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A new ovulation model from Dmitri Dozortsev and Michael Diamond argues that a modest rise in progesterone, not estradiol, triggers the LH surge that leads to ovulation. The paradigm links follicle size‑induced cortical disruption to a switch from estradiol to progesterone production, creating a fail‑safe hormonal cascade. Early case reports using progesterone as the trigger produced competent corpus lutea and a successful term pregnancy, challenging the reliance on artificial hCG or GnRH agonists. The authors call for larger trials to test progesterone‑based triggers in assisted reproduction.
In 2025, health‑care providers grappled with chronic administrative staffing shortages that slowed billing, disrupted scheduling, and ate into clinicians' patient time. By 2026, industry leaders are converting workforce stability into a formal clinical metric, tracking turnover, fill‑time and continuity for...
Healthcare systems in Northern California are deploying AI tools to make pain assessment more objective, using facial analysis, wearables, and electronic health records. Early pilots show potential for consistent pain detection and predictive analytics, yet most evidence remains limited to...
InCrowd surveyed U.S. health‑care professionals about three hot topics: a proposed reclassification of nursing degrees, Massachusetts Bill S.2732 affecting direct primary care, and emerging research linking acetaminophen to autism. Seventy‑three percent of nurses felt the reclassification diminishes their professional standing...
![Rest Is a Holy Practice: Reclaiming the Soul of Medicine [PODCAST]](/cdn-cgi/image/width=1200,quality=75,format=auto,fit=cover/https://kevinmd.com/wp-content/uploads/Design-1-1-scaled.jpg)
Dr. Roxanne Almas, a developmental‑behavioral pediatrician, discusses how chronic burnout stems from medicine’s nonstop, transactional culture and shares her personal journey through grief and caregiving. She advocates for deep rest practices—such as Yoga Nidra, narrative medicine, and mindful pauses—to restore empathy,...
The United States is confronting a health‑care affordability crisis, with one‑third of citizens postponing care and 41 percent burdened by medical debt. Federal spending reached $5.3 trillion in 2024—about 18 % of GDP—and is projected to climb to $8.6 trillion by 2033. Public polls...
Board‑certified emergency physician Vikas Patel proposes the evolutionary mismatch framework to rebuild patient trust. He argues that modern chronic diseases stem from a gap between ancient human biology and today’s lifestyle, not from a broken body. By reframing illness as...
The article argues that professional environments mistakenly equate contribution, credentials, and service with safety, exposing a systemic failure that spans health care, academia, law enforcement and corporate sectors. It uses the tragic case of Alex Pretti to illustrate how conditional...
In a candid ER column, Dr. George Issa describes the “Blanket Sign”—the tendency of adult patients who bring personal blankets to exhibit psychiatric or drug‑seeking behavior. He recounts a 42‑year‑old woman with chronic abdominal pain, opioid history, and a barrage...
The article challenges the notion that Direct Primary Care (DPC) can thrive solely on individual consumer subscriptions, arguing that household‑income constraints limit universal demand. It highlights Bureau of Labor Statistics data showing modest health‑care spending capacity, especially for middle‑income families...
The American Medical Association’s Journal of Ethics published its final issue in December 2025, ending a 26‑year legacy of scholarly oversight. Simultaneously, the AMA launched a Center for Digital Health and Artificial Intelligence, signaling a strategic pivot toward technology. The...
The essay examines how Jewish law’s reliance on legal fictions clashes with modern end‑of‑life medicine. It contrasts Halakha’s categorical certainty—viewing every moment of life as sacred—with medicine’s humility that prioritizes patient comfort and informed choice. While some rabbinic authorities allow...
Timothy Lesaca, a psychiatrist, stopped accepting pharmaceutical‑sponsored lunches, arguing they blur the line between patient care and industry influence. Recent CMS Open Payments data reveal over 1.1 million industry events in 2024, with 920 000 lunches costing $73 million. Research shows even a...
An EMT recounts a harrowing transport of a stroke‑survivor, Molly, highlighting how standard stair‑chair equipment failed to accommodate her size and mobility limitations, leading to injury and indignity. The author uses the incident to illustrate structural violence and the marginalization...
Medical students Jay Pendyala and Jonathan Berg compare chess strategy to clinical reasoning, highlighting how assessing a patient mirrors evaluating a board position. They argue that diagnostic algorithms serve as openings, but flexibility is required when cases deviate from textbook...
The Department of Justice is appealing a ruling that blocked a subpoena targeting a queer‑owned clinic providing gender‑affirming care, arguing that the clinic’s patient‑education materials should be treated as drug labeling under the Federal Food, Drug, and Cosmetic Act. By...
