It was a typical weekday morning. I woke up at 5:20, started a load of laundry, showered, dressed, unloaded the dishwasher, got the kids breakfast and lunch together, fed the pets, etc. After sending my husband off to work, I got the kids up and ready for the day. Things were going smoothly. I got my kids to school on time, and got into work early enough to go through …
Balancing part-time clinical work and motherhood
Patient engagement platforms are software systems that deliver clinical information to patients and manage patient questions and concerns outside of scheduled visits, including patient portals, mobile apps, and messaging systems. After nearly a decade of watching (and studying) the evolution of patient engagement platforms, I have come to see them as two distinct generations. I will refer to them as Generation 1 and Generation 2. Not because this distinction exists …
Understanding Generation 2 patient engagement platforms
I review your peer-to-peer calls. Here is why you keep losing.
I sit on the other side of your peer-to-peer call.
I am a physician medical director in utilization management. When you call to overturn a denial, I am the one listening. I have taken thousands of these calls over the past decade. I can tell within the first 30 seconds whether you are going to win.
Most of you lose. Not because …
How to win peer-to-peer calls: a medical director’s guide
We have been calling it burnout. The word took decades to arrive, and then it was everywhere. It appears in journal editorials, hospital wellness initiatives, and continuing medical education (CME) modules on resilience. It has validated scales. It is now the official language of physician distress. It is not wrong. But it is incomplete. It describes something real: exhaustion, detachment, the slow erosion of meaning. But burnout describes how the …
Beyond physician burnout and understanding structural immiseration
Requests for prayer at the bedside are more common than many clinicians admit. Yet these moments often unfold quietly, undocumented, unexamined, and rarely addressed in training. Whether a clinician identifies as religious, spiritual, secular, or uncertain, such requests can stir discomfort. Still, patients continue to ask.
Sometimes it is direct: “Doctor, will you pray with me before surgery?”
Other times it is woven into hope: “I am praying God gives your steady …
When patients ask to pray: Navigating spirituality in medicine
On October 20, 2015, I did something unremarkable: I turned on the GPS app on my Android phone before driving to work. I had no idea that routine act would one day save my career and expose a pattern of institutional behavior that every academic physician needs to understand.
I was an assistant professor of oral and maxillofacial surgery at a major academic medical center. Two days after a high-risk patient …
Physician legal protection: Surviving academic medical center blame
What happens when the doctor becomes the patient? Is there anything learned or reinforced? For me, it was a life-changing experience both personally and professionally when I became the patient.
My story began on New Year’s Eve. I had been feeling dizzy associated with some chest pain and was scheduled to have a stress echo at my local hospital to make sure all was OK (of course it would be OK, …
Surviving ventricular tachycardia: What I learned as a patient
Imagine a healthy eight-year-old boy going under general anesthesia for a routine procedure. His preanesthetic workup is unremarkable. His family history raises no flags. He receives sevoflurane, the most commonly used inhaled anesthetic in pediatric practice worldwide, and he does not wake up the same.
This is not a theoretical scenario. It has happened to families of Venezuelan ancestry on multiple continents, across multiple decades, and no one connected the dots. …
How a hidden genetic mutation creates a severe pediatric anesthesia risk
They tell us doctors
to practice self-care,
as if grief were a muscle
that loosens with stretching.
But no one teaches
how to set down
a conversation about dying
and pick up
the rhythm of living.
At the end of the work day,
the questions still echo,
How much time do I have?
What would you do, doc?
The charts are closed,
but the questions remain open.
Burnout does not arrive
as flames.
It seeps,
through the small cracks
between hope and reality,
between doing everything possible
and knowing we have …
A physician’s poem on burnout and end-of-life care
I still remember the first time I saw what bullying in medicine could do to a physician in training. It was not loud at first. It was not always obvious. It came wrapped in authority, tone, pressure, and the quiet threat that a career could be damaged by people in power. A resident nearing her final year of dermatology training was being bullied by program leadership and others in the …
Confronting the reality of bullying in medicine today
Most internal medicine physicians assume that when they sit for a board examination, their answers determine one thing: whether they pass. Few realize that their exam performance has been linked to federal Medicare claims data and used in research, without their knowledge or consent.
