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Gray Matters:
Analysis and Ambiguity

Articles by Lisa Rosenbaum, M.D.

As a cardiologist, Lisa Rosenbaum knew that many patients, even those who had survived an MI, didn’t take the medications they were prescribed. As a fascinated student of human behavior, she undertook research to find out why. Her articles for NEJM explore many such questions about the psychology and sociology of medicine and health care, seeking nuanced truths in often-polarized domains of human cognition, emotion, culture, ethics, and politics. Drawing on interviews, social science and medical research, and actual experience, Dr. Rosenbaum writes insightful essays that raise provocative questions for clinicians, researchers, and patients.

Cultural Conundrums

Despite the best intentions of both dedicated health care professionals and their organizational leaders, the culture of U.S. medicine is too often siloed rather than collaborative, complacent rather than activist, opaque rather than transparent. In these articles, Lisa Rosenbaum examines some troubling aspects of our current medical culture and the obstacles and possible pathways to its reinvention.
Divided We Fall February 14, 2019 Why, when there are so many easy ways to communicate, is fragmentation of patient care more common than streamlined collaboration among clinicians? And what are the barriers to better collaboration that could improve care?
Cursed by Knowledge — Building a Culture of Psychological Safety February 21, 2019 Because physicians often set the cultural tone of the hospital, it’s worth considering barriers to health care professionals’ “psychological safety” for which we’re largely responsible. Why doesn’t it always feel like everyone caring for a patient is on the same team?
The Not-My-Problem Problem February 28, 2019 In cases in which the “bystander effect” seems to be at play in medicine, inaction by a group of clinicians usually takes the form of tacit acceptance of the status quo when the status quo isn’t working. What can social psychology teach us about such group failures?
Scoring No Goal — Further Adventures in Transparency October 8, 2015 Though quality improvement in medicine and sound information to help patients choose providers are clearly needed, ProPublica’s new surgeon scorecard is likely to achieve neither. But it has triggered important discussion about appropriate assessment and transparency.
No Cure without Care — Soothing Science Skepticism April 15, 2021 To the extent that Covid vaccine hesitancy reflects deeper, longer-standing fractures in medicine’s relationship with the public, its exploration provides an opportunity to improve patient care in ways that go far beyond the pandemic.

More from Lisa Rosenbaum

Medicine and Society The Quality Movement — Part 3 May 12, 2022 Peers, Professionalism, and Improvement
L. Rosenbaum N Engl J Med 2022; 386:1850-1854
Drawing on peer review and professionalism, some quality-improvement efforts tap into physicians’ intrinsic motivations for giving their patients the best possible care. How can we scale up such promising approaches and create and sustain a spirit of inquiry?

Medicine and Society Apr 08, 2021 Escaping Catch-22
L. Rosenbaum N Engl J Med 2021; 384:1367-1371
About 27% of Americans say they definitely or probably won’t get a Covid vaccine, even if it’s free and deemed safe by scientists. The behavioral obstacles to widespread vaccination are thus as important to understand as the scientific and logistic hurdles.

Medicine and Society Oct 22, 2020 Tribal Truce
L. Rosenbaum N Engl J Med 2020; 383:1682-1685
Since human behavior — including wearing or shunning masks — will determine the ultimate toll of the Covid-19 pandemic, communication strategies that bridge our partisan divide over science may prove as important as any novel therapeutic.

Perspective Jul 09, 2020 Once Upon a Time…the Hero Sheltered in Place
L. Rosenbaum N Engl J Med 2020; 383:e5
For some clinicians, the pandemic offers an opportunity to take on the hero’s role as never before. But those who can’t must confront not only shame and guilt, but also the loss of their primordial story. Who are you, if you can’t be the hero you imagined yourself to be?

Medicine and Society Jun 11, 2020 The Untold Toll
L. Rosenbaum N Engl J Med 2020; 382:2368-2371
As the pandemic focuses medical attention on treating affected patients and protecting others from infection, how do we best care for people with non-Covid disease? Some physicians predict that “the toll on non-Covid patients will be much greater than Covid deaths.”

Perspective May 28, 2020 Harnessing Our Humanity
L. Rosenbaum N Engl J Med 2020; 382:2069-2071
As the Covid-19 pandemic spreads, we’ll continue to be plagued by resource constraints that will compromise our ability to protect ourselves, our patients, and our communities. But as Washington’s response reminds us, the professional spirit marches on, unconstrained.

Perspective Mar 18, 2020 Facing Covid-19 in Italy
L. Rosenbaum N Engl J Med 2020; 382:1873-1875
Physicians in northern Italy have learned some painful lessons about rationing care during an epidemic. As health care systems work out ethical allocation principles, it seems clear that only with transparency and inclusivity can public trust and cooperation be achieved.

Perspective Feb 06, 2020 Altruism in Extremis
L. Rosenbaum N Engl J Med 2020; 382:493-496
With a clear understanding of his terminal prognosis, W.B. wanted to donate his organs before he died — but the legal and ethical hurdles proved insurmountable. In Canada, where medical assistance in dying is now legal, some patients are able to fulfill this last wish.

Perspective Jan 09, 2020 Costs, Benefits, and Sacred Values
L. Rosenbaum N Engl J Med 2020; 382:101-104
As debate about U.S health care begins anew, with particular focus on a “Medicare for All” type insurance design, it’s worth considering why weighing the complex but real trade-offs involved in health policy remains so politically challenging.

Perspective Sep 26, 2019 Losing Hahnemann
L. Rosenbaum N Engl J Med 2019; 381:1193-1195
The announcement that Hahnemann Hospital would soon close came as a shock to many people. Is the hospital a casualty of the push to optimize the distribution of limited resources — or a cautionary tale about the greed and corruption underlying our health care ills?

Perspective Feb 07, 2019 Of Metatarsals, Meaning, and Medicine
L. Rosenbaum N Engl J Med 2019; 380:505-507
The world outside medicine can be full of unscripted caring from people who are happy for the mere opportunity to help. Many of us become doctors precisely for such opportunities. So why has it become so hard to translate this impulse into truly caring for patients?

Perspective Jul 26, 2018 Trolleyology and the Dengue Vaccine Dilemma
L. Rosenbaum N Engl J Med 2018; 379:305-307
Governments in dengue-endemic regions are facing a dilemma: a new dengue vaccine could prevent many cases of severe illness, but it could simultaneously cause other cases in children previously unexposed to dengue. What is the right thing to do?

Medicine and Society Dec 14, 2017 The Less-Is-More Crusade — Are We Overmedicalizing or Oversimplifying?
L. Rosenbaum N Engl J Med 2017; 377:2392-2397
Although reducing unnecessary care is important, the missionary waste-hunting zeal of the “less is more” movement can obscure a complex evidence base, perpetuating an oversimplified narrative about waste’s magnitude, causes, and solutions.

Perspective Feb 26, 2015 Being like Mike — Fear, Trust, and the Tragic Death of Michael Davidson
L. Rosenbaum N Engl J Med 2015; 372:798-799
In January 2015, 44-year-old Boston surgeon Michael Davidson was shot and killed by the son of one of his patients. To seek reasons for such a tragic loss is to become afraid. To seek meaning is, in a sense, to do the opposite.

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