An excerpt from The Mindful Therapist: An Interpersonal Neurobiology Approach to Healing and Wholeness, second edition. Resonance is the coupling of two autonomous processes into a functional whole without losing the essence of each one. When we resonate with another…
Resonance is the coupling of two autonomous processes into a functional whole without losing the essence of each one. When we resonate with another person, we are changed by them but do not lose our essence in the joining. Resonance is not the same as mirroring or imitating. Resonance enables two differentiated elements of …
Before surgery, anesthesiologists ask many questions. What medicines are you taking? Do you have any allergies? Have you had anesthesia before? Do you smoke or drink alcohol? Do you take any supplements? Do you snore heavily or use a CPAP…
Before surgery, anesthesiologists ask many questions. What medicines are you taking? Do you have any allergies? Have you had anesthesia before? Do you smoke or drink alcohol? Do you take any supplements? Do you snore heavily or use a CPAP machine?
Some patients answer comfortably. Others hesitate. That is understandable. A few questions may feel personal, and sometimes patients worry that the doctor may judge them. They may also think that …
I love being a doctor. I do not enjoy many aspects of practicing medicine in the U.S. health care system. In the struggle to balance these truths, mentorship from several extraordinary physicians has steadied me. As gifted diagnosticians and models…
I love being a doctor. I do not enjoy many aspects of practicing medicine in the U.S. health care system. In the struggle to balance these truths, mentorship from several extraordinary physicians has steadied me. As gifted diagnosticians and models of bedside medicine, they have meant as much to me personally as the knowledge they shared.
I return to these mentors’ words often. Their guidance provides a framework I use to …
It plays out like a modern-day digital horror movie. On my social media feed, a snippet of a horribly sad drama catches my eye: A young woman, devastated and paralyzed by an unimaginable tragedy, has taken the lives of her…
It plays out like a modern-day digital horror movie. On my social media feed, a snippet of a horribly sad drama catches my eye: A young woman, devastated and paralyzed by an unimaginable tragedy, has taken the lives of her own children. She had previously been under medical care, presenting with a complex psychiatric history that navigated the difficult waters often met with multiple therapies: antidepressants, anti-anxiety agents, and various …
Direct-to-consumer drug advertising has changed dramatically over the past decade. What began as cautious messaging about serious medications has evolved into lifestyle marketing: smiling actors, golden retrievers, and promises of freedom, energy, and "getting back to what matters." The problem…
Direct-to-consumer drug advertising has changed dramatically over the past decade. What began as cautious messaging about serious medications has evolved into lifestyle marketing: smiling actors, golden retrievers, and promises of freedom, energy, and “getting back to what matters.”
The problem is simple. Many of these drugs are not lifestyle enhancers. They are immune-altering, metabolic-altering, or infection-risk-altering agents. And the public is not hearing the truth.
As a developmental-behavioral pediatrician, I spent decades …
Atypical antipsychotics have quietly migrated from inpatient psychiatry to primary care offices, urgent care clinics, and telemedicine platforms staffed increasingly by nurse practitioners and advanced practice registered nurses (APRNs). The drugs have not changed. Their risks have not changed. What…
Atypical antipsychotics have quietly migrated from inpatient psychiatry to primary care offices, urgent care clinics, and telemedicine platforms staffed increasingly by nurse practitioners and advanced practice registered nurses (APRNs). The drugs have not changed. Their risks have not changed. What has changed is who is prescribing them, and how casually they are being marketed to the public. These medications were designed for psychosis, bipolar disorder, and acute agitation. They now …
Looking at emotional maturity through an epidemiological lens may unravel the endemic status of emotional immaturity in postmodern humanity. Is its epidemic proportion a new-age phenomenon? Has its endemicity been innate since the dawn of humanity? Does it extend beyond…
Looking at emotional maturity through an epidemiological lens may unravel the endemic status of emotional immaturity in postmodern humanity. Is its epidemic proportion a new-age phenomenon? Has its endemicity been innate since the dawn of humanity? Does it extend beyond humanity into the nonhuman systems that humans devise? Humans have long invented historical myths and fictional entities in order to organize nonhumans and to prevail over them by tradition. Are …
The referral came from a mental health clinic. A woman had been putting the hose of a handheld vacuum cleaner into her mouth, pushing the nozzle toward the back of her throat, and turning it on. She had done this…
The referral came from a mental health clinic. A woman had been putting the hose of a handheld vacuum cleaner into her mouth, pushing the nozzle toward the back of her throat, and turning it on. She had done this more than once a day for several days. The clinician who examined her found bruising and abrasions throughout her mouth. She was referred to me because her mouth and throat …
Every night on mainstream streaming platforms, I see the same rotation of charity commercials: protect dogs, save Syrian children, shelter American runaways, support childhood cancer care, preserve wildlife. Each one asks for a small monthly donation (99 cents, $5, $19),…
Every night on mainstream streaming platforms, I see the same rotation of charity commercials: protect dogs, save Syrian children, shelter American runaways, support childhood cancer care, preserve wildlife. Each one asks for a small monthly donation (99 cents, $5, $19), and each one insists that without your contribution, the suffering continues.
