Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
A doctor spoke up about problems in his residency, and months later he was walked out in front of his patients. In this episode, Vasilii Khammad, a physician and researcher who came to the United States as a Fulbright Scholar, shares what …
He spoke up in residency, then got walked out in front of his patients [PODCAST]
Physicians are precise about the value of their time in exactly one context: when someone else is paying for it. In a contract negotiation that precision is real, the figure gets built from actual numbers, and nobody signs something that prices an hour below what it’s worth.
Then the negotiation ends. The same physician spends Tuesday evening at the kitchen table verifying insurance eligibility for the next morning’s schedule, and the …
The physician opportunity cost nobody puts on a bill
Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive.
What they do not know is that the research designed to help them recover more safely at home may never be completed.
In mid-July, the Agency for Healthcare Research and Quality (AHRQ) began notifying researchers across the country that dozens of active research grants would be terminated. As …
AHRQ grant terminations leave patients without answers
The story of medical malpractice litigation in the United States is the endless struggle to find meaning.
The United States is a litigious society. One out of every 230 Americans is a lawyer, and one out of every eight Americans will be involved in litigation in one way or another and will need a lawyer. There are 40 million lawsuits per year. Between 20,000 and 85,000 are medical malpractice claims. The …
Most medical malpractice lawsuits are meritless
Both lay dabblers and scholars of history repeatedly admonish us that history repeats itself. Historical context can help us understand and grapple with issues that have plagued and continue to plague humankind.
The United States is not alone in having a dubious record of misogyny and glaring inequities in the treatment of women and people of color. In recent decades, people have re-examined historical teachings through the lens of human rights, …
Maternal mental illness is still judged like witchcraft
Medical fields don’t evolve because someone discovers a new molecule. They evolve because someone notices something obvious that everyone else has learned to ignore. In developmental-behavioral pediatrics, what shaped my early career was four studies that ended up influencing the field more than I expected. I didn’t set out to be a contrarian. I simply had a habit of asking questions that didn’t fit the standard research template.
Before I turned …
Is asking the naive question a lost research skill?
Few psychiatric terms have migrated into everyday language as completely as “bipolar.” It is now routinely used to describe irritability, emotional volatility, and rapid shifts in mood. Yet this widespread usage reflects a fundamental misunderstanding of the condition itself.
At the center of the confusion is a mismatch of scale. The public conception of “mood swings” involves rapid fluctuation, changes occurring over minutes or hours. These shifts may be mild, or …
Mood swings and bipolar disorder are not the same thing
I was recently watching the wedding and honeymoon vlog of one of my favorite content creators. Weddings are fascinating milestones. It is probably the only moment in your entire life where you get absolutely every person you love gathered together in one single room. You are the undisputed center of attention. All eyes are on you, and the atmosphere is pure, concentrated love.
But as I was watching those perfect moments …
The one-dimensional doctor is going extinct
There is a question I have heard countless times throughout my career.
“Was the patient happy?”
It is usually asked with good intentions, but I have often wondered whether we are asking the wrong question. As physicians, our responsibility has never been to make every patient happy. We cannot promise antibiotics for viral infections, unnecessary imaging for reassurance, or pain medications simply because they are expected. Good medicine often requires uncomfortable conversations …
The patient experience question physicians get wrong
In medicine, we are trained to react to alarms. A monitor beeps. A CT scan lights up. A lab value crosses a dangerous threshold. We move.
Public health is harder. Sometimes the most important signal is not a siren, but a persistent hum. That is where mpox appears to be now.
The latest World Health Organization situation report should not send clinicians into panic, but it should pull mpox back into …
Mpox in 2026 no longer looks like 2022
Walk into any tumor board and you can watch the problem resolve itself for one hour a week. A radiologist, a pathologist, an oncologist, and a surgeon each hold a piece of the same patient. It is one of the most valuable hours a hospital spends, and one of the few moments when the system concedes that a single physician cannot see an entire case.
Outside that room, we still build …
Team-based diagnosis is already how modern medicine works
If solid evidence reveals that major, long-held beliefs rest on wobbly pillars of false assumptions, how can we convince others to jettison such beliefs and embrace novel approaches? What can we learn from the tragic case of Ignaz Semmelweis in this regard?
In 1847, one in six mothers perished from childbed (puerperal) fever at the Vienna General Hospital where Dr. Semmelweis worked. In some months up to 30 percent of mothers …
Why evidence alone doesn’t change minds
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
A nurse survived a violent assault at work, then watched her hospital treat her like a liability, not a victim. In this episode, June Garen, a retired psychiatric and operating room nurse and …
Nurses are getting assaulted at work and no one listens [PODCAST]
ADVERTISEMENT
Not long ago, I wrote a Sensible Medicine article about AI called “I invented a headache to test AI and here is what I found.” I concluded that for diagnosing my headache (and a few other conditions), AI got things wrong quite often. When given full history of my problem, it did well, but a typical patient doesn’t know the pertinent negatives and positives to provide the GPT. False-positive …
Why using AI to write articles needs an audit trail
During my years in clinical dentistry, I repeatedly met patients whose oral disease had been causing symptoms long before they reached a dental office. Some had mentioned bleeding gums to another health care professional but did not understand that the symptom required evaluation. Others had lived with painful chewing, loose teeth, or persistent dry mouth while managing diabetes, cardiovascular disease, or multiple medications. By the time they sought dental care, …
Medicine keeps treating oral health as someone else’s job
An excerpt from Medicine Versus Politics: Three Tales of Patient Survival.
Deception has always been a weapon, but in our time it has become a system. In medicine especially, where facts should be the most trusted currency, lies can wound as surely as disease itself. Repetition, amplification, and manipulation turn rumor into “truth” at a frightening pace. When politics co-opts this process, the consequences are not merely theoretical; they can …
Medical misinformation arrives before the physician does
Medicine has always evolved
Every generation of physicians has witnessed change. New instruments replaced older ones. New imaging techniques revealed what could once only be imagined. Laboratory medicine became increasingly accurate. Minimally invasive procedures reduced recovery times. Digital records replaced paper files. Today, artificial intelligence is beginning to assist physicians in ways that seemed impossible only a few years ago.
For many people, these changes suggest a simple conclusion: Technology will eventually …
Clinical judgment is what turns information into medicine
Ethics education differs from other disciplines because its main goal is not to transmit information but to encourage moral reasoning. When students leave an ethics course, we hope they will be better equipped to analyze competing values, evaluate evidence, and justify their conclusions, not merely adopt those of the instructor. When you think about it, the teaching of ethics is itself an ethical act that can carry responsibilities extending beyond …
What ethics education owes students when evidence changes
Until recently people who smoke cigarettes were presented with a simple choice: continue smoking and worsen the risk and severity of tobacco-related disease or make another quit attempt. The doctor would ask, “Do you believe that you are ready to quit smoking?” Both doctor and patient would be relieved when the answer was “no.” The doctor was given back some valuable time …
Tobacco harm reduction changes the talk with your doctor
I recently had the opportunity to speak with a group of neurogastroenterologists who practice at a major referral center. These specialty physicians treat people with complex digestive disorders such as gastroparesis, abnormal motility, and irritable bowel disease. They also treat patients with illnesses categorized as “functional gastrointestinal disorders,” where no specific physical or lab abnormality can be identified. The people who have these disorders can get very frustrated and unhappy …
How specialists can handle difficult patients
Get free updates delivered free to your inbox.
