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Physician voices

Will AI replace doctors who no longer have time to care?

I work in San Francisco. Every morning I walk six blocks from the train to my office, and as I look down the street, I notice how many cars are wearing hats. The "hat" is the rooftop sensor dome, LiDAR…

I work in San Francisco. Every morning I walk six blocks from the train to my office, and as I look down the street, I notice how many cars are wearing hats. The “hat” is the rooftop sensor dome, LiDAR and cameras, on the Waymo self-driving cars that fill my city’s streets. If they have not come to your city yet, they are on their way. Waymo opened to the …

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Will AI replace doctors who no longer have time to care?

Medical education

Why smoking cessation takes more than clinician confidence

How confident are health care professionals in helping patients quit smoking? And how often does that confidence translate into practical assistance? Our recent research suggests these questions can produce very different answers. In October, we reported findings from a survey…

How confident are health care professionals in helping patients quit smoking? And how often does that confidence translate into practical assistance? Our recent research suggests these questions can produce very different answers.

In October, we reported findings from a survey of 1,538 Ukrainian health care professionals in Healthcare Business Today. The results revealed a striking contrast: Most respondents felt confident advising patients to quit smoking, despite limited formal training and …

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Why smoking cessation takes more than clinician confidence

Conditions and diseases

A nerve block checklist cannot replace the final pause

A nerve block may involve a small needle and a carefully chosen injection, but its final safety decision is larger than either. The patient may be correctly identified, the consent signed, the intended side marked, and the ultrasound machine ready.…

A nerve block may involve a small needle and a carefully chosen injection, but its final safety decision is larger than either. The patient may be correctly identified, the consent signed, the intended side marked, and the ultrasound machine ready. Yet one question remains until the procedure begins: Did the people about to perform the block actually stop and agree that this is the correct patient, side, and procedure?

In regional …

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A nerve block checklist cannot replace the final pause

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Medical education

The child psychiatrist shortage starts with what we say

"Why would you waste your medical training to go into psychiatry? Do you not want to be a real doctor?" I have heard about a hundred variations of this in my career. If you decide to become a psychiatrist, people…

“Why would you waste your medical training to go into psychiatry? Do you not want to be a real doctor?” I have heard about a hundred variations of this in my career. If you decide to become a psychiatrist, people will question your wisdom, and then if you decide to become a child psychiatrist, they will almost want to stage an intervention.

I want to be upfront here. I never did …

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The child psychiatrist shortage starts with what we say

The Podcast by KevinMD

Clinical trials answer drug questions. Health questions need other tools. [PODCAST]

No one ever ran a blinded trial on handwashing. It became standard practice around the world anyway. Narinder Singh Parhar, an internal medicine, hospital medicine, and critical care physician, calls evidence-based medicine one of the field's great achievements and credits…

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No one ever ran a blinded trial on handwashing. It became standard practice around the world anyway. Narinder Singh Parhar, an internal medicine, hospital medicine, and critical care physician, calls evidence-based medicine one of the field’s great achievements and credits it with saving millions of lives. This episode is based …

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Clinical trials answer drug questions. Health questions need other tools. [PODCAST]

Health technology

I build clinical decision support. It does not decide.

Last month I wrote here about how AI is changing what patients expect their clinicians to know. Medicine does not have an information problem. It has an interpretation problem. The chart is full. What is missing is someone with the…

Last month I wrote here about how AI is changing what patients expect their clinicians to know. Medicine does not have an information problem. It has an interpretation problem. The chart is full. What is missing is someone with the time and the tools to ask why.

In the weeks since, the conversation has moved, and it moved fast. Building clinical decision support has made me ask a related question. …

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I build clinical decision support. It does not decide.

Conditions and diseases

The infant gut microbiome shapes health for decades

When you're expecting your first child, your mind is naturally consumed by the big, tangible details: assembling the crib, choosing a car seat, and debating baby names. But beneath the surface of those exciting preparations, an invisible, high-stakes biological process…

When you’re expecting your first child, your mind is naturally consumed by the big, tangible details: assembling the crib, choosing a car seat, and debating baby names. But beneath the surface of those exciting preparations, an invisible, high-stakes biological process is taking place. From the moment of birth through a child’s second birthday, an entire microscopic ecosystem is taking root inside their body.

