Physicians writing on KevinMD about the life of the profession: the work itself, the exhaustion, what women physicians are paid and asked to carry, the losses the profession has been slow to name, and who decides how physicians work. Five maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Primary care: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words,, Physician suicide: what physicians say, in their own words, and Physicians and administrators: what physicians say about who runs medicine, in their own words.
We spend our days in the quiet reality of clinical practice. We chase elusive diagnoses, weigh the fine distinctions of symptom presentation, and measure our clinical instincts against rigorous decades of peer-reviewed science. We sit across from human beings in moments of vulnerability, applying a lifetime of anatomy, neurobiology, and pharmacology to parse real suffering from pathology.
Yet, step outside the exam room door, and we are met with a deafening …
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3 reforms to counter wellness influencers in practice
Patients considering cosmetic limb lengthening usually begin with one question: How much height can be gained? That question is understandable, but it should not drive the decision. The more important issue is who will remain responsible for the patient’s care throughout the process and what will happen if recovery requires extra attention.
Cosmetic limb lengthening is often presented as a procedure that increases height. Technically, that is the goal, but it …
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Choosing a limb lengthening surgeon requires accountability
Physicians reassure people every day:
- “Your tests are normal.”
- “There is nothing dangerous going on.”
- “This is good news.”
- “You are going to be OK.”
We usually say these things with good intentions. We want to reduce fear, provide perspective, and help patients leave our offices or emergency departments feeling safer than when they arrived. But sometimes reassurance does not reassure.
The patient continues asking questions. They return to the emergency department. …
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How to reassure patients: 5 steps beyond normal tests
For years, I thought good doctors always said yes.
Can you squeeze in one more patient? Yes. Can you answer this message before you leave? Of course. Can you finish this chart tonight? Yes. Can you take care of just one more thing? Absolutely.
It rarely felt like a major decision. Each request seemed small. A few more minutes. One more patient. One more message. But small yeses have a way of …
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Setting boundaries as a physician doesn’t mean caring less
Ask most physicians outside emergency medicine how they’d handle a patient presenting with three possible diagnoses, incomplete labs, and a deteriorating vital sign trend, and you’ll usually get a version of “I’d want more information first.” Ask an ER physician the same question, and you’ll get an action plan within seconds. That gap isn’t intelligence. It’s training. And I think it’s worth naming exactly what that training builds, because most …
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How emergency medicine decision making works under pressure
The author and his wife, at a time when getting off the floor required considerably less planning.
People ask what being an emergency physician is like, and they expect the blood, the saves, the codes, the worst nights. Those happen, and they matter, but I try not to carry those home. What I try to keep is the people. You meet everyone in …
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Why I stay in emergency medicine: a dancer at nearly 100
A few days ago, I saw a fake book cover online that was so ridiculous I laughed out loud. It was beautifully designed: deep red. Ornate gold lettering. The kind of cover that looks as though it belongs in a medieval monastery, chained to a wooden desk while a monk copies its contents by candlelight.
The title? How to Avoid Vaccines & Die Like a Medieval Peasant. The author? Robert F. …
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Distrust of science is inviting the Middle Ages back
Across the different hospitals and services where I have trained, I have noticed something I did not expect to notice. When we ask who knows the patient’s medications, who can explain what happened during the last hospitalization, or who we should call in an emergency, the answer is very often a woman. A mother. A wife. A sister. A daughter.
A specific memory I have: a seventy-year-old man with diabetes and …
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Why the family medical history lives with women caregivers
How do I know if I’m burned out or just unhappy at work? On the surface, this is a straightforward question. Job burnout is one thing; professional dissatisfaction is another. We have validated survey questions for each, like the Maslach Burnout Inventory and the Physician Worklife Survey, and measures that can differentiate burnout from dissatisfaction, like the Professional Fulfillment Index. But I’ve found that when physicians are no longer thriving …
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Burnout or job dissatisfaction: 4 causes usually in play
In the digital age, we have been conditioned to trust the social proof of a high star rating. We see five stars on a retail site and immediately assume the product is excellent. But as a psychiatrist, I have learned that when it comes to medicine, that logic is fundamentally flawed. In fact, if you encounter a physician with 375 five-star reviews and not a single negative comment on social …
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Patient satisfaction scores punish the doctors who say no
It’s time to call out medical malpractice for what it really is. Dick Durbin’s own words define what is behind medical malpractice. “Before I was elected to Congress, I worked in a courtroom. For years, I defended doctors and hospitals, and for years, I sued them on behalf of people, who were victims of medical malpractice.”
