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 …

Read more…

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 …

Read more…

Most physicians sense it, even if they struggle to name it.

Something fundamental has changed in medicine. Not the science. Not the patients. Not even, at root, the doctors themselves. What has changed is the status of medicine as a profession, and with it, the psychological footing that once made the work bearable.

For much of the last century, medicine functioned as a profession in the classical sense. That meant more than …

Read more…

Every now and then I go back to a book I read decades ago. Sometimes it feels dated, a period piece. Sometimes it sounds uncannily current, as if it has been waiting. And sometimes it does both at once, which is more unsettling.

Recently I reread Moral Dilemmas in Medicine, first published in 1975. I read it as a younger physician, still believing that if you learned enough and tried …

Read more…

For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then …

Read more…

In mid-November, thousands of junior doctors in Britain will again step away from their posts. Not for comfort. Not for gain. For something harder to name.

They have been praised as heroes and treated as expendable, thanked in speeches while their pay erodes and their patience thins. I heard one young doctor say she still loves medicine, but cannot serve a system that sees her as replaceable. She stayed through staff …

Read more…

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 …

Read more…

We are trained to move quickly. To respond before thinking. To act before doubting. To rise at three in the morning because someone’s life might depend on it. That is how we learn ethics, not in seminar rooms, but in corridors that smell of antiseptic and coffee, under fluorescent light, beside stretchers with failing hearts.

And so, somewhere along the way, we begin to believe that morality lives in the moment. …

Read more…

There is a kind of silence in hospitals that no overhead page can interrupt. The silence after you have raised a concern, documented it, escalated, and nothing changes. Some physicians endure that silence for years. Some burn out. A few walk out, not in defiance of medicine, but in fidelity to what medicine was supposed to be. And when they do, we often call them disruptive, political, or unprofessional. But …

Read more…

“When doctors strike, patients die.” That phrase—flattened into certainty—gets tossed around like a moral verdict. It shows up in op-eds, comment threads, morning rounds. As if to say: there’s no argument. The matter’s settled. You swore an oath.

But what oath, exactly?

Most physicians are taught to revere the Hippocratic Oath, but few have read the original versions. It wasn’t universal. It wasn’t sacred scripture. It forbade surgery. It invoked Apollo and …

Read more…

Across America, physicians worry about malpractice litigation—but what happens when state policies unintentionally create a malpractice litigation magnet? New Mexico offers a troubling case study every health care provider should know about.

Between 2019 and 2024, New Mexico lost 248 practicing physicians; for a large state with a small population, this is significant. Rural communities bear the brunt of this exodus. Specialists, surgeons, and primary care doctors alike have left, most …

Read more…

It was after dinner at The Goring, just the three of us—Ulla, David Chipp, and me. The kind of dinner where the wine lingers longer than the food, and the conversation slips into the quietly personal.

David, once Reuters’ correspondent in Peking during the Mao years and later editor-in-chief of the Press Association, handed me a gift: a copy of E. M. Forster’s What I believe. Inside, he had written a line …

Read more…