A position paper about using the term physician instead of provider? What does this have to do with biomedical ethics?
I fully support calling ourselves physicians and not providers, and have been sensitive to this issue in part thanks to Read more…
Physician vs. provider is an ethics issue, not just style
The Subjective, Objective, Assessment, and Plan (SOAP) framework could be expanded beyond clinical care to also address patients’ financial and legal well-being. This would require training health care providers in basic financial and legal principles, establishing dedicated financial-legal departments within health care institutions, and potentially offering financial and legal services as add-ons to health care insurance. With these changes, routine health care encounters could become more comprehensive, addressing socioeconomic needs …
Expanding the SOAP framework boosts health outcomes
A generation ago, most physicians barely considered the possibility of suddenly losing a job.
The profession was not perfectly stable, of course. Doctors still burned out, practices failed, partnerships fractured, and hospitals behaved badly from time to time. But for many physicians there remained an underlying assumption that competence and hard work created a reasonably durable professional life. If you trained well, treated patients properly, maintained your reputation, and kept your …
How to navigate physician job loss in the first week
I am a former vascular surgeon, and I left the field in 2020 at the height of coronavirus disease 2019 (COVID-19) due to burnout. And though I had not been well for some years, I was able to find myself again and rediscover my passion for music. In the end, my health and my family became my priority, so currently I work in a more stable outpatient clinical setting.
I started …
Physician burnout is a heavy burden for many healers
As a second-year internal medicine resident, I had an unexpected epiphany during my geriatrics rotation, not amid the chaos of a bustling hospital, but within the reflective calm of a rehabilitation facility.
As I walked into the room of a long-term care patient recovering after a stroke, there was a man in front of me who was wheelchair-bound and visibly distressed. His speech was difficult to understand, but as I listened …
Dehumanization in medicine: the language of disposition
There comes a point in medicine when knowledge, effort, and goodwill are no longer enough to explain why someone keeps going.
Most people enter medical training with a purpose so obvious it barely needs words. Suffering exists. Skill can help. The work matters.
Then training tests that belief. The test rarely comes as one dramatic moment. It comes through accumulation: criticism without context, responsibility before confidence, long hours, grief carried quietly, and …
Physician burnout is not a failure of resilience
I would like to share with readers a story about a clinical encounter that challenged my ability to build trust amid fear and misunderstanding. As a practicing physician and medical educator, I have long been drawn to the emotional and ethical dimensions of patient care. While the story itself is not unique, it captures a recurring tension in our work, the gap that can emerge between clinical expertise and patient …
Rebuilding patient trust when medical advice is resisted
I knew from the beginning that something was wrong in the culture of medicine, but I never believed it would almost kill me. This is not a story about my health. It’s a story about why my health story is not unusual. I hope it becomes a call to action.
I grew up in Berkeley, where speaking up is a developmental milestone. Early in my medical training, I started asking questions. …
Women physicians’ health is paying the price of medicine
As a practicing physician who also specializes in caring for patients injured in motor vehicle accidents, I’ve seen firsthand how complex and emotionally charged these situations can be. Over the years, I’ve treated people with devastating, life-changing injuries from crashes, as well as those with subtler but still very real problems like persistent pain, spinal issues, or concussions that develop over time. At the same time, I’ve witnessed the intricate …
Uber’s personal injury lawsuits split doctors and lawyers
The first time I received care as a patient in academic medicine, I felt something I did not fully appreciate until years later: safety. Not just clinical safety, but moral safety, the sense that the people caring for me were operating inside a culture that valued truth, transparency, and professional integrity. When I practiced and taught in academic medicine, I was surrounded by colleagues who believed, almost instinctively, that honesty …
How corporate medicine is eroding truth and patient dignity
I was in a deep sleep when my phone rang. I looked around; it was still dark. For a moment, I thought it was my alarm, but it was only 5 a.m. It was not the alarm after all. Instead, it was a phone call from an unknown number. I answered it, and to my surprise, it was a patient I had seen in the clinic the previous week. She …
A touching story of patient gratitude and a dozen eggs
As a physician, I encounter humanity at its most unguarded. I have held trembling hands, delivered devastating news, and witnessed emotions stripped of pretense. In exam rooms and hospital corridors, patterns emerge with unsettling consistency. Under stress, fear, or pain, humans default to self-protection. We become impatient. Defensive. Sometimes cruel. Not because we are irredeemable, but because survival instincts speak loudly when vulnerability is exposed. Kindness, by contrast, does not …
The medical case for teaching kindness in early childhood development
Again, I must discuss two cases of medical malpractice which I feel best demonstrate the quagmire our health care system finds itself in. One is a medical malpractice case against a hospital. It follows that this case also has a merit of only 33.48 percent. Nevertheless, there is a legal strategy that tips the scale by not permitting testimony discussing conditions occurring in another country, where the first 17 …
How medical malpractice cases reveal health care system flaws
Last year I watched a patient of mine, I will call him Raymond, navigate what should have been a straightforward referral to cardiology. He had insurance. Good insurance. The kind politicians point to when they say the system is working. It took 11 weeks, four phone calls, two prior authorizations, and one emergency department (ED) visit to get him seen. He was not uninsured. He was not poor. He was …
Why we must fix our fragmented health care system architecture
She was forty-eight years old and had already been through enough.
Her uterus had prolapsed. If you have not heard the term, let me be plain. The uterus had descended through the vaginal opening. It was outside her body. This is not a metaphor and it is not a minor complaint. It is a complete structural failure of the pelvic floor that turns walking, sitting, and basic dignity into a daily …
Prior authorization during surgery is not oversight
One of my patients, K, arrived in the United States in florid psychosis. Back in China, she worked as a housekeeper and lived independently. She took her medications reluctantly but consistently, forced upon her by her parents. After her parents passed away, she stopped her medications. She became convinced her life was being controlled by the Chinese government. In terror, she booked a ticket to the land of freedom, America. …
Patient autonomy in psychiatry and the ethics of care
What if the biggest problem in medicine isn’t bad decisions but rather the decisions we cannot even consider?
Clinical decisions unfold through processes shaped by the environment, which determine what clinicians can notice, consider, and act on. What seems like individual reasoning is structured in advance by systemic and environmental forces.
Within this context, this paper introduces a concept that I call “invisible triage,” a preconscious process that restricts which options are …
What hidden constraints shape clinical decisions?
The life of a physician is often viewed as a linear climb, a constant upward trajectory of achievement, responsibility, and endurance. But after decades in the field, I have come to realize that medicine is not a straight line. It is a series of seasons. If we fail to recognize the changing weather of our own lives, we risk arriving at the final season with broken bodies and weary minds. …
Why physician well-being matters at every career stage
Recently, I found myself in a place many physicians know professionally but dread personally: the waiting area outside a procedure room, this time as a mother. My six-year-old underwent what was supposed to be a simple elective procedure under general anesthesia at a day surgery center. He walked in smiling. He was put to sleep by using inhalational anesthesia through a mask. We were debriefed briefly by the ear, nose, …
How implicit bias in health care impacts patient safety
If you have just matched into residency, the profession is about to begin shaping you in ways that are not always visible at first. You have made the right decision and chosen a life of service, one whose rewards are far greater than a bank account will ever reflect. What follows is not part of a curriculum, and it will not be captured on a slide. It is learned more …
Finding meaning and purpose in medical residency training
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