Among the people exiting the hospital, I could easily pick out the medical staff leaving their shifts. It wasn’t by their clothing or the time of day, but by the unspoken language of relief on their faces: a calm twinkle in the eyes or a gentle softness around the forehead and jaw. Dawn or dusk, the look was always there. I hoped I’d have it too when I left later …
Physician burnout: Finding peace in a broken health care system
We are frequently told that our health care system is expensive. However, most of us, including physicians, have no notion about what the health care system really is, to judge whether or not we are getting our money’s worth.
There are four major structural models for a health care system:
…
Understanding the 4 models of health care: Where the U.S. fits
You became a physician because you were driven. You studied longer, pushed harder, and tolerated pressure better than most. You needed to be right and usually were. That formula worked. It got you through pre-med, medical school, residency, and into practice. It earned you respect and built your reputation.
But at some point, quietly, subtly, that same formula can start working against you. I realized this after reading Marshall Goldsmith’s book, …
What got you here won’t get you there: a physician’s guide to leadership
Welcome to the first weeks of the new year. A great moment to check in.
How are you doing? How are you feeling? Energy level?
The first days of the new year come with a lot of excitement and a lot of pressure.
Excitement for the sense of renewal and becoming better versions of ourselves. Excitement in putting the last year to rest and starting with a clean slate. Excitement at putting down …
The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions
I remember. It is a gorgeous summer day as the sunlight streaks through the redwood canopy. My grip clenches the dangling rope. My stance wobbles on the itty-bitty circular disk. I am uncertain. Teeter-tottering, I plot my next move. It does not happen. I plummet. My harness transforms into a bucket swing, saving me from the forest floor. I sway in the pleasant breeze. I cannot finish the Level 1 …
Learning from patients: How a physician gained strength and resilience
Recently, I was asked to write about my experience as a rural emergency physician in New Mexico. The timing was uncanny: I am in the final shifts of my first job out of my emergency medicine residency on the East Coast, having spent more than four years working in emergency departments across western rural New Mexico, primarily within the Indian Health Service.
Summarizing this experience concisely feels impossible. Every emergency physician …
Rural emergency medicine in New Mexico: a physician’s firsthand account
On January 29, 2026, the European Journal of Pediatrics formally retracted what had been the largest randomized clinical trial examining folinic acid as an intervention for autism. The reason, according to the journal’s notice, was direct: The study’s data did not support its published conclusions.
Originally released in 2024, the trial reported that 24 weeks of oral folinic acid therapy produced a “significant reduction” in autism symptoms among 77 children. In …
What the folinic acid retraction means for autism treatment
As physicians, most of us do not need another Zoom webinar on burnout; we need open space.
Even at the earliest stages of training, we are made to feel that we cannot take a break. In a med school course I teach, I assigned a renewal activity with a short reflection. Some protested, but most expressed gratitude for an assigned pause.
Many admitted how afraid they felt to step away, to take …
The pause medicine never taught us to take
Almost every day, a physician says to me some version of the same sentence.
It may sound like frustration about metrics. Or exhaustion. Or administrative opacity. But beneath it is something more elemental:
“I am grieving what I hoped medicine would be.”
When that sentence is spoken plainly, without defensiveness, something shifts.
The suffering moves from defect to meaning.
Grief, in existential thought, is not weakness. It is evidence of attachment. We grieve what we …
How naming grief can restore meaning in medical practice
When I arrived at a regional military hospital, it was not a dispensary or a community clinic. It was the referral hospital for the northern tier missile and bomber bases, positioned just below the major medical centers. We were second tier, but the stakes were global.
Into that setting, I brought the medical home and a mini-developmental clinic. Through a program for exceptional family members, families from around the world found …
The honest broker in pediatrics: Building the medical home
Every major policy in medicine is supposed to rest on evidence. We track outcomes for new drugs, devices, and procedures. We measure hospital mortality, infection rates, and adherence to guidelines. Yet one of the most time-consuming and expensive physician policies of all, Maintenance of Certification (MOC), has never been held to that same standard.
