Conditions

Adult autism assessment: ADOS-4 vs. narrative interviewing

Conditions
January 5, 2026

Over the past decade, there has been a marked rise in adolescents and adults seeking autism evaluations. Many of these individuals are intellectually intact, verbally fluent, and professionally capable, yet have lived for decades with persistent social fatigue, sensory sensitivities, difficulty interpreting unspoken social rules, emotional overwhelm, rigid or all-or-nothing thinking, challenges with transitions, and extensive masking or camouflaging behaviors, all without a diagnosis. When they finally seek clarity, the …

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Are mild hypertension guidelines driven by pharma ties?

Conditions
January 5, 2026

In the early 2000s, I included “drugs for mild hypertension” in my book, Money-Driven Medicine: Tests and Treatments That Don’t Work. By 2007, I proposed a Cochrane systematic review of randomized controlled trials (RCTs) to settle the debate. Cochrane is widely considered the “gold standard” of evidence-based medicine; its reviews can shift global clinical practice and multibillion-dollar drug markets.

In 2012, Cochrane published the systematic review of Pharmacotherapy for …

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The physician emotional toll of delivering bad news

Conditions
January 5, 2026

You can usually taste the excitement in the air during a first visit for pregnancy. It’s palpable. And the evidence for it is everywhere: the nervous fidgeting of hands. Do you place them on your lap or not-so-casually at your side? Paper drape sheet typically is balled up into tiny handfuls for better “grip” on this one-ply provider of modesty. And the quick glances back and forth between soon-to-be parents …

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Why home-based care fails without integrated medication and nutrition

Conditions
January 4, 2026

Consider Mrs. Chen, an 82-year-old woman discharged home after a minor ischemic stroke. On paper, her care plan was flawless.

Her physician intensified her antihypertensive regimen to protect vascular health (medication). Her well-meaning daughter, concerned about blood pressure, switched her to a strict low-sodium porridge diet, unknowingly slashing her protein intake (nutrition). Her physical therapist prescribed a daily walking program to rebuild confidence and strength (exercise).

Two weeks later, Mrs. Chen was …

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Methodological errors in Cochrane reviews of anticoagulation therapy

Conditions
January 4, 2026

My previous KevinMD article discussed a Cochrane Collaboration review that was completed in 2002 but was not published until 2006. This review examined three randomized controlled trials (RCTs) comparing anticoagulants with placebos or anti-inflammatory drugs for venous thromboembolism (VTE).

Along with my two co-authors, I found that across these three trials, anticoagulant-treated patients had six deaths out of 66 patients, compared to only one death out of 60 in the placebo …

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Why we deny trauma and blame survivors

Conditions
January 4, 2026

“The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter out loud: this is the meaning of the word unspeakable. Trauma survivors want to forget, observers want to forget, and society as a whole wants to forget. It is too painful to do otherwise. We push trauma away and it rears up in other ways: Atrocities, however, …

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Physicians’ end-of-life choices: a surprising study

Conditions
January 3, 2026

In July, I wrote about the importance of end-of-life planning (EOL). Shortly after, I read a study that examined physicians’ EOL plans with advanced cancer and Alzheimer’s disease (stage unspecified). The study encompassed nations with different forms of aid in dying, from the U.S., where a terminal coma is the only option most states allow, to Belgium, where physician-assisted dying (PAD) and euthanasia are available. Although the term suicide …

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In-flight medical emergencies: Are planes prepared?

Conditions
January 3, 2026

The cabin was quiet in that familiar, suspended way airplanes always are with a steady engine hum, passengers absorbed in movies, sleep, and anticipation with the intermittent crying child. It was an ordinary flight. Until it wasn’t. The overhead speaker crackled without warning. “If there is a doctor on board, please identify yourself.”

The voice was calm. The effect was not. Just a row behind me, a child no more than …

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Why mindfulness fails to cure existential anxiety

Conditions
January 3, 2026

For the past several decades, Western spiritual culture has been profoundly shaped by the rebranding of Buddhist contemplative practices (mindfulness, presence, and the exaltation of “the now”). As a psychiatrist, I have witnessed the arrival of this movement inside the consultation room. Patients arrive quoting teachers, apps, and books urging them to stay present, to watch their breath, to release attachment to the future or past. Many have tried, often …

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Concierge medicine access: Is it really the problem?

