Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Is your patient’s new symptom a prescribing cascade?

Medications
August 26, 2026

Modern scientific medicine has given humanity extraordinary tools. Antibiotics transformed once-lethal infections into treatable illnesses. Cardiovascular medications prevent strokes and myocardial infarctions. Insulin, anticoagulants, immunotherapies, psychiatric medications, and countless other treatments have extended and improved millions of lives.

The problem is not medication. The problem begins when our capacity to prescribe becomes greater than our discipline to ask whether every intervention remains necessary. That distinction is increasingly important in an aging …

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Is your patient’s new symptom a prescribing cascade?

Protect physicians from bureaucracy, not from patients

Conditions and Diseases
August 25, 2026

Lately, there has been considerable discussion about the changing boundaries between physicians and patients. How quickly should doctors respond to portal messages? When does reasonable access become unreasonable intrusion? Where does professional responsibility end and personal time begin?

These are legitimate questions. Physicians are entitled to privacy, reasonable working hours, and protection from inappropriate demands. No one should expect a physician to be available to every patient at every hour through …

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Protect physicians from bureaucracy, not from patients

In primary care, listening is a clinical skill

Conditions and Diseases
August 23, 2026

As a family nurse practitioner, I’ve learned that the most meaningful moments in medicine rarely happen because I found the perfect medication. They happen because someone finally felt heard.

Every day in primary care, patients arrive carrying more than symptoms. They bring uncertainty, fear, frustration, and often years of feeling overlooked. Many have seen multiple clinicians, searched endlessly for answers online, or quietly accepted that their concerns are “just part of …

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In primary care, listening is a clinical skill

Why should doctors treating family members step back?

Physician
August 22, 2026

An excerpt from Treating a Broken System: A Physician’s Cure For the Healthcare Crisis.

I remember the event clearly, even though it was more than forty years ago. I was a fairly new faculty member in a Philadelphia university medical center, having finished my residency in internal medicine a few years prior. My wife, Terry, and I had been married for six years, and we had two kids at the …

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Why should doctors treating family members step back?

I don’t like who I’ve become in primary care

Physician
August 21, 2026

I don’t like who I’ve become, working in primary care.

In the medical community, it seems like we’ve discussed the root causes of burnout ad nauseam: too much paperwork, too many in-basket messages and inane patient requests, too many clicks in the EMR, too-short appointment times, too much corporate consolidation and insurance overreach. But as I see it, the end result, the final common pathway, is this: Most of us have …

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I don’t like who I’ve become in primary care

Why setting boundaries as a physician feels impossible

Physician
August 21, 2026

Many of the physicians I work with bring up the issue of boundaries. “I know I need to set better boundaries, but.” They see the costs. They are clearly aware of what they need to do but just can’t seem to execute. They let patients drive the conversations in the exam room so that they run late and finish notes at midnight. They agree to a schedule change to help …

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Why setting boundaries as a physician feels impossible

What happens to evidence-based medicine when patients stop trusting the evidence?

Conditions and Diseases
August 20, 2026

National Immunization Awareness Month got me thinking about vaccines, but probably not in the way you might expect. I have never been anti-vaccine. In fact, vaccines are very personal to me.

My father had polio. I spent my entire life watching the effects it had on him and thinking about how different his life might have been if the polio vaccine had been available before he contracted the disease. It became …

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What happens to evidence-based medicine when patients stop trusting the evidence?

Taking a leap of faith in my career was the best thing for my patients and me

Sponsored
August 18, 2026

We’ve all taken a leap of faith at some point in our lives. For me, it was switching from a traditional physician’s practice to joining CenterWell Senior Primary Care, which employs a true team-based approach. Doing so has convinced me that it’s one of the best methods for keeping my patients healthy …

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Taking a leap of faith in my career was the best thing for my patients and me

Rituals in primary care restore what screens erase

Physician
August 16, 2026

A social worker lights a single candle, and the entire primary care staff watches the flame. In turn, we jot the names of deceased patients on slips of paper. When moved to speak, we place a name in the basket. Sometimes we speak. For Ian, whose laugh could light up a room. Other times, we bear witness in silence and sit back down. The gathering feels recent, but it last …

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Rituals in primary care restore what screens erase

When your labs are normal but you still feel sick [PODCAST]

Podcast
August 14, 2026
YouTube video

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

Your blood pressure is fine. Your cholesterol looks great. So why do you still feel exhausted, wired, and unwell? Internal medicine and functional medicine physician Shiv K. Goel returns to explain what standard lab panels miss when chronic stress quietly reshapes the …

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When your labs are normal but you still feel sick [PODCAST]

Medication-induced dry mouth quietly damages teeth

Conditions and Diseases
August 12, 2026

During my years in clinical dentistry, I often saw patients develop new dental problems after starting medication for an unrelated condition. The medication lowered their blood pressure, eased their anxiety, improved their sleep, or controlled their allergies. At the same time, their mouths became persistently dry.