For decades, the American Board of Internal Medicine (ABIM) and other specialty boards have argued that recertification …
MOC patient outcomes: Why recertification doesn’t guarantee quality
An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).
“Here is the truth: I have been on a stable dose of Wellbutrin (Bupropion) for thirteen years, and despite being quite a public advocate about self-disclosure and mental health, I have never once said that out loud. If you have ever read anything I’ve written before …
Why a chief wellness officer hid her medication use for 13 years
Our nation and the health care industry have been in shock following the assassination of the CEO of one of the largest insurance companies in the U.S. in December 2024. The reaction to Brian Thompson’s death and suspected shooter Luigi Mangione appeared to have captured America’s attention. The assassination has focused public outrage toward the health care insurance industry and a lack of empathy for the victim and his …
Physician patient advocacy: Fighting insurance denials effectively
If you have watched Stranger Things, you know the premise: A quiet town appears functional on the surface while a darker, parallel world creeps into everyday life, or the Upside Down. The true danger is not just the monsters but also the refusal of adults in power to believe what is directly in front of them. Modern health care is living in its own Upside Down.
The metric trap
In my practice, …
Health care’s Upside Down: Addressing systemic dysfunction and burnout
It was 3:17 a.m. when the trauma pager went off. “Level 1 incoming. MVC. Hypotensive.” The trauma bay shifted instantly from stillness to choreography. Blood coolers opened. Monitors lit up. A resident’s voice tightened as he called out the vitals. The patient was young. Too young. Blood pressure in the 70s. Oxygen saturation falling. The kind of numbers that make the room feel smaller. CT was not ready. Labs were …
In the age of AI, what makes a physician REAL?
I have spent 30 years as a physical medicine and rehabilitation physician in solo practice. In three decades of treating patients, I have witnessed the slow, systematic transfer of health care decision-making from clinicians to people who have never touched a patient.
When I started my career, physicians led health care. Today, private equity firms own hospitals, insurance company algorithms override clinical judgment, and administrators whose primary loyalty is to shareholders …
The cost of clinician absence in the boardroom: a 30-year perspective
At our yearly Christmas medical staff dinner this last year, our chief of staff asked all the doctors present who had been working at our hospital for five or more years to stand up. Quite a few of us rose. He then asked those who had been there 10 years or more to remain standing. After half of us sat down, he upped the ante to 15 years, then to …
An excerpt from Still Life with Stethoscope and Typewriter: Essays and Echoes of Narrative Medicine.
Every Olympic Games eventually produces its own mythology. Not the noble kind, ancient Greeks crowned in olive leaves, but the modern variety, where rumor, technology, desperation, and money form a cocktail best consumed at a safe distance.
The 2026 Winter Olympics in Milan have already delivered one such legend: the claim that elite ski jumpers were …
2026 Winter Olympics rumors: the truth about ski jumpers and hyaluronic acid
Toward the end of undergrad, I was desperate for money to support myself and feed my figurative babies, which at the time took the form of MCAT prep and medical school applications. This desperation led to some outside-the-box thinking about how to make ends meet.
One of the most out-of-character things I did was work at Williams-Sonoma. My main motivation for working there was that it was right next to a …
From Williams-Sonoma to medicine: What retail taught me about difficult patients
There are resilience workshops. Mindfulness apps. Yoga sessions scheduled between clinics. Burnout surveys. Pizza in the call room on Doctor’s Day.
There is nothing wrong with any of these efforts. Some are thoughtful. A few are genuinely helpful.
Yet many physicians feel a quiet unease. A sense that something important is being performed rather than addressed.
I have come to think of this as wellness theater.
By this, I mean programs that signal concern …
Physician wellness theater: Why pizza parties do not fix burnout
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