The 15-minute appointment is not the boundary of care

Physician
September 24, 2026

Care does not have to be finished in one encounter. But it must not be allowed to disappear between encounters.

When primary care clinicians say they cannot adequately manage their patients’ concerns in 15 minutes, I take that seriously. A patient may arrive with a new symptom, several chronic conditions, medications prescribed by different clinicians, and questions about what has changed. The clinician faces that complexity alongside chart review, examination, documentation, …

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The 15-minute appointment is not the boundary of care

Workers’ compensation pain management puts function first

Conditions and Diseases
September 24, 2026

This population, either injured workers under workers’ compensation or personal-injury claimants, faces distinct drivers of delayed recovery, including secondary gain concerns, litigation, workplace psychosocial factors, fear-avoidance beliefs, and system-level incentives that can prolong disability. Guidelines from the American College of Occupational and Environmental Medicine (ACOEM), state workers’ compensation medical treatment guidelines (e.g., New York, California), the 2022 Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing …

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Workers’ compensation pain management puts function first

BRCA mutation status in breast cancer: My approach to timing, testing and treatment

Sponsored
September 24, 2026

This article is sponsored by AstraZeneca.

As a medical professional and oncologist, personalized and compassionate care has been a core pillar of my approach. I learned early in my medical training how important understanding the whole patient can be to best support people facing cancer, especially when it comes to potential treatment options and health-related quality of life.

Outside the clinic, I also have first-hand experience of what a cancer diagnosis …

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BRCA mutation status in breast cancer: My approach to timing, testing and treatment

Observation status is a clinical choice, not a billing one

Physician
September 24, 2026

One night, during cross coverage with residents, I was called to provide clinical oversight for a frail older woman admitted from the emergency department. She had multiple comorbidities and a deteriorating clinical picture, but she had been placed under observation status. I was perplexed.

When I asked residents why observation was so often selected, the answer was usually some version of this: “It is easier to change the patient to inpatient …

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Observation status is a clinical choice, not a billing one

Kratom bans confuse the leaf with a semisynthetic opioid

Health Policy
September 24, 2026

Consider what happened in Walker County, Georgia, in the fall of 2025. Multiple middle schoolers became ill after eating gummies at school, though even the eventual headcount was never fully settled, with local reports ranging from three to five students. Emergency room physicians diagnosed a kratom overdose based on the clinical picture, and within hours the story was national: Kratom gummies had hospitalized children. Investigators collected one of the gummies …

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Kratom bans confuse the leaf with a semisynthetic opioid

What anxiety feels like while reaching for hope again

Patient
September 24, 2026

I look toward the darkening sky
As evening begins to gather,
Layers of pale blue, soft gray,
And rose spilling across the horizon,
Colors so gentle
They seem to beg me,

Set it down.

Set aside the fear that has wrapped itself
Around me like a python,
Tightening its grip
Until even my heart forgets
How to breathe.

Fear is an evil thing
When it takes up residence
Inside the mind.

It comes in the waking hours
Without invitation,
Turning ordinary thoughts into daggers,
Each one sharpened against …

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What anxiety feels like while reaching for hope again

Stigmatizing language in medical records harms care

Patient
September 24, 2026

I have never asked medicine to promise me a cure. I have asked it to help me stay alive long enough to come home to my children.

My medical record is not subtle. Recurrent pancreatitis led to sepsis and multi-organ failure in 2016, a Whipple procedure in 2017, and a total pancreatectomy in 2021. I now have no functioning pancreas, insulin-deficient type 3c diabetes, severely altered gastrointestinal anatomy, and an inability …

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Stigmatizing language in medical records harms care

Improving patient access starts with board governance

Patient
September 24, 2026

In most medical practices, daily operations rely on a familiar routine. Information moves between teams as appointments begin, and direct care continues alongside the administrative tasks that support it. These processes were designed years ago, built around historical demands and earlier models of care delivery. As patient needs change and clinical pressures grow more complex, the supporting systems beneath them do not always keep pace. Gaps begin to appear in …

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Improving patient access starts with board governance

Drought and antibiotic resistance are linked in new study

Conditions and Diseases
September 24, 2026

Droughts may be creating the perfect conditions for antibiotic-resistant bacteria to thrive. As the frequency and severity of droughts intensify in regions like California, scientists worry about the potential impact on human health.

Throughout the world, the overuse and misuse of antibiotics have led to the emergence of antimicrobial resistance (AMR), a growing global health threat that contributes to millions of deaths every year. Environmental factors like drought may worsen this …

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Drought and antibiotic resistance are linked in new study

Pain score after surgery should not define recovery

Conditions and Diseases
September 24, 2026

After surgery, patients are often asked a familiar question: “How bad is your pain on a scale from zero to ten?” Naturally, most people want that number to be zero. As doctors, we want our patients to be comfortable too. But after many operations, completely removing every trace of pain may not be realistic. And sometimes, trying too hard to reach zero can create problems of its own.

