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How deprescribing in psychiatry offers a path to safer care

Meds

December 19, 2025

America learned to add medications. Add one for sleep. Add one for nausea from the first. Add one for weight gain from the second. Add a second antidepressant when the first loses effect. Add a stimulant when a mood stabilizer slows a teenager down. Add an antipsychotic when anxiety erupts in the clinic room. Add a statin because a lab number sits outside a guideline range. Patients, however, feel the …

AI in prior authorization: the new gatekeeper

Tiffiny Black, DM, MPA, MBA

Conditions

December 19, 2025

The denial came back in less than three seconds.

A physician had just submitted a renewal for a medication her patient had taken for years, one that kept her stable, out of the hospital, and able to function. She expected the usual wait time. Maybe an hour. Maybe a day.

Instead, an automated message appeared: “Denied: automated appropriateness determination.”

No reviewer. No rationale. No path for appeal. Only an algorithm, silent, opaque, and …

Why learning specialists are central to medical education [PODCAST]

The Podcast by KevinMD

Podcast

December 18, 2025

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

Assistant professor of professional practice Adrian Reynolds discusses his article, “What is professional identity formation in medicine?” He explores how a student’s frustrated question, “Did I get dumber?” reveals the deep crisis …

Finding meaning in medicine through the lens of Scarlet Begonias

Arthur Lazarus, MD, MBA

Physician

December 18, 2025

“Once in a while you get shown the light
In the strangest of places if you look at it right.”

That line from Scarlet Begonias (lyrics by Robert Hunter, melody by Jerry Garcia) has followed generations like a benediction disguised as a song lyric. Released in 1974 on the Grateful Dead album From the Mars Hotel, it has become something more than poetry. It is a philosophy of attention, a reminder that …

Profit vs. patients in the U.S. health care system

Banu Symington, MD

Physician

December 18, 2025

Illness is inevitable, and medical care can be expensive. The U.S. is the only developed nation without some form of universal health care. Instead, it relies on a for-profit system in which insurance companies often seek ways to reduce costs, sometimes by delaying or denying coverage for services. These delays can include requirements such as prior authorization or peer-to-peer reviews for standard, guideline-directed treatments. This process takes up health care …

How to keep the soul of medicine alive in a scaling system

Gerald Kuo

Conditions

December 18, 2025

Medicine is getting faster, louder, and more efficient, and many of us feel something quietly slipping away. We talk about burnout, moral injury, and depersonalized care, but the deeper question is often left untouched: How do we keep the soul of medicine alive while building systems that must scale?

I encountered that question in an unexpected place, not in a policy meeting, not in a spreadsheet, and not in an architectural …

Why medicine needs military-style leadership and reconnaissance

Ronald L. Lindsay, MD

Physician

December 18, 2025

Robert E. Lee did not lose Gettysburg because he lacked courage or troops. He lost because he was blind. His cavalry commander, J.E.B. Stuart, galloped off on his own, leaving Lee without reconnaissance. By the time Stuart returned, George Custer cut him to pieces. Leadership without recon is leadership without eyes.

Screening tests are the point in a military formation. They provide the initial lay of the land. In medicine, they …

How to handle medical gaslighting

Alan P. Feren, MD

Conditions

December 18, 2025

You are the expert of your body. You know when something isn’t right.

Yet many patients leave an exam room feeling worse than when they came in, not because of their illness, but because they were told, directly or indirectly, that nothing is wrong. Their symptoms are minimized, reframed, dismissed, or worse, attributed to anxiety, stress, age, or weight. They are left questioning their own experience and perception of reality.

This is …

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How to handle medical gaslighting

Gender bias in medicine: Who deserves to be saved?

Anonymous

Conditions

December 18, 2025

The nurse adjusted my father’s blanket for the third time that hour, her voice soft as velvet. “We just hate to see him suffer like this,” she whispered. My mom and I watched her check his IV with the tenderness reserved for wounded pups.

Three floors down, four years earlier, this same hospital discharged me mid-vomit with a gastric outlet obstruction and a white blood cell count that screamed infection. “Go …

Why your migraine might be causing your tinnitus [PODCAST]

The Podcast by KevinMD

Podcast

December 17, 2025

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

Otolaryngologist Brian F. Worden discusses his article, “The surprising link between migraine and tinnitus.” He reveals that for the 26-47 percent of tinnitus patients who also report migraines, the tinnitus may actually …

Psychiatrists are physicians: a key distinction

Farid Sabet-Sharghi, MD

Physician

December 17, 2025

A new patient recently told me, “I’ve already seen two doctors about this.” She meant a life coach with an online certificate and a therapist with a doctorate in education. Neither was a physician. Neither had examined her, ordered labs, or considered medical causes for her rapid cognitive decline.

