The Podcast by KevinMD

"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.

"While individual doctors have obligations to both the individual and public health, their first concern is their patients. And these decisions have to acknowledge fears and respect the stance. Providers must balance reassurance with acknowledgment, care, data, and the intent to 'do no harm.' It is undeniable that the COVID vaccination has saved countless lives and will be crucial to come out of this crisis. In particular, the OAZv has many advantages for global use. But the success of a vaccination program should not expend of public trust or we may jeopardize the future of global public health." Mallika Sekhar is a hematologist-oncologist. She shares her story and discusses her KevinMD article, "Fear of vaccines grows with the need for medical ethics." (https://www.kevinmd.com/blog/2021/04/fear-of-vaccines-grows-with-the-need-for-medical-ethics.html)

"The variant keeps me up at night a little bit because it has 32 mutations in the spike protein, in contrast to the Delta mutation. But it's not just the mutations. In terms of biological plausibility, it's plausible that it could be more evasive against immunity. Not just vaccines, but potentially reinfection. What really worries me is seeing the signals line up in the wrong way. It first started in Botswana, but it's surging not just in one part of South Africa, but across six different provinces in South Africa, all at once." Eric Feigl-Ding is an epidemiologist and health economist. He can be reached on Twitter @DrEricDing. He shares his story and discusses the new COVID Omicron variant.

"Cultivating compassion for ourselves and others is a practice in which we release judgment, anger and heal our emotional wounds. We can then move forward to a version of a better world where we have evolved to a new beginning. Change is always happening, and that is our constant. What we focus on while it happens is what will determine how much we will suffer or thrive as we go through it. So, as we emerge through this time, whether as a health care worker, a parent, a newlywed or whatever your role is, let us stay present in what we have gained and be hopeful of the world that we will create tomorrow. Let us focus not on what seems to be an obvious loss or grieving process but one in which we can find introspection, wisdom, strength, and a new set of purpose. It is in this that we can evolve personally and as a collective. It is not easy. There is a lot of discomfort in shedding our old self and grieving our collective loss. Yet if we do this with compassion, we can find comfort knowing hope is waiting for us on the other side." Diana Londoño is a urologist. She shares her story and discusses her KevinMD article, "Grieving our collective loss with compassion." (https://www.kevinmd.com/blog/2021/11/grieving-our-collective-loss-with-compassion.html)

"Mr. Rodgers, I'm glad you're feeling well. This isn't altogether unsurprising given your younger age and elite physical fitness (though cases in young unvaccinated people can and have become severe) and I hope you continue to feel well as you quarantine. The medical and scientific community works on data, lots and lots of data. The process of running clinical trials and publishing data is rigorously vetted and peer-reviewed. We do not have good data that supports the use of ivermectin. In fact, a couple of preprint studies have been removed from the internet due to inaccuracy and flaws in their data. Furthermore, I fear you are missing — and propagating — a very important point. We don't just get vaccinated for ourselves, but for the greater good. As I've said, I'm glad you're feeling well. As an unvaccinated young, healthy person you pose a greater risk of spreading the virus to the portion of the very young, very old, and immunocompromised population who do not share in your level of fitness than if you were fully vaccinated, especially with the travel required of you and going maskless. Some of these people make up your fan base. As someone who has been part of a team for his whole life, I wish you would see these individuals as part of your larger "team." We have to all be in this together to achieve our goals of herd immunity just as you have had to work together with your teammates to win games and titles. I wish Mr. Rodgers a speedy recovery and hope he uses this time to reevaluate some of his recent statements and their possible repercussions. I'll be watching and cheering on Jordan Love and the rest of the team." Allison Neitzel is a physician and public health student. She shares her story and discusses her KevinMD article, "To Aaron Rodgers, from a physician and Packers fan." (https://www.kevinmd.com/blog/2021/11/to-aaron-rodgers-from-a-physician-and-packers-fan.html)

"The COVID-19 pandemic challenged health care systems and patients' personal economic capacity, leading to approximately six million adults losing their dental insurance. Additionally, the World Health Organization and the American Dental Association recommended dentists to limit their practices to emergency and urgent dental care. In the list of these diagnoses requiring emergency care, jaw pain (temporomandibular disorder (TMD) that includes several clinical problems involving the temporomandibular joint and group of muscles that help with chewing and other associated structures), was not included. This is not acceptable." Soumya Padala is a craniofacial orthodontist. She shares her story and discusses her KevinMD article, "Delta surge warning: Ignoring jaw pain comes at too high a price." (https://www.kevinmd.com/blog/2021/08/delta-surge-warning-ignoring-jaw-pain-comes-at-too-high-a-price.html)

