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Psychiatric polypharmacy is a reassessment failure

Conditions

May 12, 2026

The 72-year-old woman sitting in front of me had spent nearly a decade anxious. Not ordinary stress, not fleeting worry, but the kind of chronic physiologic anxiety that hijacks sleep, amplifies rumination, tightens the chest, and slowly shrinks a person’s world. For over eight years, she had been treated with escalating doses of bupropion, eventually reaching 450 mg daily, the maximum recommended dose. And I found myself returning to a …

Doctors with mental illness need our care, not silence

Michael F. Myers, MD

Physician

May 12, 2026

An excerpt from Physicians With Lived Experience: How Their Stories Offer Clinical Guidance (APA Publishing, 2025).

What follows is a slightly edited narrative, the story of Kieran Allen, MD. Dr. Allen is from Australia, a psychiatry resident (registrar) at the time of writing. Dr. Allen writes from a different perspective, that of someone with a relapsing and remitting mental illness. He focuses on this for the …

Primary care access is the real problem, not the system

Payam Zamani, MD

Physician

May 12, 2026

Primary care is often described as broken, but that diagnosis misses the real issue. The clinical foundation remains strong. The problem lies in how access to care is designed and delivered.

Primary care isn’t broken; access is.

People can manage nearly every aspect of their lives instantly through technology, yet health care still relies on outdated models that require patients to wait days or even weeks for routine care. This creates frustration …

Physician autonomy and the hidden curriculum of medicine

Gus W. Krucke, MD

Education

May 12, 2026

If you are a physician, you have likely heard the question: “What would you do?” Increasingly, the answer is shaped before you have the chance to speak.

Patients assume that the physician responsible for their care is the one making the decisions. In many cases, that assumption no longer holds.

Modern health care is organized around teams, protocols, and layers of oversight that shape decisions before they reach the bedside. These structures …

A Medicare for All alternative that keeps insurers in

Ken Terry

Policy

May 12, 2026

An excerpt from Beyond Medicare For All: Cracking the Code of the Healthcare Affordability Crisis.

If our goal is high-quality, comprehensive, affordable health care for all, we must make health care less profitable. If health systems and corporations continue to control health care and their main goal is profit, health costs will continue to rise faster than the ability of society to pay, regardless of any reform efforts.

On the other …

Unexplained symptoms require deeper medical curiosity

Mercedes Fleming

Conditions

May 12, 2026

I am 75 years old, and I can see perfectly. My vision is 20/20. The tests are normal. The symptom is not. The disturbance is monocular, dynamic, and light-based, not structural, not degenerative in any way that current imaging captures. And yet, every day, I see the world through a veil of intrusive light that no one seems willing to investigate.

After months of medical appointments, I have learned a difficult …

How to redesign night shift in health care

Chinyelu E. Oraedu, MD

Conditions

May 12, 2026

Hospitals operate around the clock.

Emergencies do not pause at midnight. Sepsis progresses overnight. Stroke symptoms emerge at 3 a.m. Trauma arrives unannounced. Respiratory failure does not respect business hours. While much of the world sleeps, health care professionals continue making high-stakes decisions in ICUs, emergency departments, labor floors, hospital wards, and operating rooms across the country.

Yet there remains a conversation health care systems are still largely avoiding: What is the …

Clinician grief is a hidden crisis in modern hospice care

Linda Ellington, RN

Conditions

May 12, 2026

I stood knocking at the door of my hospice patient like I did every Monday for the past eight months. A musically talented man in his early 40s was always waiting for my weekly nursing visit, more so for the aspect of socialization. He was diagnosed with colon cancer two years prior and had a colostomy bag, leaving this once vibrant, social, even handsome man a shell of what he …

Physician vs. provider is an ethics issue, not just style

American College of Physicians

Physician

May 12, 2026

A position paper about using the term physician instead of provider? What does this have to do with biomedical ethics?

I fully support calling ourselves physicians and not providers, and have been sensitive to this issue in part thanks to Read more…

Physician vs. provider is an ethics issue, not just style

HIV care requires better patient education today

Yeralis Rodriguez Velazquez, RN

Conditions

May 12, 2026

There was a moment when human immunodeficiency virus (HIV) was at the center of public conversation. Campaigns were everywhere. Education was constant. Awareness was urgent. Today, that urgency feels quieter. In many ways, this shift reflects progress. Advances in treatment have transformed HIV into a manageable chronic condition. Stigma, while still present, is not as visible as it once was. Patients are living longer, fuller lives. From the outside, it …

Bolus or drip? What the DOSE trial actually showed about heart failure [PODCAST]

The Podcast by KevinMD

Podcast

May 11, 2026

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

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 …

Accounts receivable days hide four billing problems

GetPracticeHelp

Finance

May 11, 2026

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 …

AI therapy chatbots are crossing into impersonation

Muhamad Aly Rifai, MD

Tech

May 11, 2026

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 …

The handwashing standard nobody finished. Until now.

Bernadette Burroughs, RN

Conditions

May 11, 2026

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 …

Expanding the SOAP framework boosts health outcomes

Deepak Gupta, MD and Sarwan Kumar, MD

Physician

May 11, 2026

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 …

How to navigate physician job loss in the first week

Patrick Hudson, MD

Physician

May 11, 2026

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 …

Physician burnout is a heavy burden for many healers

Moses Kim, MD

Physician

May 11, 2026

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 …

Unavoidable pressure ulcer claims live and die by the record

Tracy Liberatore, Esq, PA

Conditions

May 11, 2026

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 …

Harm reduction effectively treats substance use disorder

Amanda Perez, MD, Mary Finedore, and Alyssa Lambrecht, DO

Conditions

May 11, 2026

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 …

Dehumanization in medicine: the language of disposition

Aditya Singh, MD

Physician

May 10, 2026

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 …

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