Alan P. Feren is a retired surgeon, independent physician, health care consultant, and patient advocate with more than 50 years of experience in clinical practice, system leadership, and health care innovation. Formerly in academic and community surgical practice, he has worked across the evolving landscape of managed care and clinical governance.
In the 1990s, Dr. Feren co-authored clinical guidelines that evolved into what is now MCG Health, now used by more than 80 percent of U.S. health plans and over 3,100 hospitals. He has advised health technology startups, helped shape managed care policy, and served as a clinical content developer for health care technology platforms.
His work centers on restoring shared understanding between clinicians and patients in an era defined by speed, fragmentation, and technological mediation. Drawing on both professional experience and his own journey as a complex patient, he writes about transparency, accountability, and the disciplined methods that make medical care trustworthy. He is a contributor to KevinMD and a podcast guest. More information is available at mypersonaladvocate.net and on LinkedIn.
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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Shared responsibility in patient care needs boundaries
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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How clinical reassurance impacts patient communication
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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Clinical communication skills: the power of structured language
Most clinicians can recall a visit that technically went well, and still didn’t feel finished.
The history was taken. The exam was appropriate. High-risk diagnoses were reasonably excluded. The plan followed guidelines. The note was clean. The visit ended on time.
And yet, something lingered. Not alarm. Not guilt. Something quieter and more familiar.
We rarely talk about this state in medicine, even though we encounter it daily. We have names for missed …
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Unfinishedness in medicine: When a good visit feels incomplete
Medical gaslighting has become a widely discussed concept in health care. The term is often misunderstood as implying intentional dismissal or manipulation by clinicians. In reality, most encounters that patients later describe as gaslighting do not arise from ill intent. They arise from something far more common and far more complex: communication breakdown under system strain.
Understanding medical gaslighting requires examining the clinical encounter from both sides of the stethoscope, not …
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How system strain contributes to medical gaslighting in health care
You are the expert of your body. You know when something isn’t right.
Yet many patients leave an exam room feeling worse than when they came in, not because of their illness, but because they were told, directly or indirectly, that nothing is wrong. Their symptoms are minimized, reframed, dismissed, or worse, attributed to anxiety, stress, age, or weight. They are left questioning their own experience and perception of reality.
This is …
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How to handle medical gaslighting
Money management and career planning are considered life skills (but the skill that shapes health self-advocacy) deserves the same status. Without it, care suffers. My family member was recovering from surgery, facing medication safety concerns, severe anxiety, and the need for constant care. At the same time, I was managing my own records and preventive health. Like so many women, I had become the family’s chief health executive, carrying responsibilities …
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Why health self-advocacy is an essential life skill
Introduction: a double-edged disruptor
Artificial intelligence (AI) has quickly insinuated itself and is transforming nearly every corner of modern life. Health care is no exception. With the rise of advanced chatbots, symptom checkers, and health-focused algorithms, patients now have 24/7 access to vast medical knowledge at their fingertips in seconds. The excitement is understandable: AI can demystify medical “doctor-speak” or jargon, suggest possible diagnoses and treatment options, and empower patients to …
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AI in your health care: a double-edged digital disruptor
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:
Why agency and partnership are vital in modern health care
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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Medical gaslighting has emerged as a troubling issue for both patients and health care providers
