KevinMD.com

Applied behavior analysis criticism: the closed feedback loop

Conditions

March 3, 2026

In engineering, a feedback loop is meant to stabilize a system. In medicine, feedback guides us toward better outcomes. But in applied behavior analysis (ABA), feedback has become a trap, recycling failure under the guise of science, and leaving children and families caught in its circuitry.

The closed circuit

Stevens’ feedback loop diagrams are elegant in their simplicity: arrows circling back, showing how inputs and outputs can stabilize a system. In healthy …

The future of employer-aligned DPC and physician autonomy

Dana Y. Lujan, MBA

Policy

March 3, 2026

A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional complexity, answerable to no one but their patients.

It is a satisfying idea. It is also an empirically untested one.

The history of DPC is built on physicians willing to challenge entrenched …

Navigating the international dentist U.S. pathway

Charan Teja Bobba, DDS

Conditions

March 3, 2026

The moment I decided to become an American-trained dentist, I was holding a textbook in India. I was a first-year dental student in India when it happened. I had just bought my textbooks for the semester, the thick, heavy kind that feel important in your hands, and I started flipping through them.

Page after page, I kept noticing something. The authors. Their names. Their affiliations. Almost all of them were from …

Coping with survivor guilt: wisdom from Saadi Shirazi and Viktor Frankl

Farid Sabet-Sharghi, MD

Physician

March 3, 2026

When someone you love is in a different location and suffering while you are safe, a heavy silence begins to fill the room. This survivor guilt is one of the most difficult burdens to carry because it turns even the smallest joys, a hot cup of tea, a peaceful morning, or a moment of laughter, into something that feels like a betrayal. The heart constantly asks: Why them and not …

Medical ethics and AI: Why losing oversight endangers patients

Bhavya Ancha, MD

Physician

March 3, 2026

At the end of December 2025, the American Medical Association (AMA) Journal of Ethics ceased its operations, now just a relic of the past. Its inception began in September 1999 with a journal theme entitled “Virtual Mentor Launches with a Nod to William Osler.” It references ethical decision-making, praise for Sir William Osler’s Aequanimitas, and the experience of the spoken word from a doctor to a patient’s ears. Its …

End-of-life care and religion: Reconciling Jewish law and medicine

Jonah Rocheeld

Education

March 3, 2026

When my small-group facilitator asked whether withdrawing life support is morally different from withholding it, my classmates offered the usual responses: autonomy, prognosis, and suffering. My mind was somewhere else entirely. It was the first time I had understood something that I had never questioned.

In medicine, categories exist to serve people; in Jewish law (Halakha), people often exist to serve categories. For years I never saw the cost until we …

“Disruptive” behavior is often a cry for help from depleted doctors [PODCAST]

The Podcast by KevinMD

Podcast

March 2, 2026

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Pediatrician and certified coach Jessie Mahoney discusses her article “Disruptive physician labeling: a symptom of systemic burnout.” Jessie argues that the rising number of “disruptive” labels slapped on highly skilled doctors is …

Psychological safety in health care: Why speaking up saves lives

Jalene Jacob, MD, MBA

Physician

March 2, 2026

During a busy morning, a junior nurse notices a discrepancy between a patient’s medication order and the usual dosing protocol. The unit is short-staffed, rounds are running behind, and the attending physician appears visibly rushed. The nurse hesitates, worried about slowing the team down or appearing inexperienced.

The unit manager who is present during rounds, notices the nurse’s hesitation and pauses the discussion. Rather than pushing forward, the manager says, “Before …

Evaluating the U.S. Surgeon General nominee: Why clinical experience matters

Ben Gonzalez, MD

Physician

March 2, 2026

The single scariest moment in my medical career was not as a student, or a resident with the first dying trauma patient in front of me. Nor was it in Iraq on November 2, 2003, when two Chinooks were shot down and my ER was overwhelmed with trauma after trauma. It was the very first day as an attending in the ER. Up until then, in every single case in …

Lessons from 47 years: long-term marriage and palliative care

Richard A. Lawhern, PhD

Conditions

March 2, 2026

My wife is dying.

