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The Podcast by KevinMD

Self-care isn’t self-indulgence, and burnout isn’t only a personal problem [PODCAST]

Doctors and nurses are trained to take excellent care of other people's health, and often don't look after their own. Close to half the health care workforce has burnout, and it shows in rounded shoulders, lower back problems, and little…

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Doctors and nurses are trained to take excellent care of other people’s health, and often don’t look after their own. Close to half the health care workforce has burnout, and it shows in rounded shoulders, lower back problems, and little time to process a patient’s death. Internal medicine and critical care physician …

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Self-care isn’t self-indulgence, and burnout isn’t only a personal problem [PODCAST]

Physician voices

Spinal cord stimulation audits punish care that worked

A growing strategy among insurance companies, which is increasingly mirrored in Medicare recovery efforts, is the systematic auditing of old charts, often years after care was delivered and paid, in search of technical documentation gaps that can justify clawbacks. Artificial…

A growing strategy among insurance companies, which is increasingly mirrored in Medicare recovery efforts, is the systematic auditing of old charts, often years after care was delivered and paid, in search of technical documentation gaps that can justify clawbacks. Artificial intelligence has supercharged this approach, allowing rapid mining of historical records against today’s evolving standards rather than the clinical and documentation norms that existed at the time the care was …

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Spinal cord stimulation audits punish care that worked

Health technology

AI in health care saves time. Why does work keep growing?

A physician finishes documentation 30 minutes earlier because an artificial intelligence tool is working exactly as promised. Six months later, those 30 minutes are gone. Not because the technology failed. Not because the physician stopped using it. The organization simply…

A physician finishes documentation 30 minutes earlier because an artificial intelligence tool is working exactly as promised. Six months later, those 30 minutes are gone.

Not because the technology failed. Not because the physician stopped using it. The organization simply found another use for the time. Another appointment. Another responsibility. Another expectation.

Eventually, yesterday’s efficiency becomes today’s ordinary workload. And when the next technology promises to save another 30 minutes, who asks …

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AI in health care saves time. Why does work keep growing?

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Physician voices

Doctor-patient communication ends with the wrong question

The plan is made. The chart is closed. The doctor's voice has already changed. "Anything else?" Most physicians have asked that question thousands of times. I have asked it more times than I can count, and often at precisely the…

The plan is made. The chart is closed. The doctor’s voice has already changed. “Anything else?”

Most physicians have asked that question thousands of times. I have asked it more times than I can count, and often at precisely the moment I was ready for the visit to end.

Nearly every clinician says it, and most say it the same way. “Anything else?” sounds like an invitation. It functions as a closing. …

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Doctor-patient communication ends with the wrong question

Health technology

Read clinical AI the way you read an incomplete chart

Every shift, I read charts that are missing something. The patient can't tell me when the pain started. The outside records haven't come through. The family remembers a different medication list than the pharmacy does. I am not going to…

Every shift, I read charts that are missing something.

The patient can’t tell me when the pain started. The outside records haven’t come through. The family remembers a different medication list than the pharmacy does. I am not going to get a complete account, and waiting for one is how people die in hallways. So I do what emergency physicians do: I work from what is actually in front of me, …

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Read clinical AI the way you read an incomplete chart

Conditions and diseases

What pharmacogenetic testing can and can’t do in depression

More of my patients now arrive with a pharmacogenetic report, an ad promising to "end trial and error," or an MTHFR result from an online forum. Others ask for a blood test or brain scan to "prove" their depression. These…

More of my patients now arrive with a pharmacogenetic report, an ad promising to “end trial and error,” or an MTHFR result from an online forum. Others ask for a blood test or brain scan to “prove” their depression. These requests are reasonable. Patients want objective answers to a frustrating process. But the marketing has run ahead of the evidence, and the conversation increasingly falls to us. Here is how …

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What pharmacogenetic testing can and can’t do in depression

Health technology

I expected skepticism at Grand Rounds. I got a conversation.

This past Friday, October 23, I stood in front of a variety of clinicians sponsored by Harvard Medical School for Grand Rounds. I am not a clinician. I'm a mother whose daughter lives with schizophrenia, and I've spent years mapping…

This past Friday, October 23, I stood in front of a variety of clinicians sponsored by Harvard Medical School for Grand Rounds. I am not a clinician. I’m a mother whose daughter lives with schizophrenia, and I’ve spent years mapping the space between the appointment and my kitchen table at 2 a.m.

