Why timing, not surgery, determines patient survival

Conditions
July 8, 2025

She was 68. Diabetic. Living alone with chronic osteoarthritis. Like many patients, she carried a story more complex than any preoperative checklist could capture: a long history of opioid dependence, obesity, limited mobility, and no one at home to help her recover.

Her total knee replacement—performed with state-of-the-art robotic precision—was flawless. The surgical plan was executed to perfection. The implant was perfectly aligned. She was discharged on time, per protocol.

But protocol …

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How medicine repurposing enables value-based pain management and insomnia therapy

Meds
July 8, 2025

In today’s evolving health care environment, value-based care is reshaping the future of medicine. The push toward value-based care demands innovative, cost-effective, and patient-centered solutions. A promising yet underutilized strategy is medicine repurposing, the practice of using existing medicines for new therapeutic purposes. Drug repurposing provides a strategic pathway to improving health outcomes while minimizing costs. A compelling example of this approach is the use of clonidine, a long-established cardiovascular …

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Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

Physician
July 8, 2025

The modern medical profession presents practitioners with an abundance of opportunities that extend far beyond traditional patient care. Today’s physicians navigate complex roles as clinicians, researchers, educators, administrators, and community leaders while maintaining personal relationships and spiritual well-being. Rather than viewing these diverse responsibilities as competing demands, successful physicians learn to integrate them into a balanced approach that prioritizes meaningful contribution over external recognition.

The myth of perfect balance

The concept of …

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Forced voicemail and diagnosis codes are endangering patient access to medications

Meds
July 8, 2025

I won’t be using CVS pharmacies anymore. Sure, I may still need to send prescriptions their way as a physician—but as a consumer, I’m done.

Why?

CVS has recently implemented a new phone system that forces callers to leave a voicemail instead of waiting on hold. The idea is to streamline operations, letting pharmacy staff return calls when they have time. It’s supposed to manage call volume, reduce wait times, and shield …

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How regulatory overreach is destroying innovation in U.S. health care

Physician
July 8, 2025

Health care regulatory bodies have embraced a dangerous “accuse first, prove later” strategy that is eroding the foundation of our health care system. Physicians, the bedrock of patient care, are being subjected to accusations based on flimsy, illegitimate reports or random audits. Rather than building cases on substantial initial evidence, these authorities thrive on retrospective scrutiny—analyzing old notes, reframing past actions, and bending interpretations of guidelines to validate their accusations. …

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Why the U.S. mental health care system is failing and how to fix it [PODCAST]

Podcast
July 7, 2025
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Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Internal medicine physician and author Robert C. Smith discusses his article, “Medicine’s mental health crisis: why the system is failing us.” He reveals the shocking disparity in care, where only 25 percent of patients with mental illness receive any treatment compared to 70 percent for …

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The unseen cost of detachment in radiology

Physician
July 7, 2025

That was one of my uneventful night duties—until early morning. As usual, I had a hectic on-call day, where I barely got half an hour for dinner—which we consider routine. Around 3 a.m., I received a request for an abdominal CT scan for a middle-aged male patient with abdominal pain. The surgeons were suspecting mesenteric ischemia—blockage in abdominal vessels, which can be life-threatening.

I glanced through the scan, trying to open …

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I thought success was a destination. Then I became a doctor.

Physician
July 7, 2025

When I began the journey to becoming a doctor, I believed success was a destination—a finish line I’d reach if I just worked hard enough, studied long enough, and sacrificed deeply enough.

And I did all those things.

I pushed through sleepless nights in college. Carried the weight of relentless pressure in medical school. Survived the grind of residency, where time lost all meaning. I lived with my eyes fixed on the …

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Why psychotherapy works and why psychotherapy fails

Conditions
July 7, 2025

What is psychotherapy?

Psychotherapy is a talking process between a patient and a psychotherapist. Psychotherapy makes connections among feelings, thoughts, impulses, and behaviors to understand what works and what gets in the way of meeting life’s goals, reaching one’s fullest potential, feeling successful, and being fulfilled. This is accomplished by self-reflection. By examining life patterns, changing, improving, and unlearning emotional and behavioral habits that get in the way and are no …

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The One Big Beautiful Bill and the fragile heart of rural health care

Policy
July 7, 2025

President Trump signed into law the One Big Beautiful Bill Act (H.R. 1)—a 1,000+ page legislative thunderclap that had just cleared Congress, reshaping the landscape of American domestic policy as fireworks lit the sky. Branded as a domestic reset—heavy on tax cuts, defense expansion, and deregulation—it was not sold as a health care bill. But for those of us on the front lines of medicine, particularly in rural America, make …

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How oral health silently affects your heart, brain, and body

Conditions
July 7, 2025

The mouth is connected to the body by blood vessels, lymphatic pathways, and the immune system. Ignoring oral health means risking more than a toothache — it could mean risking your life.

