An excerpt from Treating a Broken System: A Physician’s Cure For the Healthcare Crisis.
Let me take you back to the Philadelphia suburbs in March 1997. My wife, Terry, and I had been married for almost twenty-one years, and we had three children, all teenagers. Terry had not yet completed her bachelor’s degree when we were married in May 1976. She went on to accomplish that when the kids were …
Breaking bad news: my wife’s brain tumor diagnosis
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A treatment exists that can cure aggressive lymphoma after chemotherapy has failed. Only about two in ten eligible patients receive it. Manali Kamdar is clinical director of lymphoma services at the University of …
A cure for aggressive lymphoma exists, and most patients never get it [PODCAST]
Every physician accumulates evaluations during a career. Most are read once and forgotten. Decades later, while reviewing my Air Force officer evaluation reports from Minot Air Force Base, I discovered something unexpected: a record not merely of performance, but of ideas that anticipated changes in pediatric care years before they became formal policy.
The reports documented emergency transports, developmental screening initiatives, community partnerships, staff expansion, and coordinated care systems. What struck …
A military pediatrician inside the nuclear readiness system
Medicine has developed a new mental health illness of the “attention economy.” The term was introduced by psychologist and Nobel laureate Herbert A. Simon, who argued that an abundance of information creates a scarcity of attention, making human attention an increasingly valuable resource. Physicians always depended on attention to the patient, trainee, colleagues, and the required attention to quiet work of becoming wiser. Yet professional life increasingly unfolds within an …
3 choices that protect physicians in the attention economy
“I know the treatment probably won’t work,” a patient nearing the end of life tells the doctor. “I want to try anyway.” The patient understands the risks but still hopes for a little more time. The physician wants to honor that hope while worrying that side effects could make the patient’s remaining days more painful. If the treatment requires resources in short supply, other patients’ needs make an already difficult …
Medical ethics principles do not decide hard cases
Walk into any busy pain clinic and the weight lands before you sit down. The pages never stop. The waiting room is packed with people who have already been through too many doctors. Chronic suffering hangs in the air. And that is only the visible load.
Beneath it sits a quieter, more relentless set of pressures. Insurance companies keep cutting rates. Staff feel the squeeze of financial hardship and rightly expect …
How physician resilience is built in a busy pain clinic
“I called palliative care because I needed to free up the bed. Otherwise, I could have taken care of this dying patient myself.”
The ICU attending said it standing at the nurses’ station, thumbing through a chart on a rolling laptop cart, already moving toward the next name on his list before I could answer. Down the hall, monitors kept their steady rhythm. Somewhere behind him, a family was gathered around …
Palliative care in the ICU: what the metrics never count
Pregnancy is a well-documented risk factor for intimate partner violence (IPV), with homicide reported as a leading cause of death for pregnant and postpartum women in the United States. As abortion policy has shifted in the wake of Dobbs v. Jackson (the ruling that overturned Roe v. Wade), researchers have begun examining how abortion access intersects with IPV in a post-Roe world. The sudden changes in abortion access have …
Abortion bans and intimate partner violence rise together
On Wednesday, September 9, 2026, the author spoke briefly at a hybrid conference conducted by the Reagan-Udall Foundation for the U.S. Food and Drug Administration in Washington, D.C. This was only the most recent such “listening session” conducted over a ten-year period. And from the first government speaker onward, the meeting reflected many of the historical biases and misdirection of U.S. health care agencies with respect to the so-called …
Why CDC opioid guidelines get the overdose data wrong
We previously discussed the certificate of analysis myth and economically motivated adulteration in the dietary supplement industry. This article focuses on the basics of how the supply chain of dietary ingredients works and why it is critical for clinicians always to consider the possibility of supplement-induced adverse side effects such as herb-induced liver injury (HILI).
The surging interest in dietary supplements over the past few decades reflects a positive shift …
Supplement country-of-origin labels hide the real source
The most consistent advice physicians receive about clinical AI is that we should be more careful with it. Verify the output. Treat it as a draft. Structure the input. Build verification into practice as the defining skill of the coming decade.
All of this is good counsel. None of it addresses the problem the same authors have already correctly identified.
Harvey Castro made the diagnosis on this site in May 2025, writing …
Why clinical AI limitations are not a physician problem
Every nurse, pharmacist, PA, and physical therapist in the country has to complete continuing education (CE) hours to keep their license. Those courses don’t write themselves, and accreditation rules mean they can’t be written by just anyone. They have to come from a clinician with the credentials to back up what’s being taught.
That’s a standing demand for physician expertise. Most physicians have no idea they qualify.
The obvious thing first: Your …
Monetize clinical expertise without becoming an influencer
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He counts four wounds in American medicine. Patients rarely bring up the first one, which is what health care costs. Narinder Singh Parhar is a physician with more than three decades in internal …
Doctors were told to be blind to the cost of care [PODCAST]
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Health care in America is broken. We have an aging population that requires complex, ongoing care. We have rising costs. We have a workforce of clinicians who burned out. We don’t have enough clinicians. Today, the average wait time to schedule a new physician appointment in a major U.S. city is 31 days.
That is an entire month of waiting. For a patient managing a chronic condition, a 31-day wait …
How AI can cut administrative burden and wait times
In my free time, I try not to consume too much work-related content. When you’re in a medical business, manufacturing devices used for sepsis and septic shock patients, the last thing you want is to be reminded of sepsis outside of work. So I was very surprised when I found myself binging The Pitt all weekend. I think there’s a reason why it has become the rare medical drama that …
What sepsis in The Pitt gets right, and what it misses
Jerina Gani, MD, MPH is a primary care physician in Boston, trained in internal medicine, with about twenty years in practice. She has published nine essays on KevinMD since July 2025 and has been a guest on The Podcast by …
Jerina Gani, MD, MPH, on primary care burnout: a KevinMD subscriber spotlight
abandoning ship
swim with the gentle undulations
of our stardusted oceans
as they sensitively surrender
drops of dew up
to the contemplative clouds
to convey ancient intricacies
in the dew’s quiet rest, buoyed patiently by petals who also must obey the call of gravity.
my dear mechanical world
(welded so clumsily by ego)
how blindly naive
your race
neglecting truths
engendered by beauty,
insisting instead that
the weight of time
is measured in capital.
you employ
productivity and efficiency
to justify life
proclaiming ignorantly
that sitting still
serves selfishness,
sloth,
and a stupored mind.
performative …
A poem for anyone tired of productivity culture
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In South Louisiana, hurricane season is treated like a fifth season of the year. Angela C. Johnson explains what that means for physicians and patients. She is an internal medicine physician and member …
Hurricane season is a fifth season, and medicine has to plan for it [PODCAST]
During the following year, in one of the hospitals, an algorithm will be automatically taken out of service. Either the sepsis model will drift below the performance level at which it was approved, or the monitoring process will detect the tool failing for one subgroup of patients even though the overall figures remain satisfactory, and the system, which was designed to do just that, will suspend the model and wait …
AI governance metrics need a door-to-balloon time
Americans give hundreds of billions of dollars to charity each year, making philanthropy a defining feature of our national culture. That generosity benefits more than the organizations and communities receiving support: Research suggests that giving can also improve the donor’s happiness, sense of purpose, and connection to others. Our government actively encourages this behavior through charitable tax deductions and other incentives, reflecting a longstanding public-policy judgment that private generosity serves …
Charitable giving for physicians: 7 strategies for 2026
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