Notes in the Margin - 14 July 2025
Notes from a Family Meeting is a newsletter where I hope to join the curious conversations that hang about the intersections of health and the human condition. Poems and medical journals alike will join us in our explorations. If you want to come along with me, subscribe and every new edition of the newsletter goes directly to your inbox.
Every so often, I’ll share things I’ve been reading with a few words of mine scribbled in the margins. If you have something to share, please do! The comment section is open.
Who owns the future? Ways to understand power, technology, and the moral commons
John Adams came to mind as I read this: “Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.” Of course, the Constitution was written at a time when black people weren’t counted as persons, so religion is not guarantee of democracy. However, without virtue, democracy sinks under illiberalisms on both sides of the aisle.
The ideology of machines: Medicine in life and death
reflects on several areas of medicine, from the beginning of life to its end, using Neil Postman as a guide. In many ways, she grapples with the questions that have been our companions in Notes from a Family Meeting.Hippocratic Forum podcast - Therapeutic presence with Keri Brenner
Keri Brenner is a palliative care doc and a psychiatrist. Here she explores the vital concept of therapeutic presence and how any clinician can cultivate it in their daily practice. This is medicine 101 and timely as we look forward to a new academic year.
The hospital: a total institution
Chad Raymond, writing at
, is suspicious of hospitals and the people who work there. He’s earned his suspicion, having had his own experiences suffering at the hands of clinicians who wouldn’t listen. He doesn’t comment on this, but I wonder if one of the postures of reform for clinicians working within a total institution is humility.From
: “When you embrace a technology that automates tasks to save time, you allow AI to reshape your working conditions. This opens the door for future automation and possible devaluation of your skills. Few industries will allow an employee to gain six weeks of time without adjusting their workload by increasing the tasks they need to perform or cutting their wages in response.” This is why I’m suspicious whatever efficiency gains AI offers to beleaguered clinicians will eventually be lost as workload increases. AI efficiency hype reminds me of mid-century advertisements for microwave ovens: they were going save us so much time! How many people now relish the fact that they can “cook a whole meal” in a microwave and have so much more time for other activities?Doctors don’t get much menopause training. State lawmakers are trying to change that.
A major concern, from both clinicians and the general public, is that lawmakers don’t belong in the clinic. This is cited in matters from vaccination to abortion. Here we have an instance, though, which suggests the California legislature believes the self-regulatory mechanisms to keep physicians well-educated about menopause have failed. The remedy is a legal intervention. The interviewed clinicians who are resisting this change feel like you can’t mandate that physicians learn everything (true) and that physicians are best suited to decide what they need to learn that’s relevant to their practice (probably not true, but is that for a lawmaker to decide?). Medicine and law are intertwined; the question isn’t whether law will influence medical practice but how.
Improving patients’ treatment expectations
A brief commentary, useful for July interns and seasoned clinicians alike. Setting expectations for patients (and oneself) is critical to informed consent. It’s also important for patients as they plan their lives, and it can help as things come up along the way that adverse effects or treatment failures don’t come to them out of the blue.
Past Present and Future (podcast): The History of Bad Ideas: Value-free Tech
Shannon Vallor sharing her perspective on the embedded values of technology. Many people believe technology is neutral or “value-free.” I disagree and so does Vallor. The way technologies are designed lend themselves to one use over others. So, while I could use a knife to hammer a nail, the design of the knife lends itself to cutting. Likewise, an assault rifle doesn’t lend itself to hunting animals but to the mass killing of humans. The electronic medical record, as designed, lends itself to billing and meeting regulatory requirements first and foremost, not necessarily clinical care.
From the Archives
Here's something, only a little dusty, that new readers may not have seen.
How should we think about the role of patient autonomy in setting the goals of medical care? Should we ever limit autonomy and, if so, why?
Autonomy, Values, and the Goals of Care
Welcome to the third volume of Notes from a Family Meeting! It’s not really the third volume, since many of the editions of the first volume were just selected readings I sent to my mentees at the time and transferred over to this platform. Wherever we are, I’ve enjoyed working out my thoughts in this space, in conversation with others. I hope you’ve be…
