A series of Perspective essay collections previously featured on our Medicine and Society page.

Covid and the Clinician

As Covid-19 swept, and then swept again, over the United States, many physicians found themselves on the front lines of a lethal battle, many of them with little time or energy for respite or reflection. In these Perspective essays, physicians and trainees expose some of the pandemic’s emotional effects on clinicians as well as patients.

When Covid Arrived in America

After nearly a year of Covid precautions, politicization, and a devastating death toll, it is both inspiring and humbling to look back on our initial response to the arrival of SARS-CoV-2 in the United States. The frightening unknowns of a once-in-a-century pandemic, along with the social isolation it required, seemed to compel many physicians to write Perspective essays — to share with colleagues their emotional and professional struggles.

Mayhem and Medicine

Every day in the United States, an average of 100 people are killed with guns and hundreds more are injured. One consequence is that U.S. physicians have been drafted to serve in a never-ending public health battle. These essays explore the physical, psychological, emotional, social, and financial effects of firearm violence — and some steps toward prevention, if not cure.

Quotidian Quandaries

From obtaining a patient’s consent for an emergency procedure to calling in favors for an injured family member, physicians frequently find themselves facing ethical dilemmas that must be resolved quickly, in the heat of the moment — though the second-guessing may continue for years afterward. These essays capture doctors’ struggles with both their patients’ needs and their own consciences as they practice medicine in an imperfect world.

Learning Curves

Absorbing the science of medicine is hard enough, given its enormity and pace of change, but how can one reliably learn the art of being a doctor? These essays explore moments of insight and inspiration for new or aspiring physicians, times when a deeper understanding of that art either gradually dawned or suddenly clicked into place.

Parents and Children

It’s not only in pediatrics that parents can play key roles in the drama of medicine. The parent-child bonds of the patient and, sometimes, the physician may loom large in clinical decisions, ethical dilemmas, and fundamental conceptions of health, illness, and what it means to be a good doctor. In these essays, published as Perspective articles, physicians explore moments that crystalize some of the unique and affecting aspects of parent-child relationships.

Mental Health and Medicine

While the stigma attached to some disease states has dissipated over time, thanks in part to increasing knowledge about causes and treatments, many mental illnesses remain mired in misunderstanding, fear, and shame. These essays shed light on an essential aspect of health that is too often shrouded in darkness, exploring effects in physicians as well as their patients.

The Meanings of Mortality

Death and dying are still difficult topics for many people to discuss, but physicians have little choice but to confront human mortality as part of their daily lives. So it’s not surprising that when they sit down to write about their most moving or illuminating experiences, they frequently focus on the end of life. This second collection of Perspective essays about death and dying takes a few unexpected twists and turns on the way to its final resting place.

Being a Doctor in the 21st Century

From the trials of training to the reevaluations of middle age, the internal and external pressures associated with being a doctor in the 21st century can be formative, oppressive, and sometimes illuminating. These recent essays exploring critical junctures in physicians’ careers offer glimpses of the struggles, successes, and failures that shape contemporary life in medicine.

On the Margins

From Native Americans to mentally ill people, from residents of remote rural communities to city dwellers addicted to opioids, many of our fellow citizens have been marginalized by society and face extra challenges in getting their health care needs met. These stories, told by physicians who care for such patients, vividly depict the cards stacked against people living on the margins and offer compassion, hope, and promising directions for change.

Immigrants, Refugees, and Health

Even in a nation of immigrants, many new arrivals find themselves on the margins — at best neglected, at worst blamed and persecuted for myriad social ills, even when they have struggled to escape horrors in their home countries. What is the current landscape like for immigrants and refugees, what becomes of them in our social and health care systems, and what can physicians do to help? These essays, published as Perspective articles, explore the realities faced by people driven to seek a better life in a land of often-false promise.

Going Global

As increasing numbers of U.S. medical trainees and physicians sign up for global health programs and set off for regions unknown, their experiences caring for patients in low- or middle-income countries may have ripple effects. The stories they bring back, shared well and widely, can raise awareness of critical global health issues and affect further engagement, funding, and policy. In these essays, published as Perspective articles, physicians bring patients from Brazil, Belize, Zimbabwe, Thailand, and Fiji into clear focus with stories that raise essential questions about equity, social justice, medical technology, and intercultural understanding.

