By 11 p.m., my clinic was dark but my brain wasn’t. I found myself scrolling through my schedule for the next day: 22 patient visits, a pile of unsigned notes, two meetings squeezed into “lunch,” and a post-call morning that somehow still started at 7 a.m. None of these tasks were unusual, but what struck me was the growing tightness in my chest and the realization that I had quietly …
Addiction is no longer a clinical category. It has become the cultural baseline.
We used to think of addiction as something that happened to a few vulnerable people who “couldn’t handle” life’s pressures. Now it’s woven into everyday existence. Most of us reach for our phones before we reach for a breath. We chase stimulation without noticing we’re chasing. We live in a world that subtly trains us to crave.
Somewhere along …
As an internal medicine physician, I’ve spent years watching one quiet assumption extract more unpaid labor from physicians than anything else in our system. It’s not charting. It’s not meetings. It’s not metrics.
It’s call.
I wrote a post on my LinkedIn page about my thoughts regarding call. It resonated with many physicians, and I received many messages. It became clear that being “on call” is something that is rarely spoken about …
There is a general undercurrent of dissatisfaction with health care in America that is, shall we say, palpable. Many studies and statistical analyses support this notion but I think a broader view is both valuable and less abstract than a data set. We could go measure the angle of the Leaning Tower of Pisa and evaluate the foundational errors, but it doesn’t take that level of granularity to see that …
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Physician executive Christina Johns discusses her article “Modernizing health care with AI and workflow.” Christina explains how clinicians in the U.S. are facing unprecedented burnout due to administrative burdens that detract from …
An excerpt from 99 Ways to Die: And How to Avoid Them.
In response to this chapter, I expect to receive a battery of soaking wet letters from infuriated marine biologists, since each species deserves their own chapter, but my editor cut me off.
Flamboyant cuttlefish
The flamboyant cuttlefish is not to be confused with the flamboyant cuddle-fish, which does not exist. The cuttlefish, Metasepia pfefferi, looks like an orchid that ran …
Over the past decade, there has been a marked rise in adolescents and adults seeking autism evaluations. Many of these individuals are intellectually intact, verbally fluent, and professionally capable, yet have lived for decades with persistent social fatigue, sensory sensitivities, difficulty interpreting unspoken social rules, emotional overwhelm, rigid or all-or-nothing thinking, challenges with transitions, and extensive masking or camouflaging behaviors, all without a diagnosis. When they finally seek clarity, the …
“The danger isn’t that AI is too powerful; it’s that we stop questioning it.”
Artificial intelligence in medicine is often described as revolutionary, capable of diagnosing disease, predicting deterioration, and automating once-human decisions. But I want to suggest a different lens, one drawn not from technology, but from history.
Let’s go back to ancient Greece.
There, leaders turned to the Oracle of Delphi not for …
Every New Year arrives with its familiar rituals. We raise a glass, make a resolution, and offer a toast to things we hope will be different this time around: better habits, better balance, better health. We say “I’ll drink to that” as shorthand for optimism, an easy affirmation that the future is still negotiable and a longer life is possible.
Then along comes a map.
In basketball, when a player is called for a questionable foul, he may shrug and say: “Ball don’t lie.”
It means the game has a truth of its own. Reality asserts itself. Emergency medicine, unfortunately, rarely works that way.
We once spent most of our time with patients. Now a substantial portion of every shift is spent interacting with a screen, not because we prefer it, but because the system has evolved …
In the early 2000s, I included “drugs for mild hypertension” in my book, Money-Driven Medicine: Tests and Treatments That Don’t Work. By 2007, I proposed a Cochrane systematic review of randomized controlled trials (RCTs) to settle the debate. Cochrane is widely considered the “gold standard” of evidence-based medicine; its reviews can shift global clinical practice and multibillion-dollar drug markets.
In 2012, Cochrane published the systematic review of Pharmacotherapy for …
You can usually taste the excitement in the air during a first visit for pregnancy. It’s palpable. And the evidence for it is everywhere: the nervous fidgeting of hands. Do you place them on your lap or not-so-casually at your side? Paper drape sheet typically is balled up into tiny handfuls for better “grip” on this one-ply provider of modesty. And the quick glances back and forth between soon-to-be parents …
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Emergency physician Kenneth Ro discusses his article “Why midlife men feel unanchored and exhausted.” Kenneth explains why men between 40 and 60 often visit clinics requesting hormone testing when they are actually …
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If you’ve been practicing medicine for any length of time, you’ve likely felt that familiar moment of overwhelm when a patient walks in with a stack of printouts, a list of 30 questions, or a frustrated statement like, “Well, I did my research.” And if we’re honest, many of us feel our chest tighten just a little. We feel the time pressure. We feel the responsibility. And sometimes, we feel …
Consider Mrs. Chen, an 82-year-old woman discharged home after a minor ischemic stroke. On paper, her care plan was flawless.
Her physician intensified her antihypertensive regimen to protect vascular health (medication). Her well-meaning daughter, concerned about blood pressure, switched her to a strict low-sodium porridge diet, unknowingly slashing her protein intake (nutrition). Her physical therapist prescribed a daily walking program to rebuild confidence and strength (exercise).
Two weeks later, Mrs. Chen was …
We are hearing stories about mushrooms and MDMA and see clinics advertise ketamine. We hear of friends chasing a spiritual reset. Many in America feel the weight of depression, trauma, and addiction inside families. Psychedelics sit at the center of this pressure, with hope on one side and hype on the other.
KevinMD already published multiple essays on psychedelic medicine since 2022, including pieces on what physicians need to know, prudence …
Perhaps you are standing in the same place I once stood: From the outside, everything looks great, but on the inside, you’re running on fumes.
In my mid-40s, I was on the verge of becoming a full professor. Our dream house was under construction. My retirement plan was on track so I could stop working before 60. Our kids were grown and thriving, launching their own lives. On paper, life was …
My previous KevinMD article discussed a Cochrane Collaboration review that was completed in 2002 but was not published until 2006. This review examined three randomized controlled trials (RCTs) comparing anticoagulants with placebos or anti-inflammatory drugs for venous thromboembolism (VTE).
Along with my two co-authors, I found that across these three trials, anticoagulant-treated patients had six deaths out of 66 patients, compared to only one death out of 60 in the placebo …
“The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter out loud: this is the meaning of the word unspeakable. Trauma survivors want to forget, observers want to forget, and society as a whole wants to forget. It is too painful to do otherwise. We push trauma away and it rears up in other ways: Atrocities, however, …
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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article “The burden of the eldest daughter.” Jessie explores the unique psychological weight carried by firstborn women who are taught early on to …
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