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Physician voices

What Gold Star families need beyond flags and funerals

At 2 a.m. on Saturday, Oct. 3, 1970, someone started pounding on our apartment door. My mother thought it was a prank. She had ignored the buzzer downstairs because neighborhood kids occasionally rang doorbells in the middle of the night.…

At 2 a.m. on Saturday, Oct. 3, 1970, someone started pounding on our apartment door. My mother thought it was a prank. She had ignored the buzzer downstairs because neighborhood kids occasionally rang doorbells in the middle of the night. My uncle arrived with his service pistol drawn, expecting trouble.

Instead, he found two Air Force officers standing at the door. One was a lieutenant colonel. The other was a chaplain. …

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What Gold Star families need beyond flags and funerals

Conditions and diseases

Patient education after the visit is a design problem

A patient can leave a medical appointment with an explanation, a printed instruction sheet, and a question that has not occurred to them yet. The question may arrive while arranging a ride, talking to a spouse, or looking at the…

A patient can leave a medical appointment with an explanation, a printed instruction sheet, and a question that has not occurred to them yet.

The question may arrive while arranging a ride, talking to a spouse, or looking at the calendar the evening before a procedure. It may be simple enough that the practice answers it many times a week. For that patient, at that moment, it is the missing piece …

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Patient education after the visit is a design problem

Health technology

AI psychosis hits hardest in a first episode

Researchers at Vanderbilt University Medical Center have published one of the first large looks at what is being called AI psychosis. In a study in JAMA Psychiatry, they reviewed the records of more than 215,000 patients who received mental health…

Researchers at Vanderbilt University Medical Center have published one of the first large looks at what is being called AI psychosis. In a study in JAMA Psychiatry, they reviewed the records of more than 215,000 patients who received mental health care at Vanderbilt between December 2022 and April 2026. They identified 28 people whose psychosis was linked to chatbot use.

Twenty-eight is a small number, about 0.013 percent of patients. …

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AI psychosis hits hardest in a first episode

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Patient voices

Losing a mother to cancer, and the long wait for the end

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She was the most important person in my life. My mom. The woman whose hands had held mine Before I understood the meaning of holding on, Whose voice was woven into the fabric of my childhood, Whose presence made the…

She was the most important person in my life.

My mom.

The woman whose hands had held mine
Before I understood the meaning of holding on,
Whose voice was woven into the fabric of my childhood,
Whose presence made the world
Feel a little less frightening.

Then came the words no family is ever prepared to hear.
Metastatic colon cancer.

It had already traveled through her body,
Quietly taking pieces of the woman
Who once seemed to know no exhaustion.

She had …

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Losing a mother to cancer, and the long wait for the end

Health technology

How to catch AI scribe errors before you sign the note

Ambient AI scribes have earned a place in a lot of emergency departments, and I understand why. Documentation in emergency medicine is relentless, and anything that gives time back at the end of a shift gets attention. Some of the…

Ambient AI scribes have earned a place in a lot of emergency departments, and I understand why. Documentation in emergency medicine is relentless, and anything that gives time back at the end of a shift gets attention.

Some of the hype holds up. A single-center study in JMIR AI this year followed more than 10,000 emergency encounters over 13 months and tied scribe use to about 73 seconds less documentation …

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How to catch AI scribe errors before you sign the note

The Podcast by KevinMD

AI, standing orders, and the 9 p.m. call medicine still cannot handle [PODCAST]

A patient with a urinary tract infection calls at 9 p.m. and gets told to call back in the morning. Frustrated patients default to the emergency room instead. Tod Stillson is a family physician, health care entrepreneur, and founder and…

Listen on Apple Podcasts · Spotify

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A patient with a urinary tract infection calls at 9 p.m. and gets told to call back in the morning. Frustrated patients default to the emergency room instead. Tod Stillson is a family physician, health care entrepreneur, and founder and CEO of ChatRx. This episode is based on his article …

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AI, standing orders, and the 9 p.m. call medicine still cannot handle [PODCAST]

Conditions and diseases

Cultural humility in psychiatry begins with curiosity

Quite recently, I requested a colleague to proofread a piece of my writing. When I asked for feedback, his reply through the text bubbles on WhatsApp read: "I have not been chanced to go through it." The meaning of it…

Quite recently, I requested a colleague to proofread a piece of my writing. When I asked for feedback, his reply through the text bubbles on WhatsApp read: “I have not been chanced to go through it.”

