Hospital-Based Medicine

Managing a Black Swan in health care: a lesson in transparency

Physician
February 2, 2026

An excerpt from On All Sides of the Bed: One physician’s/CEO’s journey.

In the early summer of 2013, our hospital collided with a Black Swan.

Before Europeans discovered Australia, they were familiar only with white swans. The discovery of black swans overturned a long-held assumption. In business and risk theory, a “Black Swan” refers to a rare, unpredictable event with massive consequences, a concept popularized by Nassim Nicholas Taleb. For us, …

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Why clinical excellence isn’t enough to sustain a physician-owned hospital

Physician
January 27, 2026

Most physicians begin their careers with a deeply held belief: If treatment is good, patients will come. It feels intuitively correct, and early in practice it often appears to be true. Clinical outcomes build trust, trust brings patients, and for a time the system seems to sustain itself. Yet after years of working inside physician-owned hospitals, group practices, and large corporate health systems, I have learned an uncomfortable truth. Good …

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How a pregnancy test on a male patient revealed health care flaws

Conditions
January 20, 2026

My father’s last medical bill suggested he might be expecting a child. He was 88 years old. Somewhere in the hospital’s system, common sense had vanished. We found the pregnancy test charge only after paying the bill in full. My mother and I wrote to the hospital. The first reply was warm and procedural: Thank you for contacting us. We will submit this to Revenue Integrity. You should expect a …

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Peacekeeping medicine: Saving lives in Sudan’s forgotten hospital

Conditions
January 2, 2026

When we think of peacekeeping missions, images of armored vehicles and blue helmets often dominate the narrative. Rarely do we picture the quiet, relentless battle fought within the walls of a makeshift hospital, where saving lives becomes an act of defiance against chaos. Yet, in Abyei, Sudan, that was our reality. We arrived expecting logistical challenges, but nothing prepared us for the disarray that greeted us at the UN Level …

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The role of operations research in health care crisis management

Conditions
January 1, 2026

At the height of the COVID-19 surge, many hospital leaders faced moments they will never forget. Beds were nearly full. Staff were exhausted. Supplies that once felt routine suddenly became scarce. In those moments, decisions had to be made quickly, often based on experience, instinct, and whatever information was available at the time.

We like to believe that good leadership means trusting our gut. In clinical medicine, intuition matters. Years of …

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When hospitals act like platforms, clinicians become content

Conditions
December 23, 2025

For years, hospitals have been urged to modernize. We are told to digitize workflows, optimize performance, and rely on dashboards and algorithms to improve efficiency. Much of this advice is reasonable. Medicine cannot function without systems.

But recently, while observing hospital transformation from within, I began to feel a familiar unease, one I had encountered before outside of medicine.

It reminded me of how digital platforms operate.

Platforms are not inherently unethical. They …

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Physician night shifts: Analyzing the financial and personal trade-offs

Finance
December 11, 2025

I once promised myself confidently, and with the full arrogance of a seasoned attending, that I would never sleep another night in a hospital. I’d done my time. I’d earned my daylight. But life has a way of calling your bluff. A few years later, everything had shifted. I was divorced. My kids were older and more independent. My clinical career had settled into something comfortable, but predictable. I found …

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The physician-nurse hierarchy in medicine

Education
December 5, 2025

When an attending doctor recently took me aside after a particularly hard clinical case with a first-year resident, she made pains to point out to me that the resident felt she wasn’t being treated fairly by nurses, because she was a woman. The physician went on to describe the difficulty of being a woman in a professional world where male colleagues are taken more seriously and treated with more respect, …

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Community hospital innovation: a survival story

Conditions
December 4, 2025

Innovation in health care is often described in technological terms (new devices, advanced imaging, digital platforms). But some of the most meaningful forms of innovation happen quietly, inside small hospitals struggling to survive.

This is the story of a community hospital in Taiwan that once faced collapse, and the unexpected lessons it offers to health care leaders everywhere.

Looking for a way forward

In the late 1990s, the hospital was in serious decline. …

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The erosion of evidence-based medicine: a doctor’s warning

Physician
December 1, 2025

Something unsettling is happening in medicine, and many of us feel it even if we haven’t said it out loud: evidence-based medicine is slowly being eroded, not just by outsiders, but from within our own profession.

Patients today are searching more than ever before for quick fixes, and physicians are increasingly stepping into the marketplace to meet that demand. Hormone pellets. “Longevity protocols.” Peptides that sound scientific but have no real …

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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 patient carryover crisis: Why discharge education fails

Conditions
November 28, 2025

I still remember the feeling of relief standing by my uncle’s bedside. The monitors were humming with steady rhythms; the surgical team was congratulating themselves on a textbook procedure. By all clinical metrics, he was a success story. The intervention worked. The pathology was addressed. He was “stable.”

We celebrated his discharge as a victory lap. We trusted that the packet of papers in his hand (filled with appointments, medication schedules, …

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Medical statistics errors: How bad data hurts clinicians

Conditions
November 27, 2025

Last winter, a senior nurse in our psychiatric unit told me, “The dashboard says we’re low-risk. But during night shifts, I don’t even feel safe walking to the bathroom.”

The monthly quality report on her desk said the same thing it had said for nearly a year: “Violence incidents: no significant difference among the three wards (p > .05).”

On paper, her ward looked normal. At the bedside, it was anything but.

Her …

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How to fight for your loved one during a medical crisis [PODCAST]

Podcast
November 21, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Physician and professional certified coach Chrissie Ott discusses her article “How an insider advocate can save a loved one.” Chrissie shares a terrifying recent story of a friend’s elderly, Spanish-speaking mother who …

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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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Honoring medical veterans and health care heroes

Physician
November 11, 2025

This past August, our local hospital celebrated its 50th anniversary. The media published photos from 1975 of the ceremonial groundbreaking with hospital officials, including future Chief of Staff, Dr. David Mysko.

Dr. Mysko was the first doctor I met when I joined the staff in 1987. We played on “The Hospital Mashers,” competing with other community softball teams in a city league. As a family practitioner, he probably delivered many readers …

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What is your physician well-being strategy?

Physician
October 31, 2025

Every health care organization measures recruitment and retention. HR teams work to offer competitive packages based on salary, benefits, PTO, and CME allowances. These details matter. But for today’s physicians, these are simply the baseline. The physicians entering and shaping today’s workforce expect more. They have new lines of questioning related to the amount of evening and weekend coverage, call schedules, administrative time, and available support staff. Today’s physicians will …

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How a dying patient taught a doctor the meaning of care [PODCAST]

Podcast
October 30, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Internal medicine physician Augusta Uwah discusses her article, “The dying man who gave me flowers changed how I see care.” She shares the emotional story of a terminally ill patient whose simple …

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Telehealth licensing barriers hurt patients

Physician
October 29, 2025

The highway from western North Carolina to northeast Georgia is dark at five in the morning. One of my long-time patients grips the wheel and drives two hours for a 15-minute visit with the doctor she trusts. She could have met me by video from her kitchen, but the law forbids it. The moment she crosses that state line, I lose the right to care for her. That’s not medicine. …

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