KevinMD.com

November 14, 2026Nov 14, 2026

As a psychiatrist who owns a small practice, I know the waitlist arithmetic well, and so does every colleague I talk to. More than 50 million Americans have a behavioral health condition in a given year, and fewer than half of those who need care get it in time. Psychiatrists bring expertise in severe mental illness, complex comorbidity, and prescribing, and there aren’t nearly enough of us, especially in rural …

Physician voices

Which antidepressants during pregnancy are safest?

Timothy Lesaca, MD

November 14, 2026Nov 14, 2026

A patient planning a pregnancy recently asked me which antidepressant is proven to be the safest. It is a completely fair question and one I hear regularly. Yet "proven safe" sets a standard that perinatal pharmacology simply cannot meet. Randomized…

A patient planning a pregnancy recently asked me which antidepressant is proven to be the safest. It is a completely fair question and one I hear regularly. Yet “proven safe” sets a standard that perinatal pharmacology simply cannot meet.

Randomized controlled trials designed to establish antidepressant safety in pregnancy have never been conducted, and they likely never will be. Randomizing pregnant patients with significant depression to a placebo would raise profound …

Conditions and diseases

Why primary care leaves the obesity diagnosis unsaid

Nestor de la Cruz-Muñoz, MD

November 14, 2026Nov 14, 2026

The patient across from me had been seeing the same primary care doctor for nine years. She weighed in the high 300s. She had high blood pressure, prediabetes, and knees that hurt every morning. I asked her what she'd been…

“Nothing,” she said. “He never brought it up.”

She wasn’t angry. She was a little embarrassed, as if she’d been keeping a secret that …

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Physician voices

What radiology report writing reveals about the radiologist

Dr. Ramy M. Mansour

November 14, 2026Nov 14, 2026

There's an old joke in radiology: Show me a report, and I'll tell you who wrote it, or at least what kind of radiologist they are. Every specialty has its personalities. But radiologists leave theirs on the page in a…

There’s an old joke in radiology: Show me a report, and I’ll tell you who wrote it, or at least what kind of radiologist they are.

Every specialty has its personalities. But radiologists leave theirs on the page in a way few others do, because the report is the product. The surgeon has the operation; we have the sentence. And sentences, it turns out, have fingerprints.

After years of reading other people’s …

Conditions and diseases

Sleep apnea and chronic pain: the amplifier doctors miss

Kayvan Haddadan, MD

November 14, 2026Nov 14, 2026

Sleep apnea is one of the underdiagnosed sleep disturbances that has a direct relationship with pain, and therefore treating it will help treat the pain. Two main mechanisms link obstructive sleep apnea (OSA) to increased pain: Sleep fragmentation and deprivation:…

Sleep apnea is one of the underdiagnosed sleep disturbances that has a direct relationship with pain, and therefore treating it will help treat the pain.

Two main mechanisms link obstructive sleep apnea (OSA) to increased pain:

Sleep fragmentation and deprivation: Repeated arousals prevent restorative deep and REM sleep. Poor sleep quality lowers pain thresholds, heightens pain sensitivity, and amplifies existing pain.
Intermittent hypoxia (low oxygen levels): Repeated drops in oxygen trigger inflammation and

…

Health technology

Can AI have empathy? My patient thanked me for its words.

Francisco M. Torres, MD

November 14, 2026Nov 14, 2026

In 2023, researchers writing in JAMA Internal Medicine compared physician and chatbot answers to 195 patient questions posted on a public online forum. Blinded clinicians preferred the chatbot’s answers nearly 80 percent of the time and rated them empathetic almost ten times as often. The study had limits: The physicians were volunteers typing brief replies on Reddit, not clinicians writing to their own patients. Still, the finding unsettles me.