When I evaluated her, it was immediately clear she needed urgent neurological workup. She wasn’t suffering from “stress.” She had an early …

Tick-borne disease vaccines: a 2025 update

Melvin Sanicas, MD

Conditions

December 17, 2025

Tick-borne illnesses continue to rise across the U.S. and Europe, and clinicians are feeling the impact. More patients are showing up with early Lyme disease, more are asking about prophylaxis, and more travelers want advice about tick-borne encephalitis (TBE). At the same time, vaccine development is finally accelerating after years of stagnation. For busy clinicians, here is a concise update on what’s new and what to tell patients in 2025.

Lyme …

AI and human connection: an ethical crisis

Mohammed Umer Waris, MD

Conditions

December 17, 2025

Causing quite a stir, Mark Zuckerberg (Meta’s CEO) recently proposed Artificial Intelligence (AI) companionship for those suffering from social isolation. All of this unfolds amid a climate of epidemic-levels of loneliness, as declared by the Surgeon General, and the storms it has unleashed upon the edifices of our personal and collective health. The irony, even horror, was not lost on many: The very tools and companies, in …

Why are elderly patients dehydrated?

Spasoje Neskovic, MD

Conditions

December 17, 2025

Being a family physician and geriatrician for more than 38 years, I’m trying to better understand why our elderly patients, and in general, elderly people, suffer from dehydration. For sure, there are many reasons. Some of those are simple, but some of the hidden ones we don’t think about. For example, just by getting older, we end up having less water in our bodies. Living in a humid area and …

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Why are elderly patients dehydrated?

Preventing physician burnout before it begins in med school [PODCAST]

The Podcast by KevinMD

Podcast

December 16, 2025

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Urologist William Lynes discusses his article, “Teaching medical students what it is really like to be a physician.” He confronts the tragic reality of physician burnout and suicide, arguing the culture of …

Why we can’t forget public health

Ryan McCarthy, MD

Physician

December 16, 2025

Standing in the middle of the parking lot of the Berkeley 2000 Recreation Center in February 2021, Molly Humphreys, in a single frame, captures an important moment in the public’s collective health, though it can be easily missed if we don’t pause and absorb its significance. In the chaos of 2025, it would be careless to not linger on this image.

A masked …

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Why we can’t forget public health

Why pediatric leadership fails without logistics and tactics

Ronald L. Lindsay, MD

Physician

December 16, 2025

In my previous critiques of the failure of the American Academy of Pediatrics (AAP), the American Board of Pediatrics (ABP), and the Society for Developmental and Behavioral Pediatrics (SDBP) titled “Why developmental and behavioral pediatrics faces a recruitment collapse,” I argued that “leadership presence without leadership action is theater.” The SDBP strategy had no actionable items.

Any military historian will tell you that in addition to an overall strategy, you …

Why invisible labor in medicine prevents burnout

Brian Sutter

Conditions

December 16, 2025

I was on a call a few months back with a new physician assistant. She was still finding her footing, and she shared a moment that stuck with me. Almost in a whisper, she told me: “No one, not a single person, will ever know what it took, just to keep her alive.” This feeling lingered with her long after the adrenaline of the stressful code had faded.

That hit me …

The risk of ideology in gender medicine

William Malone, MD

Conditions

December 16, 2025

Something unusual is happening in medicine. A once-rare diagnosis (gender dysphoria) has become common among American children and adolescents. An estimated three percent of youth now identify as transgender, and another two percent are questioning their gender identity. That surge should have prompted urgent, transparent scientific inquiry. Instead, the field of pediatric gender medicine has become one of the most ideologically-charged, and least open to critical debate, areas in modern …

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The risk of ideology in gender medicine

The economic case for investing in tobacco cessation

Edward Anselm, MD

Conditions

December 16, 2025

Despite decades of progress in reducing the prevalence of cigarette smoking, tobacco use remains a leading cause of preventable death and disease, and a significant driver of health care costs in the United States. Smoking cessation therapy is consistently ranked among the most cost-effective clinical preventive services and is considered to be “the gold standard of health care cost-effectiveness.” Yet, delivery of evidence-based treatment …

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