Most patients did not connect the dryness to their medication. Some considered it annoying but harmless. Others barely noticed it until eating, speaking, or wearing …

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Medication-induced dry mouth quietly damages teeth

Health care affordability starts with healthier patients

Conditions and Diseases
August 11, 2026

In Western medical training and clinical practice, one of the first questions a clinician traditionally asks is: “What is your chief complaint?” The patient tells a story. The clinician listens, asks questions, performs an examination, develops a differential diagnosis, and recommends appropriate treatment.

But what if our current health care delivery model itself were the patient? Its chief complaint might sound something like this: “Doctor, I am becoming unaffordable.” And then, …

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Health care affordability starts with healthier patients

A Muslim American physician on what an MD cannot shield

Physician
August 11, 2026

As a physician, for the longest time, I thought my MD title, this profession, would be a shield in a world full of so many challenges. I was and am wrong.

Growing up as an immigrant in the United States, I became more acutely aware of my differences after September 2001. Due to my background, skin tone, complexion, name, religion, everything about me stood out. During this formative period, I …

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A Muslim American physician on what an MD cannot shield

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A clinical research portfolio is a set of strategic bets

Physician
August 10, 2026

Clinical research is typically managed one protocol at a time, with each study having its own budget, timeline, team, recruitment target, and publication plan. While this structure is essential, it can obscure a larger truth. Research organizations do not merely manage projects; they manage portfolios of strategic bets.

Every trial utilizes limited resources. Investigator time, research staff, patient access, data infrastructure, funding, laboratory capacity, and organizational attention cannot be allocated everywhere …

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A clinical research portfolio is a set of strategic bets

Explaining clinical reasoning to patients in five questions

Physician
August 8, 2026

Every summer, a new class of medical students puts on a short white coat for the first time and walks onto a hospital floor. Elsewhere, third-year students begin their first clinical clerkships, and new residents are several weeks into carrying responsibility that no longer ends when a lecture, examination, or scheduled exercise is over.

They will be taught multiple approaches to the art, science, and practice of medicine. They will learn …

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Explaining clinical reasoning to patients in five questions

Saving a child’s permanent tooth after dental trauma

Conditions and Diseases
August 7, 2026

When trauma threatens a child’s permanent tooth

A new electric scooter for a tenth birthday party. In the excitement of trying it out for the first time and demonstrating the speed to friends, the new rider doesn’t notice the curb and goes flying over the handlebars. Landing face-first on the sidewalk, the upper lip and front teeth bear the brunt of the impact. This scenario is occurring with increased frequency, especially …

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Saving a child’s permanent tooth after dental trauma

The patient experience question physicians get wrong

Physician
August 6, 2026

There is a question I have heard countless times throughout my career.

“Was the patient happy?”

It is usually asked with good intentions, but I have often wondered whether we are asking the wrong question. As physicians, our responsibility has never been to make every patient happy. We cannot promise antibiotics for viral infections, unnecessary imaging for reassurance, or pain medications simply because they are expected. Good medicine often requires uncomfortable conversations …

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The patient experience question physicians get wrong

Medicine keeps treating oral health as someone else’s job

Conditions and Diseases
August 5, 2026

During my years in clinical dentistry, I repeatedly met patients whose oral disease had been causing symptoms long before they reached a dental office. Some had mentioned bleeding gums to another health care professional but did not understand that the symptom required evaluation. Others had lived with painful chewing, loose teeth, or persistent dry mouth while managing diabetes, cardiovascular disease, or multiple medications. By the time they sought dental care, …

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Medicine keeps treating oral health as someone else’s job

What ethics education owes students when evidence changes

Conditions and Diseases
August 5, 2026

Ethics education differs from other disciplines because its main goal is not to transmit information but to encourage moral reasoning. When students leave an ethics course, we hope they will be better equipped to analyze competing values, evaluate evidence, and justify their conclusions, not merely adopt those of the instructor. When you think about it, the teaching of ethics is itself an ethical act that can carry responsibilities extending beyond …

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What ethics education owes students when evidence changes

Shifting health care toward prevention, not just treatment

Physician
August 4, 2026

Health care has never possessed more scientific knowledge, more sophisticated technology, or more specialized expertise than it does today. Yet despite these remarkable advances, chronic disease continues to rise, health care costs continue to escalate, physician burnout persists, and patients increasingly spend more years living with illness rather than enjoying health.

This paradox raises an important question. A probable explanation: Perhaps our greatest challenge is not a lack of scientific progress. …

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Shifting health care toward prevention, not just treatment

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