Dr. Danielle Ofri – The Significance of Humanity in How We Approach Healthcare

Internist, professor, editor-in-chief, and author, Dr. Danielle Ofri, a prominent voice in the medical world, delves into the complex dynamics of hierarchy in medicine, the emotional burdens that doctors often bear, and the profound impact that active listening can have on doctor-patient relationships.

Can humility help prevent medical errors? Are we stretching providers too thin? Can active listening not only improve relationships but overall patient care as well? Tune in for a thought-provoking conversation that challenges the way we approach healthcare, communication, and compassion in the medical field.

Here are four takeaways from this episode with Dr. Danielle Ofri:

1. Medical Error Should Be Reframed as Patient Harm

Dr. Ofri emphasizes that the traditional view of medical error—focusing on dramatic mistakes like wrong-site surgery—misses the broader picture. Many instances of harm result from complex, multifactorial situations. By shifting the focus from blame to understanding systemic contributors to harm, healthcare can better address safety and improvement.

2. Hierarchy in Medicine Can Be Dangerous

The episode explores how rigid hierarchies in medical settings discourage open communication, especially among trainees. Fear of speaking up can lead to preventable harm. Dr. Ofri advocates for leadership that models humility and openness, which fosters safer environments and more honest discussions about mistakes.

3. Emotional Toll and Moral Injury Are Widespread

Dr. Ofri discusses the overwhelming emotional burden clinicians face, especially when systems stretch them too thin. She critiques superficial solutions like “resilience training” and calls for structural support—such as adequate staffing and time—to prevent burnout and moral injury, which arise when clinicians are forced to deliver substandard care.

4. Active Listening Enhances Patient Care

One of the most powerful tools in medicine, according to Dr. Ofri, is simply listening. Allowing patients to speak uninterrupted for even 90 seconds can improve trust, reduce errors, and lead to better outcomes. Respectful communication not only benefits patients but also reduces the likelihood of litigation and strengthens the doctor–patient relationship.

Transcript

Danielle Ofri:

Because it points out without saying it that hierarchy is a leading cause of patient harm, right? People are afraid to speak out because of hierarchy.

Michael Jerkins:

Welcome back to the podcast For Doctors, By Doctors. I’m Dr. Michael Jerkins.

Ned Palmer:

I’m Dr. Ned Palmer. Thanks for joining us today. Michael, how you doing?

MJ:

I think I’m pretty good. I’d say average about a, I don’t know, seven, seven out of 10.

NP:

That is maybe—you know, if you’re split sometimes between being an internist and a pediatrician, I want you to know that I am average. And then giving it a scoring system is pretty internal medicine. What if I said…

MJ:

What if I said, I’m a slightly upturned smiley face? Would that be more pediatrics?

NP:

Yeah, I mean, you just emoji’d it, so I think that is by definition in some ways. You can—you contain multitudes. I appreciate that about you.

MJ:

There you go. Just the beauty of Med-Peds, as we say. Sarcasm with hugs—another way we say it.

NP:

Sarcasm with hugs. What was the other one?

MJ:

On the shirt. I don’t know, I only remember that one. Which actually, Ned, is a pretty good segue to our guest today. It was not planned, by the way. This segue was not planned. Someone who writes—it’s really incredible, I think, over the last… maybe it’s just where I’m at in my career, but I do feel like there’s a lot of progress and a lot of voices now speaking on some of the issues doctors face today: communication, medical error, the emotional toll of treating patients. And Dr. Ofri, who we have on the show today, is probably one of the foremost voices on those topics. So I don’t know how she feels about sarcasm, but probably not the best way to communicate, I’d guess.

But I’m really excited to be able to talk with her.

NP:

I can’t wait to ask her about how humor injects into medicine. No, I’ve been following Dr. Ofri’s research for quite a while, right? I think she’s written maybe more than six or seven books at this point.

One of the many hats that you and I wear—that you all know—is one that I’m deeply interested in: ethics and bioethics as an injection into medicine. We’ve absolutely used Dr. Ofri’s work before, spoken through some of the books and writings she’s done, and some of her work in The New Yorker—on what are the ethical requirements and duties of a physician? How do we communicate about harm to each other? How do we communicate to other physicians? How do we communicate to patients about it?

