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.
The day before the attack, a senior physician at a Catholic university hospital in Taiwan sat with young medical students at noon, talking not about lawsuits or hospital finances, but about Brahms. He loved four-hand piano pieces, especially Brahms’s Hungarian Dances, and he would explain how two players must breathe together, listen to one another, and balance passion with discipline. For him, this was also a lesson about medicine: You …
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Protecting elder clinicians from violence
I just read the new Cleveland Clinic Journal of Medicine introduction by its editor-in-chief, and it’s laying out the usual playbook: demonize lipoprotein(a) (Lp(a)), list all the terrible things it does, and hint that salvation is around the corner, pending results of a major pharmaceutical trial, of course.
It’s a neat narrative arc.
But it’s incomplete.
What’s missing is the one question almost no cardiology article seems willing to ask:
Why does Lp(a) exist …
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Why does lipoprotein(a) exist?
For years, I believed that the best clinicians were the ones who never stopped. We covered extra shifts, skipped meals, charted past midnight, and proudly wore exhaustion as a badge of honor. My patients were happy, my colleagues admired my work ethic, and I was quietly unraveling.
The slow slide into burnout
Burnout didn’t arrive like a crisis; it crept in as a constant background hum. I began to dread the pager’s …
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The myth of endless availability in medicine
Idaho has become the first state to end Medicaid funding for Applied Behavior Analysis (ABA) therapy. This marks a shift away from concerns about inflated billing and variable outcome metrics toward a model focused on measurable and inclusive care. As a pediatrician who participated in NIMH-RUPP trials and has observed the clinical evolution of ABA, I recognize the significance of Idaho’s decision. The state acted proactively rather than awaiting federal …
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A new autism care model in Idaho
He came to my office holding the results of his coronary CT scan. His eyes went immediately to the numbers, his voice tense: “Doctor, my FFR is 0.86. Do I need a stent?”
This is not an unusual question anymore. Coronary CT angiography with fractional flow reserve (FFR-CT) is rapidly becoming a common tool in cardiology. It gives us noninvasive insight into whether a coronary lesion is functionally significant. In plain …
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What an FFR-CT score means for your heart
For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an advance directive. And he did: It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.
But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, …
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Advance directives not honored: a wife’s story
During a casual conversation about mental health, a friend admitted something striking: “I stopped going to therapy because I’d leave feeling great, but by the time I actually needed what we talked about, like in the middle of an argument or a panic attack, I couldn’t remember any of it. It felt like throwing money away.”
This confession revealed a silent challenge in mental health care. The issue isn’t finding the …
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The therapy memory recall crisis
Most men have heard jokes about finishing too soon, but few talk about it seriously, even when it causes anxiety, frustration, or distance in their relationships. Premature ejaculation (PE) is one of the most common male sexual health concerns, yet it remains buried under stigma and silence.
As a urologist, I often meet men who have struggled quietly for years, wondering whether what they experience is “normal,” if it can be …
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A urologist explains premature ejaculation
She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …
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The hidden epidemic of orthorexia nervosa
Memory loss is one of the most common and anxiety-provoking complaints in medicine. Over the past five years, the evaluation of cognitive decline has become remarkably refined. No longer is memory loss assessed solely to “rule out dementia.” Today, clinicians have tools to detect the beginnings of Alzheimer’s disease or other neurodegenerative conditions before major symptoms appear, allowing patients to make informed decisions about their work, life, and health.
The first …
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Why early diagnosis of memory loss is crucial
Stimulant medications have long been considered the “gold standard” for treating ADHD. When I tell colleagues I don’t prescribe them, I often get pushback: “But it’s the first-line treatment for ADHD!” In my functional and integrative psychiatry practice, I am upfront: I do not prescribe stimulants for ADHD. For patients who are interested in stimulant treatment, I provide referrals to trusted colleagues who do. This decision is not about denying …
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Rethinking stimulants for ADHD
We all know high blood pressure and cholesterol can kill, but what about low bone mineral density? Bones are composed of calcium and phosphate, which is their mineral content. Bones low in calcium are said to have low bone mineral density, which can result in a condition known as osteoporosis. Osteoporosis develops over a lifetime and is impacted by your peak bone mass as a youth. Thus, most osteoporotic problems …
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Why young people need to care about bone health now
The algorithm flagged a potential drug interaction in milliseconds. It suggested an optimal dosing regimen based on kidney function, weight, and genetic markers. It even generated patient education materials in the right language and reading level. But the patient sat there, hands trembling, unable to ask the question that mattered most: “Am I going to die?”
That’s where artificial intelligence ends and where health care truly begins.
The seduction of technological solutionism
Health …
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Why health care needs empathy, not just algorithms
I used to whisper it into the dark, lying awake, watching the clock creep past 2 a.m. My body was exhausted, but my mind refused to stop sprinting, running a veritable marathon most of the night. When the sun finally pushed through the curtains, it didn’t feel like morning. It felt like failure, another day to muscle through on fumes.
Sometimes that was the hardest moment of the day. Little sleep …
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A doctor’s story of IV ketamine for depression
For decades, cholesterol (LDL, HDL, triglycerides) has been the central focus of cardiovascular prevention. But in recent years, another player has emerged: lipoprotein(a), or Lp(a).
Many patients have never heard of it, yet research shows it may be one of the most important genetic risk factors for heart disease.
What is lipoprotein(a)?
Lipoprotein(a) is a particle in the blood similar to LDL cholesterol, but with an added protein called apolipoprotein(a). This structure makes …
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Why you should get your Lp(a) tested
They tell me the physician’s art lies in the stitching of skin,
the analysis of shadows on X-rays,
and interpreting numbers in a medical chart.
Yes, there is skill involved.
a steady hand, a quick eye,
and a good memory for pathways and procedures.
But I wonder.
where, in the span of 20-25 minutes,
is the art that cannot be quantified
or coded?
It’s found in the stillness of listening,
in the weight of one person’s story
resting in another’s hands.
A doctor …
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Is modern medicine losing its soul?
Introduction: a crisis of pain
The opioid crisis is one of the most significant public health emergencies of our time, defined by staggering rates of addiction and overdose. Yet, behind the headlines is a story of profound and often overlooked human suffering. In an effort to save lives, public health policies were enacted to aggressively reduce opioid prescriptions. While well-intentioned, these policies have inadvertently precipitated a parallel crisis of iatrogenic harm, …
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The opioid crisis’s other victims
My son Gideon is almost 12 years old. He is funny in that sharp, unexpected way that catches you off-guard. He is deeply expressive and full of life. He gives love and joy more freely than most kids his age. He is curious and social. He is healthy, and I am grateful for it. We are endlessly proud of who he is.
And, our family constantly walks the edge of breaking …
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The need for pediatric respite care
When parents bring their children to the clinic, they often expect quick advice: “Eat healthy. Exercise more.” But after years in practice, I’ve learned those generic prescriptions rarely work. Families leave feeling uncertain, children feel pressured, and real changes at home are hard to sustain.
That’s why I focus on a family-centered, personalized approach. Nutrition is not just about a child; it’s about routines, traditions, and stresses that affect the whole …
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A better way to talk about kids’ nutrition
When most people think of seizures, they picture someone falling to the ground with violent shaking, the dramatic scenes we’ve seen in movies and television. While these tonic-clonic seizures (previously known as grand mal seizures) do occur, the reality is that many seizures look nothing like what Hollywood portrays. They are often subtle, easily missed, and can be mistaken for daydreaming or unusual behavior.
More than 3 million Americans have active …
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Many seizures don’t look like the movies