"Thanks for gathering today in this anonymous detached space. Since it's unlikely that we'll ever publicly convene in a circle on metal folding chairs, I'm reaching out through this letter. You can peruse this in private and perhaps see a piece of yourself here. As a non-practicing physician who speaks openly about my decades of suicidal ideations, I know there's a thirst for connection on this topic. Colleagues pull me aside to whisper that they, too, have felt "that way." See this letter as my way of firing a flare into the dark cavernous topic of physician suicide in order to faintly shed light and, above all, signal that you are not alone." Eliza Shin is an actor and former radiologist. She shares her story and discusses her KevinMD article, "To my fellow physicians who are struggling with suicidal ideation." (https://www.kevinmd.com/blog/2021/09/to-my-fellow-physicians-who-are-struggling-with-suicidal-ideation.html)

"I left my primary care practice earlier this year to focus on life coaching. Why did I leave? Because I wanted to do more and make a bigger impact. I remember how eager I was to complete medical training as I approached the light at the end of the tunnel. I thought I could finally relax and enjoy life as an attending after all the delayed gratification from becoming a doctor. All I ever wanted was to help people feel better and live a life of ease myself. However, I was disappointed and frustrated by our broken health care system and how care coordination could impact patient outcomes negatively. Working as a PCP in the pandemic didn't make it any easier. I saw so many patients suffer and felt helpless that I couldn't do more. I wanted to offer healing on a deeper level by examining the root cause in order to change things for good and care for the person as a whole. But I was feeling stuck. I was afraid to leave my stable job. Medicine was all I knew. What else could I do?" Cindy Tsai is an internal medicine physician and can be reached on Twitter @cindytsaimd. She shares her story and discusses her KevinMD article, "Should you stay or leave medicine?" (https://www.kevinmd.com/blog/2021/09/should-you-stay-or-leave-medicine.html)

"Economics taught me that I didn't have to culture cells in a dish to do interesting and life-changing work. I built a habit of being inquisitive and intellectually curious about the world around me because I learned in undergrad that our human, flawed world contains elegant experiments, puzzling oddities, and fertile ground for inquiry. That profound change in mindset is the most important lesson I could have learned from my undergraduate major, and I'll always be a grateful ex-economist." Dan Donoho is a pediatric neurosurgeon and can be reached on Twitter @ddonoho. He shares his story and discusses the KevinMD article, "An ode to econ: the best major for a would-be MD." (https://www.kevinmd.com/blog/2021/03/an-ode-to-econ-the-best-major-for-a-would-be-md.html)

"Disrupting weight stigma and bias in health care starts with calling it out. The power of stories and shared experiences highlights the collective voice. I'm coaching TikTok Followers to own their health power and start speaking up during clinic visits to make sure they get their questions answered. Future directions and next steps are to disrupt weight stigma and bias by speaking up, calling it out, and calling on doctors, nurses, and all of health care to do better. Back to TikTok!" Karla Lester is a pediatrician. She shares her story and discusses the KevinMD article, "Medical gaslighting due to weight stigma and bias is harmful: a viral TikTok study." (https://www.kevinmd.com/blog/2021/06/medical-gaslighting-due-to-weight-stigma-and-bias-is-harmful-a-viral-tiktok-study.html)

"No matter how extensive or well-developed your capacity for empathy may be, you cannot feel empathy for everyone all the time. Whether we're talking about doctors who have never been patients, or clinicians who have never faced discrimination, we know that people's ideas can change, when properly educated and supported. In a randomized, controlled trial, one of the most exciting findings within my own research into the malleability of empathy looked at physicians of six different medical and surgical specialties. Using the E.M.P.A.T.H.Y.(R) acronym and other techniques, physicians learned how to accurately "read" their patients' states of emotion and respond more empathically. Post-intervention, the training group received significantly higher patient satisfaction scores than the control group. The good news about our research is that it showed that we can be hopeful about changing the culture of medicine. We now have evidence-based tools to accomplish this. There is hope for a brighter future in health care and all relationships when empathic principles are learned and practiced at the local, regional, and societal levels." 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, "How to preserve empathy in medicine." (https://www.kevinmd.com/blog/2021/10/how-to-preserve-empathy-in-medicine.html)

