Conditions

Uterine aging in IVF: Why the “soil” matters as much as the seed

Conditions

January 26, 2026

Most clinicians know that eggs age. Fewer acknowledge that the uterus ages too.

In reproductive medicine, we often rely on the seed-and-soil analogy. The seed is the embryo. The soil is the endometrium, the inner lining of the uterus where implantation occurs.

Here is the part that deserves more explicit counseling and strategic planning: Even when embryo quality is controlled, uterine age can independently influence implantation, miscarriage risk, and live birth rates. …

How modern health care design strains patients and clinicians

Deanna J. Gilmore, RDH

Conditions

January 25, 2026

My great-grandfather was a small-town doctor in the early 1900s.

It was a different time. A different place. A very different pace.

He knew his patients. He knew their families. He understood their lives, not just their symptoms. Care happened in the context of relationship because that was simply how medicine worked.

Today, health care looks very different. The science is better. The technology is stronger. We can do things now that would …

Physician retirement: a cultural shift from system to self

Gerald Kuo

Conditions

January 25, 2026

The number was specific: 18,000 steps.

It came from a retired hospital director in Taipei, a physician-administrator who spent four decades building services, negotiating budgets, and managing crises across a health care system that now treats an aging society as its primary patient.

Most physicians retire into silence. He retired into data.

But the more interesting revelation did not come from his smartwatch. It came from the dinner table.

A shift in governance

In Western …

ADHD and cannabis use: Navigating the diagnostic challenge

Farid Sabet-Sharghi, MD

Conditions

January 25, 2026

As a psychiatrist, I increasingly meet patients who come in convinced they have attention-deficit/hyperactivity disorder (ADHD). They arrive prepared: an online screening test, a list of symptoms (poor concentration, low motivation, distractibility) and often a quiet sense of relief at finally having an explanation. Then I do what physicians are trained to do. I take a careful history. I review medications. I ask about sleep, mood, anxiety, substance use, and …

How the mind-body split in medicine shaped modern clinical care

Robert C. Smith, MD

Conditions

January 24, 2026

In my first and second KevinMD posts, I emphasized how medicine had failed clinicians by not training them in mental health care. All agree, it’s not our fault. Now let’s look at how successfully our teachers did prepare us for patients with medical disorders. There’s an interesting history behind how we developed expertise in physical diseases: Medicine needed to overthrow the four humors theory that guided clinical care …

Is testosterone replacement safe after prostate cancer surgery?

Francisco M. Torres, MD

Conditions

January 23, 2026

It has been six months since my robotic-assisted radical prostatectomy, and I find myself suspended in a strange middle space, grateful to be cancer-free, yet still struggling with a question I cannot fully answer: Is it safe for me to restart testosterone replacement therapy?

Before my diagnosis, testosterone replacement was not just a prescription; it was a restoration. I have lived with hypogonadism for years, and TRT helped me regain the …

The impact of war on the innocence of children

Michele Luckenbaugh

Conditions

January 23, 2026

They are not born into battle.
They arrive with open hands,
with laughter,
with faith that the world will keep them safe.

Yet, men who are not content with peace
clench their fists around power,
mistaking domination for strength
and control for legacy.
They draw borders with bullets
and call it victory.

In their pursuit to prove themselves,
they let the bombs fall.
Roads darken with blood.
Homes become rubble.
The sky learns the language of fire.

And in the wreckage stand the children.

They watch …

Why epistemic trespassing in medicine is a dangerous trend

Farid Sabet-Sharghi, MD

Conditions

January 22, 2026

Somewhere over the last two decades, medicine began to drift into strange territory. Authority (once grounded in evidence, humility, and disciplined expertise) became diluted. Being loud, charismatic, or highly visible somehow became a substitute for scientific credibility.

We’ve long had celebrity doctors, but a new hybrid has emerged: Physicians who are not celebrities in the traditional sense, yet who speak with sweeping certainty far outside their field of training. A neurosurgeon …

Why evidence-based practice in nursing is a strategic imperative

Mark Mahnfeldt, RN, MBA

Conditions

January 22, 2026

Every day, nurses make thousands of clinical decisions that directly shape patient outcomes, safety, and recovery. Yet in many hospitals across the country, these critical choices are still guided by experience-based models rather than current evidence. For a profession that defines itself as patient-centered and science-driven, this approach contradicts the very standard of care we strive to uphold. True excellence in nursing is not defined by technology alone or by …

Why organizational culture eats strategy for breakfast in health care

Jeffry A. Peters, MBA

Conditions

January 22, 2026

Eighteen months ago, I learned something every patient hopes never to hear: that my cancer had returned. Years earlier, I had been treated successfully for prostate cancer. When my PSA began to rise again, I knew something was wrong. It took persistence and more than a few second opinions to confirm what my instincts already told me.

