Physician

Language doulas bridge care gaps

Physician
November 28, 2025

During health care encounters with patients from diverse linguistic and cultural backgrounds, there is always a concern about information getting lost in translation between health care providers and their patients. Language and cultural concordance significantly affect the quality and effectiveness of health care delivery. Although phone-in interpreters, with or without video capabilities, are accessible online, none can match in-person interpretation. Even if high-profile political conversations have adapted to artificially intelligent …

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The myth of no frivolous medical lawsuits

Physician
November 28, 2025

“No medical malpractice lawsuit is frivolous,” is the narrative echoed by plaintiff attorneys. Medical malpractice lawsuits are vastly underrepresented. Also, because frivolous lawsuits are too expensive to litigate, expense is a natural deterrent for filing one. Plaintiff attorneys have controlled this narrative for as long as I’ve been in practice since 1972.

Recently, I examined the veracity of this claim. Indeed, there are 66 million civil lawsuits filed in the …

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Divorced during residency: a story of clarity

Physician
November 27, 2025

Keeping my head down and working through intern year was all I had known. My days blurred into nights, and my weeks into months. The dreary Pacific Northwest winters had only compounded this. Despite a quiet yearning for connection and community, I declined most social invitations. My sense of obligation did not end at the hospital doors. It followed me home, where expectations and emotional responsibilities lingered. I often felt …

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A husband’s story of end-of-life care at home

Physician
November 27, 2025

The British tend to use the term “carer” for the people who help other persons with needs. It seems to emphasize its root word, care, with implications for family members, volunteer helpers, and professionals who fill that role. The American term tends to be “caregiver;” its usage has become more common.

Even when I worked in health care, I had never used either of those terms. But over the last fifteen …

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The H-1B crutch in rural health care

Physician
November 26, 2025

In the vast, undulating expanse of rural America (those counties where the horizon stretches like a taut bowstring, evoking the stoic endurance of Steinbeck’s Joads) one might expect the pulse of health care to beat with the resilient rhythm of native ingenuity. Yet, as a recent study in the Journal of the American Medical Association reveals, physicians sponsored under the H-1B visa program are twice as prevalent in these bucolic …

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Physician income vs. burnout: Why working harder fails

Physician
November 26, 2025

I strongly believe that working harder in medicine is making us as doctors poorer, and it’s quietly harming patients too. Not because we don’t care, but because rushing destroys the very thing patients need most: Time, attention, and real care.

Let me explain.

If you’re a medical doctor or another primary care clinician, you’ve probably heard this your whole career: “Work harder. Work faster. See more patients. Push more. Do more.” And …

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The human element in clinical trials

Physician
November 25, 2025

I have often heard people speak of numerology, weaving destinies around digits. They say that behind every event in a person’s life lies the hidden hand of numbers. I do not know if such beliefs hold scientific truth. Yet, in medicine, numbers certainly matter. Numbers fill our trial registers, power our statistics, shape our protocols. In research, life is reduced to codes, columns, and counts.

As a medical student, the jargon …

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The Silicon Valley primary care doctor shortage

Physician
November 25, 2025

Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left Kaiser after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in Silicon Valley: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor.

I saw this problem firsthand before I retired from …

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How relationships predict physician burnout risk

Physician
November 24, 2025

We entered medicine with a shared calling (to heal, to serve, and to make a difference). Yet somewhere along the journey, between the never-ending charting, late-night calls, and invisible emotional burdens, many of us forgot how to heal ourselves.

Every few months, another survey or report confirms what so many of us already sense in our bones: physicians are burning out at staggering rates. But what remains under-discussed, and perhaps even …

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Preserving your sense of self as a doctor

Physician
November 24, 2025

My fourth year of OB/GYN residency there was an essay contest about what it meant to be an advocate for women’s health while preserving your sense of self. I sent a screenshot of the contest to my then-boyfriend, now-husband. He replied, “You want to add something else to your to-do list?” He was joking, but he wasn’t wrong. Just a few days prior, I was hyperventilating from all the things …

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The geometry of communication in medicine

Physician
November 23, 2025

For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then …

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Why I became a pediatrician: a doctor’s story

Physician
November 23, 2025

One of the first questions you’re asked when applying to medical school is: Why do you want to be a doctor? For most, the answer is some version of “I want to help people.” But for me, that was never the real question. It was always “Why do you want to be a pediatrician?”

