KevinMD.com

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 …

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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 …

Tech

Human connection in medicine is the art AI cannot replace

Crystal Romero, MD

October 6, 2026Oct 6, 2026

I never thought I would have to reckon with my own mortality in my twenties. But there I was, cut off from the world in an ICU quarantine room, a monitor ringing in my ear, tuberculosis and multi-organ failure closing in. Words swirled around me as I fought to stay awake, and all I could think was: This isn’t fair. If only they [the doctors] had checked my liver when …

Physicians

Physician leadership roles have a cost no résumé shows

Ronald L. Lindsay, MD

October 6, 2026Oct 6, 2026

The other day, LinkedIn informed me that I was a strong match for a developmental-behavioral pediatrics section chief position at an academic medical center in the Midwest. The irony was hard to miss. Years ago, I held essentially the same…

The other day, LinkedIn informed me that I was a strong match for a developmental-behavioral pediatrics section chief position at an academic medical center in the Midwest.

The irony was hard to miss. Years ago, I held essentially the same leadership position. It nearly killed me.

The recommendation arrived complete with all the reassuring language modern recruiting systems like to use. My qualifications matched the position well. My experience aligned with the …

Physicians

Goals of care should be decided long before the ICU

Humeira Badsha, MD

October 6, 2026Oct 6, 2026

In the midst of a busy Monday clinic, I field calls from the nursing facility in India where my aunt is slowly dying. The young doctors there are traumatized by our family's refusal to have her admitted to a hospital.…

In the midst of a busy Monday clinic, I field calls from the nursing facility in India where my aunt is slowly dying. The young doctors there are traumatized by our family’s refusal to have her admitted to a hospital. I have become their counselor and guide.

My aunt was a mother to many nieces and nephews, despite having no children of her own. Over the years, I watched her keep …

Podcast

Doctors hide their PTSD out of fear for their license [PODCAST]

The Podcast by KevinMD

October 5, 2026Oct 5, 2026

A trauma surgeon spent two decades on call for the worst nights of other people's lives. Then he ran his hospital's pandemic response. Then he could not function. Jeremy Heffner is a trauma surgeon, speaker, and author. This episode is…

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A trauma surgeon spent two decades on call for the worst nights of other people’s lives. Then he ran his hospital’s pandemic response. Then he could not function. Jeremy Heffner is a trauma surgeon, speaker, and author. This episode is based on his article “Why frontline health care …

Conditions

Is your postpartum pelvic floor really a 30-year problem?

Amy Bourne Rozelle, DPT

October 5, 2026Oct 5, 2026

1. The six-week myth vs. the thirty-year reality We all know the current standard of maternal health care operates on a dangerous illusion: the big ole' six-week checkup. We tell moms that once they pass this test, congrats! Recovery is…

1. The six-week myth vs. the thirty-year reality

We all know the current standard of maternal health care operates on a dangerous illusion: the big ole’ six-week checkup. We tell moms that once they pass this test, congrats! Recovery is complete and they are cleared to return to normal life and exercise.

It would be convenient if bodies healed by the calendar, wouldn’t it? What really happens during pregnancy, birth, and lactation …

Policy

Nursing home ratings hide what the federal record shows

Shawn Redd

October 5, 2026Oct 5, 2026

When a patient asks where to go for a knee replacement, a colonoscopy, or their mother's rehab stay, they have usually already looked. Not at the federal record. At the stars. Here is what the stars do not show. Our…

When a patient asks where to go for a knee replacement, a colonoscopy, or their mother’s rehab stay, they have usually already looked. Not at the federal record. At the stars.

Here is what the stars do not show. Our analysis of Centers for Medicare & Medicaid Services records found that 46 percent of U.S. nursing homes carry at least one federal civil money penalty on the current enforcement record, and …

Physicians

Who monitors patients after telehealth ADHD prescribing?

