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Urologist Tracy Gapin discusses their article “Is your medical career a golden cage?” Tracy explores the paradox of achieving professional success while feeling trapped in a demoralizing and insurance-driven health care system. …
Escaping the golden cage of traditional medical practice to find joy again [PODCAST]
When asked what I wanted to be when I grew up, the answer changed from ballerina to teacher to everything in between. One thing remained constant: I wanted to be a mother. I have narrowed my career aspirations to becoming a physician, but my desire to be a mom has been unwavering. In a climate where maternal mental health is so misunderstood, I constantly wonder what support I will have …
Why pediatricians are key to postpartum depression screening
I’ve spent my entire professional life practicing medicine, guiding patients through uncertainty, and translating complex science into actionable information that could be clearly understood. I thought I had a solid grasp on what it meant to face illness. I thought I knew how to navigate the medical maze and interpret all the jargon.
Nothing prepared me for the moment when I became a patient.
The diagnosis was prostate cancer.
Suddenly, I wasn’t the …
Prostate cancer genomic testing: a physician-patient’s perspective
In the first episode of The Pitt season 2, Dr. Robby reveals he’s taking a three-month sabbatical, his last shift before heading to a UNESCO World Heritage Site in Canada. For a primetime medical drama to feature a physician stepping away for three months signals something important: Sabbaticals are entering the cultural conversation about how doctors survive in modern medicine.
But here’s what the show doesn’t tell you: Most physicians can’t …
Why every physician needs a sabbatical (and how to take one)
Recent federal policy discussions have introduced a framework that would place health care affordability dollars into individual-controlled accounts rather than routing them through insurers or employer benefit plans. Still at the framework stage and requiring legislative action, the architecture being explored signals a potential shift in how health care purchasing power flows through the system.
Whether or not this specific framework advances, the direction of travel is clear. Health care …
Retail health care vs. employer DPC: Preparing for 2026 policy shifts
In Taiwan, the year 2026 marks our transition into a “super-aged society,” where more than 20 percent of the population is over 65. Yet what strikes me most is not the demographic milestone itself, but what it does to the dinner table.
During Lunar New Year gatherings, I often observe a tense choreography among middle-aged children. Who will take father to his cardiology appointment? Who will accompany mother during the day? …
Taiwan’s “Yi-Dong-Yang”: a preventive aging model for super-aged societies
The first denial arrived not with cruelty or malice, but with a phrase so familiar it barely registers as language anymore: “not medically necessary.” The cancer drug, recommended by oncologists and supported by evidence and standard of care, was rejected. No phone call. No physician-to-physician conversation. Just an automated letter and a bureaucratic pause inserted into a life that no longer had room for delay.
The family appealed. They fought. They …
The moral injury of “not medically necessary” denials
After years of leading palliative medicine departments, as a Fellow of the American Academy of Hospice and Palliative Medicine, I’ve had countless conversations that start the same way. A colleague in the hallway says, “Oh, palliative care—that’s so important. You all are so nice.” Or a hospital administrator tells me, “We wish we could give you more, but resources are tight right now.” Or my personal favorite: “Palliative care is …
What is palliative medicine and why is it so misunderstood?
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Kenneth Botelho, founding director of the doctor of medical science (DMSc) program at The College of St. Scholastica and a physician assistant, discusses his article “Federal graduate-loan caps threaten rural health care …
Capping student loans destroys the rural medical pipeline [PODCAST]
Can there actually be a medical profession with physicians as only employees in an industrialized corporate or socialized system with a union representing their collective interests? Does it matter, and should it matter? Are there still alternatives?
Asking another party, specifically the government, to solve major predicaments consuming the profession is not a plan. Worse, it is a clear sign of dependency and weakness. There is no other entity that can …
Is physician unionization the answer to a broken health care system?
Primary care providers and primary care medicine are on the downswing in the U.S., burdened with increasing demands of documentation and numerous complicated quality programs in the face of rapidly diminishing reimbursements. While the tribe is disappearing fast, enter its newest nemesis: artificial intelligence (AI).
You might wonder why AI is detrimental to primary care and primary care physicians. The common notion is that physicians, including primary care physicians, will be …
Will AI replace primary care physicians?
Most physicians sense it, even if they struggle to name it.
Something fundamental has changed in medicine. Not the science. Not the patients. Not even, at root, the doctors themselves. What has changed is the status of medicine as a profession, and with it, the psychological footing that once made the work bearable.
For much of the last century, medicine functioned as a profession in the classical sense. That meant more than …
The decline of professionalism in medicine: a structural diagnosis
The phrase “board-certified” once carried a universal meaning. A physician had met rigorous training and testing standards and could practice confidently anywhere in the country. That clarity has faded. Today, certification and recertification requirements differ not only by specialty but also by which board you happen to fall under. What was once a single national standard has splintered into a patchwork of rules, fees, and timelines that seem designed less …
The patchwork era of medical board certification
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician suicide prevention: a call to action.” Muhamad opens with the tragic losses of Dr. Nolan R. Williams and Dr. …
Physician suicide represents a silent epidemic demanding urgent reform [PODCAST]
One of the marks of a good physician is the ability to approach illness from two complementary angles. We bring scientific knowledge, training, and objectivity to understand what is happening in the body. But the work doesn’t end there. What truly elevates a clinician is the willingness to honor how the patient experiences their illness, the internal narrative that no lab test can measure.
This dual lens is not unique to …
How neurodiversity in relationships shapes communication
When my father-in-law died by suicide, our family did not just lose a person. We lost the gravitational center of a small universe.
He was a giant in my eyes. Not because of his curriculum vitae, though his was extraordinary, but because of the way he moved through the world: steady, modest, and relentlessly devoted to the people who needed him.
He had survived what should have broken a human being. As …
Physician suicide: a daughter-in-law’s story of loss and grief
“Doc, can you prescribe me some BPC-157 with sermorelin, and maybe semaglutide too?”
He didn’t come in asking about his sleep.
He didn’t mention that his last meal the night before was at 11:30 p.m., eaten in front of a laptop glowing with unanswered emails.
He didn’t bring up the statin he’d been taking for years, the creeping fatigue he’d started to normalize, or the way his waistline had slowly expanded as his …
Why lifestyle matters more than BPC-157 and semaglutide
Most recognize me from posts about deductive reasoning on KevinMD, but I never explain deductive reasoning’s effect on a conventional medical malpractice lawsuit. Here is how it affects such a lawsuit.
All medical malpractice lawsuits have four things in common:
How deductive reasoning changes medical malpractice lawsuits
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Professor and senior associate dean of engagement Janet A. Jokela discusses her article “Reflecting on the significance of World AIDS Day from the 1980s to now.” Janet shares harrowing memories from her …
Personal memories reveal the transformation of HIV care over four decades [PODCAST]
It doesn’t take much to understand that women have had it tough throughout history. While seemingly in our age there is near parity (with many women heads of state in Mexico, Italy, Moldova, Iceland, etc.), they only gained the right to vote in the U.S. 105 years ago (with the 19th Amendment to the Constitution), which was 50 years after Black men in 1870 (the 15th Amendment). There have always …
How blaming women for a baby’s sex persisted through history
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