Ghosts of Medicine’s Past

When the NEJM archives were made available electronically in 2012, it suddenly became possible for any amateur historian to discover and expose all manner of remarkable, embarrassing, and amusing anecdotes from medicine’s past. Some compellingly written histories, however, not only entertain us, but also carry lessons relevant to medicine’s new or persistent struggles and dilemmas. These historical essays, published as Perspective articles, use narrative to illuminate topics ranging from cultural fears to scientific discoveries, from drug safety to medical efficiency.

Disaster and the Doctor

When disaster strikes — whether it’s natural or human in origin — physicians find themselves on the front lines. The sudden onslaught of critically injured patients can be overwhelming, and health care organizations may be crippled by the catastrophe, disaster-preparedness drills notwithstanding. And then the longer-term effects of massive trauma begin to appear.... These stories, published as Perspective articles, follow doctors into hurricanes, wars, terrorist attacks, and earthquakes and expose both the wounds and the pathways to healing.

Hurdles to Healing: NEJM Stories by Ranjana Srivastava

The stories recounted in these Perspective essays by oncologist-writer Ranjana Srivastava reveal some of the troubling facets of human nature, social norms, and the institution of health care that she must navigate as she strives to do her best for her patients.

Fostering the Next Generation

“See one, do one, teach one,” the saying goes. But training to practice medicine — rising to the ongoing intellectual challenges even as you invest ever more deeply in this “endeavor of your heart” — is far from simple. From figuring out how to approach new or difficult patients to taking full responsibility for their care, there are many steps and hurdles in the process of becoming an effective physician. In these essays, published as Perspective articles, physicians and medical educators explore some of the critical moments and troubling ethical and practical issues that arise in the training process.

The Making of a Doctor

The long road to physicianhood can be bumpy and hazardous, as trainees are pushed to the limits of their intellectual, physical, and emotional capacity. If they did not ask critical and troubling questions along the way — about life, death, and medical practice — it’s unlikely that they would mature into the kinds of doctors that patients could trust with their health and their lives. These essays, published as Perspective articles, provide an array of windows into the process of becoming a physician.

When the Exam Tables Are Turned

It is a truism in medicine that doctors make the worst patients. But a full understanding of the patient’s perspective — and sometimes of the frustrations and limitations of the health care system — may come only from hobbling a mile in a sick person’s moccasins. In these essays, published as Perspective articles, physicians learn unexpected lessons about medicine from the other side of the stethoscope.

Slipping through the Cracks

In the U.S. health care system, with its fragmentation of care, maldistribution of resources, patchwork of payers, checkered history, and high costs, many patients inevitably slip through the cracks. What can physicians do when confronted with the effects on patients of uncoordinated or poor care, lack of coverage, or other tragic shortcomings? These essays, published as Perspective articles, explore some of the most frustrating fallout of the system’s failures.

The Mores of Medicine

What are the rules, rituals, and boundaries that define a good physician and a healthy, productive doctor–patient relationship? How does a new physician know what to say or not say in common but fraught situations? Being a physician is often a balancing act between formal distance and engaged emotion, between accepting the role of cool-headed clinician and being oneself. In these Perspective essays, physicians explore the challenges of finding that balance for themselves.

Worry Lines: NEJM Stories by Perri Klass

In these NEJM Perspective essays, pediatrician-writer Perri Klass lets us inside the head and heart of a physician whose patients’ lives and needs touch her — following her from office to ballpark to concert hall to tropical vacation — and reveals the ways in which doctoring is life, not just a living.

Sense and Medical Sensibility: Selected Essays

William Osler, known for introducing bedside training for medical students, told his trainees: “Use your five senses . . . . Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.” These essays, published as NEJM Perspective articles, offer a taste of the sensory explorations and discoveries of physicians and trainees as they see (and touch and smell and hear) patients.

Doctors on Death and Dying

Mortality is the human condition. And just as physicians serve on the front lines of our battles to improve and extend our lives, they must often lead the charge toward easier dying and better deaths. In these essays, published as Perspective articles, physicians provide diverse insights into the needs of patients, families, and caregivers at the end of life.

The Doctor in the Family

Before he ever uttered an oath, Hippocrates must have made his mother proud, what with his insight into vapours and siring of medicine and all. Since his time, every physician has started out life as a family member — a child, a grandchild, often a sibling — and many have eventually found time to become parents as well. So what happens when physicians end up in the hospital not in their professional role, but as relatives of patients? These stories, published as Perspective articles, offer some glimpses of the perspective physicians gain as they grapple with illness in the family.