Doctors were told to be blind to the cost of care

Many doctors who run their own practices spend hours on work someone else could do. One practice owner who charges $300 an hour was his own receptionist, verifying insurance all night and stepping away from a family dinner to take a patient's call. Central AI and Wing Assistant CEO Karan Kanwar discusses his KevinMD article "The physician opportunity cost nobody puts on a bill." He argues that this time, along with the revenue lost when calls go unanswered, never shows up on a profit and loss statement. You'll hear why practices hesitate, from reluctance to let go of tasks to worries about HIPAA compliance and connecting to the EHR. He walks through the easiest places to start, including phone calls, payer calls, billing and test result questions, and non-clinical questions about medical equipment. He also shares how to judge whether an AI vendor will still be around. Stay for a simple exercise: look at everything you do in a day and decide what you can give away.

When you can't speak for yourself, a living will is supposed to speak for you. Too often, it doesn't. Seventy percent of U.S. adults don't have one, and those who do often keep it in a drawer at home. Emergency physician and MIDEO Health Technologies CEO Ferdinando Mirarchi and attorney Thaddeus Mason Pope discuss their KevinMD article "Why problems with advance directives keep harming patients." You'll learn that 80 percent of physicians equate the mere presence of an advance directive with a do not resuscitate (DNR) order. Mirarchi calls it the lethal glance, a split-second read by a clinician who has never met the patient. The errors go both ways: resuscitating people who never wanted it and failing to resuscitate people who chose full code. They explain how a POLST differs from an advance directive, how professional bias creeps in, and how patient-recorded videos can make your wishes clear in seconds. You'll leave knowing what to set up for yourself and your family now, and why clinicians should stop and ask instead of assuming.

Someone tells you their memory is slipping. What you say next can decide whether treatment is still an option for them. Emer MacSweeney is a neuroradiologist and the cofounder and CEO of Re:Cognition Health. This episode is based on her article "Early Alzheimer's diagnosis now decides who gets treated," published on KevinMD. She explains why two licensed treatments work only inside a narrow early window, and why a year spent waiting for an appointment can put a patient past it. You will hear how the three biomarker tests compare, including the blood test that is now widely available, and why she says not to order one unless the patient has symptoms. She also names the early signs she takes seriously: short-term memory trouble, losing words, getting lost in familiar places. If you have ever told someone their memory is just getting older, this conversation explains what that reassurance can cost.

A patient arrives already sure of what is wrong with them. The words they use came from somewhere else. Alan P. Feren is a retired surgeon, health care consultant, and patient advocate. This episode is based on his article "Clinical authorship: the missing principle in medical AI," published on KevinMD. He walks through the three points where artificial intelligence enters a visit: the patient shaping their story beforehand, the clinician leaning on decision support, and the ambient tool interpreting it after. No single step is reckless, he says, and that is the problem, because a diagnosis can travel from encounter to encounter with no one standing behind it. You will hear the questions he asks patients about what fits their experience and what does not, why an ambient note is an interpretation rather than a transcript, and why he puts actual intelligence first. If you sign notes you did not write, this conversation will change what you check first.

Some people process a terrible event over a week or two and move on. Others replay it for years, and their bodies never settle back down. Faust Ruggiero is a clinical psychologist who has treated post-traumatic stress in veterans, first responders, and others for years. This episode is based on his article "Understanding the types of PTSD and how to treat them," published on KevinMD. You will hear how he distinguishes stress that follows a single event from stress built on years of ongoing harm, and why that distinction shapes the treatment plan he writes. He walks through the questions he tells primary care physicians to ask, from flashbacks and interrupted sleep to exaggerated startle, anger, and isolation. He explains when short-term medication is used to bring arousal down far enough for therapy to work. Press play for a plain account of what this condition does to the body and the mind, and why he tells patients it does not have to be permanent.