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On Becoming a Healer

Saul J. Weiner and Stefan Kertesz

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Doctors and other health care professionals are too often socialized and pressured to become “efficient task completers” rather than healers, which leads to unengaged and unimaginative medical practice, burnout, and diminished quality of care. It doesn’t have to be that way. With a range of thoughtful guests, co-hosts Saul Weiner MD and Stefan Kertesz MD MS, interrogate the culture and context in which clinicians are trained and practice for their implications for patient care and clinician ...
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A recent NEJM article and accompanying podcast episode (“Tough Love”) authored and hosted by the Journal’s national correspondent sound the alarm that a culture of grievance among medical students and trainees about the discomforts of medical training is threatening to undermine both their medical education and patient care. She also describes wide…
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“Sonny’s Blues” is a 1956 story by the author, James Baldwin, about a “sensible” and pragmatic algebra teacher and his younger musically gifted younger brother (“Sonny”), who struggles with heroin addiction. Both of them, raised in Harlem, are deeply affected by anti-Black racism. Although the older brother, who narrates the story, feels responsibl…
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In a 2021 episode that we reran last month, “About me being racist: a conversation that follows an apology,” Saul talked with a former Black colleague after apologizing to her for something racist he had done twenty years earlier that hurt her for a long time. Since then, Saul has been thinking about how he got exposed to racist ideas and notions o…
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We are re-running this episode from 2021 because we’re releasing a sequel next month in which Saul reflects on his journey confronting racist ideas he’d absorbed and that became impossible to ignore after he’d acknowledged his role in the incident described here. We are also re-running the episode because it exemplifies our commitment to facing thi…
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For years, when physicians order tests to assess lung function, or blood work to determine kidney function, or look up guidelines for managing high blood pressure the results have been adjusted for race. This practice has been based on studies that seemed to indicate that the same result means different things if the patient is Black vs white. So, …
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The practice of urine drug testing during pregnancy and then often reporting positive results to Child Protective Services triggers a cascade that can result in separation of mother and newborn, with devastating consequence for both. These practices are more common when patients come from marginalized communities even when baseline substance use ra…
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Direct, covert observation of health care is a novel and underutilized tool to assess health care trainees and clinicians. In this episode we talk with experts about two such approaches: the unannounced standardized patient and patient-collected audio. In the former, actors are sent incognito into practice settings, and in the latter real patients …
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In the prior episode we learned that there is no evidence that time-limited testing improves test validity and that, in fact, there is ample research showing that it makes 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 medical students who have…
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There is a widely held perception 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 USMLE exams. Many students who request extra time because of a disability are denied accommodatio…
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Stefan interviews co-host Saul about his experiences becoming a doctor with a learning disability. This episode, first run in 2020, sets the stage for two that will follow – in August and September, with experts on the science of student learning assessment and its implications for the USMLE examinations. These will address questions such as: Does …
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A recent New York Times article, titled "When Doctors Use a Chatbot to Improve Their Bedside Manner," should raise questions about why physicians are turning to artificial intelligence for help talking with other humans. While GPTChat can generate things to say, what comes out of AI is impersonal, as it knows nothing about the individuality of the …
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The narrative that getting patients with chronic pain off opioids makes them safer was reinforced by a recent paper that got substantial media attention showing an association with reduced suicide rates at the population level -- But other data, at the patient level, shows an increased rate of suicide. Which is closer to the truth? And, if there's …
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How is it that a healing profession -- medicine -- has such a deeply ingrained culture of harming its own? And what can we do about it? In this first of two back-to-back episodes on medical student mistreatment we consider the scope of the problem and attempts to confront it. We hear from one medical school that, with external funding, developed a …
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Simon Auster, MD, was a family physician, psychiatrist, and medical educator who had extraordinary insight about practicing medicine but absolutely zero interest in drawing attention to himself. His students and patients had the good fortune of having him as their teacher or doctor but far too few have benefited from his wisdom. Today we discuss so…
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Medical training and practice habituates physicians to a culture that narrows the possibilities we see for finding joy and meaning in our work. We often become efficient task completers, stuck in routines, and prone to burnout. Saul and Stefan discuss a set of questions that challenge physicians to look at their work and themselves in fresh ways, c…
