Psychiatry

The 9 laws of health care quality: Why metrics miss the point

Physician

March 12, 2026

I have spent years watching the development of quality programs. What began as a way to ensure patient safety has gradually given way to an independent group of individuals whose job it is to interpret regulations and monitor those interpretations. In the process, the clinical richness of medicine has been lost. Judgment, narrative, and context matter less than forms and metrics. The work has shifted away from the bedside and …

The hidden risks of AI-generated progress notes in psychotherapy

Arthur Lazarus, MD, MBA

Tech

March 12, 2026

Imagine a patient who spends most of a therapy session talking about a single memory. He describes sitting in his car after visiting his mother in a nursing home, unable to start the engine. He sits there for nearly 20 minutes, staring at the steering wheel and wondering when the roles had reversed, when he had become the parent and she the child. Nothing dramatic happens in the session. No …

Grief and healing: Learning to live with absence

Michele Luckenbaugh

Conditions

March 12, 2026

Life begins, and life ends.
We know this
the way we know the sun will rise,
as a fact, not a feeling.

Those we cherish
and those who cherished us
leave without rehearsal,
no warning bell
to soften the blow.
As if the heart
could ever be trained for absence.

They were threaded into the ordinary,
morning light, evening quiet,
the familiar rhythm of breath and belonging.

We assumed their nearness was permanent,
the way we assume tomorrow.

There were shared breaths of laughter,
tears that needed …

When a code blue happens on a psychiatry unit

Devina Maya Wadhwa, MD

Conditions

March 11, 2026

The overhead call still feels wrong when it happens on a psychiatry unit. Code blue. The words echo through hallways designed for containment and calm, not cardiac arrest. Psychiatry is supposed to be about listening, de-escalation, and meaning-making. A code blue interrupts that narrative abruptly, reminding everyone in earshot that bodies, not diagnoses, ultimately set the terms. What struck me most was not the urgency of the response (clinicians are …

Physician burnout definition: Why it is blocked energy, not just exhaustion

Susan MacLellan-Tobert, MD

Physician

March 10, 2026

Most physicians experience burnout as exhaustion. We say, “I have nothing left.” The assumption is simple: We are depleted, and what we need is rest. But after decades in medicine, and years of listening carefully to burned-out clinicians, I wonder if that assumption is wrong.

What if burnout is not a lack of energy at all? What if it is energy that has nowhere to go?

Physicians enter medicine with extraordinary life …

Physician neutrality: a beacon of ethics in a divided world

Farid Sabet-Sharghi, MD

Physician

March 9, 2026

I watched with horror, grief, and tears in my eyes as the events of the last week unfolded. We witnessed a catastrophic massacre of Iranians seeking nothing more than the basic freedom to exist outside an oppressive system. As conflicts ignite in various corners of the world, it feels as though the fabric of our global society is tearing at the seams.

Yet, amidst the darkness, there was a silver lining: …

How to handle clinical disagreement with patients

Muhamad Aly Rifai, MD

Physician

March 9, 2026

One of the hardest moments in medicine is not making a diagnosis. It is not writing the prescription. It is sitting across from a patient who wants something you do not believe is right for them and knowing that whatever you say next will either build trust or break it. That moment comes every day in modern practice. A patient wants an antibiotic for a virus. A patient wants a …

The quiet paradox of physician mental health and medication

Timothy Lesaca, MD

Physician

March 9, 2026

Physicians are trained, above all, to project steadiness. Long before we feel it, we learn to perform it. The lesson begins early in training. The pager goes off, a room fills with urgency, and the expectation is unspoken but unmistakable: Remain calm. Do not let uncertainty show. Do not let fear show. Patients need confidence. Teams need direction. Over time, the composure stops feeling like a performance. It becomes a …

The Platinum Rule in health care: Moving beyond the Golden Rule

Harvey Max Chochinov, MD, PhD

Conditions

March 7, 2026

An excerpt from In Search of Dignity: A Lifetime of Reflections.

Several years before her death at the age of 55 years due to complications of cerebral palsy, my sister Ellen was again in hospital, this time in intensive care and on the brink of respiratory collapse. To say cerebral palsy had shaped her life is an understatement, in that it molded nearly every facet of her being, from the …

The passion vine: a lesson on restraint in medicine and life

Rao M. Uppu, PhD

Conditions

March 6, 2026

I cannot claim to have been the one who nurtured our garden. That credit belongs to my wife. She is the one who waters the plants faithfully and notices when something needs care. I am more often the admirer, the one who pauses to appreciate a flower that seems almost too beautiful to belong in an ordinary backyard.

