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Health technology

AI chatbots and psychosis: Families see the harm first

A new scoping review in npj Digital Medicine should be read by every clinician who treats serious mental illness. Diel, Torous, and colleagues reviewed 119 articles on the mental health harms of large language model chatbots. They sorted the harms…

A new scoping review in npj Digital Medicine should be read by every clinician who treats serious mental illness. Diel, Torous, and colleagues reviewed 119 articles on the mental health harms of large language model chatbots. They sorted the harms into five categories: direct psychiatric harm, behavioral and relational harm, cognitive harm, safety failures, and governance risks. Psychosis and severe mental illness came up again and again as the …

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AI chatbots and psychosis: Families see the harm first

Conditions and diseases

Hearing screening in primary care is a single question

We measure blood pressure before a patient has a stroke. We check cholesterol before a coronary event. We evaluate vision before impairment interferes with driving or reading. So why is hearing treated differently? For many people, the last routine hearing…

We measure blood pressure before a patient has a stroke. We check cholesterol before a coronary event. We evaluate vision before impairment interferes with driving or reading.

So why is hearing treated differently? For many people, the last routine hearing test they remember was in elementary school. Decades pass before anyone checks again, often after the problem has become impossible to ignore. Conversations are frustrating, family members are repeating themselves, and …

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Hearing screening in primary care is a single question

Health technology

After-hours charting isn’t a backlog. It’s a team problem.

The last patient leaves around six. Dinner happens, eventually, and the kids go down around eight. The laptop comes back out after that, open to a stack of notes from a day that had exactly zero room in it for…

The last patient leaves around six. Dinner happens, eventually, and the kids go down around eight. The laptop comes back out after that, open to a stack of notes from a day that had exactly zero room in it for finishing them.

Two-fifteen was the closest thing to a gap today, and a nurse used it to grab labs. Four-thirty had five minutes, spent walking a worried mother back to the …

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After-hours charting isn’t a backlog. It’s a team problem.

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Conditions and diseases

Autism behavior therapy needs a physician in the room

This month, the Centers for Medicare and Medicaid Services (CMS) announced a new 173-page toolkit to help states ensure more effective and less costly autism care for children. The launch came as government data shows spending on care increased by…

This month, the Centers for Medicare and Medicaid Services (CMS) announced a new 173-page toolkit to help states ensure more effective and less costly autism care for children. The launch came as government data shows spending on care increased by 421 percent between 2021 and 2025, far outpacing the 67 percent growth in the number of children receiving services. It also followed recent investigations by the New York …

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Autism behavior therapy needs a physician in the room

Health technology

AI and physician judgment: the risk when AI is mostly right

For many physicians, the first truly useful encounter with generative AI has been remarkably mundane. It takes notes. Ambient AI listens to the encounter, organizes the conversation, drafts the clinical note, and gives the physician something increasingly scarce in medicine:…

For many physicians, the first truly useful encounter with generative AI has been remarkably mundane. It takes notes.

Ambient AI listens to the encounter, organizes the conversation, drafts the clinical note, and gives the physician something increasingly scarce in medicine: time. That is a genuine accomplishment. But it may also have created a misleading picture of where clinical AI is headed.

The next generation of AI will not simply document what …

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AI and physician judgment: the risk when AI is mostly right

Conditions and diseases

Physicians and the death penalty: There is no humane way

"Do No Harm" is perhaps the most famous medical maxim. But reciting it is one thing; living by it is another. Sometimes, the question of "harm" is up for debate. Throughout history, physicians have lent their knowledge to all manner…

“Do No Harm” is perhaps the most famous medical maxim. But reciting it is one thing; living by it is another. Sometimes, the question of “harm” is up for debate. Throughout history, physicians have lent their knowledge to all manner of atrocities, warfare, torture, and mass sterilization, often justified under the supposedly noble pursuit of “reducing harm.”

