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24-hour urine collection flaws expose clinical bias

Sat, 16 May 2026 21:00:08 +0000

There are few rituals in medicine as aspirational as the 24-hour urine collection. On paper we see an elegant examination. A direct measurement of renal function, grounded in physiology and liberated from the assumptions that plague our estimating equations. In practice, however, what we see is a plastic jug and a set of instructions that

How a Broadway comedy saved an internal medicine doctor

Sat, 16 May 2026 19:00:50 +0000

“As a witness to so much sadness and pain, how do you keep from getting depressed?” As an internal medicine doctor, I have heard versions of this question for decades. And, despite a myriad of changes in my career, my answer has never wavered. And while there are many comedians and funny things, one particular

The administrative burden crushing California medicine

Sat, 16 May 2026 18:00:03 +0000

Think of the entire health care system as a chess game where the goal is to achieve a healthier population by checkmating against the “darker side,” which represents disease, poor outcomes, inefficiency, and the human suffering of untreated or delayed chronic conditions like pain. The patient should be the king: The most important piece. Everything

Hospital room contamination is a prescribing problem

Sat, 16 May 2026 17:00:48 +0000

Adam was twenty-four years old. He was a passenger in a car that struck a guardrail on the interstate. The airbag hit him in the face. He lost consciousness for a few seconds and was alert and walking by the time paramedics arrived. The emergency doctor did everything right. CT scan, labs, neuro checks. The

Opportunistic screening finds coronary artery disease

Sat, 16 May 2026 15:00:52 +0000

In New Orleans, shoppers often request “lagniappe,” pronounced lan-yap, to express their desire for something extra, the baker’s dozen, a 13th donut. Added benefit was a major topic of interest for the 500 participants in the combined International Early Lung Cancer Action Program (IELCAP), International Early Lung Cancer and Respiratory Tract (IELCART), and AGILE 3

SALT deduction for physicians: the $500,000 magic number

Sat, 16 May 2026 14:00:00 +0000

There were many tax code changes in the One Big Beautiful Bill Act (OBBBA) when it was signed into law in 2025. Many of these changes affected taxpayers at different income levels, and with so many changes, it can be a challenge to know which items can best benefit physicians and their families. One of

Substance use screening is vital for adolescent health

Sat, 16 May 2026 13:00:35 +0000

Last year, I saw a teenager in the emergency department (ED). He was 15, and his mother brought him in after finding a vape in his backpack. She wanted him screened for substance use, but he wanted no part of it. I asked him a few questions anyway. He gave short answers and stared at

AI clinical judgment is what AI chatbots still lack

Sat, 16 May 2026 12:00:42 +0000

In Utah, a state-sanctioned experiment recently allowed an artificial intelligence platform to renew prescriptions without physician involvement. The company describes itself as an AI-powered bridge to care. Critics describe it as a regulatory loophole with a chatbot masquerading as an unlicensed physician. As a psychiatrist and physician executive who has written about AI governance, I

5 health-destroying myths perpetuated by marketing

Sat, 16 May 2026 11:00:03 +0000

Scent beads and laundry additives are innocuous If you are online or on broadcast you cannot miss it: personal care corporations telling you that you stink. Even if you are using deodorant on “those places,” your body smells all over, say a disturbing number of ads, and the odor “transfers” all over your house. Just

Why your patient’s biggest barrier isn’t pain. It’s walking through the door. [PODCAST]

Fri, 15 May 2026 23:00:10 +0000

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! What keeps millions of people from sitting in a dentist’s chair, even when modern technology has made procedures more comfortable than ever? Kaushal Shah is a general dentist and dental director managing multiple practices in the Dallas area with 15 years

Emotional over-functioning drives the competence trap

Fri, 15 May 2026 21:00:26 +0000

There is a danger in being good at holding everything together. People start to believe you do not need holding. Competence becomes camouflage. Reliability becomes a cage. And one day you wake up realizing you have become the infrastructure of a life that no one is helping you carry. For those who thought they could

Physician depression doesn’t always look like depression

Fri, 15 May 2026 20:00:02 +0000

An excerpt from Lifeline: What To Do After A Mental Health Crisis. I have spent over two decades in emergency medicine. I know what a mental health crisis looks like. I know the clinical signs, the language, the interventions. I have initiated more psychiatric holds than I can count, written discharge summaries for people leaving

Physician retirement is a myth for the ripening doctor

Fri, 15 May 2026 19:00:57 +0000

“Are you retired yet?” The question caught me off guard. It was not the query itself, I have reached my mid-60s, after all, but the underlying assumption it carried. Having practiced for over three decades, I found myself momentarily silenced by a word that feels entirely foreign to my current internal state. As a psychiatrist,

When GLP-1 doesn’t work, look at chronic stress

Fri, 15 May 2026 18:00:22 +0000

A 59-year-old woman sat tearfully in my office today. She had spent seven weeks on tirzepatide with virtually no weight loss. “How is this possible?” she asked. “I’m eating like a saint.” She had struggled with obesity and weight-related frustration for years. Recently divorced, grieving a death in the family, caring for a mentally ill

How a diversionary legal strategy harms medical malpractice

Fri, 15 May 2026 17:00:19 +0000

A set of medical malpractice cases can be presented as examples of a legal strategy that may undermine a fair trial. In Case A v. Medical Center A, a 16-year-old girl conceives in and lives in a developing country until 17 weeks of gestation and receives no prenatal care until 20 weeks of gestation, when

Medical apology laws don’t reduce malpractice lawsuits

Fri, 15 May 2026 16:00:25 +0000

An apology after medical harm still matters, but perhaps not for the reasons medicine once believed. For a long time, medicine saw apologizing after a bad outcome as risky or, at best, a way to protect oneself. Doctors were told to say as little as possible: Avoid guessing, don’t admit fault, and don’t apologize. This

Independent physicians are missing from health care policy

Fri, 15 May 2026 15:00:32 +0000

A new federal Health Care Advisory Committee has been announced to guide policy for Medicare, Medicaid, and other major health programs. Its mission is ambitious: improve outcomes, modernize care, and address the growing burden of chronic disease. But there is a glaring omission. Not one independent, private practice physician, someone who manages chronic illness in

Physicians in venture capital see what others miss

Fri, 15 May 2026 14:00:23 +0000

Nobody in my residency program would have predicted I’d end up in venture capital. Certainly not me. I immigrated to the United States from India with a straightforward plan: become the best physician-scientist I could and build a career in academic medicine. For the first chapter of my professional life, that’s exactly what I did.

Why corporate medicine fails every physician-patient

Fri, 15 May 2026 13:00:07 +0000

Physicians make the worst patients. Not because we are demanding or entitled, but because we know exactly what is happening behind the curtain. We know when a delay is avoidable. We know when a clinician is being rushed. We know when a decision is being shaped by billing codes rather than clinical judgment. And we

Continuity of care in HIV/AIDS lives in the people who stay

Fri, 15 May 2026 12:00:26 +0000

There are moments in medicine when the entire architecture of modern health care reveals both its brilliance and its limitations at the same time. Years ago, a familiar face appeared quietly in our treatment room, though diminished enough that several people did not recognize him immediately. He had once been the life of every room