Lipoprotein(a): the hidden cardiovascular risk factor

Conditions
November 3, 2025

Lipoprotein(a) [Lp(a)] was, until recently, an underrecognized cardiovascular risk factor. However, extensive research over the last 15 years (including vast genome-wide association studies) has confirmed an independent, causal link between elevated lipoprotein(a) levels and atherosclerotic cardiovascular disease (ASCVD). The science has shown that, despite their small size, Lp(a) particles can have a substantial health impact, and as many as one in every five individuals worldwide has elevated levels (defined as …

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Systematic neglect of mental health

Tech
November 3, 2025

For the third time in six weeks, a 34-year-old woman sat in an emergency room, desperate for help, and for the third time, the system failed to see her. It saw her dehydration, severe enough to require IV fluids. It saw her malnutrition, with electrolyte imbalances that required correction. It saw her vision problems, concerning enough for an ophthalmologic consultation. It saw everything except the person suffering. Each time, the …

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What teen girls ask chatbots in secret

Conditions
November 3, 2025

Teen girls are turning to chatbots, not for homework help, but for the questions they’re too afraid to ask anyone else. Not their parents. Not their teachers. Sometimes not even their closest friends. Instead, they whisper their fears into an empty chat box late at night, hoping the words land softly somewhere.

These aren’t silly or shallow questions. They’re small windows into a generation growing up online, trying to feel safe …

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Paraphimosis and diabetes: the hidden link

Physician
November 3, 2025

Paraphimosis is a urological emergency characterized by the inability to reduce a retracted foreskin over the glans penis, leading to vascular congestion, edema, and potential tissue necrosis. While paraphimosis can result from local trauma, poor hygiene, or iatrogenic causes, it is increasingly recognized as a clinical manifestation associated with underlying systemic disease, particularly diabetes mellitus.

Diabetes mellitus, especially when undiagnosed or poorly controlled, exerts profound effects on local tissue immunity, wound …

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Silicon Valley’s primary care doctor shortage

Physician
November 3, 2025

Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left a leading integrated health plan after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in an affluent U.S. region: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor.

I saw this …

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Why women in medicine need to lift each other up [PODCAST]

Podcast
November 2, 2025
YouTube video

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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article, “Why don’t women in medicine support each other?” She explores how scarcity, competition, and cultural conditioning have discouraged women physicians from advocating …

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The problem with laboratory reference ranges

Conditions
November 2, 2025

Tonight, my lab quietly changed what it considers a “normal” ApoB. On Monday, my patient’s ApoB of 98 mg/dL was comfortably green. On Tuesday, that same number was flagged high, a 30-point swing in the normal range overnight. No new evidence. No new trial. No public health crisis. Just a reference-range recalibration. And with that one quiet adjustment, millions of people who went to bed “normal” may wake up “abnormal.”

Reference …

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My persistent adverse reaction to an SSRI

Meds
November 2, 2025

Two years ago, I took a single 20 mg dose of escitalopram. Like millions of others, I was prescribed this antidepressant with the expectation that it would help, or at worst, have mild side effects that would pass. Instead, I experienced an immediate and severe adverse reaction. What I could not have imagined then was that the symptoms would not resolve; they have persisted and, over time, have only worsened.

Since …

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Why carrier screening results are complex

Conditions
November 2, 2025

Carrier screening has outgrown the language we still use to explain it. The rapid expansion of genetic testing has uncovered new layers of complexity in how conditions present, how results should be interpreted, and how patients experience and act on genetic information. To practice responsibly in this era of Genetic Carrier Screening 3.0, clinicians must understand not only what we are testing for, but how and why the results look …

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The crisis in modern autism diagnosis

Conditions
November 2, 2025

Autism was never meant to be diagnosed in 15 minutes.

The original vision, born in war-torn Vienna and postwar Baltimore, called for deep observation, multidisciplinary insight, and time. But somewhere between the ideal and the insurance code, we lost the standard.

Today, families navigate a system built for speed, not truth. And children pay the price.