As a physician, I don’t respond to the emotional script. I respond to the ethical one. And the ethical script …
One day, my mother suddenly was unable to finish her sentences. She was admitted to the local hospital, where a CT and MRI revealed multiple lesions. Ultimately, she was diagnosed with a glioblastoma. The neurosurgeon told us she was too…
One day, my mother suddenly was unable to finish her sentences. She was admitted to the local hospital, where a CT and MRI revealed multiple lesions. Ultimately, she was diagnosed with a glioblastoma. The neurosurgeon told us she was too old to operate on and recommended hospice, adding that she was unlikely to live more than six months. At another hospital, she was offered radiation, chemotherapy, and infusions, as her …
Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then…
Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then triggers payer audits, denials, and clawbacks (recoupments) of already-paid claims, which feeds into declining reimbursement. Multiple sources discussed below, from Medicare data, physician surveys, CMS actuarial analyses, industry reports, …
A patient recently told me she hadn't seen a doctor in six years. Not because she felt perfectly healthy, but because nothing had ever felt "bad enough" to justify an appointment. By the time she came in, her blood pressure…
A patient recently told me she hadn’t seen a doctor in six years. Not because she felt perfectly healthy, but because nothing had ever felt “bad enough” to justify an appointment. By the time she came in, her blood pressure was stage 2 hypertension, her fasting glucose was in the prediabetic range, and she was carrying a level of chronic stress she’d simply learned to live with.
There was a time when becoming a physician meant entering a profession in which your experience was not merely appreciated; it was actively sought after. My father belongs to a generation that remembers this world. He once told me about…
There was a time when becoming a physician meant entering a profession in which your experience was not merely appreciated; it was actively sought after. My father belongs to a generation that remembers this world. He once told me about the difficult decision he faced: whether to continue as chief of staff at a primary health care center or leave and establish his own practice. The difficulty was not finding …
In the early 1990s, while the American Academy of Pediatrics (AAP) was formalizing its vision of the "medical home," we were already living it, without a name. At Minot Air Force Base in North Dakota, our pediatric team operationalized what…
In the early 1990s, while the American Academy of Pediatrics (AAP) was formalizing its vision of the “medical home,” we were already living it, without a name. At Minot Air Force Base in North Dakota, our pediatric team operationalized what would later be codified: interdisciplinary care, family partnership, coordinated services, and continuity across settings. We didn’t call it a medical home. It was excellent pediatric care, and we simply made …
Every patient who has spent time in an emergency department knows it's overcrowded. They've sat in the waiting room for hours. They've watched physicians move fast and nurses move faster. They've heard the department through the curtain: the monitor alarms,…
Every patient who has spent time in an emergency department knows it’s overcrowded. They’ve sat in the waiting room for hours. They’ve watched physicians move fast and nurses move faster. They’ve heard the department through the curtain: the monitor alarms, the overhead pages, the sound of a place where everyone is doing too many things at once.
What they haven’t seen is the board.
The board is how an emergency physician experiences …
I currently split my time between two worlds. I see patients in clinic and also work on AI and innovation in the health system. Most days, the dichotomy is an asset. Some days, it feels like it is two different…
I currently split my time between two worlds. I see patients in clinic and also work on AI and innovation in the health system. Most days, the dichotomy is an asset. Some days, it feels like it is two different jobs that share one calendar.
AI has closed much of the knowledge gap in medicine and did it faster than expected. The chart review, the differential diagnoses, the literature search, it …
For those of us who have spent decades practicing medicine across multiple systems, the daily reality feels less like the noble healing art we trained for and more like a corporate assembly line. We watch as science-based, patient-centered care is…
For those of us who have spent decades practicing medicine across multiple systems, the daily reality feels less like the noble healing art we trained for and more like a corporate assembly line. We watch as science-based, patient-centered care is nickel-and-dimed by administrators into mere metrics. In our exhaustion, we can easily identify with Odysseus. Like the legendary king wandering the dark seas, we feel a profound sense of alienation, …
It has already been said, "We will die in the system we create." The statement raises a larger question: What do we mean by death? Death can be spiritual through excommunication, economic through expulsion from work, social through eviction from…
It has already been said, “We will die in the system we create.” The statement raises a larger question: What do we mean by death? Death can be spiritual through excommunication, economic through expulsion from work, social through eviction from a community, psychological through exclusion and loss of sanity, or physical through extinction. Birth and death often result from forces beyond an individual’s control. Yet death can also become intentional. …
There is a small, unreasonable part of us that expects our doctors to stay in one place forever. We know better, of course. We know they grow older, become tired, change jobs, and make plans. Yet the person we bring…
There is a small, unreasonable part of us that expects our doctors to stay in one place forever.
We know better, of course. We know they grow older, become tired, change jobs, and make plans. Yet the person we bring our uncertainty to is not supposed to become another uncertainty. We may notice the gray hair without quite imagining the day when someone else opens the door.
Becoming a physician is one of the longest professional journeys in America. The path typically requires four years of college, four years of medical school, and three to seven or more years of residency and fellowship training. For surgeons, training…
Becoming a physician is one of the longest professional journeys in America. The path typically requires four years of college, four years of medical school, and three to seven or more years of residency and fellowship training. For surgeons, training routinely extends well beyond a decade after college.
The investment is financial, professional, and deeply personal. Medical graduates routinely carry substantial educational debt, spend thousands of hours studying, take licensing examinations, …
