The Nocturnists

In episode 3 of the "Uncertainty in Medicine" series, patient Dana undergoes a routine knee replacement and expects a straightforward recovery. Instead, she’s plunged into a baffling and relentless illness—one that defies diagnosis and leaves her life in limbo. As her symptoms intensify and specialists write her off, Dana finds an unwavering ally in her primary care doctor, the one person who refuses to let her fall through the cracks. This episode traces their year-long search for answers, revealing the emotional cost of medical uncertainty and the rare power of a clinician who stays the course. Along the way, we visit Lewiston, Maine, where a small, intentional change to residents’ schedules is making the uncertainty of primary care more manageable and helping keep young doctors in the field. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. This episode is sponsored by a new podcast that fans of the Nocturnists are sure to love. Unleashed: Redesigning Health Care features clinician-innovators who have changed care on the front lines. Their stories, their voices, their ingenuity. Learn more at unleashedpodcast.org. Host: Emily Silverman, MD Uncertainty Correspondent: Alexa Miller Series Illustrations by Eleni Debo This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

In this conversation, R. Scott Gemmill, a veteran television writer known for ER and NCIS Los Angeles, and Dr. Joe Sachs, an emergency physician and TV writer, delve into the making of The Pitt, a groundbreaking medical drama. They discuss the critical need for authenticity in portraying the medical field, touching on real healthcare challenges and character development. Highlights include innovative storytelling that captures ER chaos in real-time and heartfelt tributes to the commitment of healthcare workers, blending humor with deep insights.

Step inside Alexa Miller’s classroom, where paintings become portals and doctors learn to see like patients. In this episode, Alexa leads a powerful exercise called the “image circle,” where clinicians reflect on their own experiences of medical uncertainty and choose artworks that speak to those moments. What follows is anything but abstract—through close looking and deep conversation, participants begin to feel what it’s like to sit on the other side of the exam table. Alexa, a trailblazer at the crossroads of art and medicine, shares  frameworks for understanding uncertainty and introduces her BOLD framework for navigating uncertainty in healthcare. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Host: Emily Silverman, MD Uncertainty Correspondent: Alexa Miller Series Illustrations by Eleni Debo This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

In this engaging discussion, Alexa Miller, an arts educator with over 20 years of experience, serves as the uncertainty correspondent. She explores medicine's tricky relationship with not knowing, contrasting the tidy resolutions in medical dramas with the unpredictable realities physicians face. Topics include the mental health impacts of misdiagnosis and the necessity for future doctors to embrace ambiguity. Miller emphasizes that navigating uncertainty can enhance clinicians' skills, improve communication, and foster better collaboration with patients.

Our Uncertainty in Medicine series launches next week, and to set the stage, we’re sharing one of our favorite episodes from the archives - a heartfelt conversation with New York Times columnist Ross Douthat about his journey through the healthcare system while living with chronic Lyme disease. Medicine likes certainty - diseases we can see and test for and treat. But what do we do when we can't see? When we can't help? Do we keep searching? Or do we look away? In this episode, Emily speaks with New York Times columnist Ross Douthat about his book The Deep Places, which tells the harrowing story of his experience with Lyme disease, and what it's like to navigate a chronic illness that mainstream medicine hasn’t yet fully explained. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

Medicine is full of uncertainty—from ambiguous diagnoses to unpredictable outcomes and the complex emotions of not knowing. Uncertainty in Medicine is a new documentary podcast series, created in collaboration with Alexa Miller of ArtsPractica, that examines how both healthcare workers and patients navigate the unknown. Through powerful personal stories and in-depth conversations with professionals whose work depends on making decisions amid uncertainty, the series explores what it means to embrace the gray areas of medicine—and life. The first episode of Uncertainty in Medicine drops Thursday, April 3. Find show notes, transcripts, and more at thenocturnists.org The Uncertainty in Medicine series is funded by the ABIM Foundation, and is supported in part by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Series Host & Co-Creator: Emily Silverman, MD Series Correspondent: Alexa Miller (ArtsPractica) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

Dr. Allan Detsky, a Canadian physician, health economist, and Broadway producer, examines the contrasts between Canadian and American healthcare. He then delves into his passion for musical theater, recounting his unexpected journey into Broadway production and how he integrates musical theater into hospital wards as a means of decompression and connection in medical education. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

Kali Dayton, critical care nurse practitioner, ICU outcomes consultant, and host of the Walking Home from the ICU podcast, joins pioneering ICU physical therapist Heidi Engel to discuss long-standing ICU practices rooted in sedation and immobility. Together, they make a powerful case for a transformative model that keeps patients awake, engaged, and walking—even while on ventilators. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

Dr. Marcy Bolster, Dr. Jason Liebowitz, and Dr. Philip Seo, esteemed rheumatologists and co-authors of an insightful anthology, share their journeys in mastering the art of medicine. They discuss the pivotal role of mentorship and the qualities that define exceptional physicians, emphasizing empathy and lifelong learning. The trio also delves into the intersection of art and medicine, the intricate nuances of rheumatology, and the potential of AI in diagnostics. Their conversation underscores a human-centered approach to healthcare, blending personal stories with professional insights.

Dhruv Khullar, a physician and health policy expert who writes for The New Yorker, explores the complexities of modern medicine, comparing it to a Gilded Age. He discusses how groundbreaking innovations often obscure deep systemic issues like rising costs and misaligned incentives. The conversation dives into the effects of private equity on healthcare, the pitfalls of Medicare Advantage, and the significance of clinicians engaging in health policy debates. Khullar emphasizes the need to address access and equity in the healthcare system.