Post-stroke pain management: what the 2026 guidelines say

Conditions and Diseases
September 12, 2026

Pain management is rarely a blanket approach. Effective relief depends on the specific type of pain, its underlying mechanism, the patient’s comorbidities, age, functional goals, and overall clinical context. This principle is especially important after stroke, where pain is common, often under-recognized, and can significantly hinder rehabilitation, sleep, mood, and quality of life.

Stroke survivors experience several distinct pain syndromes. Distinguishing them matters because treatments differ.

Central post-stroke pain (CPSP)

Central post-stroke pain …

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Post-stroke pain management: what the 2026 guidelines say

mRNA hype moves faster than the evidence behind it

Medications
September 12, 2026

mRNA technology may be both a remarkable scientific tool and a very effective marketing machine. Those are not mutually exclusive. The challenge is distinguishing a promising platform, a useful treatment, and a product promoted beyond what the evidence can support.

In early 2020, COVID-19 was frightening. We did not know how readily the original strain would spread or how much illness and death it would cause. We soon learned that risk …

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mRNA hype moves faster than the evidence behind it

The sweet spot before physician financial independence

Physician Finance
September 12, 2026

Many physicians believe they can’t escape burnout or an unsustainable career until they’ve become financially independent. Thankfully, it’s not true.

The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners, financial independence is a mathematical problem to solve. I might be able to run your numbers in a Monte Carlo analysis and demonstrate you have, say, an 84 percent chance of …

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The sweet spot before physician financial independence

7 red flags that eugenics in medicine is returning

Physician
September 12, 2026

Adapted from The New Eugenics in Medicine: Two Novellas About Power, Science, and the Future of Human Worth.

My recent article in The Pharos, “Eugenics Is Having a Quiet Revival, and Medicine Must Respond,” began with a premise that is easy to state but harder to live by: Eugenics should not be treated as a safely quarantined historical episode. Its most dangerous legacy is not a particular …

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7 red flags that eugenics in medicine is returning

Why doctors don’t know their patients, only their initials

Physician
September 12, 2026

I am on rounds with the medical team on the floor that has patients with medical problems and psychiatric comorbidities. My presence is not actually needed; however, the social worker who attends regularly usually feels the need for support from her attendings, who do not have the “time” to attend these meetings, so I have attended at least weekly. As I sit in the nursing station where the team meeting …

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Why doctors don’t know their patients, only their initials

Why prompt engineering for physicians fails at 2 a.m.

Health Technology
September 12, 2026

Vinson James has found something that deserves more attention than it will get. Testing six large language models on validated pediatric board questions, he reports that accuracy ranged from 38 to 90 percent when the questions were delivered all at once, and converged to 83 to 88 percent when the same questions were delivered in batches of ten. Identical questions. Identical models. The only thing that changed was how the …

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Why prompt engineering for physicians fails at 2 a.m.

The immigrant doctor who belongs to two places at once

Physician
September 12, 2026

Having returned to the United Kingdom from a vacation back to Southeast Asia, I found myself reflecting on the meaning of being an immigrant.

I found myself intensely missing the sun and the food. The general miasma of security and comfort that comes from being home. Of having access to not one but three cars with a full driving license, which, being Malaysian, is a huge part of one’s identity. Strip …

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The immigrant doctor who belongs to two places at once

Antibiotics for sinusitis without a real diagnosis [PODCAST]

Podcast
September 11, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Most people who get antibiotics for a sinus infection never needed them, and the real problem goes untreated. Franklyn R. Gergits is a board-certified otolaryngologist who sees the patients that three, four, and …

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Antibiotics for sinusitis without a real diagnosis [PODCAST]

AI adoption in rural hospitals could fuel consolidation

Health Technology
September 11, 2026

A new national report on obstetric care should concern anyone worried about the future of American health care. Between 2010 and 2024, 718 U.S. hospitals lost obstetric services through unit or hospital closures. By 2024, 57.5 percent of rural hospitals had no obstetric services at all.

This is not simply a maternity-care problem. It is another warning that the economics of delivering health care in smaller communities are becoming increasingly difficult.

Now …

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AI adoption in rural hospitals could fuel consolidation

AI psychosis and the myth that disclosure protects patients

Health Technology
September 11, 2026

A few days ago, I wrote here that nobody has studied what happens when someone who already has a psychotic disorder uses an AI chatbot. I said we didn’t know yet whether these tools interact differently with an existing illness than they do with a previously stable mind.

We now have a name and a court file.

Michael Lines is a thirty-four-year-old competitive weightlifter from California who was diagnosed with bipolar …

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AI psychosis and the myth that disclosure protects patients

Why are fewer family physicians delivering babies?

