Harvey Castro, MD, MBA is an emergency physician, chief AI officer, and physician futurist known as DR GPT™. He has published 98 essays on KevinMD since January 2023 and has been a guest on The Podcast by KevinMD three times. …
Harvey Castro, MD, MBA, on AI in medicine: a KevinMD subscriber spotlight
A patient comes to you with a story you’ve heard in countless variations. She’s seen a nurse practitioner at an urgent care, a rheumatologist two states away when she was between jobs, and, more recently, an AI symptom checker that told her it was probably stress. By the time she’s in the exam room, you have maybe fifteen minutes, and a chart that reflects exactly one of those encounters.
During several …
Incomplete medical records are the real AI blind spot
For generations, we’ve heard the saying, “The eyes give you away.” The phrase suggests that the eyes reveal who we are, that they communicate our personality, emotions, and even our identity. More importantly, that one could not lie, or we’d see it in their eyes.
During the COVID-19 pandemic, however, I found myself questioning that assumption. Like countless clinicians, I spent months (years?) interacting with patients whose faces were largely hidden …
Reading faces behind masks left me repeatedly surprised
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
A man told his doctor he was struggling with addiction. The doctor told him this was not something he could help with. Devika Bhushan is a public health physician and a former acting …
Addiction stigma costs lives, and one word can change that [PODCAST]
Modern health care has never measured more. Patient satisfaction scores. Throughput. Productivity. Readmission rates. Quality metrics. Efficiency benchmarks. Engagement surveys. Dashboards filled with indicators intended to quantify nearly every aspect of care.
The impulse is understandable. Measurement drives accountability, identifies variation, and helps organizations improve. But after years of navigating health care as a patient, a parent, a caregiver, and someone paying close attention to the people working inside these systems, …
The structural causes of burnout no dashboard captures
“You know, when you go, you go. You just don’t know,” a friend used to say to me.
Mortality is the one truth we all share, whether we admit it or not. And yet, how we live with that truth varies. “John,” a recent widower I knew, had his own way of facing it: by keeping the promises his wife left behind, as if honoring them could hold together what grief …
Grief after losing a spouse does not arrive on schedule
Physicians are trained to manage complexity under time pressure. We carry twenty patients, track a dozen pending studies, remember which consultant owes us a callback, and keep it straight. Then we go looking for a job and manage the whole thing out of an inbox and a legal pad.
A hospital-employed position search generates a startling volume of material: recruiter emails, competing time zones, credentialing packets, site visit logistics, contract drafts …
AI was the chief resident for my physician job search
Florida is evaluating a proposal to eliminate four long-standing school-required vaccines: hepatitis B, varicella, pneumococcal conjugate, and Hib. These are not fringe immunizations. They are foundational protections that keep children out of ICUs, prevent meningitis, stop congenital infections, and reduce lifelong disability.
The proposal affects 2.8 million students. It would remove any vaccine not explicitly mandated by statute and expand exemptions to include “moral and ethical” objections. The vaccines would remain …
Why Florida school vaccine requirements may vanish in 2026
Artificial intelligence is no longer a future issue for hospital boards. It is already affecting clinical documentation, patient communication, revenue cycle operations, imaging, scheduling, research, cybersecurity, and physician workflow. In many organizations, AI is entering through the side door before leadership has created a clear strategy. That is risky.
A hospital does not need an AI strategy because AI is fashionable. It needs one because unmanaged AI creates clinical, operational, legal, …
AI strategy for hospitals: the 5 mistakes boards make
You open your health portal before bed, mostly out of habit, and there it is: a number in red. Or your doctor mentions, almost in passing, that your cholesterol has crept up and your blood sugar is “borderline.” Nothing hurts. You feel the same as last week. But something has shifted, and you know it. You’ve become a person with a problem.
I want to make the case that a red …
How to tell which abnormal test results actually matter
A few weeks ago, I found myself somewhere past 100 kilometers into The Rift, a 140-kilometer gravel cycling race through Iceland, wondering exactly why I had thought this was a good idea.
The scenery was spectacular. We rode through black volcanic landscapes, past mountains and rivers, across terrain that at times appeared so stunning, it looked fake. I felt incredibly lucky just to be there and to have the opportunity to …
AI in utilization management is solving the wrong problem
I live with eosinophilic esophagitis, often called EoE. It is an uncommon chronic immune condition that affects the esophagus. Living with it has involved appointments, procedures, uncertainty, and the ordinary disruption that happens when your body does not follow the plan.
That experience taught me something useful, but not what people sometimes assume. It did not make me an expert in every uncommon disease. It did not give me permission to …
What can lived experience actually teach us about helping?
1. The 6-week myth vs. the 30-year reality
We all know the current standard of maternal health care operates on a dangerous illusion: the big ole’ 6-week checkup. We tell moms that once they pass this test, congrats! Recovery is complete and they are cleared to return to normal life and exercise.
It would be convenient if bodies healed by the calendar, wouldn’t it? What really happens during pregnancy, birth, and lactation …
Postpartum pelvic floor therapy protects you at 75
ADVERTISEMENT
I left Nepal to train in a country I barely knew, carrying the kind of ambition that doesn’t leave room for doubt. Internal medicine residency, then a rheumatology fellowship at the National Institutes of Health (NIH). I pictured a career built in clinical research, publishing, discovering. That was the plan, and for years I didn’t question it.
The turning point
Then our daughter was born, and everything about that plan stopped making …
Physician burnout and the question science cannot answer
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
In a lot of towns there is only one health insurer left, and that is starting to show up in patient care. Rita Agarwal is a pediatric anesthesiologist who started asking why colleagues …
Health insurance mergers are why your doctor is leaving [PODCAST]
After more than three decades of practicing medicine in Maryland, I recently applied for medical licensure in Washington, D.C. I expected the process to be similar to neighboring Virginia, which offers an efficient pathway to licensure by endorsement or reciprocity for experienced physicians in good standing. Instead, I discovered that where I went to medical school more than thirty years ago (not my decades of practice, triple board certification, U.S. …
Why medicine needs a national physician license now
The American Society of Interventional Pain Physicians estimates the United States has fewer than 7,000 practicing interventional pain physicians. Meanwhile, approximately 60 million Americans live with chronic pain, including roughly 21 million with high-impact chronic pain, pain that substantially limits a person’s ability to work, care for themselves, or participate in social activities. These numbers translate to roughly 3,000 patients with high-impact chronic pain per interventional physician. This is an …
Why opioids for chronic pain must stay on the table
A patient sits across from her physician and asks that the AI-assisted reading of her scan not be the final word. She isn’t opposed to technology. She remembers reading about an AI system generating false clinical information at another hospital, and the story stayed with her. Her physician understands the hesitation. He has become more cautious himself after a documentation tool fabricated part of a medication history, an error he …
Trust in health care AI is a design problem, not a patch
Last week, a former patient came back to see me after spending several months with another doctor at a practice where I once worked. During our visit, the patient seemed uneasy and told me that the other doctor had made disparaging comments about me. I did not believe the patient meant to hurt me by sharing this. Still, the words stung. More importantly, the patient had been placed in an …
When criticizing another physician harms the patient
I have spent decades in health care. I know how much physicians rely on clinical judgment, pattern recognition, and experience. Those skills matter, and they also carry a risk: The human brain is constantly filling in gaps, and sometimes the story we create about a patient can become more powerful than the information the patient is trying to give us.
I experienced this recently during a telehealth visit with a physician …
How does the halo effect in medicine harm patients?
Get free updates delivered free to your inbox.
