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The Podcast by KevinMD now has a searchable home page

On May 25, 2020, I published the first episode of The Podcast by KevinMD. The idea was simple: give a microphone to the many who intersect with our health care system but are rarely heard from. The show has since…

On May 25, 2020, I published the first episode of The Podcast by KevinMD. The idea was simple: give a microphone to the many who intersect with our health care system but are rarely heard from.

The show has since grown into something I did not fully anticipate. As of today, there are 2,288 episodes, about 15 minutes each, with a new one almost every day: 365 episodes in 2023 and …

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The Podcast by KevinMD now has a searchable home page

Drugs and prescribing

Patients ask for antibiotics because they are afraid

An old man at my pharmacy window digs into his coat and hands me a piece of paper. It is soft at the folds, the way paper gets when it has been carried around for a while. He smooths it…

An old man at my pharmacy window digs into his coat and hands me a piece of paper. It is soft at the folds, the way paper gets when it has been carried around for a while. He smooths it flat on the counter.

“Do you have this?” he asks.

It isn’t a prescription. There is one word written on it. Amoxicillin.

He doesn’t say what for. He doesn’t mention a cold, or …

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Patients ask for antibiotics because they are afraid

Conditions and diseases

Transitional care fails even the best-prepared patients

This is the month after discharge from a health care facility when patients are at high risk for death, injury, or readmission to the hospital. As a physician, I have planned thousands of discharges. I have sat in a seemingly…

This is the month after discharge from a health care facility when patients are at high risk for death, injury, or readmission to the hospital. As a physician, I have planned thousands of discharges. I have sat in a seemingly infinite number of multidisciplinary rounds.

My fiance was recently hospitalized and had subsequent complications not related to the surgery. Most of the doctors that cared for him prior to discharge are …

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Transitional care fails even the best-prepared patients

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Physician voices

Nurse-physician communication starts with 4 words

Every nurse who has ever called you at two in the morning remembers how you answered. You remember almost none of them. That asymmetry runs the hospital at night. The caller carries every response forward: the sigh, the pause, the…

Every nurse who has ever called you at two in the morning remembers how you answered. You remember almost none of them.

That asymmetry runs the hospital at night. The caller carries every response forward: the sigh, the pause, the question that was really a verdict. By the time the phone rings again, they have already decided how much it is going to cost them to tell you what they are …

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Nurse-physician communication starts with 4 words

Health policy

Corporate greed in health care puts profit over patients

Money has become an increasingly dominant measure of success in modern society. Wealth, once considered a means of achieving security, independence, and a comfortable life, is too often treated as an end in itself. Nowhere is this transformation more troubling…

Money has become an increasingly dominant measure of success in modern society. Wealth, once considered a means of achieving security, independence, and a comfortable life, is too often treated as an end in itself. Nowhere is this transformation more troubling than in American health care.

Over the past two decades, health care has attracted unprecedented interest from investors, private equity firms, corporate executives, and other nonmedical stakeholders. Some have brought valuable …

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Corporate greed in health care puts profit over patients

Health technology

Physician builders no longer wait on EHR vendors

Recently, I visited Dr. Josh Pepper at his direct primary care (DPC) practice in Marin, California, Marin Family Medicine. Josh's clinic opened in January 2026, and by summer he had four physicians on the team, all of whom he's known…

Recently, I visited Dr. Josh Pepper at his direct primary care (DPC) practice in Marin, California, Marin Family Medicine. Josh’s clinic opened in January 2026, and by summer he had four physicians on the team, all of whom he’s known for many years, one since childhood. They all became family doctors, and they all landed in the same community. Marin has a long history of primary care shortage, and …

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Physician builders no longer wait on EHR vendors

Health technology

Precision psychiatry clinics are outrunning the evidence

In the same week this October, two announcements promised to bring brain science into the psychiatrist's office. In Shanghai, doctors described China's first psychiatric brain-computer interface clinic. Patients get MRI, EEG, and functional near-infrared spectroscopy (fNIRS) scans, engineers analyze the…

In the same week this October, two announcements promised to bring brain science into the psychiatrist’s office.