As physicians, our clinical training conditions us to …

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The infant gut microbiome shapes health for decades

Physician voices

Are Teams chats private? Not when a lawyer comes asking

Workplace messaging platforms such as Microsoft Teams have become a regular part of clinical work. Health care organizations rely on them to coordinate schedules, manage logistics, and keep teams connected across different locations and telehealth settings. Because these channels are…

Workplace messaging platforms such as Microsoft Teams have become a regular part of clinical work. Health care organizations rely on them to coordinate schedules, manage logistics, and keep teams connected across different locations and telehealth settings. Because these channels are closed to outsiders and separate from the electronic health record, clinicians may view them as informal, friendly, and private. However, it’s worth reconsidering that belief, as it is far from …

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Are Teams chats private? Not when a lawyer comes asking

Health policy

A stock market crash brings a second crisis: elder fraud

At a bank counter in central Taiwan, a man in his sixties tried to break a time deposit and withdraw 1 million New Taiwan dollars. He believed a stock-investment team would manage the money for him. Bank staff became concerned…

At a bank counter in central Taiwan, a man in his sixties tried to break a time deposit and withdraw 1 million New Taiwan dollars. He believed a stock-investment team would manage the money for him. Bank staff became concerned and called the police.

The disturbing detail was not the amount. Police had already intervened the previous week when the same man encountered a fraudulent investment scheme. The scammers contacted him …

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A stock market crash brings a second crisis: elder fraud

Physician voices

Will AI replace doctors? I’m not worried for 7 more years.

I'm sixty-four years old. I've practiced internal medicine for more than thirty-five years, and I figure I've got another seven good years left. And I'm not particularly worried about artificial intelligence replacing me. That doesn't mean I think AI is…

I’m sixty-four years old. I’ve practiced internal medicine for more than thirty-five years, and I figure I’ve got another seven good years left. And I’m not particularly worried about artificial intelligence replacing me.

That doesn’t mean I think AI is overhyped. Quite the opposite. I suspect it’s going to transform primary care faster than most physicians appreciate. Some of what we do today will look positively antiquated by the time I …

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Will AI replace doctors? I’m not worried for 7 more years.

Conditions and diseases

First dialysis treatment in the hospital: what to expect

If you're reading this from a hospital bed, you might still be asking yourself how you got here. A lot of my patients tell me they never thought it would come to this, that dialysis was something that happened to…

If you’re reading this from a hospital bed, you might still be asking yourself how you got here. A lot of my patients tell me they never thought it would come to this, that dialysis was something that happened to other people. If you feel that way, nothing is wrong with you. Denial is normal. It just means this is big, and your heart is still catching up to what …

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First dialysis treatment in the hospital: what to expect

Physician voices

Negative feedback changed me. Praise never did.

Positive feedback is all the rage these days. Parents (and grandparents) are hyper-focused on encouraging Junior. "Great job" may be the most common words out of this grandfather's mouth when on duty with the little ones. A crayon scrawl that…

Positive feedback is all the rage these days. Parents (and grandparents) are hyper-focused on encouraging Junior. “Great job” may be the most common words out of this grandfather’s mouth when on duty with the little ones. A crayon scrawl that only goes off the paper and onto the kitchen table a few inches merits a “well done!” Generous kudos are a big part of the work environment as well. All …

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Negative feedback changed me. Praise never did.

Conditions and diseases

Homocysteine and glutathione: the detox link we skip

Most conversations about a homocysteine genetic problem stop at the blood number, the methylation genes, or a vitamin plan. That misses the backside. Homocysteine sits at a biochemical fork. One branch remethylates it back toward methionine. The other, transsulfuration, feeds…

Most conversations about a homocysteine genetic problem stop at the blood number, the methylation genes, or a vitamin plan. That misses the backside. Homocysteine sits at a biochemical fork. One branch remethylates it back toward methionine. The other, transsulfuration, feeds cysteine into the making of glutathione, the body’s main intracellular antioxidant and a central Phase II detox carrier.

In my practice, I believe transsulfuration supplies well over half, and often most, …

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Homocysteine and glutathione: the detox link we skip

Conditions and diseases

Sedation after intubation cannot be an afterthought

An emergency intubation can create a moment of relief. The breathing tube is in place, its position is confirmed, and the ventilator is supporting a patient who may have been deteriorating only minutes earlier. But the procedure has not answered…

An emergency intubation can create a moment of relief. The breathing tube is in place, its position is confirmed, and the ventilator is supporting a patient who may have been deteriorating only minutes earlier. But the procedure has not answered another urgent question: What happens when the drug that made the patient unconscious wears off, especially if the drug preventing movement is still working?

