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Is HPA axis dysregulation causing your chronic insomnia?

Conditions

April 10, 2026

Cortisol. Almost always cortisol. I say this to patients more than almost anything else. And I say it having lived it myself, years of high-output clinical work, late nights, early mornings, and the particular exhaustion of lying in bed completely depleted but unable to actually fall asleep. Tired but wired. It is a real physiological state, and it has a name: hypothalamic-pituitary-adrenal (HPA) axis dysregulation. It is not insomnia in …

The hidden risk of protein deficiency in bariatric surgery

Kevin Huffman, DO

Conditions

April 10, 2026

I have treated over 10,000 bariatric patients across my career, and if there is one issue that comes up more than almost anything else, it is protein. Specifically, patients not getting enough of it. The research confirms what I see every day in practice. Only a minority of bariatric patients reach the recommended minimum of 60 grams per day, resulting in the loss of fat-free mass rather than the …

Knee osteoarthritis demands layered pain management

Kayvan Haddadan, MD

Conditions

April 10, 2026

Knee osteoarthritis (OA) remains a leading cause of chronic pain and reduced mobility, affecting millions of adults worldwide, particularly those over age 50. As cartilage deteriorates and inflammation increases, patients often face pain, stiffness, swelling, and limitations in daily activities. Although no cure exists, a structured, escalating treatment plan can significantly alleviate symptoms, preserve function, delay disease progression, and help many individuals avoid or postpone surgery. Current guidelines from the …

Why clinical listening skills outpace artificial intelligence

Ryan Egeland, MD, PhD

Tech

April 10, 2026

In an era of unprecedented technological adoption, it feels almost unfashionable to talk about listening. Artificial intelligence is advancing at breakneck speed. Clinical decision support tools grow more sophisticated every year. And yet, in examining the results of a new national survey from Littmann Stethoscopes, I’m struck by a simple truth that every clinician recognizes, but our system increasingly obscures: The most essential diagnostic tool in medicine is still the …

Health care startups desperately need clinical expertise

Harsha Moole, MD

Finance

April 10, 2026

Last year, a startup pitched me a device designed to improve endoscopic procedures in gastroenterology. Slick deck. Strong team. Blue-chip venture capital (VC) backing. One problem: The device added three extra steps to a workflow that gastroenterologists have spent decades optimizing for speed. Any gastrointestinal (GI) physician would have flagged this in the first five minutes. But the investors who wrote the check? None of them had ever held a …

How expiring ACA enhanced premium tax credits hurt business

Kelly Berry

Policy

April 10, 2026

I’ve recently been forced to make painful and difficult choices that impact my personal life as well as my small business because this Congress has been unwilling to renew tax credits that used to significantly lower the cost of my health insurance. My husband and I are both self-employed entrepreneurs. We don’t have access to corporate health plans and the substantial cost sharing that employers typically …

The hidden clinical cost of HCC coding in primary care

Jeffrey H. Millstein, MD

Physician

April 10, 2026

I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work shows a steep drop in her blood count. We are working together to understand what is going on. As I prepare to enter orders in the electronic health record (EHR), …

Finding peace and reclaiming humanity within a broken health care system [PODCAST]

The Podcast by KevinMD

Podcast

April 9, 2026

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

Physician wellness coach Jessica Singh discusses the article “Physician burnout: Finding peace in a broken health care system.” Jessica shares a powerful narrative of a grueling swing shift in a rural emergency …

Why walking matters most in post-acute rehabilitation

Neha Sabharwal, DPT

Conditions

April 9, 2026

One of the most common questions I hear in rehabilitation is not asked during therapy sessions. It is usually asked quietly by a family member after the session ends. “Will my mother walk again?” Families rarely ask about therapy intensity or functional scoring systems. They do not ask how many minutes of treatment occurred that day. They ask about walking. Walking represents independence. It represents the possibility of returning home. …

The hidden crisis of trainee health during medical residency

Chinyelu E. Oraedu, MD

Physician

April 9, 2026

In medicine, we are trained to recognize risk in our patients. But we often overlook those same risks in ourselves. Sometimes, the system overlooks them, too. During residency, performance is expected and endurance assumed. Health often declines quietly and almost invisibly. We label it “dedication”; we claim “resilience.” In reality, it is often neither. I learned this lesson over 48 hours, two days that would reshape both my career and …

Health care lobbying is destroying the U.S. system

Richard A. Lawhern, PhD

Conditions

April 9, 2026

In modern times, we frequently encounter messes in our public life. This seems particularly true in American health care, and it is certainly true in our politics. But few citizens seem to put the two issues together sufficiently to effectively demand change. Putting them together is what this article is about.

