How I Think About Medicine

I have spent most of my adult life studying health from the ground up — from biochemistry and research, to medical school and residency, to more than 30,000 clinic visits as an attending internist.

My biggest takeaway is simple:

Medical knowledge is only the beginning.

The real work is understanding the person in front of me well enough to know what matters, what does not fit, and what the science actually means for them.

Experience has gifted me the ability to increasingly know:

• When something doesn't quite feel right
• When to change course
• When to be patient and trust the plan

Guidelines give me a starting point. Good medicine also requires judgment, re-evaluation, and sometimes creativity.

The knowledge matters enormously. Knowing what to do with it matters even more.

At the end of the day, good medicine starts with two people sitting down together: one bringing medical expertise and judgment, the other bringing the lived experience of actually being inside the problem.

That means conversation, collaboration, and building a relationship with enough familiarity and trust that we can actually enjoy working together.

I often ask patients, "You've had more time to think about this than anyone. What do you think is going on?"

I mean it.

The relationship can become warm and familiar, sometimes almost friendship-like, without losing the professionalism or responsibility that comes with being your physician.

Expertise matters. Distance is optional.

Sometimes the pursuit of better health accidentally becomes a source of suffering itself.

Another test. Another panel. More striving. More brute force. Another attempt to eliminate uncertainty completely.

Some of us have gotten very good at optimizing, tracking, and trying to get everything right. And still find it hard to rest, enjoy ourselves, or feel at ease in our own lives.

Health is not only about living longer. It is not even only about staying functional for longer.

It is about having enough health, energy, and wellbeing that you can turn your attention back toward the things that actually matter to you.

I like helping patients find that line: what is worth testing, what actually matters, what can be left alone, and when discipline has started to become its own problem.

Sometimes the issue isn't a lack of effort. It's where that effort is going. I've watched patients pour enormous energy into things that were never going to move the needle, while the one or two changes that actually would have made a difference went untouched. Part of my job is helping you see where your attention will actually pay off.

The point of being healthier is so you can live your life — and enjoy it.

Often, patients feel physically unwell, but despite extensive testing and multiple opinions, they still can't figure out why. Other times, there is simply so much going on that it feels almost impossible to know where to start, or how to begin getting their life back.

I understand why. Medicine is very good at problems with a clear answer. It is much less comfortable when the story is messy, several things are happening at once, or the pieces do not quite add up. That is often where patients start to feel lost.

My approach to these problems usually involves:

• A deep assessment of the situation
• Isolating the different components and weighing how much each one may be contributing
• Building a practical roadmap with concrete steps forward for each piece

In these situations, patients also need partnership, advocacy, and someone in their corner.