KevinMD.com

Why doctors won’t prescribe opioids, and who profits

Wed, 19 Aug 2026 21:00:30 +0000

Opioids have acquired a terrible reputation as dangerous drugs, thanks to not one, but two opioid epidemics. America’s first opioid epidemic began in the 19th century following the purification of morphine in 1804. Widespread military use during the Civil War, followed by aggressive postwar civilian marketing, contributed to widespread opioid use. Opioids were available not

Research integrity and accountability lessons from 2026

Wed, 19 Aug 2026 20:00:54 +0000

Research misconduct deserves scrutiny. But scrutiny should not become spectacle. The landmark 1980s case of U.S. cardiology researcher John Darsee remains a defining example. Auditors found extensive data fabrication, and federal sanctions reached beyond institutional leadership, forcing science research to confront supervision, authorship, and institutional accountability. The lesson was not simply that one researcher failed.

Medical malpractice reform and the lawyers who block it

Wed, 19 Aug 2026 19:00:15 +0000

Senator Dick Durbin describes his career this way: “Before I was elected to Congress, I worked in a courtroom. For years, I defended doctors and hospitals, and for years, I sued them on behalf of people who were victims of medical malpractice.” Dick Durbin’s own words betray that, first, he was defense counsel, earning a

Chatbot safety for psychosis is failing patients in 2026

Wed, 19 Aug 2026 18:00:53 +0000

Sophie Rottenberg’s mother described her, before this year, as “a largely problem-free twenty-nine-year-old badass extrovert who fiercely embraced life.” No documented psychiatric history. No prior crisis. Just, in her mother’s words, “a mix of mood and hormone symptoms” that led her to confide in a ChatGPT persona named Harry instead of her own therapist, her

Interpreting heart rate variability beyond wearable scores

Wed, 19 Aug 2026 17:00:27 +0000

A patient recently sat across from me, phone in hand, scrolling through months of heart rate variability (HRV) data. He wasn’t asking me to interpret a lab value or an MRI. In a sense, he was asking me to interpret himself, filtered through an algorithm he strongly trusted, one that would not be contradicted by

The limits of psychiatric diagnosis require honesty

Wed, 19 Aug 2026 16:00:19 +0000

Imagine practicing oncology without pathology. No biopsy, no receptor status, no molecular profiling, no circulating tumor DNA, no tissue specimen that can be reexamined later. Instead, the physician asks a series of questions, observes the patient, determines whether enough findings have persisted long enough, and assigns a diagnosis. Modern oncology would consider such a system

AI and critical thinking: the cost of borrowed mastery

Wed, 19 Aug 2026 15:00:17 +0000

We are currently navigating a fundamental shift in how we engage with the world, one that is accelerating the rise of modern individualism and a particular brand of digital narcissism. There is a growing erosion of the boundary between authentic intelligence, which is the slow, messy, and deeply felt process of understanding, and the appearance

How measuring physician burnout could improve retention

Wed, 19 Aug 2026 14:00:20 +0000

We know that recruiting and replacing a physician costs somewhere in the range of a million dollars per physician, depending on the specialty. We know the effects of physician burnout and attrition directly affect key performance indicators, like patient access, quality metrics, and Net Promoter Scores. They also affect care continuity, organizational culture, and the

Why a supplement supply chain hides behind its label

Wed, 19 Aug 2026 13:00:00 +0000

“I bought this premium multivitamin online,” Patient A tells you during a routine history-taking at the annual checkup. “It’s a prominent Japanese brand. Since people over there have such long life expectancies, this has to be safer and purer than a domestic brand, right?” As a health care provider, you would find it easy to

Physician presenteeism starts with a dangerous myth

Wed, 19 Aug 2026 12:00:19 +0000

An excerpt from Self-Awareness and Trust: Leading Healthcare Teams from the Inside Out. “Knowing yourself is the beginning of all wisdom.” – Widely attributed to Aristotle I had been away from the intensive care unit (ICU) for a couple of weeks. When I came back for a scheduled week of service, I put on my

