026Oct 15, 2026

PCPs don't have to suffer silently under employers that deprofessionalize them and treat them as the low people on the totem pole of health care. They can embark on a mission to save U.S. health care, while increasing their earnings…

PCPs don’t have to suffer silently under employers that deprofessionalize them and treat them as the low people on the totem pole of health care. They can embark on a mission to save U.S. health care, while increasing their earnings and enhancing their status.

This may sound like a pipe dream. But all the essential elements for it are available. All that’s needed is the political will to make it happen.

As …

Responsible healthmaxxing starts with a stopping rule

Fayez Ajib, DO

October 13, 2026Oct 13, 2026

Wellness culture has become very good at telling people what else they could measure, buy, restrict, stack, or optimize. The newer language of "healthmaxxing" packages that instinct into a single word. At its most extreme, it can turn an ordinary…

Wellness culture has become very good at telling people what else they could measure, buy, restrict, stack, or optimize. The newer language of “healthmaxxing” packages that instinct into a single word. At its most extreme, it can turn an ordinary life into an endless intervention: more supplements, more tests, tighter routines, higher scores, and less tolerance for uncertainty.

The criticism of that version is justified. A routine is not responsible simply …