For more than thirty years, I practiced internal medicine. During that time, I noticed something that walked into my office almost every day, wearing a hundred different disguises.
People wanted to be fixed.
I understand the impulse. There are moments when a doctor needs to be the fixer: a ruptured appendix, a joint too far gone to save, a tumor that has to come out. In those moments, you need someone who can identify what is broken and repair it.
Most of what fills a primary care schedule isn’t that, though. The top reasons people come to see an internist are hypertension, diabetes, upper respiratory infections, musculoskeletal pain, and preventive care. These are conditions that live and die by daily choices. And yet patients arrive asking to be fixed anyway, as if I kept a repair kit in my white coat.
I’ve come to believe the request is rarely about the heartburn.
Or the blood pressure.
It’s about fear.
“If my heartburn can give me esophageal cancer, and I can’t even fix my heartburn, what hope do I have?” a patient once asked me. That question wasn’t really about acid reflux. It came from a place that had quietly decided the body is an enemy, and that only an expert with a prescription pad stands between the patient and disaster.
Modern medicine, for all its genuine miracles, has reinforced that belief. Pharmaceuticals and vaccines are powerful tools, and I’m neither anti-medication nor anti-vaccine. Their very effectiveness creates an illusion, though: that health is something done to you rather than something you participate in. Swallow the pill, get fixed. It’s tidy. It can quietly teach people to stop listening to their own bodies.
What I didn’t fully understand for years is that this dynamic isn’t one-sided. The patient isn’t the only one in the room whose fear is steering the visit. Mine was too.
When a patient pushes back, cites something they read, or asks for a second opinion, there’s a reflex in a doctor that can feel like being cornered. Years of training reward certainty and punish the appearance of doubt. Admitting “I’m not sure” can feel like exposure. So the reflex is often control instead of curiosity: another test, a firmer tone, a faster prescription. It’s often less about the best medicine and more about protecting the doctor’s own sense of authority.
Two frightened people meet in a room that’s supposed to be about healing, each trying to feel safe. That’s where unnecessary medicine is often born, and where a patient’s trust in themselves quietly begins to erode.
I decided a long time ago that my job wasn’t to feed that dynamic. It was to interrupt it. Instead of asking, “What can I fix for you today?” I tried to ask, “What can I teach you to fix yourself?”
That shift changes how you think about prescribing. When I decided a patient truly needed medication, I still asked a second question: does it have to be taken this way, every day, at full dose, forever? Or is there a smarter, more human way to use it?
Take men with an enlarged prostate. The most common medication for that condition often causes an unwelcome side effect during intimacy, but its effects last roughly 36 hours. So instead of a rigid daily pill taken on autopilot, I’d suggest patients plan around that window and take the medication with intimacy in mind. A prescription that felt like a compromise became a tool the patient controlled.
Or consider someone whose blood sugar spikes after certain meals but who isn’t yet diabetic. Rather than immediately placing them on a daily medication, I’d sometimes recommend a small dose of Acarbose only before the meals most likely to cause trouble. The point wasn’t simply lowering blood sugar. It was helping the patient understand that medication could become a tool they controlled, rather than something that controlled them.
None of this works if fear is running the visit. A frightened patient wants certainty and control handed to them. A frightened doctor is often willing to hand it over, because it resolves both people’s anxiety in the moment. But it teaches the patient nothing about their own body, and it quietly takes away their confidence that they can manage themselves.
The alternative is partnership: a doctor willing to sit in some uncertainty long enough to ask what a patient actually needs, and a patient willing to tolerate not being handed an instant fix. Guidance instead of rescue. Teaching instead of fixing.
The doctor-patient relationship was never meant to be one person fixing another. At its best, it’s one nervous system helping another find its own footing again. That happens when both people stop bracing against fear long enough to actually see each other.
That’s the medicine I tried to practice, and it is the same purpose I now bring to my writing. Not to fix people, but to help them recognize the fear that has weakened their trust in themselves and remind them that they were never as broken, or as helpless, as fear wanted them to believe.
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