This is a famous teaching in the Talmud, which in the Jewish faith is the commentary on the Hebrew Bible. Why would the holy book of the Jews make such a proclamation? It turns out this is about arrogance. It is about humility. The “best doctors” may also be the most prideful. Their arrogance may prevent them from realizing they need help. If they do realize it, their pridefulness may …
An excerpt from Real Medicine, Unreal Stories, Volume 3.
The café was quiet, tucked between a shuttered bookstore and a yoga studio that only seemed to open during Mercury retrograde. It was the kind of place that didn’t advertise, which made it perfect for writers, wanderers, and today, two physicians who had long since discovered that stories, not stethoscopes, were the truest diagnostic tools.
Dr. Gary Handler stirred his coffee absentmindedly, …
It is hard to open a medical journal in any specialty without seeing an article on burnout. There are statistics, trends, and of course a myriad of causes detailed in these articles. A few even offer some sensible solutions—flexible scheduling, peer support, delegation of clerical work, and an increased focus on personal well-being activities are steps in the right direction.
I have previously written that “the absence of burnout does …
In medicine, self-sacrifice is praised. We call it dedication. We call it loyalty. However, sometimes it is just exhaustion wearing a badge of honor, and it keeps us complicit in systems that harm us and our patients.
Burnout does not kick the door in. It just shows up quietly. One day you notice you have not called a friend back in weeks. Lunch, if you can call it that, is an …
Each year, I leave behind the electronic health record, performance metrics, malpractice fears, and the ever-present hum of burnout—and lead a medical mission trip—this year to Nicaragua. Along with a team of fellow volunteers, I carry only what we can pack: a few stethoscopes, essential supplies, and the will to serve.
We set up clinics in makeshift church halls with tin roofs in …
Well, that didn’t take long, did it?
Today’s “controversy du jour” is prevention in health care. More specifically, vaccines and their role in preventing disease, disability, and death while promoting health and lifespan.
Prevention is the mother’s milk of health care. It is core to reducing illness and disease. Sadly, the udders producing that milk are drying up quicker than you can shake a fist at what is happening before our very …
The culture of medicine is shaped in quiet ways, by the way meetings begin, the pregnant pauses before a response, and the energy transmitted in emails sent and received. These seemingly insignificant experiences ripple outward, setting the tone for entire teams, shaping what is spoken and what is not, shaping what feels possible and what feels unsafe.
The culture of medicine is not an abstract force. It is built moment by …
In the bustling environment of modern health care, the loudest voices frequently attract the most attention. Yet, a special category of physicians who are less visible but no less significant exists: the efficient, quiet clinicians who are usually underestimated. This physician type blends high productivity with a calm demeanor, allowing skill and results to speak louder than words.
Underestimation can undermine leadership opportunities for quiet physicians because visibility may play a …
Sometimes, the stethoscope doesn’t catch what the heart is really saying.
It was just another morning during my surgery posting. I was reviewing pre-op workups when I was asked to assist with the echo evaluation of an elderly woman scheduled for a routine procedure. Her echo report flashed across the screen: smooth curves, rhythmic contractions, and valves opening and closing like well-oiled gates. The left ventricular ejection fraction was over 60 …
Emergency medicine residency: where the pager announces before your coffee cools, and your personal life takes a number far behind sepsis alerts and trauma activations. Amidst this storm, there’s an unexpected survival manual—not found in Tintinalli’s or Rosen’s, but in Mark Manson’s self-help book, The Subtle Art of Not Giving a F*ck.
Manson argues that life’s meaning isn’t found in chasing positivity, but in embracing struggle, choosing your battles wisely, …
I knew there was a cost when I chose to become a physician: The long hours, delayed gratification, the strained relationships. I could understand these things as familiar from my lived experiences. I knew there would be a financial burden, and having been raised by two immigrant parents, an electrician and a nurse, I was no stranger to the pressures of financial insecurity. I was fortunate too: my parents did …
“Dr. Who?” the child asked.
“Dr. Hijano,” I said. “But you can call me Dr. Diego. Like Go Diego Go! Dora the Explorer’s cousin, the one with the baby jaguar who saves the rainforest.”
A pause. A smile. And just like that, the ice broke. In pediatric oncology, that is no small thing.
I work in a pediatric cancer center, most often in the bone marrow transplant unit. When people hear this, they …
I remember a night during my first year of residency in oncology when I was on call. It was after midnight, and I was sitting at the ward counter.
I often struggle to sleep during night shifts, especially when I’m the only doctor on call. I prefer to stay at the counter because I dread the thought of some terrible thing happening and not being able to reach the ward in …
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The message came through before dawn: “Our EHR is down. No access to patient charts.”
In a rural clinic, that is not just a technical inconvenience. It is the mother who drove forty miles before sunrise to get her child’s asthma medication, the farmer who left the fields to review his lab results, the elderly patient who cannot make another trip for months. When systems go dark, there is no backup …
The truth is not hiding. We have known for decades what allows physicians to thrive and what erodes their well-being. The science has been published, the interventions described, and the solutions tested. What we face is not a crisis of knowledge; it is a crisis of action.
I was reminded of this recently when an emergency physician preparing a talk on wellness asked me for help. She wanted to share with …
For years, I didn’t realize the name for what I was experiencing as a primary care pediatrician was burnout. I just thought I wasn’t enough—not good enough, not hardworking enough, not experienced enough. That self-doubt didn’t stay confined to my role as a doctor; it crept into how I felt as a parent, a spouse, a community member.
Nothing ever felt like enough. So I did what I was trained to …
My recent experience as a cancer patient has illuminated many things. It has shown me how our health care system is not standardized and how it sometimes makes patient care decisions based on financial incentives or convenience rather than patient preferences or best clinical practice. Take, for example, the topic of sedation.
The question of whether to sedate is common in pain management, which often involves invasive intraspinal procedures such as …
I have been a physician for 44 years.
Besides my office and hospital practice, I also make house calls for less mobile older adults. We all want to stay in the homes where we raised our children, cared for our gardens, and became part of the community. The reality is that we lack the tools and financial resources needed for seniors to “age in place.”
My house calls, though, have provided insights …
We had been trying, but the moment you see the word on the test strip, reality hits differently. My career was on an upward trajectory—I had just been offered a major promotion. And all I could think was: Why now?
When I told my husband how nervous I felt, he assumed it was about my body changing, or how our family of two would soon become three. He was wrong—and visibly …
We’ve medicalized nearly everything in life—birth, aging, sleep, even boredom. Now, in the spirit of efficiency, we’ve begun medicalizing death itself.
In his unsettling essay “The European way to die,” French novelist Michel Houellebecq warns that the normalization of euthanasia and assisted suicide is not a sign of progress but of profound cultural decay. I didn’t expect to find myself agreeing with him.
As a physician for over three decades, I’ve …
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