The ideal vs. reality

In theory, pediatricians perform routine developmental surveillance. Screenings like the M-CHAT happen at 18 …

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A poem about being seen by your doctor

Conditions
November 2, 2025

I come to you with stories
I cannot name.
They press against my chest
waiting for a moment when
it feels safe
for them to be set free.

Pain is a language
I find difficult to speak aloud,
and the silence between us
feels like a waiting room
that will never empty,
pressing in on me,
catching my breath.

Two strangers,
white walls between us,
your eyes move toward the clock,
while mine look at my folded hands
resting in my lap.

I wonder
am I just a time …

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A doctor’s cure for imposter syndrome

Physician
November 2, 2025

Picture this: It’s your second month of residency, and you’re deep into a hectic ED shift. The pressure is on; you’re managing patients, making decisions, and trying to get better. Then, a mistake happens. Not one that results in significant harm to the patient, but maybe you miss a diagnosis, fumble a procedure, or are just overwhelmed in general. You know failure is part of growth, but that doesn’t make …

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Why humanity matters in medicine [PODCAST]

Podcast
November 1, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Certified coach and professor Kathleen Muldoon discusses her article, “The humanity we bring: a call to hold space in medicine.” She shares how her experience as a mother in the neonatal intensive …

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The childhood risk we never talk about

Conditions
November 1, 2025

Parents are inundated with advice and guidance on all manner of topics from an array of sources, but as a pediatric emergency medicine physician, I have been astonished to realize that parents hear almost nothing about the risk that actually poses the greatest threat of causing serious harm to their children. Approximately 10 percent of children in the United States experience sexual abuse, with one in four girls and somewhere …

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Small habits, big impact on health

Physician
November 1, 2025

As an internal medicine physician practicing in Southaven for more than eight years, I’ve learned one simple truth: Prevention is often more powerful than treatment. Every week, I see patients who wish they had come in sooner, before diabetes, hypertension, or heart disease quietly took hold. These conditions rarely appear overnight; they build over years of small imbalances in diet, stress, and lifestyle. The encouraging news is that small, steady …

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Are we scared of the wrong environmental toxins?

Conditions
November 1, 2025

Like you, I receive many emails concerning environmental toxins. Many of their claims are based on conjecture rather than scientific evidence and are delivered in a panicked manner, implying that you or a family member is doomed if you do not act quickly. It is especially annoying that they often target minor issues rather than major ones. For example, they have emphasized the danger of artificial sweeteners. However, if one …

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A doctor’s fight to repair, not replace

Conditions
November 1, 2025

Author note: This piece is based on a series of conversations with Dr. Meng Xu, one of China’s leading cardiac surgeons. His voice, vision, and uncompromising devotion to valve repair inspired every word. Though he prefers to remain out of the byline, his story is the one being told.

It was 11:48 p.m. on August 14, 2021, China’s Qixi Festival, a day for lovers and a celebration …

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How to prepare for your death [PODCAST]

Podcast
October 31, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Physician executive Joseph Pepe discusses his article, “A doctor’s guide to preparing for your death.” He shares practical and compassionate advice on planning for life’s inevitable end, from organizing essential documents and …

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The dismantling of public health infrastructure

Physician
October 31, 2025

Florida has seen over 1,300 pertussis cases this year, an 81 percent increase from 2024. I didn’t speak as a retired pediatrician. I spoke as a witness: a witness to systems retreat, a witness to the dismantling of public health, and a witness to the consequences of ignoring coordinated care.

The numbers are staggering. Over 1,500 confirmed measles cases in 2025. Three deaths, the first measles-related fatalities in the U.S. in …

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The case for therapeutic nicotine use

Conditions
October 31, 2025

When most people hear nicotine, they picture stained lungs, cigarette ads, or sweet-flavored vapes. But nicotine isn’t tar, benzene, or formaldehyde. It’s a potent nicotinic acetylcholine receptor agonist with real neurochemical effects, and in carefully selected patients, it can help. I’ve been using nicotine gum and lozenges for years in patients with fatigue, mild depression, and ADHD, not as a miracle cure but as a targeted cognitive and mood-enhancing tool. …

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