Physicians writing on KevinMD about the diseases they treat and the people who have them: cancer and its screening arguments, pain and the drugs that treat it, diabetes and the obesity argument, mental illness and who gets treated for it, and the decisions at the end of a life. Five maintained records draw on this archive: Cancer: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, End of life: what physicians say, in their own words, Diabetes and obesity: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.
I want my doctors to know as much about treating postmenopausal women using HRT as I have learned on my own. Women should not have to become research experts to effectively advocate for an established treatment many could benefit from.
Thankfully, after months and months of back-and-forth, including paying out of pocket for expertise outside my medical plan, I am finally getting essential treatment that will not only improve the overall …
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Why women must fight for hormone replacement therapy
The death of NASCAR driver Kyle Busch, a relatively healthy 41-year-old, startled the public in late May when his severe pneumonia progressed into sepsis. While pneumonia is a common condition, Busch’s development of sepsis, when the body goes into organ failure after an infection, is highly unusual, as sepsis tends to affect patients who are either very young, very old, or have chronic medical conditions.
Despite being one of …
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What Kyle Busch’s death reveals about sepsis
The chart is already open when my patient walks in. Forty-two years old, no significant medical history, last seen 18 months ago, not by me, but by a practice three miles down the road. I scroll through the treatment plan they sent her home with. Seven procedures and four of them major. A timeline that would have her back in a chair every six weeks for the next year. She …
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How corporate dentistry changes what you’re told
Today, I am sitting in a lounge chair receiving an iron infusion while writing this article. For most people, an iron infusion is a routine medical treatment. For me, it represents something much larger. It represents years of adaptation.
For as long as I can remember, I have lived with iron deficiency anemia. It was never considered severe enough to warrant specialty treatment. The recommendations were familiar: take iron supplements, eat …
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When physician burnout starts to feel like normal
A few months ago, I had just completed another demanding overnight shift. As morning approached, I finished my documentation, prepared to hand off my patients to the day team, and looked forward to driving home. Before leaving, our hospital administrator joined our morning huddle to thank both the day and night physicians for caring for patients around the clock. As our conversation came to an end, he smiled, looked at …
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Supporting night shift workers starts with one question
Every single night in the ICU, I am shocked by the number of people who have never discussed with their family what they would want done if their heart stops beating. Whether they would want to be shocked out of a bad rhythm. Whether they would want CPR, chest compressions, bones broken in the process. What they would want if a catastrophic illness were going to take their life, or …
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Why end-of-life conversations can’t wait for the ICU
During my residency, while rotating through the spinal cord unit at the VA Hospital in Puerto Rico, I cared for young veterans who, to my surprise, had, in most cases, adjusted remarkably well to a new reality: they would spend the rest of their lives in a wheelchair. I remember one case, in particular. I recollect this case well because the patient was the unofficial Don Juan of the unit. …
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Depression after spinal cord injury hides in plain sight
A mother calls a neurologist’s office the morning after watching her daughter seize in her sleep. She calls as soon as the office opens, explains exactly what happened, and waits for guidance. The earliest appointment is three months away. That is not a worst-case scenario. It is routine.
This is what the child neurology shortage actually looks like. It does not arrive as a headline. It arrives as hold music. It …
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The child neurologist shortage is a policy choice
Walk down any grocery aisle and you will see products covered in health claims: sugar-free, naturally sweetened, organic, gluten-free. For most shoppers, these labels are a minor annoyance. For a patient recovering from bariatric surgery, trusting the wrong one can mean an afternoon of dumping syndrome.
The term “bariatric-friendly” has no regulated definition. Any company can print it on a package. That leaves physicians, and eventually patients themselves, to figure out …
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What bariatric-friendly food really means
One of the hardest questions in intellectual disability psychiatry that I have found myself grappling with over the past year as a registrar in the subspecialty is surprisingly simple: Is this person in pain?
Most people assume pain announces itself clearly. A broken bone hurts. A toothache hurts. An infection hurts. The body sounds an alarm and we respond. In practice, as I have encountered time and again, it is rarely …
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Recognizing pain in autism when there are no words
A clinical trial may be remembered for a breakthrough treatment, a new therapy, or a headline-making discovery. But its true story begins with people. Behind every promising result is a patient placing their trust in the unknown, and a clinical research nurse or study coordinator standing beside them every step of the way.
When people think about clinical trials, they often think about physicians, sponsors, study results, and scientific discoveries. What …
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What clinical research nurses do that no one sees
When people ask me why I left health care, I tell them it was for personal reasons. I tell them that it was to support my daughter and her family. That was one reason, but there are others.
Back when I was a RN I shadowed a CRNA at the hospital where I worked. I spent the day with other CRNAs and students and I had the opportunity to observe and …
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Why I left health care after almost 20 years
Health care systems do not function on institutional design alone; they function on the invisible labor of the people moving through them.
There’s a kind of education you don’t choose. It begins, in my case, when my son is eight months old and continues for nearly two decades. At some point, it stops feeling like managing medical care and starts feeling like learning a second language, except the language is institutional, …
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The invisible labor of caregiving keeps systems intact
On a Friday afternoon, my cardiologist sent me a message through the patient portal. It read, in full: “You do have coronary atherosclerosis resulting in moderate narrowing but no major narrowing of the arteries. I unfortunately do not have a clear sense of total plaque burden based on this study. Look forward to discussing in more detail next visit.”
My next appointment was four months away.
I am 55 years old. I …
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AI is filling a gap doctors have no time for
Waiting rooms reveal more than we often acknowledge.
The clock can feel louder than the conversation, and patients quietly rehearse their symptoms after weeks of waiting, hoping they will not forget something important. Clinicians enter exam rooms carrying not just the backlog of delays but the accumulated strain of navigating a system that rarely moves in step with the care they are trying to deliver.
These moments are not rare; they are …
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Why patient access breaks before staffing does
As a physician trained in musculoskeletal care and neurologic deficits, and as a qualified medical evaluator (QME) and independent medical examiner (IME) dealing with personal injury accident cases and work-related incident cases, and also as an expert witness, we are dealing with establishing causation of the accident or incident to the impairment that is being claimed. This is done using biomechanics to relate the mechanism of injury to the treatment …
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Mechanism of injury is the key to proving causation
When Taylor’s father asked a doctor for help, he did everything right: He made the appointment, showed up, and told the truth. “I need help,” he said. “I think I’m struggling with addiction.” But the doctor just looked at him and shrugged: “Well, what do you want me to do about that?”
The truth is, as a medical community, we dismiss substance use disorder and the people who live with it …
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How addiction stigma in health care costs lives
When I read that experts had officially renamed PCOS to polyendocrine metabolic ovarian syndrome, my first reaction was not surprise. It was relief. After years of practicing medicine and six years of treating my own PCOS, someone had finally written down what my body had been trying to tell me the whole time.
Six years ago I was building my own practice from the ground up while quietly falling apart inside. …
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Why renaming PCOS to PMOS changes how we treat it
Recently, I called the office of my primary care physician. I asked the person who answered the phone, “Will the doctor sign an FAA BasicMed form?” The person said, “Let me check,” and returned a minute later. “She cannot. You need to see an FAA doctor.” I tried to explain that she could, but I could not convince the desk person.
The following explains BasicMed, the Federal Aviation Administration (FAA) program …
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What every primary care physician should know about BasicMed
