KevinMD.com

October 7, 2026Oct 7, 2026

Someone you love says they are fine. They still eat, they still go to work, and no one asks a second time. Nneka Oluoha is an internal medicine physician and the author of a novel about a Nigerian immigrant living…

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Policy

Pharmacy benefit managers and the price no one can see

Matt Hasan, PhD

October 7, 2026Oct 7, 2026

A physician writes a prescription believing the clinical decision has been made. In reality, another decision-making process is just beginning. Between the prescription and the patient sits an increasingly powerful infrastructure of pharmacy benefit managers, insurers, formularies, rebate agreements, pharmacy…

A physician writes a prescription believing the clinical decision has been made. In reality, another decision-making process is just beginning.

Between the prescription and the patient sits an increasingly powerful infrastructure of pharmacy benefit managers, insurers, formularies, rebate agreements, pharmacy networks, prior authorization rules, and specialty pharmacies. Most physicians see only fragments of this system. Patients usually understand even less.

The result is a peculiar form of American medicine: The person making …

Conditions

Living with glycogen storage disease into adulthood

Andrew Williams

October 7, 2026Oct 7, 2026

Both Julieta and Rob went through long, uncertain paths to receiving a correct diagnosis. Julieta was born in 1987 outside a major city in Argentina. Very little information about glycogen storage disease (GSD) was available at the time. Her symptoms…

Both Julieta and Rob went through long, uncertain paths to receiving a correct diagnosis.

Julieta was born in 1987 outside a major city in Argentina. Very little information about glycogen storage disease (GSD) was available at the time. Her symptoms started when she was two months old: failure to thrive, hypoglycemia, and constant crying. Local pediatricians could not diagnose her, and she was referred to a nearby center, then another center …

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Tech

AI’s 360-degree view of the patient is missing the family

Nicole Drapeau Gillen

October 7, 2026Oct 7, 2026

In a recent Psychiatric Times interview, Christoph Correll, MD, made a case that every psychiatrist should hear: Artificial intelligence should replace tasks, not people. He described a decision-support platform he helps lead at MedLink Global that would pull together the electronic health record, a short avatar-guided interview before each visit, and the conversation in the exam room, then offer two or three evidence-based treatment options. The goal, in his …

Conditions

Your anesthesia care starts before the operating room

Dr. Girishkumar Modi

October 7, 2026Oct 7, 2026

Many patients meet their anesthesiologist only a few minutes before surgery. So it can look as if our job starts there. Actually, a lot has already happened before you enter the operating room. We are looking at your medical history,…

Many patients meet their anesthesiologist only a few minutes before surgery. So it can look as if our job starts there. Actually, a lot has already happened before you enter the operating room.

We are looking at your medical history, your medicines, previous anesthetics, allergies, heart and lung problems, diabetes, sleep apnea, recent illness, and anything that may affect surgery. We also think about the operation itself. How long will it …

Conditions

Lethal injection and pulmonary edema: a lesson for the ICU

Laurel A. Coons, PhD

October 7, 2026Oct 7, 2026

Before Tennessee attempted to execute Christa Gail Pike on September 30, 2026, she wrote something that captured an important distinction between death and dying. Pike, who was sentenced to death for the 1995 murder of nineteen-year-old Colleen Slemmer, wrote, “I am not afraid to die. I am only nervous about the process.” What made her nervous was not the fact of death itself, but what she might consciously experience …

Policy

A letter to Congress: Repeal the Controlled Substances Act

Richard A. Lawhern, PhD

October 7, 2026Oct 7, 2026

I write as a health care educator and author with thirty years of research experience and over three hundred papers published as author or co-author, several of them widely cited. In that role, I see thousands of emails and social media postings every month from people whose lives are being destroyed by misdirected and frequently outright fraudulent U.S. public health policy on treatment of pain and addiction. The …

Conditions

How to choose a GLP-1 weight loss program

Neil Panchal, DO

October 7, 2026Oct 7, 2026

Glucagon-like peptide-1 (GLP-1) medications work. Semaglutide and tirzepatide help people lose more weight than any pill or shot we've had before. The harder problem is everything that happens around the drug. In real-world studies, about a third of patients stop…

Glucagon-like peptide-1 (GLP-1) medications work. Semaglutide and tirzepatide help people lose more weight than any pill or shot we’ve had before. The harder problem is everything that happens around the drug.

In real-world studies, about a third of patients stop treatment within the first month. In one large insurance claims analysis, only about one in twelve adults who started a GLP-1 for weight loss were still taking it three years later. …

Conditions

Why criminal responsibility is not a medical question

Farid Sabet-Sharghi, MD

October 7, 2026Oct 7, 2026

I've watched the coverage of this case the same way most of us have. Clips from the courtroom keep looping across television, podcasts, and every social feed. A mother killed her three children. The hearings are broken into bite-sized moments…

I’ve watched the coverage of this case the same way most of us have. Clips from the courtroom keep looping across television, podcasts, and every social feed. A mother killed her three children. The hearings are broken into bite-sized moments for public consumption. And in the middle of it all sits a long parade of physicians from every specialty, plus the usual lineup of forensic psychologists and psychiatrists, each one …

Physicians

Physician professionalism and the 7 virtues of Bushido

Ronald L. Lindsay, MD

October 7, 2026Oct 7, 2026

As a fifth-grade student, I was introduced to Japanese culture through a school program. I lived in Japan on an American military base from 1967 to 1970. I remember learning about tea ceremonies, calligraphy, and the samurai code known as…

At the time, I understood very little of it. What I remembered was the idea that a person should strive to become the best version of himself every day. Not …

Physicians

What physician mothers miss while caring for everyone else

Loryn Kromrey, MD

October 7, 2026Oct 7, 2026

It's been a great summer, but we're also looking forward to getting back into the school routine. This was my first summer off since my second year of medical school. For almost twenty years, my summers were spent in medical…

It’s been a great summer, but we’re also looking forward to getting back into the school routine. This was my first summer off since my second year of medical school.