After …

Physician voices

What empathy training did for patients and clinicians

Helen Riess, MD

November 14, 2026Nov 14, 2026

As a psychiatrist, I've spent much of my career asking a question that has practical consequences for anyone who has ever sat on either side of an exam room. Can we teach clinicians to communicate empathy in ways patients can…

As a psychiatrist, I’ve spent much of my career asking a question that has practical consequences for anyone who has ever sat on either side of an exam room. Can we teach clinicians to communicate empathy in ways patients can actually feel? I experienced, firsthand, the pain patients experienced when their concerns were dismissed, misunderstood, or even disparaged, and sought to find a solution. During a medical education fellowship at …

Physician voices

AI hallucinations in medicine are more than made-up facts

Lourdes G. Bahamonde, DO

November 14, 2026Nov 14, 2026

An inference can precede its verification without becoming a fact. An observation can precede its explanation without becoming invalid. Observation ≠ explanation. Inference ≠ fact. Unverified ≠ false. The soybeans smelled like vomit. I had soaked them in water and…

An inference can precede its verification without becoming a fact. An observation can precede its explanation without becoming invalid.

Observation ≠ explanation. Inference ≠ fact. Unverified ≠ false.

The soybeans smelled like vomit. I had soaked them in water and then forgotten about them longer than intended. When I finally uncovered the bowl, a thick pale froth covered the surface. Removing them from the kitchen was the immediate priority, but I needed …

Health technology

How hospital leaders can earn physician trust in AI

Harvey Castro, MD, MBA

November 14, 2026Nov 14, 2026

In 2023, 38 percent of U.S. physicians used AI in their practice. Most weeks since, another tool has arrived: a scribe, a summarizer, a risk score. By early 2026, the American Medical Association (AMA) put physician use at 72 percent,…

Then the AMA asked those physicians a better question than whether they use AI. Its …

Conditions and diseases

Functional decline after hospitalization is not a verdict

Arjun Dutt, DPT, MBA & Pradeepika Samagh, DPT, MBA

November 14, 2026Nov 14, 2026

Medicine knows that a blood pressure reading describes a moment. Yet when an older adult is hospitalized, a snapshot of function can become a verdict. A patient is assessed while infected, sleep-deprived, medicated, dizzy, or delirious. That performance can then…

Medicine knows that a blood pressure reading describes a moment. Yet when an older adult is hospitalized, a snapshot of function can become a verdict.

A patient is assessed while infected, sleep-deprived, medicated, dizzy, or delirious. That performance can then shape assumptions about whether the person can recover or return home. The dangerous leap is from “cannot today” to “will not again.”

Consider a hypothetical scenario familiar to rehabilitation clinicians. Before an …

Conditions and diseases

Dementia prevention: what’s proven and what’s still a hunch

Larry Kaskel, MD

November 14, 2026Nov 14, 2026

When patients tell me they're afraid of getting dementia, I don't hand them a book of crossword puzzles and wish them luck. I ask three questions. What are you willing to do? What risks will you accept? How much not-knowing…

When patients tell me they’re afraid of getting dementia, I don’t hand them a book of crossword puzzles and wish them luck. I ask three questions. What are you willing to do? What risks will you accept? How much not-knowing can you live with?

For the man who watched his father stop recognizing his own children, surrogate endpoints are not an academic debate. He wants to know what to do Monday …

Conditions and diseases

How HPV self-collection could close cervical screening gaps

Samantha Byrnes, PhD, MPH

November 14, 2026Nov 14, 2026

Cervical cancer screening rates have declined over the last 25 years in spite of innovation in vaccines and screening tools. Human papillomavirus (HPV) vaccinations are extremely effective at preventing this form of cancer, as almost all cervical cancers are linked to persistent infections of HPV. Equally important in the effort to eliminate this disease are the screening tools used to detect infections and cervical cancer, helping patients receive care …

The Podcast by KevinMD

Doctors are told to push through. For addiction, that can be deadly. [PODCAST]

The Podcast by KevinMD

November 13, 2026Nov 13, 2026

Medicine rewards pushing through, but for a doctor with an addiction, pushing through can be deadly. Anthony Grandelis is an OB/GYN hospitalist in New York City and a physician in recovery from addiction. This episode is based on his article…

