Blogs
This blog features contributions from physicians including Dr. Waggel, MD. Posts reflect individual perspectives while contributing to ongoing learning and discussion in medicine. This is the link to read the student run blogs.
Did you know some letter-writers write negative letters?
By Dr. Waggel & Students
5/2/2026
Inspired by the following video by Dr. Alisha Jones, https://www.instagram.com/reels/DS3PahAiI1K/
Dr. Waggel asked some of our interns if they knew some letter writers actually do write negative letters of recommendation, and how students can prevent this.
Student 1: This is actually the first time I’ve heard of a “negative” recommendation letter. While I completely agree that students should be wise in choosing teachers/professors from classes they’ve performed well in, actively participated in, and taken every opportunity to seek advice on how to improve, I would have thought that if the teacher/professor didn’t have something positive to say they would simply refuse to write it. It’s surprising that they would take time out of their busy schedule to write something negative about the student. Although, I can also see how some students can’t take a hint and insist on getting the letter of recommendation. I love your suggestion on how to ask. You should not assume that the teacher/professor has to write you anything. Asking if they’re “comfortable in writing a strong letter of recommendation” allows them an easy way to back out of it if they don’t feel it will be strong. By using the word “strong”, they know your expectations, and can either agree with it or disagree and not do it.
Student 2: I really appreciated the information shared in the video, especially since the creator is a professor who writes recommendation letters herself. In the future, when asking for a recommendation letter, I’ll make sure that the person I am asking clearly knows my strengths and has a good opinion of me and my work. Additionally, I’ll be sure to ask if they can write an enthusiastic strong letter of recommendation to prevent asking for a recommendation that hurts my application.
Student 3: I did not originally know that a negative letter of recommendation was still possible to give when recommending someone. However, after going through the video, I realized that it is possible to do so. Furthermore, I think that the choice to write a negative letter is completely valid as it highlights the work ethic, honesty, and the quality that the individual is lacking. This transparency lets others know that the individual might not be the best candidate and helps others who are truly looking for a hardworking person to choose someone else. However, if told by your recommender that they will not be able to provide a good letter of recommendation to you, I think that it is best not to ask for one, as knowing that you are not qualified is enough to give you a reminder to change or continue something else. This might also make you miss out on good opportunities, as people do not want to see those negative letters and are looking for something that can benefit them. Not everyone can be good at every field or is capable of handling different positions, and if you do not meet expectations, it is natural to get a negative recommendation letter. In all, asking for a recommendation letter with a clear, professional intention is the first step; if told they are not able to write a good recommendation letter, it is better to ask someone else and not use that letter.
Letters of Recommendation: What Students Often Miss - By Dr. Waggel:
Did you know that a letter of recommendation is not automatically positive? While many students assume that requesting a letter guarantees support, that is not always the case. In fact, some letter writers will submit neutral or even negative evaluations if they do not feel they can genuinely endorse a student. Although I personally believe in being direct and transparent with students about their performance, not all evaluators take that approach. I have seen letters that are surprisingly critical, even when the student appeared confident that the writer supported them. One pattern that stands out is this: students are sometimes told directly that their performance does not meet expectations, and yet they still request a letter from that individual. This is a significant mistake. If a professor, supervisor, or mentor has expressed concerns about your performance, that is a clear signal not to ask them for a recommendation. A letter is not simply a formality, it is an evaluation. Choosing the wrong writer can actively harm your application.
