I walked out of my physician’s office steady and clear in my decision to transfer my care. I didn’t accuse her of anything. I didn’t raise my voice. I simply informed her that I would be transitioning to another clinician within the same concierge program.
She immediately assumed I was leaving for financial reasons and suggested physicians to see outside the system. When I clarified that her administrator had already approved …
As a physician-psychiatrist, I have watched the rise of GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound) with genuine admiration. They are transforming metabolic health, reducing cardiovascular risk, and offering hope to patients who have struggled for decades. For many, these medications are lifesaving.
But alongside the excitement, I’m witnessing something rarely discussed: a change in personality and affect, especially at higher doses.
This pattern reminds me of the early days of SSRIs. When …
Most people assume that pain and illness are caused only by injury or disease. If your back hurts, it must be damaged; abdominal pain must come only from inflammation, infection, or tumor. Most physicians learn this in medical school, as I did. But treatment based on this assumption often fails to provide relief for persistent pain, leaving millions of patients and countless well-intentioned physicians frustrated and in despair. The result …
An excerpt from My Eight Year Kidney Stone Journey.
In the fifth year of my kidney stone battle, after yet another painful episode, I reached a turning point. I remember recovering at home, sipping the bland herbal tea I had switched to (since I was even worried regular tea might have too much oxalate), and thinking, there must be something else out there that I can try. I refused to …
Three weeks after giving birth, you are hit with a blinding headache and fading vision. The next available appointment with your doctor is two weeks away. You finally go to your doctor, and your blood pressure has already reached a dangerous level without you even realizing.
The solution is straightforward. A home blood pressure monitor costs between $69 and $169. Yet most insurers will not cover it because many states do …
Anesthesia and sedation in dental patients has come under scrutiny in recent years, fueled in part by high-profile tragedies, such as the deaths of six-year-old Caleb in 2015, cardiologist Dr. Henry Patel in 2020, and the five media-reported deaths in 2025. These incidents serve as a stark reminder that the current landscape of dental sedation practices is fraught with inconsistencies and a lack of oversight, which can have devastating consequences …
There is a stillness in the waiting room,
not exactly silence,
but a quiet that settles over chairs,
minds diverted elsewhere.
Here, women sit in chairs
with their thoughts
floating in opposing directions,
pretending to read magazines,
while their minds
wander hallways
they would rather not travel.
My name is called softly,
and my heart skips a beat,
the time has come.
I follow the routine,
changing from street clothes
into bare arms and a borrowed gown
that never seems to fit properly.
I take a deep breath,
trying …
With an overwhelming role of automation in modern health care industry, the concept of medical ethics seems to be fading away in the waves of murky economic profiting from value-based bundles meant for pure revenue generation. The commercialized approach towards practice of medicine requires readdressing the core ethical framework which lies at the hearth of patient-doctor relationship. Being innate and inextricable part of clinical medicine, ethical responsibility is meant for …
With the onset of fall and winter season, my clinic in the Bronx braces for a flood of worried parents. A toddler coming in with itchy, watery eyes and a runny nose becomes a far too common sight. Parents share of their battles against poorly ventilated apartments, mould and cockroach infestations, housing insecurities; adding to this, the threat of RSV, flu, and COVID-19 exposures in day care and school causes …
I used to think the hardest part of building better health care was securing funding.
Then I watched the same cycle repeat itself: A promising pilot launches, early outcomes are celebrated, a report is written, and when the funding period ends, the program quietly disappears. The idea did not fail. It simply could not survive.
Nothing was wrong with the clinicians involved.
Nothing was wrong with the intention.
What was missing was a system.
Health …
This is a work of fiction.
I directed Mrs. Powell to sit and make herself comfortable. She lowered herself into the chair at the round table in the lobby of my office slowly, her frail, 90-year-old frame eventually settling into it.
“How’s your health, Mrs. Powell?” I asked. This is how I approached most conversations in which a client asked if they could meet suddenly. Usually, it meant they had gotten some …
For years, hospitals have been urged to modernize. We are told to digitize workflows, optimize performance, and rely on dashboards and algorithms to improve efficiency. Much of this advice is reasonable. Medicine cannot function without systems.
But recently, while observing hospital transformation from within, I began to feel a familiar unease, one I had encountered before outside of medicine.
It reminded me of how digital platforms operate.
Platforms are not inherently unethical. They …
Adapted from Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity. (Penguin Random House Canada/Signal, 2025.)
February 1992. I’m in the consulting-room side of a one-way mirror divide. Opposite us in the room are four people: thirteen-year-old Sofia, her older sister Julieta, and their mother and father. The parents speak with a strong Spanish accent. The girls’ mother has an anxious look on her face. She …
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Most of us have heard the ancient Indian and Buddhist parable “the blind men and the elephant.” Regardless of source, the parable usually contains these elements:
A ruler assembles several blind men and brings an elephant before them. One feels the head and says the elephant is like a pot; another the ear and says it is like a fan; another the leg and says it is like a pillar; another …
Every week in clinic, I meet patients who carry lab results like heavy burdens. Their cholesterol is “slightly high,” their thyroid level is “borderline,” or their blood sugar is “just above normal.” They arrive anxious, wanting certainty: Do I need treatment? Am I sick?
The truth is, much of medicine exists in the gray zone (values that are not clearly normal, but not clearly dangerous either).
What the research tells us
Borderline numbers …
All of the arguments for direct primary care (DPC) from a provider perspective are valid. As a psychotherapist and psychoanalyst, I have essentially run a direct care practice for the last 15 years. I don’t accept insurance and see patients as often and for as long as therapeutically necessary. So when DPC practices started rising in popularity, I was excited to try it. Unfortunately, as a patient who is medically …
On a winter evening in Taipei, random violence erupted across two of the city’s busiest metro stations. Within minutes, lives were lost, dozens were injured, and a familiar cycle followed: shock, fear, calls for more security, and questions about public safety. But for those of us in health care, this should not be framed as a failure of policing alone. It should be recognized for what it truly is: a …
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs. The child suffers not only from the caregiver’s direct …
Kelly D. Holder, PhD, and I first met at the Dr. Lorna Breen Heroes Foundation Health Care Worker Well-Being Day in Washington, D.C., where she was a presenter. I was impressed with Kelly’s work, focusing on helping health care professionals and leaders co-create a culture of well-being, which is so critical in medicine today.
This resonates deeply with Sarah Hollander, MD’s belief that the culture of medicine must change, starting in …
The denial came back in less than three seconds.
A physician had just submitted a renewal for a medication her patient had taken for years, one that kept her stable, out of the hospital, and able to function. She expected the usual wait time. Maybe an hour. Maybe a day.
Instead, an automated message appeared: “Denied: automated appropriateness determination.”
No reviewer. No rationale. No path for appeal. Only an algorithm, silent, opaque, and …
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