"It will take years to know the extent of the damage that has been done to my soul bearing witness to other people’s suffering." Those in medicine will feel every word in this essay... those who aren't in medicine, will you bear witness to our grief? #HealingTheHealers"

I care for children in the hospital on inpatient & consult services. Most weeks there are at least a few kids admitted with vaccine preventable diseases. Often in children who can’t get vaccinated themselves. 15 years in pediatrics and I’ve never seen a single one admitted with vaccine injury.

Huntingtons disease is a devastating disease and this is absolutely extraordinary news!

“Be less curious about people and more curious about ideas.” — Marie Curie (1867–1934)

I know this is not a unique observation but public health was basically created to deal with the Spanish flu, and then a century later COVID hit and killed twice as many people and our response was to destroy public health

Caring for patients is a profound privilege. It’s also hard, complex, & emotionally challenging. Thank you for doing this work.

I will always, no matter what the circumstances, be absolutely and adamantly opposed to letting children starve.

Healthcare is a human right Pass it on

I realize broad science-literacy problems cannot generally be solved just by shoving more facts at people but I really wish more people understood that the entire purpose and mechanism of a vaccine is to educate your OWN immune system, making it about the most "natural" medical intervention possible

It’s still so satisfying as a staff physician to give my learners time at the margins… An actual lunch break, or letting them leave early when the teaching is done. Let’s keep normalizing breaks for our students & residents as much as possible.

All people deserve healthcare, when and where they need it, regardless of their background, employment status, or personal circumstances.

Hot take: Not only are work requirements for Medicaid bad, tying health care to work at all is cruel and we should be doing it less not more. Everyone deserves health care. Everyone.

Immigrants play a huge role in US health care and the hospital workforce. If we discourage them from entering the US, this can make shortages worse—causing understaffing, decreased access to care, poorer quality of care, and more burnout among clinicians already in practice.

Over one in four (27%) physicians and surgeons at U.S. hospitals, rising to one in three in FL (37%), CA (33%), NY (33%), and TX (31%), are immigrants. Policies aimed at restricting immigration could negatively impact the health and well-being of Americans. @kff.org www.kff.org/racial-equit...

Over the next 25 years, if proposed cuts in NIH funding are made real, “In a population of more than 340 million, this reflects **82 million** fewer years of life.” In the US alone. jamanetwork.com/journals/jam...

The chart: "Patient is noncompliant with her blood thinner." Reality: She lost her job, and with it, her insurance. She barely has enough to put food on the table for her kids, let alone afford the out-of-pocket cost of the medication.

If you have never stuck a needle in the back of an infant and watched pus drip out please don’t tell me I am overreacting to RFK Jr.’s latest assault on science.

Hidden hours that clinicians work: - Writing notes, charting, & answering EMR messages - Peer to peers w/ insurance - Coordinating care with specialists - Prepping for clinic - Home call - Writing student evals and LORs What did I miss?

Why do doctors work without sleep? Tradition. In the 1890s, Dr. Halsted created a model for training where residents worked nearly 24/7. Only later, we learned: Dr. Halsted used cocaine to stay awake & morphine to fall asleep, relying on residents to cover up the addiction.

Just a reminder that even when you’re trying your best, you can’t make everyone happy. You will get bad reviews. You will have people switch to a different clinician. May we all do our best to provide thorough, compassionate care, and release the things we cannot control.

Damn this piece by @iwashyna.bsky.social and Kelly Vranas is a terrific one about the importance of stories in recommendation and nomination letters www.atsjournals.org/doi/full/10....

sleep deprivation has serious cognitive effects and letting medical doctors work on schedules that don't allow them to sleep is like if we required bus drivers to slam vodka shots at the beginning of their shift, it is SO stupid and dangerous and it's exclusively because of capitalism

“No children are dying on my watch,” said Rubio. It's blatantly false. Credible estimates count 190K deaths so far. In Kenya, I am seeing devastating impact, incl this child's starvation & many deaths directly caused by Rubio’s actions. More in my @msnbc.com clip. www.instagram.com/atul.gawande...

‪Ample research has shown that clinician burnout is not due to individual weakness or a lack of resilience but a healthcare system that pushes clinicians past their human limits with overwork, little sleep, and burdensome low-value tasks. The problem is the system, not the people.‬

There is not a single congressional district in the U.S. where more than 15% of voters support cuts to SNAP, the federal program that provides food assistance to millions of low-income Americans.

Overnight Congress approved the big beautiful bill cutting Medicaid, which insures nearly 1/2 of all kids. You may think this won’t affect you but it will. More uninsured means crowded ERs, closing practices, higher costs & longer waits. Call your senators to tell them how ugly this bill is.

Female physicians receive 25 to 40% more patient messages in the EHR compared to their male counterparts. While this often increases patient satisfaction, it also increases time spent in the chart and can contribute to burnout among female clinicians.

