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
Egregious ethical failures in health care almost always gain attention. Less visible, but no less consequential, are the systemic ones that are often overlooked: routine acts that present themselves as morally neutral, procedural, and unremarkable. They usually do not provoke outrage and are not experienced as trauma. Yet over time, one must be concerned about how they quietly reshape our well-being and our professional identities.
The effect of these acts does …
Moral injury in medicine: When silence becomes a survival strategy
Medical misinformation is rampant but should not be overstated. Vaccination remains a good barometer of the range of opinions on a subject directly related to individual as well as population health. 82 percent of Americans received at least one shot of the COVID vaccine by December 2023. However, more recently, population vaccination rates of children are decreasing.
Perspectives on safety and immunity
The increasing distrust in vaccines may be …
Medical misinformation: Navigating vaccine hesitancy with empathy
The tension between physicians and the American Board of Internal Medicine (ABIM) has simmered for a decade. What began as a professional debate over maintenance of certification (MOC) has evolved into a broader question of fairness, autonomy, and accountability. Now, the courts are involved, and the legal battles are revealing as much about the profession’s frustration as they are about the structure of American medicine.
A landscape of lawsuits
Since 2018, multiple …
Shortly after Halloween, I hid my daughter’s candy haul.
Not because candy is evil nor because I’m trying to ban sugar from our house. But because I kept finding candy wrappers in random trash cans, and I realized that having a giant bag of candy sitting out was just too tempting for my family.
We have a similar rule with ice cream. We don’t buy it at the grocery store. If we …
Physician weight loss strategy: Why willpower isn’t enough in 2026
If life is what we make it, then the end of life can be understood as a spiritual journey rather than a medical pursuit. We demedicalize dying by distancing ourselves from practices that use hope as consent (prolonging life through reflexive hospitalizations, procedures, or antibiotics that offer little dignity to those already living with serious illness).
Every medical decision poses a fundamental question: Is this the beginning of the end, or …
Demedicalize dying: Why end-of-life care needs a spiritual reset
A single screenshot. A leaked email thread. A one-star review. Then the verdict arrives fast. Faster than any investigation. Faster than any courtroom. Faster than any truth.
Recent reporting describes how physician and author Peter Attia faced immediate public fallout after the Justice Department released Epstein-related records that included extensive email correspondence. Dr. Attia apologized for the tone of those emails and denied criminal wrongdoing. Major outlets repeated selected lines. Social …
Physician due process: Surviving the court of public opinion
In the high-stakes world of medical education and lifelong clinical practice, there is a constant battle taking place: the struggle between the human brain and the Ebbinghaus forgetting curve.
The science of memory is settled. Dozens of studies confirm that spaced repetition consistently outperforms traditional “massed” study (cramming) for long-term retention. By reviewing a clinical concept just as it is about to slip from our neurons, we “hack” the brain into …
Spaced repetition in medicine: Why current apps fail clinicians
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