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In October, the New York Times published the first of several articles about an eminent professor at NYU who was dismissed after his students complained that his organic chemistry class, essential to medical school admission, was too hard. Thousands of comments were unsympathetic saying, essentially, that students who couldn't hack it shouldn't be …
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Today, Stefan talks with Saul about his favorite topic (and life's work), contextualizing care. We're re-releasing this conversation (from January of last year) because Saul's research team has just published a new study -- an RCT, titled "Effect of Electronic Health Record Clinical Decision Support on Contextualization of Care: A Randomized Clinic…
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Recent articles in mainstream media about "medical gaslighting" have struck a nerve with thousands of comments on social media platforms. People are complaining about how their doctors are treating them, with women and underrepresented minorities disproportionately telling some of the worst stories. Meanwhile physicians are responding, mostly on th…
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Urine drug screening (UDS) is used in the care of patients with opioid use disorder, and for patients receiving opioids for chronic pain. There's no strong evidence that testing helps patients, however, and no consensus on what to do with the results anyway. These tests, often mandated, may cause serious harm when physicians don't realize how often…
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Making it into and through medical school is tough even for those who have all the advantages: excellent schools starting at a young age, well-educated parents who may be doctors themselves, lots of role models and…white skin. In this episode we hear from two pre-meds and one newly minted physician, all Black, about their journeys with few of these…
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Medical students may be subject to professionalism review by committees, most commonly for “unreliability” such as not responding to emails, falling behind on compliance requirements, showing up late for assignments and so on. Then they hit the wards, and frequently experience mistreatment by residents and attendings (many of whom also don’t answer…
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Many residents are not doing well, psychologically, and sometimes physically -- and with good reason. High levels of mistreatment and harassment, patient care that some experience as moral injury, and a lack of voice in the workplace, contribute to burnout and can adversely affect the kind of physicians people become. A growing path to empowerment …
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The opioid crisis was precipitated by physicians overprescribing opioid pain medication, egged on by the pharmaceutical industry, contributing to suffering and death from addiction and overdose. Now, many physicians are forcibly cutting patients off of opioids and refusing to prescribe in the setting of a backlash, contributing to suffering from pa…
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On January 1st, the New York Times ran a story about prenatal genetic tests that are "usually wrong" -- but they got it wrong. These are actually just tests to tell if someone is high risk. The real story is that clinicians are not communicating with patients about what these tests mean, causing confusion and trauma. This happens across medicine an…
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There are two qualities we may experience in others who comfort and ground us when we feel vulnerable and lost. First that they engage with us, meaning that they are fully present with a sense of shared humanity. Second, that they respect our personal boundaries and know their own. Such boundary clarity makes them a safe sounding board. In this epi…
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Lately we've been hearing about bad behavior on airplanes. Here we discuss an incident in which a passenger unselfconsiously stepped up at an inconvenient time to assist a group of passengers in a tough spot. Saul and Stefan reflect on the qualities of people who go through life making the world a better place in small ways. As millions travel duri…
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Our guest, a resident physician, describes her reaction and what followed, when she discovered a symbol of hate tattooed on her hospitalized patient's leg. Most of us appreciate that as physicians we don't get to choose who are patients are, and that all deserve good care. But is there more to it than that? Can one grow as a physician and person, a…
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In a widely reported incident, Dartmouth Geisel School of Medicine accused, suspended and expelled medical students for cheating based on faulty data -- and then retracted the decision amidst a large public backlash. During the episode students were allegedly given only 2 minutes to defend themselves and were encouraged to plead guilty. When they c…
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A physician describes what attracted her to international medicine where she’s worked for Doctors Without Borders in many challenging places. Guest: Naina Bhalla MD, MPH Intro and Outro are Prelude by J.S Bach, arranged by Sophocles Papas, with permission from Carl Fischer. Also, Largo from Four Seasons by Vivaldi, arranged Per-Olov Kindgren. Guita…
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Introducing a new podcast that takes a critical look at medical training and the culture of medicine. Explores how interpersonal boundary clarity and the capacity to fully engage are essential to effective medical practice, mentoring, medical education, and a nourishing career. Designed to challenge you, help you grow, and prevent burnout, The podc…
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