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Generative AI systems can create references to papers that do not exist and make them look real. In medicine, a fabricated or poorly verified reference is not simply a bibliographic error. It weakens the chain of evidence on which reviews, guidelines, teaching, and clinical judgment may depend.

As a physician, telling my patients “no” never gets easier. In some cases, I have good reason, such as declining to increase opioids because of the risk of side effects. In other cases, I can only gently tell patients, “The health care system doesn’t want to pay.” In the coming months, I will be saying “no” a lot more often.

There are some patients whose names change the atmosphere of a day before they have even entered the room. You see the name on your schedule and feel it immediately. It may be a glance at the clock, a slight tightening in your chest, or the quiet hope that the visit might somehow be shorter than you remember. Every clinician knows this feeling, although few of us admit it openly. The patient who is always angry. The patient who never seems satisfied.

The heaviest things we carry are rarely the tasks. They are the standards we never thought to question. My morning mental routine: Who is picking the kids up? What are we having for dinner? What time do I need to be at work, and how much is on my plate there? What time do I need to pick the kids up in time to make dinner? Maybe we will just eat takeout today, but what will everyone be happy with? When am I finally going to plan and prep our dinners for the week on the weekend?

The cold coffee cups are the least of it. They sit abandoned on desks and in reporting rooms, small monuments to interruptions, unfinished tasks, and priorities that shift by the minute. Beside them stands the inevitable glass of lukewarm water, another reminder that even the most basic needs are often postponed in the service of someone else’s urgency. What is far more difficult to ignore are the sleepless nights. The anxiety does not come from the complexity of the work itself.

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Most women lose feeling in their chest after a mastectomy, and almost no one warns them ahead of time. Emily Hansen, a patient advocate who has spent nearly two decades in health care communication working with surgeons and breast cancer survivors, joins to explain a consequence of survivorship that stays largely hidden.

Recently, I called the office of my primary care physician. I asked the person who answered the phone, “Will the doctor sign an FAA BasicMed form?” The person said, “Let me check,” and returned a minute later. “She cannot. You need to see an FAA doctor.” I tried to explain that she could, but I could not convince the desk person. The following explains BasicMed, the Federal Aviation Administration (FAA) program for pilots.

We have spent years talking about what is wrong with nursing culture. “Nurses eat their young.” New nurses leave too soon. Burnout is everywhere. Tension on the floor feels almost expected. We have named it. We have seen it. Most of us have lived it. But naming it hasn’t fixed it. If anything, the conversation keeps circling the same territory without getting any closer to the root of it. And I think that is because this goes deeper than behavior.

Medicine likes to imagine that leadership follows predictable paths. We talk about “career tracks,” “pipelines,” and “development pathways” as if the profession reliably produces clinicians who can lead research, deliver complex care, build systems, and teach the next generation. But anyone who has spent a lifetime inside the machinery knows this is a myth. These domains rarely overlap. In fact, they often conflict. And yet, every so often, a career emerges that integrates all four.

A Black medical student with top board scores applies to cardiology fellowship. She has no research mentor, no letter from a famous cardiologist, and no one to tell her which programs to target. She does not match. The system calls it merit. But was it? Health inequity is often discussed at the bedside, focusing on access to care, treatment decisions, and clinical outcomes. Yet by the time a patient reaches the hospital, many forces shaping their health have already been set in motion.