On Becoming a Healer

Over the past several years, contextualizing care has surfaced repeatedly on On Becoming a Healer . In 2025, contextualizing care was incorporated into new Foundational Competencies for Undergraduate Medical Education . Around the same time, co-host Saul Weiner worked with the Institute for Healthcare Improvement (IHI) to develop an online course designed to teach these skills, called  Contextuali...

What if many of the core assumptions of modern psychiatry are wrong? In this episode, we speak with internist and author Dr. Khameer Kidia about his provocative new book, Empire of Madness: Reimagining Western Mental Health Care for Everyone . Kidia argues that mental illnesses are often understood too narrowly through a biomedical lens and that psychiatric diagnoses may function less as explanati...

In last month's episode we learned that there is no evidence that time limits that impose any sort of pressure on even a small percentage of students improves test validity and that, in fact, there is ample research showing that they make tests less valid and less equitable.   In this episode we discuss how, despite the data, the NBME denies accommodations on the USMLE exams to over half of medica...

There is a widely held misperception that being able to complete a test quickly is an indication of mastery when compared with those who need more time. As a result, it is often difficult to obtain accommodations on high stakes examinations, including the MCAT and USMLE exams.  Many students who request extra time because of a disability are denied accommodations and many other students who need i...

In a recent five-part series in the  New England Journal of Medicine on the future of primary care, the author asks: "Has the long-term general doctor become obsolete? In other words, should the dying primary care system be saved?" The question itself is unsettling. Could a health system function effectively without primary care? What happens to patients when no one is responsible for truly caring...

Forty-five percent of patients who die by suicide saw a primary care physician in the prior month. Physicians screen for suicide risk just half the time when seeing patients under treatment of depression.   Meanwhile, suicide rates continue to rise in the United States and are the second leading cause of death among young people.   In this episode, Saul interviews co-host Stefan, who is leading a...

Unfortunately, bad leadership is common, with 50% of American's leaving a job because of a bad boss, and medicine is no exception.   Saul and Stefan, with a combined 60 years in academic medicine and clinical practice, share personal experiences and anecdotes that highlight the characteristics of dysfunctional and toxic leaders, and discuss their implications for health care training and practice...

Writing about the illness experience, medical sociologist Richard Frank described an unspoken agreement with his doctor that if he adopted their detached and clinical language when discussing his illness, "I would have at least a junior place on the management team." Initially it seemed like "not a bad deal," until he experienced the toll it took, concluding that, "No one should have to stay cool...

A growing number of US states and other nations are legalizing either voluntary euthanasia in which a physician (or designate) administers lethal drugs, or physician-assisted dying in which the drugs are given to the patient to self-administer. Our guest, Erica Baccus, tells us about her husband's determination to end his life rather than die of Alzheimer's disease, and the journey they took to Sw...

For years, doctors and those learning to practice medicine were told pain is "the fifth vital sign" and to treat it aggressively – including with opioids, "if that's what it takes." A consequent rise in opioid prescribing contributed to the devastating opioid crisis. Then the pendulum swung in the opposite direction, hard, with physicians cutting off opioid prescribing to patients, often without t...

From the 1940 to the 1970's, medicine went from an almost exclusively male club to a profession in which women physicians were commonplace.  Our physician guest is Dr. Anne Walling, who has written a book about the experiences of 37 women who attended a Midwestern medical school,  Women in Medicine: Stories from the Girls in White This was a time when pornographic images appeared in lecture slides...

Medical educators generally acknowledge the importance of training doctors who care for the whole patient rather than just treat the disease. Most medical school curricula attempt to teach to that philosophy, but how successful are they, really?    Our guest, Robert C. Smith, is a physician and author, who trained with Dr. George Engel, founder of the biopsychosocial model. In his new book, Dr. Sm...

Soon after Lisa Iezzoni MD was diagnosed with multiple sclerosis during her first year at Harvard Medical School, from which she graduated in 1984, faculty and administrators discouraged her from practicing medicine.  And in her final year they made it impossible for her when the dean's office refused to write a recommendation letter (now called a Medical Student Performance Evaluation).  This wee...

It is difficult to overstate the achievements of Richard Clarke Cabot (1868-1939) a relatively little-known, old-moneyed physician of the early 20 th century who was far ahead of his time in how much he contributed, and how willing he was to question his own limitations. Cabot's achievements include: creation and self-funding of the first medical social work service and establishment of the fields...

In an April 23rd executive order (EO), the president of the United States alleges that the Liaison Committee for Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) are requiring medical schools and residency programs to pursue unlawful discrimination through DEI policies. The EO calls for the US Department of Education to "assess whether to suspend or ter...

The record of physicians standing up for their values as healers under authoritarian regimes is not good, whether it's Nazi Germany, the former Soviet Union, or Iraq, with behaviors ranging from assisting in torture, to psychiatric hospitalization for political reasons. And sadly, it's often without any coercion. More subtly, physicians may go along with authoritarian regimes' demands, thinking th...

Prescription Drug Monitoring Programs (PDMPs) were originally designed for law enforcement to monitor patients and physicians for criminal behavior before it became available to health care professionals. Physicians and pharmacists often find PDMPs helpful because they can verify what a patient tells them and will often decide not to prescribe or dispense opioids if they discover their patient has...

There are a lot of videos on YouTube that feature typically young physicians explaining why they decided to leave the profession after years of dedication and hard work.   For some it appears that they were so successful at building a social media presence and related businesses, that they quit medicine. Others seem to just want to share their experience in the hope it might help others. They desc...

In December 2024, the three organizations that oversee medical school (MD and DO) and residency education released a set of " Foundational Competencies for Undergraduate Medical Education ," that represent a consensus on the observable abilities medical students should exhibit as they begin practicing medicine under supervision. Not surprisingly they include taking a relevant patient history, perf...

At a moment of increasing isolationism and xenophobia and -- for physicians – burnout, in a highly bureaucratic and profit driven health system, service in low resource high needs settings can be an antidote for what ails America and American medicine, at least for the individual clinician. John Lawrence has spent decades serving all over the globe as a pediatric surgeon, most recently in war torn...

In can be confusing and even demoralizing for a medical student or resident to understand what's expected of them when caring for patients with social needs.   They already feel overwhelmed. Are they supposed to now also screen for housing insecurity? Is it their job to intervene to address social needs? And if someone else is doing the screening, what's their role? And are they also supposed to b...

To commemorate the start of our fifth season, we revisit a conversation we had almost two years ago about the wisdom of Simon Auster, MD. Simon was a family physician and psychiatrist who inspired the conversations we've been having with each other and with guests on every episode.  "Simonisms" embody Simon's insights: pithy observations about the practice of medicine that are never cliché, challe...

The two doctors charged for their roles in the events leading up to actor Matthew Perry's death were both involved in a "side hustle": selling ketamine at a big mark-up to make extra money, above what they earned through legitimate practice. One was an internist-pediatrician and the other an emergency medicine physician.  Their cynicism was starkly evident in a text one sent the other about jackin...

The term "Narrative Medicine" (NM) refers to a range of activities, including close reading and reflective writing about literature, designed to improve the clinician-patient relationship. What could go wrong?  Our returning guest, English professor Laura Greene, lays out the case for narrative medicine, while co-host Saul Weiner highlights his concern that the challenges and rewards of interactin...

There is an idealized version of physician-patient communication that is taught in medical schools, reinforced with acronyms like PEARLS, SPIKES, and LEARN, but what resemblance does it bear to how doctors actually sound in the exam room?   Co-host Saul Weiner leads a research team that has audio recorded and analyzed thousands of medical encounters. In this episode, he and Stefan read a transcrip...