Physician

The referral trap: How specialization fragments care

Ann Lebeck, MD

Physician

May 19, 2026

She was already seated when I walked in. On the desk in front of her sat a large sleeve, the kind that holds imaging films, oversized and awkward, the kind that no longer fits in a folder or a binder or anywhere in a modern clinic. Beside it was a folder. Labs indexed by specialist and date. Notes from orthopedics, neurology, rheumatology, pain management, and physical therapy. Every test, every …

California opioid prescribing: What the data actually shows

Kayvan Haddadan, MD

Physician

May 19, 2026

As a physician managing patients with chronic pain in California, I’ve witnessed the tension between necessary regulations and the daily reality of helping people in genuine distress. In the meantime, as a chairman for the National Campaign to Protect People in Pain (NCP3), I know how important it is to advocate for our patients. While foundational reviews on prescription drug oversight provide helpful context on opioids and NSAIDs (for details, …

Reclaiming the lost art of the physical exam

Ann Lebeck, MD

Physician

May 18, 2026

Before the imaging, the lab work, or the referral, there is a moment when the body is already speaking.

The way someone walks into the room. The hesitation before sitting down. The guarded turn of a shoulder. The subtle shift away from one hip before pain is ever described.

Medicine once placed enormous value on these observations. Observation was not separate from diagnosis; it was the beginning of it.

Sherlock Holmes famously suggested …

Time pressure in medicine narrows how we see

Ann Lebeck, MD

Physician

May 17, 2026

Medicine values speed, but patients often reveal themselves slowly.

We are expected to identify the problem, name it, code it, treat it, and move on. That process may be necessary in a pressured system, but it can also mistake a label for understanding.

A diagnosis can be useful. It can guide treatment, open access, and reassure patients. But it can also become a premature ending to a story that still needs to …

How physician therapy sparked a medical career transition

Shahrzad Rafiee, MD

Physician

May 17, 2026

I come from a generation that does not believe in therapy. Not because we do not believe it is effective, but because we believe we can handle things on our own. If things are hard, we push through. If we need help, we figure it out independently. By the time I became a physician, self-reliance was not just a value, it was my tried-and-true survival strategy. I remember years ago, …

How a Broadway comedy saved an internal medicine doctor

Ryan McCarthy, MD

Physician

May 16, 2026

“As a witness to so much sadness and pain, how do you keep from getting depressed?” As an internal medicine doctor, I have heard versions of this question for decades. And, despite a myriad of changes in my career, my answer has never wavered. And while there are many comedians and funny things, one particular evening more than any other reveals how …

The administrative burden crushing California medicine

Kayvan Haddadan, MD

Physician

May 16, 2026

Think of the entire health care system as a chess game where the goal is to achieve a healthier population by checkmating against the “darker side,” which represents disease, poor outcomes, inefficiency, and the human suffering of untreated or delayed chronic conditions like pain.

The patient should be the king: The most important piece. Everything revolves around protecting and empowering them. Without the king (patients), the game does not …
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The administrative burden crushing California medicine

Hospital room contamination is a prescribing problem

Franklyn R. Gergits, DO, MBA

Physician

May 16, 2026

Adam was twenty-four years old. He was a passenger in a car that struck a guardrail on the interstate. The airbag hit him in the face. He lost consciousness for a few seconds and was alert and walking by the time paramedics arrived.

The emergency doctor did everything right. CT scan, labs, neuro checks. The scan was uncertain enough (possible early changes after a head impact with witnessed loss of consciousness) …

Physician depression doesn’t always look like depression

Kenneth Scott Burnham, DO

Physician

May 15, 2026

An excerpt from Lifeline: What To Do After A Mental Health Crisis.

I have spent over two decades in emergency medicine. I know what a mental health crisis looks like. I know the clinical signs, the language, the interventions. I have initiated more psychiatric holds than I can count, written discharge summaries for people leaving my ER with a handful of pamphlets and a follow-up appointment I quietly hoped they …

Physician retirement is a myth for the ripening doctor

Farid Sabet-Sharghi, MD

Physician

May 15, 2026

“Are you retired yet?”

The question caught me off guard. It was not the query itself, I have reached my mid-60s, after all, but the underlying assumption it carried. Having practiced for over three decades, I found myself momentarily silenced by a word that feels entirely foreign to my current internal state.

