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What if one of the most common escalation strategies for acute heart failure doesn’t actually improve outcomes? Internal medicine physicians Benjamin P. Geisler, Jeffrey L. Greenwald, and Kathy May Tran, editors of 50 …
Bolus or drip? What the DOSE trial actually showed about heart failure [PODCAST]
A cash symptom can have several causes
A practice owner notices the same warning signs: collections are lower than expected, the bank balance feels tighter, and the billing report shows money still sitting unpaid. The first conclusion is usually simple. Billing is the problem.
Sometimes that is true. More often, the word “billing” is covering several different problems that require different fixes. A slow front desk, a coding issue, payer delays, denial …
Accounts receivable days hide four billing problems
For a moment, I wondered whether I had a crystal ball.
I had written several times on KevinMD about artificial intelligence in medicine. I had written for Forbes Business Council about AI as a developing cognitive tool, synthetic reality, executive distortion, and the danger of treating fluent output as reliable judgment. I kept returning to one warning. AI was one step away from a serious blunder, and that blunder …
AI therapy chatbots are crossing into impersonation
We have all seen the sign. Hanging on the wall of every restaurant, every hospital break room, every public restroom in America: Employees Must Wash Hands Before Returning to Work. And yes, washing your hands after using the bathroom is essential. The science is clear. The data backs it up. It saves lives. But after more than 30 years as a registered nurse, from the ICU and emergency room to …
The handwashing standard nobody finished. Until now.
The Subjective, Objective, Assessment, and Plan (SOAP) framework could be expanded beyond clinical care to also address patients’ financial and legal well-being. This would require training health care providers in basic financial and legal principles, establishing dedicated financial-legal departments within health care institutions, and potentially offering financial and legal services as add-ons to health care insurance. With these changes, routine health care encounters could become more comprehensive, addressing socioeconomic needs …
Expanding the SOAP framework boosts health outcomes
A generation ago, most physicians barely considered the possibility of suddenly losing a job.
The profession was not perfectly stable, of course. Doctors still burned out, practices failed, partnerships fractured, and hospitals behaved badly from time to time. But for many physicians there remained an underlying assumption that competence and hard work created a reasonably durable professional life. If you trained well, treated patients properly, maintained your reputation, and kept your …
How to navigate physician job loss in the first week
I am a former vascular surgeon, and I left the field in 2020 at the height of coronavirus disease 2019 (COVID-19) due to burnout. And though I had not been well for some years, I was able to find myself again and rediscover my passion for music. In the end, my health and my family became my priority, so currently I work in a more stable outpatient clinical setting.
I started …
Physician burnout is a heavy burden for many healers
Scenario: A resident develops a stage 4 pressure ulcer after admission to a long-term care facility. Plaintiff counsel argues the facility failed to prevent it. Defense counsel argues the ulcer was clinically unavoidable. Both positions hinge on the same federal regulation. The question is what the regulation actually says, and how the medical record measures up to it.
To work through this one, it is time for a history lesson. Travel …
Unavoidable pressure ulcer claims live and die by the record
My pager beeps as I walk through the hospital doors. It is a familiar message, “Your patient wants to leave.” We admitted John four days ago for opioid withdrawal and he is not yet ready to stop using opioids. When I walk in the room, I see him packing his bags. “So, John,” I say. “When you leave, your body cannot tolerate the same amount of opioids because you have …
Harm reduction effectively treats substance use disorder
As a second-year internal medicine resident, I had an unexpected epiphany during my geriatrics rotation, not amid the chaos of a bustling hospital, but within the reflective calm of a rehabilitation facility.
As I walked into the room of a long-term care patient recovering after a stroke, there was a man in front of me who was wheelchair-bound and visibly distressed. His speech was difficult to understand, but as I listened …
Dehumanization in medicine: the language of disposition
Early in my pediatrics rotation, I learned that I should get used to admitting children for asthma exacerbations. And so, during each intake, one question quickly became routine: “Do you use a spacer and mask with your inhaler at home?” More often than not, the answer was a no, often followed by, “What is that?”
