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.
When asked by the surgery department chair as a medical student why I wanted to treat vascular patients, my response was to be useful, useful to people with a challenging systemic disease that often results in stroke, amputation, and death. Often, wounds that have not healed for months on a foot or a hand, or persistent leg pain provoked by walking or simply laying in bed are subtle indicators that …
Read more…
Why local care matters for peripheral arterial disease
A healthy, 4-year-old girl was brought to the pediatric dental office for treatment of several cavities. The parents were told their child would be given medication to help her “sleep” through the procedure. Easier and quicker than going to a hospital, office-based dental sedation was presented as a safe, routine option for children.
After the sleeping medication was administered, the child grew quiet and became still. The dental work began. At …
Read more…
The hidden dangers of dental sedation and dental anesthesia in kids
Bree is an 11 1/2 year-old, 4.2-pound micro mutt who once lived on the streets of Long Beach. She eventually wound up at Long Beach Animal Care Services, where she sat in a crowded cold cement kennel with no bed, no blanket, no toys, and one very sick basset hound with parvovirus. Every dog in that kennel was scheduled to be euthanized on Christmas Eve 2014. If it weren’t for …
Read more…
What a tiny dog taught me about the nervous system
As a physician who has spent years managing patients with persistent pain, I often encounter the same frustrating cycle. A patient arrives with unrelenting back pain that has lasted for months. They describe not just physical discomfort but a deepening sense of hopelessness, fatigue, and withdrawal from life. Is the pain causing the depression, or did underlying depressive symptoms amplify an initially manageable ache into something chronic and debilitating? It …
Read more…
How to treat chronic pain and depression together
Every research mentor eventually faces a difficult question: What, and who, will continue when the work is no longer theirs to carry forward?
We often speak about mentoring, yet the dilemma of mentorship is rarely addressed directly. Perhaps it lies at the intersection of responsibility and uncertainty. Mentorship is often imagined as guidance freely given, with apprenticeship unfolding naturally. In modern academic life, however, the laboratory is shaped not only by …
Read more…
How research laboratory culture shapes mentorship in academic life
At a time when one in five married American couples experience infertility, and one in three American men have a low sperm count, concerns around fertility and conception have led millions to seek solutions. But family building is rarely a linear process, and for every individual or couple able to successfully conceive on the first try, there are just as many who may seem to be doing everything right without …
Read more…
The continuum of fertility care: Why IVF is not the only option
It is 4:50 p.m. on a Thursday. Your last patient is a 67-year-old with heart failure with reduced ejection fraction. He has been hospitalized twice this year. His medications look familiar. A beta-blocker. An ACE inhibitor. A loop diuretic. But something is missing. You scroll through the chart. No mineralocorticoid receptor antagonist. No SGLT2 inhibitor. No ARNI. You pause. You know the guidelines. You have heard the talks. You have …
Read more…
Why heart failure care requires spaced repetition for doctors
Each May, during Mental Health Awareness Month, the health care industry releases its usual statements about access to care, workforce stress, and the enduring shadows of stigma. I usually read them between back-to-back appointments, staring at a screen full of diagnostic codes. The systemic issues are always important, yet, amidst the charts, the 20-minute med checks, and the rhetoric, there remains a more profound question I have to ask myself …
Read more…
Therapeutic alliance in psychiatry matters more than ever
For 26 years as a plastic surgeon, I have given my patients the same advice after surgery: Listen to your body. Pain, fatigue, and swelling are not inconveniences. They are signals. They are the body’s language, guiding us toward healing or warning us when we have gone too far. What I have learned this year, at 65, is how difficult that advice can be to follow.
In January, I was training …
Read more…
Why doctors struggle to listen to your body after an injury
Two patients can have the same infertility diagnosis, need the same treatment, and see the same specialist. Yet one may move forward with insurance coverage while the other is left staring at a bill for tens of thousands of dollars. In the United States, that difference is often not medical. It is geography. As a biomedical scientist, I’ve seen how evidence should guide care. Yet for infertility, your ZIP code …
Read more…
IVF insurance coverage depends on your ZIP code
Eclampsia is one of the most severe complications of pregnancy. It occurs when a woman with preeclampsia, a condition characterized by dangerously high blood pressure during pregnancy, develops seizures. In well-resourced health systems, preeclampsia is usually detected early and treated long before seizures develop. But in many parts of Nigeria, especially rural communities in the North, women often arrive at hospitals only after convulsions begin. By then, the disease has …
Read more…
The deadly reality of eclampsia and maternal mortality in Nigeria
13 Americans will die today waiting for an organ transplant. That is a sobering line. Despite remarkable advances in transplantation medicine, the United States still cannot supply enough organs to meet demand. In 2024 alone, more than 3,400 Americans remained on the heart transplant waitlist while thousands more waited for kidneys, livers, and lungs. Yet a potential solution already exists, one that may soon move from research labs to operating …
Read more…
How xenotransplantation could finally solve organ shortages
Medication-assisted treatment (MAT) helps manage withdrawal symptoms and cravings in individuals battling opioid addiction. Despite their effectiveness, these medications can cause xerostomia (dry mouth) and an increased craving for sweet foods. These factors together contribute to accelerated dental decay, gum disease, and oral infections. The U.S. Food and Drug Administration issued a warning in January 2022 about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use …
Read more…
How medication-assisted treatment impacts oral health
“I just do not want my life to change,” said my patient. “It does not have to. With the medicine we have now, people with HIV can live a perfectly normal life,” I responded. As a family physician in the Atlanta area, I see patients at all stages of their HIV journey, some newly diagnosed and scared, others living with the virus for years, undetectable, thanks to daily medication. What …
Read more…
The reality of PrEP access and HIV prevention in Georgia
There’s a moment that happens in almost every family caring for an aging parent. It usually begins the same way. Someone leans in, frustrated, exhausted, sometimes whispering, sometimes shouting, and says, “My family is crazy.”
As a geriatric psychiatrist, I hear this often. What’s interesting is that everyone says it. Every sibling group thinks the others are unreasonable. Every adult child believes they’re the only one who sees things clearly. Every …
Read more…
The family caregiving truth nobody wants to admit
There is a large amount of evidence showing that keeping a consistent sleep schedule is incredibly important for a variety of health outcomes. Regular schedules are associated with improvements in alertness, health and safety behaviors, inflammation, mental health, cognitive performance, academic performance, sleep duration, and sleep quality. On the other hand, irregular sleep schedules have been linked to worse health outcomes across the board. Even so, sticking to a consistent …
Read more…
How to build a bedtime routine for a consistent sleep schedule
There is a place some patients end up living when they have complex medical illness. It sits somewhere between stable and emergency, and people like me spend a lot of time there. I live with serious medical conditions that keep me mostly homebound and often bedbound. My days revolve around things many people thankfully never have to think about: feeding tubes, medications, blood pressure swings, heart rate problems, and trying …
Read more…
The hidden struggles of medically complex homebound patients
“When empathy is recognition rather than absorption, it nourishes instead of depletes. It becomes sustainable.” Eva Minkoff shares this thought in our collaborative book, White Coats, Human Hearts, featuring the stories of 11 physicians, two physician spouses, and two patients. Eva has spent her life entrenched in health care, as a chronic patient, physician spouse, and now leadership coach for health care professionals and leaders. Reading those words was an …
Read more…
How regulating clinical empathy prevents physician burnout
