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The Podcast by KevinMD

U.S. health care won’t be fixed until everyone can see a doctor [PODCAST]

Almost 50 years into practice, a cardiologist says American health care is getting worse by the day. Peter R. Kowey specializes in heart rhythm disorders and ran a cardiology division for 25 years. This episode is based on his article…

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Almost 50 years into practice, a cardiologist says American health care is getting worse by the day. Peter R. Kowey specializes in heart rhythm disorders and ran a cardiology division for 25 years. This episode is based on his article “Why a broken health care system keeps getting worse,” …

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U.S. health care won’t be fixed until everyone can see a doctor [PODCAST]

Conditions and diseases

What a penile filler death should teach us about safety

Igho "Tiny" Ubiribo was forty-three when he died after receiving penile filler injections in Bangkok. My condolences go to his wife and family. As we discuss what happened, I want to be mindful of the pain they are going through.…

Igho “Tiny” Ubiribo was forty-three when he died after receiving penile filler injections in Bangkok. My condolences go to his wife and family. As we discuss what happened, I want to be mindful of the pain they are going through.

His death made headlines because he was known publicly. But the questions it raises matter to anyone considering this procedure. We should be asking the same questions even if this case …

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What a penile filler death should teach us about safety

Conditions and diseases

I wrote a book doubting statins. Now I have heart disease.

I have spent much of my 35-year medical career questioning the conventional wisdom surrounding cholesterol and cardiovascular disease. I'm an internist, a lipidologist, and what I affectionately call a lipidologist in recovery. I even wrote a book challenging the widespread…

I have spent much of my 35-year medical career questioning the conventional wisdom surrounding cholesterol and cardiovascular disease. I’m an internist, a lipidologist, and what I affectionately call a lipidologist in recovery. I even wrote a book challenging the widespread use of statins.

I remain skeptical of the idea that cholesterol is the principal villain in coronary artery disease. I believe inflammation, immune responses, and potentially infectious organisms deserve considerably more …

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I wrote a book doubting statins. Now I have heart disease.

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Health technology

An AI scribe records the words, not the patient

Last month I sat in on yet another demo for a new ambient AI scribe tool, the kind that's supposed to turn a recorded visit into a clean note by the time you walk out of the room. It was…

Last month I sat in on yet another demo for a new ambient AI scribe tool, the kind that’s supposed to turn a recorded visit into a clean note by the time you walk out of the room. It was good. Really good. Good enough that I left thinking about all the charting I wouldn’t have to do that night, and also thinking about something else, which is that the …

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An AI scribe records the words, not the patient

Health technology

AI in radiology: A missing flag is not a negative read

Picture a busy ED at 1 a.m. A CT pulmonary angiogram comes back from the scanner. The worklist shows no AI flag for pulmonary embolism. The radiologist has 30 studies in the queue. The patient's heart rate is still 112.…

Picture a busy ED at 1 a.m. A CT pulmonary angiogram comes back from the scanner. The worklist shows no AI flag for pulmonary embolism. The radiologist has 30 studies in the queue. The patient’s heart rate is still 112.

What does the missing flag mean? A new study says: less than most of us assume.

On Oct. 21, researchers at Emory published a look at two FDA-cleared PE detection algorithms …

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AI in radiology: A missing flag is not a negative read

Drugs and prescribing

The GLP-1 shortage ended. The adherence problem did not.

For several years, glucagon-like peptide-1 (GLP-1) medications seemed to dominate conversations in community pharmacy. Patients called asking whether specific products were available, prescriptions were transferred between pharmacies, and pharmacy staff spent considerable time checking inventories and monitoring shortages. It was…

For several years, glucagon-like peptide-1 (GLP-1) medications seemed to dominate conversations in community pharmacy. Patients called asking whether specific products were available, prescriptions were transferred between pharmacies, and pharmacy staff spent considerable time checking inventories and monitoring shortages. It was not unusual for patients to call multiple times or travel significant distances in search of a medication that was difficult to obtain.

GLP-1 receptor agonists, including semaglutide (Ozempic and Wegovy) and …

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The GLP-1 shortage ended. The adherence problem did not.

Physician voices

What not being valedictorian taught me about potential

There were three of us who probably could have been valedictorian. I was one of them. At English High School in Boston, I earned straight A's from tenth grade onward. Yet my academic record contained a blemish that proved impossible…

There were three of us who probably could have been valedictorian. I was one of them.