The American Board of Internal Medicine (ABIM) has published studies linking board scores to clinical outcomes derived from Medicare claims. ABIM presents these analyses as quality research …
Why ABIM’s use of Medicare claims data violates physician autonomy
The stethoscope has always been more than a tool for auscultation; it is a physical bond between two human beings that no government has the authority to sever. In early 2026, as the Iranian regime launched a brutal crackdown on its own citizens, we witnessed the most extreme test of this bond. When the state demanded that physicians become extensions of the secret police, our colleagues in Iran chose the …
Iranian physicians in 2026: a testament to medical courage
The internet has made patients more informed. It has also made some patients more misled. A small but growing body of medical commentary has used the provocative label “internet-derived information obstruction treatment (IDIOT)” syndrome to describe what happens when people trust online medical content so blindly that they delay care, stop treatment, self-medicate, or resist sound clinical judgment. The term appears in published reviews and commentaries, but it is not …
How IDIOT syndrome threatens value-based health care
The day I handed in my credentials as medical director, I sat in my car in the parking lot for a long time. I had held that role at Methodist Specialty and Transplant Hospital in San Antonio for years. I had built protocols, chaired committees, mentored residents, and managed crises at hours when the rest of the city slept. I was, by every conventional metric, succeeding. And yet there was …
Why leaving hospital medicine for private practice was worth the risk
These moments of hesitation keep happening to me. I recognize the harm. I can name it clearly. I have seen its effects over and over again with my patients. And yet, when the conversation turns to its cause, I hesitate. Not because I do not understand. Because I am supposed to stay neutral. Medicine has long held neutrality as a professional virtue. We are taught to rise above politics, to …
Why physician neutrality in the face of harm is a choice
At 2 a.m., the hospital is quieter but the stakes are not. A single page can alter the trajectory of a patient’s life. A subtle clinical shift can mark the difference between stability and decline. At night, there is less margin for error, fewer immediate resources, and no room for hesitation. Not long ago, I was called to evaluate a patient who “just did not look right.” The vital signs …
How night shift medicine exposes the reality of physician stress
In clinical practice, reassurance is both necessary and responsible. When a clinician says “nothing concerning,” it is rarely casual. It reflects a judgment: no immediate danger, no clear evidence of serious disease, no indication for urgent intervention. It is often the appropriate conclusion at that moment in time. But what happens to that statement after the visit ends is less often considered. Because outside the clinical context in which it …
How clinical reassurance impacts patient communication
An excerpt from The Leadership Prescription: How High-Performing Clinicians Become Visionary Leaders.
There I was in my habitual rhythm, seeing patients back-to-back and enjoying it. After all, seeing the patients was the fun part; the administrative burden that accompanied it was nauseating and heralded the real risk of burnout. The administrators regarded me as someone who could easily create rapport with the patients. I was the kind of physician who …
The physician leadership transition: Moving beyond the exam room
In the wake of the October 2023 Hamas attacks on Israel, allegations of antisemitism surged on American campuses, including at the University of Pennsylvania. In response, the Equal Employment Opportunity Commission (EEOC) launched a Title VII investigation and subpoenaed Penn for the names and contact information of faculty and staff affiliated with Jewish organizations and Jewish Studies programs. Penn resisted. Faculty groups intervened. The phrase that reverberated through court filings …
Balancing civil rights and trauma in an antisemitism investigation
As physicians, we rarely disagree about first principles. Nutrition, physical activity, sleep, stress, and behavioral patterns sit at the foundation of nearly every chronic disease conversation. We counsel patients on these topics every day, sometimes passionately, sometimes hurriedly, often within the narrow time constraints of a packed clinic schedule.
Yet an uncomfortable gap persists between what we know drives long-term outcomes and what we are realistically able to deliver in routine …
Lifestyle medicine support: Bridging the gap in patient care
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