Conditions
January 2, 2026

A recent Johns Hopkins study has reignited that debate. The research documents rapid growth in concierge and direct primary care practices and warns that these models may worsen access to care.

That framing feels intuitive. It is also incomplete.

It assumes that traditional primary care access was functioning before physicians began moving into fee-based models. It was not.

Long before concierge and direct primary care gained traction, primary care access had already …

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Emotional abuse recognition: a nurse’s story

Conditions
January 2, 2026

I wanted to be at the top. Clinical ladder 4 was the top. You couldn’t get any higher achievement as an ICU nurse than this.

There were many requirements to obtain this:

  • Community service.
  • Having a nursing article you wrote published in an established nursing magazine.
  • Doing many hours as a charge nurse without that differential.

I checked all the boxes, every year. It was hard work. And tiresome. The compensation for …

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Peacekeeping medicine: Saving lives in Sudan’s forgotten hospital

Conditions
January 2, 2026

When we think of peacekeeping missions, images of armored vehicles and blue helmets often dominate the narrative. Rarely do we picture the quiet, relentless battle fought within the walls of a makeshift hospital, where saving lives becomes an act of defiance against chaos. Yet, in Abyei, Sudan, that was our reality. We arrived expecting logistical challenges, but nothing prepared us for the disarray that greeted us at the UN Level …

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The role of operations research in health care crisis management

Conditions
January 1, 2026

At the height of the COVID-19 surge, many hospital leaders faced moments they will never forget. Beds were nearly full. Staff were exhausted. Supplies that once felt routine suddenly became scarce. In those moments, decisions had to be made quickly, often based on experience, instinct, and whatever information was available at the time.

We like to believe that good leadership means trusting our gut. In clinical medicine, intuition matters. Years of …

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The emotional toll of leaving patients behind

Conditions
January 1, 2026

This is not a detailed story like the ones I usually write. It’s just a little breeze of warmth that touched my soul and heart, and I wanted to share it with you.

I had been so overwhelmed over the past weeks, taking care of so many patients for months and staying in a place where there was no one to listen to me. In fact, I was the only listener …

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Peripheral artery disease prevention: Saving limbs and lives

Conditions
January 1, 2026

With the holiday season upon us, joy, warmth, and delicious food fill our homes. While we enjoy those festival meals, our own “life-highway” vessels quietly shoulder the burden of all the fats and sugars we consume. Alongside the happiness of the season comes an overlooked strain on our arteries. What strikes me even more, as a vascular specialist, is a recent study from the University Hospital at Downstate in …

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A clinician’s guide to embryo grading in IVF

Conditions
December 31, 2025

In the fast-paced world of reproductive endocrinology and infertility (REI), even seasoned clinicians from other specialties can find themselves lost in the weeds of embryo reports. While most of us recall the basics of mitosis and meiosis from medical school, the clinical nuances of embryo morphology and grading are often not taught until fellowship.

Understanding these metrics is essential for informed decision-making. Whether you are an OB/GYN managing patient expectations or …

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Why women’s symptoms are dismissed in medicine

Conditions
December 31, 2025

I walked out of my physician’s office steady and clear in my decision to transfer my care. I didn’t accuse her of anything. I didn’t raise my voice. I simply informed her that I would be transitioning to another clinician within the same concierge program.

She immediately assumed I was leaving for financial reasons and suggested physicians to see outside the system. When I clarified that her administrator had already approved …

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GLP-1 psychological side effects: a psychiatrist’s view

Conditions
December 30, 2025

As a physician-psychiatrist, I have watched the rise of GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound) with genuine admiration. They are transforming metabolic health, reducing cardiovascular risk, and offering hope to patients who have struggled for decades. For many, these medications are lifesaving.

But alongside the excitement, I’m witnessing something rarely discussed: a change in personality and affect, especially at higher doses.

This pattern reminds me of the early days of SSRIs. When …

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Emotional awareness and expression therapy explained

Conditions
December 30, 2025

Most people assume that pain and illness are caused only by injury or disease. If your back hurts, it must be damaged; abdominal pain must come only from inflammation, infection, or tumor. Most physicians learn this in medical school, as I did. But treatment based on this assumption often fails to provide relief for persistent pain, leaving millions of patients and countless well-intentioned physicians frustrated and in despair. The result …

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