It’s really a wonderful world, because ultimately what that all goes back to is supporting doctors. It’s harm through the interest of punitive behavior and of lashing out at doctors. It’s: how do you protect yourself knowing you’re in an industry where even the best decision can cause harm? Even the right decision can cause harm.

Even if you use a scoring system like “How am I doing today from zero to 10,” that’s just a probabilistic measure. It’s not completely accurate, and we need to be comfortable with these things working in something as complex as medicine.

MJ:

Yeah, well, let’s get to the interview with Dr. Ofri.

NP:

Dr. Danielle Ofri is one of the foremost voices in the medical world today, speaking passionately about the doctor-patient relationship and bringing humanity back to healthcare. A practicing internist at Bellevue Hospital, the nation’s oldest public hospital, and a clinical professor of medicine at NYU, she’s also the founder and editor-in-chief of the award-winning journal Bellevue Literary Review.

Her writing appears in The New Yorker, The New York Times, Slate, The Lancet, New England Journal of Medicine, as well as The Best American Essays and The Best American Science Writing. She has performed stories for The Moth, and her TED Talks include Deconstructing Perfection and Fear: A Necessary Emotion.

A recipient of a Guggenheim Fellowship, the National Humanism in Medicine Medal from the Gold Foundation, and an honorary Doctorate of Letters, Dr. Ofri is the author of six books about life and medicine. Her newest book is When We Do Harm: A Doctor Confronts Medical Error.

She is unequivocally our most published guest on this podcast. Thank you so much for joining us today.

DO:

Thank you, it’s a pleasure to be here.

NP:

I’d love to dive into medical errors. Let’s start with the fun bits—let’s lay it all out right up front. I remember training 10 years ago: medical errors were this thing we lived in fear of. The sense was: you’ll make an error, you’ll flame out, it will compromise your career, you won’t get through. It was all seen through this lens of fear and punishment.

But I’d love to step back. I feel like I’ve got an evolved sense of where we stand with medical errors, but you’re the specialist. My opinions aren’t as valuable as yours. Please talk to us about where you see the problems in the US healthcare system in how we deal with medical errors—and frankly, how you came to develop a passion in this space.

DO:

Sure. Well, I’ll preface this by saying I’m actually not an expert. There are people who really are experts in the field. I come to it like you do: I’m a primary care doctor.

I came to it when that article came out in BMJ about medical error being the third leading cause of death. My publisher sent me a note saying, “Is this really true?” And the truth is, I didn’t know. I work in a busy public hospital. If medical error is the third leading cause of death, I should be seeing tons of it, right? Almost as much as heart disease and cancer. But I’m not.

So either the data are wrong, or we simply have blinders on. That’s kind of how the book came to be. We could talk for an hour about the pluses and minuses of that analysis. Short answer: probably not the third leading cause of death, but it’s not a small thing. There are a lot of errors.

What I’ve come to understand—and what I think we as a field understand—is that we really want to broaden the idea. When we think about medical error, we think of amputating the wrong leg. That’s an error. But there are lots of things that fall into a gray zone. Did the error cause the death? Imagine a patient with cirrhosis gets the wrong antibiotic and dies. Was it the cirrhosis, or the antibiotic error, or both?

Most patients who have “medical errors” are very sick with multiple issues. That’s why it’s so hard to tease out causality. Nevertheless, we’ve moved ahead in terms of thinking about patient harm.

If you’re the patient, does it matter if it was an intentional error, an oversight, or a judgment call? If you’ve been harmed, if you’re in renal failure and on dialysis, it doesn’t matter. So we want to group all patient harm together.

If you get a decubitus ulcer—whether the nurse didn’t turn you enough or it was just bad outcomes—it’s still a bad ulcer. Thinking about patient harm lets us broaden the lens, both in how we tally what goes wrong and how we approach it.

Because if we only chase “bad apples,” we’re missing the bigger picture. We all know about near-misses. That’s really where we need to focus, because those are the minefields.

If we only focus on wrong-site surgery or a wrong IV fluid, we miss the enormous space where patients can be harmed. Thinking more generally, less punitively, helps us a lot.

NP:

I heard you hit on something right there in the beginning: the difference between a patient dying with an error and dying of an error. Am I tracking that correctly?

DO:

Right. And it’s just very hard to know.