"I believe there is a formula that can reduce the risk of burnout and save primary care, rooted in one key objective: Remove work from primary care doctors and nursing staff's plates immediately. Easier said than done. And that's where technology and clinical navigation must be leveraged — to assist, facilitate, streamline, and support. Where EMR messages, not requiring doctor expertise, are responded to by clinical navigators harnessing technology to guide patients to the right outcome. Where these teams of clinical navigators are integrated into the clinical pyramid and delegated all tasks that do not require physician attention. Integrated technology + navigation = relief." Ronald Dixon is an internal medicine physician. He shares his story and discusses his KevinMD article, "As doctor burnout climbs, can we save primary care?" (https://www.kevinmd.com/blog/2021/09/as-doctor-burnout-climbs-can-we-save-primary-care.html)

"My brain is still struggling to comprehend the battle for the status quo a physician faces each day; one who must, by default, be cognizant of the lurking dangers of an opioid prescription, while also helping the patient on their swiftest way to recovery, led by the very same guidelines. But what happens when the patient slips on the road to recovery and out from underneath the physician's caring cloak towards substance abuse? Whether the patient's role changes at that very threshold is a different story. While it certainly is a part of this somewhat self-perpetuated epidemic, the struggle to keep a status quo has ancient roots and every physician has — if not knowingly so — sworn to abide by them when uttering the anecdotal resemblance of the Hippocratic Oath: 'I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.' But what if we dare to question the application of this ancient commitment on this particular matter? Should we have already done so, or can we afford to wait until the death toll reaches an unspeakable capita? Should opioids for postoperative pain even be permitted to dance on this slippery spectrum between adequate analgesia and addiction? I wish the answer were that simple." Jesse Seilern und Aspang and Mara Schenker are orthopedic surgeons. They share their stories and discuss the KevinMD article, "America's prescription epidemic: Breaking an ancient promise." (https://www.kevinmd.com/blog/2021/07/americas-prescription-epidemic-breaking-an-ancient-promise.html)

"I am a woman of history who stands up and tells the truth, irrespective of what other people say. I remember the words of the late Representative John Lewis, 'Do not get lost in a sea of despair. Be hopeful, be optimistic. Our struggle is not the struggle of a day, a week, a month, or a year. It is the struggle of a lifetime. Never, ever be afraid to make some noise and get in good trouble, necessary trouble.' Black female physicians are not OK, but it is our collective duty to do something about it. It is our collective duty to go against the tide. It is time to take a stand and institute change that we need to initiate ourselves." Tomi Mitchell is a family physician. She shares her story and discusses her KevinMD article, "The unique agony of being a Black female doctor." (https://www.kevinmd.com/blog/2021/11/the-unique-agony-of-being-a-black-female-doctor.html)

"I am exhausted and sad and disappointed and discouraged. I am losing faith in humanity. Where is the 'love your neighbor as yourself'? Where is the willingness to help each other? Where is the solidarity of those first days? Physicians have gone from being heroes to being villains. We have dedicated decades of our lives to learning how to care for you, but now our knowledge and expertise are being thrown back in our faces as not good enough and not as believable as your cousin's friend who saw something on social media. It is hard to keep going. But we do. We keep going because we have dedicated our lives and careers to our patients. We follow our Hippocratic Oath, and we do the best we can for every patient no matter who they are, what they believe, or what choices they make. But many of us are barely clinging to our passion to serve. Each day, I get out of bed, swallow my frustration and disappointment, and pray for the fortitude and resilience to face another workday, because I know that if I can make a difference, however small, it means something. And I know that my patients and their families bring me joy! But each day, my heart breaks a little more. It shouldn't have to be this way, but this is the world we live in right now. I am exhausted." Lisa Cronk is a pediatrician. She shares her story and discusses her KevinMD article, "Physicians have gone from being heroes to villains." (https://www.kevinmd.com/blog/2021/09/physicians-have-gone-from-being-heroes-to-villains.html)