In Shanghai, doctors described China’s first psychiatric brain-computer interface clinic. Patients get MRI, EEG, and functional near-infrared spectroscopy (fNIRS) scans, engineers analyze the data to choose personal stimulation targets, and patients then receive an intensive course of navigated transcranial magnetic stimulation (TMS): 30 to 50 sessions over 6 to 8 days. When the …

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Precision psychiatry clinics are outrunning the evidence

Medical education

Physician attrition is not a generational problem

Medical school applications are climbing again after years of decline. More students are committing to heavy course loads and long hours to cross the finish line and earn their white coat. What students don't yet realize is that the clinical…

Medical school applications are climbing again after years of decline. More students are committing to heavy course loads and long hours to cross the finish line and earn their white coat.

What students don’t yet realize is that the clinical work of helping patients is only part of the job. The other, often more consuming, part is one that medical school rarely prepares students for: battling insurance companies, navigating changing …

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Physician attrition is not a generational problem

Conditions and diseases

Esketamine vs. ketamine: what to ask before you refer

In my practice, more and more patients arrive with a ketamine clinic advertisement in hand. Many have already asked their primary care physician, "Should I try this?" The honest answer depends on a distinction those advertisements routinely blur: The "ketamine"…

In my practice, more and more patients arrive with a ketamine clinic advertisement in hand. Many have already asked their primary care physician, “Should I try this?” The honest answer depends on a distinction those advertisements routinely blur: The “ketamine” offered for depression is not a single, standardized therapy.

On one side is intranasal esketamine (Spravato), the S-enantiomer of ketamine. The FDA approved it in 2019 for treatment-resistant depression (TRD) in …

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Esketamine vs. ketamine: what to ask before you refer

Conditions and diseases

Compassion fatigue in paramedics is an occupational hazard

It was 10 minutes before the end of a 12-hour shift when the call came in: a woman in her thirties, vomiting for about an hour, who had called a nurse hotline and been told to dial 911. She wanted…

It was 10 minutes before the end of a 12-hour shift when the call came in: a woman in her thirties, vomiting for about an hour, who had called a nurse hotline and been told to dial 911. She wanted a hospital 45 minutes away, not the five perfectly good ones closer to her. I was tired, hungry, and, if I am being honest, fairly certain this was not an …

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Compassion fatigue in paramedics is an occupational hazard

The Podcast by KevinMD

Not all PTSD is the same, and the difference decides the treatment [PODCAST]

Some people process a terrible event over a week or two and move on. Others replay it for years, and their bodies never settle back down. Faust Ruggiero is a clinical psychologist who has treated post-traumatic stress in veterans, first…

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Some people process a terrible event over a week or two and move on. Others replay it for years, and their bodies never settle back down. Faust Ruggiero is a clinical psychologist who has treated post-traumatic stress in veterans, first responders, and others for years. This episode is based …

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Not all PTSD is the same, and the difference decides the treatment [PODCAST]

Conditions and diseases

Cancer Alley taught me the data was never the problem

I noticed the plant before I noticed anything else. Not because it announced itself. Because it was simply there, the way a wall is there: chain-link fence, cooling towers, a low hum I felt in my chest before I understood…

I noticed the plant before I noticed anything else. Not because it announced itself. Because it was simply there, the way a wall is there: chain-link fence, cooling towers, a low hum I felt in my chest before I understood it as sound. I was standing in a man’s backyard in Reserve, Louisiana, holding a notebook, trying not to cough.

His daughter had been hospitalized that week. She was a toddler. …

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Cancer Alley taught me the data was never the problem

Health policy

Why hospital metrics miss the patient who never returns

On October 15, I walked through a Taipei hospital with an international group of health professionals and an uncomfortable question I could not fit on a presentation slide: If our hospital becomes genuinely better at keeping people well, will our…

On October 15, I walked through a Taipei hospital with an international group of health professionals and an uncomfortable question I could not fit on a presentation slide: If our hospital becomes genuinely better at keeping people well, will our management system recognize that as success, or as lost business?

The visitors came from Malaysia, the Philippines, Vietnam, Mongolia, and Somaliland, representing five countries or regions with different health systems. There …

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Why hospital metrics miss the patient who never returns

Health technology

AI scribes in psychiatry can turn a maybe into a diagnosis

A recent KevinMD piece by an emergency physician laid out what AI scribes get wrong and how to catch it before signing. I read it as a mother of someone living with serious mental illness, and one error type stopped…

A recent KevinMD piece by an emergency physician laid out what AI scribes get wrong and how to catch it before signing. I read it as a mother of someone living with serious mental illness, and one error type stopped me cold: The scribe can take a diagnosis the doctor was only thinking out loud about and record it as fact.