NP:

Because of causality, right? Especially in chart reviews—these are post-hoc analyses. You’re looking back, and how much of that represents what was really happening in the moment? There are almost layers of obfuscation that make this difficult to unpack.

DO:

Right. And I think when people outside of medicine look at medical error, they don’t grasp what it’s like inside when caring for a complex patient. In the hospital, a patient may have 16 issues, 55 medications and drips, 20 consultants. There’s so much going on. To tease out one factor as the cause—it’s almost impossible.

Sure, sometimes someone grabs the wrong syringe. But 98% of the time it’s an amalgam: bad luck, bad outcomes, bad disease, and everything else. We want to prevent what we can, but if we chase after “the one thing to blame,” we waste energy and get nowhere.

NP:

Mm-hmm, completely. In your initial answer, you mentioned there’s a history to medical errors. We’re coming up on the 25th anniversary of To Err Is Human from 1999. I think it ignited this talking point that medical error was the third leading cause of injury or death.

You said the language has shifted to “harm.” What other changes have you seen in how healthcare has adapted since then?

DO:

I think another shift is focusing less on punishment and more on the conditions that make an error likely. Sure, the nurse grabbed the wrong bag of fluid. But: do all the bags look the same? Are they stored in a poorly lit room? Does the nurse have too many patients?

There are systemic factors that increase the likelihood of error. Think of look-alike syringes, overwork, poor labeling. We can’t eliminate all error—that “zero vision” sounds great on a bumper sticker, but it’s not realistic. We’re human. If reported error is “zero,” it means the data are being fudged.

Instead, we should think about mitigation. How do we make healthcare safer, reduce danger zones, and lessen the probability of harm? If you just fire everyone who messes up, no one will be left. And no one will speak up about near misses if they’ll be humiliated or fired.

So the shift is: less litigious, more focused on making care safer for patients and practitioners—because harms happen to providers too, from needle sticks to psychological trauma.

NP:

I imagine there have been some big improvements in how healthcare addresses these risks. You mentioned “danger zones.” Can you explain that?

DO:

I didn’t know it was a real term—I just think of it that way. For example: in the OR, anesthesiologists hook up multiple gas tubes. If mixed up, the patient can die. First, they color-coded them. But errors still happened. Finally, they made the valves and tubes different sizes so they can’t be mixed up.

It’s not rocket science. Think about your food processor—you can’t turn it on unless it’s locked. Cars don’t start until you put the seatbelt on. These are simple safety measures.

In medicine, we have dangerous duplications: different concentrations of heparin, epinephrine 1:1000 vs 1:10000, look-alike or sound-alike meds like Lamisil and Lamictal. Why do we even allow that? There are lots of things we can do better.

MJ:

Absolutely. And speaking of things we can do—I’m curious what you’ve seen over the years in residency training or medical school, specifically in how doctors are trained to think about medical error and talk about it openly. Have you seen evolution there?

DO:

Well, I do see now that we have kind of a new generation of doctors who are the attendings for those, because you know, the attendings for us were kind of a generation a little bit bygone—that model of the “perfect doctor.” Either you’re perfect, or you go work for the pharmaceutical industry, or there’s something in between. It was perfection or failure.

I think we’ve gotten a bit out of that mindset. Now, we have many more doctors who are comfortable talking about their errors. I’ve seen attendings who, on day one, tell their team: Here are the top five errors I’ve made, the big ones. I’ll spare you the other 50. When you make your first error—not if, but when—you’ll come talk to me. I’m not going to scream at you, throw you out of the program, or give you a bad recommendation.

That kind of modeling, coming from the top, is much more common now. I don’t think I ever heard an attending tell me about an error—or their errors—when I was training. You just got screamed at by the division chief.

I’ve also seen M&Ms now where more senior people come up to the stand. Not just the intern, but the division chief, the attending—we can all talk about this together. It’s really this sort of team issue and not about putting one person on trial. That’s been a salutary change in medical education.

MJ:

Yeah, I think the whole modeling aspect is really important. If you don’t see someone modeling that in training, it’s hard to know how to do it yourself.

I think about being transparent as an attending with trainees—sharing times when you had to brush up, ask a colleague, or go read more. The purpose of training isn’t to know everything—because nobody does. The purpose is to understand how to look things up, how to treat patients, and how to find answers.