That gap in knowledge has significant clinical consequences. Proper inhaler use entails a choreograph of multiple …
Pediatric asthma care demands better proper inhaler use
There comes a point in medicine when knowledge, effort, and goodwill are no longer enough to explain why someone keeps going.
Most people enter medical training with a purpose so obvious it barely needs words. Suffering exists. Skill can help. The work matters.
Then training tests that belief. The test rarely comes as one dramatic moment. It comes through accumulation: criticism without context, responsibility before confidence, long hours, grief carried quietly, and …
Physician burnout is not a failure of resilience
Every year, as Mother’s Day approaches, we see the same messages.
Celebrate your mom. Call her. Hug her. Don’t take her for granted.
And yet, for so many, that hug is no longer possible.
There is a quiet grief that lives inside this day.
Because as long as our parents are alive, a part of us remains a child, protected, grounded, held by something bigger than ourselves.
And when that is gone, something shifts forever.
Years …
How a clinical trial changed the way I see Mother’s Day
An excerpt from The Quest for Fertility.
Prologue: a quiet place of hope
Even in the stillness, life is quietly unfolding.
There’s a small butterfly garden tucked away in Wheaton Regional Park, a place I’ve long considered sacred. It isn’t grand or loud; it doesn’t demand attention. You step into a soft netted enclosure surrounded by blooms so vivid they almost seem unreal. Inside, monarchs and swallowtails drift lazily through the air, …
What no one tells you about fertility, from a doctor
When I graduated from medical school, I carried an assumption I suspect many of us do: Bipolar II disorder is a “milder” version of bipolar I. After all, mania is dramatic. It is disruptive. It can involve psychosis, hospitalization, legal consequences, and financial devastation. Hypomania, by comparison, seems restrained: more energy, less sleep, no involuntary admission. The hierarchy seemed obvious. Mania is more severe than hypomania. Therefore bipolar I must …
Why bipolar II is not just a milder version of bipolar I
I would like to share with readers a story about a clinical encounter that challenged my ability to build trust amid fear and misunderstanding. As a practicing physician and medical educator, I have long been drawn to the emotional and ethical dimensions of patient care. While the story itself is not unique, it captures a recurring tension in our work, the gap that can emerge between clinical expertise and patient …
Rebuilding patient trust when medical advice is resisted
I knew from the beginning that something was wrong in the culture of medicine, but I never believed it would almost kill me. This is not a story about my health. It’s a story about why my health story is not unusual. I hope it becomes a call to action.
I grew up in Berkeley, where speaking up is a developmental milestone. Early in my medical training, I started asking questions. …
Women physicians’ health is paying the price of medicine
Clinician burnout is frequently discussed as a workforce challenge, a morale issue, or a retention concern. It is all of those. It is also something more. Burnout can function as a governance signal. Health care systems operate under sustained complexity: regulatory demands, reimbursement pressures, digital transitions, workforce instability, and constant performance scrutiny. In such environments, strain is not incidental. It is structural.
The governance question is not whether strain exists. It …
Clinician burnout demands better health care governance
As a practicing physician who also specializes in caring for patients injured in motor vehicle accidents, I’ve seen firsthand how complex and emotionally charged these situations can be. Over the years, I’ve treated people with devastating, life-changing injuries from crashes, as well as those with subtler but still very real problems like persistent pain, spinal issues, or concussions that develop over time. At the same time, I’ve witnessed the intricate …
Uber’s personal injury lawsuits split doctors and lawyers
The story that I still can recall is about a patient sitting across from me and apologizing for telling me, “I know that this is not really a health concern for me.” It was neither pain nor a life-threatening illness that brought him to see me. It was just baldness. However, what he was feeling was absolutely real. He discussed the importance of not using mirrors. Not accepting invitations because …
Hair loss and the emotional toll: a doctor’s perspective
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