The Podcast by KevinMD

"The way to do this is by recognizing the power of words. I don't mean fervently declaring one's position and arguing why those who disagree are wrong. There has been way too much of this, and health professionals are no exception. Rather what's needed to deliver the best health outcomes for the most people is listening, engaging and having something to offer that misinformation peddlers don't — interventions that work. It's also time to recognize the importance of innovating how those of us in health professions communicate. COVID has made it clear that getting your message across is an essential part of health care — the best interventions in the world can do nothing if people do not believe in them. Effective communication strategies should be pursued, studied, innovated and taught with the same rigor as the biological aspects of medicine. Biomedical innovation has been a resounding success in creating vaccines and treatments to fight the COVID pandemic. Now let's put the same effort into understanding how to tackle the health care concerns of different communities and how to reach across the political divide with empathy. That's how we end the misinformation pandemic." Ellen F. Foxman is an immunologist. She shares her story and discusses her KevinMD article, "How to end the misinformation pandemic." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Stress is just part of the alcohol con trick. And the truth is that every benefit we have ever imagined alcohol giving us it doesn't. It is a drug, and it works the same way as all other drugs. Many of my clients are doctors and nurses, and some are in the role of advisor for alcohol issues, and yet are themselves caught in the alcohol trap. This shows how endemic the problems are and how little is understood. The great news here is that when you start waking up to the truth, you are beginning to get wise, and that gives you the power to get wiser still." Michaela Weaver is an alcohol coach. She shares her story and discusses her KevinMD article, "Stress: Is it time to expose the alcohol con?" Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Crowdfunding models of paying for health care maximize the probability that all members' eligible bills will be paid in full each month. These models come without the burdens of skyrocketing premiums and deductibles. Unlike traditional models, members aren't chained to yearly contracts and have more flexibility and autonomy with crowdfunded models." Andy Schoonover is a health care executive. He shares his story and discusses his KevinMD article, "Open enrollment: It's time to leave your insurance plan behind." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Virtually everyone understands the importance of major medical insurance as it relates to unexpected high-dollar care for severe injuries and significant medical conditions, but the value equation for health insurance is quite different when applied to coverage for primary care services. The full potential cost for primary care services is neither expensive nor unpredictable. Routine and preventive care and the management of most acute illnesses and the majority of chronic disease processes by primary care physicians would be quite affordable for most Americans even if they had no health insurance. The involvement of health insurance in the relationship between patients and their primary care physicians introduces several major challenges and disadvantages. Here are the six primary areas of concern." Troy A. Burns is an internal medicine physician and author of Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor. He shares his story and discusses his KevinMD article, "6 major disadvantages of insurance involvement in primary care." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The data are remarkable and promising, though beyond the numbers is a bigger picture. Each data point represents a life – a mother, uncle, grandparent, loved one, friend. Technological advances in image guidance and therapeutic delivery are allowing us to extend life – and quality of life – for patients who previously thought they were facing sudden death. Seeing these patients celebrate another birthday, travel somewhere new, and achieve major milestones is humbling and what drives my work every day. I believe these improved survival findings are just the tip of the iceberg. With MRI-guided radiation therapy, we're changing the paradigm in the treatment of pancreatic cancer, and I venture to guess that through continued awareness, research and innovation, I may be fortunate enough to present findings that rival even these someday soon." Michael Chuong is a radiation oncologist. He shares his story and discusses his KevinMD article, "How MRI-guided radiation therapy is changing the paradigm in pancreatic cancer." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The unvaccinated patient is the addicted person, the overweight patient, the smoker in the waiting room. Our antipathy toward them endangers their health, maybe their lives. The unvaccinated will not be convinced with stigma. They will be convinced with integrity, sincerity, and love. Stigmatization has never been an effective health intervention. And that's exactly what these reflexive responses to the unvaccinated are. It's not righteousness, as if righteousness ever helped in an examining room. These days, maintaining grace and an open heart to the unvaccinated is the most ethical practice a physician can undertake." Stephanie Sun is an internal medicine physician. She shares her story and discusses her KevinMD article, "Anger toward the unvaccinated will only cause more harm." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Physicians, nurses, advanced practice providers, medical assistants, and other health care workers are a finite resource. They don't grow on trees. And, though we all seem to deny it, they are human. The physicians I coach often wonder what they are doing wrong that their lives feel impossible. They are baffled by their inability to finish work on time, get the number of open charts down, clear their in-basket. They worry about the effects on their families and on their health and about whether they will later regret the long hours at work or charting at home when their children are hoping to engage with them. Poor work-life integration, when the needs of work and personal life collide, is a contributor to clinician burnout." Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon. She shares her story and discusses her KevinMD article, "Hello, health care organization leader, are you listening?" Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Six air changes per hour and HEPA grade filtration of indoor air for our children is an investment in their futures for long beyond when the COVID-19 pandemic fades from view. We know there is poor indoor air quality in multiple schools, from inadequate ventilation to air pollution to wildfire smoke. Kids learn better and have less absenteeism in healthy air. COVID-19 has just added fuel to that fire. Let this be a torch to light our way forward to healthy indoor air- starting right now. Most importantly, we need to make sure this opportunity is available to all children, particularly those who have often been left behind in this pandemic. Heartbreakingly, there are kids who never logged on last year or showed up to school, and may have families afraid to send them this year. There are federal funds available from the COVID-19 relief bills to ensure that we can provide this assistance even to already financially-distressed schools. Nothing will ever make our children completely safe, which is the persistent ache of being a parent. However, they deserve a school year in person if possible, and we as the adults in their lives, should do our best to make sure they get it. Don't buy your kids' teachers apples this year. Get them some HEPA filters." Erika Maria Moseson is a pulmonary and critical care physician. She shares her story and discusses her KevinMD article, "Clearing the air our kids share: a prescription for healthy schools." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"I imagine I would have, as I'm sure so many others do, headed to the Internet, reading both accurate and inaccurate information. While much of my visit with my genetic counselor feels like a blur, I left that meeting with a list of answered questions, referrals to specialists, contact information for virtual support groups, and a friend by my side holding my hand. I am grateful that I know about my mutation and live by the phrase "knowledge is power." But when I imagine the thousands of people receiving the news that they have Lynch through a report, I prefer to believe that knowledge is power only when it is accompanied by context and support. March is colon cancer awareness month, and March 22nd is Lynch Syndrome Awareness Day. There is no better time to make a plan to talk about the history of cancer in your family with your loved ones, including the tough topic of colon and rectal cancers; consult a genetic counselor. And arm yourself not only with knowledge but context and support." Kerry E. Evers is a psychologist. She shares her story and discusses her KevinMD article, "With Lynch Syndrome, knowledge alone isn't power."