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Physician voices

Turf wars in medicine and the anesthesiologist’s next skill

Amit Jain, MD & Deepak Gupta, MD & Mohamed Ismaeil, MD

November 13, 2026Nov 13, 2026

In this age of artificial intelligence, the relevance of each medical specialty is shifting and uncertain. From here on, medical specialists will have to weigh the relevance of: Training and certification in their own specialties Licensing and credentialing to practice…

In this age of artificial intelligence, the relevance of each medical specialty is shifting and uncertain. From here on, medical specialists will have to weigh the relevance of:

Training and certification in their own specialties
Licensing and credentialing to practice and bill as experts in those specialties
The growing need to learn and practice skills traditionally considered outside their specialties
Adapting as others learn and practice skills traditionally restricted to their specialties

Interestingly, “today” may …

Patient voices

Alan P. Feren, MD, on patient advocacy: a KevinMD subscriber spotlight

Subscriber Spotlight by KevinMD

November 13, 2026Nov 13, 2026

Alan P. Feren, MD, is a retired surgeon, independent physician, health care consultant, and patient advocate with more than 50 years in clinical practice, system leadership, and health care innovation. He has published 18 essays on KevinMD since April 2025,…

…

Conditions and diseases

Polio vaccine history and the paradox of cleaner living

Gary A. Koretzky, MD, PhD

November 13, 2026Nov 13, 2026

An excerpt from Your Immune System: The Amazing Science of Who You Are. Polio is a viral disease of the nervous system. It attacks people of all ages, but children and young adults are disproportionately affected. Like many other viral…

An excerpt from Your Immune System: The Amazing Science of Who You Are.

Polio is a viral disease of the nervous system. It attacks people of all ages, but children and young adults are disproportionately affected. Like many other viral diseases, polio starts with nonspecific symptoms, like headache, fever, sore throat, vomiting, and diarrhea. These symptoms occur as the patient’s innate immune system responds to the viral PAMPs, the pathogen-associated …

Conditions and diseases

Why TMS targets now differ for depression, OCD, and anxiety

Ravi Singareddy, MD

November 13, 2026Nov 13, 20262

For most of its history, psychiatry has treated the brain as a chemical soup, adjusting neurotransmitters and waiting weeks to see whether anything changed. Transcranial magnetic stimulation (TMS) represents a different idea: that mental illness lives in specific, dysfunctional circuits, and that those circuits can be targeted directly. Since the Food and Drug Administration (FDA) first cleared TMS for treatment-resistant depression in 2008, the field has moved from a fixed …

Physician voices

Medical jargon that means something else to patients

Dr. Gurdev Singh

November 13, 2026Nov 13, 2026

Four words of mine sent a woman into a hospital hallway to find out whether her father was dying. Every one of them was true. I found her there an hour later, phone 6 inches from her face, the search…

Four words of mine sent a woman into a hospital hallway to find out whether her father was dying. Every one of them was true.

I found her there an hour later, phone 6 inches from her face, the search box readable over her shoulder. Shadow on lung. The results were what you would expect. She looked up and said, “You said it was just a shadow.” She was right. I …

The Podcast by KevinMD

How the 764 network pushes kids to self-harm, and the signs doctors miss [PODCAST]

The Podcast by KevinMD

November 12, 2026Nov 12, 2026

An online network is coercing children into hurting themselves, and the warning signs are easy to miss. Matthew Turner is an emergency medicine physician, and Dana Grueser is a parent advocate. This episode is based on their article "The 764…

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Conditions and diseases

Plaque in arteries grows inside the wall, not on it

Larry Kaskel, MD

November 12, 2026Nov 12, 2026

I'm sick of seeing this cartoon in my Apple News feed. You know the one. A bright red artery lined with yellow globs of cholesterol, with a few red blood cells squeezing through what's left of the opening. It looks…

I’m sick of seeing this cartoon in my Apple News feed.

You know the one. A bright red artery lined with yellow globs of cholesterol, with a few red blood cells squeezing through what’s left of the opening. It looks like someone poured bacon grease down the kitchen sink.

There it was again this week, accompanying a November 6 article about cholesterol and dementia in BBC Science Focus magazine. Really? It’s …

Real physician voices, twice a week

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