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Most patients on antidepressants are told they can’t take methylene blue, even for brain fog. Steven E. Warren, a physician and longevity medicine clinician, joins Kevin to discuss his KevinMD article “51 cases that reframe methylene blue serotonin syndrome.” You’ll hear …
Why most methylene blue cases came from anesthesia, not pills [PODCAST]
The patient would come in with a printout.
You know the one. Pulled from a website you’ve never heard of, about a mechanism you weren’t taught in medical school, asking about a test that isn’t in your standard workup. For a long time, my answer was some version of: I’m not familiar with that, the evidence isn’t there, let’s focus on what we know. Which was the honest answer. It was …
Guidelines are not evidence: the research to practice gap
I will never forget the look on his face. He wasn’t frightened. He wasn’t uncertain. He came into the hospital the way people used to come into courtrooms: with evidence already assembled, a verdict already reached, and very little interest in hearing otherwise. He had consulted an AI program before arriving, which had given him a diagnosis. He had read it, believed it, and arrived not as a patient seeking …
When the AI diagnosis arrives before the patient does
The morning it happened, I had just come back from a run. It was a beautiful day. I was training for a marathon, grateful for my life. I came home and stepped into the shower.
A family member I had welcomed in my home had a psychotic break and violently assaulted me with a kettlebell. The surgeon offered to schedule the repair of my severed tendon for the following morning. I …
Institutional betrayal in medicine nearly broke me
Health care spending in the United States reached about 18 percent of GDP in 2024, totaling $5.3 trillion, or roughly $15,474 per person. That’s dramatically higher than peer countries, which average around 11 percent. Yet patient outcomes haven’t kept pace.
Two major, interconnected problems stand out: exploding administrative overhead that diverts money away from actual care, and a systemic preference for treating problems after they occur rather than …
The hidden tax driving up U.S. health care costs
As I prepare to graduate medical school, I’ve spent a lot of time thinking about the person this journey has shaped me into and the person I still hope to become.
When I started medical school, I was driven by achievement. I wanted the best grades, strong evaluations, leadership positions, research, and ultimately a successful Match. I wanted to be seen as hardworking, dependable, compassionate, and capable. Looking back, I think …
Character is not reputation: a medical school reflection
Have you ever been cozy in bed, under your blankets, about to drift off to sleep, when suddenly the pile of clothes in the corner looks like a horrific creature that you’re sure, for a split moment, is real? Well, I have had that experience many times. When I am extremely fatigued while driving home at night, there’s a particular street sign that looks like a really tall man with …
Why seeing things doesn’t mean you’re losing your mind
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Up to 40 percent of infertility cases involve combined male and female factors, but the male partner is often skipped. Erica Bove, a reproductive endocrinology and infertility specialist, returns to discuss why that gap exists and what can be done about it. …
Low T treatment is silently destroying sperm counts [PODCAST]
To this day, I still don’t remember the car accident that changed my life. It was Thursday, August 8, 2024, a day like any other. I had gone to my local gym for an afternoon conditioning class. I finished hot and sweaty, grabbed my things, and walked toward the door. That’s the last thing I remember.
The next thing I’m aware of, I’m in a hospital bed, mid-conversation with a doctor. …
The delayed brain injury symptoms I almost ignored
Our culture mythologizes the lone genius (Edison, Einstein, Jobs), systematically erasing the collaborative ecosystems that made their contributions possible. This tendency has had profound consequences. It has contributed to a century-long devaluation of the generalist, the integrative thinker who ranges across domains, synthesizes disparate knowledge, and holds the whole in view while others tend the parts. This essay traces that arc and argues that artificial intelligence (AI) now presents an …
Generalist physicians and AI are a comparative advantage
An excerpt from Medicine at the Crossroads: Commentaries from a Profession Caught Between Patients, Politics, Technology, and Trust.
An emergency medicine physician writing in the New York Times recently described an interaction she had with an AI chatbot that might be a teaching lesson for our profession. After receiving her own lab results, she tried to discuss them with her physician. She was told a phone call would require …
Patients are turning to AI because doctors lack time
There is a number most physicians carry quietly, and a second number almost none of them are told.
The first: If you practice medicine in the United States, the odds that you will be named in a malpractice claim at some point in your career are high, and in some specialties close to certain. The American Medical Association’s most recent analysis of its Physician Practice Benchmark data puts the share of …
Why a malpractice lawsuit follows you after you win
American health care faces many challenges: rising costs, workforce shortages, an aging population, increasing chronic disease burden, and growing administrative complexity. Yet one of the most important health care crises receives far less attention than it deserves: the declining physical and emotional well-being of the health care workforce itself.
Physicians, nurses, respiratory therapists, pharmacists, physical therapists, and countless other health care professionals devote their careers to caring for others. Yet many …
The health care workforce crisis we keep ignoring
Shortly after midnight on April 16, 2026, a terrified teenage boy placed a 911 call from inside his family’s residence in Annandale, Virginia. Moments later, police officers arrived to encounter a scene of unspeakable devastation. Cerina Fairfax lay dead from multiple gunshot wounds, while the body of her estranged husband, former Virginia lieutenant governor Justin Fairfax, was later discovered upstairs in what authorities described as an apparent murder-suicide following an …
When men falling behind unravels families and futures
When an independent practice evaluates a billing company, the diligence usually concentrates on three questions: what it costs, how clean the claims are, and how fast someone answers the phone. Those are the right questions for choosing between vendors that exist. They say nothing about the scenario practices plan for least and recover from worst: The vendor stops existing. That scenario sounds like an edge case. The data says it …
1 in 12 medical billing companies just vanished
The following piece is an AI-generated character study based on the author’s own self-reflection.
He is the kind of person who learned early that being noticed was a form of safety. Not necessarily through anything dramatic, just enough comparison, enough hierarchy, enough subtle reinforcement that visibility became tied to worth. Somewhere along the way, he internalized a quiet equation: If I am seen, I matter; if I am not, I disappear.
What …
Needing external validation is a strategy that fails
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Your ER doctor has about 25 minutes to figure out your medical history and decide what to do next. Hamad Husainy, an emergency physician and physician executive, explains why so much of that …
Why your ER doctor doesn’t know your medical history [PODCAST]
During my pediatrics rotation, I met a 13-year-old girl with obesity. She was trying to follow her doctor’s advice to eat healthier and exercise more, but it was tough: She lacked access to a gym, her neighborhood lacked sidewalks, and local traffic was fast and busy. It was not safe for her to walk or rollerblade alone, despite her motivation to be more active.
Her problem is a common one in …
The built environment is shaping our patients’ health
I am a proud Pakistani Hoosier.
My father immigrated from Pakistan in 1992 in search of a better life than what was possible back home. After moving around for work in those early years, my parents settled outside Indianapolis when I was four years old, and Indiana has been home ever since. As I now pursue my medical education, I find myself thinking often about the two places that shaped me …
From Pakistan to Indiana: climate change and patient health
From 1992 to 1995 I was a GI fellow. Nothing on the market made clinical sense for endoscopy reporting. The tools available were designed by people who had apparently never performed a procedure or written a note for one. I met a colleague in Australia, and together we built one of the first Windows-based endoscopy reporting systems in the country.
Microsoft Access. It worked.
It worked well until the United States moved …
The case for an AI-native health care platform
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