When most people think of oral health, they think of teeth, cavities, brushing, flossing, maybe the occasional root canal. But the truth is, what’s happening in your mouth can have a ripple effect throughout your entire body. This is …

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How President Biden’s cognitive health shapes political and legal trust

Conditions
July 6, 2025

In the realm of American politics, discussing the mental fitness of a sitting president – or the performance of a former one – is as delicate as it is critical.

As a psychiatrist, I am profoundly aware of the ethical constraints outlined by the Goldwater Rule, adopted by the American Psychiatric Association (of which I am a Fellow). Psychiatrists’ ethical responsibility is to refrain from making specific clinical diagnoses without Read more…

Decoding your medical bill: What those charges really mean

Finance
July 6, 2025

Most people don’t read their medical bills—they panic over them. After all, receiving a multi-page statement full of confusing codes, unexplained charges, and unclear payment instructions isn’t just frustrating—it’s intimidating. I’ve worked with countless individuals who feel helpless in the face of these documents, unsure of what they owe, why they owe it, or whether the charges are even correct.

This confusion isn’t just common—it’s systemic. As a patient advocate and …

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The emotional first responders of aesthetic medicine

Conditions
July 6, 2025

When people think of Botox and filler, they think of vanity. Frozen foreheads. Pouty lips. Women chasing youth. Injectors chasing cash. They don’t see the woman who finally escaped her husband after 20 years of abuse, coming in not for attention but for control. They don’t see the mother burying her child, hoping that looking “normal” on the outside might steady the chaos inside. They don’t see the cancer survivor …

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Why testosterone matters more than you think in women’s health

Conditions
July 6, 2025

Menopause is finally having its moment in the spotlight, thanks to high-profile women breaking the long-standing taboo around discussing this life stage. Yet, while discussions around hormone replacement therapy (HRT) have increased, one critical component remains largely overlooked — testosterone.

Traditionally seen as a “male hormone,” testosterone is equally vital for women’s health, playing a key role in mood, energy, libido, muscle mass, bone density, and cognitive function. Yet, …

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A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

Tech
July 6, 2025

I do not fear artificial intelligence—nor do I revere it. What I feel toward the rise of intelligent systems in medicine is something quieter: a tempered trust, a measured hope. I recognize their immense potential, but I also hold firm to the belief that the deepest work of medicine happens not through automation, but through human connection. There is a quiet power that lives between symptom and story, between numbers …

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How subjective likability practices undermine Canada’s health workforce recruitment and retention

Physician
July 5, 2025

In the face of worsening health workforce shortages, Canada must shift from a culture of personal likability to a system of objective qualifications or merits in recruiting and retaining physicians. While team cohesion and interpersonal compatibility are essential, an overemphasis on “fit” or likability excludes talented physicians, particularly immigrants and racialized minorities, who may not share the cultural background, communication style, or social behaviors preferred by decision-makers. This practice undermines …

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How veteran health care is being transformed by tech and teamwork

Conditions
July 5, 2025

Veterans deserve the highest-quality health care our nation can offer, but fulfilling this promise often means overcoming major challenges. About 9 million veterans receive care through the VA, with a third living in rural areas far from VA facilities. Meeting their needs requires innovative solutions that combine expertise, technology, and strategic partnerships.

Why VA’s holistic model outpaces traditional care

The VA stands apart with its integrated, long-term approach to care. Unlike the …

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Why judgment is hurting doctors—and how mindfulness can heal

Physician
July 5, 2025

Judgment pervades medicine—of patients, colleagues, and ourselves.

We’re trained to judge, disguised as caring, standards, and competence. It’s seen as essential to being a “good physician.” We do it so instinctively, we rarely question it.

But we should.

The culture of judgment in medicine

Judgment is baked into our training: The scrutiny of rounds, the competition of grades, the pressure of evaluations. It’s in our language: “noncompliant,” “failure to thrive,” “incompetent cervix.” Even our …

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Why medical schools must ditch lectures and embrace active learning

Education
July 5, 2025

When I was a medical student, some enterprising classmate started a note taking service so we wouldn’t have to take notes on our own. He set up a tape recorder and transcribed the notes for distribution the next day. One day, our professor showed up with a tape recorder, set it up on the table in front of the lecture hall, and turned it on. The result was an electronic …

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