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You drive home after a long shift and see someone standing at the roadside. It turns out to be a sign. ≈ had that happen more than once, and her first thought …
Why exhaustion can make you see things that aren’t there [PODCAST]
We spend our days in the quiet reality of clinical practice. We chase elusive diagnoses, weigh the fine distinctions of symptom presentation, and measure our clinical instincts against rigorous decades of peer-reviewed science. We sit across from human beings in moments of vulnerability, applying a lifetime of anatomy, neurobiology, and pharmacology to parse real suffering from pathology.
Yet, step outside the exam room door, and we are met with a deafening …
3 reforms to counter wellness influencers in practice
Work may provide incomparable inner peace, but the timing of that work still matters. A shift may begin in the morning, evening, or night, and it may end during another part of the day. For workers’ circadian rhythms, the relevant question is not simply how long they work, but how the beginning and end of a shift fit together. That question matters whether the work ultimately serves humans or nonhumans.
Does …
Shift work and circadian rhythms shape the 24/7 workplace
In 2024, Medicare cut every physician’s rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand.
The code is G2211. CMS calls it a visit complexity add-on. In plain words, it pays for office visits where you are the patient’s ongoing doctor, either as the continuing focal point for all their care …
Physicians paid for G2211 twice. Most never bill it.
Roughly half of American children receive their health care through Medicaid or CHIP. These programs were legislated to cover them, and the choice has been made (repeatedly, across decades and both parties) not to fund them at the level their aims require. Pediatricians did not make that choice and should not stop saying it is the wrong one.
However, that choice, and the confines it creates, defines the real-world conditions …
Medicaid managed care and the case for mutual stewardship
Patients considering cosmetic limb lengthening usually begin with one question: How much height can be gained? That question is understandable, but it should not drive the decision. The more important issue is who will remain responsible for the patient’s care throughout the process and what will happen if recovery requires extra attention.
Cosmetic limb lengthening is often presented as a procedure that increases height. Technically, that is the goal, but it …
Choosing a limb lengthening surgeon requires accountability
Every caregiver of someone with schizophrenia or bipolar disorder knows this moment: Someone you love is in crisis, and at some point (because it’s 2 a.m., because the on-call line is busy, because you don’t know what else to do) you open a browser or a chat window and type the question directly. What crisis resources are there for psychosis? What crisis resources are there for mania?
Those two questions aren’t …
Why AI crisis advice may fail families facing psychosis
Recently, I cared for a woman at a Pittsburgh shelter clinic whose blood pressure was dangerously elevated. She told me she had insurance through a regional health plan but had not seen a primary care physician in quite some time. I prescribed losartan, a common blood pressure medication, and e-prescribed it to a downtown CVS pharmacy. A week later, she returned. She had not received the medication.
The pharmacy had told …
How AI phone systems in health care create barriers
With 66 percent of U.S. adults, some 131 million people, now taking prescription drugs, and with Medicare drug spending running into the hundreds of billions, it is worth asking how the pharmaceutical industry came to occupy so central a place in American health care. Several recent developments show how the relationship works.
The FDA announced this month that it is hiring more than 2,000 employees, rebuilding after reductions …
The conflict of interest that discloses as nothing
Little has captured public awareness in recent years more than the meteoric rise of artificial intelligence (AI). With this rise has come a fair share of controversy, with many both inside and outside of health care claiming, or at least hoping, that it will bring about a revolution that improves patient care, improves patient outcomes, reduces physician workloads, and drives down health care costs. Many are eager adopters, hopeful to …
AI data centers and public health demand regulation
A recent public discussion following a tragic event has reduced a complex clinical reality to a simplistic narrative: Telehealth, psychiatrists, or psychiatric medications must be to blame.
That conclusion may feel satisfying in the aftermath of an incomprehensible loss. But it is not how medicine, causation, or accountability should be understood.
A postpartum patient who is unable to get out of bed may appropriately receive care by telehealth. Virtual visits can be …
Telehealth and postpartum psychosis defy simple blame
I work in Dallas-Fort Worth (DFW) emergency departments where Spanish and English share the same hallway. Residents ask me the same question every block: Can we use ChatGPT for triage?
My answer is short. You can use it to practice thinking. You cannot use it to decide who waits. Here is what I actually teach on shift and in conference.
1. Fluency is not acuity
A clean English summary can hide a Spanish …
ChatGPT for triage: 5 rules I teach ER residents
Gambling as a recreational activity continues to expand, driven by the constant availability of online platforms. Sports betting, casino-style games, and real-time micro-betting are now accessible on smartphones at any hour, turning what was once occasional into a continuous presence shaped by artificial intelligence, big data, and app designs that permit bets before, during, and after events.
Gambling disorder is recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth …
Underage online gambling needs more than a checkbox
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Physicians reassure people every day:
We usually say these things with good intentions. We want to reduce fear, provide perspective, and help patients leave our offices or emergency departments feeling safer than when they arrived. But sometimes reassurance does not reassure.
The patient continues asking questions. They return to the emergency department. …
How to reassure patients: 5 steps beyond normal tests
On the 13th floor of the Jen Chi station-front building in Taipei, a school bell rings. The room does not feel like a hospital.
Older adults move through simple exercise, cognitive activities, music, conversation, and the small rituals that make a day feel like a day. Some need prompting. Some repeat a question. Some are stronger than their families expected. Nearby, caregivers finally have a little room to breathe.
What stays with …
How to build a dementia care pathway, not a referral sheet
Throughout pregnancy, clinicians carefully monitor a woman’s health. Vitals are obtained, laboratory testing is performed, growth is monitored, and complications are identified. Then, a new life is brought into the world, and medical attention dramatically shifts. The medical attention previously directed toward a mother abruptly ends, and the infamous “See you in six weeks” appointment is scheduled.
Unfortunately, childbirth is often considered a marker of the end of maternal medical risk …
Why must fourth trimester care begin after delivery?
Health systems are buying software that assembles a prior authorization packet from the chart, files it, and chases status. Health plans are buying software that reads the same packet, scores medical necessity against internal rules, and routes a yes or a request for more information. Vendors on both sides advertise essentially the same promise: Artificial intelligence will fix prior authorization.
That is only half true. What is arriving is a dual-use …
AI in prior authorization: 3 contract questions for 2027
By the time Kapil Grover enrolled in our nutrition program in June 2026, he had already faced substantial nutritional and physical challenges during his cancer journey. He received a colon cancer diagnosis in January 2026, but his symptoms had started months earlier. Stomach problems began in October 2025 and persisted, prompting further investigation. A CT scan revealed several tumors and lesions involving his small and large intestines, leading to extensive …
Nutrition during cancer treatment is more than calories
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This episode is sponsored by Oracle Health and Life Sciences.
Doctors have heard promises about health technology for decades. Now artificial intelligence has to …
Making AI work for physicians [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
She loved the job for 20 years. She left anyway. Christine King, certified registered nurse anesthetist, returns to explain what changed in the operating room and what it cost her. This episode is …
Why business pressure and threats ended a career she loved [PODCAST]
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