Ned and I talk a lot about this, especially in the summer months, July and August. It’s refreshing when interns or trainees are unafraid to say, I don’t know, but let me find out. That transparency and willingness to admit when something didn’t go exactly right makes patients much safer.

DO:

Do you remember any attending modeling how to talk to a patient about a bad outcome? I don’t. If I had seen that, I would remember it. The fifty kinds of vasculitis are gone from my memory, but an attending showing us how to tell a patient or family about a mistake—that would have stayed with me. That’s a lesson that has to be modeled. You can’t learn it from PowerPoint or a textbook. You need to see it done thoughtfully and sensitively.

NP:

I’ll tell you what I remember. In First Aid Step 1, there was an acronym for breaking bad news. They’d test you on it with a multiple-choice question—one of the most complex things we struggle with, reduced to an acronym. It was the SPIKES acronym. I still remember the letters, not what they stand for.

But it was all external: how to disclose a devastating diagnosis or new finding. There was no reflection that bad news might come from a mistake, an error, or even our best intentions gone wrong. That was the only “training” we had, and it had nothing to do with error.

DO:

When I actually saw an attending break bad news to a patient in a humane and empathetic way—that I remember. Those moments stand out. Those are my role models.

NP:

Yeah, I think some days I’m still channeling those experiences—just parroting what I saw work. Training is critical. Have you seen more formalized programs for this—like in med-peds or internal medicine residencies?

DO:

I can’t say I’m deeply involved in curriculum planning, but I do see a little more openness—less of a litigious approach, more of a “Swiss cheese model” mindset. The M&Ms I’ve witnessed recently are much less about blame. They’re more about figuring it out together, not crucifying someone at the podium.

That shift is an incredible gift to trainees. They see us wrestle with the reality that things will go wrong. The other side is educating the public: medicine isn’t perfection. It’s not Amazon. It’s infinitely more complex.

We often compare to aviation, but there are a finite number of airplanes. With humans, you have infinite combinations of diseases, presentations, and psychosocial factors. A checklist doesn’t cover that.

So talking more openly with patients about uncertainty, diagnostic probabilities, and ambiguous results is crucial. People want yes/no answers, but most of medicine is about probability. Helping patients understand that is a big part of our job.

MJ:

Can I ask—because we may have listeners who don’t know—what exactly is an M&M?

DO:

M&M stands for morbidity and mortality rounds. It’s where departments present cases where something went wrong—sometimes harm, sometimes death—and discuss what happened and how to improve.

My first M&M was on a surgery rotation. We were in this huge conference room, with the chair at the head of the table. The chief was a small Texan man with a huge personality who terrified everyone—attendings, deans, everyone.

There was an error in a case. He pointed to a resident and said, in his drawl: Why even operate? Just take the guy to the parking lot with a rifle and shoot him. Why even operate?

The resident turned gray. I thought we’d have to call a code. I was just a medical student, but I learned three things that day:

I am never making an error. I’ve got to be perfect.

If I do make an error, I will never tell anyone.

I’m not going near the surgery department parking lot.

That was our education about medical error. And it stayed with me all these years.

But it certainly didn’t encourage openness. I doubt that resident actually killed the patient. But the way it was handled made it impossible to talk honestly about falling short.

MJ:

Absolutely. Where Ned and I trained, the conference was technically called M&M&I—morbidity, mortality, and improvement. The idea was to focus on improvement for patient care, which didn’t always take up much time, but at least it acknowledged the goal.

I’ve got plenty of traumatic M&M stories myself—especially in trauma surgery, and OB-GYN was tough too.

NP:

Gen surg. Shocker there.

DO:

The biggest nod to humanity I saw in surgery M&Ms was when they passed around peanut M&Ms in a suction canister. That was their version of lightening the atmosphere.

NP:

That’s wild. I still remember my first—and probably most traumatic—M&M. General surgery again. A patient had gone into AFib with RVR post-op after a big laparotomy.

I thought that was the worst possible thing that could happen to a patient. Later, in internal medicine, I realized it’s something you see almost nightly on call. But because of how that case was presented—and how the resident was treated—I carried the idea that AFib with RVR was catastrophic. It completely warped my sense of risk.

DO:

That brings me to another interest of mine: emotions. Emotion-laden experiences sear themselves into us—for better or worse. They shape how we learn.