Health Policy
September 11, 2026

A family physician can complete residency fully prepared to care for low-risk pregnancies and deliveries, only to discover that the hospital where they practice will not grant obstetric privileges, their employment contract does not include deliveries, or the demands of call are unsustainable. The consequences extend beyond an individual physician’s career. In rural communities, it means the loss of a clinician who can provide maternity care close to home.

The rural …

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Why are fewer family physicians delivering babies?

Opioid red flags mean caution in medicine, guilt in law

Conditions and Diseases
September 11, 2026

Anyone working as a clinician or pharmacist in pain medicine these days has heard the term “red flag” to the point of personal nausea. In everyday practice, the term has multiplied like termites, and with equally destructive effect on the lives of patients and their doctors. It is almost always applied as a reason (actually an excuse) for denying patient access to safe and effective prescription opioid analgesics and/or benzodiazepine …

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Opioid red flags mean caution in medicine, guilt in law

Patient experience in urgent care is a workflow issue too

Physician
September 11, 2026

When I joined OrthoIllinois in 2022 and took on leadership responsibilities at Injury Express, our orthopedic urgent care practice was already delivering high-quality clinical care. But as I became more involved in reviewing our patient-experience data, I noticed that some of our biggest opportunities for improvement had little to do with the medical care itself. Many involved waiting.

In 2022, our overall patient satisfaction score was 92.10 percent. When we looked …

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Patient experience in urgent care is a workflow issue too

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A novel about AI and the drug risk its makers kept quiet

Health Technology
September 11, 2026

An excerpt from The AI: Breakout, the second book in The AI series, publishing in November. 

Seth Ballard runs a private research lab built off the grid, deliberately outside the funding race. Niko is the researcher who evaluates what their model can do, and Darin is the partner who has funded the work from the beginning. What the model has just done is find something in approved medicine that no …

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A novel about AI and the drug risk its makers kept quiet

Patient noncompliance is often a system failure in disguise

Conditions and Diseases
September 11, 2026

At 4:00 p.m. on a Friday, a patient walked out of a community crisis stabilization unit without his medication. On paper, the chart note was predictable: “Patient left against medical advice,” “poor impulse control,” “non-adherent with treatment regimen.” It is a familiar refrain in psychiatric care, one that quietly transfers a systemic failure onto the person in distress.

Look closer at the operational workflow, however, and a very different story emerges. …

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Patient noncompliance is often a system failure in disguise

Does cash-pay medicine change the standard of care?

Physician
September 11, 2026

Not long ago, I attended a webinar on regenerative medicine. The speaker was the sort of polished, confident expert you expect at these events. During the Q&A, someone finally asked the question that always comes up: Does insurance cover any of this?

The answer was a flat no. Cash only. And not a small sum, either. A number that made even me, after decades in medicine and not easily shocked by …

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Does cash-pay medicine change the standard of care?

Protein-maxxing at the cookout: Skip the eggs and beef

Conditions and Diseases
September 11, 2026

As a primary care physician, I’m sometimes asked about protein-maxxing, a viral internet trend. Chances are you’re already getting enough protein, but the current trend can be a positive influence if it prompts you to explore plant-based sources of protein. Pecans, black-eyed peas, chickpeas, and many other delicious foods provide you with plenty of protein as well as fiber, iron, and other important nutrients.

If you’re focused on …

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Protein-maxxing at the cookout: Skip the eggs and beef

Toxic leadership in medicine punishes doctors who speak up

Physician
September 11, 2026

In four consecutive positions, I encountered the same pattern: toxic bosses and non-clinical administrators dictating how physicians should practice. Their tool of choice was always the same: the RVU hamster wheel, a metric that works beautifully in MBA classrooms and fails catastrophically in real medical clinics.

The problem isn’t productivity. Physicians have always worked hard. The problem is being managed by people who do not understand the work.

When administrators who have …

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Toxic leadership in medicine punishes doctors who speak up

Hearing voices in children rarely means schizophrenia

Conditions and Diseases
September 11, 2026

Tommy, a seven-year-old boy, had started telling his mother that he was hearing voices.

I think about Tommy often now, because the families who come to me are more frightened than ever, and they often arrive already certain. By the time parents reach my office to tell me their child has begun hearing voices, or seeing things, they have usually asked the internet what it means. More recently, and increasingly, they …

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Hearing voices in children rarely means schizophrenia

Your AI judges patients by how they write, not their symptoms [PODCAST]

Podcast
September 10, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

What if medical AI judges you by how you write instead of what’s actually wrong? A health care executive says it already does. Craig Hauben has spent 30 years in health care and …

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Your AI judges patients by how they write, not their symptoms [PODCAST]

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