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Health medical

The Screen Between Us: How Data Eclipsed the Art of Healing

We often think of medicine as an intimate dance between two human beings—one seeking solace, the other offering expertise and care. For centuries, the physician’s most powerful tools weren’t just pills or scalpels, but their profound presence. It was the careful listening, the observational gaze, and the reassuring touch. Today, however, a glowing rectangular barrier has been erected right in the center of the examination room.

In our relentless pursuit to optimize and quantify healthcare, we inadvertently changed the very nature of the profession. As Dr. Robert Wachter observes in A Giant Leap, the introduction of the Electronic Health Record (EHR) transformed the physician’s daily life:

“In short, the job of being a physician was transformed by the electronic health record—and not for the better. Doctors found that they were spending half their day staring at their EHR and clicking through screens, nearly double the time they spent with their patients. Physician burnout reached alarming levels in 2022, with more than half of American doctors experiencing symptoms of exhaustion and detachment. EHR documentation was a key factor, significantly diminishing both wellbeing and career satisfaction.”

We digitized medicine to make it efficient, to prevent errors, and to capture vital data. Those were, and still are, noble goals. But in our rush to catalog the patient, we inadvertently turned the healer into a data entry clerk. The cost of this digital optimization is the soul of the medical practice.

When more than half of American doctors report symptoms of exhaustion and detachment, we cease facing a mere administrative hurdle; we begin witnessing a systemic crisis of spirit. Physician burnout is rarely just about working too many hours. It is, more often, a deep moral injury. It occurs when a professional is systematically prevented from doing the very work that gives their calling its meaning. Doctors endured grueling years of medical school to heal people, to connect, and to solve complex biological puzzles—not to feed a ravenous digital ledger.

The EHR was supposed to be a tool that served the physician, a modern augmentation of their capabilities. Instead, the physician has become the tool that feeds the EHR. The documentation demands have significantly diminished career satisfaction and personal wellbeing because they sever the foundational human connection that makes the practice of medicine bearable during its darkest hours.

We are at a critical juncture. The technology itself is not inherently evil, but its current implementation is failing the very people it was built to empower. We must reimagine medical technology not as a master that demands a constant tribute of keystrokes, but as a silent, invisible servant. Until we restore the primacy of the doctor-patient relationship—until the screen is pushed aside and unhurried eye contact is restored—the exhaustion will persist. Medicine is, at its core, a deeply human endeavor. It is time we step out from behind the screen and let the healers return to healing.

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Health medical

Looking Back: Reflections on “My Life in a Sling”

It is hard to believe it has been over 15 years since I first shared the story of my rotator cuff surgery in a post titled My Life in a Sling!.

What started as a simple update about a “nasty fall in the dark” ended up becoming one of the most-read and most-commented-on pieces I’ve ever published. To date, that post has over 1,200 comments from people all over the world sharing their own recovery journeys. Looking back at that experience today, a few things still stand out.

The Original Recovery “Toolkit”

In 2009, I shared the specific things that got me through those first few weeks. Even years later, when friends ask me about shoulder surgery, these are the points I find myself repeating:

• The Ice Machine: It was the unsung hero of the first 72 hours. While it felt strange not to “feel” the cold through the bandages, it was the primary reason my pain stayed manageable.

• The “Elephant Trunk” Exercise: Those early passive therapy movements were crucial for preventing the joint from freezing up.

• The Sleep Puzzle: Navigating the challenge of being a side-sleeper forced to sleep in a recliner or on the “wrong” side remains one of the most vivid memories of that time.

The Power of the Community

The most surprising part of that post wasn’t the surgery itself—it was the 1,217 replies (and counting). It became a digital waiting room where people shared their fears about the nerve block wearing off, practical tips on how to shower with one hand, and encouragement for those who felt like their recovery was taking too long.

Reading through those comments over the years has been a masterclass in human resilience and the value of shared experience. It turned a personal health update into a community resource.

The Importance of Capturing the Journey

I originally added a note to that post about the value of personal journaling. Looking back now, I’m so glad I documented the specifics of the recovery. Memory fades, and it is easy to forget the small milestones—like the day you can finally drive again or the first night you get a full eight hours of sleep.

If you are facing a similar health challenge today, I still stand by my original advice: Write it down. Not just for your future self, but because your story might be exactly what someone else needs to hear while they are sitting in their own “sling phase.”

For those who found that original post years ago—how are your shoulders doing today? And for those just starting the journey: what are you most nervous about?

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AI AI: Large Language Models medical

Stethoscopes and Statutes in the Age of AI

David Sparks (aka MacSparky), dropped a casual bombshell on a recent podcast, the kind of offhand remark that lodges in your mind like a burr on a sock.

