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Palliative care physician and certified physician development coach Christie Mulholland discusses her article “5 things health care must stop doing to improve physician well-being.” Christie challenges the pervasive narrative that younger physicians …
Blaming younger doctors for setting boundaries ignores the broken system [PODCAST]
During the COVID-19 pandemic, conversations about burnout and stress exploded, particularly among health care workers. Much of the advice centered on self-care practices: taking time off, scheduling massages and spa days, practicing mindfulness, protecting your evenings, using your PTO. While these strategies are valuable, they are not the full story.
Positioning self-care as the solution to stress oversimplifies a much deeper physiological process. For many patients (and clinicians) stress is not …
Nervous system dysregulation vs. stress: Why “just relaxing” doesn’t work
More physicians than ever are reaching out for support after being labeled disruptive, inefficient, delinquent, reactive, or poor communicators.
These are highly skilled, deeply committed professionals being written up for professionalism concerns, communication issues, behavior, and “reactivity.” These cases span every specialty, gender, and stage of career.
This is not a reflection of declining professionalism. It is a predictable outcome of practicing in an untenable and broken system. It is an expected …
Disruptive physician labeling: a symptom of systemic burnout
I entered medicine believing (perhaps naïvely) that experience mattered. Triple board certification, years of clinical practice across three specialties, and working in New York City felt like assets that would translate beyond the bedside. Like many burned-out physicians, I assumed that transitioning into a non-clinical role would be difficult, but not absurdly so.
I was wrong.
Over several years, I applied to what felt like thousands of positions in pharmaceutical companies, utilization …
The hidden costs of the physician non-clinical career transition
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Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician legal rights: What to do when agents knock.” Muhamad shares a terrifying but essential guide for any …
Invoking your rights is the only way to survive a federal investigation [PODCAST]
You don’t learn this in medical school: Clinical familiarity creates attachment.
Not the kind we mean in romance. Not even the kind we mean in psychotherapy. Something quieter and more automatic, built through repetition and stakes.
You don’t have to say anything deeply personal for it to happen.
You just have to show up again. And again. And again.
Same hallway turns. Same waiting room chairs. Same voice calling your name. Same pace in …
Clinical attachment in medicine: How familiarity creates safety
In medicine, we are trained to lead with logic. To analyze, evaluate, and act. We are praised for decisive thinking, efficiency, and evidence-based decisions. In the hardest moments of my life, career, and leadership, none of those tools brought me clarity.
Ten years ago, as a practicing pediatrician and physician leader, my personal life began to fall apart. My husband, who had always been steady and supportive, began to slide into …
Leading with love: a physician’s guide to clarity and compassion
My great-grandfather was a small-town doctor in the early 1900s.
It was a different time. A different place. A very different pace.
He knew his patients. He knew their families. He understood their lives, not just their symptoms. Care happened in the context of relationship because that was simply how medicine worked.
Today, health care looks very different. The science is better. The technology is stronger. We can do things now that would …
How modern health care design strains patients and clinicians
As a psychiatrist, I increasingly meet patients who come in convinced they have attention-deficit/hyperactivity disorder (ADHD). They arrive prepared: an online screening test, a list of symptoms (poor concentration, low motivation, distractibility) and often a quiet sense of relief at finally having an explanation. Then I do what physicians are trained to do. I take a careful history. I review medications. I ask about sleep, mood, anxiety, substance use, and …
ADHD and cannabis use: Navigating the diagnostic challenge
I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …
Why I chose disruption over conformity in medicine
The pilot of a commercial aircraft, descending into near-zero visibility, hands control to an automated system designed for precisely that moment. The landing is flawless. The passengers are safe. The pilot announces it proudly. Technology functions exactly as promised.
A doctor on board writes, “It made me think about the health care journey I am on with AI. The safety and well-being of 140 people wasn’t left to human intervention; the …
AI in medicine vs. aviation: Why the autopilot metaphor fails
In my first and second KevinMD posts, I emphasized how medicine had failed clinicians by not training them in mental health care. All agree, it’s not our fault. Now let’s look at how successfully our teachers did prepare us for patients with medical disorders. There’s an interesting history behind how we developed expertise in physical diseases: Medicine needed to overthrow the four humors theory that guided clinical care …
How the mind-body split in medicine shaped modern clinical care
Somewhere over the last two decades, medicine began to drift into strange territory. Authority (once grounded in evidence, humility, and disciplined expertise) became diluted. Being loud, charismatic, or highly visible somehow became a substitute for scientific credibility.
We’ve long had celebrity doctors, but a new hybrid has emerged: Physicians who are not celebrities in the traditional sense, yet who speak with sweeping certainty far outside their field of training. A neurosurgeon …
Why epistemic trespassing in medicine is a dangerous trend
The man sitting across from me is a Titan.
In the taxonomy of the 2026 economy, he is the apex predator: an MD, a CEO, and the chair of multiple boards. He has navigated the post-pandemic attrition and the algorithmic market corrections that swallowed lesser firms. He is wildly, empirically successful.
But recently, he sat across from me, sharing a shade of rage I hadn’t seen before. He had just navigated a …
Beyond burnout: the rise of the optimized, dissociated executive
Light drives human biology. Morning light sets the daily clock. Daylight supports attention, energy, and mood. Evening darkness supports sleep. Modern routines disrupt that rhythm through indoor lighting, screens, night shifts, and rapid travel. Psychiatry sees the costs. Sleep disruption feeds anxiety. Circadian drift worsens depression. Cognitive speed and motivation fall when sleep timing slips. Most recently, screen time has joined circadian disruptors.
Light as a diagnostic tool
Light already powers diagnosis …
How fNIRS and light therapy are shaping precision psychiatry
The first denial arrived not with cruelty or malice, but with a phrase so familiar it barely registers as language anymore: “not medically necessary.” The cancer drug, recommended by oncologists and supported by evidence and standard of care, was rejected. No phone call. No physician-to-physician conversation. Just an automated letter and a bureaucratic pause inserted into a life that no longer had room for delay.
The family appealed. They fought. They …
The moral injury of “not medically necessary” denials
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician suicide prevention: a call to action.” Muhamad opens with the tragic losses of Dr. Nolan R. Williams and Dr. …
Physician suicide represents a silent epidemic demanding urgent reform [PODCAST]
One of the marks of a good physician is the ability to approach illness from two complementary angles. We bring scientific knowledge, training, and objectivity to understand what is happening in the body. But the work doesn’t end there. What truly elevates a clinician is the willingness to honor how the patient experiences their illness, the internal narrative that no lab test can measure.
This dual lens is not unique to …
How neurodiversity in relationships shapes communication
When my father-in-law died by suicide, our family did not just lose a person. We lost the gravitational center of a small universe.
He was a giant in my eyes. Not because of his curriculum vitae, though his was extraordinary, but because of the way he moved through the world: steady, modest, and relentlessly devoted to the people who needed him.
He had survived what should have broken a human being. As …
Physician suicide: a daughter-in-law’s story of loss and grief
Pick up a bestselling nonfiction book today and you’ll see confident claims about habit change, dopamine detoxes, and rewiring the “default mode network.” These ideas now circulate in podcasts, blogs, and social media as if the brain were an appliance that simply needs the right setting. But in real life, human behavior is not so easily reconfigured.
What I’ve observed is that habits, motivations, and compulsive patterns are shaped not only …
Why sustainable habit change requires more than willpower
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