The meaning of it was perfectly clear. Yet I caught myself correcting his sentence almost automatically in my head. Once I caught myself in the act, I stopped abruptly. I found myself wondering whether the …

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Cultural humility in psychiatry begins with curiosity

Physician voices

The physician retention problem nobody wants to touch

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I keenly remember the day one of our partners said he was quitting as soon as possible (no new job lined up, no plan). His dad had died just days before, and he said he simply didn't know how to…

I keenly remember the day one of our partners said he was quitting as soon as possible (no new job lined up, no plan). His dad had died just days before, and he said he simply didn’t know how to keep going. He needed a break, and this was his way out.

For those in private practice, this story likely hits a nerve. Life happens. Physicians hurt and struggle, and often …

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The physician retention problem nobody wants to touch

Health policy

What a baby’s gene therapy owes to curiosity-driven research

Some research starts with an obvious destination: a disease to treat, a test to build, a technology to improve. Other research begins much earlier, with a question about how nature works and no clear application in sight. The difference can…

Some research starts with an obvious destination: a disease to treat, a test to build, a technology to improve. Other research begins much earlier, with a question about how nature works and no clear application in sight. The difference can make the first kind of research seem more useful and the second more difficult to justify. But by the time a scientific problem has a recognizable clinical or technological solution, …

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What a baby’s gene therapy owes to curiosity-driven research

Health policy

Low-value care wastes billions. Clinicians can say no.

In a previous article, I admitted that my criticism of modern medicine had become too broad. I have received excellent care from physicians who looked up from the computer, asked questions, and made me believe they were listening. Exceptional doctors…

In a previous article, I admitted that my criticism of modern medicine had become too broad. I have received excellent care from physicians who looked up from the computer, asked questions, and made me believe they were listening. Exceptional doctors still exist. That admission does not mean the larger problems have disappeared. Caring matters, but caring alone cannot repair the American health care system.

Blaming individual doctors and nurses for the …

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Low-value care wastes billions. Clinicians can say no.

The Podcast by KevinMD

Patients on ventilators have things to say, and no way to say them [PODCAST]

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Only 4 in 10 caregivers say a doctor asked how the patient prefers to communicate. The patients who cannot answer often have the most to report. Chris Ross is a speech-language pathologist and school administrator. This episode is based on…

Listen on Apple Podcasts · Spotify

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Only 4 in 10 caregivers say a doctor asked how the patient prefers to communicate. The patients who cannot answer often have the most to report. Chris Ross is a speech-language pathologist and school administrator. This episode is based on her article “Communication access is a patient safety issue,” …

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Patients on ventilators have things to say, and no way to say them [PODCAST]

Drugs and prescribing

Are 12-step programs maligned because they sell nothing?

Twelve Step programs like Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous are free, self-supporting, and do not advertise. That's why many do not know about them and their success rate. Instituted in the 1930s, such programs promote no drugs and…

Twelve Step programs like Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous are free, self-supporting, and do not advertise. That’s why many do not know about them and their success rate. Instituted in the 1930s, such programs promote no drugs and use no psychiatric or psychology experts, relying instead on peer-to-peer healing and often meeting in church basements.

In the last decade, drugmakers and insurance companies, distressed by all that non-prescription health …

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Are 12-step programs maligned because they sell nothing?

Medical education

Continuing medical education needs a tutor, not a lecture

Like most physicians, I have earned a great many continuing medical education credits in rooms where I learned very little. A slide deck, a speaker reading the slides aloud, a ten-question quiz at the end that anyone could pass by…

Like most physicians, I have earned a great many continuing medical education credits in rooms where I learned very little. A slide deck, a speaker reading the slides aloud, a ten-question quiz at the end that anyone could pass by recognizing the longest answer. The credits counted. Whether my practice changed is another question.

I am an endocrinologist and a geneticist. Both fields move quickly. Genetic variant classifications get revised, new …

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Continuing medical education needs a tutor, not a lecture

Health technology

Mental health apps could unite psychiatrists and therapists

Today I had the privilege of speaking at The Chicago School about technology and serious mental illness. We covered apps, wearables, virtual reality (VR), and prescription digital therapeutics. But one question rose to the center of our conversation, and I…

Today I had the privilege of speaking at The Chicago School about technology and serious mental illness. We covered apps, wearables, virtual reality (VR), and prescription digital therapeutics. But one question rose to the center of our conversation, and I haven’t stopped thinking about it.

