Tag Archives: Education

Rethinking Legacy Thinking

tree and books Rethinking Legacy Thinking


Legacy thinking is often described as a way of thinking about the future, especially when it involves leaving something behind for the next generation. Yet the same phrase can mean something quite different. Legacy thinking can also refer to the habit of staying anchored to the past. In this sense, it means hoping or presuming that habits and ideas that once worked will continue to work indefinitely.

In my experience as a physician, teacher, and writer, healthy legacy thinking transmits principles rather than habits. Principles endure even as methodologies, tools, and techniques evolve. Each new generation faces the challenge of deciding what should be preserved, what should be discarded, and what warrants adaptation.

For those interested in a contemplative examination of the subject, I explore these reflections more fully in a recent essay on Substack: https://henricolt.substack.com/p/rethinking-legacy-thinking

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The Physician’s Journey: Transitions, Burnout, and Reinvention

physician by river calmly thinking about professional transition and reinvention


Medicine is a profession marked by transitions, though we rarely name them as such. In this Substack essay, I reflect on burnout, not as a weakness, but as a signal that change is necessary before health care professionals collapse under the burdens of accumulated years, growing responsibilities, unfriendly work environments, and shifting systems.

As medicine enters an era increasingly affected by artificial intelligence and structural transformation, the ability to transition and even reinvent oneself is even more important than before. We are reminded that while tools and roles may evolve, the moral dimensions of medical practice remain. What endures is more than technical expertise, it is the human capacity to care, with judgment, presence, and compassion.

You can read the full essay on Substack here. https://henricolt.substack.com/p/the-physicians-journey-transitions

I welcome your reflections. 

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Anyone Can Be A Mentor

Doctor in white coat and stethoscope thinking. Two doctors in the background with a chart.


Mentorship is an essential part of professional and personal development. In medicine, it has been an especially dominate force, in part because of traditional apprentice-like training, but also because it has been a most opportune way for health care providers to learn to emulate certain behaviors and ways of thinking. It has also been a traditional vehicle for the transmission of knowledge. Authority descends from senior to junior physicians, to trainees, and students. Today, however, that alignment is less secure.

Technology puts information as well as world-class training tools and illustrated behaviors at the hands of virtually anyone almost immediately. Younger generations are often more adept at using new technologies than their senior colleagues. Traditions are questioned. Conventions demand justification based on more than experience alone. I’ve been thinking quite a bit about mentoring; about its good sides as well as its limitations and vulnerabilities, especially in an era of democratized knowledge and reversed mentoring.

For those interested in a contemplative examination of the subject, I explore these reflections more fully in a recent essay on Substack: Anyone Can Be a Mentor

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What Remains After a Patient Dies

: A solitary human figure seated in a dim, quiet interior space, facing soft light


I’ve written before on Colt’s Corner about resilience in medicine, mostly in the context of endurance, burnout, and recovery. Recently however, I found myself returning to the question from a different direction, less as a skill to be cultivated and more as an ethical stance based on human connection. 


After a recent lecture, several nurses and physicians spoke about what remains after a patient dies. They asked how one can resume work after facing therapeutic failures repeatedly or after suffering the emotional toll of sustained compassionate caregiving. Their questions led me to revisit resilience not as toughness, but as a form of presence that allows compassion without collapse. 

For those interested in a more contemplative examination of the subject, I explored these reflections more fully in a recent essay on Substack: What Remains After a Patient Dies.


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History of Pulmonary Medicine: From Antiquity to AI

history of pulmonary medicine shows evolution and AI


The history of pulmonary medicine is replete with famous names and milestone events that changed the face of medical science over centuries. From early empirical observations in ancient civilizations to Egyptian texts describing herbal treatments and surgical interventions, it is clear that humanity has suffered from lung disease since the days when Homo sapiens and its predecessors first walked the earth. What follows is not a comprehensive history, but some thoughts on how shifts in knowledge have shaped pulmonary medicine. 

Hippocrates and other Greek practitioners set guidelines for medical practice. They also defined and described many breathing disorders, not the least of which was phthisis, later known as consumption or pulmonary tuberculosis. They described and treated pleurisy and raised awareness about the potential contagiousness of what would ultimately be recognized as infectious lung diseases centuries before the discovery of germ theory.