Among the plants that brought me the greatest joy was a passion vine. …

Physician vulnerability and authenticity: How shared stories heal [PODCAST]

The Podcast by KevinMD

Podcast

March 5, 2026

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

Professor of clinical psychiatry Michael F. Myers discusses his book Physicians With Lived Experience: How Their Stories Offer Clinical Guidance and the article “Breaking the silence: mental health and racism in medical …

The hidden cost of uncompensated work on physician burnout

Jessie Mahoney, MD

Physician

March 5, 2026

Physicians are renowned for their dedication to helping others. The problem is that their dedication has become synonymous with self-sacrifice and working for free.

Giving away time, energy, and expertise is simply “what good doctors are supposed to do.”

We work through lunch. We attend meetings during lunch. We respond to patient messages on our days off. We prepare lectures and teach without compensation. Leaders hold space for complaints and conflict and …

Physician burnout solutions: Why system change isn’t enough

Diane W. Shannon, MD, MPH

Physician

March 5, 2026

When I experienced burnout as a young primary care physician, I thought it was my fault. Actually, I didn’t know it was burnout; I had never heard the word. But I believed whatever was causing the deep exhaustion, lack of empathy, and feelings of uselessness were surely due to a flaw or weakness in me.

Eventually, I stumbled across the definition of professional burnout. I was so curious to understand what …

Rest is a holy practice: Reclaiming the soul of medicine [PODCAST]

The Podcast by KevinMD

Podcast

March 4, 2026

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

Developmental behavioral pediatrician Roxanne Almas discusses her article “The making of a rested healer.” Roxanne shares her deeply personal journey through the “quiet unraveling” of burnout and the profound grief of losing …

Applied behavior analysis criticism: the closed feedback loop

Ronald L. Lindsay, MD

Conditions

March 3, 2026

In engineering, a feedback loop is meant to stabilize a system. In medicine, feedback guides us toward better outcomes. But in applied behavior analysis (ABA), feedback has become a trap, recycling failure under the guise of science, and leaving children and families caught in its circuitry.

The closed circuit

Stevens’ feedback loop diagrams are elegant in their simplicity: arrows circling back, showing how inputs and outputs can stabilize a system. In healthy …

Coping with survivor guilt: wisdom from Saadi Shirazi and Viktor Frankl

Farid Sabet-Sharghi, MD

Physician

March 3, 2026

When someone you love is in a different location and suffering while you are safe, a heavy silence begins to fill the room. This survivor guilt is one of the most difficult burdens to carry because it turns even the smallest joys, a hot cup of tea, a peaceful morning, or a moment of laughter, into something that feels like a betrayal. The heart constantly asks: Why them and not …

Psychological safety in health care: Why speaking up saves lives

Jalene Jacob, MD, MBA

Physician

March 2, 2026

During a busy morning, a junior nurse notices a discrepancy between a patient’s medication order and the usual dosing protocol. The unit is short-staffed, rounds are running behind, and the attending physician appears visibly rushed. The nurse hesitates, worried about slowing the team down or appearing inexperienced.

The unit manager who is present during rounds, notices the nurse’s hesitation and pauses the discussion. Rather than pushing forward, the manager says, “Before …

Lessons from 47 years: long-term marriage and palliative care

Richard A. Lawhern, PhD

Conditions

March 2, 2026

My wife is dying.

The day has yet to be determined, but the causes are certain. Stage 4 metastatic pancreatic and liver cancers will allow her a few weeks more in which to say goodbye to a large circle of family and friends. She has decided not to undergo chemotherapy or radiation that at best might extend her life by a few weeks, at the cost of the quality of whatever …

Why I stopped accepting pharmaceutical-sponsored lunches

Timothy Lesaca, MD

Physician

March 2, 2026

A pharmaceutical representative recently brought lunch to my office to present a new drug. The drug may help some patients. The food was abundant. The room was full, with excess all around, including leftovers that were eventually thrown away. None of that is unusual in American medicine.

What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the …

Bipolar I and the illusion of insight: a firsthand account

Tommy Saborido, MD

Physician

February 28, 2026

I’m Tommy. Bipolar type one, I’m told. I actually have something to say, something to share.

The thing no one talks about in mental health, bipolar type one specifically, is how seductive and sweet the upswing feels. It’s deeply more than just “good” to me. It feels like the limits of the brain have been cut loose, severed, done away with. Suddenly all those moments and ideas and thoughts and connections …

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