KevinMD.com: Social media’s leading physician voice
The KevinMD newsletterReal physician voices, twice a weekFree, and one click to unsubscribe.
Subscribe free →
Timothy Lesaca, MD

Enhanced author page

Timothy Lesaca, MD

A psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania.

52 articles on KevinMD

timothylesacamd.com

About

Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient-clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.

Latest articles

Physician voices

The question to ask new patients that intake forms skip

The first patient appointment begins long before we introduce ourselves. Patients often spend days gathering records, completing forms, reading about symptoms, and contemplating what we might say. As a result, by the time we meet, they may also have formed…

The first patient appointment begins long before we introduce ourselves. Patients often spend days gathering records, completing forms, reading about symptoms, and contemplating what we might say. As a result, by the time we meet, they may also have formed expectations about how we will respond. They may have read your biography and online reviews, but those descriptions cannot tell them whether you will welcome a difficult question or let …

Read more…

The question to ask new patients that intake forms skip

Physician voices

Is teen anxiety normal or a disorder? Both answers can fail.

Teenage anxiety is real, but if we treat every feeling as a medical issue, we might overlook what is truly important. When a teen says, "I'm anxious," we shouldn't have to choose between saying, "You have a disorder," or "That's…

Teenage anxiety is real, but if we treat every feeling as a medical issue, we might overlook what is truly important. When a teen says, “I’m anxious,” we shouldn’t have to choose between saying, “You have a disorder,” or “That’s just adolescence.” Both responses can shut down a conversation before it even starts.

A 2026 study in JAMA Pediatrics reveals this distinction. Analyzing 2024 National Survey on Drug Use and Health …

Read more…

Is teen anxiety normal or a disorder? Both answers can fail.

Physician voices

Who protects children from a livestreamed execution?

Before this or any government broadcasts an execution, it should first consider an obvious public health question: How will it protect children and other vulnerable people who might see the footage? This question needs a medical answer, no matter what…

Before this or any government broadcasts an execution, it should first consider an obvious public health question: How will it protect children and other vulnerable people who might see the footage? This question needs a medical answer, no matter what someone thinks about capital punishment.

On October 8, 2026, the United States Pentagon announced plans to livestream the execution of Nidal Hasan, who was convicted for the 2009 Fort Hood mass …

Read more…

Who protects children from a livestreamed execution?

Physician voices

Who monitors patients after telehealth ADHD prescribing?

Last month, I took on five new patients who were already prescribed stimulants. I had not met any of them in person before. Each came to me with a diagnosis, an active Schedule II prescription, and a chart note from…

Last month, I took on five new patients who were already prescribed stimulants. I had not met any of them in person before. Each came to me with a diagnosis, an active Schedule II prescription, and a chart note from a telehealth visit that I cannot fully piece together. My role now seems to be continuing these prescriptions. I am concerned about the handoff, and I doubt anyone decided who …

Read more…

Who monitors patients after telehealth ADHD prescribing?

Physician voices

Are antidepressant prescriptions for teens rising too fast?

She is fifteen and has been taking sertraline for three weeks. Her mother asks if we can increase the dose, since the first dose didn't work quickly enough. I look at her medication list, which is already longer than mine…

She is fifteen and has been taking sertraline for three weeks. Her mother asks if we can increase the dose, since the first dose didn’t work quickly enough. I look at her medication list, which is already longer than mine was at twice her age. I find myself doing something I rarely do during a seven-minute visit: I pause.

I do not doubt the value of antidepressants. I have seen these …

Read more…

Are antidepressant prescriptions for teens rising too fast?

Physician voices

Losing your doctor: the grief no health system notices

There is a small, unreasonable part of us that expects our doctors to stay in one place forever. We know better, of course. We know they grow older, become tired, change jobs, and make plans. Yet the person we bring…

There is a small, unreasonable part of us that expects our doctors to stay in one place forever.

We know better, of course. We know they grow older, become tired, change jobs, and make plans. Yet the person we bring our uncertainty to is not supposed to become another uncertainty. We may notice the gray hair without quite imagining the day when someone else opens the door.

