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 …
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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All physicians lead, not just those with designated leadership titles, such as Medical Director, Department Chair, or Chief Medical Officer. Leadership is foundational to the doctor’s role.
Fortunately, leadership is a learned skill and improving physicians’ leadership skills can change how well we do our key job of taking care of patients. As physicians improve individual leadership skills the entire health care system will reap the benefits: nurses, technicians, administrators, finance …
Paige Bueckers, a 23-year-old WNBA star, was drafted number one this year to the Dallas Wings and has been having a historic rookie season. Against the Los Angeles Sparks on August 20, she scored forty-four points while shooting eighty percent, tying an all-time WNBA rookie record. As a physician, I find that Bueckers’s mindset has a lot to teach me about being a physician. Here are the top five Paige …
In the shadowed corridors of America’s great academic hospitals, those bastions of progressive piety nestled in sanctuary cities like Denver, New York, Chicago, and San Francisco, a quiet usurpation unfolds. For decades, as a physician committed to mentoring Black Americans, I have viewed my profession not merely as a vocation but as a form of restitution: a personal reckoning with the sins of our white forebears, whose legacy of chattel …
Commercial airline pilots are required to retire at 65 under Federal Aviation Administration regulations. It’s not ageism; it’s safety. Yet physicians, whose decisions can be just as life-or-death, face no such requirement. As a former internist, chief medical officer, and hospital CEO, I have seen what happens when physicians practice past their prime. The results can be dangerous, heartbreaking, and entirely preventable.
When “going out on top” doesn’t happen
During my tenure …
An excerpt from Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock.
Dr. Raul Morales sat alone in Exam Room 3, now used for storage, staring out at the fading autumn light through a slit in the blinds. The clinic was quiet, eerily so. His last patient had left an hour ago. He was supposed to be packing up his …
Each academic year, I have watched as a new class of residents and fellows prepares to graduate and launch their medical careers. They step out of the structured training environment into a professional world that is exciting, expansive, and, for many, overwhelming. Clinically, they are well trained. But residency rarely prepares physicians to recognize and advocate for what they truly need to thrive in practice. The data reflect this gap. …
An excerpt from Whispers of the Mind: A Neurologist’s Memoir.
I have never been one to seek out medical care, as I have been fortunate to have been in excellent health most of my life. So, when I presented to my GYN for my yearly follow-up, I brought up my first health complaint in the twenty years I had been seeing her, abnormal bleeding. We were colleagues and she knew …
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