Physicians go into medicine curious. That's almost universal. The interest in how bodies work, in how people work, in the puzzle of diagnosis and the complexity of what brings someone into the room — curiosity is close to the center of what drew most physicians to the field. Which is why its absence is such a significant signal. Not hatred of patients — that's a different conversation. Not frustration with the system — that's appropriate and accurate. Just flatness. A patient presents...
1 day ago • 1 min read
There was a period in my practice — maybe six months, maybe a little longer — where I noticed something I didn't have words for at the time. I was doing my job. Seeing patients, making decisions, doing the work competently. But I had started keeping a kind of emotional distance that I hadn't had before. Not from hard cases — from ordinary ones. From the mom who wanted to talk through her concerns at length. From the parent who got emotional about something I thought was routine. I told myself...
2 days ago • 1 min read
Here are five warning signs that the structural architecture of your practice is failing. Not burnout — the precursors to burnout. The signals that arrive well before the breakdown. 1. Persistent low-grade dread around specific clinical tasks. Not hard cases — routine ones. The inbox. The charting queue. Monday morning. When ordinary parts of the job start producing dread before you've encountered them, the structure around those tasks is broken. 2. Inability to be fully present even during...
3 days ago • 1 min read
There's a specific feeling a lot of physicians know. It's not anxiety exactly. It's not dread about a particular patient or a hard conversation coming up. It's a lower, vaguer thing — a slight heaviness that shows up before you even start. On Sunday nights. On the drive in. In the thirty seconds before you log into the EMR. Most physicians explain it away. It's just how this job is. It's always been like this. Everyone feels this. Some of those things are true. Not all of them. Low-grade...
4 days ago • 1 min read
This week I wrote about presence. About why the physician who is fully present in the room isn't trying harder — they built something that stops competing with their attention. About the single structural change that most improved my own presence. About a specific clinic day that worked differently, and why. About open loops and the mechanism by which they steal the attention you're trying to give your patients. If you've read this week and felt something between recognition and frustration —...
7 days ago • 1 min read
If you've ever walked into a patient room and realized halfway through the visit that you weren't fully there — that some part of your attention was somewhere else, on something else, running a background calculation you couldn't quite turn off — you already know what an open loop feels like in clinical practice. You just may not have called it that. An open loop is any task, decision, or commitment that your brain has registered as incomplete. It doesn't matter how small. The inbox message...
8 days ago • 1 min read
I want to describe a specific clinic day. It was a Tuesday. Full schedule — seventeen patients, which is normal for my practice. Nothing unusual about the day on paper. What was unusual was that I had spent the previous week intentionally changing the structure around how I was managing notes and transitions. By midmorning I noticed something I didn't have a name for yet. I wasn't behind. Not just not-very-behind — actually not behind. The notes from the morning were closed. The referrals I'd...
9 days ago • 1 min read
People ask me sometimes what the single highest-leverage change was in my own practice. The thing that moved the needle most on how sustainable the work feels, and on the quality of attention I can bring to patients. My answer is never the one people expect. It wasn't a charting strategy, although charting changes helped. It wasn't a schedule adjustment, although that helped too. It wasn't learning to say no more often, or taking better care of myself, or the mindfulness app I tried for about...
10 days ago • 1 min read
Full presence in the room with a patient is not something you decide to have. I want to say that clearly, because the advice physicians usually receive about presence sounds like a decision: be more mindful, put the device away, make eye contact, take a breath before you walk in. These are not bad suggestions. But they treat presence as something you conjure through intention. It isn't. It's a structural outcome. The physician who is genuinely present in the room with their patients — not...
11 days ago • 1 min read