Physician

How system strain contributes to medical gaslighting in health care

Physician
January 20, 2026

Medical gaslighting has become a widely discussed concept in health care. The term is often misunderstood as implying intentional dismissal or manipulation by clinicians. In reality, most encounters that patients later describe as gaslighting do not arise from ill intent. They arise from something far more common and far more complex: communication breakdown under system strain.

Understanding medical gaslighting requires examining the clinical encounter from both sides of the stethoscope, not …

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Why tele-critical care fails the sickest ICU patients

Physician
January 20, 2026

Not long ago in a community intensive care unit (ICU) in a midsized American city, I cared for a sick young woman who had just delivered a baby. Part of the placenta, which is supposed to be fully expelled following delivery, remained in her uterus. This condition, known as “retained products of conception,” provided an opportunity for bacteria to infect the retained tissue. The infection spread from her uterus to …

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Difficult patients in medical history

Physician
January 19, 2026

During the COVID-19 pandemic, while some people learned to bake bread and my family made the dubious choice of adopting a high-anxiety poodle who bites, superstar author Lisa See spotted an unopened book on her shelf about women’s medicine in Imperial China. In a fortuitous chain of discovery, Ms. See stumbled upon the name of Tan Yuxiang, a lady doctor during the Ming Dynasty, who published a book of her …

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Why every physician needs a sabbatical (and how to take one)

Physician
January 16, 2026

In the first episode of The Pitt season 2, Dr. Robby reveals he’s taking a three-month sabbatical, his last shift before heading to a UNESCO World Heritage Site in Canada. For a primetime medical drama to feature a physician stepping away for three months signals something important: Sabbaticals are entering the cultural conversation about how doctors survive in modern medicine.

But here’s what the show doesn’t tell you: Most physicians can’t …

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The moral injury of “not medically necessary” denials

Physician
January 16, 2026

The first denial arrived not with cruelty or malice, but with a phrase so familiar it barely registers as language anymore: “not medically necessary.” The cancer drug, recommended by oncologists and supported by evidence and standard of care, was rejected. No phone call. No physician-to-physician conversation. Just an automated letter and a bureaucratic pause inserted into a life that no longer had room for delay.

The family appealed. They fought. They …

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Is physician unionization the answer to a broken health care system?

Physician
January 15, 2026

Can there actually be a medical profession with physicians as only employees in an industrialized corporate or socialized system with a union representing their collective interests? Does it matter, and should it matter? Are there still alternatives?

Asking another party, specifically the government, to solve major predicaments consuming the profession is not a plan. Worse, it is a clear sign of dependency and weakness. There is no other entity that can …

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The decline of professionalism in medicine: a structural diagnosis

Physician
January 15, 2026

Most physicians sense it, even if they struggle to name it.

Something fundamental has changed in medicine. Not the science. Not the patients. Not even, at root, the doctors themselves. What has changed is the status of medicine as a profession, and with it, the psychological footing that once made the work bearable.

For much of the last century, medicine functioned as a profession in the classical sense. That meant more than …

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The patchwork era of medical board certification

Physician
January 15, 2026

The phrase “board-certified” once carried a universal meaning. A physician had met rigorous training and testing standards and could practice confidently anywhere in the country. That clarity has faded. Today, certification and recertification requirements differ not only by specialty but also by which board you happen to fall under. What was once a single national standard has splintered into a patchwork of rules, fees, and timelines that seem designed less …

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How neurodiversity in relationships shapes communication

Physician
January 14, 2026

One of the marks of a good physician is the ability to approach illness from two complementary angles. We bring scientific knowledge, training, and objectivity to understand what is happening in the body. But the work doesn’t end there. What truly elevates a clinician is the willingness to honor how the patient experiences their illness, the internal narrative that no lab test can measure.

This dual lens is not unique to …

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Why lifestyle matters more than BPC-157 and semaglutide

Physician
January 14, 2026

“Doc, can you prescribe me some BPC-157 with sermorelin, and maybe semaglutide too?”

He didn’t come in asking about his sleep.

He didn’t mention that his last meal the night before was at 11:30 p.m., eaten in front of a laptop glowing with unanswered emails.

He didn’t bring up the statin he’d been taking for years, the creeping fatigue he’d started to normalize, or the way his waistline had slowly expanded as his …

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How deductive reasoning changes medical malpractice lawsuits

Physician
January 14, 2026

Most recognize me from posts about deductive reasoning on KevinMD, but I never explain deductive reasoning’s effect on a conventional medical malpractice lawsuit. Here is how it affects such a lawsuit.

