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Policy

What would Dolly do about universal health care?

The passing of Dolly Parton was a gut punch to those like me assuming she still had many years left to spread kindness on this earth. It was incredible to see how she touched so many hearts well beyond U.S.…

The passing of Dolly Parton was a gut punch to those like me assuming she still had many years left to spread kindness on this earth. It was incredible to see how she touched so many hearts well beyond U.S. borders. I got tears in my eyes watching Britain’s King’s Guard play “9 to 5” in her memory. Though her beaming smile may be gone, her eternal optimism remains. We …

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What would Dolly do about universal health care?

Tech

Behavioral science in health care is what AI is missing

Artificial intelligence is rapidly reshaping health care: clinical decision support, documentation, operations, patient engagement. Most of the conversation about it focuses on the technology itself: the quality of the data, the sophistication of the models, the accuracy of the outputs.…

Artificial intelligence is rapidly reshaping health care: clinical decision support, documentation, operations, patient engagement. Most of the conversation about it focuses on the technology itself: the quality of the data, the sophistication of the models, the accuracy of the outputs.

These are real questions. But they can obscure a more basic one: Health care is a human system, and every outcome it produces depends on what people do. That includes patients, …

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Behavioral science in health care is what AI is missing

Physicians

Jessie Mahoney, MD, on physician burnout and well-being: a KevinMD subscriber spotlight

Jessie Mahoney, MD, is a board-certified pediatrician and certified coach who spent nearly two decades as a physician leader at The Permanente Medical Group before founding Pause & Presence Coaching & Retreats. She has published 37 essays on KevinMD since…

Jessie Mahoney, MD, is a board-certified pediatrician and certified coach who spent nearly two decades as a physician leader at The Permanente Medical Group before founding Pause & Presence Coaching & Retreats. She has published 37 essays on KevinMD since

…

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Jessie Mahoney, MD, on physician burnout and well-being: a KevinMD subscriber spotlight

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Tech

Nobody owns your EHR templates, and it shows in every note

A physician pulls up a patient's medication list mid-visit and stops. Something's off. The patient stopped that drug months ago, and the list never caught up. Nothing in the system flagged it; the physician just happened to notice. Ask who's…

A physician pulls up a patient’s medication list mid-visit and stops. Something’s off. The patient stopped that drug months ago, and the list never caught up. Nothing in the system flagged it; the physician just happened to notice. Ask who’s responsible for making sure that gets caught every time, and nobody has an answer.

Someone built that list years ago, correctly, for a patient who’s since moved on to a different …

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Nobody owns your EHR templates, and it shows in every note

Conditions

I was wrong: Doctors who listen still exist

The last time I wrote for KevinMD, I asked, "What happened to real care in health care?" I was tired of commercial after commercial promising that a new drug could fix nearly anything. I was frustrated by the steady stream…

The last time I wrote for KevinMD, I asked, “What happened to real care in health care?” I was tired of commercial after commercial promising that a new drug could fix nearly anything. I was frustrated by the steady stream of new labels and acronyms that sometimes make ordinary human struggles sound like conditions waiting for a prescription. That frustration was personal, but it was not entirely imagined. From …

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I was wrong: Doctors who listen still exist

Conditions

Measuring autism treatment progress beyond therapy hours

One of the things I value most in medicine is our ability to ask a seemingly simple question: Is the treatment working? In many areas of medicine, we have objective measures that help us answer it. When caring for a…

One of the things I value most in medicine is our ability to ask a seemingly simple question: Is the treatment working?

In many areas of medicine, we have objective measures that help us answer it. When caring for a child with diabetes, we can follow hemoglobin A1C. When managing hypertension, we monitor blood pressure. Those measurements do not replace the physician’s judgment or the patient’s experience. They give us another …

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Measuring autism treatment progress beyond therapy hours

Conditions

Can nervous system regulation reduce the pull of cravings?

Addiction is often understood as a behavioral response to a craving. But beneath the urge to use, something else is happening: A person is trying to change how they feel. Trauma can fundamentally alter our sense of safety in the…

Addiction is often understood as a behavioral response to a craving. But beneath the urge to use, something else is happening: A person is trying to change how they feel.