"The medical profession hasn't changed. Our credibility hasn't changed. Our commitment to care for you – to adore you, to grieve your diagnosis and what it means for you and your family – hasn't changed. Our advice hasn't changed. I'm grateful for your trust in me. I wish it didn't require a cancer diagnosis to win it." Cynthia Cooper is a hospitalist. She shares her story and discusses her KevinMD article, "I'm grateful for your trust in me. I wish it didn't require a cancer diagnosis to win it."

"When you enter medical school, you put your trust into an unspoken promise: Work hard, pass all your classes, and you'll come out as a doctor after four years. While mostly true, this perception doesn't take into account the residency application process and the possibility of graduating without a position as a physician-in-training. This thought didn't cross my mind until I decided to apply for otolaryngology, one of the most competitive specialties. I went into the application season hoping for the best, knowing that the number of applicants was higher than ever. On the Monday of Match Week, I opened my email from the NRMP to be met with the words, 'We're sorry, you did not match into a residency position.'" Katherine Yu and Shaan Somani are clinical research fellows. They share their stories and discuss the KevinMD article, "Unsolicited advice from unmatched residency applicants."

"I am sitting in hot springs deep in the dark and crisp air woods – naked. It has been a day of lectures and workshops at a retreat with my fellow physicians. We are all naked in the effervescent, warm bubbles of the springs. In the dark, I can recognize who people are by the fluorescent necklace each wears. You know, the kind that you crunch and shake to activate that the kids get at a party. The kind you give the kids to be safe when trick or treating in the neighborhood. In many ways, these were our safety lights, worn around the neck to give a glow – but not too much light that would allow us to realize our nakedness. Funny how doctors are about nakedness. If you think about it, we deal with naked or partially naked bodies all the time, day in and day out. We take it for granted that our patients are willing to disrobe and be examined. As an OB/GYN, I saw at least twenty naked women a day. They did have a drape for their comfort, but I certainly gave it no thought. I tend to think of fellow physicians as floating heads full of information that we exchange – certainly not as embodied butt – naked humans. This is so weird. Naked with my fellow physicians that I barely know? What? What am I doing here? The thought fades for a few moments with the fading tension in my body as the warmth of the water envelopes me." Robyn Alley-Hay is a retired obstetrician-gynecologist and life coach. She can be reached at her self-titled site, Dr. Robyn Alley-Hay. She shares her story and discusses her KevinMD article, "The profound experience of being naked with other doctors."

"I recognize that finding time for staff training and making sure the training is effectively practiced are challenges in a busy clinical setting. But taking care of patients means that both goals must be met to ensure safety, quality, and best possible clinical outcomes. As one who speaks and writes regularly about patient advocacy, I am more comfortable than most when it comes to finding my voice and speaking up – professionally and constructively. It may not be so easy for others. The bottom line is that clinical staff have an obligation to make sure all patients are well cared for from the time they walk in the door until they are ready to leave. The Joint Commission's 2021 Ambulatory Health Care National Patient Safety Goals address four critical areas of health care safety: patient identification, medication management, infection control, and prevention of medical errors. Based on my experience, two more areas are needed: patient communication and discharge protocols. In the meantime, I will keep my advocacy sword polished and ready, honoring the spirit of Alexander Cockburn who died at age 71 of cancer. I'd like to think he advocated for himself as long as he could until his death." Bonnie Friedman is the author of Hospital Warrior: How to Get the Best Care for Your Loved One and can be reached at Hospital Warrior. She shares her story and discusses her KevinMD article, "The advocate's sword stands polished and ready."

