Why I Write Medical Satire (Because Health Care Keeps Writing It for Me)

An excerpt from Essays and Echoes: Reflections from a Life in Medicine

I’ve written eight books of medical satire—nine if you include a “best of” volume—hoping to make readers laugh, think, and recognize that satire works because real life often feels just as absurd. Medical satire uses humor, irony, and exaggeration to highlight flaws in our healthcare system, medical practices, and even doctors’ behavior. Satire has long held up a mirror to medicine and helped clinicians cope with stress. That’s why I write satire: to expose the chaos behind the scenes. I don’t make fun of medicine because it’s frivolous—I write satire because medicine is serious, and organizations often look most absurd when they insist they’re being serious.

Satire exposes the gap between what institutions say and what they do. A hospital proclaims “the patient comes first” yet puts callers on hold. An insurer calls a claim denial a “coverage determination,” as if the decision were handed down from on high. An electronic health record promises better communication but demands a dozen clicks just to note that you spoke with someone. A “wellness committee” schedules a mandatory resilience workshop during lunch, the only time caregivers get a break. The joke writes itself—it even has a policy number.

In my eight volumes—naturally titled Sick and Systemic: Absurd Scenes from a Medical System That Works—Just Not for You—I’ve tackled topics such as prior authorization, overflowing inboxes, corporate health care, artificial intelligence, performance metrics, patient portals, paperwork overload, wearable devices, burnout, and how health systems turn every human need into a workflow. My fictional committees may seem over-the-top, but they often feel all too familiar. Some readers laugh; others say, “That happened to me last week.” A policy paper can explain problems, but satire lets you feel what it’s like to live inside them.

Who I aim at matters. I don’t punch down—patients, their families, or overworked staff aren’t the joke. Often, those front-line workers are simply following rules set by people far from the bedside. Mocking the powerless doesn’t help; it only makes suffering more efficient.

My real target is the system that forces good people into ridiculous roles and then measures how well they play along. Doctors are not exempt—our field can be pompous and territorial. We use jargon and hide behind certainty, as if admitting doubt were a moral failing. We complain about administrators’ language while describing patients in terms they can’t understand.

That’s why I satirize myself in my writing. You can’t honestly mock a system if you pretend you’re outside it. I’ve spent decades as a clinician, executive, advisor, and writer. I’ve sat through “process improvement” meetings that spawned more meetings and unproductive work. I’ve used baffling phrases that said more than they explained. I’ve nodded along to PowerPoints with arrows and circles that had no connection to patient care. Satire lets me confess these moments without drafting a legal document.

Satire also lowers defenses. Tell doctors they’re part of a dehumanizing system, and they’ll argue back. Show them a “Department of Inboxology” where clinicians practice “virtual peacekeeping,” and they’ll laugh—then realize they work there. That laugh opens a brief window for real insight.

Physicians face constant evaluation, ranking, and reminders that their notes don’t justify billing codes. Another dry lecture on dysfunction only causes fatigue. Satire sneaks in from the side, exaggerating what’s visible until the hidden logic becomes clear. A step-by-step description of utilization review sounds tedious—but put it in a scene where a doctor must prove a patient has “failed” a drug they can’t safely try, and you see it for what it is: a moral choice dressed up as paperwork.

Laughing in that moment isn’t dismissive. It’s relief and recognition: “I’m not the only one who thinks this is crazy.” In a profession that compels people to treat absurdity as normal, that recognition can sustain them.

Still, satire has its limits. Some wounds need direct talk, careful analysis, anger, grief, or silence. I don’t rely on satire alone because no single form of writing can bear medicine’s full moral weight. A patient’s death isn’t a joke—but the system that turns that death into a cold morbidity and mortality review and a quarterly stat can be.

Satire helps clinicians process distress, but it can also serve as a form of emotional anesthesia. Dark humor has long helped medical teams function in overwhelming situations, yet overuse breeds cynicism or distance from the people they care for. Good medical satire doesn’t hide suffering; it exposes the structures that enable us to ignore it. E.M. Papper wrote that satire’s power lies in probing medicine itself. As long as our bodies and minds matter, medical satire will endure, he concluded.

Early medical lampoons fiercely attacked blind obedience, false expertise, social climbing, and profiteering at patients’ expense. Yet they upheld one constant rule: a doctor’s first duty is to the patient. Any breach warrants scrutiny. That’s my rule, too.

Satire becomes vital when the official narrative of care no longer aligns with lived experience. Our focus on measurable results—mortality, readmissions, infection rates, access, safety, response rates, and costs—widens that gap. We count what we can, but we begin to mistake what’s measurable for what’s meaningful.

A dashboard can show whether a patient made it to an appointment, but not how hard it was to get there. A depression rating scale gives a number but can’t explain why a widower still sets two plates at dinner. An AI scribe captures words but can’t sense what a patient almost said and chose not to say.

Satire lays bare these contradictions. Push an idea just past its polite limits, and you see where it was headed all along. You enter a heightened world, only to realize that even a little exaggeration was needed to match reality.

For me, the gold standard remains The House of God by Samuel Shem, published in 1978. It still rings true because it doesn’t flatter the profession. Its residents survive exhaustion, hierarchy, suffering, and indifference by making their own rules and defenses. We feel their burnout not from charts or studies but from living their experience.

No burnout survey moves us like that novel. It doesn’t just tell us that doctors depersonalize; it shows depersonalization as a survival tactic and forces us to confront its cost. That’s literature doing clinical work.

Satire also lets us rehearse moral choices. In a fictional scene, doctors can see what happens when responsibility is passed around and falls through the cracks, when AI overrides judgment, or when everyone follows protocol yet the outcome is horrendous. You can explore these scenarios without defending your own workplace. Fiction protects, but it doesn’t let you escape.

I write satire because I believe medicine can improve. It would be easier to write out of pure contempt, but that’s less useful. Satirists split into those who seek correction and those who seek punishment. I aim for correction. My goal isn’t to excoriate medicine but to remind it of its promises.

The laugh isn’t the finish line; it’s an invitation. It invites doctors to notice what they’ve normalized. It invites leaders to hear how their words echo beyond the boardroom. It invites everyone to see that a process can be efficient and compliant—and still be wrong. Above all, it invites us to look beyond the numbers to the patient, who is waiting for someone to stop admiring the dashboard and ask, “What happened to you?”

As I said at the start, reality wrote most of this. Satire just polishes it, adds punctuation, and circles the absurd in red. And then, hopefully, someone fixes the system.