Modified DSM-5 opioid use disorder criteria for pain patients

Conditions
December 1, 2025

Two years ago, I asked, “Doctors diagnosing addiction: Are the blind leading the blind?”

The estimated rates of substance use disorder among clinical patients treated for pain vary greatly, depending on whom one believes. Studies also suffer from a widespread failure to address genetically mediated variability in minimum effective opioid dose between individuals. Thus, I have many times respectfully suggested that the entire body of literature on opioid …

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Rethinking opioid prescribing policies

Physician
December 1, 2025

As a pain management specialist, my intent is not to promote unchecked opioid prescribing or overlook the serious risks these medications pose. Instead, I advocate for viewing the full picture in patient care. Physicians, trained in medicine and its side effects, must be empowered to use their knowledge and direct observations, including subtle cues like body language and patient interactions during brief visits, to make tailored decisions. Documentation in charts …

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Understanding the deadly gaps in pediatric dental safety [PODCAST]

Podcast
November 30, 2025
YouTube video

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Pediatric anesthesiologist Irim Salik discusses her article, “The hidden danger in pediatric dental offices.” Irim reveals a terrifying oversight in ambulatory pediatric dental care: children are suffering neurologic injuries or dying during …

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A lesson in empathy from a young patient

Physician
November 30, 2025

Anyone close to me knows orthopedics has never been my cup of tea. I rarely studied it properly; somehow, my enthusiasm always remained low. No offence to the subject, but maybe it started the day I saw my best friend’s forearm break. Fractures have always made me uncomfortable. During one of our postings, we were asked to do a case presentation. A patient was assigned to us, and it happened …

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wRVU threshold risks in physician contracts

Finance
November 30, 2025

Many physicians do not seem to grasp the risks inherent in physician employment agreements that impose a minimum threshold of wRVU production. However, there can be many pitfalls in these agreements.

What is the effect of the threshold?

The first pitfall is determining the effect of a threshold. Some agreements provide a salary “assuming a minimum threshold of” some number of wRVUs. I have reviewed many agreements with a provision like that …

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My late ADHD diagnosis in med school

Education
November 30, 2025

“When people with ADHD are able to get the treatment that they need as soon as they’re diagnosed as children, it gives them the best chance to realize their full potential.” These were the words that hit me like a ton of bricks one day as my preceptor was talking about his experiences treating adult patients with ADHD. I was soaking up every bit of information as he was teaching …

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How online physician reviews impact your medical career

Physician
November 30, 2025

Have you ever wondered how a single online comment might shape your reputation as a physician? I have, especially after reading a review that sardonically suggested I had earned my medical degree from Amazon (the company, not the rainforest). The jab was clearly meant to sting. Although I regret the dissatisfaction behind it, it gave me pause. How much weight do we give these offhand remarks, and what do they …

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Why is compression stocking compliance low?

Conditions
November 30, 2025

Every cardiology clinic has them: patients with swollen, aching legs and bulging varicose veins. We talk about conservative management: exercise, leg elevation, and, of course, compression stockings. And almost without fail, patients smile politely, nod, and then admit at the next visit: “I couldn’t wear them. They’re too tight, too hot, too uncomfortable.”

The paradox of a simple solution

Compression stockings are one of the most effective noninvasive treatments for varicose veins …

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Why modern dentists must train like pilots [PODCAST]

Podcast
November 29, 2025
YouTube video

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Dentist Lincoln Harris discusses his article, “How cloud-based simulation training is revolutionizing dentistry.” Drawing on his background as a pilot, Lincoln exposes the critical training gap in modern dentistry, arguing that dentists …

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Why you need a GLP-1 exit plan

Conditions
November 29, 2025

I’ve seen clients start GLP-1 medications full of hope, and stop them feeling betrayed by their own biology. Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way: one step forward, five steps back.

We …

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Why midlife men feel unanchored and exhausted

Physician
November 29, 2025

Most midlife men don’t walk into our clinics asking for help. They walk in asking for labs.

