By 11 p.m., my clinic was dark but my brain wasn’t. I found myself scrolling through my schedule for the next day: 22 patient visits, a pile of unsigned notes, two meetings squeezed into “lunch,” and a post-call morning that somehow still started at 7 a.m. None of these tasks were unusual, but what struck me was the growing tightness in my chest and the realization that I had quietly …
As an internal medicine physician, I’ve spent years watching one quiet assumption extract more unpaid labor from physicians than anything else in our system. It’s not charting. It’s not meetings. It’s not metrics.
It’s call.
I wrote a post on my LinkedIn page about my thoughts regarding call. It resonated with many physicians, and I received many messages. It became clear that being “on call” is something that is rarely spoken about …
If you’ve been practicing medicine for any length of time, you’ve likely felt that familiar moment of overwhelm when a patient walks in with a stack of printouts, a list of 30 questions, or a frustrated statement like, “Well, I did my research.” And if we’re honest, many of us feel our chest tighten just a little. We feel the time pressure. We feel the responsibility. And sometimes, we feel …
At its best, the doctor-patient relationship is an intimate one. Often, our patients appear before us in the most vulnerable moments of their lives. We treat their diseases, but we also tend to their emotional and spiritual well-being. That kind of intimacy can be meaningful and rewarding, but it can also breed awkward and even potentially compromising interactions. That is particularly true when money gets involved.
Despite widespread dissatisfaction with the …
I’ve recently been intrigued by this question: Are you giving from extra or essence?
In many respects, giving from one’s essence is what burnout is all about. Your energy reserves (emotional, physical, mental, cognitive) are heading rapidly toward empty. Because of a mismatch between the energy drain from internal and external stressors and the ability to replenish your energy, you are left depleted.
I see this mismatch daily in the physicians whom …
An excerpt from Pandemics, Poverty, and Politics: Decoding the Social and Political Drivers of Pandemics from Plague to COVID-19.
We talk about health as if it were an individual act of will, a matter of personal choice or risk tolerance. But anyone who has walked alongside people living in poverty, in refugee settlements, in overcrowded housing, or on the street knows that illness does …
The discomfort I felt around supervising did not arise in the clinic. It arose while reading the agreements meant to define it.
Supervisory agreements. Collaborative designations. Regulatory language that needed to be reconciled (carefully, deliberately) because names, roles, and obligations matter. Like many physicians, I have signed these documents countless times. But reading them slowly, rather than reflexively, produced an unexpected unease, one that felt structural rather than personal.
The language was …
Early in medical school, a professor warned us: “Never prescribe for someone who isn’t your patient.” He shared a story of writing a simple antibiotic for a friend who later developed Stevens-Johnson syndrome, a devastating outcome that haunted him long after. His message was clear: There is a bright line between caring and causing harm.
Fifteen years out, we now understand just how blurry that line really is.
“First, do no harm” …
In a valuable episode of the Wealth Planning for the Modern Physician podcast, host David Mandell, JD, MBA, spoke with Dr. Matthew Provencher, an orthopedic surgeon, Navy veteran, former team physician for the New England Patriots and Boston Red Sox, and current partner at The Steadman Clinic in Vail, Colorado. Dr. Provencher’s story spans small-town roots, elite military service, academic medicine, professional sports, and entrepreneurial ventures. His journey offers physicians …
I walked out of my physician’s office steady and clear in my decision to transfer my care. I didn’t accuse her of anything. I didn’t raise my voice. I simply informed her that I would be transitioning to another clinician within the same concierge program.
She immediately assumed I was leaving for financial reasons and suggested physicians to see outside the system. When I clarified that her administrator had already approved …
In the annals of social science, few imperatives are more solemnly intoned than the necessity of measuring racism with the cold precision that only quantification can provide. Only when bias is reduced to p-values and effect sizes may one confidently proclaim, “Behold, the incontrovertible evidence of racism,” secure in the knowledge that no reasonable interlocutor can wriggle free on the strength of anecdote or wounded sentiment. Yet such measurements, to …
Most people assume that pain and illness are caused only by injury or disease. If your back hurts, it must be damaged; abdominal pain must come only from inflammation, infection, or tumor. Most physicians learn this in medical school, as I did. But treatment based on this assumption often fails to provide relief for persistent pain, leaving millions of patients and countless well-intentioned physicians frustrated and in despair. The result …
I recently returned from a truly magical trip to Iceland. While there, my husband and I hiked, ate wonderful food, and soaked in a different culture.
On day five of six, we ventured out to find what was described as a “hot springs river,” a body of water fed equally by glacier melt and geothermal hot springs. As a floating enthusiast, this was a must-see for me.
We hiked for an hour, …
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A modest proposal for the reform of American medicine might begin, improbably enough, in a suburban pediatrician’s office where, last week, a physician of evident earnestness instructed my adolescent son to sleep until noon whenever possible, on the theory that tardy rising is the royal road to superior intelligence. The authority cited was a single paper (published, with all due respect, in the journal Personality and Individual Differences) bearing the …
It was Christmas Eve 2005, and the health plan was closing at 3 p.m. By 4 p.m., the nurses, doctors, pharmacists, and support staff who handled utilization management for HIP Health Plan were already on their way home. My usual role at the health insurance company involved creating quality profiles for physicians caring for our roughly 1 million members. But that afternoon, I was covering hospital admissions so colleagues could …
The news headlines and the online chatter are full of chest-thumping claims from both political parties about saving democracy, scandalous finger-pointing at the other guys, battles over sound bites, and circus antics to grab the attention of the media. It is easy to get distracted by all the political drama and lose sight of important facts.
When it comes to health outcomes, the U.S. is leading the world in the amount …
There is a stillness in the waiting room,
not exactly silence,
but a quiet that settles over chairs,
minds diverted elsewhere.
Here, women sit in chairs
with their thoughts
floating in opposing directions,
pretending to read magazines,
while their minds
wander hallways
they would rather not travel.
My name is called softly,
and my heart skips a beat,
the time has come.
I follow the routine,
changing from street clothes
into bare arms and a borrowed gown
that never seems to fit properly.
I take a deep breath,
trying …
I used to think the hardest part of building better health care was securing funding.
Then I watched the same cycle repeat itself: A promising pilot launches, early outcomes are celebrated, a report is written, and when the funding period ends, the program quietly disappears. The idea did not fail. It simply could not survive.
Nothing was wrong with the clinicians involved.
Nothing was wrong with the intention.
What was missing was a system.
Health …
Medicine teaches us to recognize disease, to listen for the subtle signs of pathology, to read lab values and imaging scans as if they are languages unto themselves. Yet what many of us were never taught is how to interpret the quiet, internal signals of our own humanity. We can identify cardiac murmurs with precision, but we often miss the whispers of our own exhaustion.
As physicians, we spend years mastering …
Linda had seen seven physicians in three years. She was on five medications. And she was exhausted, not just physically, but existentially.
“Dr. Goel,” Linda said quietly, “I’ve done everything they told me. The diets. The pills. The exercise programs. Why isn’t anything working?”
At 54, Linda was a meticulous accountant living with hypertension, type 2 diabetes, obesity, chronic fatigue, and generalized anxiety disorder. Her lab results painted a picture of metabolic …
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