KevinMD.com

The economic shift from fee-for-service to direct primary care

Policy

March 9, 2026

According to the Primary Care Collaborative, primary care accounts for roughly 5 percent of health care spending, yet it influences nearly 90 percent of downstream costs. That statistic is not a compliment. It is a diagnosis. And for a profession that has spent decades accepting influence as a substitute for economic ownership, it is long past time to read it that way. For decades, physicians …

The quiet paradox of physician mental health and medication

Timothy Lesaca, MD

Physician

March 9, 2026

Physicians are trained, above all, to project steadiness. Long before we feel it, we learn to perform it. The lesson begins early in training. The pager goes off, a room fills with urgency, and the expectation is unspoken but unmistakable: Remain calm. Do not let uncertainty show. Do not let fear show. Patients need confidence. Teams need direction. Over time, the composure stops feeling like a performance. It becomes a …

Why medicine ignores its Cassandras: a case study in health disparities

Ronald L. Lindsay, MD

Conditions

March 9, 2026

Cassandra saw the future. No one believed her. Medicine has its Cassandras too, clinicians who name the failures before anyone else. Their warnings are dismissed, their foresight ignored, until the damage is undeniable.

This essay is built on an AI comparison. It set my 1998 Nisonger grant beside my 2025 testimony. The themes are identical: health disparities, economic justice, ethics, listening to families. I named them then. I name them now. …

A celebrity patient and the core of patient confidentiality

Francisco M. Torres, MD

Physician

March 9, 2026

During my second year of private practice, I was still close enough to academics to miss morning conferences, but far enough along to appreciate a predictable lunch break. It was then that I had an encounter that taught me why the core ethics of medicine must remain steady, even when the patient is someone the world recognizes. It happened on a Thursday, a day when the clinic usually looked like …

The sensing gap: Why medical AI misses critical diagnoses

John C. Ferguson, MD

Conditions

March 9, 2026

The patient walked into the ER obtunded, breathing deep and fast, blood sugar over 400. Classic diabetic ketoacidosis. She had been symptomatic for three days.

Three days earlier, she had asked ChatGPT about her symptoms: excessive thirst, frequent urination, fatigue. The AI told her it was “probably related to dehydration and stress” and recommended increasing fluid intake and rest. It suggested calling her doctor “if symptoms don’t improve in a few …

Essential personnel safety: the hypocrisy of hospital snow policies

Debbie Moore-Black, RN

Conditions

March 9, 2026

Oh, how I remember this well: The wicked snowstorm that paralyzed many cities, year after year. I was driving my van to work as it slid on black ice and directed me down a hill towards a large church. I had no control and could only pray that I didn’t hit that large telephone pole. When my van finally came to a stop, I realized I had missed the telephone …

Hospitals must establish safety guardrails before deploying AI [PODCAST]

The Podcast by KevinMD

Podcast

March 8, 2026

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

Physician and health care consultant Harvey Castro discusses his article “ChatGPT Health in hospitals: 5 essential safety protocols.” Harvey outlines the immense potential of large language models to reduce administrative burdens while …

The Mamba Mentality of an immigrant physician’s journey

Joshua Salabei, MD, PhD

Physician

March 8, 2026

There is a kind of discipline that develops quietly over time, shaped not by certainty, but by persistence. I often think of it as the Mamba Mentality: a commitment to steady improvement, resilience, and focus on the process rather than the outcome.

For many immigrants, this mindset is not aspirational. It is necessary.

My own journey reflects this reality.

Before coming to the United States in 2007, I spent one year in the …

Why hospitals shouldn’t own physician practices: 6 key reasons

David Wild, MD

Physician

March 8, 2026

Over the past two decades, hospital systems have increasingly acquired physician practices, arguing that integration improves care coordination, lowers costs, and stabilizes struggling practices. In reality, this consolidation has often produced the opposite effect: higher costs, reduced physician autonomy, diminished innovation, and care that is less responsive to patients’ needs. While hospitals and physicians must collaborate closely, ownership is not collaboration, and hospital systems should not be in the business …

Why does sex work seem like a more viable path than medicine in 2026?

Corina Fratila, MD

Physician

March 8, 2026

I’d rather be a sex worker than practice medicine in this broken system (and I’m 53, menopausal, and retired from my hot years).