According to the nonprofit public interest group Open Secrets, individuals and political action committees spent a record $4.5 billion in …

Low-dose lithium treats suicidal ideation safely

Carrie Friedman, NP

Conditions

April 9, 2026

A patient in his 20s recently came to see me in a state of severe distress. He described feeling consumed by his thoughts, constantly anxious, unable to function, and deeply exhausted. His sleep had collapsed. His sense of identity felt lost. He was experiencing persistent passive suicidal thoughts, not because he wanted to die, but because everything felt overwhelming and unrelenting.

Within three days of starting low-dose lithium at 150 milligrams …

Why Florida physician background checks are driving doctors away

Tamzin A. Rosenwasser, MD

Physician

April 9, 2026

I decided to be a physician because my mother died from tuberculosis, after quite a struggle, including with not only tuberculosis, but also with the United States Public Health System, when I was 15 years old. I got an academic scholarship to college and then put myself through medical school.

I did an internal medicine residency at Washington University and Barnes Hospital and was an emergency room physician for about seven …

Redefining physician leadership and adversity after a life-changing illness

Bertina Marie Hooks, MD

Physician

April 9, 2026

There are moments in life when the identity you have carefully built over decades is interrupted so abruptly that you are forced to ask who you are when the familiar parts no longer function the way they once did.

For physicians, identity often begins early. We learn to attach meaning to competence, endurance, reliability, and service. We become the person others call when decisions must be made, when systems feel uncertain, …

Why physicians pay more in taxes and how to reclaim your income [PODCAST]

The Podcast by KevinMD

Podcast

April 8, 2026

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

Physician and tax specialist Logan Foltz discusses the article “Physician tax strategies: Why your tax bill is so high and how to fix it.” Logan explains why the Internal Revenue Code patterns …

Why cardiovascular medicine should focus on patients, not environmental advocacy

Kurt Miceli, MD, MBA

Conditions

April 8, 2026

The treatment of cardiovascular diseases has advanced at an extraordinary pace over the past half-century resulting in an age-adjusted 60 percent reduction in heart disease death rates. This dramatic decline is directly attributable to primary and secondary preventive therapies such as statins and small interfering messenger RNAs along with disruptive technologic advances in procedural techniques. New pharmacologic options for thromboprophylaxis and novel therapies for heart failure …

Medical mistakes happen and you are still enough

J. C. Sue, DO

Physician

April 8, 2026

One prominent characteristic of medicine is its ability to repeatedly remind you to be humble. There is always something new to learn about it, and in real life patients rarely present exactly as they do in the textbook. On top of that, health care workers commonly feel pressure to be perfect due to the potentially serious consequences of many medical mistakes. Of course, since we are human, we are bound …

Peer-led storytelling in adolescent substance use prevention

Stephen M. Sandelich, MD and Anthony Alvarado

Conditions

April 8, 2026

Every week in the pediatric emergency department, I see the consequences of adolescent substance use that started too early and went unaddressed for too long. A teenager in crisis. A family blindsided. A window of prevention that closed long before anyone realized it was open.

We keep asking the same question: How do we reach kids before it gets to this point?

The answer, it turns out, might already be sitting in …

Navigating dense breast tissue and breast cancer screening guidelines

Amantia Kennedy, MD

Physician

April 8, 2026

“Pathology confirms invasive ductal carcinoma.”

I had said those words to patients many times before. This time, they were said to me. For years, I had been the voice on the other end of that call, gently guiding patients through one of the hardest moments of their lives. I knew how to say the words. I knew how to explain the diagnosis. I knew how to help women process what came …

Balancing part-time clinical work and motherhood

Jessica L. Jones, MD

Physician

April 8, 2026

It was a typical weekday morning. I woke up at 5:20, started a load of laundry, showered, dressed, unloaded the dishwasher, got the kids breakfast and lunch together, fed the pets, etc. After sending my husband off to work, I got the kids up and ready for the day. Things were going smoothly. I got my kids to school on time, and got into work early enough to go through …

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