Dr. Charan Teja Bobba recounts treating a patient with meth‑associated dental disease in a MassHealth safety‑net clinic. Methamphetamine caused extensive enamel loss, xerostomia, and rapid decay, demanding complex restorative procedures over several visits. By involving the patient in every step and building...
Lymphangioleiomyomatosis (LAM), a rare estrogen‑sensitive lung disease, highlights the absence of standardized reproductive care for women with rare conditions. While FDA‑approved therapies have extended patients' lives, guidance on pregnancy, contraception, and menopause remains fragmented. The author’s personal journey—freezing embryos and...
A new commentary challenges the notion that cancer overdiagnosis undermines screening, arguing that population‑wide programs have consistently reduced mortality for the five most screened cancers. Critics point to rising incidence without proportional mortality as evidence of overdiagnosis, yet recent trial...
![Primary Care Receives only Five Cents of Every Health Care Dollar [PODCAST]](/cdn-cgi/image/width=1200,quality=75,format=auto,fit=cover/https://kevinmd.com/wp-content/uploads/Design-4-scaled.jpg)
The KevinMD podcast features family physician Jonathan Bushman highlighting that primary care receives only about five percent of total health‑care spending while addressing roughly ninety percent of patient health issues. Bushman contrasts the modest financial return for primary‑care physicians with...
Rural maternity care across the United States is collapsing as hospitals shutter labor and delivery units, leaving many counties without obstetric services. The article identifies five actionable solutions: expanding cross‑trained clinician workforces, implementing obstetric‑ready nursing models, forging collaborative transfer networks,...
Recent research highlights that BMI alone misclassifies up to 34% of adults, masking critical changes in muscle mass and fluid balance. Rapid weight loss driven by GLP‑1 therapies can cause substantial muscle and intracellular water loss while extracellular fluid rises,...
The article explains how repeated failed quit attempts create learned helplessness among smokers, undermining their belief that effort matters. It contrasts this with self‑efficacy, a task‑specific confidence that predicts successful cessation. Pharmacotherapy combined with structured counseling can double quit rates,...
Anesthesiologist Jim Ellwood explains that ketamine, like propofol and fentanyl, is safe when administered by trained professionals but becomes dangerous in unregulated settings. He contrasts high‑profile overdose headlines with the controlled, low‑dose protocols used for anesthesia and emerging mental‑health treatments....
The new book Physicians With Lived Experience by Dr. Michael F. Myers compiles personal narratives that illuminate the hidden crisis of physician mental health and suicide. Forewords by Jennifer Breen Feist and Dr. Darrell Kirch highlight the power of storytelling, the passage...
Physician Francisco M. Torres argues that the bedside physical exam remains a vital diagnostic tool despite rapid advances in imaging and lab tests. He recounts two personal cases—a misdiagnosed sciatica caused by shingles and a postoperative fluid collection missed without...
A recent OurCare survey found 5.9 million Canadians lack a primary‑care provider, and those with one face long waits and rushed visits, driving emergency‑department crowding. The federal government responded by creating 5,000 Express Entry slots for international doctors, but experts argue...
Dr. Daganzo recounts paying $78 for identical lab tests through a direct‑pay platform versus an estimated $900 cash price at Quest Diagnostics, highlighting extreme price opacity in traditional settings. Patients increasingly bypass insurance‑based pathways, preferring transparent, upfront pricing and predictable...
The United States still uses an opt‑in organ donation system, meaning individuals must actively register to become donors. Behavioral‑economics research shows that default settings heavily influence decisions, and the opt‑in model creates inertia at points like DMV renewals. Countries that...
The post‑holiday period often reveals hidden cardiovascular strain from excess calories, alcohol, and disrupted sleep. These habits can raise blood pressure, cholesterol, and glucose, creating a short‑term risk window. Men face higher risk due to binge‑drinking patterns and delayed preventive...
A dentist refused to perform a routine cleaning without bitewing X‑rays, despite the patient’s low‑risk status and recent radiographs. The practice cited a two‑year imaging policy and warned that proceeding could jeopardize the hygienist’s license. After consulting the supervising dentist,...
Type 2 diabetes is reframed as chronic elevated blood sugar (CEBS) rather than a disease of insulin deficiency. The article argues that what is labeled "insulin resistance" is a protective cellular response to persistent glucose oversupply caused by excessive carbohydrate consumption....
