The Podcast by KevinMD

"In the end, the patient-physician relationship is crucial to overall decision-making for any plan of care, treatment, or surgery. There are many variations in the reviewed studies in health care literature as to the cost-effectiveness of second opinions in medicine. These studies could be easily misconstrued that there are no benefits to second opinions, thus possibly leading to little pay or no pay by insurance companies. A patient should consider the substantial short and long-term implications of their body's health and well-being. In other words … it is worth it. Go with your intuition. When in doubt, or if you have more questions, get a second opinion." Sonya M. Sloan is an orthopedic surgeon and author of The Rules of Medicine: A Medical Professional's Guide for Success. She shares her story and discusses her KevinMD article, "Think again: Get a second opinion." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The more I spoke with individuals who had experienced a shared crossing event, the more I also noticed repeating patterns. A woman in West Virginia and a woman in Australia with deeply similar experiences around the loss of a baby. A grown daughter in California and a grown daughter in Pennsylvania; a woman in Alabama and a man in Spain. None had met, yet each spoke a common language. Again and again, I found that this moment of shared connection that they had experienced also changed their lives and how they chose to live them in unexpected ways. It provided insight. It provided closure. It made end-of-life decisions easier. It eased grief." William Peters is a grief and bereavement therapist and author of At Heaven's Door: What Shared Journeys to the Afterlife Teach About Dying Well and Living Better. He shares his story and discusses his KevinMD article, "What shared journeys to the afterlife teach about dying well and living better." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"As individual patients, we often don't think about these costs. In my Instagram poll, nearly everyone taking Descovy reported receiving the drug effectively for free, largely due to Gilead's copay coupons. However, as with anything in life, nothing really ever is free. More patients taking Descovy rather than generic Truvada means higher overall spending by insurance companies. This eventually comes back to haunt us in the form of higher premiums, and is why we shouldn't simply adopt a costlier drug like Descovy without good reason to do so." Frank F. Zhou is a medical student. He shares his story and discusses his KevinMD article, "Is Descovy really the better option?" Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

Emergency physician and financial planner Noah Kaufman gives a general cryptocurrency market update. He discusses the state of Bitcoin and the impact of fiscal tightening by the Federal Reserve and also comments on Paul Krugman's recent New York Times column comparing cryptocurrency to the subprime mortgage crisis. Finally, we talk about Crypto Pulse, a free newsletter he runs with Chris Palmer, MD, educating clinicians about Bitcoin and cryptocurrency. Noah Kaufman is an emergency physician, financial planner, and can be reached on Twitter @noahkaufmanmd. He is co-founder of the free newsletter, Crypto Pulse, an educational and actionable bi-weekly newsletter written by passionate crypto investors/traders (and medical doctors) for health care professionals. Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"When I came into the business world, I saw a huge spectrum of ethics and am still shocked at how there aren't any standards. Why must one be in a professional career only to have some guidelines and/or rules to follow? I don't currently have patients in the entrepreneurial world, but I do have a lot of people in my sphere with whom I have the ability to educate and empower. I am bringing the Hippocratic Oath into the field of venture capital and entrepreneurship in an effort to impact the world on a different but equally important scale." Navin Goyal is a physician-entrepreneur and author of Physician Underdog. He shares his story and discusses his KevinMD article, "Bringing the Hippocratic Oath into the field of venture capital and entrepreneurship." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Lifestyle medicine's foundational pillars include a specialized look into diet, physical activity, sleep, stress, mood, substance use, and relationships. Creating a patient-centered plan of care based on these areas are proven successful in preventing, treating, and reversing chronic diseases. Some may say that health care providers do not have time to focus on intensive lifestyle modification in their visits with patients. This is true in the current fee-for-service, physician-dominated care delivery model. But to be successful in obtaining shared-cost savings in the value-based care and as accountable care organizations, it is urgent to shift to utilizing more nurse practitioners, dietitians, nurses, social workers, and health coaches in chronic disease treatment and prevention. This makes it possible to reduce the social and economic impact that many chronic illnesses place on individuals, the health care system, and society. There is indeed a better way to better health for all Americans." Elizabeth Simkus is a nurse practitioner. She shares her story and discusses her KevinMD article, "It's a lifestyle: Adopting a behavioral approach to health care is urgent." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Ultimately, patients need doctors to help them be healthy, and need their doctors to be healthy to help them! Unless interventions are done now, our health care system risks a downward spiral. While the pandemic has brought increased levels of stress and burnout, it has prompted us to take action on mitigating this serious issue. Hospitals, practices, administrators, and physicians must realize that working together to combat burnout is essential for the health of our entire health care system." Lalitha Sundararaman is an anesthesiologist. She shares her story and discusses her KevinMD article, "Prioritizing physician wellness: Reducing burnout during the COVID-19 pandemic and beyond." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Anyone can win at poker when dealt a royal flush. But what can you do when the cards you are dealt don't appear winning at all? My answer: Make the best of what you have. Recently I learned of a colleague who sustained a broken back in an accident. He continues to work, wearing a brace and not taking pain medication. I know from watching his videos that he routinely handles the most complicated eye surgeries. Such cases are challenging to any seasoned ophthalmologist, without physical constraints and constant pain. This internationally renowned eye surgeon dubbed his constant pain 'background noise.' How on earth has he maintained a positive attitude despite such a major setback?" 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, "Playing the hand you are dealt." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Taking stock of all these experiences, I feel like I have no answers. They lead me to a space of unrest and dissatisfaction for not having a pill that would instantly drop 10 kilos, cure hep E, curb food craving or resolve a heartache. But I feel grateful for bypassing most life hurdles that people live with, those hurdles that life chooses for them rather than themselves." Natasha Khalid is a physician in Pakistan. She shares her story and discusses her KevinMD article, "Pay heed to the little life traumas that hit us daily." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Inaccurate patient records aren't just an inconvenience. They're a risk. The EHR might speak for the patient when they cannot speak for themselves, and if it's wrong, it's a serious liability. In lieu of any system-wide improvements to EHRs, I try to be vigilant. I ask the medical assistants to review the medication list at every appointment, if I can. Luckily for me, my chart's problem list is accurate now that the HNHSA diagnosis has been removed. All the same, I worry that if a medical assistant mixes up my conditions and punches in the wrong ICD code again, the chart will suffer. And I worry that if it happens, correcting the issue will prove difficult again. EHRs are wonderful additions to the clinician's toolbox, and they aid patients in accessing their records and having clear information about their health. However, some adjustments are necessary, including a more effective way to screen for and correct errors, so this tool will always be helpful and do no harm." Denise Reich is a patient advocate. She shares her story and discusses her KevinMD article, "When records are wrong, patients are at risk." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The reality of the last two years is that almost all of us have experienced some mental health disorder symptoms, and that mental and physical health are equally important components of overall health. We call these subclinical symptoms, or symptoms that are there but that don't meet full criteria for a disorder. Most of us have experienced subclinical symptoms, or psychosocial stressors, since the start of the pandemic due to the stress that we've been under. These can include things like divorce, illness, job loss, and even things like stressful homeschooling. If you get enough of them, you're more likely to tip over into subclinical or clinical levels of symptoms, including increasing the risk for many types of physical health problems, particularly long-lasting conditions like diabetes, heart disease, and stroke. The setpoint of our average well-being levels has shifted down the spectrum over the last few years. That means that almost all of us can benefit from seeing a provider and getting professional mental health support, whether through a digital tool or via face-to-face therapy. It's important to think about the total person, and all of the facets that may need treatment. Using technology that integrates siloed services into one ecosystem has the advantage of being able to provide highly coordinated care, whether that's for mental health, chronic condition management, substance use monitoring, managed behavioral health, or other needs." Jay Spence is a psychologist. He shares his story and discusses his KevinMD article, "Mental health and the balance between technology and the human touch." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"A hundred years ago, women lived one year longer than men, but now they live five years longer than men. And things are getting worse. Currently, the lifespan of men in the U.S. is declining due to alcohol, opioids, and suicide. These trends need to change. I take care of men. I've been a urologist for almost 25 years and have seen thousands of men as patients, many of whom have shared their most personal thoughts and feelings with me. I've followed many men in my practice for 15 to 20 years and have witnessed the slow physical decline that is inevitable with age. Over that time, I have also aged, yet many of my patients have had it far worse than I have. As a urologic surgeon, clinical researcher, physician educator, and practicing clinician, I have embarked on a journey to help myself, my patients, and other physicians meet these challenges, to maximize our health and maintain the glow and vitality of youth." Judson Brandeis is a urologist. He shares his story and discusses his KevinMD article, "The catastrophe of men's health and how we can help." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Studies show that those physicians with negative online reviews were more often scored poorly due to non-physician specific causes. In my career, I've read comments from patients that said they were not satisfied with their provider because they didn't like the color of the walls in the exam room. Another mentioned that tea wasn't offered in the waiting room, just coffee. Surveys are not necessarily bad, but they have changed the way we interact with patients. Doctors are now feeling pressured to provide care patients don't need because of fears of bad patient satisfaction scores or negative reviews online. This causes more stress on health care professionals. In a national study, 78 percent of clinicians said patient satisfaction scores moderately or severely affected their job satisfaction negatively, and 28 percent said the scores made them consider quitting." Peter Valenzuela is a family physician and author of Doc-Related: A Physician's Guide to Fixing Our Ailing Health Care System. He shares his story and discusses his KevinMD article, "Patient surveys: the quest for positive reviews." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"All the faceless young men who are brought to his operating table, prepped and draped, broken and bleeding, are finding their experience of war bears little resemblance to their reveries of war. They should have known better. At corner taverns in Chicago, Albuquerque, and Murphysboro, there were tired veterans with scars and limps; men with faded names of regiments or slogans like "Semper Fi" tattooed on their biceps; men with creased faces and shuttered eyes, who quietly nursed schooners of beer while they watched the Sox or the Dodgers on the TV behind the bar; men who had been to places like Bastogne and Peleliu and the Chosin Reservoir. They, too, once had reveries. Carelessly fingering an old scar or slowly twisting a worn ring, they might have explained some things to these un-blooded young men, things forever indecipherable to those who have never worn the uniform, who have never lit the flame. But words are weapons, slashing open memories, ripping open wounds, stirring the smoldering fires of pain that old warriors have doused with alcohol and denial for millennia. And while they spoke, these old veterans could not help but see distorted reflections of their own youthful faces on the bar's polished surface and could not help but remember things they had tried so long to forget." Michael J. Collins is an orthopedic surgeon and author of All Bleeding Stops. He can be reached on Twitter @mjcollinsmd. He shares his story and discusses his KevinMD article, "War is really not all it's cracked up to be." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"No matter what, your healing work matters. No one should tell you otherwise, and nothing can change that, not even a shortcoming. You provide healing in a way no one else can. Care for yourself, and you can be the healer you truly wish to be." J. C. Sue is a family medicine resident. He shares his story and discusses his KevinMD article, "Self-care should now be your plan." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

Welcome to a special episode of The Podcast by KevinMD. In this 60-minute episode, I partner with DrFirst, a pioneer in health IT for over 20 years. We bring together physicians with different backgrounds to explore information overload and physician burnout. Dr. Sameer Badlani is chief digital officer, M. Health Fairview, a major health system in Minnesota. He is also adjunct faculty at Carnegie Mellon University. Dr. Colin Banas is chief medical officer, DrFirst. He was an internal medicine hospitalist and served as the chief medical information officer for VCU Health System in Richmond, VA. They share their stories and discuss the following questions: Based on your roles as physicians and as leaders in health IT, what are your insights into what is contributing to clinician burnout? How did you look at it differently when you became a tech leader? Did your perspectives change? Does tech sometimes contribute to burnout? How can tech best help burnout? What advice do you have for docs? For other IT leaders? Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"For me, my own personal stories of opioid patients come to mind, including one who keyed my car when I stopped prescribing his opioid after an acute injury. I think of some local opioid overdose deaths in my community. I would love to hear what other doctors and clinicians have to say about these issues, like the 'not responsible' verdict and the Sackler family running away liability-free and still worth billions of dollars. Does anybody feel like the opioid companies were pushy in the '90s and 2000s? Were they in the right? Is the California ruling in line with the common good? Are our prescribing practices under scrutiny? What runs through our heads right now, doctors? I would love to know." Rebecca Thaxton is a family physician. She shares her story and discusses her KevinMD article, "The people vs. opioid pharma: Pharma wins again." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Advanced analytics can provide the insights needed to understand social determinants and help develop interventions that assist patients in overcoming some of the challenges and adverse environmental and social factors that are barriers to healthier behavior. Analytics are needed to support the team-based approach to care delivery. With advanced analytics bringing together data on clinical and social needs, as well as health behaviors, providers and payors can enable effective care coordination and successfully implement value-based care models." Mike Dulin is a family physician and health care executive. He shares his story and discusses his KevinMD article, "How advanced analytics can help social determinants of health." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Guiding kindly illustrates mentorship, whether it be in the dojo or in an academic medical setting. Regardless of one's stage in medical training, certain errors in patient management will be made … this is part of the learning process. It is the role of the mentor (i.e., attending physician to resident, resident to medical student, attending physician to medical student) to help identify these errors, determine their causes, and work through solutions, while being cognizant of the educational level of the learner. Through all the chaos of the House of Pain, Doc would remind us to find calmness, controlling our breathing and minds. Above all, he encouraged us to pursue good health as good health precedes good life. If the House of Pain was a blacksmith, then its teachings are the forged, intangible swords I have gained to become a better man and future physician." Casey Paul Schukow is a medical student. He shares his story and discusses his KevinMD article, "What I learned about medicine in the House of Pain." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"For too long have gardeners allowed our food supply to be dependent on mysterious logistics. We have criminally allowed our own food growing capacity to be displaced. Growing something you eat and trading with people who grow what you don't are ways to be less reliant on Big Food and its failed connections and also to help your neighbors. We have the opportunity to subvert the dominant supply chain. Local gardens and gardeners should be at the center of a new, three-part food supply chain — grow, share, eat." John La Puma is an internal medicine physician and author of ChefMD's Big Book of Culinary Medicine. He can be reached at What is Nature Therapy? He shares his story and discusses his KevinMD article, "Grow, share, eat: We have the opportunity to subvert the dominant supply chain." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The lack of diversity in academic medicine is a significant issue that can compromise our patients' health and the education of our training clinicians. There is a vicious cycle in which there are few black academic physicians, leading to seemingly fewer available mentors for black students, which in turn leads to even less of them pursuing careers in academic medicine. As a medical community at large, it is imperative that we understand the implications of this problem, not just on the black patient population, but on the nation as a whole. Its effects ripple through our economy and finances, public health/disease transmission, and educational infrastructure. Knowing this, it is more important now than ever that we promote diversity in academic medicine and to be more specific, that we encourage students, residents, and fellows to pursue such careers." Mary Branch is a cardiology fellow. She shares her story and discusses her KevinMD article, "Analyzing the deficit of African-Americans in academic medicine." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Through empathy-based training, physicians and other health care providers learn the skills to have honest informed consent discussions without causing undo fear, while also preparing patients for all possible outcomes. Empathic skills make for better physicians, better communications, and better conversations for all outcomes. With a strong alliance, a reduction in medical professional liability claims is the result of increased trust, better understanding and expectations of all possible outcomes, and knowledge that physicians deeply care about their patients, because, when it comes to health care, empathy matters." Helen Riess is a psychiatrist and author of The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences. She shares her story and discusses her KevinMD article, "The role of empathy in improving patient care and decreasing medical liability." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Today, more students are disclosing and speaking out about their disability and how their disability is an asset to their way of learning and what they can bring to their field. Across college campuses, more student-led organizations are forming to promote initiatives to identify and remove structural and systematic barriers to ensure equal access in all aspects of the educational experience. While aging clinicians may have had to live in the shadows with their disabilities, we have a new generation of aspiring clinicians who want to be "out" with their disability and share their experiences to bring more representation to their respective fields. It seems like a new generation of real superheroes is in the making." Marie Lusk is a social worker and disability specialist. She shares her story and discusses her KevinMD article, "Superheroes can have disabilities, too." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The classic thinking has always been that a career in medicine is more than just a job; it is a passion, a calling, an anchor of identity. There is a pervasive stigma in medicine against the self-advocacy of the worker. Bedside care providers who push back against their work/life imbalance are often made to feel guilty for putting themselves before their patients. Antiwork challenges those assumptions and inspires health care workers to reevaluate what role they want their jobs to play in their lives. The empathy and work ethic that inspired most of us to choose a career in medicine are not inexhaustible resources, and they should not be treated as such. Doctors and nurses can and should use their newfound bargaining power to demand better compensation, improved working conditions, and protected time to enjoy life outside of the hospital or clinic. The past year of working in medicine has been so enormously challenging that it has caused many to question how much we are willing to sacrifice for our jobs. This is a painful but necessary process. Learning from some of the lessons of antiwork can hopefully help us find a new balance that still allows us to care for our patients while taking better care of ourselves." Brendan James Flanagan is an emergency physician. He shares his story and discusses his KevinMD article, "What medicine can learn from the antiwork movement." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The weekend after Isabelle's discharge, I take my shoes outside onto the driveway. The sky is a brilliant blue, and green tinges of leaves poke through shells of buds; the wind slips through my fleece. I scrub the spots of blood with an antibacterial wipe, and tan shoe polish comes off instead, leaving the burgundy spots haloed and dark. Next, I smear shoe polish into the leather and brush away the brown curds of polish with a horsehair brush. The drops of blood remain. All these years later, those spots are still there, and I think of Isabelle every time I wear those tan shoes. And like those marks on my shoes, memories of babies and families remain etched in my mind—stories of failures, tragedies, successes, and joys. Our patients become an inextricable part of our lives. We carry their stories with us." Benjamin Rattray is a neonatologist. He shares his story and discusses his KevinMD article, "Our patients become an inextricable part of our lives." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"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)