After that, another Greek physician, Galen of Pergamon, who practiced in the Roman Empire in the second century CE, shaped the future of medicine for centuries. Although many of his findings rooted in anatomical studies and theoretical iterations of what ultimately became the humoral theory for disease needed to be revised or debunked, Galen was forward-thinking in the ways he tied symptomatology (medical semiology), the anatomical structure of the human body, and the external environment on the course of disease. He was among the first to suggest that air, water, and even emotional disturbances could have an adverse impact on human health and wellness.

New theories of medicine prospered only centuries later, when the Islamic physician Avicenna (Ibn Sina) published his Canon of Medicine and Book of Healing (11th century). The Renaissance, however, brought about some of the greatest changes and the abandonment of most antiquated Galenic theories regarding lung disorders. Anatomists/physicians such as Vesalius, who described the mechanics of respiration and demonstrated the principles underlying positive-pressure ventilation, and Michael Servetus, among the first to describe the pulmonary circulation (early to mid-16th century), were instrumental in building new foundations from which future discoveries in pulmonary medicine would be made.

From the 17th to the 20th century, new breakthroughs would occur particularly in the realms of microbiology, pharmacology, imaging studies, and physician concerns for public health. The discovery of oxygen and the physiology of respiration, accompanied by widespread adoption of Laennec’s stethoscope revolutionized bedside diagnosis and global thinking about the diagnosis, treatment, and prevention of pulmonary diseases. 

Concomitantly, advances in the diagnosis and management of infectious lung disease, the establishment of links between smoking and disorders such as lung cancer and COPD, and growing attention to occupational lung disease anchored pulmonary medicine as a social discipline.

Today, we have reached a new inflection point in the history of pulmonary medicine. Artificial intelligence is reshaping medical diagnosis and decision-making in ways that we cannot yet fully comprehend. Machine-learning algorithms already outperform traditional methods in image interpretation for lung nodules and interstitial lung disease. AI-assisted pathology and cytology promise laboratory expertise in even the most remote corners of the world. Tools combining large language models with genomic and gene-editing processes are accelerating discovery and assisting in earlier diagnosis and management of genetic disorders. Robotics and robotic-assisted bronchoscopy are penetrating the pulmonary procedures world at almost warp speed, providing higher diagnostic yields for lung cancer and other disorders by enabling better access to hard-to-reach peripheral nodules compared to traditional methods.

In the face of such rapidly changing times, our challenge is in finding ways to both embrace and harness computational power. While debates about the risks versus the advantages of AI in pulmonary medicine are helpful, we should also focus on how technological authority can go hand-in-hand with professional responsibility.

  • The Cambridge History of Medicine (2006). Eds. Roy Porter. Cambridge University Press.
  • Murray JF. A thousand years of pulmonary medicine: good news and bad. European Respiratory Journal 2001 17(3): 558-565; DOI: https://doi.org/10.1183/09031936.01.17305580.
  • Mahajan AK, Duong DK, Cortes J, et al. The Match 2 Study: Robotic Assisted Bronchoscopy with Integrated Imaging with Assessment of Digital Tomosynthesis (DT) and Augmented Fluoroscopy (AF): Three-Dimensional Accuracy as Confirmed by Cone Beam Computed Tomography (CBCT), Respiratory Medicine 2026. https://doi.org/10.1016/j.rmed.2026.108693.
  • Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med 2019;25(1): 44-56. 

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A New Home for My Writing

landscape stethoscope and ink pen announcement of new home for Henri Colt on Substack


I’m grateful you have been reading my work here, and I’m honored that so many of you around the world have viewed or downloaded educational materials from bronchoscopy.org in support of our shared educational mission.

I will continue to add to this website, and to post on Colt’s Corner.

For some time now, however, I’ve been thinking about where my longer, more reflective writing belongs. These include excerpts from my books, longer essays, short stories, and commentaries—reflections on medicine, philosophy, literature, science, art, and the fragile beauty of our shared lives.

I’ve begun publishing this work on Substack — a quieter space that allows for long-form writing and more direct conversation with readers. 

If you would like to continue reading there, 
you can find my work and subscribe here:
Subscribe on Substack

A recent essay:  On Friendship and Sudden Loss

Communication in Health Care: Patients and Providers

Effective communication in healthcare

 Communication in health care relies on a foundation of trust and psychological safety amid unexamined assumptions, non-dits (which is French for things left unsaid), potentially mismatched expectations, asymmetries of knowledge and power, vulnerability, unspoken emotional defenses, and differences in understanding or health care literacy. Perhaps this is why effective communication requires more than clarity of language. It also requires our attention to meaning, context, and subjective experiences, including the “emotional baggage” carried by all those involved in our conversations.