Dick Durbin became a lawyer in 1969. He was first elected to Congress in 1982. …
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Frivolous malpractice lawsuits are a governance failure
History has taught medicine some brutal lessons. Nearly two centuries ago, Ignaz Semmelweis noted a disturbing pattern in the maternity wards of Vienna, Austria. Women cared for by physicians were dying of puerperal fever at dramatically higher rates than those cared for by midwives. The hospital still looked functional, the wards remained open, physicians continued working, and the institution carried on. But something inside the system was profoundly wrong. Semmelweis …
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Why physician outsourcing is a warning sign for hospitals
I have intubated people who intentionally overdosed on many things they could find. I have sat with families in the minutes after we lost someone who didn’t have to be lost. I have written discharge summaries for patients I worried about the moment they walked out the door.
For twenty-three years, I was the doctor on the other side of the crisis. Then I wasn’t.
It didn’t arrive the way emergencies do: …
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Physician mental health and the shame of asking for help
When I was younger in surgery, I watched hands. I watched how senior surgeons held an instrument, how little unnecessary movement they made, how calmly they worked around a vessel that could turn an orderly operation into an emergency within seconds. Technical mastery was visible. You could stand across the operating table and recognize it.
I wanted that kind of control. Most young surgeons do.
In my first year of cardiovascular surgery …
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Surgical judgment: the skill no one sees from the gallery
The room was still dark, my cat curled next to me, when I looked at the clock: 4:18 a.m. It was well before my alarm was set to go off, but I knew I wasn’t going to fall back asleep. Reluctantly, I grabbed my phone, put on my slippers, and shuffled downstairs to the coffee maker. While the coffee brewed, I skimmed my email and read the news headlines. Coffee …
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Physician burnout often begins with self-abandonment
Our cultural ethos has revolved around the paragons of “hard work” and so much so that now our health leaders are suggesting that “healthy” Americans work longer to delay retirement to stimulate the economy. In the words of Dr. Oz, “If Americans could stay healthy enough to work just one additional year or start working earlier in their lives, it would increase the GDP of our nation by trillions …
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Can physicians and organized labor stand together?
I recently read Kara Wada’s September 7, 2026, KevinMD essay asking a simple but profound question: Who holds the telescope? Her article resonated with me immediately because I know the answer.
When my wife Kathy was dying, nobody did.
Kathy was not the victim of one catastrophic mistake. There was no single dramatic error that changed the course of her illness. What I witnessed instead was something more common and, in many …
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Fragmented care made my family her care coordinator
Every physician accumulates evaluations during a career. Most are read once and forgotten. Decades later, while reviewing my Air Force officer evaluation reports from Minot Air Force Base, I discovered something unexpected: a record not merely of performance, but of ideas that anticipated changes in pediatric care years before they became formal policy.
The reports documented emergency transports, developmental screening initiatives, community partnerships, staff expansion, and coordinated care systems. What struck …
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A military pediatrician inside the nuclear readiness system
Medicine has developed a new mental health illness of the “attention economy.” The term was introduced by psychologist and Nobel laureate Herbert A. Simon, who argued that an abundance of information creates a scarcity of attention, making human attention an increasingly valuable resource. Physicians always depended on attention to the patient, trainee, colleagues, and the required attention to quiet work of becoming wiser. Yet professional life increasingly unfolds within an …
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3 choices that protect physicians in the attention economy
“I know the treatment probably won’t work,” a patient nearing the end of life tells the doctor. “I want to try anyway.” The patient understands the risks but still hopes for a little more time. The physician wants to honor that hope while worrying that side effects could make the patient’s remaining days more painful. If the treatment requires resources in short supply, other patients’ needs make an already difficult …
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Medical ethics principles do not decide hard cases
