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Psychiatrist Muhamad Aly Rifai discusses his article “A psychiatrist’s 20-year journey with ketamine.” Aly recounts his first encounters with ketamine at the National Institute of Mental Health, where its rapid impact on …
A psychiatrist reflects on two decades of treating depression with ketamine [PODCAST]
On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it permanent. That would not just be bad policy. It would be malpractice by Congress.
I think of a patient of mine in northeast Georgia who lives 90 minutes from my clinic. …
Congress must make telemedicine permanent now
As a fertility specialist, recurrent implantation failure is one of the most difficult and heartbreaking problems we face. Over the last forty years, we’ve made tremendous improvements in both IVF protocols and lab techniques. A high-quality embryo may have up to a 70 percent chance of yielding a live birth. However, how do we approach the patient when high quality embryos are not taking? And what does the evidence really …
Why do high-quality IVF embryos fail?
Psychiatry, perhaps more than any other medical specialty, is a field defined by ambiguity. Unlike other branches of medicine, where diagnostic tests and standardized protocols guide treatment, psychiatry often operates in a landscape where clear-cut answers are rare. The psychiatrist’s primary tools are not scalpels or stethoscopes, but words, presence, and (most crucially) the self.
Psychological transference and countertransference: double-edged swords
Psychological transference and countertransference are central to the practice of psychiatry, …
The psychiatrist’s self as a clinical tool
More than 400 amputations happen in the U.S. daily. Not from gun violence, shark attacks, or car crashes, but from a disease that is easily diagnosed, preventable, and treatable, if caught early. Peripheral artery disease, or PAD, is a circulation problem in which narrowed arteries reduce blood flow to the limbs, most often the legs. More than 200 million people suffer from PAD, yet many aren’t even aware they have …
The silent disease causing 400 amputations daily
Here is what I have seen across two decades of admitting and managing patients on inpatient psychiatric units. People do not ask for a locked door when life is comfortable. They come to us when the ground drops out. Families arrive with the weight of sleepless nights in their faces. Emergency clinicians pass me the chart, then the baton, and sometimes the quiet plea that says please help this person …
The crisis in inpatient psychiatric care
After seventeen years of marriage, I found myself divorced, co-parenting, and facing two of life’s most daunting transitions at once: reentering the dating world and buying a new home. The reasons were many: parenting stressors, mid-life transitions, childhood wounds, and outside influences. There was no doubt that my career as a full-time, call-taking anesthesiologist also played a role. While the brutal 24-hour calls and 80-hour weeks were mostly behind me, …
Why can’t finding a doctor job be like Zillow?
Imagine your hospital’s entire IT operation grinding to a halt because of a snowstorm, cut fiber lines, or unstable internet connectivity. This is not a worst-case scenario for many rural health care providers; it is a regular reality. And it highlights just how fragile the digital infrastructure is in many parts of our country.
Across rural America, hospitals are losing physicians and fighting to stay open while serving communities …
The digital divide in rural health care
At the risk of sounding out of the times, I think back to how simple education was back in the day: attend lectures, take notes, read books (gasp), do any relevant flashcards or question sets, and repeat. Indeed, this formula is a functional strategy for many prior generations of doctors. For my own medical journey, now fifteen years in as an otolaryngology resident, this simple strategy has worked well enough.
The …
One doctor’s journey to making an AI study tool less corrosive to critical thinking
Introduction: a double-edged disruptor
Artificial intelligence (AI) has quickly insinuated itself and is transforming nearly every corner of modern life. Health care is no exception. With the rise of advanced chatbots, symptom checkers, and health-focused algorithms, patients now have 24/7 access to vast medical knowledge at their fingertips in seconds. The excitement is understandable: AI can demystify medical “doctor-speak” or jargon, suggest possible diagnoses and treatment options, and empower patients to …
Is it time to embrace augmented empathy while using artificial intelligence in health care?
All physicians lead, not just those with designated leadership titles, such as Medical Director, Department Chair, or Chief Medical Officer. Leadership is foundational to the doctor’s role.
Fortunately, leadership is a learned skill and improving physicians’ leadership skills can change how well we do our key job of taking care of patients. As physicians improve individual leadership skills the entire health care system will reap the benefits: nurses, technicians, administrators, finance …
Why physician leadership should be taught from day one of medical school
Paige Bueckers, a 23-year-old WNBA star, was drafted number one this year to the Dallas Wings and has been having a historic rookie season. Against the Los Angeles Sparks on August 20, she scored forty-four points while shooting eighty percent, tying an all-time WNBA rookie record. As a physician, I find that Bueckers’s mindset has a lot to teach me about being a physician. Here are the top five Paige …
What Paige Bueckers’s historic rookie season can teach doctors
At lunch on September 10, 2025, I opened Instagram for a palate cleanser: cute dog videos, life hack reels, something sweet and uplifting. Instead, I ran into a video and headline I wanted to dismiss as a deepfake. It was graphic and disorienting and, for a few seconds, I tried to bargain with reality: This cannot be real, and if it is, how is it on my phone? Would it …
Can a doctor’s personal post violate their oath?
In the shadowed corridors of America’s great academic hospitals, those bastions of progressive piety nestled in sanctuary cities like Denver, New York, Chicago, and San Francisco, a quiet usurpation unfolds. For decades, as a physician committed to mentoring Black Americans, I have viewed my profession not merely as a vocation but as a form of restitution: a personal reckoning with the sins of our white forebears, whose legacy of chattel …
The cost of illegal immigration on Black communities
You are entering orders, rounding, or thinking through a patient problem in the hospital when a team member interrupts. Then comes another interruption. And another. You lose your train of thought, and you feel your jaw clench. Does this sound familiar? Physicians are expected to be efficient, accurate, and approachable, yet these three goals are nearly unattainable due to constant interruptions. Studies show that physicians are interrupted, during critical tasks, …
A physician’s guide to managing interruptions
He literally rolls into my office every three months, shoes still clipped to his carbon-fiber lifestyle. Lycra damp, Apple Watch buzzing, resting heart rate of 42. He is fit, smart, and tightly wound.
“Doc,” he begins, eyes wide, “I read that morning workouts burn more fat and lower clotting factors. Should I move my rides earlier? Or maybe late evening is better for heart rate variability?”
This is a man who, when …
Stop worrying about when to exercise
This article is sponsored by Takeda.
When I started in gastroenterology 19 years ago, I didn’t imagine my professional journey would lead me to specialize so deeply in inflammatory bowel disease (IBD). But once I began caring for people with Crohn’s disease and …
The evolving field of inflammatory bowel disease care — why staying educated matters more than ever
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Internal medicine-pediatric physician Chrissie Ott discusses her article “When the pediatrician is the parent: a personal reckoning with childhood obesity.” Chrissie shares the deeply personal story of her own child’s struggles with …
When a pediatrician becomes the parent navigating childhood obesity [PODCAST]
A young woman in her late twenties came to me after surgery for extensive endometriosis. The procedure had given her relief; her pain was gone. Her follow-up testing looked reassuring: her fallopian tubes were open on hysterosalpingogram (HSG), and her anti-Müllerian hormone (AMH) level was above 4 ng/mL, which is considered normal. Her question was straightforward: “If my AMH is good and my tubes are open, doesn’t that mean everything …
Endometriosis, AMH, and your fertility
My current feeling as a nurse is more closely related to those of a line cook than to what I imagined nursing would be. Patients arrive with complex medical needs, yet we are forced to see them as checklists to be processed before the next shift arrives. Turnover feels like moving products down a line instead of treating people with care and dignity. This is not a failure of individual …
Why we need national nurse-to-patient ratios
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