A better question …

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Pain score after surgery should not define recovery

Why exhaustion can make you see things that aren’t there [PODCAST]

Podcast
September 23, 2026
YouTube video

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

You drive home after a long shift and see someone standing at the roadside. It turns out to be a sign. ≈ had that happen more than once, and her first thought …

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Why exhaustion can make you see things that aren’t there [PODCAST]

3 reforms to counter wellness influencers in practice

Physician
September 23, 2026

We spend our days in the quiet reality of clinical practice. We chase elusive diagnoses, weigh the fine distinctions of symptom presentation, and measure our clinical instincts against rigorous decades of peer-reviewed science. We sit across from human beings in moments of vulnerability, applying a lifetime of anatomy, neurobiology, and pharmacology to parse real suffering from pathology.

Yet, step outside the exam room door, and we are met with a deafening …

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3 reforms to counter wellness influencers in practice

Shift work and circadian rhythms shape the 24/7 workplace

Conditions and Diseases
September 23, 2026

Work may provide incomparable inner peace, but the timing of that work still matters. A shift may begin in the morning, evening, or night, and it may end during another part of the day. For workers’ circadian rhythms, the relevant question is not simply how long they work, but how the beginning and end of a shift fit together. That question matters whether the work ultimately serves humans or nonhumans.

Does …

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Shift work and circadian rhythms shape the 24/7 workplace

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Physicians paid for G2211 twice. Most never bill it.

Physician Finance
September 23, 2026

In 2024, Medicare cut every physician’s rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand.

The code is G2211. CMS calls it a visit complexity add-on. In plain words, it pays for office visits where you are the patient’s ongoing doctor, either as the continuing focal point for all their care …

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Physicians paid for G2211 twice. Most never bill it.

Medicaid managed care and the case for mutual stewardship

Health Policy
September 23, 2026

Roughly half of American children receive their health care through Medicaid or CHIP. These programs were legislated to cover them, and the choice has been made (repeatedly, across decades and both parties) not to fund them at the level their aims require. Pediatricians did not make that choice and should not stop saying it is the wrong one.

However, that choice, and the confines it creates, defines the real-world conditions …

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Medicaid managed care and the case for mutual stewardship

Choosing a limb lengthening surgeon requires accountability

Physician
September 23, 2026

Patients considering cosmetic limb lengthening usually begin with one question: How much height can be gained? That question is understandable, but it should not drive the decision. The more important issue is who will remain responsible for the patient’s care throughout the process and what will happen if recovery requires extra attention.

Cosmetic limb lengthening is often presented as a procedure that increases height. Technically, that is the goal, but it …

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Choosing a limb lengthening surgeon requires accountability

Why AI crisis advice may fail families facing psychosis

Health Technology
September 23, 2026

Every caregiver of someone with schizophrenia or bipolar disorder knows this moment: Someone you love is in crisis, and at some point (because it’s 2 a.m., because the on-call line is busy, because you don’t know what else to do) you open a browser or a chat window and type the question directly. What crisis resources are there for psychosis? What crisis resources are there for mania?

Those two questions aren’t …

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Why AI crisis advice may fail families facing psychosis

How AI phone systems in health care create barriers

Health Technology
September 23, 2026

Recently, I cared for a woman at a Pittsburgh shelter clinic whose blood pressure was dangerously elevated. She told me she had insurance through a regional health plan but had not seen a primary care physician in quite some time. I prescribed losartan, a common blood pressure medication, and e-prescribed it to a downtown CVS pharmacy. A week later, she returned. She had not received the medication.

The pharmacy had told …

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How AI phone systems in health care create barriers

The conflict of interest that discloses as nothing

Medications
September 23, 2026

With 66 percent of U.S. adults, some 131 million people, now taking prescription drugs, and with Medicare drug spending running into the hundreds of billions, it is worth asking how the pharmaceutical industry came to occupy so central a place in American health care. Several recent developments show how the relationship works.

The FDA announced this month that it is hiring more than 2,000 employees, rebuilding after reductions …

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The conflict of interest that discloses as nothing

AI data centers and public health demand regulation

Health Technology
September 23, 2026

Little has captured public awareness in recent years more than the meteoric rise of artificial intelligence (AI). With this rise has come a fair share of controversy, with many both inside and outside of health care claiming, or at least hoping, that it will bring about a revolution that improves patient care, improves patient outcomes, reduces physician workloads, and drives down health care costs. Many are eager adopters, hopeful to …

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AI data centers and public health demand regulation

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