Alan P. Feren, MD

Care does not have to be finished in one encounter. But it must not be allowed to disappear between encounters.

When primary care clinicians say they cannot adequately manage their patients’ concerns in 15 minutes, I take that seriously. A patient may arrive with a new symptom, several chronic conditions, medications prescribed by different clinicians, and questions about what has changed. The clinician faces that complexity alongside chart review, examination, documentation, …

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As the saying goes: A picture may be worth a thousand words. In health care, it may spare a thousand words used to explain by telephone what “the incision seems more open,” “more red than I expected,” or “concerned that the wound is not healing right” means.

However, a photograph is not a diagnosis. Sending one is not, by itself, a treatment plan.

More than twenty years ago, after my fifth spinal …

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Every summer, a new class of medical students puts on a short white coat for the first time and walks onto a hospital floor. Elsewhere, third-year students begin their first clinical clerkships, and new residents are several weeks into carrying responsibility that no longer ends when a lecture, examination, or scheduled exercise is over.

They will be taught multiple approaches to the art, science, and practice of medicine. They will learn …

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Trust is often discussed in medicine as if it were mainly personal. Did the patient trust the clinician? Was the clinician empathetic? Did communication feel respectful? Did the patient feel heard? All of that matters. But it does not fully explain why trust breaks down in modern care.

Patients do not lose trust only when a clinician is rude, dismissive, or wrong. They lose trust when they leave an encounter without …

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Patients often assume that someone is directing their care. That there is a clinician who sees the whole picture, integrates the information, and guides what happens next. In many cases, that is not how modern care is structured. Patients move between clinicians (primary care, specialists, urgent care, consultants), each focused appropriately on a specific aspect of the problem. Each encounter may be thorough. Each decision may be reasonable. Each plan …

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At the end of a visit, it is common to say: “Call if things get worse.” It sounds supportive. It sounds open-ended. It sounds safe. But what does “worse” mean? More frequent pain? More intense pain? Pain that wakes the patient at night? Pain that interferes with work? Without definition, responsibility shifts quietly.

Modern care depends on patients, not simply to follow instructions, but to understand the treatment plan, to carry …

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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 …

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Consider a common scenario. A 65-year-old patient presents with intermittent chest discomfort present for several days and no prior history of heart disease, including among family members. The physical exam is unrevealing. An EKG and cardiac enzymes are negative. The clinician explains, “I do not see anything concerning. Given your age and symptoms, this is likely reflux. Let us have you wait three hours after eating before retiring for the …

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We often hear the phrase “practice what you preach.” As both a physician and a patient, I’ve learned that nowhere is this more important than in how we navigate health care.

Over the years, I’ve written about the importance of collaboration between physicians and patients. But as I’ve grown older and more frequently interact with the health care system, I’ve come to believe that good care rests on four essential elements:

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ECRI just published in its Top 10 Patient Safety Concerns 2025 that the risks of dismissing patient, family, and caregiver concerns is now the number one safety concern. The term refers to instances where patients feel their symptoms are dismissed, minimized, or outright ignored by clinicians. Intentionality is not always present: Most occurrences are rooted in systemic issues such as time constraints, communication breakdowns, cognitive biases, and overwhelming administrative burdens. …

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