For twelve years as a hospitalist, I wrote every single day. Almost none of it was mine.
It was progress notes, admission histories, and discharge summaries built for billing and liability. I got fast at it, fast enough to compress a person’s worst week into four lines and a problem list. Nobody told me this was a kind of writing. Nobody mentioned it was also a quiet kind of forgetting.
I call it the documentation tax, and every physician pays it. We spend our evenings describing patients to other systems. We rarely spend a single sentence describing what we actually saw in the room.
This page is about why I started writing for readers instead of for the chart. It is also an argument that more physicians should do the same.
What the chart leaves out
A chart is good at some things. It holds medication lists, allergy flags, and the slow trend in a creatinine. It is honest about numbers, but it has almost no room for the reason the numbers moved.
I see this most clearly with one kind of patient, usually a woman in her forties or fifties. Her labs have come back normal twice, and she has been told she is fine. She is tired in a way that sleep does not touch. Some mornings she sits in her car for ten minutes before she can walk into the clinic. Her chart says “fatigue, workup negative,” but her life says something else.
Good labs. Bad life. There’s a reason.
That reason almost never fits in a structured field. It might be a divorce nobody coded, or caregiving for a parent that started three years ago. Sometimes it is a grief that never got a visit of its own. The body was keeping a record the whole time, in her sleep and in her weight. It loyally followed the life it was given, until it could not adapt anymore. The body doesn’t malfunction. It escalates.
A physician who writes is trying to put that record somewhere a person can finally read it. Your biography, written in your biology. The chart has no field for that sentence, but an essay does.
Why the gap gets filled by someone else
The uncomfortable part comes next: when physicians stay quiet, the page does not stay empty. The wellness economy writes into that silence every single day. Some of it is careful and thoughtful. Much of it sells a supplement stack to someone who needed to be heard first.
I do not think those readers are foolish. They are responding to a real need that medicine has left unmet for decades. They wanted someone to connect their exhaustion to the shape of their life. A fifteen-minute visit rarely has room for that conversation. So they found a voice that would have it, even when the science underneath was thin.
Mainstream medicine gets a great deal right, and our evidence standards exist for good reasons. I would rather name a trial than repeat a vague claim about what research found. But evidence spoken only to other physicians never reaches the woman sitting in her car.
The work, as I see it, sits between those two camps. It means finding what is actually happening in this specific human being. Then it means saying it plainly enough that she recognizes herself on the page.
What writing did to my practice
I did not expect writing to change how I listen to patients, but it did, and fairly quickly.
When you might one day write about a pattern, you start watching it more closely. I began noticing what a patient says with her hand already on the doorknob. The “one more thing” often turns out to be the whole visit. Those moments rarely make it into the note. But they almost always make the diagnosis clearer.
Writing also forced me to admit what I did not know. A progress note rewards certainty, while an essay punishes false certainty fast because readers write back. Some of them are physicians who disagree with me. Sometimes they are right, and I have had to say so in public.
I have been told no many times. Editors have passed on pieces I thought were finished, and one editor passed on three of mine. Each decline sent me back to the draft with a harder question. I once read a pass as a verdict on me, and now I read it as information about the piece.
I write in a few places now, each with a different reader in mind. On KevinMD and Doximity’s Op-Med, I write to colleagues, usually confessional pieces that argue one thing. On Medium, I test ideas with a broader audience before they grow. The longer work lives on my Substack, Healing the Split. I explain why I write a paid newsletter in a separate essay.
The book grew out of the same gap. Healing the Split: When Your Biology Is Fighting Your Biography follows patients whose bodies kept a record their charts missed. The subtitle names how it feels from the inside. The deeper truth is quieter, because biology was never fighting at all. It followed the biography for as long as it could adapt.
The patients I see at Prime Vitality Care in San Antonio shaped every chapter of that book. Their stories appear only as composites, with identifying details changed. More of these essays are collected in my Thought Leadership Hub.
If you are a physician who wants to write, start with one pattern you cannot shake. Composite it, change every identifying detail, and leave out the lab values. The person comes first, always, before the essay does.
Write it the way you would explain it to a friend over dinner on a weeknight. Drop the jargon you use to sound careful in the chart. Keep the clinical terms that are actually precise, because readers can handle them. The HPA axis and hsCRP deserve a place on the page. “Optimize your wellness” does not.
Expect editors to decline you and readers to correct you, since both will make you a better doctor. You do not need a platform to begin. You need one true paragraph about one real pattern.
I still think about that woman with the normal labs. For years, her whole story lived in two words: workup negative. If she ever reads this, I hope she finds the line her chart left out.
Dr Shiv Kumar Goel is an internal medicine and functional medicine physician in San Antonio. Across 25 years in hospitals, intensive care, and functional medicine, he has studied the gap between what medicine can measure and what patients actually live through. He writes Healing the Split and is the author of the forthcoming book Healing the Split: When Your Biology Is Fighting Your Biography.