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What happens to your body and clinical judgment when you’re managing a code blue at the exact hour your biology demands deep sleep? Chinyelu E. Oraedu is an academic hospitalist and nocturnist with …
2 a.m. is a biological stress test no one talks about [PODCAST]
Spend enough time in a hospital, and patterns start to emerge. Not the clinical kind, the human kind. During my daughter’s recent hospitalization, residents rotated in and out every 12 hours. Over time, I found myself paying attention in a different way. Not with the intent to evaluate, but with a kind of quiet curiosity about how different people showed up in the same role, under the same conditions. It …
How medical residents build patient trust today
I have spent over two decades treating bariatric patients, and one of the most frustrating clinical situations I encounter is this: A patient sitting across from me who has done everything right. They are hitting 75 grams of protein a day. They are tracking every gram. They are bringing their food logs to every appointment. And they are still losing hair, losing muscle, and showing up with low labs.
In my …
How to improve protein absorption after gastric bypass
For much of my career, I understood my responsibility in familiar terms: care for the patient in front of me, advocate for better health systems, and teach the next generation of trainees. I still believe that. But I now believe something else just as strongly: If we are serious about health, we cannot stop at the clinic door. We also have to show up in civic life and in the …
How civic engagement empowers health care workers
The ECG was normal. The troponin was negative. The stress test was reassuring. Yet the patient in front of you looked as if he had been living under siege for months.
He was not sleeping. His blood pressure had worsened, despite medication adherence. He described chest tightness, reflux, headaches, irritability, and difficulty concentrating. He woke most nights around 3 a.m., his heart beating fast, checking an account balance, and then lay …
Why physicians miss business owner stress in patients
About half of the primary care visits I see these days involve patients that have consulted ChatGPT and have “an answer” to their medical symptoms that I need to debate, but that is just the beginning of what is coming to engulf all of health care in the near future. Working part-time for an Amazon One Medical clinic in Silicon Valley, I am seeing the rollout of artificial intelligence (AI) …
Artificial intelligence disrupts health care delivery
I was doing the dishes recently when I was hit with a stomach-dropping sensation and an unprompted memory. A negotiation I’d had years ago with my department. I had secured fair compensation for work they needed done, using the leverage I had. I walked away feeling good about it. And yet, standing at the sink with my guard down, years later, I felt a flash of guilt so unexpected it …
Why your physician guilt may not actually be yours
The momentous annual occasion known as Match Day was recently upon us. Thousands of medical students across the country opened envelopes that revealed their academic destiny for the next several years. What medical students learn during several intense years of study and practical application has evolved over time, with increased recognition that biomedical knowledge is necessary but not sufficient to develop humanistic, person-centered physicians. Noticeably missing from the curriculum, however, …
Medical education needs diversity and true excellence
Something is happening in women’s health care. Perimenopause is finally being discussed openly. Vaginal estradiol has entered mainstream conversation. Testosterone therapy for women is no longer confined to niche clinics or whispered discussions. Across medicine and social media alike, women are asking new questions about tissue health, sexual function, intimacy, discomfort, sensation, and quality of life. And perhaps more importantly, they are no longer accepting silence as an answer.
These conversations …
The exam question OB/GYNs were never taught to ask
Recently, a California jury found the tech giants Meta and Google guilty for the depression and anxiety which ensued in a young woman following her compulsive use of social media. The court found the corporations liable for features that cause children to become addicted to the platforms and that it results in the aforementioned mental health distress. Many are calling this ruling social media’s tobacco moment, citing parallels …
Social media addiction rulings impact mental health
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
What happens when you match into a residency but it still feels like a loss? Kathleen Muldoon is a coach and medical educator with 20 years of experience partnering with medical students through …
When what’s in the envelope doesn’t match what you expected [PODCAST]
Health care-associated infections (HAIs), including Clostridioides difficile infection (CDI), Candida auris, and multidrug-resistant organisms (MDROs), persist as significant challenges for U.S. hospitals despite advancements in infection management, environmental cleaning, and isolation protocols. These infections pose a huge threat to patients and health care staff. But at the bedside, there is one persistent issue that seems more overwhelming and messier than other protocols dealing with fecal incontinence in critically ill patients …
How fecal incontinence impacts infection prevention today
I sometimes find myself reflecting when my well-cited journal articles begin to show a decline, whether gradual or sudden. In academic medicine, citations have become a form of currency, used not only to trace ideas but also to measure worth. Yet what gets cited is not always what matters most. In biomedical research, citations support arguments and help measure impact. In principle, they show how knowledge develops over time. In …
How citation metrics reshape modern academic medicine
She was already seated when I walked in. On the desk in front of her sat a large sleeve, the kind that holds imaging films, oversized and awkward, the kind that no longer fits in a folder or a binder or anywhere in a modern clinic. Beside it was a folder. Labs indexed by specialist and date. Notes from orthopedics, neurology, rheumatology, pain management, and physical therapy. Every test, every …
The referral trap: How specialization fragments care
As a physician managing patients with chronic pain in California, I’ve witnessed the tension between necessary regulations and the daily reality of helping people in genuine distress. As chairman for the National Campaign to Protect People in Pain (NCP3), I know how important it is to advocate for our patients. While foundational reviews on prescription drug oversight provide helpful context on opioids and NSAIDs (for details, refer to chapter …
California opioid prescribing: What the data actually shows
Whether parent coaching is getting delivered formally, through parent behavior training programs, or informally, through evidence-based parenting advice and recommendations shared in clinic with the family, parent coaching has become an essential part of clinical care today, both in general and in subspecialized pediatric clinics. The American Academy of Pediatrics (AAP) recommends anticipatory parenting guidance to be provided starting at the first visit. The AAP also recommends that pediatric health …
How cultural competence transforms modern parent coaching
While excellent guides exist for research topic discovery or planning, and finding suitable journals for publication, a short practical checklist to help trainees determine if a project proposal is a great fit is useful (see the checklist below). Here, I outline items to consider before you commit to a project and provide my take on two main categories of topics: 1) those where a single NO generally should lead to …
A 20-item checklist for trainee research projects
10 years ago, I met a local news health reporter at my cousin’s house. By then, I had been a general surgery attending for almost a decade and was shocked by the lack of public health education about anal health care issues. I had also amassed a particularly busy proctology clinic over the years, seeing patient after patient who had suffered for extended periods, afraid to see a doctor and …
How anal health education helps detect anal cancer
Policy changes eventually become operating decisions
Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain services, then asks the obvious question: How much revenue is at risk?
That question matters, but it is not the only operator question. Medicare practice expense and related Physician Fee Schedule changes also affect the billing-service decision. If the practice outsources billing, the policy change does not …
How Medicare changes affect medical billing contracts
Randy McNeely: We are never more vulnerable than in the moments when life delivers news we did not expect, and are not prepared to hear. That moment came for my wife and me in early August 2023.
A few weeks earlier, Kimberly was helping our daughter move a small chest freezer when she felt a sharp twinge in her right thigh. It seemed like a pulled muscle, so she treated it …
Compassionate health care transforms the patient journey
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