Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
What happens when you ask clinicians to hit dozens of quality metrics but never explain why those metrics matter or how to manage them? Kenneth Botelho, founding program director …
Clinicians are failing at value-based care because no one taught them the system [PODCAST]
In today’s fast-paced health care environment, many clinicians face overwhelming demands: packed schedules, electronic documentation, administrative pressures, and institutional productivity targets. While these pressures are real, an alarming concern has emerged in clinical practice. Patients increasingly feel that their voices are not being heard. They report that their providers seem distracted, rushed, or focused on screens rather than on the human being sitting in front of them. As a clinician …
Why listening is the core of patient-centered care
For many adolescent girls, the first visit to a gynecologist is surrounded by anxiety, embarrassment, and misinformation. Stories shared among peers, exaggerated portrayals online, and a general lack of education about reproductive health often lead young patients to expect invasive exams or uncomfortable procedures. In reality, the first gynecologic visit is rarely about procedures. Instead, it represents one of the earliest opportunities in medicine to build trust, introduce preventive care, …
What to expect at your first gynecologic visit
I started volunteering on Saturday mornings out of a feeling of restlessness. Having been in primary care for several years, I was looking for something new, to break from routine, and to feel like I was doing real good. Which is how I ended up at our medical student-run free clinic, and have been blessed with an opportunity that has grown into a primary passion of mine. We see mostly …
Why relationship-centered care matters in medicine
During the first months of COVID-19, the threat was unmistakable. Hospitals were stretched to capacity. ICU beds were made wherever space could be found. Frontline staff worked on adrenaline, obligation, and the unspoken recognition that at any second the whole thing could collapse. It was defined by volume that was relentless, tangible, and measurable. But the crisis today is different. It is much quieter. It does not announce itself with …
The quiet hospital financial crisis threatening health care
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
What happens when your deepest religious convictions collide with a patient suffering from metastatic cancer and no miracle in sight? Medical student Jonah Rocheeld shares the raw tension between …
Why I would never compromise on withdrawing care until I saw it firsthand [PODCAST]
During a conversation between classes one afternoon at my medical school, two classmates were discussing where they planned to train after graduation. One had already mapped out a pathway toward the USMLE and residency in the United States. The other hesitated. His hesitation had little to do with grades, ambition, or even finances. It was language. The first had studied medicine entirely in English; the second mostly in French and …
How language shapes physician migration and medical training
Health care has made extraordinary progress in clinical knowledge. Diagnostic capabilities have advanced, treatments have become more precise, and predictive analytics now help clinicians identify patients at risk for complications or readmissions. Yet despite these advances, health care systems continue to struggle with a familiar challenge: Care plans that look clear inside the hospital often break down once patients return home. Medication instructions are misunderstood. Follow-up steps are delayed. Symptoms …
Closing the execution reliability gap in health care systems
As a pain management specialist, I see patients every week who feel like they have tried nearly everything. They come to me after months, or even years, of battling chronic or refractory headaches. Their primary care doctor and neurologist have already walked them through the usual first-line options, yet the pain keeps coming back relentlessly. It steals their focus, disrupts their sleep, and robs them of the simple joys in …
How pain management solves a refractory headache
A few months ago, a well-connected investor sent me a deal for a surgical device with a proprietary safety feature. U.S. Food and Drug Administration (FDA)-cleared. Strong intellectual property. Thousands of units sold. Multiple institutional backers across several rounds. The investor who referred it had taken a company to a NASDAQ initial public offering and was putting in his own money.
On paper, this was exactly the kind of deal most …
Health care investing insights from a venture capital pro
Doctor, you see only the faint visible smile
on my exterior, my hand reaches out to shake yours
as you enter the space.
But you cannot see the “me” within,
the fear, the stress, the anxiety
that circulates inside me.
These emotions swirl within,
poking and prodding,
they hang like a weighted chain
about my heart.
I guess one could say
I am an imposter,
a person in disguise.
But couldn’t the same be said of you?
I guess you were trained
to keep your …
The silent patient experience in the exam room
I sat up on that thin mattress in a nursing home. My earthly possessions were gone. The house I loved so much and worked so hard to buy, built in 1918, was no longer mine. I had taken a second job just to move out of the dilapidated trailer my husband had brought me to. I felt surrounded by poverty and hopelessness while he showed no ambition to leave. My …
A nurse’s final reflection on life, death, and regrets
Most institutional failures appear sudden. A hospital collapses under regulatory scrutiny. A leadership crisis erupts. A safety breakdown exposes systemic weaknesses that had remained invisible for years. When these moments occur, they are often described as unexpected. But in complex systems like health care, failure rarely arrives without warning. The warning signs are almost always present long before the crisis becomes visible. The challenge is that institutions often learn to …
Recognizing structural drift and institutional failure in health care
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
What happens when a patient can’t afford the treatment you prescribe but is too embarrassed to say so? Health care executive Adam Cunningham joins the show to unpack the devastating ripple effects of …
Why your patient isn’t filling that prescription (and won’t tell you) [PODCAST]
One hundred million Americans carry medical debt. Research published in JAMA Network Open found that medical debt is associated with higher mortality across every leading cause of death, including suicide. A national study in the Journal of Clinical Psychiatry found that people carrying debt burden are more than three times as likely to attempt suicide. Sixteen percent of suicides in this country involve a financial crisis. I do not write …
The hidden toll of medical debt on patient health and survival
The Ruth Jackson Orthopaedic Society (RJOS) Dr. Jessi Block Courage Award is awarded annually to an RJOS member who demonstrates strength and integrity in the face of everyday obstacles. The definition of courage is “the ability to do something that frightens one” and “strength in the face of pain or grief.” Courage is a conscious choice and a willingness to confront a difficult situation. As health care professionals, we become …
How one doctor navigated orthopedic residency while pregnant
I was recently speaking with an intensive care unit (ICU) nurse, and she described a moment that perfectly captures the weight of her profession. She was managing a post-surgical patient whose vitals were quietly deteriorating. Before the monitor alarms even registered the crisis, she had anticipated the drop, prepped the pressors, and calmly updated the attending physician. Through sheer clinical vigilance, she held the fragile line between stabilization and a …
National Nurses Week needs better nursing recognition
Super Typhoon Sinlaku got the coverage it deserved, the satellite loops, the wind speed updates, the landfall reports over the Northern Marianas. Every wobble in the eye wall drew a headline. No one was talking about what was happening inside people’s bodies. I have sat with patients days after a storm passed, experiencing blood pressure that will not budge and hands that will not stop shaking, and the sky has …
Natural disaster trauma requires mental health planning
I. Intake notes
Subject presents as a high-functioning adult with a long history of academic success and an unusual number of existential questions for someone who technically has their life together. Primary characteristics include intellectual curiosity, restlessness, and a persistent suspicion that the conventional path laid before them (while impressive) might also be some kind of elaborate trap. The subject is not failing by any objective metric. In fact, the opposite …
The reluctant achiever: Navigating identity in medical training
He had just been named a partner. The youngest in the firm’s history. The first thing he said when he sat down in my office was, “I think they made a mistake.” I have heard some version of this more times than I can count, from physicians, attorneys, founders, and C-suite executives. People whose resumes would make anyone’s jaw drop, yet who live with a persistent, quiet dread that someone …
How imposter syndrome affects high-achieving professionals
Get free updates delivered free to your inbox.
