KevinMD.com

First dialysis treatment in the hospital: what to expect

Henry Mercines, RN

November 6, 2026Nov 6, 2026

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 …

Negative feedback changed me. Praise never did.

Bill Kinnard, MD

November 6, 2026Nov 6, 2026

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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Homocysteine and glutathione: the detox link we skip

Dan Purser, MD

November 6, 2026Nov 6, 2026

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, …

Sedation after intubation cannot be an afterthought

Dr. Girishkumar Modi

November 6, 2026Nov 6, 2026

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 …

Patient voices

A poem about being alone in the hospital at night

Michele Luckenbaugh

November 6, 2026Nov 6, 20262

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 …

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

November 5, 2026Nov 5, 2026

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…

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Medical education

Who will teach in new orthodontic residency programs?

Arati Sharma & Dr. Soumya Padala & Nikki Sangha, DMD & Shweta Padala Nallam

November 5, 2026Nov 5, 2026

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 …

Drugs and prescribing

How contract research organizations took over drug testing

Martha Rosenberg

November 5, 2026Nov 5, 2026

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 …

What the 2026 MI definition means for myocardial injury

Dr. Tarik Alsalih

November 5, 2026Nov 5, 2026

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 …

Leaving a role is not leaving medicine

Leaving a role is not leaving medicine

Joe Pazona, MD

November 5, 2026Nov 5, 2026

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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Health technology

Why the numbers your executives and board read are wrong

Thomas Powell, MD

November 5, 2026Nov 5, 2026

When a potassium of 8.8 comes back on a patient who looks well and the one before was 4.1, no experienced physician treats that number first. The first question is whether the value is correct, and the second is how the specimen was drawn and transported. A tourniquet left on too long, a small-bore needle, a slow draw, and red cells shear and spill potassium into the tube. The result …

When a failed newborn heart screen reveals something rare

Srinivasarao Badugu, MD

November 5, 2026Nov 5, 2026

A newborn failed her routine screening for critical congenital heart disease. What followed was a journey through one of the rarest forms of congenital heart disease, and a reminder of how a simple screening test, followed by the right clinical response, can change the course of a child’s life. The infant had been born near term by urgent cesarean delivery after concerns developed about the fetal heart rate tracing. After …

Medical education

Why teaching clinical judgment can’t be left to chance

Dr. Mathias Goyen

November 5, 2026Nov 5, 20262

Medical schools are extraordinarily good at teaching future physicians what they need to know. The harder question is whether they prepare them for the moment when knowledge no longer provides a single answer. Medical education has transformed an enormous and…

Medical education has transformed an enormous and constantly expanding body of scientific knowledge into something that can be taught, examined, and applied to patients. Students learn anatomy and physiology, pathology and pharmacology, diagnosis and treatment. They learn to …

Health technology

Who pays physicians to catch AI medical errors?

Brian Hudes, MD

November 5, 2026Nov 5, 2026

Medical AI is deployed on the assumption that a physician will catch its mistakes. One new study asks what happens when the advice is wrong on purpose. In a 2026 medRxiv preprint that has not been peer-reviewed, the authors gave…

Medical AI is deployed on the assumption that a physician will catch its mistakes. One new study asks what happens when the advice is wrong on purpose.

In a 2026 medRxiv preprint that has not been peer-reviewed, the authors gave 225 physicians written neurocritical-care cases with AI advice attached. When the advice was deliberately steered toward a harmful choice, physicians made a harmful decision in 49.4 percent of the targeted decisions. …

Jennifer S. Mensik Kennedy, PhD, MBA, RN

I went to space and still teach physician expert witnesses

Gretchen E. Green, MD

November 5, 2026Nov 5, 20262

When I traveled to space aboard Blue Origin's New Shepard in May 2025, I fulfilled a dream that had begun nearly forty years earlier at Space Camp. I became the first woman physician commercial astronaut, an achievement that still feels…

When I traveled to space aboard Blue Origin’s New Shepard in May 2025, I fulfilled a dream that had begun nearly forty years earlier at Space Camp. I became the first woman physician commercial astronaut, an achievement that still feels extraordinary to me.

You might think that after reaching my highest goal, I would leave my previous professional life behind. After all, I retired from clinical medicine in 2024 and have …

Health technology

Shadow AI: why clinicians paste patient data into chatbots

Harvey Castro, MD, MBA

November 5, 2026Nov 5, 2026

It's 3 a.m. There's a septic patient in room 6 and someone intoxicated yelling in the hallway. A 78-year-old on eleven medications is going home, and her daughter needs discharge instructions she can actually follow. The hospital's approved AI tool…

It’s 3 a.m. There’s a septic patient in room 6 and someone intoxicated yelling in the hallway. A 78-year-old on eleven medications is going home, and her daughter needs discharge instructions she can actually follow. The hospital’s approved AI tool sits behind two logins and only runs on a desktop. The chatbot on your phone opens with one tap.

Most clinicians I know have felt that pull. Some have given in.

Late …

Health policy

Congress must act on workplace violence against nurses

November 5, 2026Nov 5, 2026

In HBO's The Pitt, nurses are punched, grabbed, and choked while trying to care for patients. The scenes are fictional and dramatic, but they are not exaggerated. The physical danger nurses step into every single shift is painfully real. Across…

In HBO’s The Pitt, nurses are punched, grabbed, and choked while trying to care for patients. The scenes are fictional and dramatic, but they are not exaggerated. The physical danger nurses step into every single shift is painfully real. Across the country, nurses experience workplace violence with alarming regularity, facing physical assault, verbal abuse, threats, and intimidation from patients, family members, and visitors. Too often, this hostility is casually dismissed …

Hidden fees in employer health plans are about to come out [PODCAST]

November 4, 2026Nov 4, 2026

Many companies pay for their workers' health care directly, and the fees buried in those plans have been hard to see. Paul Pender, an ophthalmologist, explains why new transparency and fiduciary rules taking hold in January 2027 will force these…

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Many companies pay for their workers’ health care directly, and the fees buried in those plans have been hard to see. Paul Pender, an ophthalmologist, explains why new transparency and fiduciary rules taking hold in January 2027 will force these self-insured employers to ask for that data. This episode is …