"The truth is, we were all drowning, alone, and hiding behind the image of perfection. Clearly, each of us secretly thought that the others had it all figured out. We were so afraid of admitting weakness or asking for help, so we kept it to ourselves and muddled through, burnt out and miserable, terrified of being judged for our vulnerability. When we negatively judge ourselves for needing help, we end up judging others who need our help too. Our patients feel this undercurrent of judgment when they ask for our help. They don't want to face that vulnerability because they too feel judged. Asking for help and facing our struggles with honesty is a sign of courage and compassion. It is human nature to need each other and to feel connection. Maybe if we'd all been a little less armored, more vulnerable, and shared our struggles with each other, our cohort of future doctors could have leaned on each other to cope better back during our intern year too." Jordana Rothschild is a preventive medicine physician. She shares her story and discusses her KevinMD article, "Doctors are humans, not heroes." (https://www.kevinmd.com/blog/2021/08/doctors-are-humans-not-heroes.html)

"What are altcoins, and should you be investing in them? I cannot speak to whether investing in altcoins is appropriate for you. Altcoins are a highly volatile and risky asset class that offers the potential for high returns. Every investor must decide whether they are willing to bear the associated risk. When evaluating thousands of coins to select the best opportunities, it is critical to have an appropriate framework to work from. That is why I am sharing my 5-step framework." John Stillson is a medical student and an investment manager. He shares his story and discusses his KevinMD article, "Alternative cryptocurrencies: 5 tips for physicians." (https://www.kevinmd.com/blog/2021/08/alternative-cryptocurrencies-5-tips-for-physicians.html)

"Go ahead, give yourself permission, summon the compassion and grace you'd bestow on your best friend, and tell yourself, "This is the breadth of the human experience, and I'm only human." There is immense beauty and strength in that vulnerability. I lied to myself for too long, couldn't see the road ahead through the cracked glass until it, and I, in turn, shattered. Once those broken shards that obscured and distorted the path forward have been swept away, only then can the clarity of a stronger, more resilient soul begin to emerge. I'm not back to normal, and it's possible I may never get there. But each day, there are glimmers of hope that I might be closer to my true self than before — and that's all I can ask for right now." Luyi Kathy Zhang is a palliative care physician and can be reached on Twitter @DrKathyZ. She shares her story and discusses her KevinMD article, "Maybe we're not all hanging in there. And that's OK." (https://www.kevinmd.com/blog/2021/02/maybe-were-not-all-hanging-in-there-and-thats-ok.html)

"When the medical profession—a career you have pursued for years, a career you love and trust to do no harm does something to shatter the foundations of your sense of trust and worldview, the resulting trauma can be severe resulting in loss of sense of self and life-altering betrayal grief that mirrors the stages of acceptance of one's own death (or the death of a piece of one's soul when swept up in the betrayal cascade)—denial, anger, bargaining, depression, and acceptance. As a witness to immense betrayal within the medical profession, I've felt them all." Pamela Wible is a family physician and author of Physician Betrayal: How Our Heroes Become Villains. She shares her story and discusses her KevinMD article, "Medicine's culture of betrayal." (https://www.kevinmd.com/blog/2021/09/medicines-culture-of-betrayal.html)

"I was first diagnosed with major depressive disorder as a preteen after my teenage sister died. I attempted suicide three years later. This would be the first of several attempts and the first of countless times I felt my life was not worth living. But I am not unique. According to the Centers for Disease Control (CDC), 1 person dies by suicide every 11 minutes. My depression is like a chronic autoimmune disease — constitutively present at a low level with flares. But there's no Humira for depression. At baseline, I am exhausted, anxious, lacking motivation, and full of self-doubt. When severely depressed, I am at the bottom of the sea, struggling to breathe and unable to swim. I am paralyzed by a high-pressure, heavy and humid darkness. Through physical or mental isolation, I may not see another living creature for hours, days or weeks. I can look up and see the sun shining beyond the water surface, but the surface is miles beyond my reach. I must physically force myself to breathe as my mind tells me to stop. Trying to take a test, see patients or study can prove impossible." This anonymous medical student shares her story and discusses her KevinMD article, "Surviving medical school with depression." (https://www.kevinmd.com/blog/2021/06/surviving-medical-school-with-depression.html)