As a psychiatrist, I have spent a lifetime listening to the narratives of others. Now, I find my own narrative …

How a diversionary legal strategy harms medical malpractice

Howard Smith, MD

Physician

May 15, 2026

A set of medical malpractice cases can be presented as examples of a legal strategy that may undermine a fair trial. In Case A v. Medical Center A, a 16-year-old girl conceives in and lives in a developing country until 17 weeks of gestation and receives no prenatal care until 20 weeks of gestation, when she arrives in the United States. At that time, she is found to have chlamydia.

Other …

Medical apology laws don’t reduce malpractice lawsuits

Timothy Lesaca, MD

Physician

May 15, 2026

An apology after medical harm still matters, but perhaps not for the reasons medicine once believed.

For a long time, medicine saw apologizing after a bad outcome as risky or, at best, a way to protect oneself. Doctors were told to say as little as possible: Avoid guessing, don’t admit fault, and don’t apologize. This made sense in a legal system where lawsuits are common. But after a serious mistake, staying …

Why corporate medicine fails every physician-patient

Ronald L. Lindsay, MD

Physician

May 15, 2026

Physicians make the worst patients. Not because we are demanding or entitled, but because we know exactly what is happening behind the curtain. We know when a delay is avoidable. We know when a clinician is being rushed. We know when a decision is being shaped by billing codes rather than clinical judgment. And we know when a system is quietly failing us, the same system we once defended, taught, …

Continuity of care in HIV/AIDS lives in the people who stay

Gus W. Krucke, MD

Physician

May 15, 2026

There are moments in medicine when the entire architecture of modern health care reveals both its brilliance and its limitations at the same time.

Years ago, a familiar face appeared quietly in our treatment room, though diminished enough that several people did not recognize him immediately. He had once been the life of every room he entered, effortlessly social, funny, alive in the particular way some people seem born carrying light …

The tragic reality of pregnancy-associated breast cancer

Dr. Damane Zehra

Physician

May 15, 2026

This photo shows one of my patients’ children. (I am sharing the photo with the family’s consent.) Can you guess the secret behind this photo? Let me tell you about the background.

The difficult diagnosis of pregnancy-associated breast cancer

Mrs. U was in her first trimester of pregnancy when she discovered a lump in her right breast. Work-up revealed that it was a highly …

Clinician peer support is a patient safety issue

Olumuyiwa Bamgbade, MD

Physician

May 14, 2026

Frontline clinicians work in a paradox. We care for others at their most vulnerable moments, yet we struggle to admit our own vulnerability. We recognize pain in patients, but we may miss it in the colleague working with us. We respond quickly to patients’ clinical deterioration, but we ignore our emotional deterioration until it becomes dangerous.

Frontline clinician suicide is not only an individual tragedy. It is also a workplace warning …

Death certificate errors expose flawed medical history

Karen Glover, MD

Physician

May 14, 2026

My mother died recently. I received the death certificate. I disagree with her cause of death. The doctor who completed her worksheet did not know her well. The death certificate has a diagnosis that she never had that was handed down from her previous doctor. It omitted a long-standing, chronic disease. Why am I bothered? Because I would complete death certificates on a routine basis, for I am a hospice …

Primary care crisis requires new training and skills

Justin Oldfield, MD

Physician

May 14, 2026

The primary care crisis has been well documented. Experts cite low pay, lack of respect and administrative burden, all of which have contributed to burnout and a growing shortage of primary care physicians (PCPs). But even if we solve those problems, are PCPs well-prepared to care for an increasingly older, sicker population saddled with psychiatric disease? For many PCPs practicing today, the answer is no. There are myriad reasons for …

Institutional misrepresentation harms vulnerable patients

Ann Lebeck, MD

Physician

May 14, 2026

She came back three weeks later, sicker. She had been seeing a physical therapist for her lower back pain. At her last visit she mentioned that her cough was getting worse. He said nothing, and she did not push it. She assumed if it mattered, he would have said so.

What she did not know was that she had been told she was seeing “the doctor.” Not a physical therapist. The …

Moral injury in medicine goes beyond simple burnout

Gus W. Krucke, MD

Physician

May 14, 2026

Most young physicians enter medicine with a sincere desire to help people. They expect long hours, difficult training, and personal sacrifice. What many do not expect is how profoundly the environment around them will shape not only how they practice medicine, but who they become.

Medicine teaches many things that never appear on a syllabus. A resident quickly learns which patient encounters generate complaints, portal messages, administrative scrutiny, or poor satisfaction …

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