Unfortunately, bad leadership is common, with 50% of American's leaving a job because of a bad boss, and medicine is no exception. Saul and Stefan, with a combined 60 years in academic medicine and clinical practice, share personal experiences and anecdotes that highlight the characteristics of dysfunctional and toxic leaders, and discuss their implications for health care training and practice environment, including the trickledown effect on patients. They consider why and how bad leaders end up in positions of power, and what to do about it, acknowledging the difficulties in identifying and promoting effective leaders.

Writing about the illness experience, medical sociologist Richard Frank described an unspoken agreement with his doctor that if he adopted their detached and clinical language when discussing his illness, "I would have at least a junior place on the management team." Initially it seemed like "not a bad deal," until he experienced the toll it took, concluding that, "No one should have to stay cool and professional while being told their body is breaking down, though medical patients always have to do just that."

Through three poems selected by our repeat guest, English professor Laura Greene of Augustana College, we see the pain and cost to patients when their doctors and nurses hold them at arm's length, unable or unwilling to see their humanity. We reflect on why, and what to do about it.

A growing number of US states and other nations are legalizing either voluntary euthanasia in which a physician (or designate) administers lethal drugs, or physician-assisted dying in which the drugs are given to the patient to self-administer. Our guest, Erica Baccus, tells us about her husband's determination to end his life rather than die of Alzheimer's disease, and the journey they took to Switzerland to make it possible (US laws don't apply to dementia). His wishes were unquestionably honored. At the same time the procedure has implications we find troubling, especially for what it can mean for the doctor-patient relationship, such as in Canada where some physicians are now killing several of their patients a week.