Take handwashing. We put up signs and screensavers, but people forget in 10 seconds. Imagine instead the attending walks into a patient’s room, puts their stethoscope on the chest, then turns and asks: What did I do wrong?

Someone says: You didn’t wash your hands. Then the attending asks: So why didn’t you stop me?

That emotional moment highlights hierarchy as a cause of patient harm. People are afraid to speak up. Modeling that dynamic in a safe way teaches far more effectively.

NP:

That ties into something Michael and I discuss a lot: medicine is hierarchical, and sometimes it has to be. Responsibility has to stop somewhere. But how do we break down unhealthy parts of hierarchy without losing respect and order?

DO:

I think it starts at the top. Leaders modeling openness and honesty. Competence plus humility actually builds respect. Students don’t lose respect for an attending who admits mistakes. If anything, they gain respect.

So we need to stop doubling down and pretending to be infallible. Owning up to mistakes—even in the moment—defuses tension and builds trust. I do it with my teenagers all the time. I screw up, I admit it, and we move on. It works the same in medicine.

NP:

Mm-hmm.

MJ:

And you’ve also written about the emotional toll doctors take on from caring for patients. How widespread is that problem, and what’s being done in a positive way to address it?

DO:

So for starters, 100%, right? Everyone has an emotional toll of that. I just came home grumbling yesterday to my husband. We have a new patient session every other week and we’ve traditionally had 40 minutes for a new patient, but because of the overwhelming demand in New York City for people who need care—many of whom are under- or uninsured, including migrants and New Yorkers—the demand is so high that they’ve cut it to 20 minutes. Which I understand why, but man, every single patient came.

It was so overwhelming and I couldn’t finish with each patient. I kept leaving one thing undone, going to the next patient, then leaving another thing undone. Leaving things undone just undoes me. I like to finish it, close it, move away. I was starting to mix up patients. I had three patients in a row with knee pain. They were very different, but I mixed them up because they had the same chief complaint.

And so I think everyone feels overwhelmed by the gravity of what we do. If you do mix it up, it’s not widgets on a factory line. These are people. One guy came in as a new patient whose last A1C was six—so pre-diabetic. I thought, let’s just check another. It was 13.9. Overnight, in one second, now he’s a new diabetic with out-of-control glucose—all systems firing. And this is the same 20 minutes as the guy with a little arthritis in the knee.

I really do think it’s 100%. The system is so unwieldy, the responsibility so big, the stakes of letting something drop so large, that we all feel it. Sometimes we lump it into “burnout” and say, hey, you should take Pilates, you should do resilience classes. But I don’t need a Pilates class. I need an assistant. That’s what I need. Or a massage therapist.

It sort of puts it on us—”you just need to calm down.” And that’s not fair. Just like with medical error, there’s a system that makes this so crazy. Part of it’s the way we bill. Talking to patients about eating broccoli and brown rice doesn’t bring in money. But if while you’re talking about broccoli, you put a tube into one of the orifices, the reimbursement is 20 times higher. We have a very procedure-based system. Not a lot of time is given for the cognitive side of medicine.

I just saw an orthopedic surgeon get promoted to full professor. Nice person, smart person, but they’re not doing anything more intellectually than my colleagues are doing. Yet they get promoted because they operate. Surgeons bring in money, they keep the lights on. I don’t blame institutions for valuing them, but there’s little time for the grunt work—like convincing patients why they need another COVID vaccine. Every single patient said, “I’ll get the flu shot, not the COVID.” That’s exhausting.

Then there’s the moral injury part, which is a really good term. It identifies when the system pushes you to do substandard care, where you have to see twice as many patients and cut corners. That is corrosive. If you care about what you do, being forced to do a crappy job is the worst. Cut my pay, take away the coffee machine, fine. But forcing me to do a bad job is excruciating. That’s when people say, “I can’t do this anymore.”

I’ve written a lot, but the one that resonates most is this: the way the system holds together is the professionalism of nurses and doctors. That’s the glue. No one’s going home until they’ve finished their job. The system knows that. You can double the number of patients, and I’m not going to go home until it’s done. On my day off, I’m sitting in Epic following up on all those patients. Because I can’t not.

It’s elastic and ever-stretching. The doctor never goes home until the job is done. The nurse doesn’t leave until the last medication is given. The system knows this, so it keeps stretching. That’s problematic. And Pilates is not going to cut it.

