Rewriting the Rules of Care, One Post at a Time
How a doctor’s inner truth built an outer platform
Sometimes a Substack begins with a quiet question—one that won’t go away.
For this writer, that question surfaced during early motherhood, when she realized she couldn’t ask her daughter to follow a path she herself didn’t believe in. So, she left her career in programming, pursued medicine, and years later—after raising children, battling leukemia, and caring for thousands of patients—found herself drawn to writing.
Doctoring Unpacked was born not from ambition, but from a desire to connect. To explain. To give readers the kind of clear, compassionate conversations most doctors don’t have time for.
Her stories—rooted in fictional patients but grounded in real-life medicine—quickly resonated. They’re not just educational. They’re human.
In this conversation, she shares how courage, clarity, and curiosity shaped her writing voice—and why vulnerability might be the most powerful prescription of all.
Meet
Q: Tell us a little bit about your background
I am a primary care doctor. Unlike most doctors, I career-switched into medicine. My initial career was as a computer programmer. After my first daughter was born, I was not sure if I wanted to go back to work or to stay home with her. In the hormone-soaked, sleep-deprived state that mothers of newborns are in, I found a thought drifting through my head about my daughter’s future career. It occurred to me that if she felt about her job the way I felt about mine, I hoped she’d quit it. This thought grabbed my attention. I realized that I should be giving some serious thought to quitting my job, which I soon decided to do.
This left me having to give serious thought to what I wanted to do instead. I thought about being a birth doula. Back then, I lived in Berkeley. There was a doula training place within a mile of my house. I volunteered there for a while. One day as I was answering phones and dealing with their broken mailing list, I overheard some doula trainees talking about an exam they had just taken. Their conversation hinged on whose blood was in the placenta: the baby’s or mother’s. I knew the answer, and I was surprised that they didn’t.
I started thinking about how much I had enjoyed all the quasi-medical stuff you read when you’re pregnant. It was then that the thought occurred to me that I could become a doctor. At that moment, I had the sensation that you get when you’re putting a plastic toy together and suddenly there’s a snap and everything goes into place. I could be a doctor!
This required some educational catch-up. I started taking pre-med classes, one or two at a time. I entered med school when my baby entered first grade. Along the way, I had another baby, did residency, and after that, moved to New Hampshire. I got leukemia. I got divorced. I got married again - to a writer. He’s published a book, and he has a Substack. He encouraged me to start my own Substack, to give me a platform, however small, for the things I wanted to write about.
I started publishing regularly. For several months, I got little traction, then suddenly I did! It turns out that lots of people were interested in “How to make your eighties miserable.” I write engaging stories about doctor-patient interactions and about common diseases. As privacy laws prevent me from talking about real patients, I write about fictional patients, giving them realistic personalities and backstories. In article form, I have a big advantage over real-life interactions: I have all the time in the world to answer their questions about their medical condition. This style of article quickly generated a sizable following of readers. One of my articles even went viral, getting over 1,300 likes. I now have a sizable group of highly engaged fans. My Substack is called “Doctoring Unpacked.”
I am an internist. That means I only take care of people who are 18 and up, and I only do medical (as opposed to surgical) care. I did not intend for it to work out this way. At the beginning of my career, I thought I’d specialize in perimenopausal care. What happened instead was that the oldest, frailest, and most complicated patients kept showing up in my schedule. I found that treating these patients was what I enjoyed the most and it set up a positive feedback loop. You don’t have to be my patient long before you hear me say, “You never want your doctor to think you’re interesting.” Well, almost everyone in my panel is interesting.
My favorite thing to talk about with patients is when one organ system would benefit from a particular treatment but they have another organ system would be harmed by that treatment. The most important input into this calculation is the patient’s values, beliefs, hopes, and desires. The thing that turns me on the most is when I can understand a phenomenon from the molecular level, through increasing scale, right up to the societal level.
I cannot believe my good fortune. I have a job that allows me to do much of that and a platform on Substack that allows me to do the rest.
It’s like an intellectual orgasm.
Q: Beyond the act of hitting "publish," what's the most courageous thing you've done as a writer on Substack?