Capital punishment or the death penalty is another instance of this dilemma. Doctors shouldn’t …

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Physicians and the death penalty: There is no humane way

The Podcast by KevinMD

Why patients stop trusting doctors who listened to them [PODCAST]

A patient says her hip has hurt for a while. Whether she leaves trusting her doctor depends on what happens next. Alan P. Feren, a retired surgeon, health care consultant, and patient advocate, separates active listening, which makes a patient…

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A patient says her hip has hurt for a while. Whether she leaves trusting her doctor depends on what happens next. Alan P. Feren, a retired surgeon, health care consultant, and patient advocate, separates active listening, which makes a patient feel heard, from careful listening, which changes the reasoning. This …

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Why patients stop trusting doctors who listened to them [PODCAST]

Conditions and diseases

Blood sugar and brain aging start long before diabetes

Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years.…

Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years. What most of us, myself included, haven’t been saying nearly often enough is anything about the brain, and a study published this summer in Molecular Psychiatry is a good reason …

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Blood sugar and brain aging start long before diabetes

Drugs and prescribing

What did the tirzepatide study actually test?

If you take Ozempic, Wegovy, Mounjaro, or Zepbound, or you are simply trying to make sense of GLP-1s (glucagon-like peptide-1) and GIPs (glucose-dependent insulinotropic polypeptide), you may have seen a recent Medscape article asking whether GIP really adds any benefit…

If you take Ozempic, Wegovy, Mounjaro, or Zepbound, or you are simply trying to make sense of GLP-1s (glucagon-like peptide-1) and GIPs (glucose-dependent insulinotropic polypeptide), you may have seen a recent Medscape article asking whether GIP really adds any benefit in type 2 diabetes. It is a fair scientific question. The problem is that the headline makes the answer sound much clearer than it is.

The study behind the article, …

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What did the tirzepatide study actually test?

Conditions and diseases

Why is psychic pain treated as a symptom instead of pain?

There is a conceptual inconsistency in contemporary medicine that I have become increasingly unable to reconcile. Psychiatry recognizes psychic pain as a genuine clinical phenomenon, and suicidology has long recognized unbearable psychological pain as integral to suicidal states. Neuroscience has…

There is a conceptual inconsistency in contemporary medicine that I have become increasingly unable to reconcile. Psychiatry recognizes psychic pain as a genuine clinical phenomenon, and suicidology has long recognized unbearable psychological pain as integral to suicidal states. Neuroscience has simultaneously demonstrated that nociception, affective pain, reward, motivation, salience, stress responsivity, and emotional regulation are interconnected biological processes.

Yet when psychic pain becomes intolerable, psychiatry has remarkably little therapeutic infrastructure directed …

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Why is psychic pain treated as a symptom instead of pain?

Physician voices

Diagnostic overshadowing and the war in her throat

The referral came from a mental health clinic. A woman had been putting the hose of a handheld vacuum cleaner into her mouth, pushing the nozzle toward the back of her throat, and turning it on. She had done this…

The referral came from a mental health clinic. A woman had been putting the hose of a handheld vacuum cleaner into her mouth, pushing the nozzle toward the back of her throat, and turning it on. She had done this more than once a day for several days. The clinician who examined her found bruising and abrasions throughout her mouth. She was referred to me because her mouth and throat …

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Diagnostic overshadowing and the war in her throat

Physician voices

Why do charity commercials leave clinicians uneasy?

Every night on mainstream streaming platforms, I see the same rotation of charity commercials: protect dogs, save Syrian children, shelter American runaways, support childhood cancer care, preserve wildlife. Each one asks for a small monthly donation (99 cents, $5, $19),…

Every night on mainstream streaming platforms, I see the same rotation of charity commercials: protect dogs, save Syrian children, shelter American runaways, support childhood cancer care, preserve wildlife. Each one asks for a small monthly donation (99 cents, $5, $19), and each one insists that without your contribution, the suffering continues.

As a physician, I don’t respond to the emotional script. I respond to the ethical one. And the ethical script …

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Why do charity commercials leave clinicians uneasy?

Physician finance

Revenue cycle management is more than medical billing

Ask an independent practice owner who handles the revenue cycle and the answer is usually the name of a billing company. Ask what that company actually does each month and the answer gets shorter. Claims go out. Payments get posted.…

Ask an independent practice owner who handles the revenue cycle and the answer is usually the name of a billing company. Ask what that company actually does each month and the answer gets shorter. Claims go out. Payments get posted. Denials get worked. Statements get mailed. That is medical billing, and it is valuable work. It is not the same thing as managing the revenue cycle, and the space …

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Revenue cycle management is more than medical billing

Health technology

Why AI fails in health care: Your data is the problem

Health care has never had more data. The industry generates approximately 30 percent of the world's data volume, and that share continues to grow faster than nearly every other industry. Electronic health records, claims systems, pharmacy records, lab results, care…

Health care has never had more data. The industry generates approximately 30 percent of the world’s data volume, and that share continues to grow faster than nearly every other industry. Electronic health records, claims systems, pharmacy records, lab results, care management notes, social determinants of health data, wearable devices, and patient-generated information are producing an unprecedented volume of information about the patients we serve.