NP:

Yeah. You’re describing something Michael knows I’ve been insufferable about. I’m lucky enough to teach bioethics at Harvard Med School. One of the things we talk about is responsibility and duty. That elastic band you describe—we discuss that. It’s a one-sided ethical responsibility. The doctor and nurse have the relationship with the patient and the work. The system is ethically agnostic. It treats it like widgetry, extracting more gain. The endpoint is moral injury, then burnout—or whatever we’ve renamed burnout to now.

DO:

I’d go beyond agnostic. There are forces that work against us. Market forces that profit from inefficiency. For example, there’s more money to be made making a doctor call for prior authorization every time you want a CT scan. That’s destabilizing.

Are there money-grabbing doctors? Sure. But most aren’t in medicine for that. If you just want money, it’s easier to get an MBA—three years, no one pukes on your shoes, no sleepless residency. People go into medicine to do the right thing. Maybe some get corrupted, but primarily they want to help. Nurses even more so—they’re certainly not doing it for the salary.

So this is fundamentally different. Am I going to not check the potassium because there’s no money? No. If it needs checking, I’m staying until the result comes back. That’s just what you do. What’s fascinating is to see how much of society and government has melted away, and we’re among the last standing—maybe along with teachers. You couldn’t not do the right thing. That’s why there’s still trust in doctors, nurses, and teachers.

NP:

Yeah.

MJ:

You talk a lot about patient communication. And you just mentioned the work the system puts on doctors because they know we care. How does that interplay with the issues doctors have communicating with patients?

DO:

Yesterday, running around with new patients, every time I went to the waiting room, one patient would stop me. One woman came up speaking Spanish—it’s not my first language. I was trying to think while all these patients were waiting. Finally, I said, I can’t talk to you now. I felt so bad cutting her off, but I couldn’t do it. That makes it harder to communicate.

So much of communication is listening. If we listened better, we’d make fewer errors and build more trust. But when you feel bombarded, it’s hard. On good days, I close the door, sit down, and say, “How can I help you? Tell me about yourself.” It feels great. Especially when patients are used to being disrespected—you can give them respect, agency, partnership. That’s the greatest part of medicine. When you can defuse anger, uplift a patient, and yourself, that’s the real reward.

But overloading clinicians makes it much less likely we’ll be good listeners and communicators.

MJ:

So outside of fixing the workload system, what else drives better doctor-patient communication?

DO:

Study after study shows doctors cut patients off after 9–18 seconds. We dominate verbally, especially with patients who are obese, people of color, elderly, pregnant, disabled—any group struggling in life. They get less talking time.

One simple thing: zip it. If a patient starts talking, resist the urge to clarify. Just let them go. I wondered how long patients would really talk. One Swiss study let patients speak without interruption. Average? Ninety seconds. Not a tidal wave. I tried it myself—even my most talkative patients stopped after two or three minutes.

With one especially difficult patient, I let them unload everything. They finished, I said, “Here are 27 things. We’ll do three today, the social worker will help with others.” It was finite. The patient said, “Just talking a lot made me feel better.” For these patients, just being heard reduces stress. They left feeling better, and so did I. Plus, fewer follow-ups and messages later.

So I tell students: don’t say anything for the first 90 seconds. Full frontal listening—no typing, eye contact. It’s money in the bank. You’ll make fewer errors too. Otherwise, you risk missing key information when you cut patients off.

NP:

So your gestalt is that investing in communication upfront pays dividends overall—it’s not adding work?

DO:

Not at all. Both in the moment and long term. In the moment, respect creates an ally for getting things done. Long term, it reduces follow-ups. We all know those MyChart messages—5% of patients send 95% of them.

NP:

Right—95% of your magic.

DO:

But kind of reassuring them, you know, and even just saying, if there’s something else that comes up, you can let me know, but if it’s a lot that comes up, we’ll make another appointment. I don’t want to give your concerns short-shrift. And so if you message me a really big question, I won’t be able to answer it well in the message—save it for a visit or make a dedicated visit for that. And kind of preempt all of that.

We want to make our patients feel better. And there are so many things that we cannot solve in primary care medicine. The world is too big and the aches and pains are too many. But if you can move the needle even a degree from when the patient comes in to when they walk out, you have succeeded. Even if you didn’t cure their illness, you made them feel better physically or emotionally.