To lower the burden of cancer: YES - Make healthy food more accessible/ affordable (food deserts are real) - Make sidewalks/communities safe for exercise - Help pol quit smoking AND - Encourage HPV & hepatitis vaccines - Increase access to cancer screening - Fund cancer research

4 things clinicians do that patients don’t see: • Answering a call from the ER at 4 am to guide care • Waiting on hold for an hour after insurance denied treatment • Coordinating care with their other doctors after work • Thinking about them in the spaces between visits

Burnout is not due to individual weakness but is "a result of healthcare systems that take emotionally healthy, altruistic people and squeeze the vitality and passion out of them." - Dr. Stephen Swensen & Dr. Tait Shanafelt

Clinicians are not superhuman. We have degrees in medicine, not martyrdom. Our health and humanity matter, too.

My daughter’s speech therapist went out of business because Medicaid reimbursement rates were too low. We do not have Medicaid. I’m going to keep posting this until people understand that when Medicaid gets cut *everyone* loses services.

All healthcare workers need mental health support, reasonable workloads, adequate rest, and an understanding that while we dedicate our lives to serving others, we are also human beings, too.

Testicular cancer was fatal in ~95% of cases before cisplatin was developed in the 1970s. Today, survival exceeds 95%, even when cancer has metastasized. That’s thanks to: Chemotherapies Scientific research Biopharmaceutical therapies Evidence-based medicine 1/

8/ Bottom line: A balanced diet, exercise, and sanitation are all important for keeping us healthy, but they are not a magic cure. Infections have historically been the top killer of humans, and if we abandon the tools we’ve created to keep them at bay, they will be sure to remind us again.

The suicide risk for female physicians is 76% higher than the general population. Women in medicine need your support. We need reasonable workloads, adequate support, respect from colleagues, equitable pay, & work environments absent of discrimination & harassment.

Well the NIH has cancelled the Women's Health Initiative, the largest study of women in history It has been running continuously since 1991 and has provided massive key knowledge about diseases in women Unreal www.science.org/content/arti...

Holy crap Indiana cut public health funding to $40 million annually The Governor's public health commission recommended $225 million annually to get us to median 2019 state spending levels Good grief

Which FDA-approved vaccines had randomized, placebo-controlled trials? ALL OF THEM. Polio? Measles, mumps, rubella? Haemophilus influenzae B? Diphtheria, tetanus, pertussis? Meningococcus? Varicella? Pneumococcus? Rotavirus? RSV? Hepatitis B? Influenza? HPV? COVID-19? Shingles? YEP. A thread🧵 1/

Foodborne illnesses surged in 2024, with bacterial cases increasing by 25% and hospitalizations and deaths more than doubling. Maybe not the best time to dismantle the FDA and USDA safety systems.

Thinking about physician well-being a lot lately. #Medsky, what would have to be true for you to experience less burnout, depression, anxiety, etc.? Even if it is impossible, I’m curious what it would be.

“what do you understand about your condition?” “only what they’ve told me” “what have they told you?” “it’s in my chart” “can you summarize it for me?” “doc, i’ve been a patient since before you were born. i know how to evade any question to conceal my cognitive decline. i can do this all day”

Heard a great talk by a commercial airline pilot about safety regulations for pilots compared to surgeons. I asked if older pilots get mad when younger pilots voice safety concerns because they think the only way to be a great pilot is to work while exhausted and he looked at me like I was crazy.

If you’re facing burnout today, remember this: You are not defective. You are not inefficient. You do not lack resilience. You’ve been asked to do more than a human being can do, while being taught to equate your self-worth with exhaustion and productivity. This is not normal.

In honor of #MentalHealthAwarenessMonth, I’d like to remind you that your body NEEDS IRON to make serotonin and dopamine and ~40% of 12-21 yo females are deficient and most don’t even know it. tinyurl.com/JAMAFe

HUGE NEWS. A study presented at #AACR25 found that one dose of the HPV vaccine (which prevents CANCER) is as effective as two, with efficacy rates >97%.

To the patients who waited an hour to see me today, thanks for understanding. Know that I was trying my best. I didn't have time to go to the bathroom or eat. I was often doubled booked because cancer can't wait. I sat with you. I cried with you. I care about you. And this takes time.

Medical students need sleep. Resident doctors need sleep. Fellows need sleep. Seasoned practitioners need sleep.

Doctors need sleep. We're not superhuman—we're just human beings caring for other humans. When we take away something as essential to our humanity as sleep, everything erodes: our ability to think, our coordination, our mental and physical health, and, sadly, even our empathy.

Incredibly honored to give the graduation keynote at my alma mater, Indiana University School of Medicine, South Bend! It was a full-circle moment to celebrate this year's graduates. Thank you to Dr. Fox & the IUSM-SB team, and congrats, new graduates!