"Confidence and humility are strongly related, but one arises when we focus on self, and the other arises when we focus on others. However, each attribute can become unhealthy when it becomes too extreme, or when we lose the perspective of the other attribute. In the case of confidence, we focus on our worth as a remarkable human being—the fact that we have tremendous potential and deserve compassion and opportunity. But when we lose the perspective of the importance of others, confidence can veer into arrogance—the belief that our needs and value are somehow more important than everyone else's. In the case of humility, we recognize that we are just one person within a much bigger world and that all people have value and importance. But the risk here is that, if we lose the perspective of our own value and worth, healthy humility can devolve into self-loathing. What does all this philosophizing have to do with social media?" Brian A. Primack is a physician and author of You Are What You Click: How Being Selective, Positive, and Creative Can Transform Your Social Media Experience. He shares his story and discusses his KevinMD article, "How to balance confidence and humility online."

"Physicians can find — or start — writing workshops at medical conferences, or just about anywhere else, at any time. These workshops can become part of wellness or burnout-prevention events. To interact with other writers, all you need is a champion―someone to organize a time and space for you to get together and share what you've written. It's great to exchange ideas and give feedback to one another, either online or off. Participants in these events can feel energized, enlightened and creative. You can even tweet haikus or flash fiction to one another. The work doesn't have to be perfect; it just needs to be thoughtful and come from the heart. Not everyone wants to write, but there's room for those who have not yet tried. Who knows? You might wind up writing a book or two yourself." Sandra Miller is a family physician. She shares her story and discusses her KevinMD article, "How writing fiction can free physicians."

"The worst part of the climate crisis is that our kids, my kids, may never get to witness the most beautiful parts of our world because they may, and will, cease to exist without our action and power. As I watch my own kids looking out over the ocean on a clear, cool day in awe at the behemoth of wonder before them, I know they are the ones I am fighting the battle against the climate crisis for, and I beg you to fight too. Beauty in the world and love of our environment and each other are not partisan issues; they are simply the components that make our lives worth living. And if that is not worth saving, then I don't know anything that is." Elizabeth M. Barreras-Rivest is an emergency physician. She shares her story and discusses her KevinMD article, "The climate crisis as viewed by an emergency physician."

"In 2010, a landmark study from Princeton was published "proving" that money just doesn't buy happiness. Study participants were asked to compare their emotional well-being from yesterday to today, and it appeared that making more than $75,000 a year didn't lead to concurrent increases in well-being. Since then, Americans have been flooded with the psychological opium of mindfulness, yoga, and leaning out, urging contentment instead with the status quo. In this column, I'd like to humbly suggest some rather radical concepts: Perhaps paying off your student loans early isn't in your best interests, and neither is dumping all your disposable income into multiple 4xx(x) tax-deferred vehicles. This article is all about using the physician's higher-than-average income to buy something that truly leads to happiness: early financial independence." Khaled A. Dajani is a pediatric anesthesiologist. He shares his story and discusses his KevinMD article, "Don't pay off your student loans early."

"The journey to becoming a physician is generally a linear path. Sure — there are exceptions, but for the most part, you can accurately predict what you will be doing in the future. For example, when you are in high school, the next step is college, then medical school, residency, possibly a fellowship, and finally your first job. (That's approximately 16-18 years of your life!) But what happens when things don't go on as planned? In the earlier stages of your educational career, it's easier to transition to something different. But what about in the later ones? Unfortunately, this was the dilemma I found myself in." This anonymous physician resident shares his story and discusses his KevinMD article, "How to navigate residency probation."

"I love stories, either told, written, or listened to. Songs tell stories, as does art. Blogs such as the rich content open so many doors for rich conversations. Telling stories is part of who I am. My father loved to tell them, as did my grandfather, whose name I took. They were called bull-sh*tters – and perhaps some refer to me that way at times. In medicine, I find storytelling to be critical. Each time we present a case, we are telling a story. Those residents and students who can present a case to me in a way that draws me in while giving me the necessary facts, but goes the next step that allows me to see that person in their life are the ones I know will be amazing doctors." John F. McGeehan is an internal medicine physician. He shares his story and discusses his KevinMD article, "Why storytelling is critical in medicine."

"In the months just prior to the infantile spasms, as Josephine's mind had begun to develop and grow, so, finally, had my love for her. My lack of affection for her up until that point had troubled me, and it was with relief that I had realized I was beginning to look at her with adoration—that a random thought of her was accompanied by delight as often as sadness. I knew that my lack of acceptance had been at the root of my difficulty bonding with her, and I had felt that I was beginning to find peace with the person that she was, limitations included. Looking back, I see that my reaction to her that night in the rocker—my denial of her personhood, my despair at the thought of being obligated to mother her—reveals that what I mistook for love and acceptance was actually something much more tenuous and conditional. I wasn't truly beginning to love her, I was beginning to love who she might become. It was only her potential I valued, not her current self. The odyssey to fully embracing her, disabilities and all, was one I had yet to make." K. Jane Lee is a pediatrician and author of Catastrophic Rupture: A Memoir of Healing. She shares her story and discusses her KevinMD article, "A shift from the medical perspective of disability to a mother's perspective."