I expected polite skepticism. What surprised me most was how open the room was to the entire conversation. Here …

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I expected skepticism at Grand Rounds. I got a conversation.

Physician voices

Concierge medicine gave this family doctor his time back

Seventeen years ago, I opened a family medicine practice with a simple goal: take care of my community. I am board-certified in family medicine and obesity medicine, and I loved the work. What I did not love was what the…

Seventeen years ago, I opened a family medicine practice with a simple goal: take care of my community. I am board-certified in family medicine and obesity medicine, and I loved the work. What I did not love was what the work slowly became.

Like many of you, I spent my days racing a clock I didn’t set. Short visits. Prior authorizations stacked on my desk. Evenings spent finishing notes while my …

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Concierge medicine gave this family doctor his time back

Health technology

AI medical devices and the check nobody pays for

Medical AI is deployed on the assumption that a clinician will review its work. I found no payer that prices the review. The Food and Drug Administration (FDA) has now cleared 1,614 AI-enabled medical devices. By analyst Chi-way Li's count,…

Medical AI is deployed on the assumption that a clinician will review its work. I found no payer that prices the review.

The Food and Drug Administration (FDA) has now cleared 1,614 AI-enabled medical devices. By analyst Chi-way Li’s count, at least 79 have payment of their own; most of the rest are bought from hospital budgets or ride inside tests insurers already cover. Yet whenever an AI read, note, or …

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AI medical devices and the check nobody pays for

Physician voices

Impostor syndrome in physicians is about worth, not skill

A fellow sits across from my desk, talking about becoming faculty in a few months. She's nervous about her first attending rotation on the consult service and wonders whether she should do an extra rotation before her fellowship ends, just…

A fellow sits across from my desk, talking about becoming faculty in a few months. She’s nervous about her first attending rotation on the consult service and wonders whether she should do an extra rotation before her fellowship ends, just to be sure she is ready. She doesn’t want to disappoint anyone.

Down the hall, a junior faculty member works hard to prove her value. She sees the patients, writes the …

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Impostor syndrome in physicians is about worth, not skill

Conditions and diseases

Immune evasion is the real evolutionary triumph

Conventional evolutionary narrative has accustomed us to a story of triumph: an expanding neocortex that, emerging from the savannas of East Africa, allowed Homo sapiens to position themselves at the pinnacle of the biological world. We view ourselves as the…

Conventional evolutionary narrative has accustomed us to a story of triumph: an expanding neocortex that, emerging from the savannas of East Africa, allowed Homo sapiens to position themselves at the pinnacle of the biological world. We view ourselves as the apex of nature due to our ability to manipulate the environment, decipher the cosmos, and articulate abstract thought. However, when contemporary molecular biology and genomics examine the fissures in our …

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Immune evasion is the real evolutionary triumph

Physician voices

When caring for Medicaid patients hurts the bottom line

When I arrived in Phoenix, families seeking developmental evaluations often faced a bewildering process. A child with suspected autism might spend 90 minutes with a pediatric nurse practitioner. Parents completed multiple questionnaires. Detailed histories stretched for ten to twenty pages.…

When I arrived in Phoenix, families seeking developmental evaluations often faced a bewildering process. A child with suspected autism might spend 90 minutes with a pediatric nurse practitioner. Parents completed multiple questionnaires. Detailed histories stretched for ten to twenty pages. Then came the waiting. Weeks. Sometimes months.

Only after navigating this maze would the child finally see a developmental-behavioral pediatrician. Parents hated it. I didn’t blame them.

The system was not designed …

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When caring for Medicaid patients hurts the bottom line

Conditions and diseases

9 Enneagram types every practice leader should know

I have enjoyed being the center of attention and always pretending that I am on stage. This works out just perfectly as my wife likes being behind the scenes and allows me to take center stage. Thus, I would describe…

I have enjoyed being the center of attention and always pretending that I am on stage. This works out just perfectly as my wife likes being behind the scenes and allows me to take center stage. Thus, I would describe myself as an extrovert.