That is something of value, and we shouldn’t underestimate it. Giving that extra bit of respectful communication really matters. Think about it: when’s the last time someone listened to you straight on for a minute and a half without interrupting? It’s pretty rare. It’s startling—like someone just gave you a massage, and you feel empowered. I think it matters a lot, and the same goes for colleagues, friends, and partners.

But for patients in particular, because there is a power differential. It’s not the same as with a friend. Patients are coming in less knowledgeable, in pain, maybe less educated, sometimes after waiting months for the appointment. And you’re the busy doctor running the visit. If you can elevate them, it goes a long way.

NP:

I mean, Michael typically only gives me 17 to 19 seconds, so I’m kind of used to that. It’s fun.

MJ:

Day.

DO:

When it comes to things going wrong—and things will always go wrong—who is going to sue you? We’re all afraid of lawsuits. If you want to make an investment in reducing the likelihood of being sued, I think having a respectful, honest, caring relationship goes a long way.

I had a patient where a disastrous chain of events happened after I advised him to do a procedure. It was a nightmare. When I spoke to him, I said, “I’d understand if you want to change doctors. That’s always an option.” He wouldn’t hear of it. Because of our long relationship, he understood that an error can happen, but that doesn’t mean you are the error. That distinction often isn’t made by patients—or by physicians—but it matters.

If a patient sees that you mean well, even if something bad happens, they may not equate the event with negligence. They see you as a human being who treats them seriously. That makes everything better—for them and for you. It makes practice more enjoyable. Yesterday was a crazy day, but with one new diabetes patient, we laughed, connected, and even got self-deprecating. That rapport made a tough day lighter.

NP:

Absolutely. The physician–patient relationship is structured around communication. What you’re describing is authenticity—you can be self-effacing, you can diffuse tension, especially when stressful news comes up. That humanity is critical.

DO:

And the same holds for learners. When you’re the top of the medical team, you can still be respectful and honest, admit when you don’t know, or when you’re nervous. That builds trust. I had one chief of service like that. Even when he had to deliver bad news—salary cuts, position cuts—we respected him, and we’d go the extra mile for him. Other leaders without that respect and empathy would not get the same response.

MJ:

Can I ask about communication in light of patients now having greater access to our records—notes, histories, labs? How are you navigating that?

DO:

Funny you should ask. I wrote a piece for The New Yorker on medical transparency. In theory, we love transparency, but full transparency isn’t always good. Now patients get labs before I even see them. With a panel of labs, something is always flagged in red or yellow, and it scares people unnecessarily. I get endless emails about chloride or MCHC levels, which are clinically meaningless most of the time but terrifying when you Google them.

What’s more concerning is patients receiving serious diagnoses from the portal before I can talk with them. Twice now, patients saw malignancy-related results before I could explain. I think that’s unconscionable. Most people would not want to learn of cancer from a portal alert. That creates a huge burden for doctors, especially on weekends when results post automatically.

I’ve developed dot phrases to reassure patients that many results may look abnormal but aren’t. If something is truly concerning, I’ll call them. Still, this system often makes things harder for both sides.

There are privacy concerns, too. Who else can access the chart? Patients in abusive relationships, immigrant families with children managing electronic records, or cases like a patient not wanting his daughter to see his Viagra prescription. I’ve had to handwrite prescriptions and leave things off the record to protect privacy. Similarly, a daughter not wanting her father to see birth control notes.

Transparency also changes how I write. I write less, leaving out observations like “well-groomed” that can upset patients. It’s a loss, but avoiding distress outweighs thoroughness.

NP:

We were counseled after the Cures Act to write as if patients will read everything. But soon we realized we weren’t communicating with each other anymore. Lay language replaced clinical language. It became harder to follow a colleague’s thought process. Dropping this change during COVID made it even more disruptive.

DO:

Exactly. The chart is primarily for clinicians to communicate. Patients may own the chart, but I still write for colleagues. I’ll adjust wording to avoid misinterpretation, but I won’t rewrite everything for patients. I need my notes to remind myself of clinical reasoning too.

NP:

And you can’t just keep everything “off the books.” Notes still need to be comprehensive.

MJ:

It just occurred to me—internists get teased for long notes, but maybe that’s why internists like you write six books and contribute to The New Yorker. I doubt many surgeons have done that.

