For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then …
When I was a resident, the trauma surgeon was the go-to person for anything complicated. It seemed like they could do everything, and do it well. That’s what drew me to the field. There was a confidence, decisiveness, and scope that made trauma surgery feel like the pinnacle of surgical mastery.
For most of my career, I’ve worked as a trauma and critical care surgeon, from busy academic Level I trauma …
The creed of compliance
In every hospital, a grotesque comedy unfolds: Poor Sod, our hapless patient, lies gut-shot, aorta spewing like a B-movie fountain. Clinicians, faces blank as overcooked porridge, scurry in a choreographed panic, clutching flowcharts like sacred scrolls. Monitors bleep like a chorus of lobotomised parrots. A registrar, mad enough to trust his gut, tries a life-saving stunt not in the Holy Manual. A nurse, eyes glinting with the …
Imagine having to ask your competitors for permission to open a new business: a corner café, a diagnostic clinic, or a surgical center. For decades, that was the reality in South Carolina health care. Certificate of Need (CON) laws gave entrenched hospital systems the power to contest new outpatient facilities, imaging centers, and physician-led ventures. It stifled competition, raised costs, and preserved the status quo.
That era is ending. In 2023, …
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 …
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 …
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Neurosurgeon Jeffrey Hatef, Jr. discusses his article “Guilty until proven innocent? My experience with a state medical board.” In this episode, Jeffrey shares the shocking story of how his medical license was …
For over forty years, I worked as a general and vascular surgeon. For the last ten of those years, I was employed under an RVU-based compensation model. That period is when my dissatisfaction with medicine truly began. Complex, life-saving operations were reduced to “productivity units.” The pressure was relentless, the system unforgiving.
And unlike primary care physicians, surgeons do not have the option of concierge or direct-pay models. We are necessarily …
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Surgeon Fateh Entabi discusses his article “A surgeon’s take on God, intelligence, and cosmic responsibility.” Fateh reflects on how the complexity of the human body inspired him to think more broadly about …
Ever been so tired you forgot your own name? I remember a junior doctor on strike in London who told me exactly that. Thirty-six hours awake, stumbling into the children’s ward, staring at a prescription pad. “I couldn’t even remember my own name,” he said, “let alone the right antibiotic dose.”
That was not about wages. That was about survival, his and the children’s.
Yet the story always gets told the same …
More than 400 amputations happen in the U.S. daily. Not from gun violence, shark attacks, or car crashes, but from a disease that is easily diagnosed, preventable, and treatable, if caught early. Peripheral artery disease, or PAD, is a circulation problem in which narrowed arteries reduce blood flow to the limbs, most often the legs. More than 200 million people suffer from PAD, yet many aren’t even aware they have …
All physicians lead, not just those with designated leadership titles, such as Medical Director, Department Chair, or Chief Medical Officer. Leadership is foundational to the doctor’s role.
Fortunately, leadership is a learned skill and improving physicians’ leadership skills can change how well we do our key job of taking care of patients. As physicians improve individual leadership skills the entire health care system will reap the benefits: nurses, technicians, administrators, finance …
Each academic year, I have watched as a new class of residents and fellows prepares to graduate and launch their medical careers. They step out of the structured training environment into a professional world that is exciting, expansive, and, for many, overwhelming. Clinically, they are well trained. But residency rarely prepares physicians to recognize and advocate for what they truly need to thrive in practice. The data reflect this gap. …
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Appointments booked months out. Overwhelmed specialists. ERs struggling to stay staffed. The physician shortage is not coming. It is already here.
The Association of American Medical Colleges projects a shortfall of more than 124,000 physicians by 2034. But that number does not capture the reality that doctors are leaving medicine quietly, every single day. Some retire early. Others step into nonclinical roles. Many more are simply trying to find a better …
We are trained to move quickly. To respond before thinking. To act before doubting. To rise at three in the morning because someone’s life might depend on it. That is how we learn ethics, not in seminar rooms, but in corridors that smell of antiseptic and coffee, under fluorescent light, beside stretchers with failing hearts.
And so, somewhere along the way, we begin to believe that morality lives in the moment. …
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Health care executive David Fischel discusses his article “How robotics are reshaping the future of vascular procedures.” David explains how robotic-assisted systems are overcoming long-standing challenges in endovascular care by improving precision, …
You can live without a nipple, but what if you don’t have to?
Historically, this specialized region of the breast—known as the nipple-areolar complex—was one of the most vital aspects of human anatomy, providing not only nutrition but also immunologic safety for the infant via breastfeeding. The nipple deserves our respect; without it, human society would not exist.
While there are ample supplemental options today that allow people to …
The “pay-play it forward” concept for organ transplantation is simple. Simplistically, the organ donors’ data can be explored, if feasible, to determine incidence or prevalence of organ donations by the organ recipients, thus “paying it forward.” Thereafter, the organ recipients’ data can be explored, if feasible, to determine incidence or prevalence of pledged organ donors among the organ recipients. Finally, the transplant waiting lists’ data can be explored, if feasible, …
Throughout my career as a board-certified colorectal surgeon, I have prided myself on my commitment to providing high-quality patient care and upholding professional integrity. As a long-standing member of a major surgical society, I have always believed in the mission to foster excellence in the field of surgery. However, my relationship with that organization took a challenging turn when I was placed on probation after testifying in a medical malpractice …
When I found out about the summary suspension of my medical license in February, I was terrified and shocked, but I knew it was a mistake. There had not been any hearing. I was not even aware they were charging me until I got the letter.
The allegations involved three patients. I had the cases reviewed by four independent spine surgeons, leaders in the field from stellar institutions; all agreed that …
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