Few relationships ask so much …

Read more…

Losing your doctor: the grief no health system notices

Conditions and diseases

Grief after cancer treatment belongs in follow-up visits

Recently, a patient of mine shared her final follow-up after successful cancer treatment. Instead of celebrating the clear scans, she burst into tears. Recovery from serious illness is often seen as a triumphant return to normal life, but the reality…

Recently, a patient of mine shared her final follow-up after successful cancer treatment. Instead of celebrating the clear scans, she burst into tears.

Recovery from serious illness is often seen as a triumphant return to normal life, but the reality is far more complex. For many patients, the end of treatment marks the beginning of a new emotional journey that is rarely discussed or anticipated. As patients recover, the losses from …

Read more…

Grief after cancer treatment belongs in follow-up visits

Physician voices

Medical ethics principles do not decide hard cases

"I know the treatment probably won't work," a patient nearing the end of life tells the doctor. "I want to try anyway." The patient understands the risks but still hopes for a little more time. The physician wants to honor…

“I know the treatment probably won’t work,” a patient nearing the end of life tells the doctor. “I want to try anyway.” The patient understands the risks but still hopes for a little more time. The physician wants to honor that hope while worrying that side effects could make the patient’s remaining days more painful. If the treatment requires resources in short supply, other patients’ needs make an already difficult …

Read more…

Medical ethics principles do not decide hard cases

Health technology

Patient trust in AI is not proof the advice is right

"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…

“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 …

Read more…

Patient trust in AI is not proof the advice is right

Conditions and diseases

When criticizing another physician harms the patient

Last week, a former patient came back to see me after spending several months with another doctor at a practice where I once worked. During our visit, the patient seemed uneasy and told me that the other doctor had made…

Last week, a former patient came back to see me after spending several months with another doctor at a practice where I once worked. During our visit, the patient seemed uneasy and told me that the other doctor had made disparaging comments about me. I did not believe the patient meant to hurt me by sharing this. Still, the words stung. More importantly, the patient had been placed in an …

Read more…

When criticizing another physician harms the patient

Conditions and diseases

Punishing a suicide attempt teaches people to hide it

On August 3, a nineteen-year-old sailor went overboard from the aircraft carrier USS Abraham Lincoln. Rescuers pulled him from the water and took him for medical care. According to his wife, he was attempting to die by suicide. The Navy…

On August 3, a nineteen-year-old sailor went overboard from the aircraft carrier USS Abraham Lincoln. Rescuers pulled him from the water and took him for medical care. According to his wife, he was attempting to die by suicide. The Navy has not confirmed this, but news reports say charging documents accuse him of malingering under Article 83 of the Uniform Code of Military Justice and being absent without leave under …

Read more…

Punishing a suicide attempt teaches people to hide it

Conditions and diseases

911 dispatcher mental health is not a wellness issue

A 911 dispatcher might never see the blood, the wreckage, or the scared family waiting by the road. But they hear everything. They hear the panic in a parent's voice when a child stops breathing. They listen as domestic violence…

A 911 dispatcher might never see the blood, the wreckage, or the scared family waiting by the road. But they hear everything. They hear the panic in a parent’s voice when a child stops breathing. They listen as domestic violence happens in real time. Sometimes, they stay on the line during a suicide attempt, a shooting, or someone’s last moments. All the while, they have to get an address, figure …

Read more…

911 dispatcher mental health is not a wellness issue

Health policy

How measuring physician shortages reveals hidden gaps

Physician shortage forecasts influence everything from residency expansion to rural workforce policy. But many of those forecasts begin with a deceptively simple question: How many physicians are practicing? A physician with a full clinical schedule and a physician approaching retirement…

Physician shortage forecasts influence everything from residency expansion to rural workforce policy. But many of those forecasts begin with a deceptively simple question: How many physicians are practicing?

A physician with a full clinical schedule and a physician approaching retirement who sees patients only a few days each month may both appear as one physician in a workforce database. Yet their contributions to patient care differ dramatically. When workforce planning relies …

Read more…

How measuring physician shortages reveals hidden gaps

Conditions and diseases

Collaborative care must reshape psychiatry training

The landscape of psychiatric care has shifted beneath our feet, yet residency training still clings to an older map. Programs continue to imagine a world where the psychiatrist alone sits with each patient, weighs the options, and steers the course…

The landscape of psychiatric care has shifted beneath our feet, yet residency training still clings to an older map. Programs continue to imagine a world where the psychiatrist alone sits with each patient, weighs the options, and steers the course of treatment. That tradition endures, but it is no longer the only current running through the field. Across the country, in clinics and hospitals both large and small, a new …

Read more…

Collaborative care must reshape psychiatry training

Conditions and diseases

AHRQ grant terminations leave patients without answers

Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive. What they do not know is that the research designed to help them recover more safely…

Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive.

