Halfway through a teletherapy session, you notice your therapist pause mid-sentence. They’ve just heard the soft clatter of your keyboard, or seen your eyes flick sideways to a second screen. You’re technically “there” on video, but a work email just popped up, laundry is buzzing, someone’s messaging you, and suddenly the session is sharing space with three other tabs in your brain.
On the therapist’s end, it can feel like talking …
The average KevinMD reader may wonder why I’m so prolific in my commentary on pediatric medicine and the systemic reforms it demands. The answer is simple: I go to the source. Always.
That habit was forged nearly 30 years ago when the American Academy of Pediatrics invited me to serve as contributing section editor for Developmental-Behavioral Pediatrics in AAP Grand Rounds. My role: select key studies, critique methodology, and distill bottom-line …
As a psychiatrist, I’m often asked by family or friends to “help,” to intervene in the mental struggles of a loved one, a friend, or even a distant acquaintance. It usually begins with kindness and concern: “Could you just talk to them?” or “Maybe you can prescribe something, you’d know what’s best.” What follows is always a difficult conversation, because I have to explain something that sounds incomprehensible to most …
A few days ago, I was speaking with a high-achieving, articulate, brilliant friend, someone always up and doing, super-expressive. During our conversation, I noticed her stumbling over her words, which was quite unusual, and her fidgety hands. She was narrating a traumatic incident that had occurred to her and how it tore her apart and made her simply give up on everything, in her words, “she was done.” Throughout the …
Applied Behavior Analysis (ABA) has become the default therapy for autism in the U.S., not because it’s the most effective, but because it’s the most entrenched. Mandated by insurers, funded by Medicaid, and marketed as “medically necessary,” ABA now consumes hundreds of millions of dollars annually. But here’s the truth: ABA is unproven, ethically fraught, and fiscally unsustainable.
As a developmental-behavioral pediatrician and lead investigator for the NIH-funded RUPP trials, I …
Every clinic has moments that stick with you. They aren’t always dramatic, but they show why some people end up suffering longer than they should. During my time working as a medical office assistant, I observed a recurring pattern that spanned across various age groups, backgrounds, and diagnoses. Patients didn’t delay care because they were careless. They delayed because the system had quietly taught them to.
One afternoon, a middle-aged woman …
For years, I believed that the best clinicians were the ones who never stopped. We covered extra shifts, skipped meals, charted past midnight, and proudly wore exhaustion as a badge of honor. My patients were happy, my colleagues admired my work ethic, and I was quietly unraveling.
The slow slide into burnout
Burnout didn’t arrive like a crisis; it crept in as a constant background hum. I began to dread the pager’s …
During a casual conversation about mental health, a friend admitted something striking: “I stopped going to therapy because I’d leave feeling great, but by the time I actually needed what we talked about, like in the middle of an argument or a panic attack, I couldn’t remember any of it. It felt like throwing money away.”
This confession revealed a silent challenge in mental health care. The issue isn’t finding the …
She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …
We talk about burnout like it’s just being “tired” or “stressed.” However, it is not. It is a fundamental breakdown of the operating system: your brain. I know, because I’ve been there. I was the high-performer, the one who “got things done,” until my executive function packed its bags and left the building. If you’re feeling this way, you’re not weak; your system is simply overloaded. You have entered the …
In medicine, we are taught to care deeply.
When criticism arrives, whether from a patient, a colleague, an administrator, or an anonymous review, it stings. A lot. The sting usually lasts long after we read the words. It usually leads to rumination, self-doubt, and often even poor sleep, a questioning of our career choice, and our abilities.
Even with years of mindfulness, self-compassion, and coaching, I still feel upset when it happens …
Current Procedural Terminology (CPT) is the billing language of American medicine. The health care system established the CPT code that was created by The American Medical Association (AMA) in 1966 and updated yearly, as the national common language used by federal, public, and private plans.
Evaluation and Management (E/M) codes are the CPT section used for office and telehealth visits. In 2021, E/M rules changed. You select the visit level by …
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “The crisis in inpatient psychiatric care.” In this episode, Muhamad examines the growing dysfunction within the nation’s psychiatric hospital system, …
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I used to whisper it into the dark, lying awake, watching the clock creep past 2 a.m. My body was exhausted, but my mind refused to stop sprinting, running a veritable marathon most of the night. When the sun finally pushed through the curtains, it didn’t feel like morning. It felt like failure, another day to muscle through on fumes.
Sometimes that was the hardest moment of the day. Little sleep …
As a psychiatry resident, I have been closely monitoring developments in the proliferation of AI chatbots for therapy. The moment feels like the ground shifting below my feet, and I have just started my career. In my clinical practice I feel unprepared to discuss how these new technologies are impacting my patients’ lives, but from my digest of national media, I am certain that a substantial number of my patients …
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Psychiatrist Yekaterina Angelova discusses her article “Are you addicted to false urgency?” In this episode, Yekaterina explores how modern professionals, including physicians, get caught in a cycle of constant busyness and fabricated …
The human psyche is built for connection. Our evolutionary history, our families, and our communities shape us to seek cooperation, mutual respect, and shared purpose. We are, by design, social beings whose sense of safety depends on trust and belonging.
When that natural orientation toward unity is fractured; when instead we encounter hostility, harsh language, or dehumanization, it cuts against the grain of who we are. What might once have been …
As physicians, we are trained to balance truth with compassion, and science with empathy. It’s a delicate balance and an uncertain path. Medicine requires both strength and vulnerability because navigating this balance can leave ambiguity as to whether the healer’s words heal as much as intended. These moments also reveal the tension between knowledge, ethics, and emotion, a struggle between the imperative to speak to fact and the human need …
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Physician executive Mona Potter discusses her article “When anxiety runs the show: How medication can help kids thrive.” In this episode, Mona explores how clinical anxiety differs from everyday worry, why it …
I never thought I’d be the cautionary tale.
For decades, I worked at a financial company. I’m a youth sports coach, a husband, and a father of two. I’ve spent decades coaching, mentoring players, and proudly producing high school sports telecasts. I built a life around leadership, precision, and community.
But none of that prepared me for what happened when I was prescribed pramipexole (Mirapex) to treat Parkinson’s.
The warnings were there: compulsive …
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