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The Podcast by KevinMD

Why malpractice lawsuits are rarer but more expensive than ever [PODCAST]

Doctors are sued far less often than they were 25 years ago, but the average malpractice payout has never been higher. Robert E. White, Jr., president of The Doctors Company, has spent 58 years in malpractice insurance. This episode is…

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Doctors are sued far less often than they were 25 years ago, but the average malpractice payout has never been higher. Robert E. White, Jr., president of The Doctors Company, has spent 58 years in malpractice insurance. This episode is based on his article “Why medical malpractice claims cost …

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Why malpractice lawsuits are rarer but more expensive than ever [PODCAST]

Health policy

Medicare Advantage profits are speeding the collapse

I receive emails from a senior citizen's organization urging me to sign a petition to protect Medicare Advantage (MA) nonmedical benefits. After reading and deleting the first one, I ignored subsequent ones for two reasons. First, since CMS, the federal…

I receive emails from a senior citizen’s organization urging me to sign a petition to protect Medicare Advantage (MA) nonmedical benefits. After reading and deleting the first one, I ignored subsequent ones for two reasons.

First, since CMS, the federal agency that administers Medicare, allowed private insurers to provide these benefits, their cost grew by over 800 percent. CMS intended these benefits to improve elder health, but this was not codified, …

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Medicare Advantage profits are speeding the collapse

Physician voices

Women’s pain dismissed as stress can have a treatable source

A patient came to my clinic after three years of being told her pain was "probably stress." She had seen her primary care doctor, two orthopedists, and a neurologist. She had tried medications, been handed pamphlets, and learned to apologize…

A patient came to my clinic after three years of being told her pain was “probably stress.” She had seen her primary care doctor, two orthopedists, and a neurologist. She had tried medications, been handed pamphlets, and learned to apologize for bringing it up at all. By the time she reached me, she had stopped believing anyone in medicine would take her pain seriously.

She is not unusual. She is the …

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Women’s pain dismissed as stress can have a treatable source

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Health policy

Opioid settlement funds reward fewer pills, not less pain

Somewhere along the way, the patient stopped being the point. A patient who was stable A year ago this month, 74-year-old Martha was stable. She lives with osteoporosis, osteoarthritis, degenerative disc disease, multiple joint replacements, and chronic anxiety. Even so,…

Somewhere along the way, the patient stopped being the point.

A patient who was stable

A year ago this month, 74-year-old Martha was stable. She lives with osteoporosis, osteoarthritis, degenerative disc disease, multiple joint replacements, and chronic anxiety. Even so, she was functioning. Her pain was controlled on a low, unchanged dose of oxycodone that she had taken responsibly for more than five years.

At her annual visit, everything changed. Her primary care …

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Opioid settlement funds reward fewer pills, not less pain

Physician voices

Hunger, delays, and the making of a difficult patient

When I see patients these days, it is usually in a hospital. Most are not particularly happy to be there. They are sick, uncomfortable, frightened, or simply exhausted by whatever brought them through the emergency department and into a hospital…

When I see patients these days, it is usually in a hospital. Most are not particularly happy to be there. They are sick, uncomfortable, frightened, or simply exhausted by whatever brought them through the emergency department and into a hospital bed. For a long time, I assumed that their frustration with being in the hospital was simply part of being sick. Of course people don’t want to be hospitalized. And, …

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Hunger, delays, and the making of a difficult patient

Health technology

Remote patient monitoring in psychiatry needs an owner

In a recent KevinMD piece, physician executive Thomas Powell argued that alert fatigue is a design problem, not a vigilance problem. When clinicians override 49 to 96 percent of drug-interaction alerts, he wrote, they aren't being careless. They're responding sensibly…

In a recent KevinMD piece, physician executive Thomas Powell argued that alert fatigue is a design problem, not a vigilance problem. When clinicians override 49 to 96 percent of drug-interaction alerts, he wrote, they aren’t being careless. They’re responding sensibly to a system that buries the rare important warning under a pile of trivial ones.

