5/When strong primary care disappears, patients lose something essential:
a physician who knows them, notices when something is wrong, and takes responsibility for helping them stay well.
Without that, many people face the health system alone.
4/Yet our health system rewards procedures and volume far more reliably than it rewards continuity, judgment, and trust.
Those are exactly the things strong primary care depends on.
3/Primary care is often described as “basic.”
But anyone who has practiced it knows the opposite.
The work means diagnosing early illness, integrating scattered information, managing uncertainty, and knowing patients well enough to make decisions together.
2/New episode of On Becoming a Healer:
“Why Good Primary Care Is Non-Negotiable.”
A conversation with Dr. John Scala, a solo primary care physician in Colorado, about the real work of primary care: knowing patients well, diagnosing early illness, and caring for people over years.
@nejm.org
1/A recent New England Journal of Medicine series on primary care poses a stark question:
“Has the long-term general doctor become obsolete?”
If primary care disappears, who protects patients? Who knows them and takes responsibility for patients over time?
pod.link/healer/episo...
In December of 1944, my father was 9 years old in a camp near Vienna.
He was among thousands of Hungarian Jews the Nazis kept “on ice.”
One day he slipped through the barbed wire looking for food.
The story:
stefankerteszmd.substack.com/p/december-2...
The Persian Empire is often dated to c. 550 BCE under Cyrus the Great.
Over ~2,500 years, Persia/Iran has faced repeated conquest or regime-change efforts. Some succeeded briefly; none lasted.
This is context, not sympathy for the current regime. The Ayatollah’s departure is a good thing.
I wrote a longer piece examining how the CDC’s December hepatitis B vaccine decision was reported, why the distinction between “delay” and withdrawal matters, and how to regain public trust open.substack.com/pub/stefanke...
Quote comparing media coverage of the CDC’s hepatitis B decision to reporting that an athlete stopped buying Nikes without mentioning that her feet had been amputated
Much of the coverage treated this as a “delay.”
That framing missed what actually changed.
Quote noting that before December the U.S. was one of 191 of 194 countries recommending universal childhood hepatitis B vaccination, and afterward joined only Denmark, Iceland, and Finland in not doing so.
This was not a small or technical change.
Connection is what we can offer to prevent isolation, and to prevent suicide.
Doing this correctly requires clear boundaries and self-understanding, but it's the start point.
Our podcast on suicide prevention is out as part of
"On Becoming a Healer" pod.link/healer/episo...
A lot of today's suicide research is on "risk factors" and "means reduction"
Those matter. What matters most is having a reason to live
William Styron described how he stepped back from suicide in his book "Darkness Visible". - our latest On Becoming a Healer podcast.
pod.link/healer/episo...
Our latest podcast covers suicide - the last 20 years of progress in research, including compelling theories of suicide, caring interventions, the role of clinicians, reflections from the writing of William Styron and our personal stories
Listen to On Becoming a Healer
pod.link/healer/episo...
4/Designing primary care to fit people’s realities takes investment—but it pays off.
Better continuity. Less downstream utilization.
Full study: jamanetwork.com/journals/jam...
#HealthPolicy #HomelessHealth #primarycare
3/The data:
• High continuity: 65% vs 58%
• ED visits/year: 1.0 vs 1.4
• Specialty visits/year: 6.2 vs 7.9
All favor tailored primary care.
2/This isn’t just philosophy—we measured it!
In a study of 3,942 Veterans with recent homelessness, tailored clinics (H-PACTs) helped patients see the same clinician more often, without pushing care to the ER.
1/New study in JAMA Network Open:
When patients with lived experience of homelessness receive care in clinics designed for their needs, they get more consistent primary care and rely less on emergency and specialty care
Good leaders aren't about power; they're about service.
The best leaders in medicine and health care are often the ones you don't notice
We discuss this in our latest On Becoming a Healer podcast, which streams everywhere, and at this link: pod.link/healer/episo...
Good leaders aren't about power; they're about service.
The best leaders in medicine and health care are often the ones you don't notice
We discuss this in our latest On Becoming a Healer podcast, which streams everywhere, and at this link: pod.link/healer/episo...
** Reposting
We salute these VA workers for honoring #AlexPretti.
As they say, "We are healthcare workers for veterans. We know what heroes look like."
bsky.app/profile/unit...
bsky.app/profile/unit...
We salute these VA workers for honoring #AlexPretti.
As they say, "We are healthcare workers for veterans. We know what heroes look like."
youtube.com/shorts/bgCcE...
Alex Pretti, RN Veterans Administration ICU nurse and highly-regarded by VA staff. Killed Jan 24 by federal officers.
Advisory for health care workers :
Veterans Administration staff wishing to honor Alex Pretti, RN should consider wearing black (ribbon on badge, arm band, or other) this week. This is similar to what police officers do.
As a health care professional who cares for Veterans, I grieve the killing of Alex Pretti, a Veterans Health Administration ICU nurse and health scientist in Minneapolis.
I ask that people honor the memory of this man who dedicated his work to those who protect this country
#ICE #AlexPretti
Surviving toxic bosses in medicine and health care
From our latest On Becoming a Healer podcast
pod.link/healer/episo...
5/So I think that's the mindset that I think you have to adopt if you've decided to stay.
It just becomes a pragmatic puzzle. How do I continue to move forward under these circumstances?”
From On Becoming a Healer podcast
pod.link/healer/episo...
4/ “I think that the healthiest thing you can do is to acknowledge that the person you're working for is an asshole, I mean, to yourself, not to them.
‘You know, I can take a lot of shit to get to what I want, but it doesn't say anything about how I feel about those who are putting it in my face.’
3/ He continues:
“And the thing is you're afraid that if you say anything, they're going to be like,
‘The problem is you, buddy, and I'm going to write this up, or I'm going to take away a privilege.’