Whenever we communicate, we receive, transmit, and interpret both information and feelings. Psychological research shows that effective communication in health care is tied to perceived empathy, narrative coherence, and opportunities for all involved parties to be heard. Taking the time to sit at the patient’s bedside and avoiding potential distractions such as phone calls, computer screens, or unnecessary interruptions can be key to establishing rapport. In my experience, providers operating under time constraints, emotional strain, or institutional pressures have difficulty recognizing how fear, hope, and struggles tackling ambiguity or uncertainty adversely affect their patients’ understanding. They risk using technical jargon, matter-of-fact approaches, or paternalistic attitudes to rush through a conversation, disregard differences in health care literacy, or achieve a specific desired outcome. Hence, health care providers might subconsciously or intentionally distance themselves emotionally from their patients. The result is a potential undermining of a patient’s trust. Consequently, both caring and compassion are sacrificed on the altar of efficiency.  

Interprofessional communication between physicians, nurses, technicians, and allied health professionals also has its challenges. Healthy dialogue means overcoming real and perceived hierarchical barriers and role ambiguities. It means negotiating intergenerational differences, acknowledging differing professional identities grounded in diverse yet strangely singular training paradigms, and recognizing inward disengagement even when outward appearances signal agreement or a willingness to comply.

Overall, this introduces yet another layer of complexity to effective communication. Cultural expectations can vary significantly among trainees, mid-career professionals, and more senior practitioners. Intergenerational differences of opinion might exist regarding what constitutes competence and professionalism, for example, or how to communicate with respect to cultural diversity. Not everyone has similar views on the appropriateness of multitasking (it took me a while to realize that young people can remember and reflect on what I say even while scrolling through pictures and texts on their mobile phones), or on when to rely on narrative versus factual reasoning. 

Much more can be said about communication in health care. In future essays, I will briefly address dialogue between health care providers and administrators, conversations with patients’ families, and the challenge of effective communication with staff, other team members, and direct reports. I will also discuss communication failures and why I believe the observation and improvement of communication skills should be an integral part of competency—based training.  

Maleficence in Healthcare

Shows doctors and examples of intentional and unintentional maleficence


Maleficence in healthcare refers to any intentional and unintentional harm caused by healthcare providers or health systems. It is usually discussed in contrast to nonmaleficence, the avoidance of causing harm, one of the pillars of the Four Principles approach to medical ethics proposed by Beauchamp and Childress in the 1970s.

Intentional maleficence manifests as deliberate actions that knowingly harm patients. Thankfully, it is rare, and acts of intentional hurt, deception, exploitation, or fraud are universally frowned upon by health care providers, professional organizations, institutions, and society at large. Any intentional infliction of harm obviously betrays patient trust, which is the foundation of all physician-patient relationships.

Some of the most notorious examples of intentional maleficence stem from authoritarian regimes or times of military conflict. Acts ascribed to Nazi healthcare providers before and during World War II are among those most frequently cited. Forced euthanasia, the deliberate killing of populations considered unworthy of life, forced sterilization programs, and harmful experimentation in the name of science (such as cold-water immersion, intentional injection, or exposure to knowingly toxic substances, etc.) illustrate how Nazi doctors, midwives, nurses, and technicians intentionally murdered, tortured, or abused patients and other victims of the repressive Nazi regime. 

Other flagrant examples of intentional maleficence occurred during Argentina’s brutal military dictatorship (1976-1983). During this time, some health care providers were complicit in the torture or murder of innocent victims detained by state agents. This included documenting false causes of death (such as falls from high places), administering drugs to torture victims, and falsifying records used to facilitate unlawful adoptions of disappeared children. 

Equally disturbing are discoveries made during and after the Second Gulf War (2003-2011). Health care providers pressured by Saddam Hussein’s oppressive Ba’ath regime allegedly falsified death certificates and misrepresented legal reports of torture. Also troubling are reports that psychologists and United States military personnel failed to report human rights abuses of detainees undergoing interrogations at Abu Ghraib and Guantanamo Bay. 

Of course, cases of intentional maleficence are not limited to health care delivery under authoritarian or military regimes. Other examples include unethical human experimentation, the deliberate withholding of treatment (the 40-year Untreated Syphilis Study at Tuskegee comes to mind), performing unnecessary procedures regardless of context, economic misconduct and fraudulent practices to satisfy scientific, personal, or financial ambitions, and ideologically-driven care that disregards patient welfare in favor of personal gain or adherence to doctrinal beliefs and political policies.