Trauma can fundamentally alter our sense of safety in the world. When we don’t feel safe, the nervous system activates its innate defenses, which can leave us feeling anxious and hypervigilant, or emotionally numb and shut down. Over time, the nervous …

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Can nervous system regulation reduce the pull of cravings?

Physicians

Anesthesia standards should follow the patient, not the room

More procedures are now performed far from the traditional operating room. Endoscopy units, interventional radiology suites, cardiac catheterization laboratories, and MRI rooms routinely host patients who need sedation or anesthesia. That expansion is a clinical success. But the room label…

More procedures are now performed far from the traditional operating room. Endoscopy units, interventional radiology suites, cardiac catheterization laboratories, and MRI rooms routinely host patients who need sedation or anesthesia.

That expansion is a clinical success. But the room label can create a misleading sense that the anesthesia is somehow less consequential.

Sedative and anesthetic drugs affect breathing, airway tone, blood pressure, and consciousness wherever they are given. In an endoscopy room, …

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Anesthesia standards should follow the patient, not the room

Conditions

Whole-person care starts where the specialties stop

I have had thousands of first appointments. I knew within thirty seconds that this one was going to matter. She was not hopeful. She made that clear before she even sat down. She had been to enough offices, received enough…

I have had thousands of first appointments. I knew within thirty seconds that this one was going to matter. She was not hopeful. She made that clear before she even sat down. She had been to enough offices, received enough referrals, and heard enough versions of the same answer that she had stopped expecting a different one.

She looked at me and asked directly, “Are you going to help me, or …

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Whole-person care starts where the specialties stop

Podcast

Hospice waits on a court order when no family can speak for you [PODCAST]

A man is dying. He cannot speak, and no one in his life can say what he would have wanted. Kirsten Engel is a palliative medicine physician, and Medha Tripathi is a health writer and incoming Fulbright research scholar. This…

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A man is dying. He cannot speak, and no one in his life can say what he would have wanted. Kirsten Engel is a palliative medicine physician, and Medha Tripathi is a health writer and incoming Fulbright research scholar. This episode is based on their article “Guardianship and …

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Hospice waits on a court order when no family can speak for you [PODCAST]

Conditions

How to catch functional decline before discharge day

We know when a patient's laboratory values have improved. We know when the infection has cleared, the fracture has been repaired, or the heart failure has stabilized. But before declaring treatment successful, we should ask a more ordinary and often…

We know when a patient’s laboratory values have improved. We know when the infection has cleared, the fracture has been repaired, or the heart failure has stabilized. But before declaring treatment successful, we should ask a more ordinary and often more consequential question:

Can this person safely get out of bed?

Too often, health care discovers the answer only when discharge is approaching. Rehabilitation is then asked to solve, in a matter …

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How to catch functional decline before discharge day

Tech

Can independent medical judgment survive AI in medicine?

Every few weeks, another headline asks whether artificial intelligence is about to replace physicians. I doubt it. Patients don't want to hand the most important conversations of their lives to a computer. Doctors didn't spend years training to become little…

Every few weeks, another headline asks whether artificial intelligence is about to replace physicians. I doubt it. Patients don’t want to hand the most important conversations of their lives to a computer. Doctors didn’t spend years training to become little more than supervisors of software. Medicine has always been, and should remain, a profoundly human profession.

But I do think we’re asking the wrong question. The real question isn’t whether AI …

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Can independent medical judgment survive AI in medicine?

Physicians

Good trouble: lessons from a physician whistleblower

Rep. John Lewis nearly lost his life on the Edmund Pettus Bridge in Selma, marching for rights that should never have required a march. His courage redefined the moral calculus of resistance, what he called "good trouble, necessary trouble." I've…

Rep. John Lewis nearly lost his life on the Edmund Pettus Bridge in Selma, marching for rights that should never have required a march. His courage redefined the moral calculus of resistance, what he called “good trouble, necessary trouble.”