At English High School in Boston, I earned straight A’s from tenth grade onward. Yet my academic record contained a blemish that proved impossible to overcome. A B+ in ninth-grade English.

The explanation was even harder to forget than the grade itself. My teacher wrote that my work “did not reach my potential.”

At fourteen, I was …

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What not being valedictorian taught me about potential

Physician voices

Why malpractice carriers settle cases they could win

As a doctor, I rely on legislators to safeguard my professional interests, most of which concern medical malpractice litigation. However, because they fail in this mission, I do not trust them, so I become proactive. I know that medical malpractice…

As a doctor, I rely on legislators to safeguard my professional interests, most of which concern medical malpractice litigation. However, because they fail in this mission, I do not trust them, so I become proactive.

I know that medical malpractice insurance carriers face operational challenges, to which I am completely sympathetic. The most important challenge is whether to settle a defensible case, which involves a severe complication but no negligence, or …

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Why malpractice carriers settle cases they could win

The Podcast by KevinMD

Joining a private practice? Get the partnership terms in writing first. [PODCAST]

Being offered partnership in a medical practice is usually good news, but not always. One physician paid $60,000 to buy in, then signed a contract making her cover all of a $325,000 bonus her two partners had given themselves. That…

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Being offered partnership in a medical practice is usually good news, but not always. One physician paid $60,000 to buy in, then signed a contract making her cover all of a $325,000 bonus her two partners had given themselves. That meant $9,000 a month out of her pay, and leaving …

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Joining a private practice? Get the partnership terms in writing first. [PODCAST]

Health policy

Why payer contracting can no longer be a back-office job

Payer contracting has reached an inflection point. Although these contracts are the lifeblood of a health system, the managed care function is often seen as a routine set of transactional and administrative activities. Too often, these critical activities sit within…

Payer contracting has reached an inflection point. Although these contracts are the lifeblood of a health system, the managed care function is often seen as a routine set of transactional and administrative activities. Too often, these critical activities sit within an overwhelmed and under-resourced team that isn’t optimally connected with enterprise strategy. The result is that health systems are leaving significant value on the table by failing to capture the …

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Why payer contracting can no longer be a back-office job

Health technology

Accessibility is not a device. It is an ecology.

"Yeh kaise aaye hai?" This first comment followed us through the wooden doors of the theater, accompanied by snickering from the group of young boys who had said it. Inside, the lobby was flooded with bright fluorescent light, movie posters…

“Yeh kaise aaye hai?”

This first comment followed us through the wooden doors of the theater, accompanied by snickering from the group of young boys who had said it. Inside, the lobby was flooded with bright fluorescent light, movie posters stretched from floor to ceiling, and the overpowering smell of buttered popcorn and samosas. My family waded through it, working my grandmother’s wheelchair through the clusters of people. I was ten …

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Accessibility is not a device. It is an ecology.

Health technology

Accelerated TMS: 5 questions families should ask first

Psychiatrist Ravi Singareddy did something rare in his recent KevinMD piece on accelerated transcranial magnetic stimulation (TMS): He slowed the hype down. SAINT's open-label pilot reported remission in about 90 percent of completers. Under sham control, remission was closer to…

Psychiatrist Ravi Singareddy did something rare in his recent KevinMD piece on accelerated transcranial magnetic stimulation (TMS): He slowed the hype down. SAINT’s open-label pilot reported remission in about 90 percent of completers. Under sham control, remission was closer to 50 percent versus 21 percent. SWIFT showed that an accelerated deep TMS course could match a standard one, reaching remission about a week sooner. His conclusion: “Faster” is not …

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Accelerated TMS: 5 questions families should ask first

Physician voices

Uncertainty in medicine beats a confident deepfake

New fear unlocked: waking up to a viral TikTok of "me," gushing about a probiotic nasal spray that cures chronic sinus infections. As a board-certified ear, nose, and throat surgeon, I've been considering creating a platform to combat the misinformation…

New fear unlocked: waking up to a viral TikTok of “me,” gushing about a probiotic nasal spray that cures chronic sinus infections.

