On my first week of onboarding as an attending, before I had seen a single patient, I met the boulder in a training room.
It arrived as a screenshot. The EHR instructor clicked into a demo chart and a cascade opened: quality gaps, refill requests, preventive care nudges, “smart” routing rules that promised efficiency and smelled faintly of delegation without authority. I had imagined the threshold to attendinghood as a clean …
Two emergency physicians with similar training work at the same hospital. Both have twelve years of experience. Both are contracted to work 2,000 hours per year, see roughly twenty patients per shift, and supervise staff. One is a man, the other is a woman. The same work, the same training, the same conditions. Not the same salary: The woman earns about $21,000 less each year.
That is not a hypothetical. That …
In the ER, we ask, Was he wearing a seatbelt
Partly for the note, but partly so we can remove ourselves
From exploded flesh, splintered bones,
Not sure if we can save that eye.
Something in us says, that will not be me;
I take precautions. We live on,
On the strength of the stories we tell ourselves.
But in the ICU, when one of our own has come in,
After a well-informed try at smothering the spark,
There …
Our one and only daughter has gone off to college. My wife and I dropped her off the weekend before. As we made the four-hour drive from Houston to Baton Rouge along I-10, the road stretched ahead, both endless and fleeting, as if time itself were torn between holding on and letting go. Between bursts of laughter and quiet silences, we spoke of classes, friendships, boys, the discipline of focus, …
When most people talk about obesity, the blame often falls on donuts, McDonald’s, fast food, lack of exercise, or lack of willpower.
But as a primary care physician, I see a different reality. Obesity is not always born from a donut, and it is not always caused by time poverty. Yet in many cases, it grows out of time poverty, a system that robs people of the space to think, to …
The gimmick of the day is to make -preneur the suffix of the year. Solopreneurs. Doctorpreneurs. Digipreneurs. Trumpreneurs. It should come as no surprise then, that leaderpreneur has appeared in your latest Google search. What is a leaderpreneur, anyway, and why should anyone care? Recognizing that there are as many definitions of leadership, entrepreneurship, and innovation as there are practitioners of those arts, here is my take:
Entrepreneurship is the pursuit …
I had been hearing so much about burnout in medicine; and one day, I realized it had crept up on me. It began at my mother’s funeral, when an acquaintance, a former family friend, approached me asking me to examine her painful toe. I tried to avoid her, yet I could not say no. Through my grief and exhaustion, conditioned by years of striving to live a life of purpose, …
These days, getting spun out into a state of worry and panic is just a click away: Turn on any device for constant updates on the chaos around us.
Adding to this, on a personal level, the last six years have been the most difficult and transformative period of my life. I had never imagined that I would experience and recover from the darkness of depression and suicidality six years ago, …
Ever been so tired you forgot your own name? I remember a junior doctor on strike in London who told me exactly that. Thirty-six hours awake, stumbling into the children’s ward, staring at a prescription pad. “I couldn’t even remember my own name,” he said, “let alone the right antibiotic dose.”
That was not about wages. That was about survival, his and the children’s.
Yet the story always gets told the same …
Everywhere in American medicine today, you hear the word leadership. Hospitals advertise leadership programs. AMCs hold leadership retreats. Colleagues are urged to “develop as leaders.” Yet when you talk to practicing doctors (the ones actually seeing patients), most will tell you all they want is to do their work, fairly scheduled, with decent colleagues, and without interference.
That is the paradox of the physician leader. Everyone talks about leadership, but almost …
We were walking up the fairway on the ninth hole when one of my patients asked, “Larry, when should I come in for my annual?” I had a seven-iron in hand, breeze at my back, and I answered without thinking: “Doesn’t matter.” He looked at me like I had just duffed a wedge. To him, it sounded like I did not care. In a way, I suppose I mishit that …
During the COVID-19 pandemic, I cared for a patient in the intensive care unit whose condition was critical. When I asked how he was feeling, he said, “Doctor, I am not afraid. My family is praying for me, and I believe God will give me strength.” Despite receiving the best medical interventions available, it was clear that his faith, cultural practices, and the support of his family played an undeniable …
In the late 1990s, Yahoo dominated the internet by organizing websites. Human editors manually reviewed, categorized, and arranged them into a hierarchical directory, essentially a digital Yellow Pages. This worked while the web was small, but the approach couldn’t scale. Google took a radically different path. Instead of relying on human judgment, they built algorithms to crawl, index, and rank pages based on links and relevance. This allowed them to …
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In the grand edifice of American medicine, where the Enlightenment’s promise of rational progress once shone brightly, a shadow now lengthens across the corridors: the tyranny of the metric. Conceived in the spirit of Taylorism’s efficiency and Deming’s quality control, these numerical arbiters were meant to elevate the healer’s art, transforming subjective judgment into objective excellence. Yet, as with so many well-intentioned intrusions of bureaucracy into human affairs, they have …
My mind became the centerpiece of my identity early on in life. I lived so intimately with my thoughts that I came to believe this is who I was. As academic success and the praise of being “the smart one” set me apart, I internalized a sense of uniqueness. Others saw it too, which created early recognition… and isolation.
And here lies the hidden cost:
In the early 1990s, while the American Academy of Pediatrics was formalizing its vision of the “medical home,” we were already living it, without a name, without a policy statement, and without institutional applause. At Minot Air Force Base in North Dakota, our pediatric team operationalized what would later be codified: interdisciplinary care, family partnership, coordinated services, and continuity across settings. We did not call it a medical home. We …
Twenty years ago, when I started medical school, I had no idea that this would be my path. Coming from a research background in cancer biology and biophysics, I did not have much exposure or interest in integrative medicine. My path to practicing integrative and functional medicine and incorporating new modalities to my foundation as a general internist, was not linear, and not expected.
I was pregnant twice during my three-year …
In medicine, we’re trained to stay. To endure. To prove our worth by how much we can carry and how long we can carry it. Our roles become our identities. Our achievements and labels become scaffolds of self-worth. In medicine, stepping down is often labeled as a sign of weakness. So we hold on to roles even when they no longer fuel us. We are usually still doing the job …
When we think about palliative care, our first instinct is to picture pain medications, symptom checklists, and clinical protocols. But for patients with terminal brain cancer, the reality is much more complex. As speech declines, as motor function deteriorates, and as identity itself feels threatened, the greatest need is not always more medicine; it is meaning, connection, and dignity.
In recent years, I have had the opportunity to study an ancient …
Psychiatry, perhaps more than any other medical specialty, is a field defined by ambiguity. Unlike other branches of medicine, where diagnostic tests and standardized protocols guide treatment, psychiatry often operates in a landscape where clear-cut answers are rare. The psychiatrist’s primary tools are not scalpels or stethoscopes, but words, presence, and (most crucially) the self.
Psychological transference and countertransference: double-edged swords
Psychological transference and countertransference are central to the practice of psychiatry, …
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