Show Notes
In his book, The Present Illness, American Health Care and Its Afflictions, physician and historian Martin Shapiro, MD, PhD, MPH presents a scathing critique of a profession suffused with status, money, and power. At the same time, he also describes many deeply caring and rewarding patient care experiences, his own and those of colleagues. But these relationships are only possible when the clinician has a clear understanding of the pernicious corrupting forces in medicine and consciously rejects them. This is a moral act that must be renewed continuously. They also require a capacity to confront one's own insecurities -- Dr. Shapiro describes years of psychotherapy that were essential to his own growth as a physician who can be fully present in the face of suffering. Martin indicts the profession for producing far too many doctors who want to get rich and who are unprepared, through a faulty process of selection and training, to be truly caring towards those they serve. Martin reminds us that the motives of the profession have long been suspect, quoting Plato's Republic in which Socrates asks, "Is the physician a healer or a maker of money?" Never before, however, and nowhere on the scale found in the United States has health care become such a massive industry, one that keeps growing. Martin argues that the profession can only heal itself if it confronts its demons honestly and openly, beginning at the earliest stages of medical training.
More from On Becoming a Healer
As On Becoming a Healer begins its seventh year, Stefan turns the questions on Saul: What does it actually mean to "become a healer"—and why does that idea remain at the center of both the podcast and Saul's 2020 book, On Becoming a Healer: The Journey from Patient Care to Caring About Your Patients? Beginning with an encounter in which a patient's worsening back pain could not be understood apart from a devastating recent trauma, Stefan and Saul explore the difference between treating a clinical problem and engaging with the person experiencing it. They consider why genuine engagement is not friendship, forced intimacy, "good bedside manner," or additional emotional labor; how boundary clarity makes openness safer; and why medical education has such difficulty teaching something that cannot be reduced to a script or competency. In a profession increasingly shaped by financialization, bureaucracy, and the efficient-task-completer mindset, it is not enough to ask what physicians are against. We must also ask what they are for. This episode argues that engagement is not an optional grace note in medical care. It is medicine's missing center—and the foundation of a healing interaction.
What happens when a healthcare system organized around profit repeatedly gets in the way of doing what is right for patients? Physicians for a National Health Program (PNHP) calls one consequence moral injury: the distress physicians experience when the system prevents them from providing the care they believe patients need. PNHP president Diljeet Singh, MD, DrPH, joins Stefan and Saul to discuss the organization's recent report on moral injury and the financialization of American medicine. Saul strongly shares PNHP's commitment to universal health care—but challenges whether the language of moral injury puts too much emphasis on what the system does to physicians and too little on physicians' own agency and responsibility within that system. What follows is a candid and provocative exchange that begins with substantial agreement about what is wrong with American health care and the need for universal coverage, but moves into harder questions about moral distress, physician complicity, professional responsibility—and how much courage we should expect from doctors when doing the right thing comes at a personal cost.
Fazlur Rahman, a retired oncologist, is the author of The Temple Road, a richly evocative memoir about growing up in what was then East Pakistan, before it became Bangladesh. His second book, Our Connected Lives, chronicles several patients he cared for during his 35 years as a cancer doctor in West Texas – and his relationships with them in the rural region where he was the only oncologist. Fazlur is a gifted writer who became a beloved physician in a community that needed him. Fazlur also faced prejudice along the way, and his story is a reminder of how much America gains from those who come from seemingly far-off lands. It is an inspiration and illustration of humility, presence, compassion and joy in patient care.
Most of us who care for patients can remember seeing a name on the schedule and feeling our heart sink. What makes some clinical relationships so difficult? Is it something about the patient—or something about the interaction itself? Dr Jeffrey Jackson has spent more than two decades studying this question. His research has shown that difficult encounters are associated not only with patient characteristics but also with physician factors, including the clinician's approach to psychosocial issues. In this conversation, we explore what his work can teach us about why encounters become difficult, how trust can gradually emerge, and why some of the patients that physicians initially dread eventually become among the most meaningful to care for. Along the way, we discuss chronic pain, personality disorders, longitudinal relationships in primary care, the role of physician self-awareness, and the difference between caring for patients and trying to control them. This episode asks what it means to remain present with patients whose suffering—and whose behavior—challenge us the most.
Over the past several years, contextualizing care has surfaced repeatedly on On Becoming a Healer. In 2025, contextualizing care was incorporated into new Foundational Competencies for Undergraduate Medical Education. Around the same time, co-host Saul Weiner worked with the Institute for Healthcare Improvement (IHI) to develop an online course designed to teach these skills, called Contextualizing Care for the Clinician (IHI Open School). Now that the course has been added to IHI's subscription-based Open School curriculum, making it available to learners at hundreds of subscribing institutions, we thought it would be a good time to revisit several conversations from past episodes that illustrate what contextualizing care is, why it matters, and how we can teach it.