What they do not know is that the research designed to help them recover more safely at home may never be completed.

In mid-July, the Agency for Healthcare Research and Quality (AHRQ) began notifying researchers across the country that dozens of active research grants would be terminated. As …

Read more…

AHRQ grant terminations leave patients without answers

Drugs and prescribing

Semaglutide and cravings: what the 2026 trial changed

Patients start glucagon-like peptide-1 (GLP-1) drugs expecting to think less about food. They did not expect to think less about alcohol. The nightly drink became easier to skip. Cigarettes felt less urgent. Cannabis, gambling, or compulsive shopping sometimes lost their…

Patients start glucagon-like peptide-1 (GLP-1) drugs expecting to think less about food. They did not expect to think less about alcohol. The nightly drink became easier to skip. Cigarettes felt less urgent. Cannabis, gambling, or compulsive shopping sometimes lost their pull. As “food noise” quieted, another possibility emerged: Perhaps these drugs were turning down craving itself.

At first, these reports might have seemed like coincidences. Instead, they sparked new research. Scientists …

Read more…

Semaglutide and cravings: what the 2026 trial changed

Physician voices

Institutional betrayal in medicine begins after the harm

Most institutions do not fail because they miss obvious moral harm. They fail because they overlook warning signs and protect themselves, rather than face what they reveal. The debate over microaggressions concentrates on the initial act. Was the comment intentional?…

Most institutions do not fail because they miss obvious moral harm. They fail because they overlook warning signs and protect themselves, rather than face what they reveal.

The debate over microaggressions concentrates on the initial act. Was the comment intentional? Was it serious? Did it violate policy? But those questions do not describe the whole moral event. In medicine, the deeper injury may begin after authority speaks. I call this institutional …

Read more…

Institutional betrayal in medicine begins after the harm

Conditions and diseases

Military sexual trauma is not just another cause of PTSD

Military sexual trauma (MST) affects an estimated 1.4 million U.S. veterans and is one of the most consequential noncombat-related health burdens associated with military service. Military trauma is still commonly viewed through the lens of combat exposure, but MST is…

Military sexual trauma (MST) affects an estimated 1.4 million U.S. veterans and is one of the most consequential noncombat-related health burdens associated with military service. Military trauma is still commonly viewed through the lens of combat exposure, but MST is a distinct form of military trauma involving interpersonal violation, power imbalance, disrupted trust, and long-term mental and physical health consequences.

For clinicians, MST should not be understood simply as another cause …

Read more…

Military sexual trauma is not just another cause of PTSD

Physician voices

Leadership diversity is a governance problem, not a slogan

Hospitals would never rely on the idea that "we know good care when we see it" to control infections. Yet when choosing leaders, many still rely on the vague belief that "we know leadership potential when we see it." Medicine…

Hospitals would never rely on the idea that “we know good care when we see it” to control infections. Yet when choosing leaders, many still rely on the vague belief that “we know leadership potential when we see it.”

Medicine reviews nearly every process that affects patient care. But choosing leaders often happens privately, through conversations, informal nominations, search committees, and personal opinions about “fit.” This process is rarely reviewed as …

Read more…

Leadership diversity is a governance problem, not a slogan

Physician voices

Clinical trial ethics fails the world’s poorest patients

The consent form says participation is voluntary. Yet in some global clinical trials sponsored by organizations based elsewhere and conducted in lower-resource countries, joining a study may be the only realistic way to see a physician, receive diagnostic testing, obtain…

The consent form says participation is voluntary. Yet in some global clinical trials sponsored by organizations based elsewhere and conducted in lower-resource countries, joining a study may be the only realistic way to see a physician, receive diagnostic testing, obtain medication, or remain in care. When ordinary care is unavailable, how voluntary is the choice to participate?

This is not always coercion in the narrow legal sense. Rather, it reflects constrained …

Read more…

Clinical trial ethics fails the world’s poorest patients

Real physician voices, twice a week

Free, and one click to unsubscribe.

No spam. We never share your email.

3
pages