"Medical debt is the mortal enemy of the patient, the physician, the hospital, the community, the state, and the nation. When we think of others' debts, we tend to think such debts are their personal responsibility. If they're unable to pay the debt, it's their problem. (We make it a You problem, not a Me problem) Society tells us a problem with personal debt is a direct result of bad decisions, poor personal financial habits, profligate spending, living beyond one's means. We blame those with medical debt for their bad choice of buying substandard health insurance, or else for not purchasing any health insurance at all. We say the consequences of debt are rightly visited on the debtor. Whatever the impact — canceled credit cards, low credit, wage garnishment — it's on them. Personal responsibility. Is this true? In the big picture, we individuals and society both bear the costs and burdens of personal "bad debt." For individuals who fall into arrears in their payments, who cannot pay their financial obligations, unpaid debt means their ability to buy goods and services is curtailed or perhaps ended. If new credit is not extended, the person must live on cash. For any business, any debt that's not paid by the customer creating it becomes a cost to the enterprise extending credit. The business recoups its loss by raising prices on products or services for all future customers. The business may stop its loss by not providing goods or services to a debtor, disciplining those not paying their bills. In such cases, the consequences of unpaid bills fall on the debtor and creditor, usually ending there." Robert E. Goff is a health care consultant and co-author of End Medical Debt: Curing America's $1 Trillion Unpayable Healthcare Debt. He shares his story and discusses his KevinMD article, "Medical debt is the enemy of everyone."

"My practice consisted of patients who suffered from serious injuries and illnesses. Concerning the latter, a significant number had cancer, especially breast cancer. The issue all patient groups have in common to a certain degree is protein calorie malnutrition (PCM). The most dramatically affected are those stricken with a malignancy. PCM leads to increased morbidity, mortality, complications, length of hospital stays, and hospital readmissions. As physicians, we must bring awareness to this devastating problem and offer solutions based on education and new product innovation." Steve Snodgrass is a surgeon and founder, Dr. Steve's Nutri Snax. He can be reached on Instagram @drstevesurgeon. He shares his story and discusses his KevinMD article, "Protein calorie malnutrition is devastating for patients."

"To better meet the needs of patients, providers can improve access to treatment and offer more immediate solutions through the use of prescription digital therapeutics (PDTs). With technology, providers can now deliver programming aligned with proven mental health treatment methods, such as cognitive-behavioral therapy, and connect teens and young adults to an immediate, safe, and effective treatment option. Technology cannot replace good patient relationships, but the future of mental health care rests in leveraging technology that complements a clinician's hands-on care. The last year and a half has underscored the need to shift rapidly and use new solutions in a meaningful way. People are becoming increasingly more receptive to telehealth and virtual treatment – especially teenagers and young adults. Now is the time for physicians to consider digital therapeutics to quickly and safely support their patients who need mental health treatment, intervening early to achieve better outcomes." Benjamin Alouf is a pediatrician. He shares his story and discusses the KevinMD article, "How digital therapeutics can strengthen the provider-patient relationship and improve behavioral health outcomes."

"Many of us suffer in silence for myriad reasons. Being a physician with infertility presents a perfect storm of stress, anxiety, guilt, and shame – all of which we know don't contribute to managing any medical problem. Consider what it's like to undergo a typical cycle of in vitro fertilization. You administer nightly hormone injections to grow your follicles in preparation for an egg retrieval procedure. The process usually takes 1-2 weeks, but you don't know exactly how fast your follicles will grow. For the first week, maybe you just need to arrange to get away from the hospital or clinic for a couple of blood draws. But during the second half of your stimulation cycle, you must physically go into your clinic for daily transvaginal ultrasounds to monitor the progress." Dawn Baker is an anesthesiologist who blogs at Practice Balance. She shares her story and discusses her KevinMD article, "The voices of women physicians with infertility." (https://www.kevinmd.com/blog/2021/12/the-voices-of-women-physicians-with-infertility.html)

"Patients communicate immense amounts of information through body language. The primary understood, universal body language is choking. Anywhere in the world you go, if someone is choking, they use both hands to grab their throats. No matter what country you are in or what language is spoken, you can recognize someone choking and provide aid if trained. Body language is also understood to convey various subconscious emotions – crossed arms can be used by someone who is angry, frustrated, or scared, or shutting down in a conversation; open arms and uncrossed legs can be used by individuals who are open to new ideas, and willing to communicate with those they are talking to." Jennifer Ribar is an osteopathic physician. She shares her story and discusses her KevinMD article, "Listening to patients with our eyes." (https://www.kevinmd.com/blog/2021/11/listening-to-patients-with-our-eyes.html)

"Medicine is not a business You fools. Healing is your blueprint, activated to complete itself. A doctor does not broker it, The best anyone can do is align you With what you should be, And stay out of the way. (Like a teenager setting off an illegal firecracker.) Mostly, you pay the doctor for the alignment, And the nurse To keep the doctor out of the way. If you're not ready, to get on with the business of what you should be, You come back later. Or, maybe, next lifetime. It's not complicated. And it's not a business. You fools. The doctor knows what you should be, when they know what they are, And if they don't And the nurse can't tell them, You come back later, Or, maybe, next lifetime. It's simple, but It's not easy, And it's not a business you fools. I've seen it, GNP and recurring revenue and prayers so many pairs of high-intervention end-of-life care. It's cosmic law That you cannot profit from someone else's suffering. You only appear to, When you do not know what you are. When you are blind to the part of yourself that suffers with them. Which is why medicine is not a business it's a relief, A chance to make yourself right, Whole. When you are whole, you come back later if you want or next lifetime, To heal." Drea Burbank is a physician-entrepreneur. She shares her story and discusses her series of poems, "When you die: a poem," "Medicine is not a business: a poem," and "A physician's pain poem."