All medical malpractice lawsuits have four things in common:

  • All have an underlying complication, either an error-of-nature, which is caused by random chance, or a medical error, which is caused by the medical intervention.
  • All test the premise that there …

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How blaming women for a baby’s sex persisted through history

Physician
January 13, 2026

It doesn’t take much to understand that women have had it tough throughout history. While seemingly in our age there is near parity (with many women heads of state in Mexico, Italy, Moldova, Iceland, etc.), they only gained the right to vote in the U.S. 105 years ago (with the 19th Amendment to the Constitution), which was 50 years after Black men in 1870 (the 15th Amendment). There have always …

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Why ACIP’s ruling on universal hepatitis B vaccination endangers newborns

Physician
January 12, 2026

On December 5, I started my hospital shift learning that the ACIP (Advisory Committee on Immunization Practices) had voted against offering universal administration of hepatitis B vaccine at birth, opposing the long-standing practice endorsed by experts. After a long day of examining newborn babies and counseling families, my mind drifted back to the announcement and unearthed a memory of a boy named Sam.

Sam was born a healthy newborn to loving …

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The burden of being both doctor and family: an ethical reflection

Physician
January 12, 2026

I come from a long line of physicians. My grandfather was a pioneer in pharmacy and biochemistry, so influential that a museum now bears his name. My father, also a doctor, was cut from a very different cloth. I have written before about our strained relationship and the heavy expectations placed on a child born into a family with a reputation to uphold. Those tensions shaped my early views …

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A physician father on the Dobbs decision and reproductive rights

Physician
January 12, 2026

I proudly bear the title of “Dad,” and my daughter is five (going on 15), fiery, carefree, and unmistakably precocious, yet still my silly, innocent, sweet little girl. I imagine many girls with older brothers develop a similarly spirited personality. However, with her brothers being slightly older, I’ve watched that same innocence gradually diminish in them, as they are being slowly exposed to life’s complexities through school, friends, and their …

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WISeR Medicare pilot: the new “AI death panel”?

Physician
January 11, 2026

There are many ways to say “no” in medicine.
“No, this antibiotic won’t help a viral infection.”
“No, this test won’t change our management.”
“No, that surgery carries more risk than benefit.”

And then there is the newest way:
“No, the algorithm doesn’t prioritize your health.”

Welcome to WISeR, short for “Wasteful and Inappropriate Service Reduction,” a Medicare pilot program that promises to usher artificial intelligence into health care decision-making with all the subtlety of …

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Ghost networks in health care: Why physicians are suing insurers

Physician
January 11, 2026

For years we have told patients the same thing when they have trouble finding a doctor: Go to your insurance directory, look it up, they can help you.

And despite saying that, many of us have quietly known for a long time that this advice is broken. We still give it. We give it hoping for the best, knowing there really are not many other useful options to offer at this …

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Why sustainable habit change requires more than willpower

Physician
January 10, 2026

Pick up a bestselling nonfiction book today and you’ll see confident claims about habit change, dopamine detoxes, and rewiring the “default mode network.” These ideas now circulate in podcasts, blogs, and social media as if the brain were an appliance that simply needs the right setting. But in real life, human behavior is not so easily reconfigured.

What I’ve observed is that habits, motivations, and compulsive patterns are shaped not only …

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Psychedelic retreat safety: What the latest science says

Physician
January 9, 2026

“Turn on, tune in, drop out” was a rallying cry for liberation. “What a long, strange trip it’s been” is how we nostalgically narrate the aftermath. Psychedelic-assisted therapy now sits somewhere between those two cultural bookends: a rapidly professionalizing clinical enterprise and a booming, loosely regulated marketplace of “retreats” selling healing, insight, and transcendence.

The science behind psychedelics is more real than ever. So are the risks. The problem is …

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Why a nice surgeon might actually be a better surgeon

Physician
January 8, 2026

“If you ask what they like about their surgeon and they only say they are nice? I don’t want a nice person.” This sentiment comes from Dr. Oz, a boarded and licensed thoracic surgeon, and was posed to the house of medicine at the 2025 House of Delegates Interim Meeting.

I have grappled with what being a good surgeon means to me. Our training would have us believe that a good …

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