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While intentional maleficence is a clear violation of professional ethics and fiduciary duty, the picture is less clear in cases of unintentional maleficence, which is both more prevalent and ethically complex. Unintentional maleficence usually stems from cognitive and experiential bias, system pressures, fragmented care, miscommunication, a propensity to practice medicine defensively, clinical uncertainty, or unwarranted therapeutic zeal. It can also be an unfortunate and even deadly result of medical error, negligence or professional incompetence.

Unintentional maleficence often occurs despite well-intentioned practices. In these cases, ethical analysis is challenging because health care providers usually act in the pursuit of beneficence. A prime example is any medical intervention for which possibilities for an undesired outcome are underestimated or not revealed. High-risk treatments, polypharmacy in vulnerable populations, and technically correct but ethically damaging decisions are other instances where harm may occur despite a health care provider’s intention to help. A well-known illustration is “the double effect,” in which a medical intervention has two causally independent outcomes: one that is ethically and legally acceptable, such as the relief of pain or anxiety, and another that is not, such as a patient’s death from oversedation.

Maleficence in healthcare includes both intentional and unintentional harm caused by clinicians or systems, raising complex ethical challenges that go beyond nonmaleficence. In my opinion, more conversations about these topics are warranted within the Interventional Pulmonology community. This is because maleficence encompasses both intentional and unintentional harms arising from clinical actions, flawed decision-making, or omission. These may result in ethical violations, poor patient outcomes, and ideological harm. Health care providers, institutions, and professional societies are morally accountable to design systems that minimize foreseeable harm and respond proactively to sentinel events. They should create and support conditions that prioritize patient safety, transparency, overall well-being, and ethical awareness over convenience, personal gain, or professional protectionism.

  • Beauchamp TL and Childress JF (2019). Principles of Biomedical Ethics (8th ed). Oxford University Press.
  • Beecher HK. Ethics and Clinical Research. N Engl J Med 1966;274:1354-1360.
  • Weindling PJ (2004). Nazi Medicine and Nuremberg Trials. Palgrave Macmillan.
  • Reis C, Ahmed AT, Amowitz LL, et al. Physician Participation in Human Rights Abuses in Southern Iraq. JAMA. 2004;291(12):1480–1486. doi:10.1001/jama.291.12.1480.
  • Scheper-Hughes, N. The Ghosts of Montes de Oca: Buried Subtext of Argentina’s Dirty War.” The Americas2015;72(2):187-220. Project MUSE, https://muse.jhu.edu/article/579738.
  • Newly unredacted report confirms psychologists supported illegal interrogations in Iraq and Afghanistan. ACLU Release, April 30, 2008. https://www.aclu.org/press-releases/newly-unredacted-report-confirms-psychologists-supported-illegal-interrogations-iraq.

Why World AIDS Day Still Matters

Doctor in white coat wearing the Red Ribbon that remains a symbol of awareness, compassion, and the unfinished work of ending AIDS.
Photo courtesy Bermix studio (Unsplash)

HIV/AIDS is now manageable, yet millions of people still lack access to care. The world commemorates December 1 as World AIDS Day, a date observed since 1988 to remind us that HIV/AIDS remains a major global health challenge. Today, more than 40 million people are living with HIV worldwide, the majority in sub-Saharan Africa. Thanks to antiretroviral therapy and improved treatment of opportunistic infections, deaths from HIV/AIDS have fallen by more than fifty percent since 2010, and HIV can now be considered a chronic, manageable health condition. 

Transmission of HIV continues, however. More than one million new infections occurred in 2024, with particularly high rates among young women in Africa. Moreover, according to the World Health Organization, only 87 percent of people living with HIV know their status, and nearly one quarter are not receiving antiretroviral therapy.

Yet political commitment has not translated into equitable access. In 2015, United Nations world leaders unanimously pledged to end the AIDS epidemic by 2030. According to UNAIDS, the world is not on track to meet that goal. Progress has been hampered by breaks in solidarity between and within countries. Advances in long-acting treatment and prevention technologies are not being adequately shared with all low- and middle-income nations, and many HIV programs continue to overlook people from key populations. These include sex workers; gay men and other men who have sex with men; people who inject drugs; transgender people; and people who are incarcerated or detained in closed settings. At the same time, rising infection rates are being reported in eastern Europe and central Asia, Latin America, and the Middle East and North Africa. 