Timothy Lesaca, MD

October 5, 2026Oct 5, 2026

Last month, I took on five new patients who were already prescribed stimulants. I had not met any of them in person before. Each came to me with a diagnosis, an active Schedule II prescription, and a chart note from a telehealth visit that I cannot fully piece together. My role now seems to be continuing these prescriptions. I am concerned about the handoff, and I doubt anyone decided who …

Conditions

Refusing to treat a patient is not the same as a boundary

Natalia Eden, RN

October 5, 2026Oct 5, 2026

A recent study found that, compared with people from other cultures, Americans are less likely to report feeling a sense of obligation to be present for their friends. If that reflects a broader cultural shift, it raises an uncomfortable question: Is this same emphasis on personal autonomy and individual comfort seeping into health care? Are health care professionals increasingly opting out of their obligation to care for patients when the …

Policy

Access to interventional psychiatry should not end downtown

Ravi Singareddy, MD

October 5, 2026Oct 5, 2026

A standard course of repetitive transcranial magnetic stimulation (TMS) for depression means coming to the clinic five days a week for four to six weeks, roughly 20 to 36 sessions. That is because response depends mainly on the number of…

Esketamine (Spravato) carries a different but equally demanding logistical load. Under its FDA safety program, known as a Risk Evaluation and Mitigation Strategy (REMS), each …

Education

Chronic curiosity is a diagnosis worth keeping for life

Jack Tiller

October 5, 2026Oct 5, 2026

ChatGPT once diagnosed me with chronic curiosity. I've been thinking about that diagnosis ever since, so I wanted to sit with it a little longer. Typically, the word "chronic" comes with a bad connotation. All it really means is that…

ChatGPT once diagnosed me with chronic curiosity. I’ve been thinking about that diagnosis ever since, so I wanted to sit with it a little longer.

Typically, the word “chronic” comes with a bad connotation. All it really means is that something is going to be with you forever but won’t shorten your life. If anything, chronic curiosity might extend mine; it means my brain is always working harder than baseline. …

Meds

Hunger after stopping tirzepatide can feel like burning

Patience C. Ennis

October 5, 2026Oct 5, 2026

When my hunger returned, it felt as though my stomach was burning from the inside out. It was acute, painful, and very physical. I pushed everything else aside and concentrated on getting rid of it. There was no negotiating with…

When my hunger returned, it felt as though my stomach was burning from the inside out.

It was acute, painful, and very physical. I pushed everything else aside and concentrated on getting rid of it. There was no negotiating with hunger that intense. My attention narrowed to what I could eat to make it stop.

I am a registered nurse with more than thirty years of clinical experience. I have had bariatric …

Tech

How to test ambient AI scribes before you sign a contract

Pat Williams

October 5, 2026Oct 5, 2026

For over a decade, the administrative burden in specialty medicine has quietly worsened. Orthopedic surgeons doing forty patients a day are spending more time in the EHR than in the room. Ambient AI scribes have changed that equation in ways that are only beginning to show up in the data. But the real opportunity isn’t efficiency for its own sake. It’s building toward a future where technology absorbs the mundane …

Podcast

ICU telemedicine done right is a program, not a doctor on a screen [PODCAST]

The Podcast by KevinMD

October 4, 2026Oct 4, 2026

A patient in intensive care gets worse at 2 a.m., and the hospital has no critical care doctor in the building. Chris Gallagher, a cardiologist and founder of Access TeleCare, has spent 15 years building virtual care programs inside hospitals,…

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Policy

Voting and health outcomes: the cycle doctors ignore

Jacob Player, MD, MPH

October 4, 2026Oct 4, 2026

Poor health can negatively impact any and all aspects of our lives, often discouraging us from participating fully in activities we otherwise would. It shouldn't be surprising, then, that those with worse health are also less likely to vote, or…

Poor health can negatively impact any and all aspects of our lives, often discouraging us from participating fully in activities we otherwise would. It shouldn’t be surprising, then, that those with worse health are also less likely to vote, or that voter participation is inversely associated with time spent in inpatient care. And while we may accept this at face value, the downstream consequences of this are often …

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