That journey eventually led me to a leading cancer center. I had already seen …

The economics of prevention: Why an ounce is worth a pound

Joshua Mirrer, MD

Conditions

January 21, 2026

We repeat the phrase “an ounce of prevention is worth a pound of cure” as if it were a folksy reminder to eat better or get a flu shot. But taken seriously, it is not a medical cliché. It is an economic law. And it exposes a devastating flaw in how modern societies choose to spend money.

Prevention is not the opposite of cure. Cure is essential, lifesaving, and often extraordinary. …

Methamphetamine-induced lung injury: the hidden diagnosis in South Texas

Shiv K. Goel, MD

Conditions

January 21, 2026

Methamphetamine has become an unavoidable presence in South Texas medicine. It shows up in our EDs, clinics, and ICUs, usually framed as a cardiotoxic, neurotoxic, or psychiatric problem. But over the past few years, a different pattern has kept surfacing in my practice: “pneumonia” cases that don’t behave like pneumonia, young lungs that look like ARDS, and hypoxic patients whose imaging and labs do not match the story, until someone …

The cost of ignoring pharmacist clinical judgment in health care

Muhammad Abdullah Khan

Conditions

January 21, 2026

A patient walks into the pharmacy with a prescription. The pharmacist reviews it, recognizes a serious problem, and contacts the prescriber. The prescriber dismisses the concern. The pharmacist has two choices: dispense a medication they know is wrong, or refuse and risk professional consequences. This happens daily. And health care pretends it doesn’t.

The power imbalance nobody discusses

Pharmacists are trained to be medication experts. They study pharmacokinetics, drug interactions, disease-specific dosing, …

10,000 steps before lunch: How a retired doctor models prevention

Gerald Kuo

Conditions

January 21, 2026

On a recent morning, my mentor, a retired breast cancer surgeon in his 70s, sent me a screenshot from his Apple Watch.

10,208 steps.
7.25 kilometers.
One flight of stairs.
Before lunch.

For him, it was just another day. For me, a younger volunteer and PhD student watching Taiwan age into a super-aged society, it was a quiet masterclass in what prevention really means.

This surgeon, Dr. Lin, is not just any retiree. For more than …

How a pregnancy test on a male patient revealed health care flaws

Eric Goldfarb

Conditions

January 20, 2026

My father’s last medical bill suggested he might be expecting a child. He was 88 years old. Somewhere in the hospital’s system, common sense had vanished. We found the pregnancy test charge only after paying the bill in full. My mother and I wrote to the hospital. The first reply was warm and procedural: Thank you for contacting us. We will submit this to Revenue Integrity. You should expect a …

Beyond burnout: the rise of the optimized, dissociated executive

Jenny Shields, PhD

Conditions

January 20, 2026

The man sitting across from me is a Titan.

In the taxonomy of the 2026 economy, he is the apex predator: an MD, a CEO, and the chair of multiple boards. He has navigated the post-pandemic attrition and the algorithmic market corrections that swallowed lesser firms. He is wildly, empirically successful.

But recently, he sat across from me, sharing a shade of rage I hadn’t seen before. He had just navigated a …

How fNIRS and light therapy are shaping precision psychiatry

Muhamad Aly Rifai, MD

Conditions

January 19, 2026

Light drives human biology. Morning light sets the daily clock. Daylight supports attention, energy, and mood. Evening darkness supports sleep. Modern routines disrupt that rhythm through indoor lighting, screens, night shifts, and rapid travel. Psychiatry sees the costs. Sleep disruption feeds anxiety. Circadian drift worsens depression. Cognitive speed and motivation fall when sleep timing slips. Most recently, screen time has joined circadian disruptors.

Light as a diagnostic tool

Light already powers diagnosis …

The emotional labor of volunteering in an aging society

Gerald Kuo

Conditions

January 19, 2026

Hospitals are not the only ones who rely on volunteers.

Nonprofits rely on them for aging programs. Faith communities rely on them for spiritual formation. Philanthropy relies on them for legitimacy. Even emerging “wellness” and “compassion training” industries rely on them for content and credibility.

But no one ever asks: Who sustains the sustainers?

For more than 20 years, I have watched hospital volunteers become the invisible infrastructure of modern care. We are …

Understanding the evolutionary mismatch in health and modern disease

Max Goodman, MD

Conditions

January 19, 2026

As a family medicine resident physician who practices primary care, it is my responsibility to be the first doctor a patient, their family, and their community may visit for any undifferentiated issue. No other field of medicine increases the life expectancy and the quality of life in a community as much as primary care, which provides more meaning to me than can be qualified. My objective is for people to …

Why Brooklyn’s aging population needs more vascular health specialists

Anil Hingorani, MD

Conditions

January 17, 2026

When I began my surgical training in the 1990s, vascular surgery looked very different than what it does today. At that time, only a small number of physicians specialized in treating blood vessel diseases, and even fewer practiced in Brooklyn. I chose to complete my education and surgical training here in New York so I could stay rooted in the community I care most about. As the second board-certified vascular …

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