Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Pediatrician and certified coach Jessie Mahoney discusses her article “Why physician wellness programs must evolve beyond institutions.” Jessie reflects on her seventeen years leading in-house wellness initiatives and argues that while institutional …
Wellness requires safe spaces outside the medical system [PODCAST]
I just signed my first attending contract.
It should feel like pure celebration. Mostly, it does. But it is also a moment that forces reflection. For first-generation physicians, the hardest part of the journey often is not medical school or residency. It is learning how to navigate what comes after, inside systems we were never born into.
You are just as capable, compassionate, and prepared as anyone else. You have worked harder …
First-generation physician: Navigating the first attending contract
An excerpt from NOMERGENCY: Reclaiming Focus and Calm from False Urgency.
Your heart plummets.
It’s 4:55 p.m., five minutes until freedom, five minutes until you’re finally out the door to go and try that restaurant your friends have been raving about for months. But you’ve already caught a glimpse of the new e-mail from your boss, and it cannot be unseen.
The subject line reads: “Take a quick look?”
Your stomach twists.
Maybe I …
Workplace boundaries: How to stop answering e-mails at 5 p.m.
In the emergency department, you learn to function under pressure. You compartmentalize. You prioritize. You override your own nervous system in order to keep someone else alive.
During COVID, that skill became oxygen.
We worked in zones of four to eight critical patients, all unstable, all needing constant vigilance, or we were assigned to the lobby and hallways, managing 50 or 60 patients triaged as “non-critical,” knowing any one of them could …
Lowercase PTSD: Why emergency staff are still hypervigilant
Modern medicine can transplant organs, cure hepatitis C, and deploy artificial intelligence to read radiology scans. Yet one of the most effective life-saving interventions in clinical medicine, treatment for tobacco dependence, is still delivered inconsistently. More than 28 million Americans continue to smoke cigarettes. Evidence-based treatments are widely available, inexpensive, and highly cost-effective. But across health systems, physicians rarely deliver them in a systematic way. By every measure, physicians are …
Improving tobacco treatment in clinical practice
One of us (NB) has been reasonably conscientious about his health for the past 50 years. He sees his PCP twice a year and has tried to set an example for his patients by focusing on diet and exercise. I have done well, except I need a little work on stress reduction and sleep hygiene. Curiously, in 50 years and more than 100 office visits to health care providers, no …
The mouth as a gateway: Why oral health matters for physicians
In today’s clinical oncology practice, the saying “no two cancers are alike” is more relevant than ever. I recently treated two patients with very similar advanced non-small cell lung cancer (NSCLC) who were both critically ill. However, molecular profiling revealed distinct genetic drivers for each case, leading to very different, highly customized treatment plans.
Patient presentation and initial assessment
Both patients, in their late 60s and never-smokers, presented with weight loss, worsening …
EGFR vs. ALK: How molecular profiling defines lung cancer treatment
I called my old professor the other day to ask a very specific question about the Geriatric Depression Scale and expressed to him a big frustration on my end on how we are no longer able to perform such complex assessments among our patients, especially in primary care. During residency, we are taught to take thorough histories and perform physical exams by the book, but in reality, it is very …
The lost art of connection: Why medicine needs to slow down
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Occupational medicine physician and life coach Claudine Holt discusses her article “Nervous system dysregulation vs. stress: Why ‘just relaxing’ doesn’t work.” Claudine challenges the common advice to treat burnout with self-care like …
Why “just relaxing” fails when your nervous system is stuck in survival mode [PODCAST]
For years, the U.S. has felt the impact of ever-rising health care costs while facing decreasing access, affordability, and worsening clinical outcomes, as compared to other countries. Multiple disruptive forces increasingly plague our health care system, our workforce and workplaces, health care facilities, health care consumers, …
The health care economic crisis: Why the system is failing in 2026
Consider a common scenario. A 65-year-old patient presents with intermittent chest discomfort present for several days and no prior history of heart disease, including among family members. The physical exam is unrevealing. An EKG and cardiac enzymes are negative. The clinician explains, “I do not see anything concerning. Given your age and symptoms, this is likely reflux. Let us have you wait three hours after eating before retiring for the …
Clinical communication skills: the power of structured language
For many years the health care industry has operated under the “prestige” hiring model. We have been led to believe that to solve the crisis of patient safety and quality, we basically need more of the “top-tier” talent and specialists for MDs, more PhD-level nurses, and highly credentialed execs.
But we are now in the first quarter of 2026 and the data tells a different story. In spite of record spending …
The health care credentialing gap: Why top-down hiring fails
Health care works best when it solves real problems in real lives. That is why recent research on ketamine therapy for chronic pain deserves attention. The peer-reviewed study looked at 20 adults living with chronic pain who also struggled with substance misuse. The results suggest that carefully designed pain treatment may help more than pain alone. It may also improve mood and support recovery from substance misuse. In a …
Ketamine therapy for chronic pain and substance misuse
Families worry about stock market crashes. Retirees check their portfolios, track dividends, and follow market headlines. But in aging societies, the event that truly destroys a household’s stability rarely happens on Wall Street. It happens in the bathroom. An older adult falls.
I have seen this sequence unfold many times. The patient survives the hospital stay. The fracture is treated, medications are adjusted, and discharge instructions are printed. Clinicians feel relieved …
How a broken hospital-to-home transition harms older adults
The clink of ice in the glass had been an evening “wind down” routine ever since the pandemic. It had served as a way to drown remnants of stress that bubbled up throughout the course of the day. This “routine” developed over weeks, but eventually evolved into dependence, addiction even, he worried. I need to do something about this before I lose it all, he thought one morning upon waking …
Kratom vs. 7-OH: Understanding the potency gap and risks
Six months ago, I encountered a challenge I never expected: a robotic-assisted radical prostatectomy. Even now, writing about it feels surreal. Cancer rearranges life without warning, and surgery, regardless of how “minimally invasive” brochures describe it, alters you in ways only understood through experience.
The post-op instructions said that, within hours of surgery, I needed to stay active. That sounded simple enough beforehand. But no one asked about my fitness …
Navigating postoperative complications and post-surgical depression
In the late 1990s, a U.S.-funded study randomized HIV-positive pregnant women in Bangkok, Thailand, to either a placebo group or a group treated with a short course of AZT. At the time, AZT was the standard of care in the U.S., and researchers knew the medication protocol worked at reducing mother-to-child HIV transmission by nearly 70 percent. The study looked at whether a shortened protocol could meaningfully reduce …
Repeating history: the ethics of the new Guinea-Bissau hepatitis B study
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, characterized by intrusive memories (flashbacks, nightmares), avoidance of reminders, negative mood changes (fear, anger, detachment), and heightened arousal (easily startled, irritability). The diagnosis of PTSD requires symptoms lasting over a month causing significant distress or impairment, and not due to substances or other conditions.
The five types of post-traumatic stress disorder
There are …
Understanding the types of PTSD and how to treat them
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Hematologist-oncologist Khushali Jhaveri discusses her article “What the research really says about infrared saunas.” Khushali shares her personal journey from skepticism to advocacy after experiencing the profound physiological shifts of infrared heat …
Heat therapy activates proteins that repair cells and protect the heart [PODCAST]
I have spent years watching the development of quality programs. What began as a way to ensure patient safety has gradually given way to an independent group of individuals whose job it is to interpret regulations and monitor those interpretations. In the process, the clinical richness of medicine has been lost. Judgment, narrative, and context matter less than forms and metrics. The work has shifted away from the bedside and …
The 9 laws of health care quality: Why metrics miss the point
Get free updates delivered free to your inbox.
