For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then …
The geometry of communication in medicine
One of the first questions you’re asked when applying to medical school is: Why do you want to be a doctor? For most, the answer is some version of “I want to help people.” But for me, that was never the real question. It was always “Why do you want to be a pediatrician?”
I’ve known since I was very young that I wanted to work with children. I’ve always loved …
Why I became a pediatrician: a doctor’s story
Children often surprise us with the seriousness they bring to a clinic visit. Every so often, when the room feels tense, I turn to a simple question and ask what their favorite toy is. Caregivers smile, and children lean forward with the kind of excitement that only play can spark. In a moment, the atmosphere changes. The room feels lighter, the conversation easier, and the visit begins to unfold with …
Why toys matter in the exam room
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Health care strategist Dana Y. Lujan discusses her article “Why direct primary care (DPC) models fail.” Dana argues that the DPC community’s obsession with “purity” is missing the point, stating that these …
Why bad math (not ideology) is killing DPC clinics [PODCAST]
All clinical trials are fueled, in part, by optimism. A trial currently underway in California is fueled by the optimism of one patient in particular, Kayvon Goodarzy.
Despite decades of effort, there has been an abject lack of new approved therapies for glioblastoma (GBM). The standard of care for this deadly brain tumor has been chemotherapy and radiation, to less-than-ideal results. But that might be changing, and it’s all thanks …
Glioblastoma immunotherapy trial: a new breakthrough
“Vaccines do not cause autism.” That statement once anchored public health. The CDC just dismantled it, quietly, strategically, and dangerously.
Presumption reversed, justice subverted
Attorney Lindsey Halligan didn’t misspeak when she claimed James Comey must prove his innocence beyond a reasonable doubt to a Virginia grand jury. She exposed the new doctrine: guilt by accusation, innocence by loyalty. Then she staged a procedural ambush. She bypassed the full grand jury entirely. She …
Did the CDC just dismantle vaccine safety clarity?
When the American Academy of Child and Adolescent Psychiatry released its October 2025 policy statement expanding what counts as valid, evidence-supported autism treatment, it marked a turning point that has been needed for years. For more than a decade, insurance companies pushed a narrow, outdated narrative that applied behavior analysis was the only evidence-based intervention for autism. That narrative was not accurate. It shaped policy, and it left families with …
New autism treatment guidelines expand options for families
When the first pandemic lockdowns swept through hospitals, our hallways went silent. The absence of visitors felt practical at first, a necessary shield against viral spread. But weeks turned into months, and that silence began to echo with something deeper: distrust.
I remember walking into a patient’s room to find her eyes fixed on the door. She wasn’t waiting for the nurse. She was waiting for her daughter, the daughter she …
Why visitor bans hurt patient care
Even the most “affordable” DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into higher-income neighborhoods. Without understanding these behavioral and economic realities, physicians risk building a model the community cannot sustain long-term.
I previously argued that physicians must answer five market questions before …
Direct primary care in low-income markets
It happens almost every clinic day. A patient walks in, sits down for their vital signs, and their blood pressure reads higher than expected. Sometimes much higher. Moments later, when I retake it myself after we’ve talked for a few minutes, it’s 20 or 30 points lower.
“But, doctor, I check it at home and it’s never this high!”
They are right. This is the phenomenon of white coat hypertension, blood pressure …
Is white coat hypertension harmless?
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Physician and professional certified coach Chrissie Ott discusses her article “How an insider advocate can save a loved one.” Chrissie shares a terrifying recent story of a friend’s elderly, Spanish-speaking mother who …
How to fight for your loved one during a medical crisis [PODCAST]
When I was a resident, the trauma surgeon was the go-to person for anything complicated. It seemed like they could do everything, and do it well. That’s what drew me to the field. There was a confidence, decisiveness, and scope that made trauma surgery feel like the pinnacle of surgical mastery.
For most of my career, I’ve worked as a trauma and critical care surgeon, from busy academic Level I trauma …
Is trauma surgery a dying field?
Halfway through a teletherapy session, you notice your therapist pause mid-sentence. They’ve just heard the soft clatter of your keyboard, or seen your eyes flick sideways to a second screen. You’re technically “there” on video, but a work email just popped up, laundry is buzzing, someone’s messaging you, and suddenly the session is sharing space with three other tabs in your brain.
On the therapist’s end, it can feel like talking …
Gen Z, ADHD, and divided attention in therapy
Medicine thrives on structure. Protocols, guidelines, and standards safeguard patient outcomes and reduce error. Yet the same structure that preserves consistency can quietly suppress creativity.
For physicians who dream of improving systems, innovating within such rigid frameworks can feel like trying to work inside a box. But structure and creativity do not have to be opposites. Oftentimes, the struggle lies in how we spark creativity in a system built for safety.
The …
Innovation in medicine: 6 strategies for docs
The average KevinMD reader may wonder why I’m so prolific in my commentary on pediatric medicine and the systemic reforms it demands. The answer is simple: I go to the source. Always.
That habit was forged nearly 30 years ago when the American Academy of Pediatrics invited me to serve as contributing section editor for Developmental-Behavioral Pediatrics in AAP Grand Rounds. My role: select key studies, critique methodology, and distill bottom-line …
Why we fund unproven autism therapies
I found a lump at age 32, just four months after a clear clinical breast exam. No family history. No genetic markers. I noticed the golf-ball-sized mass one day while putting on my bra.
It turned out to be stage 3C, with spread to 14 lymph nodes, as advanced as it gets without being terminal. I went through a year of aggressive treatments: bilateral mastectomy, chemo, radiation, reconstruction, and hormone therapy.
My …
Early-onset breast cancer: a survivor’s story
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Food allergy advocate Lianne Mandelbaum discusses her article “Why Hollywood’s allergy jokes are dangerous.” As the mother of a child with a life-threatening food allergy, Lianne shares her personal trauma and outrage …
Why mocking food allergies in movies is a life-threatening problem [PODCAST]
When I began PA school, I faced an unexpected financial hurdle: I no longer qualified for employer-sponsored health insurance, and although at the time, I didn’t meet the requirements for Medicaid, I did qualify for subsidized health coverage through the marketplace. However, even with subsidies, the monthly premiums and out-of-pocket costs were still a financial strain. To afford health care and cover basic living expenses, I had to continue working …
Why we need to expand Medicaid
Where a person lives far too often determines the quality of cancer care they receive and, ultimately, their chances of survival. Despite decades of progress in precision oncology, stark disparities persist between patients treated in urban academic centers and those in rural or underserved communities. A JAMA Network Open study of nearly 37,000 patients found that when rural and urban patients receive the same, protocol-driven care, their outcomes …
Remote second opinions for equitable cancer care
Leadership is often discussed in broad strokes: some leaders are structured and precise, while others are flexible and improvisational. But behind those visible styles lie quiet personal and generational histories, the emotional terrain that shaped how we learned safety, trust, and control. I’ve come to see that these histories profoundly influence how we lead and how we’re perceived as leaders, especially in health care, where the stakes are high and …
How your past shapes the way you lead
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