My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood. I looked over my shoulder and froze. A…
My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood.
I looked over my shoulder and froze. A patient stood in the deserted hallway, blood streaking his arm from where he appeared to have ripped out an IV. A pair of bandage scissors hung loosely in his hand.
Medicare Advantage has become one of the most important parts of the American health care system. Designed as a privately administered alternative to traditional Medicare, the program allows insurers to manage coverage for older adults while receiving payments from the…
Medicare Advantage has become one of the most important parts of the American health care system. Designed as a privately administered alternative to traditional Medicare, the program allows insurers to manage coverage for older adults while receiving payments from the federal government. Supporters argue that Medicare Advantage can reduce unnecessary spending while giving seniors access to benefits that traditional Medicare may not fully provide.
A physician writes a prescription believing the clinical decision has been made. In reality, another decision-making process is just beginning. Between the prescription and the patient sits an increasingly powerful infrastructure of pharmacy benefit managers, insurers, formularies, rebate agreements, pharmacy…
A physician writes a prescription believing the clinical decision has been made. In reality, another decision-making process is just beginning.
Between the prescription and the patient sits an increasingly powerful infrastructure of pharmacy benefit managers, insurers, formularies, rebate agreements, pharmacy networks, prior authorization rules, and specialty pharmacies. Most physicians see only fragments of this system. Patients usually understand even less.
The result is a peculiar form of American medicine: The person making …
I write as a health care educator and author with thirty years of research experience and over three hundred papers published as author or co-author, several of them widely cited. In that role, I see thousands of emails and social…
I write as a health care educator and author with thirty years of research experience and over three hundred papers published as author or co-author, several of them widely cited. In that role, I see thousands of emails and social media postings every month from people whose lives are being destroyed by misdirected and frequently outright fraudulent U.S. public health policy on treatment of pain and addiction. The …
When a patient asks where to go for a knee replacement, a colonoscopy, or their mother's rehab stay, they have usually already looked. Not at the federal record. At the stars. Here is what the stars do not show. Our…
When a patient asks where to go for a knee replacement, a colonoscopy, or their mother’s rehab stay, they have usually already looked. Not at the federal record. At the stars.
Here is what the stars do not show. Our analysis of Centers for Medicare & Medicaid Services records found that 46 percent of U.S. nursing homes carry at least one federal civil money penalty on the current enforcement record, and …
A standard course of repetitive transcranial magnetic stimulation (TMS) for depression means coming to the clinic five days a week for four to six weeks, roughly 20 to 36 sessions. That is because response depends mainly on the number of…
A standard course of repetitive transcranial magnetic stimulation (TMS) for depression means coming to the clinic five days a week for four to six weeks, roughly 20 to 36 sessions. That is because response depends mainly on the number of sessions delivered, not on calendar time.
Esketamine (Spravato) carries a different but equally demanding logistical load. Under its FDA safety program, known as a Risk Evaluation and Mitigation Strategy (REMS), each …
Poor health can negatively impact any and all aspects of our lives, often discouraging us from participating fully in activities we otherwise would. It shouldn't be surprising, then, that those with worse health are also less likely to vote, or…
Poor health can negatively impact any and all aspects of our lives, often discouraging us from participating fully in activities we otherwise would. It shouldn’t be surprising, then, that those with worse health are also less likely to vote, or that voter participation is inversely associated with time spent in inpatient care. And while we may accept this at face value, the downstream consequences of this are often …
For ten years, I lived with my family, 45 minutes from the rolling clover fields and dairy farms of Lancaster County, Pennsylvania, iconic markers of a world defined by quiet tradition. Yet in the fall of 2026, this peaceful landscape…
For ten years, I lived with my family, 45 minutes from the rolling clover fields and dairy farms of Lancaster County, Pennsylvania, iconic markers of a world defined by quiet tradition. Yet in the fall of 2026, this peaceful landscape has become a dark microcosm of modern medicine’s greatest crisis: the weaponization of politics, the spread of bad-faith disinformation, and the collapse of public trust in the medical profession.
As more families depend on human milk banks to meet the vital health and nutritional needs of babies, these facilities should implement emergency response plans, similar to those in blood and tissue banks and other critical medical services. Human milk…
As more families depend on human milk banks to meet the vital health and nutritional needs of babies, these facilities should implement emergency response plans, similar to those in blood and tissue banks and other critical medical services. Human milk is a lifesaving resource for preterm, low-birth-weight, and critically ill infants, with the World Health Organization recommending pasteurized donor milk for babies who are unable to receive their …
Imagine if we only treated lung cancer and never tackled smoking. Is that what we're doing with depression? We always ask people struggling with depression to reach out. But maybe we should also ask whether anyone is within reach. Every…
Imagine if we only treated lung cancer and never tackled smoking. Is that what we’re doing with depression? We always ask people struggling with depression to reach out. But maybe we should also ask whether anyone is within reach.