Diabetes prevalence has surged past 800 million adults, with youth type 2 rates climbing 94 % since 1990, intensifying vascular complications like peripheral artery disease. Surveys reveal 55 % of Americans delay seeking care for leg pain and 80 % of primary‑care clinicians lack confidence...
The United States faces a critical vascular surgeon shortage that is directly fueling a rise in preventable amputations. Only about 5,800 vascular surgeons practice today, while the current demand exceeds 8,000 and is projected to reach 9,000 within a decade...
A new analysis reveals the massive hidden cost of nursing turnover, dubbed the “shadow ledger,” with replacement expenses averaging $61,110 and annual hospital losses up to $5.7 million. The piece quantifies related waste, including $18.27 billion in workplace‑violence costs and billions in...
A malfunctioning pager at a remote Air Force base hospital exposed a supervisor’s abusive behavior, prompting the hospital commander to intervene. The commander forced a formal apology, reassigned the supervisor, and installed new service chiefs to restore stability. Leveraging the...
Maintenance of certification (MOC) for physicians varies dramatically across specialties and states, creating a fragmented, costly system with little evidence of patient‑outcome benefits. Boards under the ABMS set broad standards but allow autonomous, disparate requirements ranging from quarterly quizzes to...
The article argues that traditional death certificates, which require a single primary cause, fail to reflect the complex, multifactorial nature of mortality in the elderly. It uses Ella’s case to illustrate how chronic conditions, functional decline, and repeated infections intertwine,...
Surgeon Paul Toomey describes how outdated phone and scheduling systems cripple surgical practice efficiency, leading to patient frustration and staff burnout. He identifies interruptions—missed calls, last‑minute cancellations, and lack of shared accountability—as the primary sources of wasted time. By redesigning...
The health‑care sector’s shift to value‑based care is outpacing clinicians’ preparation for system‑level responsibilities. While medical training excels at diagnosis and treatment, it often omits the operational, financial, and population‑health skills required for coordinated outcomes. This misalignment creates early‑career attrition...
The United States continues to spend more on health care than any other nation while delivering poorer health outcomes, a gap the article attributes to a profit‑driven insurance model. The author argues that incremental reforms have failed and proposes a...
Medical schools increasingly mandate reflective assignments, yet unchecked introspection can devolve into rumination that erodes confidence. The article cites a student’s journal turning from insightful notes to self‑doubt, illustrating how constant, unstructured reflection amplifies perfectionism and anxiety. Drivers include a...
The article argues that stringent opioid prescribing guidelines, aggressive DEA oversight, and state medical board prosecutions have created a hidden cost to the U.S. health‑care system. These regulatory and prosecutorial practices restrict legitimate pain management, drive physicians toward defensive medicine,...
A functional‑medicine physician documented a leukemia patient’s four‑week integrative nutrition program that complemented maintenance chemotherapy. The regimen emphasized time‑restricted eating, phytonutrient‑dense low‑carb foods, magnesium repletion, and personalized movement. Laboratory markers showed platelets rise 63%, hemoglobin up 7%, and red cells...
Since 2005, 195 rural hospitals have shut down, with 50 closures occurring between 2017 and 2023, deepening access gaps for millions of Americans. Rural residents experience higher rates of diabetes, mental distress, and premature mortality, compounded by looming federal Medicaid...
Dr. Sriman Swarup warns that the hourly rate in locum tenens contracts is often the least critical factor. He emphasizes that contract clarity—especially around responsibility for cancellations, payment guarantees, and termination triggers—determines whether an assignment is viable. Ambiguous language typically...
Hormone therapy has re‑emerged in menopause care, but many clinicians prescribe it as a first‑line fix without evaluating underlying stress, metabolic, or nervous‑system dysfunction. The article argues that estrogen, progesterone, and testosterone are often used to treat fatigue, burnout, and...
Midlife women often follow the classic "eat less, move more" mantra yet see stagnant scales because perimenopause and menopause trigger profound physiological shifts. Hormonal fluctuations raise insulin and cortisol, blunt glucose flexibility, and promote fat oxidation over muscle use. Simultaneously,...
The article outlines the four canonical health‑care system models—Beveridge, Bismarck, national single‑payer, and hybrid—and shows that the United States operates a hybrid structure combining elements of each. It highlights WHO’s six criteria for high‑performing systems and notes that despite world‑class...
Psychiatrist Courtney Markham‑Abedi describes personal experiences of moral injury triggered by caring for vulnerable patients and the killing of immigrant activist Renee Good. She expands the concept of moral injury, originally defined for veterans, to healthcare workers, coining it as...