The quiet beliefs that lead to a delayed diagnosis

Wed, 19 Aug 2026 11:00:27 +0000

During my time as a registered nurse, I once cared for a woman in her late fifties (with identifying details changed) who had spent nearly a year adapting to symptoms she never thought signaled something serious: body aches, fatigue, frequent nighttime urination, constant thirst, breathlessness, and headaches. Each time the pain flared, she visited a

Who should own the AI that doctors built [PODCAST]

Tue, 18 Aug 2026 23:00:43 +0000

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! A tech founder used one pediatrician’s public advice to train her own AI. Sonal Patel decided doctors should own the tools built on their knowledge instead. Patel is a pediatrician and neonatologist who built and controls her own AI for the

Mental health stigma in medicine silences physicians

Tue, 18 Aug 2026 20:00:01 +0000

I grew up in the western suburbs of Chicago as the youngest of three boys. I experienced deep depression and suicidality at nineteen, after a childhood of anxiety that often left me paralyzed and physically sick. I was treated by an amazing psychiatrist and started on Prozac, which flipped me into mania. I had underlying

Why imposter syndrome and burnout share a circuit

Tue, 18 Aug 2026 19:00:37 +0000

A study in JCO Oncology Practice surveyed 542 oncology professionals across 55 countries on exactly this overlap. The numbers are stark: 56.1 percent met criteria for burnout, 34.1 percent had high impostor phenomenon scores, and 38 percent were identified as maladaptive perfectionists. The lead author, an oncology fellow who began the project after recognizing the

Finding purpose in patient care after a wartime injury

Tue, 18 Aug 2026 18:00:42 +0000

An excerpt from One Pocket. I reported to Walter Reed Army Medical Center on August 25, 1969. The complex was in Bethesda, Maryland, about thirty minutes from the White House. Founded in 1909, it had cared for every president of the United States, along with members of Congress and the Supreme Court. It had 1,122

Multimodal cancer pain management starts with assessment

Tue, 18 Aug 2026 17:00:42 +0000

As a pain specialist who manages cancer-related pain daily with both interventional and non-interventional approaches, I still encounter a frustrating reality: Too many patients suffer longer than necessary. Recent data show that roughly 44.5 percent of patients with cancer experience pain, and about 30 percent report moderate-to-severe intensity. While prevalence has declined modestly over the

Closed-loop referral management needs a defined owner

Tue, 18 Aug 2026 16:00:31 +0000

A radiologist flags something on a scan that shouldn’t be there. The physician sends a referral to oncology that same day, the kind where a few weeks genuinely matter, not the kind you let sit in a queue. The system logs it, and the chart shows it as clean and complete: sent. Four months later,

What kidney stone pain taught me about human suffering

Tue, 18 Aug 2026 15:00:45 +0000

One morning after finishing surgery, my nurse pulled me aside. “You need to get into Exam Room One,” she said. “He’s in bad shape.” Curled up on the floor was an active-duty Navy SEAL. His girlfriend knelt beside him, rubbing his back as he rocked back and forth in pain. A military backpack leaned against

Taking a leap of faith in my career was the best thing for my patients and me

Tue, 18 Aug 2026 14:00:14 +0000

We’ve all taken a leap of faith at some point in our lives. For me, it was switching from a traditional physician’s practice to joining CenterWell Senior Primary Care, which employs a true team-based approach. Doing so has convinced me that it’s one of the best methods for keeping my patients healthy while benefiting me

Reforming hospital peer review requires independence

Tue, 18 Aug 2026 13:00:02 +0000

An adverse peer-review determination is one of the most consequential events in a physician’s professional life. When a hospital revokes clinical privileges or imposes a suspension exceeding thirty days, federal statute mandates a report to the National Practitioner Data Bank (NPDB). In today’s consolidated health care landscape, an adverse NPDB report is an indelible mark