Welcome to an expedited episode of The Podcast by KevinMD. Trevor Bedford is a computational biologist and infectious disease scientist, Fred Hutchinson Cancer Research Center. He was selected as a recipient of the 2021 MacArthur Fellowship and can be reached on Twitter @trvrb.

"The holiday season is rapidly approaching, and it is not uncommon for us to gain up to 10 pounds between Thanksgiving and Valentine's Day. But what if we do not want to put on some insulation? What can we do? I specialize in medical weight loss, and my first recommendation would simply be to be aware of the food around us and recognize that seeing food in itself can be a trigger to eat." Angelice Alexander-Martin is a family physician. She shares her story and discusses her KevinMD article, "Don't let the holidays sabotage your weight loss goals." (https://www.kevinmd.com/blog/2021/11/dont-let-the-holidays-sabotage-your-weight-loss-goals.html)

"The victims of this now distorted concept of liberty are ones that we physicians encounter every day. The one that inspired this essay for me is an 11-year-old boy that I saw three weeks ago. He is a patient of mine in my pediatric practice who came to see me with typical respiratory symptoms that led to a diagnosis of COVID-19. While he recovered uneventfully, his father got sick the next day and died from the same illness five days later. Like the vast majority of people who die from COVID-19 now, he was unvaccinated, believing that getting vaccinated was unnecessary and part of a greater effort to undermine his personal liberty. His son is now dealing with the unimaginable grief of losing a parent at such a tender age and asking his mother if he killed his father by getting sick and causing his death. This happens every day now in our communities across our nation. These are wounds that will never heal for this generation of kids." Jason V. Terk is a pediatrician. He shares his story and discusses his KevinMD article, "The dimming of the shining city." (https://www.kevinmd.com/blog/2021/10/the-dimming-of-the-shining-city.html)

"The U.S. Department of Education recently announced some major changes to the rules and qualifications around the Public Service Loan Forgiveness (PSLF) Program. Now, for a limited period of time, borrowers may receive credit for past payments made on loans that would otherwise not qualify for PSLF. The good news is that public service loan forgiveness is now available to more people. The bad news is that there will be more people waiting in line to have their federal student loans waived. This issue impacts anyone from medical residents to physicians who are making payments on loans for at least ten years." Will Koster is a financial planner. He shares his story and discusses his KevinMD article, "The Public Service Loan Forgiveness waiver and its impact on physicians." (https://www.kevinmd.com/blog/2021/10/the-public-service-loan-forgiveness-waiver-and-its-impact-on-physicians.html)

"Finding out I was gene-positive had hit me harder than I could ever have imagined. How was I to know that my decision to get tested would have such an impact on my life? All of the rehearsing I had done in the weeks leading up to my results appointment proved useless. At the genetics clinic that day, the doctor told me most people feel better after about three months. As I sat on the hard plastic hospital chair, staring at the creased piece of paper containing my test results, I thought, That doesn't seem so bad. Three months isn't that long. The problem was it had been longer than that and I still didn't feel better, not even a little bit. I was starting to think something was wrong with me, that I was the cause of my own misery. Am I wallowing in my own self-pity? Do I like feeling this way? I didn't understand why I couldn't make myself better. I had never experienced a depression as deep or as long-lasting as this. I had recently begun to realize that anything I had felt previous to my HD diagnosis that I thought was depression was just sadness. Every day, every moment, was a struggle. There was no more joy in my life. I hadn't smiled in weeks. I had more unanswerable questions now than before I got tested. How am I supposed to live with this? I can't stop it from happening, so how am I ever going to feel OK?" Erin Paterson is a writer and the author of All Good Things: A Memoir About Genetic Testing, Infertility and One Woman's Relentless Search for Happiness. She shares her story and discusses her KevinMD article, "The emotional side of genetic testing." (https://www.kevinmd.com/blog/2021/10/the-emotional-side-of-genetic-testing.html)

"I'm not brave. I'm just me. Full of light and lifted by my light. You see, when you strip away the darkness and lies that others surround you with, you're left only with your light. The genuine you. Moving forward in life in ways that are authentically you. Not because it's brave to rise above and be disconnected from your humanity, but rather because when you become un-brave, you step into your own courage. Courage has understanding of what you're doing and who or what you're doing it for. Courage gives you permission to feel the feels, and connect not only with others, but also with yourself. Whether you're a nurse, an abuse survivor, or whatever has led to your belief that brave is the face you need to show, I hope you give yourself permission to become un-brave. Step into the courage that allows you to embrace the fears that are the keys to your strength, compassion, and humanity. May you show that courage first to yourself and the parts of you that are hurting, so that you can be genuinely and authentically courageous for others." Traci Powell is a nurse practitioner. She shares her story and discusses her KevinMD article, "If you're a nurse or an abuse survivor, you don't have to be brave." (https://www.kevinmd.com/blog/2021/11/if-youre-a-nurse-or-an-abuse-survivor-you-dont-have-to-be-brave.html)

