Here's a reframe that changed how I think about inbox management. The inbox isn't a communication tool. It's a demand system. Every message in it is a demand on your attention, your time, your cognitive bandwidth, or your emotional labor. The inbox doesn't sort by what you have capacity for. It doesn't distinguish between what's urgent and what's just loud. It delivers everything to the same place at the same time and leaves you to sort it. That's not a neutral design. It's a design that...
1 day ago • 1 min read
This week I wrote about warning signs. The low-grade dread before clinic that most physicians dismiss as normal. The five signals of architectural failure that precede burnout. The day I realized I was protecting myself from my patients and calling it professional composure. The loss of curiosity that isn't apathy — it's a structural output. If you read this week and recognized yourself in it — if the dread or the flatness or the protection felt like an accurate description of where you are —...
4 days ago • 1 min read
Physicians go into medicine curious. That's almost universal. The interest in how bodies work, in how people work, in the puzzle of diagnosis and the complexity of what brings someone into the room — curiosity is close to the center of what drew most physicians to the field. Which is why its absence is such a significant signal. Not hatred of patients — that's a different conversation. Not frustration with the system — that's appropriate and accurate. Just flatness. A patient presents...
5 days ago • 1 min read
There was a period in my practice — maybe six months, maybe a little longer — where I noticed something I didn't have words for at the time. I was doing my job. Seeing patients, making decisions, doing the work competently. But I had started keeping a kind of emotional distance that I hadn't had before. Not from hard cases — from ordinary ones. From the mom who wanted to talk through her concerns at length. From the parent who got emotional about something I thought was routine. I told myself...
6 days ago • 1 min read
Here are five warning signs that the structural architecture of your practice is failing. Not burnout — the precursors to burnout. The signals that arrive well before the breakdown. 1. Persistent low-grade dread around specific clinical tasks. Not hard cases — routine ones. The inbox. The charting queue. Monday morning. When ordinary parts of the job start producing dread before you've encountered them, the structure around those tasks is broken. 2. Inability to be fully present even during...
7 days ago • 1 min read
There's a specific feeling a lot of physicians know. It's not anxiety exactly. It's not dread about a particular patient or a hard conversation coming up. It's a lower, vaguer thing — a slight heaviness that shows up before you even start. On Sunday nights. On the drive in. In the thirty seconds before you log into the EMR. Most physicians explain it away. It's just how this job is. It's always been like this. Everyone feels this. Some of those things are true. Not all of them. Low-grade...
8 days ago • 1 min read
This week I wrote about presence. About why the physician who is fully present in the room isn't trying harder — they built something that stops competing with their attention. About the single structural change that most improved my own presence. About a specific clinic day that worked differently, and why. About open loops and the mechanism by which they steal the attention you're trying to give your patients. If you've read this week and felt something between recognition and frustration —...
11 days ago • 1 min read
If you've ever walked into a patient room and realized halfway through the visit that you weren't fully there — that some part of your attention was somewhere else, on something else, running a background calculation you couldn't quite turn off — you already know what an open loop feels like in clinical practice. You just may not have called it that. An open loop is any task, decision, or commitment that your brain has registered as incomplete. It doesn't matter how small. The inbox message...
12 days ago • 1 min read
I want to describe a specific clinic day. It was a Tuesday. Full schedule — seventeen patients, which is normal for my practice. Nothing unusual about the day on paper. What was unusual was that I had spent the previous week intentionally changing the structure around how I was managing notes and transitions. By midmorning I noticed something I didn't have a name for yet. I wasn't behind. Not just not-very-behind — actually not behind. The notes from the morning were closed. The referrals I'd...
13 days ago • 1 min read