The SPMD After Action No. 1 June 28, 2026
Welcome.
Every Sunday night I sit down and debrief the week. What moved. What the evidence says about the things that came up in performance medicine and leadership. What I learned from patients, from colleagues, and from the comment sections where the real conversations happen.
This is that debrief. In writing. Sent to you. That is the plan at least.
Field Notes are the intelligence gathered in the moment. The After Action is the debrief after the week closes. What did the week reveal? What needs to be said that did not fit neatly into a post?
I am building SustainablePerformanceMD from the ground up. The mission is specific: to introduce and hold a physician fiduciary standard in the Human Performance, Leadership, and High Pressure Professions coaching spaces. That standard does not currently exist there. Nobody is enforcing it. Nobody is even asking for it.
Entering that space means confronting the things that actually impair human performance. Those things are not always what the coaching industry wants to talk about.
They include health insurance systems that deny medically necessary care and force physicians and patients into bureaucratic fights that consume clinical resources and produce worse outcomes. They include a supplement and wellness industry that peddles interventions under the word natural as if that word means safe. Cyanide is natural. It is produced in many fires. Arsenic is natural. Hemlock is natural. The word natural is not a clinical standard. It is a marketing claim. And they include the weekend certification crowd. Eight hours of continuing education, a certificate, and a sudden expertise in sleep science that somehow exceeds the clinical judgment of physicians with over 20,000 hours of patient care and documented outcomes.
This is the space we are entering. Eyes open.
This Week
The SPMD Leak Assessment went live.
A free ten-minute physician-designed diagnostic across five performance domains. It gives your primary performance leak, the active DRAINS mechanism behind that leak, the matched CLEARS intervention, and your Initial MOVES. No supplement attached to the result. No purchase required.
I also learned more about web backends, conditional logic, and database routing than I ever intended to. Building a clinical tool from a ship with intermittent WiFi in the middle of a deployment is its own kind of performance test. The DRAINS were active. The CLEARS held. I made MOVES!
The assessment is live at SustainablePerformanceMD.com/assessment.
The rest of the architecture will have to wait as it requires bandwidth I don’t have. Physical and data service types.
From the Clinic This Week
I had a patient encounter this week that I did not expect.
I went in with clinical directness. The kind that comes from a physician who has seen the same presentation enough times to have developed a calibrated skepticism about it. I was not kind. But the patient had behaved inappropriately to my staff. This is the US Navy. You will either abide by my orders or the Chain of Commands while in my spaces as a visitor, guest, or patient. Or, you will be corrected, and privileges that are no longer deserved will be revoked.
He responded by telling me something real.
That does not always happen. In high-pressure clinical environments it happens less than it should. Most people come in defended and leave the same way. This one did not. My directness, which I always do deploy with therapeutic intervention attempting to make cognitive distortions and dissonance obvious to my patients, turned out to be exactly what the encounter needed.
I have been thinking about that all week. About the difference between Resistance that needs to be met with patience and Resistance that needs to be met with a wall that it cannot get around. About how often we soften clinical truth in the name of rapport and end up with neither.
A physician builds calluses. That is not the same as losing the capacity to be surprised by a patient. This week I was surprised.
Sunday Night Ritual
Before I write this newsletter I draft my Monday muster speech.
Every Monday and Friday mornings I address my department. One hundred and eight healthcare professionals, most of them young corpsmen who are early in their careers and still figuring out what kind of people they want to be under pressure. The speech is not long. Five minutes at most, and if it’s over a minute, I am told about it and reminded about it until I give an extremely short one Friday to compensate. But it sets the operating standard for the week and it gives me a moment to say something true before the noise of the day takes over.
I write it on Sunday nights.
Nick Saban used to say that the process is not about the scoreboard. It is about the daily standard. What did you do today to get better? That question applied to a Monday morning muster is the difference between a department that drifts through the week and one that moves with intention.
I do not always know what I am going to say until I sit down and write it. Tonight I know. This week the speech is about the patient encounter I described above. About what happens when you stop managing a conversation and start having one. About the difference between a clinician who is present and one who is performing presence.
They are not the same thing. My corpsmen need to know that before they hit their first difficult patient interaction. Better they hear it from me on a Monday morning than learn it the hard way at 0200 when there is nobody else in the room.
Bill Hennessey MD and his Insurance Fight
Bill Hennessey MD posted this week about Highmark denying payment for his wife's recent hospital admission. Mark Cuban commented. I commented. Bill and I connected. Still waiting on Mark to connect...
What struck me was the comment thread more than the resolution. Dozens of physicians and patients recognizing the same pattern: a system that makes clinically necessary care the exception rather than the standard and requires a public fight to reverse decisions that should never have been made.
That is a performance impairment. Not for the individual patient. For the entire clinical system those patients depend on. The DRAINS framework applies to organizations as readily as it applies to individuals. Avalanche looks the same whether it is one executive drowning in open loops or one health system drowning in administrative denial processes that have nothing to do with clinical outcomes.
Bill said he plans to post an update Monday. His comments on Highmark customer service he said will be up Tuesday. Those are definitely going to be posts you want to read and be a part of!
What I Read and Am Reading
I am over halfway through The Field Guide to Understanding Human Error, halfway through Faster: A system for Finishing What Matters, halfway through The Hard Thing About Hard Things, a third through The Daily Surgeon. The deployment completed book list is Dungeon Crawler Carl books 4/5/6/7, The Personal MBA, The Lion Tracker’s Guide to Life, Focus on the Process: The Simple “Secret” to Achieving your Goals, Split Second: Stop Stalling. Start Doing, The Wisdom of the Bullfrog, Self Discipline: The complete mindset guide to hacking and stacking habits of mental toughness
Field Notes This Week
Four published. One going up tonight.
Avalanche. The performance DRAINS that buries you in your own backlog. https://www.sustainableperformancemd.com/field-notes/avalanche-performance-drain
Identity Lock. Why your self-concept may be the ceiling. https://www.sustainableperformancemd.com/field-notes/identity-lock-performance-drain
DENIED! The clinical case against prior authorization. https://www.sustainableperformancemd.com/field-notes/denied-insurance-industry-bets-no-one-appeals-on-auto-denial
Auto-Denials and External Review Rights. What your insurance company does not want you to know you can do. https://www.sustainableperformancemd.com/field-notes/auto-denials-are-medical-decisions-last-i-looked-health-insurance-companies-do-not-have-medical-licenses
The Assessment
Free. Ten minutes. No supplement attached. SustainablePerformanceMD.com/assessment
Performance. Revealed.
Will King-Lewis MD FAAFP, Sustainable Performance Physician, Founder of Sustainable Performance MD
You can contact me at will@sustainableperformancemd.com
The SPMD After Action publishes most Sunday nights.
The original Newsletter can be found here.