"Some policymakers may be wary of not using case numbers as the primary metric to guide public behavior and policy. As cases become more complex, however, health departments should still monitor infection numbers, but guidance should be tied to hospitalization metrics. When rising cases do not reliably predict hospitalization surges, hitching Covid policies to cases alone is no longer effective policy — or good public health." Monica Gandhi is an infectious disease physician and co-author of the New York Times opinion article, "Why Hospitalizations Are Now a Better Indicator of Covid's Impact."

"We orthopedic surgeons are disappointed with the growing lack of enthusiasm in your reports. When I began in practice almost 15 years ago, it wasn't unusual to see a report of a post-reduction or post-surgical X-ray that read, 'alignment is now anatomic' or, at a minimum, 'near anatomic.' What happened? What did we do to deserve reports like, 'Overlying cast obscures fine bony detail. Alignment is improved from pre-reduction imaging,' after we closed reduced a mangled looking extremity and got it back anatomically? Or better yet, '54 seconds of fluoroscopic time was provided for ORIF of femur. Correlate with operative report,' when we ORIF'd the hell out of it." Samara Friedman is a pediatric orthopedic surgeon. She shares her story and discusses her KevinMD article, "An open letter to radiologists from a jilted orthopedic surgeon." (https://www.kevinmd.com/blog/2021/11/an-open-letter-to-radiologists-from-a-jilted-orthopedic-surgeon.html)

"Right now, I think that people need to understand that this virus is clearly mutating to become more contagious, and that is in its evolutionary best interest. That's what viruses do. That is not the same thing as a virus having an advantage by making us more sick or breaking through our vaccines. There's no advantage there. So we don't yet know about that. So what I really want your audience to know and to think is, do I care about infection or do I care about outcomes? Sometimes those things are totally interchangeable, like an infection is an outcome. You get infected. You have a long-term consequence. But as time goes on, I want people to really think about whether we've uncoupled that with our vaccines, with our therapeutics. And if we have, then we should really be watching a different set of outcome metrics. So I want people to be willing to stand up their level of concern when something new and unknown comes along. But I want them to also be able to deescalate that when we learn more. Because look, we've been humbled by this many times in many directions, and I think that watching those issues in real-time and responding to the data is really our best chance to keep getting better at this." Jeremy Faust is an emergency physician who can be reached on Twitter @JeremyFaust and on Instagram @JeremySamuelFaust. He also publishes the newsletter, Inside Medicine.

"Physicians can exert their influence in a health care environment to put the patient-physician relationship at the center of the enterprise. Working with middle-market employers (between 200-2,000 employees), some companies pair bold doctors with innovative employers to bring exceptional value to employee health benefits. There are no pre-authorizations for medical decisions, but doctors are held accountable for best practices. Customized health benefits offered within the ERISA framework allow employers to tailor programs and coverage to their employee population. A purpose-built tech solution allows all the players to see more, see it sooner, and maximize health. Nurses serve as the point of contact for employees and as trusted guides for any health concerns, facilitating appointments with doctors and other healthcare professionals. In this model, doctors are equal partners with employers, reducing avoidable costs while delivering higher quality care. Instead of a fragmented journey, patients are supported through three phases of care—navigation, facilitation, and resolution." Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor's Prescription for a Post-Pandemic America. He shares his story and discusses his KevinMD article, "'Take it or leave it' is not negotiation but coercion." (https://www.kevinmd.com/blog/2021/11/take-it-or-leave-it-is-not-negotiation-but-coercion.html)

In this special episode of The Podcast by KevinMD, I'm on the other side of the podcast mic. It was an honor to be interviewed by Jonathan Baktari, MD on his show, the Baktari MD Show. In this hour-long episode, Life as an MD Online, I discuss how I got started, online reputation and social media, the KevinMD platform, my medical career, physician burnout, online misinformation, how COVID impacts medicine, and much more. Thanks again to Jonathan Baktari who can be reached at BaktariMD.com (https://baktarimd.com/) on Twitter @baktarimd and YouTube.

