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Everyone agrees health care should reward better outcomes at lower cost. So why hasn’t it happened? The answer isn’t payment models or policy. It comes down to the everyday choices individual clinicians make, …
Why value-based care hasn’t lowered your medical bills [PODCAST]
“We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.” Elisabeth Kubler-Ross
Over the course of my career, I have witnessed an inexorable decline in the quality of medical care that we, as physicians, render to our patients. There is a myriad of reasons for this sad development, some …
Why a broken health care system keeps getting worse
A patient tells you that her deceased grandmother still visits her in dreams. Another believes that unseen spiritual forces influence his health. A third insists the government has implanted a device that broadcasts his thoughts.
Which patient is psychotic? The answer is that you don’t know. At least not yet.
One of the most common misconceptions about psychiatry is that delusions are simply “false beliefs.” In reality, experienced clinicians rarely diagnose psychosis …
Diagnosing psychosis starts with process, not content
“Can you make this sound less demanding?” A patient types the question into a chatbot while trying to write a message to her doctor. She wants to ask why a test was ordered and whether she should be worried, but she does not want to come across as difficult. She describes the appointment. Then she adds what she did not say at the time: that she left frightened, has been …
Patient trust in AI is not proof the advice is right
Former cosmetic surgeon Robert Yoho, MD, after retiring from medical practice in 2019, became an author and health care whistleblower and recently addressed the “explant” trend in which breast implants are surgically removed. According to the American Society of Plastic Surgeons, 306,196 women bought breast augmentation in 2024. In 2021, the FDA added a boxed warning to implants cautioning that they are linked to breast implant-associated anaplastic large cell lymphoma …
Breast implant removal leaves patients paying 3 times
This is dedicated to my fellow Zebras. I hear you. I see you.
This is not an easy story to share, but I want to do so in the hope of bringing greater visibility to conditions that are often overlooked and poorly understood. This reflection explores my experience as both a patient and doctor navigating hypermobility and its associated conditions. My aim is to help reduce delays in diagnosis, encourage clinicians …
Medical gaslighting delayed my diagnosis by 20 years
Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in the practice management system as a negative number on a patient or payer account, it rarely triggers an alert, and it quietly inflates the bank balance the owner looks at …
Credit balances in medical practices have a deadline
It was a quiet Sunday morning, coffee on the desk, and I was doing what most residents do at some point in their training: grinding through multiple-choice questions (MCQs) for my in-training exam. I had been using large language models (LLMs) as study partners for weeks. ChatGPT to walk through a tricky electrolyte case. Gemini for a second opinion on a renal physiology question I couldn’t square. DeepSeek when I …
Why prompt engineering in medicine beats picking a model
About a year ago, KevinMD published an article that I wrote about avoiding online scams when one is highly visible in media as a patient advocate. During that year, I’ve come to recognize that I should have taken more of my own advice on the subject.
I have also learned that the technology supporting online criminals has expanded at a far faster rate than I’d anticipated. AI-based search engines can …
Book publishing scams took $7,500 from me by wire transfer
Make the world a better place strobed through my mind as I trudged anxiously to my organic chemistry final exam after an all-night study session and a few NoDoz capsules. Unprepared and scared, I hoped for the best, as I took yet another exam on material which failed to come easily. Spanish Lit, Writing, and even Calculus clicked in my brain readily, but I had decided to mimic my mother’s …
Leaving clinical medicine when doing right became a battle
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Patients now choose doctors the way they shop for everything else, judging your practice online before they walk in. Ashley Gay, a branding expert, argues that a strong brand is not about ego …
Why weak branding is costing private practices patients and talent [PODCAST]
Christopher Nolan’s The Odyssey was more than just a tale about a man’s long journey home. It is ultimately a warning about what happens when society abandons its shared obligations. I found his modern interpretation helpful for framing a recent shift in attitudes toward public health and medicine.
In the film, the actions of the Greeks at Troy violated one of their wider society’s most foundational social norms: Zeus’ Law. It …
Physician advocacy is a duty, not a political choice
When I was deciding whether to leave full-time clinical medicine, I asked my most trusted colleagues what they thought. Most of them did not understand why I would leave something I had worked so hard to build. Others suggested I not make a change so early in my career. My family did not understand the new job either, not even my husband. In the end I did it anyway.
After asking …
How to stop asking for permission and decide for yourself
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I’ve been thinking a lot about what we are losing in modern medicine. We were taught to treat the patient, not just the labs. To listen. To notice patterns. To pay attention when something doesn’t quite fit. To ask, “What am I missing?”
Angus Fletcher, a professor of story science at Ohio State’s Project Narrative, calls this primal intelligence. He names four capacities: intuition, imagination, emotion, and common sense.
In medicine, we …
Fragmented care leaves patients holding the whole picture
For decades, vascular care has focused on solving problems within the circulatory system. When an artery narrows, we restore blood flow. When a patient requires dialysis, we create reliable vascular access. These interventions are critical, but they represent only part of the picture.
Today’s vascular patients rarely have disease confined to a single organ system. Many are living with chronic kidney disease, heart disease, and diabetes simultaneously. As these conditions become …
Dialysis access and heart failure need one care plan
When pain interferes with work, exercise, sleep, or everyday movement, it is natural to look for the fastest possible solution. Patients often arrive at an appointment asking whether a particular treatment will “fix” a painful knee, back, shoulder, or hip. That question is understandable, but it may not be the best place to begin.
Before choosing any non-surgical approach, patients should first understand what may be causing the pain, what the …
7 questions to ask before pain treatment begins
Patients are hearing more about artificial intelligence (AI) in medicine. Some are excited. Some are worried. Many are unsure what it means when a clinician, hospital, insurer, or digital health company says AI is being used in their care. That uncertainty matters.
Trust is not created by telling patients that a tool is advanced. Trust is created when patients understand what is happening, why it is happening, who is responsible, and …
Patient trust in AI starts with human accountability
It’s not a simple question, and one that many physicians outside our specialty still find surprisingly difficult to define. Have you ever called a rehab consult and struggled to understand why you need one? Many have. The truth is, physiatrists often think differently. Every specialty develops its own lens through which it views disease. A surgeon asks whether a problem can be repaired. A neurologist localizes it. An oncologist determines …
How does a rehabilitation physician actually think?
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Social media says to spike your fiber intake as fast as you can. That is where the bloating starts. Lisa Talamini is a registered dietitian nutritionist and senior vice president of clinical solutions …
Bloated from all that fiber? You added it too fast.
Wael Khouli wrote here on July 26 that AI will not replace physician advisors, volume will. He is right, and his argument applies elsewhere in the clinic to the people who build prior authorizations. I build this kind of software and have seen automation rescue teams as much as I have seen careless implementations bury them. The difference comes down to the quality of existing data, workflows, and knowing when …
Prior authorization automation has an arithmetic problem
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