I’ve known since I was very young that I wanted to work with children. I’ve always loved …

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Is trauma surgery a dying field?

Physician
November 21, 2025

When I was a resident, the trauma surgeon was the go-to person for anything complicated. It seemed like they could do everything, and do it well. That’s what drew me to the field. There was a confidence, decisiveness, and scope that made trauma surgery feel like the pinnacle of surgical mastery.

For most of my career, I’ve worked as a trauma and critical care surgeon, from busy academic Level I trauma …

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Why we fund unproven autism therapies

Physician
November 21, 2025

The average KevinMD reader may wonder why I’m so prolific in my commentary on pediatric medicine and the systemic reforms it demands. The answer is simple: I go to the source. Always.

That habit was forged nearly 30 years ago when the American Academy of Pediatrics invited me to serve as contributing section editor for Developmental-Behavioral Pediatrics in AAP Grand Rounds. My role: select key studies, critique methodology, and distill bottom-line …

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How your past shapes the way you lead

Physician
November 20, 2025

Leadership is often discussed in broad strokes: some leaders are structured and precise, while others are flexible and improvisational. But behind those visible styles lie quiet personal and generational histories, the emotional terrain that shaped how we learned safety, trust, and control. I’ve come to see that these histories profoundly influence how we lead and how we’re perceived as leaders, especially in health care, where the stakes are high and …

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How private equity harms community hospitals

Physician
November 20, 2025

Early in the pandemic, we began using yellow cloth isolation gowns, environmentally superior, perhaps, to the paper gowns that preceded them, but not without complications. The strings at the neck were invariably tied and tightly knotted after going through the wash. If you’re a smallish doctor or nurse, the pre-tied neckline hung down around the tip of the xiphoid. I stood outside my patients’ rooms on long, weary days and …

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The U.S. health care crisis: a Titanic parallel

Physician
November 19, 2025

Two years ago, Drs. Aaron Morgenstein, Corinne Sundar Rao, and Shreekant Vasudhev drew a compelling parallel between the Titanic’s tragic voyage and the looming crisis in U.S. health care. They highlighted systemic issues such as administrative egotism, outdated practices, and substandard resources, warning that without significant course corrections, the health care system was on a collision path with disaster.

Today, in 2025, the iceberg has struck, and the cracks are …

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Interdisciplinary medicine: lessons from the cockpit

Physician
November 19, 2025

In aviation, the right seat is typically reserved for the instructor. In medicine, it’s the role of the diagnostician, the mentor, the gatekeeper. I once piloted a T-37B “Tweet” trainer from the right seat, not as a student, but as someone trusted to guide. That experience shaped how I approach clinical decision-making, interdisciplinary fluency, and the choreography of care.

During a military training program, our squad faced a simulated obstacle: an …

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How Acthar Gel became a $250,000 drug

Physician
November 19, 2025

It started with a phone call.

“Doc,” my CEO said, “do you know this doctor?”

I asked why.

“He wrote a prescription for a drug that cost $250,000 for one course.”

“You must mean $25,000,” I said.

“No,” she replied. “The insurer already paid two hundred fifty thousand dollars.”

I assumed it had to be a miracle therapy, some one-in-a-million life-saving treatment. Then she told me the name: Acthar Gel. I nearly fell out of my …

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Physician legal rights: What to do when agents knock

Physician
November 19, 2025

An excerpt from Doctor Not Guilty.

The Fifth Amendment of the United States Constitution exists for a reason. It protects you from self-incrimination. If you remember one rule from this book, hold on to this: Never talk to the police.

By “police,” I mean every investigative agent: FBI, DEA, OIG, HHS, state boards of medicine, and investigators from the attorney general’s office. Not with a lawyer. Not without one. Not ever.

Silence …

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