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Rural doctors hit a ceiling around 35 patients a day, and hiring more clinicians will not move it. Tod Stillson, a family physician, medical device inventor, and health care entrepreneur, argues that the …
What happens when physicians cede AI to direct-to-consumer startups [PODCAST]
Ensuring a patient escort has long been a standard safety requirement for discharge after outpatient anesthesia. The rule is increasingly difficult to satisfy for patients who live alone. Even when a loner patient can arrange for someone to closely oversee them at home until the effects of anesthesia have completely worn off, which is generally presumed to be a 24-hour period after administration, they cannot always ensure someone to physically …
How a self-driving car medical escort could work
The emergence of artificial intelligence (AI) in health care is reshaping how clinical teams diagnose, document, and deliver care. Adoption is rising quickly, with the American Medical Association reporting that two in three U.S. physicians already use AI tools in practice, a 78 percent increase in just one year. To keep pace with this acceleration, health care organizations must focus on building and maintaining clinical trust in the technology before …
Clinician trust in AI is not a one-time milestone
It has been 20 years since the term “value-based care” (VBC) entered the health care lexicon.
VBC was supposed to transform health care. It promised to move the system away from fee-for-service (FFS), a model that rewards volume over outcomes, toward a future defined by prevention, efficiency, better patient results, reduced waste, and lower costs. Two decades later, that promise remains largely unfulfilled. Despite years of pilots, policy pushes, and payment …
The real reason value-based care has not delivered
Mental health is often discussed as if it belongs to a certain kind of person. Someone who can articulate their feelings clearly. Someone who can describe anxiety, name sadness, or explain what feels off. But this way of thinking leaves out an entire group of people whose emotional lives are just as real, even if they are expressed differently.
People with intellectual disabilities experience stress, frustration, loneliness, and joy in deeply …
Mental health in intellectual disability is real, not less
The history of psychiatry is often a story of our own impatience. When we look back at the era of the ice-pick lobotomy, we tend to view it as a distant, primitive horror. But if we look closer, the impulse behind it remains very much alive. It was the dream of the “quick fix,” the belief that if we could just physically alter the brain, we could bypass the messy, …
Psychedelics in psychiatry are not a neural reset
If GLP-1 drugs are the breakthrough of this decade, diet may be the most overlooked way to enhance their effect.
These medications have transformed the treatment of obesity and type 2 diabetes, delivering levels of weight loss and glycemic control that were once unimaginable. They are, without question, one of the most important pharmacologic advances in modern medicine.
But amid this progress, we are overlooking a simpler and more fundamental question. Have …
Diet and GLP-1 drugs work better together
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Most physicians spend more time fighting their software than seeing patients, and piling on new tools has not fixed it. Grace E. Terrell, a physician executive, argues that decades of layering electronic health …
Why every new health care tool keeps making the job harder [PODCAST]
There are experiences that do not ask to be understood right away. They ask to be felt.
On Teshima Island in the Seto Inland Sea of Japan, tucked quietly away from the rhythm of daily life, sits Les Archives du Cœur, The Heart Archive, by Christian Boltanski. It is, in essence, a collection of heartbeats. Thousands of them, recorded, stored, and offered back into the world as sound, light, and memory. …
Finding meaning in medicine at a career’s quiet edge
There is a topic that has been avoided since the beginning of the Age of Enlightenment in medical discourse. Nothing to do with diagnosis, prognosis, or treatment protocols, but about the invisible human nature that holds patients together when science runs out of answers. That conversation is about faith.
I personally did not have it for a long time. For most of my thirty-five years in medicine, I kept faith neatly …
What happened when I brought faith into medicine
I remember the moment I understood I would have to write this story.
I was in Berlin with my girlfriend, wandering the city hand in hand, stopping for coffee near the Tiergarten with no real plan. We decided to visit the Jewish Hospital, the Jüdisches Krankenhaus. I had heard the name so many times in my family, and now I was just a few metro stops away.
We entered beneath the old …
Why do physicians write fiction?
While protein has dominated the nutrition conversation over the past decade, fiber is rapidly gaining ground as more consumers recognize its role in preventing disease and promoting overall well-being. From digestive health and weight management to heart health, blood sugar control, colon cancer prevention, and even reducing inflammation, the benefits are hard to ignore.
Yet most Americans average only 50 percent of optimal fiber requirements, with most consuming just 15 grams …
How to eat more fiber without the bloating
Whether the spread of bird flu to dairy cows, pigs, cats, dogs and seals or the spread of COVID-19 to deer, minks and zoo animals, the press is often mum about zoonotic viruses when they jump species.
Who, for example, knows that Ebola can spread to dogs, pigs and antelopes? Is non-reporting of virus activity to forestall panic or protect commercial markets?
The spread of animal viruses is caused by domestication, warfare, …
Why the press stays silent on zoonotic viruses
Years ago, when I was the only otolaryngologist in Columbia County, Pennsylvania, I treated a young boy with allergies. We had tested him, confirmed his sensitivities, and gotten him stable: a daily antihistamine, a nasal steroid spray, and allergy shots he received in my office. He was doing well. Then, at the end of one summer, he went back to school and fell apart. His controlled allergies flared. His asthma …
Your sinus infection may not be an infection
For more than three decades, I prescribed Schedule II stimulants to children and adolescents with ADHD. I did it carefully, consistently, and always within clinical standards. Yet throughout those years, I carried a quiet, persistent fear, not of harming patients, but of being misinterpreted by the Drug Enforcement Administration (DEA).
That fear wasn’t irrational. It was structural.
The DEA’s enforcement posture has long treated volume as suspicion, clinical judgment as potential misconduct, …
DEA fear is reshaping how doctors prescribe
After nearly four decades in medicine, I have become convinced that one of the greatest threats facing American health care is not a lack of scientific advancement. It is the growing imbalance between what our health care system excels at and what it often neglects.
Modern medicine has achieved extraordinary successes. We routinely save patients from heart attacks, strokes, severe infections, trauma, and many cancers. We transplant organs, replace joints, implant …
Why scientific medicine alone is not making us healthier
For many years, the medical establishment has argued, and in my view correctly, that addiction is a legitimate neurobiological condition that may often require long-term pharmacologic treatment, including with an opioid such as buprenorphine or methadone. This is not, in itself, a controversial stance. However, when the subject turns to pain, whether acute or chronic, many of the same institutions abruptly change their tone and, more importantly, their mindset. Pharmacologic …
The double standard at the heart of chronic pain treatment
Gen X (roughly 1965 to 1980) grew up as “latchkey kids” with no constant internet, more independence, figuring things out through trial and error. They often developed real resilience from facing hardships without much handholding. Gen Z (1997 to 2012) entered a world saturated with technology, social media, instant information, and a big emphasis on mental health. Many are thoughtful about emotional well-being but can be less practiced …
Youth online gambling is the new opioid crisis
Last week, KevinMD published my blog titled “The anticoagulant standard of care nobody tested.” This week I’ll continue with a discussion of patients who may have been harmed by anticoagulants.
In 2001, two co-authors and I initiated a systematic review of “Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism.” The Cochrane Database of Systematic Reviews delayed publishing it until 2006. Because of the delays, Medscape General …
Heparin for acute coronary syndrome: a closer look
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The same Robert Kennedy Jr. who sued Monsanto over glyphosate in 2017 is now defending an order to expand its production. What does a functional medicine physician do with that? Shiv K. Goel, …
MAHA has the right diagnosis and the wrong treatment plan [PODCAST]
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