In medicine, we’re trained to stay. To endure. To prove our worth by how much we can carry and how long we can carry it. Our roles become our identities. Our achievements and labels become scaffolds of self-worth. In medicine, stepping down is often labeled as a sign of weakness. So we hold on to roles even when they no longer fuel us. We are usually still doing the job …
When I received an invitation to a webinar titled “Special Session on a New Autism Risk Test,” I expected a discussion on screening strategies or intervention innovations. Instead, when I researched the company and reviewed its website, I discovered a pitch for a punch-biopsy-based lab test marketed as a way to detect autism risk in newborns as early as two days after birth.
As a nurse practitioner who treats autistic patients, …
When we think about palliative care, our first instinct is to picture pain medications, symptom checklists, and clinical protocols. But for patients with terminal brain cancer, the reality is much more complex. As speech declines, as motor function deteriorates, and as identity itself feels threatened, the greatest need is not always more medicine; it is meaning, connection, and dignity.
In recent years, I have had the opportunity to study an ancient …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Psychiatrist Muhamad Aly Rifai discusses his article “A psychiatrist’s 20-year journey with ketamine.” Aly recounts his first encounters with ketamine at the National Institute of Mental Health, where its rapid impact on …
Psychiatry, perhaps more than any other medical specialty, is a field defined by ambiguity. Unlike other branches of medicine, where diagnostic tests and standardized protocols guide treatment, psychiatry often operates in a landscape where clear-cut answers are rare. The psychiatrist’s primary tools are not scalpels or stethoscopes, but words, presence, and (most crucially) the self.
Psychological transference and countertransference: double-edged swords
Psychological transference and countertransference are central to the practice of psychiatry, …
Here is what I have seen across two decades of admitting and managing patients on inpatient psychiatric units. People do not ask for a locked door when life is comfortable. They come to us when the ground drops out. Families arrive with the weight of sleepless nights in their faces. Emergency clinicians pass me the chart, then the baton, and sometimes the quiet plea that says please help this person …
You are entering orders, rounding, or thinking through a patient problem in the hospital when a team member interrupts. Then comes another interruption. And another. You lose your train of thought, and you feel your jaw clench. Does this sound familiar? Physicians are expected to be efficient, accurate, and approachable, yet these three goals are nearly unattainable due to constant interruptions. Studies show that physicians are interrupted, during critical tasks, …
An excerpt from Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock.
Dr. Raul Morales sat alone in Exam Room 3, now used for storage, staring out at the fading autumn light through a slit in the blinds. The clinic was quiet, eerily so. His last patient had left an hour ago. He was supposed to be packing up his …
Sarah, an emergency room nurse with eight years of experience, did not leave because she stopped caring. She left because the numbers no longer worked. Student loans outpaced her wages, overtime became mandatory without premium pay, and patient loads rose to unsafe levels. Eventually, the arithmetic of her life and work collapsed.
Sarah’s story is not unusual. Across the country, clinicians are leaving medicine in numbers that no longer feel like …
In 2024, centralized cryptocurrency exchanges recorded approximately USD 18.4 trillion in trading volume, with Binance alone accounting for forty percent (~USD 7.7 trillion). While the total number of cryptocurrency holders exceeded 600 million globally, active traders (those engaging in high-frequency or large-scale trading) appear limited to thirty to sixty million monthly users. Epidemiological data indicate these traders skew male (≈sixty-one percent), primarily aged 25 to 34 (thirty-four percent of owners), …
As a founder in digital mental health, I’ve watched our industry celebrate reaching $8.34 billion in valuation while systematically failing 40 percent of the population. This isn’t just a moral failure, it’s a $20 billion market opportunity that’s being ignored because of cultural blindness. For physicians trying to refer diverse patients to digital mental health resources, the options are frustratingly inadequate. With the total U.S. behavioral health market valued …
As a physician provider in my State Physicians Health Program, I have watched brilliant colleagues flicker out. Not because they lacked skill or grit, but because the system treated their humanity like an optional feature. We train physicians to master physiology, not how to metabolize grief. We celebrate heroics, not healing. Then September arrives, Suicide Prevention Month, and we draft statements. The statements are sincere. They are not sufficient. It …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Pediatrician and certified coach Jessie Mahoney discusses her article “Why so many physicians struggle to feel proud—even when they should.” Jessie explains how medical training conditions doctors to downplay success, deflect compliments, …
ADVERTISEMENT
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Why kratom addiction is the next public health crisis.” Muhamad explains how kratom, a botanical imported from Southeast Asia, has …
The urgency epidemic
I was in my office at 8 p.m. about a year ago. My back was hunched, phone in one hand and papers in the other, with twenty open tabs glaring at me from two adjacent monitors. I heard a nearby door shut and wondered, “Why is my colleague leaving so late?” Then it hit me: Have I thought of leaving yet?
If you asked me what I was doing …
The brain is a pattern-seeking organ that continually organizes the world into a more predictable experience. Our first predictions arise out of early childhood and are predicated on messaging from primary caregivers. These are deeply buried in implicit memory meaning that much of what we anticipate from interactions lies outside of our awareness. Over the course of a lifetime, these guiding assumptions working in the background are continuously modified in …
Modern medicine is failing in three critical areas: mental health, chronic disease, and prevention at the cost of trillions of wasted dollars and untold suffering.
The problem runs deep. In my earlier KevinMD post, “Medicine’s mental health crisis: why the system is failing us,” I described the “mind-body split” theory of the 16th and 17th-century Scientific Revolution as guiding medicine and medical education since that time. It …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Licensed counselor and certified coach Mary Remón discusses her article “How doctors can turn criticism into collaboration.” Mary explains why physicians often react defensively to suggestions from colleagues, citing hierarchy, malpractice fears, …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Clinical psychologist Faust Ruggiero discusses his article “How to rewire your brain with positive language.” Faust explains how the words we use internally shape our thoughts, emotions, and behaviors, and why negative …
I offer these ten points in the hope that you will surpass my generation of physicians, myself included, and learn from our mistakes. God help us all if you do not.
Congratulations on your hard work, academic achievements, and the persistence and sacrifice that brought you to this moment in your medical careers. Good for you. And now, reality.
1. Although you have memorized many facts, you know nothing. Truth does not …
Get free updates delivered free to your inbox.