What You Should Say Instead: Rather than asking, “Can you write me a letter of recommendation?” a more effective and professional approach is: “Would you be able to write a strong letter of recommendation on my behalf?” This phrasing gives the person an opportunity to decline if they cannot genuinely support you. A hesitant response, delay, or vague answer should be interpreted as a “no,” even if it is not stated directly. How to Avoid a Weak or Negative Letter – 7 items. There are several practical steps you can take to protect yourself: 1. Ask early, not urgently - Last-minute requests often lead to rushed or generic letters. Ask at least 4–6 weeks in advance, and provide clear deadlines. Improve Life actually asks for 3-months’ notice. Both because we have many letters to write but also to teach our students the importance of advanced notice. 2. Choose someone who actually knows you - A well-known name who barely remembers you is far less valuable than someone who can speak specifically about your work, reliability, and character. Strong letters are detailed, not generic. It is important they have specific details about you. This is why Improve Life has students record and hour-log. 3. Build the relationship before you ask - If you only spoke once in class or had minimal interaction, that is not enough. Attend office hours, participate meaningfully, contribute to projects, and demonstrate consistency over time. 4. Pay attention to feedback - If someone has given you constructive criticism about your performance, take it seriously. Your response to feedback is often more important than the mistake itself. 5. Make it easy for them to write a strong letter - Provide your resume, personal statement, and a brief summary of your goals. Remind them of specific projects or interactions you had together. This helps them write a detailed and accurate letter. For Dr. Waggel, send her your hour-log. 6. Be respectful of their time - Do not send repeated follow-ups or pressure them. A polite reminder is appropriate, but excessive messaging can reflect poorly on your professionalism. 7. Watch for subtle warning signs - If someone seems hesitant, noncommittal, or slow to respond when you ask, that is often an indirect way of declining. It is better to seek another writer than risk a lukewarm letter.
Final Thought: A strong letter of recommendation can significantly strengthen your application, but a weak or negative one can do the opposite. Choosing the right person, asking the right way, and building a genuine professional relationship are all within your control.
Take the process seriously. It reflects not just your achievements, but how others experience working with you.
As a practicing physician who has worked in the health care field in five different countries, I have a pretty solid idea of why health care in the U.S. is so problematic. In the U.S., many entities related to health care are owned by the same companies. This is a concept called vertical integration, where one business controls every stage of the supply chain. To understand this, imagine the car industry. Suppose one company owned the factory that manufactures car parts. That same company also owns the dealership that sells the cars. They also own the bank that provides the auto loans. They own the insurance company that sells the car insurance. They own the repair shops that fix the cars. And they own the suppliers that provide the replacement parts.
If this were the case, how expensive do you think cars and car insurance would be? A company that both sets the price and receives the payment would have no incentive to keep those prices low. This is increasingly what is happening in major parts of U.S. health care.
For example, my health insurance is UnitedHealthcare, which is owned by UnitedHealth Group. They operate a highly integrated model:
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A pharmacy benefit manager (PBM), which acts as a middleman for prescription drugs, called OptumRx
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A group purchasing organization (GPO) called Emisar
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A pharmaceutical commercialization company called Nuvaila
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An advanced therapy distribution and pharmacy business called Optum Frontier Therapies
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A pharmacy called Optum Specialty Pharmacy
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A retail pharmacy called Genoa Healthcare
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Health care providers through Optum
I am an orphan: A medical school without a family medicine department
The author, a fourth-year medical student (now a board-certified physiciam), describes feeling like an “orphan” in training because his school lacks a family medicine department, leaving him and his peers with little exposure to the specialty. As a result, students often misunderstand family medicine, equating it narrowly with general primary care and remaining unaware of its full scope, which can include prenatal care, procedures, and even hospital-based roles. The curriculum substitutes family medicine with rotations in internal medicine or pediatrics, which limits comprehensive training and contributes to low interest in the field. The author argues this lack of exposure is a disservice, helping explain why so few students pursue family medicine despite its importance. He expresses concern about the future of primary care and emphasizes his own commitment to becoming a family physician despite the gaps in his education.
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How to ease men’s fear of mentoring in medicine
The blog post titled "How to ease men’s fear of mentoring in medicine" on KevinMD addresses the concerns and fears that men in the medical field have about mentoring, especially in light of the #MeToo movement. Dr. Waggel offers strategies to create a safer and more supportive environment for mentorship. She discusses the importance of clear communication, establishing professional boundaries, and fostering a culture of respect to alleviate apprehensions and encourage effective mentoring relationships.
Behind that computer in your doctor’s office, there is a war going on
In the article "Behind that computer in your doctor’s office, there is a war going on," published by KevinMD, Dr. Sarah Diekman highlights the challenges doctors face in the modern healthcare system. She explains how bureaucratic and legislative pressures, combined with the influence of insurance companies, negatively impact patient care and doctor-patient relationships. Dr. Diekman, speaking from her dual perspective as both a physician and a patient, emphasizes that doctors are often unfairly blamed for issues beyond their control. She describes how doctors are constrained by administrative demands, such as the need to justify every minute spent with patients, and the time-consuming process of obtaining insurance approvals for necessary treatments. Despite these obstacles, doctors continue to fight for their patients' best interests, often at great personal sacrifice. Dr. Diekman concludes by expressing gratitude to the doctors who saved her life, acknowledging the immense dedication and sacrifice they make in the face of a challenging healthcare environment.
