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.
At age 80, I am an old man. I am also an experienced writer and voracious reader. I’ve been active in internet bulletin boards and social media interest groups since the 1980s—in what we used to call “users net” (USENET)—before the emergence of the World Wide Web.
In the 1980s, I briefly moderated a community on the internet called “Internet Village Elders.” The forum was intended to share information between librarians …
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Why Americans are failing to keep up with essential knowledge
I didn’t know who Emmitt Smith was. I didn’t know September was Prostate Cancer Awareness Month. I didn’t know what was going on in the weekend football game my husband was watching next to me on the couch. I was typing a clinic note because, in general, that is what I am doing if I am sitting down, regardless of the day or time. I am an academic physician with …
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Why a football legend’s prostate cancer advice sparked controversy
When a 26-year-old male with a history of tracheostomy arrived in our emergency department, the case appeared routine—until we uncovered an unusual detail. The patient’s sister had recently changed his tracheostomy tube at home but noticed something concerning afterward: the terminal piece, or the distal end of the tube, was missing. Despite searching, the piece couldn’t be found. This immediately raised concerns that it might be lodged within his trachea, …
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A missing tracheostomy tube fragment in an asymptomatic 26-year-old
In previous flu seasons, only about half of all Americans got the flu shot. Now we face pan-respiratory season, when we must worry about RSV, COVID, and the flu. The good news is these vaccines are lifesaving. The bad news is that if people don’t get them, they aren’t very effective and we might see fewer people get them at all.
As a clinical psychologist, I’ve spent my career thinking about …
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More than just the flu: Helping families and doctors prepare for pan-respiratory viruses
In the rapidly evolving landscape of health care, startups promising disruption often make headlines. But not all disruption leads to success. Forward Health, once hailed as a pioneer with its ultramodern clinics and AI-driven “doctor-in-a-box” CarePods, recently announced its abrupt closure. Despite raising over $650 million in funding, Forward’s inability to deliver on its ambitious promises is a case study in the pitfalls of prioritizing technology over patients.
The story of …
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Lessons from Forward Health: How direct primary care is the future of health care
I went to the emergency room 16 times for allergies and asthma as a college freshman. Each time I was given a prescription for an EpiPen, an auto-injector pen that administers a dose of epinephrine, used for the emergency care of an acute allergic reaction.
I was told to figure out what I was allergic to. I tried very hard but couldn’t. All my life, I have had hives, eczema, asthma, …
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From ER overload to genetic breakthrough: How allergies transformed my life and career
As someone working in the health care field, I have become all too familiar with the need for early intervention and how important it can be for a child’s overall progress.
There are parents who travel to larger states in search of better medical care and services, of which early intervention is a significant one. One particular case comes to mind, where Spanish-speaking parents sought early intervention for their daughter, but …
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The urgent need for better early intervention programs
As I lay abandoned on a stretcher in the hallway of my university hospital’s emergency room, I felt powerless in my ability to improve the quality of my care. Nurses bustled back and forth between patient rooms, too busy to give me the attention I deserved. My bladder was getting painfully full, but I was too weak to get up to use the restroom and unable to find anyone I …
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Top-down hierarchies in health care harm patients and health care workers alike
A patient came to see me recently (all my stories start like this: “A patient walked into the room…,” akin to “A guy walked into a bar…”), and she was so embarrassed to be there. That’s not uncommon for me. What was unusual was that she refused to talk about her bowel habits. She couldn’t say what her symptoms were or what her poop looked like. To her, it was …
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Why your doctor wants you to talk about poop — and it could save your life
The state of mental health care in the U.S. is dire, and with the telehealth prescription waivers projected to expire at the end of the year, it’s only going to get worse. If a temporary extension is granted, we can leverage technology and present data for clearer decisions moving forward, if it is not, we are leaving patients and clinicians without a clear understanding of how to care for their …
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How we can safeguard patients without restricting telehealth access
With sixteen years of experience working with dermatology residents, my role as a program coordinator has evolved immensely. Within the auspices of graduate medical education (GME), I manage the dermatology residency program, projects, and program budgets, assist in determining policies and procedures, and work closely with the program director with any and all directives given. I guess you could say that I am the person who makes sure residents “get …
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Ways that one can succeed in dermatology residency: words of wisdom from a program coordinator
It was that bewitching hour. 0300. Behavioral health unit/behavioral health intensive care unit.