At the same time, health care …

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Why AI fails in health care: Your data is the problem

The Podcast by KevinMD

Some relationships work like medicine. Others work like a diagnosis. [PODCAST]

A patient came in with weight gain nobody could explain. Every test came back fine. Shiv K. Goel is an internal medicine and functional medicine physician. This episode is based on his article "How relationships affect health, seen from the…

Listen on Apple Podcasts · Spotify

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A patient came in with weight gain nobody could explain. Every test came back fine. Shiv K. Goel is an internal medicine and functional medicine physician. This episode is based on his article “How relationships affect health, seen from the exam room,” published on KevinMD. He treats the people …

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Some relationships work like medicine. Others work like a diagnosis. [PODCAST]

Conditions and diseases

Cancer care in Ghana: Poverty is the true malignancy

As an incoming fifth-year dental student beginning my clinical internship at Tamale Teaching Hospital, the major tertiary referral center for northern Ghana, I expected to refine my surgical hand and master diagnostic pathology. The fine instructors at the department made…

As an incoming fifth-year dental student beginning my clinical internship at Tamale Teaching Hospital, the major tertiary referral center for northern Ghana, I expected to refine my surgical hand and master diagnostic pathology. The fine instructors at the department made this possible, but I also got to witness firsthand the brutal arithmetic of health care access in the northern parts of Ghana.

She first presented to our oral and maxillofacial …

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Cancer care in Ghana: Poverty is the true malignancy

Physician voices

The insurance maze that single-payer health care would end

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One day, my mother suddenly was unable to finish her sentences. She was admitted to the local hospital, where a CT and MRI revealed multiple lesions. Ultimately, she was diagnosed with a glioblastoma. The neurosurgeon told us she was too…

One day, my mother suddenly was unable to finish her sentences. She was admitted to the local hospital, where a CT and MRI revealed multiple lesions. Ultimately, she was diagnosed with a glioblastoma. The neurosurgeon told us she was too old to operate on and recommended hospice, adding that she was unlikely to live more than six months. At another hospital, she was offered radiation, chemotherapy, and infusions, as her …

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The insurance maze that single-payer health care would end

Health technology

Digital noise in health care is fragmenting clinical focus

Walk into any exam room today, and you'll find more than a conversation between a clinician and a patient. Behind every visit is a steady stream of digital interactions: marketing messages, electronic health record (EHR) alerts, patient portal messages, pharmacy…

Walk into any exam room today, and you’ll find more than a conversation between a clinician and a patient. Behind every visit is a steady stream of digital interactions: marketing messages, electronic health record (EHR) alerts, patient portal messages, pharmacy notifications, clinical decision support prompts, and administrative tasks, all competing for a clinician’s attention. Health care professional (HCP) media is more than just banner advertising; when delivered thoughtfully, it is …

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Digital noise in health care is fragmenting clinical focus

Physician voices

Moral agency in medicine is being squeezed by payer audits

Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then…

Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then triggers payer audits, denials, and clawbacks (recoupments) of already-paid claims, which feeds into declining reimbursement. Multiple sources discussed below, from Medicare data, physician surveys, CMS actuarial analyses, industry reports, …

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Moral agency in medicine is being squeezed by payer audits

Conditions and diseases

Why choose sleep medicine as an intellectual frontier

The hidden agenda of medical school curricula is loud and clear: Acuity equals status. Students are taught that the "best and brightest" belong in the windowless trauma bays of the ER or the high-pressure theaters of the OR. In this…

The hidden agenda of medical school curricula is loud and clear: Acuity equals status. Students are taught that the “best and brightest” belong in the windowless trauma bays of the ER or the high-pressure theaters of the OR. In this antiquated hierarchy, sleep medicine is often paternalistically patted on the head and labeled a “lifestyle” specialty, the medical equivalent of a quiet retirement.

It’s time to call out this misconception. As …

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Why choose sleep medicine as an intellectual frontier

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