Reader, Here's a reframe that took me a while to land on. Mid-career exhaustion isn't usually about losing motivation. It's about the architecture. Early in practice, the structure is inherited — residency gave you a schedule, a team, clear expectations. The work was hard, but the container was defined. Then you become an attending. And one by one, roles accumulate. Mentor. Committee member. Department lead. More patients, more complexity, more responsibility. The weight scales. The structure...
9 days ago • 1 min read
Reader, We've talked this week about spillover. The attention tax. Decision closure. Inbox dread. The architecture of mid-career. If any of it landed — I want to make an offer. I'm a pediatrician, a physician informatician, and an ICF-credentialed coach. I work with physicians one-on-one on exactly this territory: charting, workflow, the weight that follows you home, and what to do about it. I have a small number of 60-minute sessions open. Pay-what-you-want — three tiers, you choose what...
9 days ago • 1 min read
Reader, For a long time I thought charting was a speed problem. If I could just type faster, think faster, finish faster — the day would work. It's not a speed problem. It's a rhythm problem. Here's the rhythm that changed things for me: Before the visit — read the chart. Not a deep review. Enough to hold the thread. Growth trajectory, last note, open issues. Two minutes. During the visit — build the note while you're there. Not a full draft. The skeleton. HPI fragments, plan thinking, order...
9 days ago • 1 min read
Reader, There's a difference between ending a visit and closing it. Ending a visit is when the patient walks out the door. Closing it is when the decision is finished — note signed, orders in, nothing left running in the background. Most workflows are designed around ending visits. Very few are designed around closing them. The result: a physician who sees twenty patients in a day but carries twenty open loops into the evening. Not because they're slow. Because closure wasn't built into the...
9 days ago • 1 min read
Reader, I want to say something honest about coaching, because I think there's a lot of noise around it. Coaching isn't about giving you more information. You already have more information than you can act on. It's not about motivation. If motivation were the issue, you'd have solved this already. What a good coaching conversation does is create a space to think clearly about something that's gotten tangled. To hear yourself say out loud what you've only been saying internally. To have...
9 days ago • 1 min read
Reader, Calling and career aren't the same thing. Career is what you do. The title, the specialty, the institution, the RVUs, the productivity metrics. Career is measurable. Calling is why you do it. The internal reason you walked into medicine. The thing that makes you stay even when the career part is grinding. They can coexist. For most physicians, they do — at least for a while. But career can erode calling. Not all at once. Slowly. Visit by visit, inbox by inbox, year by year. Until one...
9 days ago • 1 min read
Reader, I want to be direct today. I have a small number of 60-minute coaching sessions open. Pay-what-you-want. Three tiers: $50 / $97 / $150. Same session regardless of what you choose. No upsell at the end. No program pitch. One hour focused on whatever is most in the way for you right now — charting, workflow, the weight that follows you home, what's keeping you from practicing the way you want to. I'm also working toward my ACC credential with the International Coaching Federation, which...
9 days ago • 1 min read
Reader, Here's something most physicians never question: what their note actually has to contain. The template exists. The fields are there. So you fill them. But some of those fields are real requirements — billing, compliance, clinical safety. And some of them are accumulated inertia. Someone built a template years ago. It got copied forward. Nobody removed anything. And now you're filling in sections that serve no downstream reader. A note that says the right things in organized fragments...
9 days ago • 1 min read
Reader, I hear "better boundaries" a lot in physician wellness conversations. Set better limits. Say no more. Protect your time. And I don't disagree — but I think we're describing the outcome without naming the mechanism. Containment — the clinical work staying inside the clinical day — isn't something you decide to have. It's something you build. It's a structural outcome, not a personal achievement. When the workflow has closure built into each visit, when decisions get finished at the...
9 days ago • 1 min read