She was a small young woman. Her eyes appeared black as coal, as if her soul had been sucked out repeatedly. There were bruises around her eyes, black and blue punch marks up and down her arms. Several superficial cuts on her forearm—self-destruction. She was quiet, almost invisible. She wanted to sit in the corner of her bed, …
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Abused and broken: her fight for survival in a behavioral health unit
For over twenty years, I’ve had a recurring nightmare: I’m back in medical training, and my patient is crashing. To save them, I must enter my medical orders into the electronic health record (EHR). The only problem is, there are no open computers. I could give a verbal order in a real-life emergency, but those aren’t the rules in this nightmare world. I go from computer to computer, begging for …
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The emotional toll doctors face: a book review
According to the National Institutes of Health, the majority of individuals experience several traumatic events in their lifetimes, but do they all develop post-traumatic stress disorder (PTSD)? If you question the general populace or the media, they would indicate that PTSD is extremely common. Although it varies by sub-population, for the general populace, 13 and above, the rate of diagnosed PTSD is 4 percent to 8 percent. It is highest …
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PTSD: Why trauma’s impact is more complex than you think
Recently, I encountered a stark reminder of the challenges facing our mental health care system. A 16-year-old Black boy came to us at Boston Community Pediatrics (BCP) in a state of crisis, expressing suicidal thoughts and a deep sense of fear. As part of our integrated behavioral health model, my mental health colleague and I immediately recognized the urgency of his situation. We arranged for an Uber to transport him …
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The urgent need for equity and accessibility in pediatric mental health care
I recently encountered a new patient, a seemingly healthy 25-year-old man who had just graduated from college and was working his first job. He was not a tobacco user and had no medical diagnoses, but shoulder and abdominal pain brought him to Mass General Brigham. After a series of tests, the diagnosis was clear: stage IV lung cancer.
As a lung cancer oncologist who has treated patients for 20 years, I’ve …
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Why rethinking cancer risk is critical to addressing rising cancer rates in young adults
In the weeks after her mother died, Stacy’s mind was filled with thoughts about things she believed she’d done wrong and ways she’d let her mother down. “I shouldn’t have gotten so impatient with her”; “I should have been kinder, should have spent more time with her.” She was even tormented by the inaccurate belief that she had caused her mother’s death by failing to “try harder to get her …
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The dangerous impact of cognitive distortions on grieving
An excerpt from Disabled Ecologies.
The multicolored poisonous waste disposed of by Hughes Aircraft Company was never just TCE, the most infamous ingredient. It was always a toxic soup: dozens of volatile organic compounds and heavy metals, contaminants with names like dichloroethylene, chromium, cadmium, and benzene. The chemicals were used in the early 1950s in the manufacture and cleaning of missiles that would travel thousands of miles overseas to …
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Toxic waste disaster: How Hughes Aircraft poisoned Tucson’s environment and people
As a patient advocate, I have witnessed firsthand the devastating effects of policies leading to untreated and undertreated pain. As a mother who has lost a child to drug poisoning, I have also witnessed how drug policy is driving an increasingly lethal street drug supply. With overdose deaths rising, well-intentioned policies have left many suffering without the medications they need for quality of life. Tragically, some patients, overwhelmed by unrelenting …
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Restoring compassionate pain care: a call to action
For years, the U.S. public has been hearing that prescription opioid pain relievers are always and forever a bad thing—and that doctors and big pharma companies are supposedly responsible for an epidemic of addiction and drug overdose-related deaths. However, these assertions are outright lies. Both the U.S. Centers for Disease Control and Prevention and the Veterans Administration know it.
The recent national opioid settlement is as bogus as a three-dollar bill—and …
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The real cause of the opioid crisis isn’t what you think
