Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Is the new oral Wegovy pill a breakthrough or a risk most patients never hear about? Shiv K. Goel, an internal medicine and functional medicine physician, joins the show to unpack his KevinMD …
Oral Wegovy sounds easy, but the reality is more complicated [PODCAST]
The recent record snowstorm in New England got me all in a deep wintery nostalgia. I contacted my friends back in Boston who have been living there for well over 40 years to get their perspectives, and it brought back memories of living on the East Coast and surviving the seemingly interminable long winters there before I moved to California in the late 1980s. Most prominently in my memory is …
Surviving a hospital blizzard as a physician on call
She came in having done the work. She had watched the clinic videos. Read the website. She knew the name of the proprietary technique for knee replacement that the surgeon’s practice was advertising. She used it correctly in the first sentence of our consultation. What she could not tell me was what the approach actually did differently, which structures it spared, or why it might matter for her specific anatomy …
Knee replacement marketing undermines informed consent
We turned pharmacies into the backbone of public health during coronavirus disease 2019 (COVID-19). Then we went back to paying them like retail stores. The result is what I think of as the pharmacy paradox. We expanded their role without changing the economics that sustain them. Now, across the country, those same pharmacies are closing, quietly and disproportionately in the communities that need them most.
In 2021, the corner drugstore ceased …
Pharmacy closures threaten our entire public health system
Intro
This is not a story of a 28-year-old successful serial entrepreneur, nor a work of personal development literature. It is rather an auto-dissection of a very regular and tired doctor who was arrogant enough to co-found a medical startup and become its chief executive officer (CEO) without having any qualifications for it whatsoever.
It is also not a story of great success (yet) merely because the journey is in its diapers …
Pathogenesis of a medical startup: a physician’s diary of daring, doubting, and doing it anyway
We enter the cathedral of medicine with a specific architecture of the soul: high ambition, perfectionism fueled by a productive neuroticism, and a boundless capacity for self-sacrifice. For many of us, the “best years” (the physical and cognitive prime of our 20s and 30s) are traded for the fluorescent hum of the wards and the weight of six-figure debts. This financial burden does more than strain the bank account; it …
The existential crisis of aging in medicine
Calls to declare family physicians the “backbone of health care” are emotionally appealing, but they do not withstand scrutiny. When we examine training pathways, cost structures, insurer incentives, and real-world performance, a different picture emerges, one in which many other clinicians are better trained for the populations they serve and, critically for insurers, far cheaper. This is not an attack on family physicians. It is a call for accuracy in …
Rethinking the role of family physicians vs. specialists
Your hospital recently adopted a new piece of technology. Maybe it was an electronic health record (EHR) module. A patient monitoring upgrade. A documentation tool. A new device in the operating room (OR). Think about what happened next. Some of your colleagues embraced it. Others resisted. The nurses figured out workarounds within a week. The information technology (IT) department sent three emails about training sessions that nobody attended. Six months …
Health care investing demands thorough clinical diligence
You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptoms warranting a specific imaging study, medication, or procedure. You know what they need. The evidence is clear. But instead of moving forward with care, you are forced into a gauntlet of prior authorizations, peer-to-peer reviews, …
Administrative burden is driving severe physician burnout
I have practiced medicine for 45 years. In that time I have learned that the biggest threat to a patient is not a missed diagnosis. It is a missed owner. Every patient has a story. Most of them have a complicated one. Multiple doctors, multiple medications, multiple specialists, multiple systems. And in all of that complexity, nobody steps forward and says: I own this patient. I will follow the thread …
Patient ownership is the key to a better health care system
May is AANHPI Month. As we celebrate the heritage, resilience, and contributions of Asian American, Native Hawaiian, and Pacific Islander communities, I also think of a poorly recognized health disparity within our community: lung cancer disproportionately affecting women who have never smoked. I was one of these women. Exactly five years ago in May 2021, I underwent major thoracic lung surgery that literally saved my life. The shocking diagnosis made …
Lung cancer in nonsmokers: a hidden health disparity
I grew up in a family of nine in New Delhi, where scarcity was our daily companion. We had no processed food, no artificial dyes, no glyphosate-laced cereal aisles stretching into infinity. We ate whole foods, not by philosophy, but by necessity. We moved our bodies, not by gym membership, but because life demanded it. We slept when the sun went down and woke when it rose. Circadian rhythm was …
Make America Healthy Again fails true functional medicine
There is a conversation happening in the medical-legal space right now, and most clinicians doing expert witness work are not part of it. It is about artificial intelligence (AI). Specifically about whether AI belongs anywhere near an expert witness report. I want to weigh in. Not as a technology enthusiast and not as a skeptic. As someone who has spent a decade as a practicing physician assistant, earned a law …
Expert witness credibility is destroyed by AI opinions
KevinMD recently published a paper describing the horrible impacts of health care lobbying in the U.S. This article assesses how effective the lobbyists have been in misdirecting four key legislators on health care-related committees of the U.S. House of Representatives and Senate.
As we will shortly discover, these highly influential lawmakers have parts of their story right. They also have parts desperately wrong, in ways that are destroying American medicine …
How health care lobbying distorts the U.S. opioid crisis
Obesity is an epidemic. Obesity, the predispositions for obesity, and the medical consequences of obesity are a major, if not the major, contributing factors to most medical conditions that plague American society. This is true for everything, including cancers. For instance, how many people smoke in the mistaken belief that smoking controls appetite, and how many cancers have obesity as a risk factor? There are genetic …
The evolving standard of medical weight loss and obesity treatment
It is no secret that the hyperscalers (e.g., Google Cloud, Amazon AWS, etc.) and the frontier AI labs (e.g., OpenAI, Anthropic, DeepMind) are devoting extraordinary attention, time, and capital to the AI buildout. The big four (Amazon, Google, Microsoft, Meta) have earmarked over $600 billion to this in 2026 alone. This trend has been the central theme in the equity market for the last three years or so. During this …
Artificial general intelligence and the future of surgery
I am sharing my experience of what I believe to be retaliation and the non-renewal of my contract at a major academic medical center in New York following my refusal to engage with inappropriate advances. As an international medical graduate who immigrated to the U.S. from Brazil at the age of three, I have devoted my life to medicine and patient care. Throughout my career, I have worked across multiple …
How an international medical graduate fought workplace retaliation
I began my physical medicine and rehabilitation residency in 1986, during the height of the acquired immunodeficiency syndrome (AIDS) epidemic. Fear shaped every personal interaction. We were still learning how human immunodeficiency virus (HIV) spread, how to protect ourselves, and how to care for patients who were as terrified of the diagnosis as they were of the disease.
Of all the many patients I saw that year, one has particularly stayed …
Unrecognized depression is a hidden crisis in medicine
Is science shaping the future of obesity care, or is pharmaceutical marketing now in the driver’s seat? After 15 years in bariatric surgery, I am witnessing a shift that should make us all pause. From the gold standard of laparoscopic results to the “liberal” use of new injections for runway aesthetics, we are at a crossroads. Are we truly treating a disease, or are we building a model of lifelong …
How weight-loss injections are changing obesity treatment
You open the chart. You start clicking. Labs here. Imaging there. Notes in four different tabs, none of them organized in any order a clinician would have chosen. Prior hospitalizations buried three levels down behind a menu that requires two clicks just to find the menu. Medication reconciliation on a screen you have to navigate to separately. Problem list in one place, active diagnoses in another, allergies somewhere a third …
Severe note bloat is fueling dangerous physician burnout
Get free updates delivered free to your inbox.
