This conceptual preprint examines a central limitation of competency-based medical education: competent physicians cannot, by themselves, create the housing, food systems, institutional capacity, legitimate governance, or ecological conditions on which health depends. It proposes LIFE — Life, Influences, Fit, and Evidence — as a recursive operational grammar for connecting excellent clinical care with prevention and life-enabling action. A child with recurrent asthma provides the main clinical tracer, while cardiometabolic disease, food systems, Indigenous food sovereignty, and planetary health provide a broader systems stress test. The framework distributes accountability according to competence, authority, jurisdiction, resources, and practical power, without assigning physicians responsibilities they cannot fulfil. This independent, non-peer-reviewed conceptual synthesis includes implementation tools and a research agenda through which its added value can be tested.