"By denigrating midwifery care, pathologizing the natural process of birth, and instilling fear of complications and pain, doctors persuaded women to give birth at the hospital under their care. By touting the benefits of anesthesia, forceps delivery, episiotomy and promoting in-hospital birth, doctors and hospitals were able to capitalize on the new specialty. Interventions of increasing risk and complexity, and their routine use — without proof of benefits for the 80 percent of birthing people who are low risk — have caused harm not just because of their invasive nature, but because the birthing person is subjected to various forms of persuasion and coercion (without informed consent) to do what doctors believe is best for them and their babies. Many of the practices employed on labor and delivery interfere with the natural process of birth. When patients ask to avoid those interventions (which often make life easier for the staff or more money for the hospital), they are told they are not allowed to do what they want for their labor and birth. In a 2019 survey of women who gave birth in U.S. hospitals, 28 percent reported mistreatment. Black people report discrimination in about one-third of their medical encounters." Leslie Farrington is an obstetrician-gynecologist. She shares her story and discusses her KevinMD article, "This obstetrician recommends midwifery care." (https://www.kevinmd.com/blog/2021/07/this-obstetrician-recommends-midwifery-care.html)

"This survey study examines the self-reports of personal attacks and sexual harassment of physicians through social media outlets. A total of 108 physicians (23.3%) reported being personally attacked on social media, with no significant difference between female and male physicians. In contrast, women were significantly more likely than men to report online sexual harassment." Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain. She can be reached on Twitter @ShikhaJainMD. She shares her story and discusses the article, "Prevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media."

"The collective resiliency of the medical education community shone through the challenges of the past year. In medicine, physicians must adapt to all situations, and GME is no exception. Even in a pandemic, everyone adjusted as needed. Program coordinators and faculty were flexible and creative, while applicants remained passionate and pushed past roadblocks. It seems that there is no situation to which GME cannot adjust. With the financial and time-saving benefits of an all-virtual and/or hybrid recruitment model on the horizon, applicants and programs can rest assured that, while it will take some getting used to, the residency recruitment process will be changed forever." Jason Reminick is a physician-entrepreneur. He shares his story and discusses the KevinMD article, "A transformative year for GME recruitment: How the process has changed forever." (https://www.kevinmd.com/blog/2021/05/a-transformative-year-for-gme-recruitment-how-the-process-has-changed-forever.html)

"My mother screamed. It meant my father needed a doctor — now. But why? We just visited the hospital days before to refill his drugs. He would be better if he used the drugs. Magic drugs. That is what he called them. I stood up from the mat where I slept beside them to find him not moving. But why? When he got sick, he moved. He moved a lot. Then, he got better and stopped moving. But he always moved first. My mother noticed me. Her eyes reminded me of a movie. The warrior dropped her sword in the middle of a battle. Her comrades were all dead. But she was not. I never understood why she dropped her sword. She could have fought and lived. But she died. My mother held the same look as the warrior." Sarah Fashakin is a medical student. She shares her story and discusses her KevinMD article, "What my father taught me about language." (https://www.kevinmd.com/blog/2021/10/what-my-father-taught-me-about-language.html)

"Practicing culturally relevant care means we can account for the social determinants of health, barriers to access, and the emotional disconnect that results from the status quo, one-size-fits-all approach many patients have come to expect. It helps us reach into underserved communities and lift them up, which is essential during a pandemic that disproportionately affects low-income and diverse Americans. If we, as clinicians, can align around the fact that we exist to serve all patients, we must realize that culturally relevant care is more than a situational deviation from the norm. Rather, it must represent the new normal—the new standard of care." Vik Bakhru is a clinician and health care executive. He shares his story and discusses his KevinMD article, "To achieve health equity, we must make culturally relevant care the standard of care." (https://www.kevinmd.com/blog/2021/04/to-achieve-health-equity-we-must-make-culturally-relevant-care-the-standard-of-care.html)

"You have more power than you realize. It's no secret that medical providers feel structurally powerless in our chaotic health care system. Control over the volume, pace, and elements of our work often rests squarely in the hands of others. But know this: Your own personal power over your work remains formidable and fully intact. If you're stressed out, burning out, and dreading Mondays, you have the power to make quality decisions about your work and life — decisions that honor who you are and what you want. Imagine waking up excited to do work that gives you joy, not despair. Imagine work that promotes happiness and wellbeing, not stress and impairment. As a health expert, surely you deserve healthy work." Cathy Woodhouse is an internal medicine physician. She shares her story and discusses her KevinMD article, "Amid powerlessness, reclaim your personal power." (https://www.kevinmd.com/blog/2021/10/amid-powerlessness-reclaim-your-personal-power.html)

"I can attest to the tremendous power of simply noticing these rhythms and attending to them. It's part of a larger attempt to live a more authentic life. So much of my time over the past 20 years has been vying to achieve someone else's standards or to live the way I 'should.' I should exercise in the morning since it's healthier! I should shut down my computer at 5 p.m. so I can be focused on my family! I should block out all distractions on the weekends! The fight against the 'should' is a common one for many physicians, especially female physicians. We are inculcated with the notion that success is defined by one particular aspect of our lives or one particular way of being. In the process, and in the struggle, we silence the part of ourselves that knows a better way. We silence the truth inside that is trying to guide us down our individual path. If we turn towards that truth – little by little – we open up to endless possibilities and countless ways of being. We can turn on our creativity and bring forth our unique gifts and skills; and in doing so, increase our abilities to honor ourselves and serve others." Laura Huete is a family physician. She shares her story and discusses her KevinMD article, "An argument against time management." (https://www.kevinmd.com/blog/2021/03/an-argument-against-time-management.html)