One of his tests for retiring an alert stopped me: If no one will claim …

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Remote patient monitoring in psychiatry needs an owner

Conditions and diseases

Reactive attachment disorder may be a physiology problem

I have lived on the autism spectrum and with reactive attachment disorder (RAD) throughout my life. Now, as a 40-year-old woman and an independent medical researcher, I am diving into ways to better comprehend and contribute to neurological investigation. For…

I have lived on the autism spectrum and with reactive attachment disorder (RAD) throughout my life. Now, as a 40-year-old woman and an independent medical researcher, I am diving into ways to better comprehend and contribute to neurological investigation. For much of my life, these experiences were treated as separate facts: autism on one side, attachment disturbance on the other, and the physiological and emotional consequences of both somewhere else. …

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Reactive attachment disorder may be a physiology problem

Health policy

Doctor vs. physician and the El-Sayed licensing fight

The halls of American power are currently experiencing a severe outbreak of semantic existentialism. We have reached a point in our political discourse where holding a degree from an elite institution is no longer a qualification but a linguistic trapdoor.…

The halls of American power are currently experiencing a severe outbreak of semantic existentialism. We have reached a point in our political discourse where holding a degree from an elite institution is no longer a qualification but a linguistic trapdoor. If you have spent years collecting expensive, gold-embossed sheepskins but have not sat in a windowless room for three days to check boxes under the watchful eye of a state …

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Doctor vs. physician and the El-Sayed licensing fight

Physician finance

Retiring from medicine won’t cure physician burnout

I don't practice medicine. My background is almost thirty years in market research, work built entirely around noticing patterns across a lot of people's decisions rather than trusting any single story to explain itself. I bring that lens now to…

I don’t practice medicine. My background is almost thirty years in market research, work built entirely around noticing patterns across a lot of people’s decisions rather than trusting any single story to explain itself. I bring that lens now to a different but related problem: what happens to accomplished professionals when the role that organized their identity for decades disappears. This often happens to physicians, and this site has already …

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Retiring from medicine won’t cure physician burnout

The Podcast by KevinMD

Active sitting: Why ergonomic chairs and standing desks fail [PODCAST]

The office chairs most of us sit in all day have little science behind them, and the popular fixes may not be much better. Turner Osler is a trauma surgeon and epidemiologist. This episode is based on his article “How…

Listen on Apple Podcasts · Spotify

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

The office chairs most of us sit in all day have little science behind them, and the popular fixes may not be much better. Turner Osler is a trauma surgeon and epidemiologist. This episode is based on his article “How the benefits of active sitting change desk work,” published

…

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Active sitting: Why ergonomic chairs and standing desks fail [PODCAST]

Conditions and diseases

Nutrition in pediatric oncology is not a fixed meal plan

In pediatric oncology, nutrition is often reduced to a simple question: Is the child eating enough? In practice, it is rarely that straightforward. During intensive cancer treatment, appetite, swallowing, taste, gastrointestinal tolerance, body weight, body composition, and functional capacity can…

In pediatric oncology, nutrition is often reduced to a simple question: Is the child eating enough? In practice, it is rarely that straightforward. During intensive cancer treatment, appetite, swallowing, taste, gastrointestinal tolerance, body weight, body composition, and functional capacity can change within days. A nutrition plan that works well in one phase of treatment may become difficult, or even impossible, a few weeks later.

This is the journey of a twelve-year-old …

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Nutrition in pediatric oncology is not a fixed meal plan

Conditions and diseases

Accelerated TMS: what the SAINT and SWIFT numbers mean

More and more patients now ask me about "five-day TMS for depression." Some have read about Stanford's protocol. Others have seen clinics advertise two-week treatment. Referring colleagues ask a version of the same question: Is accelerated transcranial magnetic stimulation better,…

More and more patients now ask me about “five-day TMS for depression.” Some have read about Stanford’s protocol. Others have seen clinics advertise two-week treatment. Referring colleagues ask a version of the same question: Is accelerated transcranial magnetic stimulation better, and which protocol should patients look for?

The honest answer starts with a caveat. SAINT, now marketed as Stanford Neuromodulation Therapy (SNT), has reported higher remission rates than SWIFT, an accelerated …

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Accelerated TMS: what the SAINT and SWIFT numbers mean

Physician finance

The true meaning of financial independence for doctors

Doctors earn millions of dollars over the course of their careers and save only a small portion of it. That is not simply because most doctors lack financial literacy. It is also because of the personal circumstances each of us…

Doctors earn millions of dollars over the course of their careers and save only a small portion of it. That is not simply because most doctors lack financial literacy. It is also because of the personal circumstances each of us must face. A financial plan may become a shining light in the darkness of those circumstances.