Every October, Depression Awareness Month urges us to recognize the symptoms and seek help. As a physician, I support that message. As a public health and preventive medicine practitioner, I also ask …
A recent Guardian article described a troubling reality unfolding across England: Nearly 1 million people are waiting for ADHD assessments, approximately 295,000 are awaiting autism evaluations, and some National Health Service (NHS) regions have imposed minimum waiting periods of two…
A recent Guardian article described a troubling reality unfolding across England: Nearly 1 million people are waiting for ADHD assessments, approximately 295,000 are awaiting autism evaluations, and some National Health Service (NHS) regions have imposed minimum waiting periods of two years before patients can even be assessed. “Two-year waiting times highlight NHS struggle with rise in ADHD and autism awareness” reported that overwhelmed health systems are struggling to keep …
Canadian health organizations invite First Nations representatives to comment on services after budgets and priorities have already taken shape. Consultation can improve a proposal, but it offers limited influence when the decisions remain elsewhere. Health equity requires First Nations to…
Canadian health organizations invite First Nations representatives to comment on services after budgets and priorities have already taken shape. Consultation can improve a proposal, but it offers limited influence when the decisions remain elsewhere. Health equity requires First Nations to take the lead in services that affect their communities, supported by adequate resources and clear accountability.
For physicians, governance may seem distant from the examination room. Yet governance determines whether patients …
As a health care educator with three decades of experience in research and hundreds of published papers, I have written at some length both on KevinMD and in clinical journals, concerning the dangers of artificial intelligence in medicine. I have…
As a health care educator with three decades of experience in research and hundreds of published papers, I have written at some length both on KevinMD and in clinical journals, concerning the dangers of artificial intelligence in medicine. I have also recently written about the profound differences between meanings of the term “Red Flag” in legal versus clinical contexts. Moreover, I have declared that predictive algorithms on …
As medical students who will inherit and treat the health consequences of climate change, we are witnessing how it reshapes the physical and emotional landscapes of our generation. These fears are actively shaping how an entire generation plans its future,…
As medical students who will inherit and treat the health consequences of climate change, we are witnessing how it reshapes the physical and emotional landscapes of our generation. These fears are actively shaping how an entire generation plans its future, from whether to have children to where to live and work. Across the country, young people are experiencing what researchers have termed eco-anxiety: chronic stress, fear for the …
An emergency department can stabilize a mental health crisis. It cannot, by itself, provide the relationships, housing, and continuing support that sustain recovery. For First Nations patients in Canada, we should promote mental health and substance use services that communities…
An emergency department can stabilize a mental health crisis. It cannot, by itself, provide the relationships, housing, and continuing support that sustain recovery. For First Nations patients in Canada, we should promote mental health and substance use services that communities help govern, and patients can reach before, during, and after a crisis. For example, a patient receives instructions to arrange counseling, attend substance misuse therapy, and return if symptoms worsen. …
The One Big Beautiful Bill Act (OBBBA) lays bare a brutal truth about American health care: When coverage depends on politics, paperwork, employment status, and state budgets, people lose care, and some will die because of it. Cuts and administrative…
The One Big Beautiful Bill Act (OBBBA) lays bare a brutal truth about American health care: When coverage depends on politics, paperwork, employment status, and state budgets, people lose care, and some will die because of it. Cuts and administrative barriers to Medicaid, new hurdles for Affordable Care Act marketplace coverage, and continued failure to guarantee stable access to care all point in the same direction: Our fragmented system …
The first time I treated a newborn with the same congenital heart defect my unborn son was expected to have, I hesitated at the doorway. I couldn't stop picturing my own baby intubated and sedated, a fresh incision running the…
The first time I treated a newborn with the same congenital heart defect my unborn son was expected to have, I hesitated at the doorway. I couldn’t stop picturing my own baby intubated and sedated, a fresh incision running the length of his sternum.
I thought a terrifying fetal diagnosis would be the primary stressor of my pregnancy. I was wrong. The greatest obstacle wouldn’t come as a parent navigating her …
Consider what happened in Walker County, Georgia, in the fall of 2025. Multiple middle schoolers became ill after eating gummies at school, though even the eventual headcount was never fully settled, with local reports ranging from three to five students.…
Consider what happened in Walker County, Georgia, in the fall of 2025. Multiple middle schoolers became ill after eating gummies at school, though even the eventual headcount was never fully settled, with local reports ranging from three to five students. Emergency room physicians diagnosed a kratom overdose based on the clinical picture, and within hours the story was national: Kratom gummies had hospitalized children. Investigators collected one of the gummies …
Roughly half of American children receive their health care through Medicaid or CHIP. These programs were legislated to cover them, and the choice has been made (repeatedly, across decades and both parties) not to fund them at the level their…
Roughly half of American children receive their health care through Medicaid or CHIP. These programs were legislated to cover them, and the choice has been made (repeatedly, across decades and both parties) not to fund them at the level their aims require. Pediatricians did not make that choice and should not stop saying it is the wrong one.
However, that choice, and the confines it creates, defines the real-world conditions …
On the 13th floor of the Jen Chi station-front building in Taipei, a school bell rings. The room does not feel like a hospital. Older adults move through simple exercise, cognitive activities, music, conversation, and the small rituals that make…
On the 13th floor of the Jen Chi station-front building in Taipei, a school bell rings. The room does not feel like a hospital.
Older adults move through simple exercise, cognitive activities, music, conversation, and the small rituals that make a day feel like a day. Some need prompting. Some repeat a question. Some are stronger than their families expected. Nearby, caregivers finally have a little room to breathe.
