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Internal medicine and functional medicine physician Shiv K. Goel discusses his article “Mind-body connection in chronic disease: Why traditional medicine falls short.” Shiv explores the limitations of conventional medical models that focus …
Healing chronic illness requires treating the mind alongside the body [PODCAST]
My great-grandfather was a small-town doctor in the early 1900s.
It was a different time. A different place. A very different pace.
He knew his patients. He knew their families. He understood their lives, not just their symptoms. Care happened in the context of relationship because that was simply how medicine worked.
Today, health care looks very different. The science is better. The technology is stronger. We can do things now that would …
How modern health care design strains patients and clinicians
The number was specific: 18,000 steps.
It came from a retired hospital director in Taipei, a physician-administrator who spent four decades building services, negotiating budgets, and managing crises across a health care system that now treats an aging society as its primary patient.
Most physicians retire into silence. He retired into data.
But the more interesting revelation did not come from his smartwatch. It came from the dinner table.
A shift in governance
In Western …
Physician retirement: a cultural shift from system to self
As a psychiatrist, I increasingly meet patients who come in convinced they have attention-deficit/hyperactivity disorder (ADHD). They arrive prepared: an online screening test, a list of symptoms (poor concentration, low motivation, distractibility) and often a quiet sense of relief at finally having an explanation. Then I do what physicians are trained to do. I take a careful history. I review medications. I ask about sleep, mood, anxiety, substance use, and …
ADHD and cannabis use: Navigating the diagnostic challenge
The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …
Multifactorial drivers of the U.S. physician shortage: a data analysis
To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.
I am not a nurse. I am …
Alex Pretti: a physician’s open letter defending his legacy
I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …
Why I chose disruption over conformity in medicine
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Saravanan Kasthuri, medical director at Northwest Endovascular Surgery, and Jason McKitrick, executive director at the Office Based Facility Association, discuss their article “Medicare payment is failing rural health.” Saravanan and Jason analyze …
Medicare cuts are destroying independent rural medical practices [PODCAST]
Let me start with a truth many of us sense long before we ever speak it aloud. We whisper it to ourselves on post-call mornings. We feel it in the drive home after another shift that took more than it gave. We carry it into our kitchens, into our bedrooms, and into the quiet moments where no pager or EMR alert can compete with what’s happening inside us.
The elephant in …
The elephant in the room: Why physician burnout is a relationship problem
A patient with diabetes, hypertension, and obesity comes in for her annual wellness visit. The physician has already spent 20 minutes on chronic disease management and lifestyle guidance. As the visit wraps up, the patient mentions daily heart palpitations that started a month ago.
The exam was benign. The physician has two choices: spend another 20 minutes performing an EKG, discussing differential diagnoses, and developing a workup plan; or refer to …
Why the primary care system failure forces unnecessary referrals
The pilot of a commercial aircraft, descending into near-zero visibility, hands control to an automated system designed for precisely that moment. The landing is flawless. The passengers are safe. The pilot announces it proudly. Technology functions exactly as promised.
A doctor on board writes, “It made me think about the health care journey I am on with AI. The safety and well-being of 140 people wasn’t left to human intervention; the …
AI in medicine vs. aviation: Why the autopilot metaphor fails
In my first and second KevinMD posts, I emphasized how medicine had failed clinicians by not training them in mental health care. All agree, it’s not our fault. Now let’s look at how successfully our teachers did prepare us for patients with medical disorders. There’s an interesting history behind how we developed expertise in physical diseases: Medicine needed to overthrow the four humors theory that guided clinical care …
How the mind-body split in medicine shaped modern clinical care
President Trump recently made national headlines by calling a female reporter “Piggy,” an act widely decried as outrageous, even for a man who doesn’t shy away from misogyny. It’s one thing to intentionally refer to someone with a derogatory, dismissive label. This kind of behavior should appropriately be met with indignation and moral outrage. But what happens when we carelessly (and repeatedly) call someone a name that belongs to …
Racial mistaken identity in medicine: a pervasive issue in health care
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Family physician Tod Stillson discusses his article “Why AI in medicine elevates humanity instead of replacing it.” Tod explains how his career evolution revealed that artificial intelligence is not a threat to …
Artificial intelligence demands that doctors become architects of digital health [PODCAST]
It has been six months since my robotic-assisted radical prostatectomy, and I find myself suspended in a strange middle space, grateful to be cancer-free, yet still struggling with a question I cannot fully answer: Is it safe for me to restart testosterone replacement therapy?
Before my diagnosis, testosterone replacement was not just a prescription; it was a restoration. I have lived with hypogonadism for years, and TRT helped me regain the …
Is testosterone replacement safe after prostate cancer surgery?
Most of us don’t notice moral development happening while it is happening. Moral character forms quietly, through repetition, through what we get used to doing and through what we slowly stop doing without much forethought.
Artificial intelligence matters from a moral perspective long before it ever potentially becomes conscious or autonomous. Although AI may or may not confront us with dramatic ethical dilemmas, it does change our moral lives in a …
AI and moral development: How algorithms shape human character
They are not born into battle.
They arrive with open hands,
with laughter,
with faith that the world will keep them safe.
Yet, men who are not content with peace
clench their fists around power,
mistaking domination for strength
and control for legacy.
They draw borders with bullets
and call it victory.
In their pursuit to prove themselves,
they let the bombs fall.
Roads darken with blood.
Homes become rubble.
The sky learns the language of fire.
And in the wreckage stand the children.
They watch …
The impact of war on the innocence of children
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Surgeon and health tech strategist Sarah Matt discusses her article “Why fee-for-service reform is needed.” Sarah analyzes the friction between efficient digital health tools and an outdated payment system that rewards activity …
Overcoming the economic barriers of fee-for-service medicine [PODCAST]
Somewhere over the last two decades, medicine began to drift into strange territory. Authority (once grounded in evidence, humility, and disciplined expertise) became diluted. Being loud, charismatic, or highly visible somehow became a substitute for scientific credibility.
We’ve long had celebrity doctors, but a new hybrid has emerged: Physicians who are not celebrities in the traditional sense, yet who speak with sweeping certainty far outside their field of training. A neurosurgeon …
Why epistemic trespassing in medicine is a dangerous trend
Every day, nurses make thousands of clinical decisions that directly shape patient outcomes, safety, and recovery. Yet in many hospitals across the country, these critical choices are still guided by experience-based models rather than current evidence. For a profession that defines itself as patient-centered and science-driven, this approach contradicts the very standard of care we strive to uphold. True excellence in nursing is not defined by technology alone or by …
Why evidence-based practice in nursing is a strategic imperative
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