In the emergency department, that might mean a ruled-out …

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AI scribes in psychiatry can turn a maybe into a diagnosis

Physician voices

What David Satcher taught me about health disparities

In December 2001, I received an invitation that surprised me. U.S. Surgeon General David Satcher invited me to present at his final official conference, Closing the Gap: Surgeon General's National Conference on Health Disparities and Mental Retardation. The invitation was…

In December 2001, I received an invitation that surprised me. U.S. Surgeon General David Satcher invited me to present at his final official conference, Closing the Gap: Surgeon General’s National Conference on Health Disparities and Mental Retardation.

The invitation was unexpected. At the time, I was directing Ohio’s Rural Developmental and Behavioral Clinic Initiative, a program designed to bring developmental and behavioral services to underserved communities. The work aligned closely with …

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What David Satcher taught me about health disparities

Medical education

Patient anxiety during MRI should change what we order

My rushed morning started in the injection bay, where the radiology technician was getting ready to start an IV line to inject a contrast agent called gadolinium into the patient's vein. As a third-year medical student, I was curious to…

My rushed morning started in the injection bay, where the radiology technician was getting ready to start an IV line to inject a contrast agent called gadolinium into the patient’s vein. As a third-year medical student, I was curious to finally see a part of patient care that often happens out of my view when working with physicians: imaging. I often saw physicians order imaging studies, read the radiologist reports, …

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Patient anxiety during MRI should change what we order

Physician voices

Why physician depression goes untreated, and what helps

Few of us would tell a patient with moderate-to-severe depression to wait it out alone. Many of us do exactly that for ourselves. Physicians develop depression at rates comparable to or higher than the general population, yet we are among…

Few of us would tell a patient with moderate-to-severe depression to wait it out alone. Many of us do exactly that for ourselves. Physicians develop depression at rates comparable to or higher than the general population, yet we are among the least likely to seek timely care. The reasons are structural, not personal.

A 2025 JAMA strategic review found that fear of stigma was a primary barrier to seeking help for …

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Why physician depression goes untreated, and what helps

Physician voices

Your physician mindset is keeping you on the hamster wheel

You've been trained to obey and execute. To be the operator, the one grinding, reacting, and doing the work others have designed for you. Medical school taught you to follow protocols. Residency taught you to work within systems. Your career…

You’ve been trained to obey and execute. To be the operator, the one grinding, reacting, and doing the work others have designed for you. Medical school taught you to follow protocols. Residency taught you to work within systems. Your career has reinforced the pattern of being the highly skilled technician who executes what others decide.

Someone else decides how much time you can spend with patients. Someone else determines what treatments …

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Your physician mindset is keeping you on the hamster wheel

Health technology

Judge AI in health care by its worst answer, not its best

Health care's AI conversation is moving from documentation to decision. The pitch, repeated across the industry, is that we should stop using AI merely to write our notes and start using it to improve the decisions those notes record: to…

Health care’s AI conversation is moving from documentation to decision. The pitch, repeated across the industry, is that we should stop using AI merely to write our notes and start using it to improve the decisions those notes record: to surface risks, close care gaps, and deliver “actionable intelligence” inside the workflow. The ambition is reasonable. But it quietly raises the stakes on a problem the documentation era let us …

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Judge AI in health care by its worst answer, not its best

Health technology

How to match your ambient AI scribe to visit complexity

The future of health care offers flexibility in if, how, and when providers adopt AI documentation, but the true priority is finding a middle ground where practicing medicine still feels natural. Having access to dynamic documentation options lets clinicians set…

The future of health care offers flexibility in if, how, and when providers adopt AI documentation, but the true priority is finding a middle ground where practicing medicine still feels natural. Having access to dynamic documentation options lets clinicians set the pace for visits and creates real-world exam-room efficiency.

Rather than forcing every clinical encounter into a certain type of AI option, health care-specific platforms that offer distinct AI-supported tiers allow …

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How to match your ambient AI scribe to visit complexity

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