I’ve created trouble too. Not on bridges, but in boardrooms. Not with batons overhead, but with data, dissent, and quiet refusal. I’ve challenged supervisors, disrupted systems, and questioned protocols that harmed more …

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Good trouble: lessons from a physician whistleblower

Tech

AI deskilling in medicine: lessons from Air France 447

In 2021, at four endoscopy centers in Poland, endoscopists got a new tool to aid in colonoscopies. A computer equipped with an artificial intelligence watched the video alongside them and highlighted anything that looked like a polyp. The centers were…

In 2021, at four endoscopy centers in Poland, endoscopists got a new tool to aid in colonoscopies. A computer equipped with an artificial intelligence watched the video alongside them and highlighted anything that looked like a polyp. The centers were part of a trial, so, as part of the study, the doctors had access to the tool on some days and not on others. This variability allowed researchers a chance …

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AI deskilling in medicine: lessons from Air France 447

Policy

Workplace violence in health care needs a national standard

My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood. I looked over my shoulder and froze. A…

My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood.

I looked over my shoulder and froze. A patient stood in the deserted hallway, blood streaking his arm from where he appeared to have ripped out an IV. A pair of bandage scissors hung loosely in his hand.

I ran …

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Workplace violence in health care needs a national standard

Conditions

Should good faith immunity cover trained clinicians?

The high-profile Take Care of Maya case, chronicled in the Netflix documentary, placed the complex legal doctrines of qualified immunity and good faith immunity directly into the public spotlight. While a jury initially awarded the Kowalski family $261 million in…

The high-profile Take Care of Maya case, chronicled in the Netflix documentary, placed the complex legal doctrines of qualified immunity and good faith immunity directly into the public spotlight. While a jury initially awarded the Kowalski family $261 million in damages (later reduced to $213.5 million) against Johns Hopkins All Children’s Hospital for claims including false imprisonment, medical negligence, and wrongful death, a Florida appellate court overturned the verdict. The …

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Should good faith immunity cover trained clinicians?

Physicians

Physician leaders at the bedside see what dashboards miss

Some of the most useful information I get as a medical director does not come from a dashboard or a meeting. It comes from working a clinical shift. When you are seeing patients alongside the people affected by the processes…

Some of the most useful information I get as a medical director does not come from a dashboard or a meeting. It comes from working a clinical shift.

When you are seeing patients alongside the people affected by the processes you help oversee, problems become difficult to ignore. You see where the workflow slows down, where responsibilities are unclear, and where a seemingly simple administrative change creates extra work. That is …

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Physician leaders at the bedside see what dashboards miss

Conditions

Biomarker testing can find the mutation driving your cancer

"What was cancer, Grandpa?" These were words I hoped to hear from my grandchildren. As a practicing physician for over forty-five years, I wasn't sure whether futuristic care would include finding a cure for cancer. But that time has arrived.…

“What was cancer, Grandpa?” These were words I hoped to hear from my grandchildren. As a practicing physician for over forty-five years, I wasn’t sure whether futuristic care would include finding a cure for cancer. But that time has arrived.

Unfortunately, this realization came from personal experience as my wife was diagnosed with terminal cancer four years ago. Initially in 2022, we thought it was a slow-growing thyroid cancer that would …

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Biomarker testing can find the mutation driving your cancer

Tech

Clinical informatics is not about the technology

I have asked the same question in a lot of hospitals, and I have never once received a good answer. Name the three largest technology investments your organization made in the last five years. Now say what clinical outcome each…

I have asked the same question in a lot of hospitals, and I have never once received a good answer.

Name the three largest technology investments your organization made in the last five years. Now say what clinical outcome each one was meant to change, whether it changed, and whether anyone even checked.

The room usually goes completely quiet. Not because the leadership are careless. Most of them are serious, and many …

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Clinical informatics is not about the technology

Policy

How Medicare Advantage prior authorization delays care

Medicare Advantage has become one of the most important parts of the American health care system. Designed as a privately administered alternative to traditional Medicare, the program allows insurers to manage coverage for older adults while receiving payments from the…

Medicare Advantage has become one of the most important parts of the American health care system. Designed as a privately administered alternative to traditional Medicare, the program allows insurers to manage coverage for older adults while receiving payments from the federal government. Supporters argue that Medicare Advantage can reduce unnecessary spending while giving seniors access to benefits that traditional Medicare may not fully provide.

Yet recent scrutiny has raised a more …

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How Medicare Advantage prior authorization delays care

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