It is July. You take over the inpatient service, and you can feel the tension before you open a single chart. The new senior is running rounds for the first time, and the pace is slow. The interns know the medicine. They do not know the system. One...

You forget the diagnosis. Most likely, you will forget names. You will never forget how someone made you feel. Every July, a new class of interns walks onto the wards. The patients change hands. The pagers change owners. Somewhere on the wards, a ne...

In my time as a division director, no one has walked into my office and asked to do less. Not once. The requests run the other way. People want to build a program, start a lecture series, take on the students, design the thing they have been picturi...

I’m a grandfather. Those are words I wasn’t sure I’d ever say out loud. I grew up in a big, traditional family. Sunday supper at my grandparents’ table was a regular occurrence. An aunt or uncle would turn up unannounced, and there was always a plac...

The offer letter is sitting in your inbox. The title is better than the one you have now. The scope sounds like growth. On paper, you should be thrilled. So why does something keep nagging at you? That nag is data. Most physicians treat it as nerves...

You learned a lot of medicine in training. You also learned a lot of things that were never on the syllabus. Medical training conditioning is not a single lesson Be a good doctor. Be smart. Hardworking. Emotionally blunt. Perfectionist. We called al...

When I started medical school, the curriculum had just shifted to small-group case discussion. Six to ten students sat around a table every week. A faculty member graded our participation. I dreaded it. I am naturally introspective. Generally, I thi...

The first morning I signed out a patient as the attending, nobody behind me was going to catch what I missed. The pay was better. The call schedule looked lighter on paper. Vacation accrued. And I still stayed an extra hour to confirm a finding nobo...

I showed up to my first overnight call in a tie, a dress shirt, and khakis. The chief resident took one look at me and laughed. “Put on scrubs,” she said. “You’re going to be more comfortable.” She was right about the scrubs. She was also right, in...

I have been teaching physicians to audit their Energy Accounts for two years. Then I spent six weeks wearing a sensor from Arena Labs that audited them for me. The numbers did not lie. By week three, I could pull up a graph that told me, almost to t...