I learned about personality testing as a psychology major in undergraduate school. I never took personality testing seriously. There are many different methods used to identify personality …

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9 Enneagram types every practice leader should know

The Podcast by KevinMD

Why malpractice lawsuits are rarer but more expensive than ever [PODCAST]

Doctors are sued far less often than they were 25 years ago, but the average malpractice payout has never been higher. Robert E. White, Jr., president of The Doctors Company, has spent 58 years in malpractice insurance. This episode is…

Listen on Apple Podcasts · Spotify

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Doctors are sued far less often than they were 25 years ago, but the average malpractice payout has never been higher. Robert E. White, Jr., president of The Doctors Company, has spent 58 years in malpractice insurance. This episode is based on his article “Why medical malpractice claims cost …

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Why malpractice lawsuits are rarer but more expensive than ever [PODCAST]

Health policy

Medicare Advantage profits are speeding the collapse

I receive emails from a senior citizen's organization urging me to sign a petition to protect Medicare Advantage (MA) nonmedical benefits. After reading and deleting the first one, I ignored subsequent ones for two reasons. First, since CMS, the federal…

I receive emails from a senior citizen’s organization urging me to sign a petition to protect Medicare Advantage (MA) nonmedical benefits. After reading and deleting the first one, I ignored subsequent ones for two reasons.

First, since CMS, the federal agency that administers Medicare, allowed private insurers to provide these benefits, their cost grew by over 800 percent. CMS intended these benefits to improve elder health, but this was not codified, …

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Medicare Advantage profits are speeding the collapse

Physician voices

Women’s pain dismissed as stress can have a treatable source

A patient came to my clinic after three years of being told her pain was "probably stress." She had seen her primary care doctor, two orthopedists, and a neurologist. She had tried medications, been handed pamphlets, and learned to apologize…

A patient came to my clinic after three years of being told her pain was “probably stress.” She had seen her primary care doctor, two orthopedists, and a neurologist. She had tried medications, been handed pamphlets, and learned to apologize for bringing it up at all. By the time she reached me, she had stopped believing anyone in medicine would take her pain seriously.

She is not unusual. She is the …

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Women’s pain dismissed as stress can have a treatable source

Health policy

Opioid settlement funds reward fewer pills, not less pain

Somewhere along the way, the patient stopped being the point. A patient who was stable A year ago this month, 74-year-old Martha was stable. She lives with osteoporosis, osteoarthritis, degenerative disc disease, multiple joint replacements, and chronic anxiety. Even so,…

Somewhere along the way, the patient stopped being the point.

A patient who was stable

A year ago this month, 74-year-old Martha was stable. She lives with osteoporosis, osteoarthritis, degenerative disc disease, multiple joint replacements, and chronic anxiety. Even so, she was functioning. Her pain was controlled on a low, unchanged dose of oxycodone that she had taken responsibly for more than five years.

At her annual visit, everything changed. Her primary care …

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Opioid settlement funds reward fewer pills, not less pain

Physician voices

Hunger, delays, and the making of a difficult patient

When I see patients these days, it is usually in a hospital. Most are not particularly happy to be there. They are sick, uncomfortable, frightened, or simply exhausted by whatever brought them through the emergency department and into a hospital…

When I see patients these days, it is usually in a hospital. Most are not particularly happy to be there. They are sick, uncomfortable, frightened, or simply exhausted by whatever brought them through the emergency department and into a hospital bed. For a long time, I assumed that their frustration with being in the hospital was simply part of being sick. Of course people don’t want to be hospitalized. And, …

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Hunger, delays, and the making of a difficult patient

Health technology

Remote patient monitoring in psychiatry needs an owner

In a recent KevinMD piece, physician executive Thomas Powell argued that alert fatigue is a design problem, not a vigilance problem. When clinicians override 49 to 96 percent of drug-interaction alerts, he wrote, they aren't being careless. They're responding sensibly…

In a recent KevinMD piece, physician executive Thomas Powell argued that alert fatigue is a design problem, not a vigilance problem. When clinicians override 49 to 96 percent of drug-interaction alerts, he wrote, they aren’t being careless. They’re responding sensibly to a system that buries the rare important warning under a pile of trivial ones.

One of his tests for retiring an alert stopped me: If no one will claim …

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Remote patient monitoring in psychiatry needs an owner

Conditions and diseases

Reactive attachment disorder may be a physiology problem

I have lived on the autism spectrum and with reactive attachment disorder (RAD) throughout my life. Now, as a 40-year-old woman and an independent medical researcher, I am diving into ways to better comprehend and contribute to neurological investigation. For…

I have lived on the autism spectrum and with reactive attachment disorder (RAD) throughout my life. Now, as a 40-year-old woman and an independent medical researcher, I am diving into ways to better comprehend and contribute to neurological investigation. For much of my life, these experiences were treated as separate facts: autism on one side, attachment disturbance on the other, and the physiological and emotional consequences of both somewhere else. …

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Reactive attachment disorder may be a physiology problem

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