They’ll tell us they’re “just tired,” “not as sharp,” or “feeling off.” They’ll blame work or age. They’ll ask for hormone testing or a quick fix. What they rarely say (and what most of us rarely ask about) is the deeper truth underneath the symptoms.

There is a silent crisis unfolding in midlife men, and …

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How medicine reflects women’s silence

Physician
November 29, 2025

My mother’s life was defined by silence. She was born in India. In a world where a woman’s worth was measured in duty: how well she cared for others, how quietly she endured. She was obedient. Her dreams were practical, her voice gentle. Never shared an opinion.

I used to think that by becoming a doctor (a woman with a career, a passport, a voice) I had escaped that silence for …

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Why not all ADHD generics are created equal

Conditions
November 29, 2025

A 2022 KevinMD article raised concerns about generic formulations of ADHD medications. The author described what many patients and families had already discovered: Not all generics are created equal. For those of us who lived through the substitutions, the difference was not abstract. It was a roller coaster that intruded on daily life, even on vacation.

The generic in question was manufactured by Mallinckrodt. Unlike Concerta, which uses an osmotic-controlled …

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Early Alzheimer’s blood test: Is it useful?

Conditions
November 29, 2025

In May, a published report indicated that changes indicative of Alzheimer’s disease (AD) were detected at age 24 via a blood test, which is increasingly available. These changes may begin earlier, but these were the study’s youngest participants. There are no medical treatments for these early manifestations, and aside from providing knowledge of a possible future and potentially causing anxiety, what value does the test hold? Unless a person has …

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How medical gaslighting almost cost a neurologist her life [PODCAST]

Podcast
November 28, 2025
YouTube video

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Neurologist Carolyn Larkin Taylor discusses her article, “How medical gaslighting almost cost me my life.” Carolyn shares her terrifying personal story of being dismissed by her long-time gynecologist, who labeled her cancer …

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Language doulas bridge care gaps

Physician
November 28, 2025

During health care encounters with patients from diverse linguistic and cultural backgrounds, there is always a concern about information getting lost in translation between health care providers and their patients. Language and cultural concordance significantly affect the quality and effectiveness of health care delivery. Although phone-in interpreters, with or without video capabilities, are accessible online, none can match in-person interpretation. Even if high-profile political conversations have adapted to artificially intelligent …

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The patient carryover crisis: Why discharge education fails

Conditions
November 28, 2025

I still remember the feeling of relief standing by my uncle’s bedside. The monitors were humming with steady rhythms; the surgical team was congratulating themselves on a textbook procedure. By all clinical metrics, he was a success story. The intervention worked. The pathology was addressed. He was “stable.”

We celebrated his discharge as a victory lap. We trusted that the packet of papers in his hand (filled with appointments, medication schedules, …

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Why diagnostic error is high in offices

Conditions
November 28, 2025

The National Academy of Medicine defines diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” Office-based practices are the predominant setting for malpractice claims related to diagnostic error.

Yes, office-based care settings.

Fast-paced, high-acuity emergency departments (EDs) have fewer malpractice claims related to diagnostic error than physician offices, according to recent research. Furthermore, 53 …

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The myth of no frivolous medical lawsuits

Physician
November 28, 2025

“No medical malpractice lawsuit is frivolous,” is the narrative echoed by plaintiff attorneys. Medical malpractice lawsuits are vastly underrepresented. Also, because frivolous lawsuits are too expensive to litigate, expense is a natural deterrent for filing one. Plaintiff attorneys have controlled this narrative for as long as I’ve been in practice since 1972.

Recently, I examined the veracity of this claim. Indeed, there are 66 million civil lawsuits filed in the …

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A pediatrician explains the real danger of food perfectionism [PODCAST]

Podcast
November 27, 2025
YouTube video

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Pediatrician Wendy Schofer discusses her article, “Why food perfectionism harms parents.” Wendy explains how the intense worry over family eating habits and ultraprocessed foods is often a symptom of a deeper issue: …

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