For content related to philosophy, ethics.

My compass

As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let alone occasionally heal. It has been - and continues to be - a glorious and fulfilling career. But it has not been easy or without pain, confusion, fear, or despair.

Dear (Patient) John letter

This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years. I hope I have retired by that time, because it would be truly shameful to actually sign and send such a letter.


Dear (computer generated patient name),

I am writing to express my deepest regret that I can no longer serve as your PCP.  I will continue to provide you with all appropriate care during the next sixty days while you arrange an alternative provider.

Skis and the hazards of tool worship

I used to dream about a new pair of cross-country skis for a season, evaluate different options, wait for a bargain, then purchase an expensive pair, and finally spend hours prepping the bases. Having invested so much time, money and effort in the skis, it seemed natural to do everything in my power to preserve them. I waxed and scraped them repeatedly, stored them carefully between uses, and skied carefully to avoid rocks or other hazards. In fact, I respected the value of the skis so much, I only used them in perfect conditions.

Entropy is relentless

“…it’s easier to add stuff than to take it away.  It brings to mind thesecond law of thermodynamics in physics, which (very loosely) says that a system will always develop greater disorder (or randomness, or “entropy”) unless work is done on that system.  Stated from a clinical point of view: unless we invest more time and energy in our patients, their care will become more scattered, disorganized, and chaotic.”