"My mother, bless her ninety-year-old heart, is slowing down. The things that made her happiest — getting to church, visiting friends, taking walks, and wandering the aisles in the grocery store —are increasingly difficult. She worries that her lack of energy will soon make every activity impossible. It is 2005 and she is living alone in Chicago, about ninety miles from where my wife and I live. My father died suddenly the year before, and she is settling into the life of a widow. She has always been very healthy and upbeat, but she's become more and more fatigued. 'What do you think it is?' she asks. 'Do you think it is my heart?' 'Let's find out.' We arrange an appointment with her internist. Sure enough, her heart rate is uncharacteristically slow and does not speed up when she walks or moves about. 'I believe you need a pacemaker,' her doctor confirms. 'I'll arrange a visit with a cardiologist.' This gives my mother something new to worry about. 'I'm too old for any procedures, don't you think?' she says. 'Do you think I could tolerate having a pacemaker?'" Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror. He is the author of A Fullness of Uncertain Significance: Stories of Surgery, Clarity, & Grace. He shares his story and discusses his KevinMD article, "Mom's new pacemaker: a story." (https://www.kevinmd.com/blog/2021/09/moms-new-pacemaker-a-story.html)

"Institutional real estate private equity funds have dramatically outperformed all other methods of investing in real estate such as syndicated real estate deals, crowdfunding, and REITs because larger real estate funds have the best deal sourcing capabilities that enable them to identify and execute opportunistic acquisitions with speed and at the most attractive pricing. Syndicated deals, crowdfunded deals, small deal sponsors, and REITs just cannot compete with institutional investment funds. Unfortunately, institutional real estate private equity funds have been inaccessible to individuals due to their multi-million dollar minimum investment required. And the more experience a real estate manager is, the more capital they attract. I set out on a mission to change this." Alan Donenfeld is founder and CEO, CityVest (https://www.cityvest.com/home.html), providing investors with insider access to pre-screened, institutional real estate investments historically unavailable to individuals. This episode is sponsored by CityVest (https://www.cityvest.com/home.html), providing investors with insider access to pre-screened, institutional real estate investments historically unavailable to individuals.

"While much of the conversation around financial independence is tied to the ability to retire early, the real prize is flexibility. I hear a lot of 'I love what I do and will work until I die' amongst physicians. Not so fast. Your goals and priorities will likely change as you get older. And sometimes, you don't have a choice. A close family member needs extra care or passes away. Your child has special needs or other needs that require your time and attention. You never know what life may bring. Working toward financial independence as a woman physician allows you to create your dream job. You have the ability to scale back your hours, take a leave of absence, or make other arrangements to optimize your day and your life. In short, you have a fall-back when life throws you curveballs. By taking control of their finances and pursuing financial independence, women physicians are able to be better physicians, better mothers, and better partners. Being debt free, spending mindfully, and employing other strategies to reach financial freedom gives the woman physician choices and flexibility to live on her terms." Bonnie Koo is a dermatologist and founder and editor, Wealthy Mom MD. She shares her story and discusses her KevinMD article, "Why women physicians should take control of their finances." (https://www.kevinmd.com/blog/2019/05/why-women-physicians-should-take-control-of-their-finances.html)

"If you treat chronic pain, or are someone living with it, remember this: Changing the brain can change pain. Addressing emotional health directly impacts physical health, because brain and body are always connected. Pain psychologists can serve as pain coaches – it doesn't mean you're crazy, and it's not 'all in your head' (it's in your brain!). Try biobehavioral interventions like CBT, biofeedback, and mindfulness, and demand that your insurance company reimburse these treatments. If you're a health care provider, spread the word about biopsychosocial pain management. Teach patients how pain works, connect brain with body, and offer hope. Knowledge is power. Let's empower our patients – and each other – to find integrative solutions that work." Rachel Zoffness is a pain psychologist. She shares her story and discusses her KevinMD article, "What you don't know about pain will hurt you." (https://www.kevinmd.com/blog/2021/11/what-you-dont-know-about-pain-will-hurt-you.html)

"For twenty years, I defended doctors when they were sued, and now I coach female leaders from all industries on how to advocate for themselves and their potential with the tools of a trial lawyer. I know that when doctors are exhausted, distracted and powerless they're more likely to be sued. They're also more likely to burnout, less likely to enhance the patient experience, and more likely to have complications. And I know there is another way." Heather Hansen is a communications consultant and attorney. She can be reached at Heather Hansen Presents. She shares her story and discusses her KevinMD article, "When telemedicine leads to burnout." (https://www.kevinmd.com/blog/2021/10/when-telemedicine-leads-to-burnout.html)

Welcome to this special episode of The Podcast by KevinMD, where I interview two infectious disease physicians on the COVID Omicron variant. They share their unique perspective on this threat answer the following questions: How do these early days of the Omicron variant contrast with past variants? What do they think about the travel restrictions? How has the media covered Omicron? What are the best-case and worst-case scenarios? And about Omicron keeps them up at night? Nahid Bhadelia is an infectious disease physician and founding director, Center for Emerging Infectious Diseases Policy & Research (CEID). She can be reached on Twitter @BhadeliaMD. Paul Sax is an infectious disease physician and contributing editor, NEJM Journal Watch Infectious Diseases. He can be reached on Twitter @PaulSaxMD.