DO:

Well, I’ll say there are probably fewer surgeons, not less.

MJ:

Touché.

NP:

And we get the grammar lesson, too. This is the best day.

MJ:

That was my pediatrics side talking.

DO:

Well, that gives me a chance to plug the Bellevue Literary Review. Editing poetry and fiction, we’re always precise about language—just like in the medical chart.

NP:

That’s wonderful.

MJ:

Ned’s day is made.

Dr. Ofri, before we wrap up, we always ask: what’s one thing you’ve changed your mind about recently?

DO:

One larger thing is bariatric surgery. Initially, I thought it was absurd—why surgically correct a societal problem of food and lifestyle? But over time, I’ve seen real, sustained benefits in my patients. Losing weight builds confidence, which makes it easier to exercise and maintain healthy habits.

It’s similar to GLP-1 medications. Not my first choice, but I’ve seen transformative results. Bariatric surgery isn’t my first-line treatment, but I now recognize it as a valuable option for the right patient. Even though the larger societal issues—portion sizes, food industry practices, soda prices—remain unsolved, this can still change an individual patient’s life for the better.

MJ:

That makes a lot of sense. Thank you for that. I wanted to see if our listeners wanted to follow you or find out more about what you’re doing, where can they find you?

DO:

Sure, my website is just danielleofri.com. All my writings are there. I do a monthly newsletter. And then I’d encourage them to check out Bellevue Literary Review. We have a website, blreview.org. We have a newsletter. We publish this great issue twice a year, in print and digital. We have online and in-person events—things with dance, poetry, and even live storytelling.

Lots of creative ways to think about health, illness, and healing. We read a lot of journals, textbooks, and notes, but there’s something limiting about that. You can describe a patient’s disease process, but not necessarily their experience of illness. Fiction, poetry, and creative nonfiction let you dig into aspects that are equally crucial.

I often say patients walk out of our offices cured but not healed—and there’s a big difference. We can cure some diseases, but patients may still not feel fully healed. That requires other dimensions. This ties into our conversation earlier about ambiguity and uncertainty. How we grapple with that is critical to becoming good clinicians, and the creative arts help us navigate it. I recommend literature for that, and Bellevue Literary Review is a great way to access it.

MJ:

Wonderful. Well, thank you for sharing. We’ll definitely check it out. Dr. Danielle Ofri, thank you for joining us on the show today.

DO:

Thank you, it’s been a pleasure.

NP:

Thank you, Dr. Ofri. What do you think, Michael?

MJ:

I thought that I needed to work on my grammar.

NP:

I learned that too, and I’m thrilled to keep calling you on it.

MJ:

I doubt you just learned that I need to work on my grammar. I still don’t understand commas and a few other things. But no, she was amazing. In medicine, there are a lot of really intelligent people, and then there are folks who are next level—who bring additional skills to the table. She is definitely in that category. She brings in really complex concepts and communicates them so effectively, whether verbally or in writing, which seems to be where she thrives.

NP:

Absolutely. I thought it was such a fascinating conversation because she has the clinical background and chops of being an internist at Bellevue—the oldest hospital in the country, about which countless books have been written, good, bad, and ugly. Then she brings in topics like ethics and humanity—the philosophical layer that underpins medicine. That affects everything we do: choosing medicines, interventions, or even the way we communicate with patients and train the next generation of doctors.

MJ:

It’s also encouraging because we’re all individuals as doctors, and we all have different skills. It’s cool to see examples of people bringing those other skills into their work. It’s not just seeing patients, writing notes, or doing surgery. There are other ways to contribute that lift up the doctor community and, ultimately, the patient community. She’s a great example of that.

NP:

Absolutely. And I think we were lucky to speak with her. Given how busy she is and how many books she’s written, I’m blown away and humbled that she spent more than an hour with us.

So thank you for listening to The Podcast for Doctors by Doctors with Dr. Michael Jerkins, Dr. Ned Palmer, and today’s guest, Dr. Danielle Ofri. Thanks for joining us. You can catch the podcast on Apple, Spotify, YouTube, and all major platforms. If you enjoyed this episode or learned something today, please take a moment to give us a rating and subscribe so you don’t miss the next one.

As always, thank you for listening. And next time you see a doctor, maybe you should prescribe this podcast. We’ll see you next time.

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