Let me be clear: This is not a whimsical “maybe I will pivot into OnlyFans” moment. I am 53 years old. I am menopausal. My libido is in witness protection. The bloom is not just off the rose, the whole damn bush was yanked out and replaced with …

Finding balance in political turmoil: a poem on resilience

Michele Luckenbaugh

Conditions

March 8, 2026

The world has slipped out of rhythm,
like a clock knocked from the wall
that still insists on ticking,
though the hours no longer agree.

Nothing aligns with the way it lived
in my body a year ago.
Then, there was a sense of ballast.
Morning came without dread
clinging to its edges.
I could rise,
place my feet on the floor,
and believe, perhaps naively,
that the ground would hold.

I believed the voices we chose would,
at minimum, remember us.
That disagreement was …

Names as social texts: Navigating cultural identity in medicine

Esiri Gbenedio

Education

March 8, 2026

I cannot recall the first time my name was mispronounced; that is the point. It happened so often that no single moment stands out. The sounds were altered to make them easier. In first grade, a boy loudly said my name sounded like “cereal.” I disliked it but did not tell a teacher. Early on, I learned how others would value attributes like skin color, regardless of my permission.

When adults …

Unregulated botanical products pose hidden risks in convenience stores [PODCAST]

The Podcast by KevinMD

Podcast

March 7, 2026

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

Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Unregulated botanical products: the hidden risks of convenience store supplements.” Muhamad explores the dangerous misconception that “natural” equals safe, revealing …

What neck pain taught a medical student about patient trust

Gillian Zipursky

Education

March 7, 2026

My eyes opened with the familiar heaviness of a Monday morning, and as I began to pull myself out of bed, I felt a shooting pain in my neck. I was alarmed, but not wanting to be too dramatic, I repositioned on my side, pushed off and got to my feet, struggled to put a dress on without moving my neck, and headed to class. Finding that the painless range …

Artificial intelligence and the future of fetal heart rate monitoring

Martin G. Frasch, MD, PhD, Mark I. Evans, MD, and Philip J. Steer, MD

Conditions

March 7, 2026

For half a century, the “gold standard” of labor safety has been a single, flickering line on a screen. But as recent reporting confirms, that line is often a lie. Our obsession with isolated fetal heart rate patterns has created a surgical “false positive pipeline,” driving C-section rates to historic highs without actually reducing the incidence of cerebral palsy.

The myth of the “failed” test

The skepticism surrounding EFM often stems from …

The hidden dangers of AI voice assistants in elder care

Gerald Kuo

Conditions

March 7, 2026

“Mom says she talks to me every day now.”

The son told me this during a clinic visit. His 82-year-old mother, once painfully lonely, now smiled again. She told everyone she spoke with her son every morning. He asked about her day. He reminded her to take her medication. He listened to her stories.

There was only one problem.

She was not talking to her son. She was talking to an AI voice …

Medicine in 1926: What being a doctor was really like

George F. Smith, MD

Physician

March 7, 2026

Even with all the incredible advances in medicine over the past 70 years, there remain severe deficits in the care of many serious deadly diseases. Pancreatic cancer, multiple sclerosis, glioblastoma, Alzheimer’s, ALS, and ovarian cancer easily come to mind in that desperate category.

However, let’s get a perspective of what it was really like to practice medicine a hundred years ago. What kind of doctors were there? What did they do? …

The Platinum Rule in health care: Moving beyond the Golden Rule

Harvey Max Chochinov, MD, PhD

Conditions

March 7, 2026

An excerpt from In Search of Dignity: A Lifetime of Reflections.

Several years before her death at the age of 55 years due to complications of cerebral palsy, my sister Ellen was again in hospital, this time in intensive care and on the brink of respiratory collapse. To say cerebral palsy had shaped her life is an understatement, in that it molded nearly every facet of her being, from the …

AI could end the administrative nightmare for doctors [PODCAST]

The Podcast by KevinMD

Podcast

March 6, 2026

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

Internal medicine physician Shiv K. Goel discusses his article “Claude for Healthcare vs. administrative burden: a physician’s review.” Shiv contrasts the two hours he spent fighting a prior authorization with the promise …

Silent heart attack symptoms: my missed diagnosis story

Brian Ferri

Conditions

March 6, 2026

Most people expect a heart attack to announce itself with unmistakable force, crushing pain, shortness of breath, a dramatic collapse. Mine arrived quietly, unnoticed, and remained hidden for years. What I discovered in 2026 forced me to revisit events from 2018 and 2019 and confront how easily critical medical information can slip through the cracks when communication fails.

A routine appointment reveals a hidden past

On Jan. 8, 2026, during a routine …