As a board-certified ear, nose, and throat surgeon, I’ve been considering creating a platform to combat the misinformation on social media. Before I even made an account, the American Medical Association reported about recent scams involving AI-generated deepfakes of influential doctors peddling unproven supplements on TikTok. A woman spent …

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Uncertainty in medicine beats a confident deepfake

The Podcast by KevinMD

Self-care isn’t self-indulgence, and burnout isn’t only a personal problem [PODCAST]

Doctors and nurses are trained to take excellent care of other people's health, and often don't look after their own. Close to half the health care workforce has burnout, and it shows in rounded shoulders, lower back problems, and little…

Listen on Apple Podcasts · Spotify

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Doctors and nurses are trained to take excellent care of other people’s health, and often don’t look after their own. Close to half the health care workforce has burnout, and it shows in rounded shoulders, lower back problems, and little time to process a patient’s death. Internal medicine and critical care physician …

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Self-care isn’t self-indulgence, and burnout isn’t only a personal problem [PODCAST]

Physician voices

Spinal cord stimulation audits punish care that worked

A growing strategy among insurance companies, which is increasingly mirrored in Medicare recovery efforts, is the systematic auditing of old charts, often years after care was delivered and paid, in search of technical documentation gaps that can justify clawbacks. Artificial…

A growing strategy among insurance companies, which is increasingly mirrored in Medicare recovery efforts, is the systematic auditing of old charts, often years after care was delivered and paid, in search of technical documentation gaps that can justify clawbacks. Artificial intelligence has supercharged this approach, allowing rapid mining of historical records against today’s evolving standards rather than the clinical and documentation norms that existed at the time the care was …

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Spinal cord stimulation audits punish care that worked

Health technology

AI in health care saves time. Why does work keep growing?

A physician finishes documentation 30 minutes earlier because an artificial intelligence tool is working exactly as promised. Six months later, those 30 minutes are gone. Not because the technology failed. Not because the physician stopped using it. The organization simply…

A physician finishes documentation 30 minutes earlier because an artificial intelligence tool is working exactly as promised. Six months later, those 30 minutes are gone.

Not because the technology failed. Not because the physician stopped using it. The organization simply found another use for the time. Another appointment. Another responsibility. Another expectation.

Eventually, yesterday’s efficiency becomes today’s ordinary workload. And when the next technology promises to save another 30 minutes, who asks …

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AI in health care saves time. Why does work keep growing?

Physician voices

Doctor-patient communication ends with the wrong question

The plan is made. The chart is closed. The doctor's voice has already changed. "Anything else?" Most physicians have asked that question thousands of times. I have asked it more times than I can count, and often at precisely the…

The plan is made. The chart is closed. The doctor’s voice has already changed. “Anything else?”

Most physicians have asked that question thousands of times. I have asked it more times than I can count, and often at precisely the moment I was ready for the visit to end.

Nearly every clinician says it, and most say it the same way. “Anything else?” sounds like an invitation. It functions as a closing. …

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Doctor-patient communication ends with the wrong question

Health technology

Read clinical AI the way you read an incomplete chart

Every shift, I read charts that are missing something. The patient can't tell me when the pain started. The outside records haven't come through. The family remembers a different medication list than the pharmacy does. I am not going to…

Every shift, I read charts that are missing something.

The patient can’t tell me when the pain started. The outside records haven’t come through. The family remembers a different medication list than the pharmacy does. I am not going to get a complete account, and waiting for one is how people die in hallways. So I do what emergency physicians do: I work from what is actually in front of me, …

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Read clinical AI the way you read an incomplete chart

Conditions and diseases

What pharmacogenetic testing can and can’t do in depression

More of my patients now arrive with a pharmacogenetic report, an ad promising to "end trial and error," or an MTHFR result from an online forum. Others ask for a blood test or brain scan to "prove" their depression. These…

More of my patients now arrive with a pharmacogenetic report, an ad promising to “end trial and error,” or an MTHFR result from an online forum. Others ask for a blood test or brain scan to “prove” their depression. These requests are reasonable. Patients want objective answers to a frustrating process. But the marketing has run ahead of the evidence, and the conversation increasingly falls to us. Here is how …

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What pharmacogenetic testing can and can’t do in depression

Health technology

I expected skepticism at Grand Rounds. I got a conversation.

This past Friday, October 23, I stood in front of a variety of clinicians sponsored by Harvard Medical School for Grand Rounds. I am not a clinician. I'm a mother whose daughter lives with schizophrenia, and I've spent years mapping…

This past Friday, October 23, I stood in front of a variety of clinicians sponsored by Harvard Medical School for Grand Rounds. I am not a clinician. I’m a mother whose daughter lives with schizophrenia, and I’ve spent years mapping the space between the appointment and my kitchen table at 2 a.m.

I expected polite skepticism. What surprised me most was how open the room was to the entire conversation. Here …

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I expected skepticism at Grand Rounds. I got a conversation.

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