The day has yet to be determined, but the causes are certain. Stage 4 metastatic pancreatic and liver cancers will allow her a few weeks more in which to say goodbye to a large circle of family and friends. She has decided not to undergo chemotherapy or radiation that at best might extend her life by a few weeks, at the cost of the quality of whatever …

Health care credentialing is broken: How to fix the staffing crisis

Marc Ayoub, MD

Physician

March 2, 2026

Imagine a world-class anesthesiologist at a major hospital in Manhattan. She is fully credentialed, board-certified, and has been saving lives at that facility for 5 years. On her day off, she wants to pick up an extra shift at a surgery center 3 blocks away that is currently short-staffed and desperate for help. Logic says she should be able to walk in, show her “Ready-to-Work” status, and start. Instead, she …

Why I stopped accepting pharmaceutical-sponsored lunches

Timothy Lesaca, MD

Physician

March 2, 2026

A pharmaceutical representative recently brought lunch to my office to present a new drug. The drug may help some patients. The food was abundant. The room was full, with excess all around, including leftovers that were eventually thrown away. None of that is unusual in American medicine.

What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the …

Why buprenorphine prescribing still lags after the X-waiver repeal

S. Hillary Kim-Vences, MD, MPH

Conditions

March 2, 2026

The repeal of the “X-waiver” in the Consolidated Appropriations Act of 2023 was widely celebrated as a long-overdue step toward expanding access to buprenorphine for opioid use disorder (OUD). By removing the requirement for supplemental training and a special DEA designation, policymakers hoped to normalize treatment and reduce barriers for clinicians.

Yet nearly two years after, buprenorphine prescribing remains inconsistent across the country. Only one in four Americans …

Philosophy in medicine: Why doctors need to ask “why”

Lauryl Cardoza

Conditions

March 2, 2026

“Why are you studying that? Philosophy won’t help you save lives.” If I had a dime for every time someone said this to me, I could single-handedly fund an entire class’s medical school tuition. Being a pre-medical student who majored in philosophy feels like being the only person asking “why” in a room full of people asking “how.” I have thought to myself many times that there is no balance …

Unpaid on-call shifts are driving doctors into early retirement [PODCAST]

The Podcast by KevinMD

Podcast

March 1, 2026

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Internal medicine physician Corinne Sundar Rao discusses her article “Physician on-call compensation: the unpaid labor driving burnout.” Corinne argues that the term “call” is a euphemism used to extract free labor from …

What chess taught me about clinical reasoning and humanism

Jay Pendyala and Jonathan Berg

Education

March 1, 2026

I first learned to respect silence over a chessboard. Two players sit across from one another, the clock ticking audibly, 64 squares holding more possibility than certainty. You arrive, survey the position, and wait. You gather information, recall principles, recognize patterns, and only then commit, knowing that every decision constrains the future in ways you cannot fully predict.

Now, as a third-year medical student on clinical rotations, I find myself standing …

Physician free speech rights under fire: the DOJ vs. patient education

Crystal Beal, MD

Physician

March 1, 2026

I never imagined that providing standard, evidence-based medical care, and explaining that care clearly to patients, could put me at risk of federal prosecution.

Yet that is the position I find myself in today.

I am a board-certified family medicine physician and the founder of a small queer- and trans-owned clinic providing gender affirming care. Our clinic is now at the center of a Department of Justice appeal after we Read more…

Physician free speech rights under fire: the DOJ vs. patient education

Treating methamphetamine-associated dental disease in safety-net clinics

Charan Teja Bobba, DDS

Conditions

March 1, 2026

He came in wanting to get his smile back. I did not know he was also asking for his life.

He sat down in my chair and did not say much at first.

That happens a lot in a MassHealth practice in Massachusetts. People come in with more than just one problem. They carry shame, years of avoiding problems, and a lifetime of being told by systems, situations, and sometimes even their …

Reproductive care for rare diseases: the missing playbook

Lyndsay Hoy, MD

Conditions

March 1, 2026

In my first week of anesthesiology residency at the Hospital of the University of Pennsylvania, I learned two things at once: how to keep other people breathing and how it feels to lose your own air. My chest filled with liters of lymphatic fluid. A scan showed lungs that looked like lace. The diagnosis was LAM, lymphangioleiomyomatosis, a rare, estrogen-sensitive lung disease that overwhelmingly strikes women in their reproductive years.

At …