To become a fully trained doctor, you first set up a path and a timeframe …

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The true meaning of financial independence for doctors

Conditions and diseases

Why stool consistency matters, not just how often you go

After more than thirty-five years practicing internal medicine, I've come to appreciate something that received remarkably little attention during my medical education. A good bowel movement is as much a problem of physics as it is of physiology. We spend…

After more than thirty-five years practicing internal medicine, I’ve come to appreciate something that received remarkably little attention during my medical education. A good bowel movement is as much a problem of physics as it is of physiology.

We spend years learning about gastrointestinal hormones, digestive enzymes, microbiology, inflammation, and intestinal motility. We memorize the causes of constipation and diarrhea. We prescribe medications, recommend fiber, and order colonoscopies.

But here’s a question …

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Why stool consistency matters, not just how often you go

Patient voices

Insurance referrals treat adults like schoolchildren

For anyone with their finger on the pulse of American medicine, it is clear that referrals to see specialists as required by many health insurance plans have become a serious problem for doctors and patients alike. Primary care physicians often…

For anyone with their finger on the pulse of American medicine, it is clear that referrals to see specialists as required by many health insurance plans have become a serious problem for doctors and patients alike. Primary care physicians often resent the time that these referrals take out of their day. Many also resent the fact that patients sometimes make appointments for no other reason than to …

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Insurance referrals treat adults like schoolchildren

Health technology

AI in health care must not cost us our human skills

Artificial intelligence, robotics, and other emerging technologies are transforming health care at an extraordinary pace. Their potential is enormous, and their development is both welcome and increasingly necessary. As populations age, health care systems will face growing demands for medical…

Artificial intelligence, robotics, and other emerging technologies are transforming health care at an extraordinary pace. Their potential is enormous, and their development is both welcome and increasingly necessary.

As populations age, health care systems will face growing demands for medical care, rehabilitation, long-term support, and assistance for people with disabilities. Meanwhile, the volume of medical and pharmaceutical knowledge has expanded beyond what any individual clinician can reasonably master. AI-assisted clinical decision …

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AI in health care must not cost us our human skills

Patient voices

Medical gaslighting nearly killed me

There I was lying on my bathroom floor: semi-conscious, teeth-chattering; relieved my fever-sweat was plastering my back to the cold tile. I was weak, trying my best to will my body to the warmth of an elusive ray of light…

There I was lying on my bathroom floor: semi-conscious, teeth-chattering; relieved my fever-sweat was plastering my back to the cold tile. I was weak, trying my best to will my body to the warmth of an elusive ray of light bouncing off the floor, playing hide-and-seek behind a transient cloud. Whenever the light flickered across my face, it seared straight through my squinted eyelids and settled on top of the …

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Medical gaslighting nearly killed me

Physician voices

The question to ask new patients that intake forms skip

The first patient appointment begins long before we introduce ourselves. Patients often spend days gathering records, completing forms, reading about symptoms, and contemplating what we might say. As a result, by the time we meet, they may also have formed…

The first patient appointment begins long before we introduce ourselves. Patients often spend days gathering records, completing forms, reading about symptoms, and contemplating what we might say. As a result, by the time we meet, they may also have formed expectations about how we will respond. They may have read your biography and online reviews, but those descriptions cannot tell them whether you will welcome a difficult question or let …

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The question to ask new patients that intake forms skip

Physician voices

What is physician career success without a trophy case?

I recently read a press release announcing a physician as the new head of a regional health system. Among his accomplishments were six consecutive "Top Doctor" citations and a long list of other accolades. Closer to the end of my…

I recently read a press release announcing a physician as the new head of a regional health system. Among his accomplishments were six consecutive “Top Doctor” citations and a long list of other accolades. Closer to the end of my career than the beginning, I found myself taking stock of my accomplishments. My trophy case looked decidedly sparse in comparison, and I started to question my legacy and impact.

My trophy …

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What is physician career success without a trophy case?

The Podcast by KevinMD

Fired for seeing her own patients: moral injury and life after medicine [PODCAST]

A physician was fired by the doctors she had trained, in part because she preferred to see her own patients herself. Moral injury, she argues, does not require 100-hour weeks. Sarah A. Vlach is a physiatrist and sports medicine physician.…

Listen on Apple Podcasts · Spotify

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

A physician was fired by the doctors she had trained, in part because she preferred to see her own patients herself. Moral injury, she argues, does not require 100-hour weeks. Sarah A. Vlach is a physiatrist and sports medicine physician. This episode is based on her article “Moral injury …

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Fired for seeing her own patients: moral injury and life after medicine [PODCAST]

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