The morning it happened, I had just come back from a run. It was a beautiful day. I was training for a marathon, grateful for my life. I came home and stepped into the shower.
A family member I had welcomed in my home had a psychotic break and violently assaulted me with a kettlebell. The surgeon offered to schedule the repair of my severed tendon for the following morning. I …
Institutional betrayal in medicine nearly broke me
Shortly after midnight on April 16, 2026, a terrified teenage boy placed a 911 call from inside his family’s residence in Annandale, Virginia. Moments later, police officers arrived to encounter a scene of unspeakable devastation. Cerina Fairfax lay dead from multiple gunshot wounds, while the body of her estranged husband, former Virginia lieutenant governor Justin Fairfax, was later discovered upstairs in what authorities described as an apparent murder-suicide following an …
When men falling behind unravels families and futures
We all saw the report on early clinical departure. Women are leaving medicine at age 45.8. A senator immediately replied that we needed to be more selective and implied that medical school applicants should accept 30 plus years in a career that is crumbling under our feet.
We know the data. Women physicians have higher burnout than male physicians, and we also know that women physicians have double the suicide …
10 ways to keep women physicians from leaving
Two people sit in an exam room. One has an illness that will end their life. The other knows. Neither wants to say it out loud, so neither does. The conversation drifts toward next steps (another scan, another line of therapy, another visit on the calendar), and both leave the room feeling that it went well.
This is not a thought experiment. In 2012, the New England Journal of Medicine published …
The collusion in discussing prognosis with cancer patients
For thirty-five years, I was a practicing vascular surgeon in a four-person private vascular surgery group. For thirteen years, I also served as chairman of surgery for a large health network.
I sat in morbidity and mortality conferences and watched experienced surgeons present cases that quietly revealed patterns. I looked at internal scorecards and noticed which names appeared on the better side of the outcomes curve and which on the worse …
Surgeon outcomes data is no longer ours alone
In health care, we often describe what we are experiencing as system failure. We point to clinician burnout, staffing shortages, administrative burden, and the growing distance between those delivering care and those designing it. We talk about breakdowns in communication, gaps in safety, and the increasing strain placed on a workforce asked to adapt faster than it can recover. The language is familiar. The concern is real. But the conclusion …
Health care system design isn’t failing, it’s working
There is a growing conversation in medicine about leadership. We talk about the need for more physician leaders, more voices at the table, more representation in decision-making spaces. And while these conversations are important, they often overlook a more fundamental issue. The problem is not a lack of physician leadership. It is the model of leadership we continue to promote.
From early training, physicians are conditioned to equate leadership with endurance: …
3 traits the physician leadership model is missing
In the golden days of practicing medicine, the hospitals’ boards were composed of community leaders acting on behalf of the hospitals to raise funds, negotiate insurance contracts, screen and supervise the performance of the key employees, and interact with the government. They used their passion and influence to facilitate the delivery of health care to the communities they served. Most of these board members were volunteers or philanthropists. Few practicing …
Corporate practice of medicine vs. the golden days
Lena spotted Dr. Kreindl, who without his cigarette, seemed a bit lost. But he knew better than to light up: The Gestapo would have never tolerated such an act of freedom, coming from a Jew.
“Ah, there you are,” he said. “Listen, it’s quite simple. Most of these patients have ingested large doses of Veronal. Do you know this drug? It’s a highly powerful sedative. Anyway, many of these people were …
Nursing during the Holocaust, one IV at a time
I did not intend to visit an emotionally dark place. But now I think I was destined to be there, to maybe find some light.
Recently, I began a literature review of articles on workplace aggression toward mental health clinicians. It was meant to be a routine process. Instead, I became focused on research exploring how workplace violence fundamentally changes people, and how, for some, perceptions of self and others are …
When a patient attacks you, it changes your life
Earl Haskell doesn’t exist. But thousands of patients exactly like him do. They live in counties where the nearest hospital is more than an hour away. Where the local clinic closed years ago. Where a chest pain isn’t just a symptom, it’s a logistical problem. Earl is a composite. His reality is not.