Although access to HIV treatment continues to expand, prevention and education programs have suffered from chronic underfunding. Household surveys suggest that condom use has declined in recent years, particularly among young people aged 15-24 and among those engaging in sex with non-regular partners. In many countries, community-led organizations are also struggling to survive financially, especially those addressing HIV alongside broader human rights concerns, including the right to universal health care.

Given that millions of people continue to live with HIV infection and HIV-related disease, HIV/AIDS remains a serious threat to public health. Continued progress in prevention, diagnosis, and treatment is essential, but at least three additional challenges demand attention. First, stigma and discrimination must still be eliminated in many regions. Second, the aging population of people living with HIV requires health systems capable of managing patients with chronic comorbidities such as hypertension, diabetes, and cancer. Finally, health care providers and community educators must not overlook the ongoing risk of HIV transmission among older adults.

The awareness ribbon reminds us that awareness without action is insufficient. The never- trademarked Red Ribbon was chosen as the international symbol of AIDS awareness by the Visual AIDS Artists Caucus in 1991 and was first worn by actor Jeremy Irons at that year’s Tony Awards. The ribbon symbolizes love and compassion for those people living with HIV/AIDS, blood in recognition of transmission, and urgency—a signal that the work of prevention, solidarity, and care remains unfinished.

Lung Cancer Awareness Month

White ribbon logo for lung cancer awareness month


November is Lung Cancer Awareness Month, and with it, renewed interest in what is still the most diagnosed cancer in the world when both sexes are combined. Recent statistics show that about 2.5 million new cases are discovered each year, representing one in eight cancers worldwide (12%). 

In the United States, lung cancer accounts for about 11% of all new cancer diagnoses (about 227,000 cases per year). While most lung cancers are attributed to smoking, the disease also strikes an increasing number of people who never smoked (20,000-40,000 cases per year). 

One alarming statistic is that among never-smokers (defined as having smoked less than 100 cigarettes), females had a 54% higher risk for developing lung cancer compared to their male counterparts. Dr. Narjust Florez of the Dana-Farber Cancer Institute said that “Younger women take three times as long to be diagnosed compared with younger men – even when you match for age, risk factors, and geography.” 

Studies show that secondhand (environmental) tobacco smoke, outdoor and indoor air pollution, and genetic susceptibility (family history and genomic variants such as EGFR mutations and ALK gene rearrangements) are risk factors for lung cancer in non/never-smokers. These represent 15-20% of all lung cancers worldwide!

According to the American Lung Association, less than a third of lung cancers are diagnosed at an early stage. Progression is often silent, and by the time symptoms such as cough, chest discomfort, or shortness of breath are taken seriously by patients and health care professionals, the disease has often progressed. Not surprisingly, it has one of the lowest five-year survival rates of all cancers and remains the leading cause of cancer death worldwide.

All of the above are reasons enough to increase the public’s awareness of lung cancer.

If we are to combat lung cancer effectively, November and every month should be lung cancer awareness month. It is crucial for all health care providers to recognize the dangers of this disease and the need for people at risk to enroll in newly developing lung cancer screening programs. Both specialists and primary care providers should never neglect the possibility of lung cancer in non-smokers, including in men and women under the age of sixty-five. I have heard too many stories about doctors who ignored what turned out to be early symptoms of the disease or neglected to follow up with someone at low or no risk, whose cough transiently disappeared enough for them to avoid seeking more medical attention.  

From a philosophical standpoint, awareness involves more than information processing. It is a character of our consciousness. To become “aware” means to experience something and to consciously recognize what we are doing, feeling, and thinking in the present moment. The menace of lung cancer is real, and like many illnesses, threatens us all. 

Let’s be AWARE of that and do something about it.

  • American Cancer Society. (2025). Cancer facts & figures 2025. American Cancer Society.
  • American Lung Association. New report: Lung cancer survival rate improves…https://www.lung.org/media/press-releases/state-of-lung-cancer-2024.
  • Bray F,  Laversanne M,  Sung H, et al.  Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin.  2024; 74(3): 229-263. doi:10.3322/caac.21834
  • Couraud, S., Zalcman, G., Milleron, B., et al. Lung cancer in never smokers – A review. European Journal of Cancer;2012:48(9), 1299–1311.
  • Narjust Florez (Dana-Farber Cancer Institute) https://www.uicc.org/news-and-updates/news/25-m6-hidden-epidemic-rise-lung-cancer-among-women-and-need-equity
  • Hui C et al. Higher lung cancer risk among female never-smokers than males in a large married couple study. Lung Cancer 2025;210; https://doi.org/10.1016/j.lungcan.2025.108836.