Paraphrasing, he said something like: “AI seems to be a boon for doctors and a threat to lawyers.” He was commenting on how he’s observed that sense among the members of his MacSparky Labs community.

It’s the sort of statement that invites you to pause, tilt your head, and wonder what lies beneath.

Sparks, a lawyer himself who gave up his legal career a few years ago, knows one of those worlds intimately. His words carry the weight of someone who’s walked the halls of courthouses and squinted at screens late into the night.

So what’s he pointing out that the rest of us might miss?

Start with doctors. Medicine is a profession of patterns and particulars, a dance between the general and the specific. A patient walks in—say, a 52-year-old man with a cough that’s lingered too long. The doctor’s mind whirs: pneumonia? Bronchitis? Something rarer, like sarcoidosis? The human brain is a marvel at this, but it’s not infallible. Enter AI, with its tireless capacity to sift through terabytes of data—X-rays, lab results, decades of case studies—and spot the needle in the haystack. A tool like Harvey, an AI platform now making waves in medical research, can crunch genetic sequences or flag anomalies in real time, handing doctors a sharper lens. It’s not replacing the physician; it’s amplifying her reach. For doctors, AI is like a stethoscope that’s upgraded.

Lawyers, though, face a different challenge. Their craft is less about data and more about argument, a tapestry of precedent and persuasion woven over centuries. Sparks knows this: he’s stood before judges, parsing statutes, coaxing juries with a turn of phrase. But here’s the rub—much of lawyering is rote. Drafting contracts, reviewing discovery, chasing down case law—these are tasks of repetition, not revelation. AI can do them faster, cheaper, and with fewer coffee stains. Harvey, repurposed for legal work, joins programs like ROSS, built on IBM’s Watson, to scan legal databases in seconds, spitting out answers that once took associates hours to unearth. For the grunt work, AI is a scythe through wheat. The threat isn’t extinction but erosion—junior lawyers, the ones who cut their teeth on those late-night searches, might find the ladder’s lower rungs sawed off.

Yet law isn’t just mechanics; it’s theater. A machine can draft a motion, but can it read a juror’s furrowed brow? Can it pivot mid-trial when a witness veers off script?

Doctors heal with facts; lawyers win with stories. AI—Harvey or otherwise—might streamline the former, but the latter resists its grasp—for now. Sparks sees a fault line: medicine gains an important new partner, law sees a new rival.

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Journaling Living medical

Lessons from 2012: Keeping a Personal Journal

Home Delivery - North Beach - 2012

Years ago, I tuned into the journaling work of Ira Progoff – reading his books and appreciating what he was advocating. But I never seriously committed to his journaling practice. Just too lazy, I think. (Yes, I did decide to start blogging over 10 years ago – but blogs and journals are different – public/private, etc.)

Earlier this year, I had surgery for prostate cancer. In the process, I reconnected with the notion of keeping a personal journal – and it’s proven to be a very valuable process for me ever since.

Here’s how that happened…

As it turns out, both my Dad and his Dad died from the effects of prostate cancer – and, as a result, I had begun a monitoring regime with my GP a few years ago utilizing PSA tests to monitor the health of my prostate. Two years ago, my PSA results crossed a threshold of concern – which led to me having a series of tests that identified I had a low grade prostate cancer.

After the tests raised the alarm, I sought the advice of prostate cancer specialists at the University of California – San Francisco. We entered an “active surveillance” program – involving periodic ultrasound examinations and PSA screenings. Early this year, my results indicated I’d crossed a threshold – where some sort of active treatment was going to be required. I opted for what’s known as a prostatectomy – a surgical procedure that removes the prostate gland and, in the process, hopefully excises the cancer. In my case, it worked very well – the cancer is gone.

I wanted to start keeping a post-surgery journal following my surgery – and, as it happened, Day One had been released just a few months before. The nerd that I am was attracted to the notion of having a journal in the cloud accessible from all of my various devices – and that’s what Day One promised to deliver. My first journal entry was early the morning of my surgery – as we were heading up to UCSF. My second journal entry was late afternoon the day after my surgery – appropriately titled “Coming Home” – describing how I was heading back home with my catheter installed and walking everywhere with “my bag” on my leg.

Since those initial entries, I’ve written at least once a day in my journal. Initially, mostly about how I was feeling post-surgery. But gradually my focus shifted – as my recovery progressed and I began writing in my journal about other, much more interesting things! Having a quick place to write my thoughts into my journal has been a delightful experience. I wish I’d started this practice a couple of years ago when I had rotator cuff surgery on my right shoulder.

As I look back on the last several months of snapshots of my thoughts captured in journal entries, I smile. They bring back memories, things I noticed at the time and would otherwise forget. Somehow having them at my fingertips just feels satisfying.

My journaling turns out to be a new treat – another lesson I learned in 2012.