In my years as a physician on the front lines of addiction and pain medicine, I have never encountered a medication as transformative as buprenorphine (Suboxone). I have seen patients, broken by years of opioid addiction, have their lives change within an hour of their first dose, ready to reclaim a life they thought was lost. For these patients, buprenorphine is as essential as insulin is for a person with …
The unfair war on buprenorphine
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Health care executive Ashish Mandavia discusses his article “Why U.S. health care pricing is so confusing—and how to fix it.” Ashish explains how systemic misaligned incentives, opaque insurance practices, and weak enforcement …
Why U.S. health care pricing confusion demands bold solutions [PODCAST]
I never expected that iron deficiency anemia would change the course of my life. I felt off. Tired in a way that sleep could not fix. Foggy, weak, emotionally distant. At first, I thought I was just worn down from work and the daily grind. I was not myself, physically, mentally, or emotionally.
Eventually, I was diagnosed with iron deficiency anemia, a condition many associate with mild fatigue or simply “not …
My invisible illness destroyed my marriage
Kidney stones are not only about what you eat or the genes you inherit. They are also about where you live and how hot it gets. Every summer, urologists notice the same pattern: as the temperature climbs, so do the visits for kidney stones. Because heat and humidity do not just make us sweat, they change how our bodies handle water and minerals. Dehydration concentrates the urine, crystals form more …
How summer heat increases your kidney stone risk
Let me just start by saying: If you are reading this and thinking, “Who voluntarily takes medical board exams at 63?” You are absolutely right. Normal people do not do that. They take up golf from the Green tees, try to marry off their kids, and complain that the younger generation cannot drive. But me? I spent four precious months of my remaining life cramming for the ABIM boards like …
I passed my medical boards at 63. And no, I was not having a midlife crisis.
The night shift was unusually calm. Mr. T, a 74-year-old admitted for pneumonia, had completed his evening antibiotics and was resting quietly. His blood pressure, heart rate, temperature, and oxygen saturation were all within normal limits. The nurse’s 2 a.m. note was brief but telling: “Less talkative tonight,” “Needed encouragement to walk to the bathroom,” “Left most of his dinner untouched.”
By morning, Mr. T was febrile, hypotensive, and confused. Within …
Your clinical notes can save lives with AI
Appointments booked months out. Overwhelmed specialists. ERs struggling to stay staffed. The physician shortage is not coming. It is already here.
The Association of American Medical Colleges projects a shortfall of more than 124,000 physicians by 2034. But that number does not capture the reality that doctors are leaving medicine quietly, every single day. Some retire early. Others step into nonclinical roles. Many more are simply trying to find a better …
It is time to bring doctors back to medicine
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Pediatrician and certified coach Jessie Mahoney discusses her article “Why so many physicians struggle to feel proud—even when they should.” Jessie explains how medical training conditions doctors to downplay success, deflect compliments, …
Why physicians struggle to embrace pride and why it matters for leadership [PODCAST]
As physicians, we are trained to prescribe, to fix, to optimize. Our patients expect it, and frankly, so do we. I built a career around lipid panels, trial data, and prescriptions meant to shave percentage points off cardiovascular risk. But lately, I find myself offering something far less high-tech and far more radical: a walk.
Walking is slow. Impractical. Rarely the efficient choice. Which is exactly why it matters.
Everywhere around us, …
Your nervous system does not need another hack. It needs a walk.
An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
What is a high-risk pregnancy?
You may find it strange that there is no single accepted definition of what constitutes a high-risk pregnancy. Probably more than half of women will have at least one risk factor that could be an issue, but for most of these women it will minimally affect their pregnancy care or the outcome. For other …
High-risk pregnancy: Who should manage your care?
In recent years, American politics has witnessed a disturbing rise in conspiracy-driven health narratives that undermine science and public safety. Among the most vocal proponents of anti-vaccine rhetoric has been Robert F. Kennedy Jr., whose campaign of misinformation poses a clear threat not only to childhood immunization but to medical research more broadly. One might assume that the nation’s leading physician organizations, particularly major medical and pediatric associations, would respond …
A critique of medicine’s response to RFK Jr.
When I am sued by a prominent medical malpractice plaintiff attorney, I open the firm’s website. Despite the lawyer’s prominence, the website uncharacteristically solicits for medical malpractice, claiming, “If you have a phone, you have a lawyer.” We all know that it takes more than a phone; it takes a case. What I have learned since that day is a lesson for every physician practicing medicine because each, like it …
Can AI spot a frivolous malpractice lawsuit?
A dangerous truth is hidden behind the winning smiles and cartoon-adorned walls at pediatric dental offices: Children are dying or suffering from debilitating neurologic injury during routine care, and few are paying attention. This glaring oversight in ambulatory pediatric dental care is concerning not only for the potential harm to vulnerable, unknowing families but also to the medical community at large. Now more than ever, pediatric dental care is being …
The hidden danger in pediatric dental offices
In the hierarchy of health care professionals, I supposedly stand on one of the lowest steps of that ladder. Some say I am just a CNA. Some say I am the backbone of nurses and physicians. I say: I am a strategic part of this ladder. I do not have the medical knowledge or skills of a physician nor of a nurse. But what I do have is a heart …
He begged for mercy and his family refused
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Why kratom addiction is the next public health crisis.” Muhamad explains how kratom, a botanical imported from Southeast Asia, has …
Why kratom addiction is emerging as a hidden public health crisis [PODCAST]
Physicians dedicate years of training to caring for patients, often at the expense of their own financial well-being. While most doctors are well-versed in diagnosing illness, far fewer have the tools to diagnose the emotional and behavioral challenges that affect their relationship with money. In a recent episode of my podcast, I sat down with orthopedic surgeon Greg Gilot, MD, and financial therapist Erika Wasserman to explore the emerging field …
What is financial therapy for physicians?
The urgency epidemic
I was in my office at 8 p.m. about a year ago. My back was hunched, phone in one hand and papers in the other, with twenty open tabs glaring at me from two adjacent monitors. I heard a nearby door shut and wondered, “Why is my colleague leaving so late?” Then it hit me: Have I thought of leaving yet?
If you asked me what I was doing …
Are you addicted to false urgency?
The brain is a pattern-seeking organ that continually organizes the world into a more predictable experience. Our first predictions arise out of early childhood and are predicated on messaging from primary caregivers. These are deeply buried in implicit memory meaning that much of what we anticipate from interactions lies outside of our awareness. Over the course of a lifetime, these guiding assumptions working in the background are continuously modified in …
How therapy helps uncover hidden patterns
The first time I watched One Flew Over the Cuckoo’s Nest, it stayed with me for days. As an internist who has had the opportunity to care for psychiatric patients, I could not watch it as just a movie. I saw the familiar faces, the emotional extremes, the silent battles between care and control. And I felt the weight of questions the film still asks us today: Are we truly …
Lessons on compassion and autonomy from One Flew Over the Cuckoo’s Nest
Modern medicine is failing in three critical areas: mental health, chronic disease, and prevention at the cost of trillions of wasted dollars and untold suffering.
The problem runs deep. In my earlier KevinMD post, “Medicine’s mental health crisis: why the system is failing us,” I described the “mind-body split” theory of the 16th and 17th-century Scientific Revolution as guiding medicine and medical education since that time. It …
Why medicine needs a second Flexner Report
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