If a psychiatrist “orders” an app that requires therapeutic work, how does that therapy actually happen?

This is not hypothetical. The FDA recently cleared Motivista, the first …

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Mental health apps could unite psychiatrists and therapists

Conditions and diseases

What we are saving when we keep a father alive in the ICU

He was critically ill. During one conversation, his wife told me that their young children believed their father had gone out of town for work and would be home soon. They were too young, she felt, to understand why he…

He was critically ill. During one conversation, his wife told me that their young children believed their father had gone out of town for work and would be home soon. They were too young, she felt, to understand why he was really away, or that he might not return.

Until then, I had been thinking about how to keep him alive. After that conversation, I found myself thinking about the children …

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What we are saving when we keep a father alive in the ICU

Medical education

A $480 editing fee and the fairness of academic publishing

After nearly four decades in medicine, I have had more than my fair share of encounters with academic publishing, some pleasant and some less so. I spent the earlier part of my career in academic medicine and, even after moving…

After nearly four decades in medicine, I have had more than my fair share of encounters with academic publishing, some pleasant and some less so. I spent the earlier part of my career in academic medicine and, even after moving into private practice, I never quite shook the urge to write. These days I gravitate toward essays and books, but working alongside students has pulled me back into case reports …

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A $480 editing fee and the fairness of academic publishing

Conditions and diseases

Responsible healthmaxxing starts with a stopping rule

Wellness culture has become very good at telling people what else they could measure, buy, restrict, stack, or optimize. The newer language of "healthmaxxing" packages that instinct into a single word. At its most extreme, it can turn an ordinary…

Wellness culture has become very good at telling people what else they could measure, buy, restrict, stack, or optimize. The newer language of “healthmaxxing” packages that instinct into a single word. At its most extreme, it can turn an ordinary life into an endless intervention: more supplements, more tests, tighter routines, higher scores, and less tolerance for uncertainty.

The criticism of that version is justified. A routine is not responsible simply …

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Responsible healthmaxxing starts with a stopping rule

Physician voices

AI diagnosis can list 100 causes but can’t examine you

The triage note read, "The patient wants her thyroid checked." On the stretcher, fully dressed, sat a 65-year-old woman with her family members at the bedside. She said she had been feeling weak and tired lately, so bad that even…

The triage note read, “The patient wants her thyroid checked.”

On the stretcher, fully dressed, sat a 65-year-old woman with her family members at the bedside. She said she had been feeling weak and tired lately, so bad that even her voice had turned hoarse. She’d never had any problems with her thyroid in her life, but she had looked it up; maybe it was her thyroid or anemia. That was …

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AI diagnosis can list 100 causes but can’t examine you

Physician voices

Prior authorization delays run on 3 clocks, not just 1

When a surgeon tells a patient, "You need surgery," the patient understandably hears that the next step is scheduling it. Inside the practice, however, an entirely different process is just beginning. The clinical decision must be converted into documentation. The…

When a surgeon tells a patient, “You need surgery,” the patient understandably hears that the next step is scheduling it. Inside the practice, however, an entirely different process is just beginning.

The clinical decision must be converted into documentation. The documentation must be translated into the language of a payer’s policy. The request must reach the organization that actually controls the decision. Only then does the formal review begin.

Prior authorization is …

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Prior authorization delays run on 3 clocks, not just 1

Drugs and prescribing

Does nicotine cause cancer? What clinicians should say

A patient considering a nicotine patch asks, "Doesn't nicotine cause lung cancer?" A reassuring answer should not minimize nicotine's risks. It should explain why a nicotine patch and a cigarette are not medically equivalent. Our survey in Ukraine suggests that…

A patient considering a nicotine patch asks, “Doesn’t nicotine cause lung cancer?” A reassuring answer should not minimize nicotine’s risks. It should explain why a nicotine patch and a cigarette are not medically equivalent.

Our survey in Ukraine suggests that this distinction warrants attention. Healthy Initiatives collected 1,538 responses to a questionnaire targeting health care professionals between October 2025 and September 2026. Asked to identify the most harmful components of smoking, …

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Does nicotine cause cancer? What clinicians should say

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