In anesthesiology, paralysis, sedation, and pain relief …

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Sedation after intubation cannot be an afterthought

Patient voices

A poem about being alone in the hospital at night

2

I lie upon these stiff white sheets, In a room meant only for the unfeeling. White walls. White linens. White lights That have been dimmed But never truly disappear. Wires cling to places on my body, Small adhesive circles holding…

I lie upon these stiff white sheets,
In a room meant only for the unfeeling.

White walls. White linens. White lights
That have been dimmed
But never truly disappear.

Wires cling to places on my body,
Small adhesive circles holding me captive
To a machine that knows the rhythm of my heart
Better than I do tonight.

Telemetry has free rein over my innermost secrets:
Every beat, every pause, every rebellion
My heart decides to wage.

I am vulnerable here.

Not the kind …

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A poem about being alone in the hospital at night

The Podcast by KevinMD

Is your clinical AI tool safe? 4 questions to ask first [PODCAST]

Doctors are adopting tools that answer clinical questions, and some give inconsistent answers or invented patient data. Neil Panchal, an emergency physician and cofounder and chief medical officer of Longevitix, a clinical AI decision support company, wrote a quick screen…

Listen on Apple Podcasts · Spotify

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Doctors are adopting tools that answer clinical questions, and some give inconsistent answers or invented patient data. Neil Panchal, an emergency physician and cofounder and chief medical officer of Longevitix, a clinical AI decision support company, wrote a quick screen for colleagues asking which tools to trust. This episode is …

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Is your clinical AI tool safe? 4 questions to ask first [PODCAST]

Medical education

Who will teach in new orthodontic residency programs?

It is past 10 p.m., and the program director is still at their desk. The accreditation visit is months away, and the records they need sit in a system only one administrator can open. Down the hall, a resident drafts…

It is past 10 p.m., and the program director is still at their desk. The accreditation visit is months away, and the records they need sit in a system only one administrator can open. Down the hall, a resident drafts an email about a supervision problem, then deletes it, because the only person who could act on it is the person it concerns. An international resident has already decided to …

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Who will teach in new orthodontic residency programs?

Drugs and prescribing

How contract research organizations took over drug testing

It's no secret that drug research and development is commercialized. "Technology transfer" and for-profit partnerships have turned some medical centers, universities, and National Institutes of Health research itself into for-profit pipelines for the drug industry. In 2007, Northwestern University, for…

It’s no secret that drug research and development is commercialized. “Technology transfer” and for-profit partnerships have turned some medical centers, universities, and National Institutes of Health research itself into for-profit pipelines for the drug industry.

In 2007, Northwestern University, for example, made $700 million by selling part of its worldwide royalty interest in the anti-seizure medicine Lyrica, which its chemists developed. Pfizer, which sold the drug, paid massive commercial …

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How contract research organizations took over drug testing

Conditions and diseases

What the 2026 MI definition means for myocardial injury

An elevated cardiac troponin level often changes the trajectory of a clinical encounter. A patient presents with pneumonia, severe anemia, tachycardia, hypoxemia, or another acute illness, and the troponin comes back above the laboratory's upper reference limit. The immediate question…

An elevated cardiac troponin level often changes the trajectory of a clinical encounter. A patient presents with pneumonia, severe anemia, tachycardia, hypoxemia, or another acute illness, and the troponin comes back above the laboratory’s upper reference limit. The immediate question is often: “Is this a myocardial infarction?” The answer is not necessarily.

The Fifth Universal Definition of Myocardial Infarction (UDMI), released in 2026 by the European Society of Cardiology, American …

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What the 2026 MI definition means for myocardial injury

Physician voices

Leaving a role is not leaving medicine

I spent eight years as a urologist in rural Washington, two of them as chief of staff at our hospital. I loved my patients. I also saw, up close, what happens when a community can't get specialty care close to…

I spent eight years as a urologist in rural Washington, two of them as chief of staff at our hospital. I loved my patients. I also saw, up close, what happens when a community can’t get specialty care close to home. I watched a woman die of bladder cancer after years of being treated for “recurrent UTIs.” The medicine was never the hard part. Access was.

Later, in a leadership role …

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Leaving a role is not leaving medicine

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