A patient once sat across from me in my exam room, glanced at the bookshelf behind me, and said, “Doc, I just don’t have your discipline.” He was looking at a copy of one of my first books, “Dr. T’s Drop the Fat Diet,” which features a before-and-after photo on the cover. The “after” image shows a six-pack I built through years of focused effort. To him, that cover was …
Discipline isn’t the missing piece. Agency is.
Hospitals would never rely on the idea that “we know good care when we see it” to control infections. Yet when choosing leaders, many still rely on the vague belief that “we know leadership potential when we see it.”
Medicine reviews nearly every process that affects patient care. But choosing leaders often happens privately, through conversations, informal nominations, search committees, and personal opinions about “fit.” This process is rarely reviewed as …
Leadership diversity is a governance problem, not a slogan
Artificial intelligence has not entered the clinical encounter at one point. It has entered at three discrete points, and they’re rarely discussed as one problem.
Before the visit, patients are using AI to organize symptoms, interpret test results, and decide whether a concern is worth seeing someone about. During the visit, clinicians are using AI to search evidence, broaden a differential, and check guidelines. After the visit, ambient tools are turning …
Clinical authorship: the missing principle in medical AI
If you hadn’t smoked your whole goddam life, I would be asleep right now. This thought floated through my brain as I stood waiting for the elevator to take me to where an old man with emphysema was gasping for breath. It was 4 a.m. I was a second-year resident on call. I had been working almost 24 hours with barely time to pee, let alone sleep. And here I …
Physician burnout is the hazard no one trained me for
Testosterone is having a moment. From patients requesting testosterone testing, to morning sports radio urging me to “get my T checked,” to Pete Hegseth’s recent recommendation to screen military personnel, testosterone just won’t go away. The renewed interest in testosterone is as much cultural as it is medical. Culturally, prominent male podcasters and proponents of the Make America Healthy Again (MAHA) movement equate muscles and testosterone with masculinity. So, after …
Testosterone replacement therapy isn’t a military fix
Being a doctor is hard.
Becoming a doctor is hard.
The hours are tough.
The days are tiring,
and the nights are tiring.
Missed holidays with family are difficult.
The exhaustion is palpable.
The insecurity in your ability is real.
The sadness about sick patients is human.
It seems obvious that it might become overwhelming.
What happens when you are faced with this?
Reach out.
Reach out to anyone and everyone.
Years ago, as an intern in pediatrics, the hours, fatigue, and on-call …
The ceramic tree that got me through residency
It was two in the morning and I was starting a heparin drip on a patient whose clot was not going to wait for daylight. I typed the order, the electronic health record (EHR) flagged the weight-based dose, and minutes later a nurse hung the bag and programmed the smart infusion pump at the bedside. The pump beeped, the number climbed, and I moved on to the next patient without …
The business of medicine was never on my syllabus
An excerpt from Dizzy: A Memoir.
Two days later, in the nurse practitioner’s office, she said, “Here, take a look at the X-ray.” On the backlit screen, she hung up the butterfly image of my torso and I wanted to yank it down immediately. I had always been so strong, so independent, and here was proof that I was nothing but whispery, small bones, the rest of my body fading …
When doctors don’t believe you, you’re on your own
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When a patient’s heart stops, the person leading the code is running on memory alone, and memory fails under that kind of pressure. Michael Peck is an anesthesiologist and retired faculty member at …
Cardiac arrest is a human problem, not a training problem
I understand why clinicians kill themselves.
That’s not a dramatic opening. It’s a fact I’ve carried for years, one that most people in medicine understand but rarely say out loud, because saying it feels like an indictment of something we gave everything to.
And yet here we are. Still losing people. Still calling it something it isn’t.
The word everyone reaches for is “burnout.” It’s on hospital posters, in wellness newsletters, in keynote …
It isn’t physician burnout. It’s erosion.
Every day, thousands of health care workers put on lead aprons before stepping into imaging suites, fluoroscopy rooms, and interventional radiology labs. These garments, unglamorous, heavy, and easy to overlook, are the last line of defense between clinical staff and the cumulative effects of ionizing radiation. According to the World Health Organization, repeated exposure to radiation can lead to skin and blood damage, cataracts, infertility, congenital disabilities, and cancer. …
Lead apron management is a logistics problem ignored
For nearly three decades, I lived inside the machinery of medicine.
As a busy endocrinologist, my days revolved around blood sugars, thyroid glands, hormones, weight, lab results, prescription refills, insurance denials, prior authorizations, and the occasional body part someone believed had betrayed them. My schedule was full before I even sat down. There were charts to sign, labs to review, patients to see, and paperwork quietly reproducing in every corner.
Medicine is …
From endocrinologist to writer: a doctor’s second act
My grandfather might still be here were it not for how electronic health records exist in a silo.
As an incoming stroke alert, the ambulance would soon bring him to a hospital system he had never been to. Unaware that he was on a blood thinner, their well-meaning thrombolysis converted his thrombotic stroke to a devastating hemorrhagic death sentence. But how could something like this even happen?
The electronic health record (EHR) …
The EHR interoperability gap that costs lives
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Over my more than 20 years as a pain management physician, I have seen countless patients struggle with chronic pain. Many describe the same frustrations: breakthrough pain that disrupts their days, the challenge of sticking to home exercises or medications, and the anxiety of wondering whether their symptoms are worsening between office visits. Traditional care, with its reliance on scheduled appointments, often leaves gaps that can lead to flare-ups, unnecessary …
Remote therapeutic monitoring for the gaps between visits
Historically, followers have been positioned as subordinate actors, defined more by compliance than by contribution. In contrast, leadership roles are associated with an assumption of power, which may be formal, positional, and at times authoritative. This dichotomy is misleading. Many individuals in formal leadership roles experience constraints in their ability to effect change, as authority alone does not reliably translate into influence. Conversely, we all know individuals who are “not …
Undercover leadership: influence without the title
Senator Lindsey Graham died on Saturday, July 11, at his home in Washington, D.C., at 71. Emergency responders had been called to his home for a cardiac arrest. His office initially described only a “brief and sudden illness”; the next day it released preliminary findings from the District’s chief medical examiner: aortic dissection due to arteriosclerotic cardiovascular disease.
Nothing in the public reporting suggests Graham’s care was delayed or that anyone …
What Lindsey Graham’s death reveals about aortic dissection
I’m an engineer, not a physician. For the better part of a year I worked on AI for primary care, and much of that time I spent close to primary care doctors and the people who keep their practices open. I went in assuming the hardest problems would be clinical. They weren’t. The thing I watched wear people down, week after week, was billing.
Not the medicine. The paperwork wrapped around …
Why independent practices sell comes down to billing
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Medicare for All keeps dying in Congress. So what would actually get the major players to agree on universal coverage? Health care journalist Ken Terry returns to lay out a different model, one …
How to fix health care without Medicare for All [PODCAST]
The committee had met six times. The quality data was clear. The care pathway was evidence-based. The physicians in the room nodded. Six months later, nothing had changed.
Not because the initiative was wrong. Not because the physicians were resistant. Because the environment it landed in was never built to hold it.
This is the diagnosis most physician leaders never make, not about their patients, but about their organizations. They identify the …
Why change fails in health care organizations
Needle exchange programs are one of the most well-known, and subsequently most controversial, forms of harm reduction in addiction medicine. These programs provide clean needles and/or syringes for drug users, often in exchange for used needles, in efforts to curb the unsanitary reuse of needles and subsequently decrease the spread of infectious diseases such as hepatitis and HIV. Needle exchange programs, on their own, have been shown to decrease …
Needle exchange programs treat the symptom, not the disease
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