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The Imposter Effect
Jamie Katuna shares a personal experience of failing a medical school test with a score of 57%, which was a first for her. She describes the shock, embarrassment, and feelings of inadequacy that followed, highlighting how failure can lead to an identity crisis where one feels like a personal failure. Katuna cites Dr. Suzanne Koven’s quote from the New England Journal of Medicine about the pervasive fear of being a fraud in the medical profession. She emphasizes that this feeling of inadequacy is common among medical students and professionals, leading many to suffer in silence, quit, or disconnect. Katuna challenges those in medicine to openly discuss their fears and mistakes, arguing that doing so can build confidence and foster a more supportive environment.
Laughter is the Best Medicine
Amy Wen's blog summarizes three articles addressing critical issues in the medical field. Erene Stergiopoulos, in "Illness in doctors: a source of expertise, not a sign of weakness," shares her experience as a cancer patient and medical student, challenging the notion that doctors must be superhuman and urging medical professionals to embrace their vulnerabilities for better patient care. Faye Reiff-Pasarew, in "I’m a young, female doctor. Calling me ‘sweetie’ won’t help me save your life," discusses the gender biases female doctors face, highlighting the need for respect and equal treatment in the profession. Sarah Maslin Nir's "Bronx Hospital Shooting: What We Know and What We Don’t Know" reports on a tragic shooting at Bronx-Lebanon Hospital Center, emphasizing the need for improved security and thorough vetting processes in hospitals.
How Should We Deal With Physicians' Mental Health?
Jamie Katuna discusses the tragic Bronx-Lebanon hospital shooting, highlighting a critical issue: physician mental health. On June 30th, a physician entered the hospital, killing one person, wounding six others, and ultimately committing suicide. Before opening fire, he reportedly shouted, "Why didn’t you help me when I was getting in trouble?"
This incident underscores a larger issue: physicians' mental health struggles and the lack of adequate support. Statistics reveal alarming trends: one-third of physicians experience burnout, medical students have a 15%-30% higher depression rate, physicians have a 10%-20% higher divorce rate, and 300-400 physicians die by suicide annually.
The culture of medicine, characterized by high stress, lack of autonomy, sleep deprivation, and immense responsibility, contributes to these issues. Physicians often avoid seeking help due to fear of losing privileges or licenses, and a prevailing stoicism prevents them from admitting struggles.
Interventions like meditation and exercise are impractical due to time constraints. The article questions whether the "tough-it-out" mindset is inherent or created, and how to foster a supportive medical culture where seeking help is encouraged.
Perspectives in Healthcare
This blog series features interviews with Summer Fellows and health interns at Improve Life PLLC, offering a behind-the-scenes look at what it’s like to gain hands-on experience in a psychiatric clinic. Each post highlights a student’s unique journey—whether they’re shadowing providers, participating in events like the Suture Clinic, or learning the logistics of running a private practice. Interns reflect on everything from developing professionalism and empathy to understanding patient confidentiality and the team-based nature of psychiatric care. Some found unexpected inspiration through marketing and clinic operations, while others deepened their passion for mental health and medicine. Together, these blogs aim to inform and inspire future healthcare students by showcasing real-world learning in a supportive, forward-thinking environment.
Skills in Healthcare
This blog series features interviews with Summer Fellows and health interns at Improve Life PLLC, offering a behind-the-scenes look at what it’s like to gain hands-on experience in a psychiatric clinic. Each post highlights a student’s unique journey—whether they’re shadowing providers, participating in events like the Suture Clinic, or learning the logistics of running a private practice. Interns reflect on everything from developing professionalism and empathy to understanding patient confidentiality and the team-based nature of psychiatric care. Some found unexpected inspiration through marketing and clinic operations, while others deepened their passion for mental health and medicine. Together, these blogs aim to inform and inspire future healthcare students by showcasing real-world learning in a supportive, forward-thinking environment.
