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What if the real driver of aging isn’t your mitochondria or your telomeres but the tiny capillaries you never think about? Double board-certified emergency and internal medicine physician Kenneth Ro returns to the …
You can’t stent a capillary: Why aging starts in your smallest blood vessels [PODCAST]
The 72-year-old woman sitting in front of me had spent nearly a decade anxious. Not ordinary stress, not fleeting worry, but the kind of chronic physiologic anxiety that hijacks sleep, amplifies rumination, tightens the chest, and slowly shrinks a person’s world. For over eight years, she had been treated with escalating doses of bupropion, eventually reaching 450 mg daily, the maximum recommended dose. And I found myself returning to a …
Psychiatric polypharmacy is a reassessment failure
An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).
What follows is a slightly edited narrative, the story of Kieran Allen, MD. Dr. Allen is from Australia, a psychiatry resident (registrar) at the time of writing. Dr. Allen writes from a different perspective, that of someone with a relapsing and remitting mental illness. He focuses on this for the …
Doctors with mental illness need our care, not silence
Primary care is often described as broken, but that diagnosis misses the real issue. The clinical foundation remains strong. The problem lies in how access to care is designed and delivered.
Primary care isn’t broken; access is.
People can manage nearly every aspect of their lives instantly through technology, yet health care still relies on outdated models that require patients to wait days or even weeks for routine care. This creates frustration …
Primary care access is the real problem, not the system
If you are a physician, you have likely heard the question: “What would you do?” Increasingly, the answer is shaped before you have the chance to speak.
Patients assume that the physician responsible for their care is the one making the decisions. In many cases, that assumption no longer holds.
Modern health care is organized around teams, protocols, and layers of oversight that shape decisions before they reach the bedside. These structures …
Physician autonomy and the hidden curriculum of medicine
An excerpt from Beyond Medicare For All: Cracking the Code of the Healthcare Affordability Crisis.
If our goal is high-quality, comprehensive, affordable health care for all, we must make health care less profitable. If health systems and corporations continue to control health care and their main goal is profit, health costs will continue to rise faster than the ability of society to pay, regardless of any reform efforts.
On the other …
A Medicare for All alternative that keeps insurers in
I am 75 years old, and I can see perfectly. My vision is 20/20. The tests are normal. The symptom is not. The disturbance is monocular, dynamic, and light-based, not structural, not degenerative in any way that current imaging captures. And yet, every day, I see the world through a veil of intrusive light that no one seems willing to investigate.
After months of medical appointments, I have learned a difficult …
Unexplained symptoms require deeper medical curiosity
Hospitals operate around the clock.
Emergencies do not pause at midnight. Sepsis progresses overnight. Stroke symptoms emerge at 3 a.m. Trauma arrives unannounced. Respiratory failure does not respect business hours. While much of the world sleeps, health care professionals continue making high-stakes decisions in ICUs, emergency departments, labor floors, hospital wards, and operating rooms across the country.
Yet there remains a conversation health care systems are still largely avoiding: What is the …
How to redesign night shift in health care
I stood knocking at the door of my hospice patient like I did every Monday for the past eight months. A musically talented man in his early 40s was always waiting for my weekly nursing visit, more so for the aspect of socialization. He was diagnosed with colon cancer two years prior and had a colostomy bag, leaving this once vibrant, social, even handsome man a shell of what he …
Clinician grief is a hidden crisis in modern hospice care
A position paper about using the term physician instead of provider? What does this have to do with biomedical ethics?
I fully support calling ourselves physicians and not providers, and have been sensitive to this issue in part thanks to Read more…
Physician vs. provider is an ethics issue, not just style
There was a moment when human immunodeficiency virus (HIV) was at the center of public conversation. Campaigns were everywhere. Education was constant. Awareness was urgent. Today, that urgency feels quieter. In many ways, this shift reflects progress. Advances in treatment have transformed HIV into a manageable chronic condition. Stigma, while still present, is not as visible as it once was. Patients are living longer, fuller lives. From the outside, it …
HIV care requires better patient education today
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
What if one of the most common escalation strategies for acute heart failure doesn’t actually improve outcomes? Internal medicine physicians Benjamin P. Geisler, Jeffrey L. Greenwald, and Kathy May Tran, editors of 50 …
Bolus or drip? What the DOSE trial actually showed about heart failure [PODCAST]
A cash symptom can have several causes
A practice owner notices the same warning signs: collections are lower than expected, the bank balance feels tighter, and the billing report shows money still sitting unpaid. The first conclusion is usually simple. Billing is the problem.
Sometimes that is true. More often, the word “billing” is covering several different problems that require different fixes. A slow front desk, a coding issue, payer delays, denial …
Accounts receivable days hide four billing problems
For a moment, I wondered whether I had a crystal ball.
I had written several times on KevinMD about artificial intelligence in medicine. I had written for Forbes Business Council about AI as a developing cognitive tool, synthetic reality, executive distortion, and the danger of treating fluent output as reliable judgment. I kept returning to one warning. AI was one step away from a serious blunder, and that blunder …
AI therapy chatbots are crossing into impersonation
We have all seen the sign. Hanging on the wall of every restaurant, every hospital break room, every public restroom in America: Employees Must Wash Hands Before Returning to Work. And yes, washing your hands after using the bathroom is essential. The science is clear. The data backs it up. It saves lives. But after more than 30 years as a registered nurse, from the ICU and emergency room to …
The handwashing standard nobody finished. Until now.
The Subjective, Objective, Assessment, and Plan (SOAP) framework could be expanded beyond clinical care to also address patients’ financial and legal well-being. This would require training health care providers in basic financial and legal principles, establishing dedicated financial-legal departments within health care institutions, and potentially offering financial and legal services as add-ons to health care insurance. With these changes, routine health care encounters could become more comprehensive, addressing socioeconomic needs …
Expanding the SOAP framework boosts health outcomes
A generation ago, most physicians barely considered the possibility of suddenly losing a job.
The profession was not perfectly stable, of course. Doctors still burned out, practices failed, partnerships fractured, and hospitals behaved badly from time to time. But for many physicians there remained an underlying assumption that competence and hard work created a reasonably durable professional life. If you trained well, treated patients properly, maintained your reputation, and kept your …
How to navigate physician job loss in the first week
I am a former vascular surgeon, and I left the field in 2020 at the height of coronavirus disease 2019 (COVID-19) due to burnout. And though I had not been well for some years, I was able to find myself again and rediscover my passion for music. In the end, my health and my family became my priority, so currently I work in a more stable outpatient clinical setting.
I started …
Physician burnout is a heavy burden for many healers
Scenario: A resident develops a stage 4 pressure ulcer after admission to a long-term care facility. Plaintiff counsel argues the facility failed to prevent it. Defense counsel argues the ulcer was clinically unavoidable. Both positions hinge on the same federal regulation. The question is what the regulation actually says, and how the medical record measures up to it.
To work through this one, it is time for a history lesson. Travel …
Unavoidable pressure ulcer claims live and die by the record
My pager beeps as I walk through the hospital doors. It is a familiar message, “Your patient wants to leave.” We admitted John four days ago for opioid withdrawal and he is not yet ready to stop using opioids. When I walk in the room, I see him packing his bags. “So, John,” I say. “When you leave, your body cannot tolerate the same amount of opioids because you have …
Harm reduction effectively treats substance use disorder
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