I think writing that previous sentence required a certain amount of courage.
Telling people what we like, what we value, and what is important to us is an act of courage and makes us vulnerable. It’s like pointing out where your exposed flank is.
Q: Many people dream of writing but fear judgment or failure. What advice would you give to those who are hesitant to share their voice on Substack?
The same advice I give to any thirteen-year-old who happens to cross my path. Nobody is thinking about you anywhere near as much as you think they are. You’ll write something, and no one will notice. You’ll bleed out onto the page and no one will notice. You’ll wish people would judge you because at least then you’d know someone was paying attention.
Say you define failure by having no subscribers. If you write nothing, you’re guaranteed to have no subscribers. If you write a little something, maybe your Aunt Martha will subscribe. Then maybe some more will subscribe. Maybe not, but you’ve not done any worse than if you’d not tried at all.
The prospect of having no subscribers didn’t bother me. The barrier for me is that the world is awash in voices. Do I really have something so interesting to say that saying it is more valuable than being quiet? What I discovered was that no one was writing about the things I said to patients. I wanted more people to hear these things than just the patient in front of me and that helped me overcome my complex.
Q: In your opinion, what's the most courageous thing a reader can do after engaging with your work?
Use the information provided to talk with their own doctor. Doctors can be very paternalistic and sometimes don’t like it when their authority is questioned. Patients feel vulnerable. It takes a lot of courage to say to your doctor, “I don’t think you’ve heard how distressing I find symptom XYZ. Are you sure there is nothing more we can do about it?” Even just asking for a thorough physical exam can require courage.
Q: Vulnerability is often a key component of courage. How do you balance being vulnerable with maintaining healthy boundaries as a writer in such a public space?
My articles are not really about me. They are about the patients, and our relationship, and the diseases. Certainly, my attitudes and ideas are expressed here, but I am not the focus of my Substack.
Q: Courage often involves taking risks. What's the biggest risk you've taken in sharing your writing or building your Substack community?
Encouraging people who know me in real life - patients and doctors I admire - to read my work. Saying “I have a Substack; I think you’ll like it” is a bit like saying “Here are my best thoughts.” We equate people liking us with people thinking our thoughts are good thoughts. More importantly, we equate people not liking us with people thinking our best thoughts are not good thoughts. This is, of course, foolishness, but I’m human and do my best not to fall into that trap.
Q: What advice would you give to other thought leaders who feel stuck or unfulfilled but are hesitant to take the leap and reinvent themselves?
To give some thought to why they are feeling stuck or unfulfilled. Is it really the career or circumstances or is it internal? I do see a lot of people who blame their unhappiness on externals when really they have a dysfunctional belief that is causing them to be unhappy. I have an article about this: Doctor, My Belief Hurts
Is there something else they think they’d like to do? If so, if the problem is money, maybe give some thought to downsizing their life so that they can switch careers. Can they retire? If so, maybe do that. If they don’t know what else they’d like to do, but just know they’re unhappy, maybe read some books and reflect, or see a therapist or a life coach to figure out what gives their life meaning.
Q: If you could go back and tell your pre-Substack self one thing about the journey ahead, what would it be?
Nothing. I am more than satisfied with the journey and doubt that any tweaking on my part would improve anything.
Q: What’s the one thing that stressed you out the most as a writer, creator, and thought leader? And what are some of the tools you use to deal with your stress?
That I will make a mistake or be unclear, and this will contribute to a cascade of events that ultimately results in someone being harmed. The same stuff that everyone else uses: meditation, good self-care, all kinds of self-talk, breathing, yoga, exercise, time in nature, talking with friends, etc.
Probably the most important one is to really examine
what I’m responsible for and what I am not responsible for.
The serenity prayer is helpful to contemplate, but I do best to turn it around. “Grant me the wisdom to tell when it is most helpful for me to act with courage and when, serenity. Grant me the wisdom to understand to what end I am being useful.”
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Thank you for introducing Dr Bates. I liked her approach to life and holistic healing, compelling
Thank you for featuring me! It was very fun to do the interview.