He lives in Loving County, Texas, the least populated county in the United States. On a map, it …
Rural health care delivery is not a coverage problem
There comes a night, somewhere near the end of a long career, when a physician sits alone with himself after the corridors have emptied and the pagers have gone quiet. He turns the years over in his mind, the patients who lived and the ones who did not, the diagnoses made in time and the ones missed, the easy hours and the impossible ones, and he discovers that the question …
The one question that measures physician integrity
During my Air Force years, I served under three commanders with three very different personalities. One was methodical and procedural. One was operational and instinctive. One was strategic and future-focused. They disagreed about many things, but they agreed about one: they wanted to retain me. All three wrote it in my Officer Evaluation Reports (OERs).
At the time, I didn’t think much about it. I was young, busy, and focused on …
3 Air Force leadership lessons from three commanders
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Something that I had been resisting tacitly for a while, eventually happened last week. As I was supposed to be all ears towards a patient, my concentration drifted towards the screen. The cursor blinked, translating his words into codes the system would accept as symptoms, durations, and checkboxes. When I looked back at him, he ebbed. The story had been interrupted, and I wasn’t sure I could retrieve it.
Modern medicine …
Narrative medicine is what AI in medicine cannot replace
We are living in an era where attention, not information, is the scarce resource. And what we pay attention to (not what we claim to value) reveals the architecture of our priorities.
Consider a few comparisons that, though deliberately absurd, tell a deeper truth. We now have more Marvel movies than major classes of antibiotics. The world produces more aspiring pop singers than there are widely used chemotherapy regimens. Strangely enough, …
The attention economy is starving public health
Reason for consultation
Burnout. Workforce decline. Moral distress. Concern regarding physician formation.
Chief complaint
Burnout.
History of present illness
Medicine presents with burnout. Chronic. Recurrent. Poorly responsive to treatment.
Associated symptoms now include workforce shortages, declining interest in primary care, moral distress, loss of meaning, and concern regarding what kind of people the profession is forming.
Treatment efforts have been substantial. Wellness initiatives. Resilience training. Mindfulness. Workflow redesign. Administrative intervention. Repeated attempts to improve work-life balance. Partial …
Physician burnout is not the whole diagnosis
My father’s melanoma diagnosis arrived on a Tuesday. By Thursday, we had a plan of care. By the following Monday, I was back at work seeing my own patients, pretending the world had resumed its normal shape. But it hadn’t. Not really. Because his cancer didn’t pause between appointments, didn’t stop growing or spreading, and neither did the fear, the questions, or the quiet unraveling that comes with navigating a …
Physician advocacy can close the gap between appointments
When people wear hierarchy as a badge of honor, they literally stunt the growth of young doctors, especially in settings where resources are already limited.
I graduated from the Latin American School of Medicine in Havana, Cuba in 2023, and have since returned home to serve my community. I am the first doctor from my village of Logwerle, Central Equatoria State, South Sudan, East Africa, and the first to speak four …
Medical hierarchy is silencing young doctors who want to write
He came to me with chronic neck pain and headaches that would not quit. The diagnosis was already there: neck pain, degenerative disc disease, chronic headaches. But a diagnosis is not the same thing as a story.
We built a sports medicine treatment plan around what I could find on exam: trigger point injections, massage, soft tissue work. The pain would improve, then return. Every four weeks became every two because …
Why military patients carry pain a chart can’t explain
At 6:41 on a Tuesday morning, a physician sits in the hospital parking garage after a long shift and reads an email on her phone three times. “We would love to understand how your clinical background translates to this role.” She has been a physician for twenty years. She has taken care of septic children at 2 a.m. She has told families their child won’t make it. She has built …
Leaving medicine is a translation problem, not a loss
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