Every first appointment with a new clinician, every first review after being admitted to a psychiatric ward, I spent less time thinking about what I wanted to say and more time wondering how I was going to answer the question I knew was coming. The question that always left me silent. The question that left me feeling as if I had already failed the conversation before it had even begun. …
Trauma-informed care starts before the first question
We are taught from the first days of medical school that bedside manner is a clinical tool as vital as a stethoscope. We are told to listen, to mirror, and to connect. But for many of us, this directive has quietly morphed into a high-stakes performance. If you find yourself leaving the exam room physically exhausted, not from the medicine, but from the emotional labor of managing patient reactions, you …
The people-pleasing in medicine that burns doctors out
This is why we get it wrong
As clinicians, we were taught that advance directives (ADs) and Portable Orders for Life-Sustaining Treatment (POLSTs) protect patient autonomy. So, we encourage our patients to complete them. Hospitals and health systems promote and measure our efforts. Public and private insurers pay for it. And policymakers celebrate them.
But these familiar tools upon which we so heavily rely at the end of life have been creating …
Why problems with advance directives keep harming patients
Developmental-behavioral pediatrics did not collapse overnight. It eroded the way institutions usually do: slowly, quietly, and then all at once. For those of us who practiced during its rise and decline, the story is not merely professional history. It is a record of what happens when a field built on dignity, patience, and longitudinal care is left without structural support.
For decades, developmental-behavioral pediatrics (DBP) served as a stabilizing force for …
The slow collapse of developmental-behavioral pediatrics
As a pediatric endocrinologist, I often meet families on one of the hardest days of their lives: a T1D diagnosis. I watch as the shock sets in. I hear their worries, their concern for the future, and the questions that arise when I mention that family history can increase the risk of developing the disease by up to 15-fold. “What does this mean for our family? Could this happen to …
Type 1 diabetes family history is still misunderstood
When I started my first full-time faculty position, one of my biggest worries was how I would manage working with the interdisciplinary team. I’d spent the last few months working as a locum at my most recent site of training, where I’d had years to develop rapport with consultants, nurses, allied health, and other staff. While that experience left me feeling confident in my abilities on the clinical side of …
Impression management nearly burned me out
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Your kidney test comes back normal after surgery, so you must have recovered. Except the damage can be hiding in plain sight. John Erbey is an epidemiologist by training and the founder and …
Your kidney never fully recovered from surgery, and the labs won’t show it [PODCAST]
The occasional “Doc, can you look in my ear?” or “Doc, my throat’s been scratchy, can you check it?” used to catch me off guard. I’d oblige, but with a disclaimer: “Well, I’m just a vagina doctor, but you’re here and, for some reason, I have an otoscope in my office, so let’s take a look.”
It never quite made sense to me. Why ask your OB/GYN to sort out an …
The perimenopause annual visit OB/GYNs keep missing
A lawsuit filed this month in California should make every clinician managing a psychotic disorder pay attention. According to the filing, a Bay Area man with schizoaffective disorder (stable for years, medicated, working, helping raise his sister’s kids) began using ChatGPT’s GPT-4o model in a way that gradually shifted from tool to companion. When he shared a personal theory he’d developed about “mathematical cosmology,” the chatbot didn’t push back …
AI chatbots and psychosis: the question nobody asks
More than thirty-four years in long-term care, first as a social worker and admissions director in skilled nursing, later on the technology side, I have sat with countless families at the moment they needed help most. A parent who could no longer manage at home. A spouse whose memory had begun to slip. An adult child trying to make sense of a hospital discharge plan they did not see coming.
By …
Why doctors should start long-term care planning
Yesterday, I read an article that stopped me. Rachel Wells, a writer and technology entrepreneur, publicly shared that her family is facing the loss of their home. She described continuing to write, build, pitch, and speak about artificial intelligence (AI) and the future of work while privately confronting a far more immediate question: Where will my family live?
Her story stayed with me because it exposes something larger than one family’s …
Celebrating resilience can conceal a private crisis
Most institutions do not fail because they miss obvious moral harm. They fail because they overlook warning signs and protect themselves, rather than face what they reveal.
The debate over microaggressions concentrates on the initial act. Was the comment intentional? Was it serious? Did it violate policy? But those questions do not describe the whole moral event. In medicine, the deeper injury may begin after authority speaks. I call this institutional …
Institutional betrayal in medicine begins after the harm
Science, especially Newtonian physics, has taught us to appreciate the elegant laws that govern the physical world. A moving object carries momentum. A stationary object possesses inertia. One tends to keep moving in its current direction until acted upon by an external force. The other resists movement until sufficient force is applied. These principles explain planets, automobiles, athletes, and machinery.
Perhaps less obviously, they also offer a useful way to understand …
Health care resists change for the same reason planets do
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Nebraska is not always where national political conversations about health care begin, but it is increasingly where they become impossible to ignore. What is unfolding here is a preview of the pressures reshaping health care systems across the country and the elections that will decide their future.
In 2026, health care is no longer confined to policy debates in Washington or state capitals. It is embedded in the workforce, the economy, …
Nebraska shows health care as an election issue in 2026
I write this to “honor” my sister Gail on her sixty-seventh birthday, not with nostalgia, but with clarity. My sister Gail was the golden child when we were young. That never changed, not after adolescence, not after tragedy, not even after adulthood should have leveled the field. When our father died in an air crash, I was thirteen and she was eleven. The family mythology stayed intact: She remained the …
Breaking generational patterns in a family of favorites
After almost any major medical event, someone walks you through what happened. A surgeon explains the procedure, a cardiologist reviews test results, and even a routine outpatient visit ends with some version of: here’s what we found, here’s what it means, here’s what’s next.
After birth, that conversation often doesn’t happen at all.
I had a birth that didn’t go the way anyone planned. There were interventions I didn’t fully understand in …
Cardiac patients get a debrief. New mothers don’t.
This morning I’m celebrating. I did something last night for the very first time. I walked on stage alone, opened my mouth, and sang. I’ve marveled at every singing performance I ever attended, wondering, how do they do that? And now, I can say, I have.
I’m a high-achiever. I say that with a bit of embarrassment. It feels like a pejorative term: the student who does it all, who joins …
Physician perfectionism can keep you from ever trying
My LinkedIn feed has been flooded with discussion about a recent Nature Medicine study showing that general-purpose large language models outperform specialized clinical AI tools on medical benchmarks. Clinical informatics leaders are calling it a wake-up call for health care, pointing to a timeless truth: Technology rarely fails at the technical layer. It fails because we don’t map how the work actually happens on the ground.
As a clinician working in …
A South Sudan doctor on the AI health equity gap
Recent product announcements from major wearable companies showcased the polarization of views on the direction of well tech. During the past two weeks, Google has made significant moves to deepen its health AI ambitions, and Whoop has doubled down on positioning its device as a clinical-grade monitoring tool. Both companies represent serious, well-resourced bets on the future of consumer health. And watching these developments closely, I’ve found myself thinking about …
AI versus clinicians is the wrong health care question
As pediatricians, we enter patients’ lives at moments of uncertainty. You learn how to listen for what is said and what is not said. You walk guardians through fevers, developmental milestones, and the thousand small worries that come with raising a child. Over time it all feels comfortable. Routine.
Then you become the parent. The questions you have answered so many times drip with new urgency, and your own uncertainty. Sleep, …
Becoming a physician mother changed how I practice
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