For almost twenty years, my summers were spent in medical school, residency, fellowship, studying for and taking my boards, interviewing for jobs, or working. Medicine and motherhood were intertwined from the very beginning. My water broke while I was in the …

Education

Teaching clinical reasoning starts with saying it out loud

Lynn McComas, DNP, ANP-C

October 7, 2026Oct 7, 2026

One of the most useful teaching techniques I have used as a preceptor is also one of the simplest: I think out loud. Experienced clinicians make hundreds of small decisions throughout the day. We know which questions to ask, which…

Much of that thinking becomes so automatic that we may not realize our students cannot see it. They can watch us conduct …

Physicians

The history of managed care told through its language

Howard Smith, MD

October 7, 2026Oct 7, 2026

The 1960s marked the end of "the good old days" of America's health care system. In those days, there were no HMOs, PPOs, medical exchanges and the like; there were just doctors, hospitals, and health insurance. Health insurance protected against…

The 1960s marked the end of “the good old days” of America’s health care system. In those days, there were no HMOs, PPOs, medical exchanges and the like; there were just doctors, hospitals, and health insurance. Health insurance protected against unexpected medical conditions and reimbursed according to the UCR, the usual, customary, and reasonable. The 1960s were much simpler.

Indeed, there were medical malpractice lawsuits, but people had more realistic expectations …

Podcast

Hospitals are replacing bedside ICU doctors with a video screen [PODCAST]

The Podcast by KevinMD

October 6, 2026Oct 6, 2026

A young mother arrived in the intensive care unit sick but improving. Overnight, her care was handed to a telemedicine physician on a video screen. By morning she was beyond saving. Keith Corl is an emergency and critical care medicine…

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Conditions

Informed consent has become a signature, not a choice

M. Bennet Broner, PhD

October 6, 2026Oct 6, 2026

When I began studying medical ethics, forty-five years ago, patient autonomy and informed consent (IC) were major issues. While some academics and practitioners today argue that autonomy has been overly emphasized, in my decades of practice and as a patient,…

There is little oversight of medical IC by a federal or state agency, but to state that it is required and its general …

Conditions

Functional recovery after hospitalization starts early

Pradeepika Samagh, DPT, MBA

October 6, 2026Oct 6, 2026

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 …

Tech

Administrative bloat in hospitals is a design choice

Brian Hudes, MD

October 6, 2026Oct 6, 2026

The secretary who became fifteen executives' assistant A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel…

The secretary who became fifteen executives’ assistant

A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel went through an agency. Over the next twenty years, email replaced the mail, voice recognition replaced the typist, and a website replaced the travel agent. By the time he retired, one …

Physicians

Self-sacrifice in medicine needs self-trust to balance it

Christine Kempton, MD

October 6, 2026Oct 6, 2026

The lessons no one formally taught us Your pager goes off in the middle of the night. You slip out of bed, trying not to wake your spouse, and call the emergency department back from the guest room. You hope…

The lessons no one formally taught us

Your pager goes off in the middle of the night. You slip out of bed, trying not to wake your spouse, and call the emergency department back from the guest room. You hope it was a missed page so you can return to sleep, while knowing a misfired page will feel almost as frustrating as the interruption itself.

It is the end of clinic, and …

Physicians

How palliative care improves climate change communication

Christian Archer, MD & Daniel Mahoney, MD

October 6, 2026Oct 6, 2026

Imagine sending a page to the palliative care service that reads: "Patient is 4.5 billion years old with recent history of fever and nonhealing wounds, now in multisystem failure. Request consult for IDT support, symptom management, and goals-of-care conversation." While…

Imagine sending a page to the palliative care service that reads: “Patient is 4.5 billion years old with recent history of fever and nonhealing wounds, now in multisystem failure. Request consult for IDT support, symptom management, and goals-of-care conversation.” While tongue in cheek, there are clear parallels between communicating with patients about serious illness and communicating with patients about climate change. In both cases, our palliative care colleagues’ serious illness …

Conditions

5 OCD screening questions every clinician should ask

Ravi Singareddy, MD

October 6, 2026Oct 6, 2026

Obsessive-compulsive disorder (OCD) is one of the most delayed diagnoses in psychiatry, and much of that delay happens in offices like ours. Patients typically notice their first symptoms in adolescence or early adulthood but are not correctly diagnosed until roughly a decade later. One outpatient study found an average of about 12.8 years between symptom onset and diagnosis, and a meta-analysis of 31 studies put the pooled duration of untreated …

Real physician voices, twice a week

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