"I am here to testify that it is possible, and I am not alone in this specialist direct care market. There are other specialists' practices like mine, hidden gems for patient care. During my journey, I learned specialists are thriving to remove the "middlemen" and reconnect with patients. Patients are eager to shop for their health, discover transparent pricing and excellent quality. Patients and physicians desire mutual accountability. Since the direct primary care movement started approximately ten years ago, many patients that signed up to this model quickly realized the benefit of having access, affordability, and price transparency. Specialists in direct care now exist across the country. In the last two years, I have been in contact with many thriving physicians providing a direct care model. However, it was so hard to find and connect. Our hope – and our patients' need – is that connecting patients with direct care specialists gets easier. We are working on that now – we are working to change the system because our patients need it – and practicing good health care depends on it. This is just the beginning of a new era in medicine, where patients and physicians reunite." Diana M. Girnita is a rheumatologist and founder and CEO, Rheumatologist OnCall. She can also be reached on Facebook, Instagram, and YouTube. She shares her story and discusses her KevinMD article, "The emergence of direct specialty care." (https://www.kevinmd.com/blog/2021/09/the-emergence-of-direct-specialty-care.html)

"At the hospital, the nurse is the one who is at the patient's bedside around the clock. When the patient has to go to the bathroom or needs help to sit up in a chair, he or she calls the nurse. The nurse is the one who is changing the diapers for the elderly; she is the one cleaning the sputum and the spilled urine; she is the one holding the patient's hand and stroking his hair while he is having a painful procedure done. She is the one arranging the flowers and picture frames in the room. She is the one administering the medications when the patient is in pain or nauseous. She is the foremost advocate for the patient. She is at the bedside when the patient is taking his last breath, and she is the one to call the doctor to pronounce him dead after having first witnessed and confirmed it herself." Farhan S. Imran is a hematology-oncology physician who blogs at Did I Ask? He shares his story and discusses his KevinMD article, "A nurse is to a patient what a mother is to a child." (https://www.kevinmd.com/blog/2021/05/a-nurse-is-to-a-patient-what-a-mother-is-to-a-child.html)

"Many patients, doctors, nurses, and health care administrators appear to have a seat on the blimp with little concept of how the game has evolved over the years and is being played now. They may have attended the game in the past, but they likely haven't seen the action from 5,000 feet above the field—and seeing the health care picture from the big picture distance can create some impetus for adapting to the new rules. We need to not only explain the new rules of the game but also show how passion of the team can overcome adverse conditions and ultimately prevail. Everyone on the blimp needs to become engaged, including those who have been riding involuntarily. The health care game has changed. We will find season ticket holders. And those of us on the field will get messy, no doubt. But who knows? Our game might just become a national pastime." 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, "Getting messy in the game of health care." (https://www.kevinmd.com/blog/2021/08/getting-messy-in-the-game-of-health-care.html)

I did not realize I was a perfectionist. I was far from perfect. It was not until I listened to a master class on perfectionism from a physician coach that I had my "aha moment." I am now working extremely hard on training my brain to be an imperfectionist. To do that means to let go of the mental constructs that I have created for myself. In particular, I had to let go of the narrative that said to me: You are not someone unless you look like the epitome of success. I was a young African-American doctor full of "firsts." However, these firsts did not protect me from the hurt of failure or the heartache associated with imperfection. For sure, it did not provide me with what I longed for most, self-worth and validation." Frieda Millhouse-Jones is an internal medicine physician. She shares her story and discusses her KevinMD article, "A Black physician's perfectionism." (https://www.kevinmd.com/blog/2021/05/a-black-physicians-perfectionism.html)

"We have observed that delays in screenings and intervention for patients with certain common chronic conditions can contribute to claims. Now, clinicians have the opportunity to identify patients whose conditions merit priority contact, such as those with cardiac conditions, those on blood pressure medication, or those with diabetes, and request they come in for delayed screenings or checkups. Explicitly recommending that those without medical contraindications get vaccinated not only helps slow the spread of COVID-19, but may also stop a patient from claiming that they remained unvaccinated for lack of counsel from their physician. Whether or not a practice or institution is distributing vaccines, it should communicate to patients that COVID-19 vaccines are extremely safe, remarkably effective, and vital to ending the pandemic. Invite patients who have questions about vaccines to communicate their concerns. Since risks exist even if patients did not present for care, documenting the practice's efforts to reach patients who have delayed care will reduce litigation risks. If a patient is considering filing a claim, a review of the patient's medical record will be among a plaintiffs' attorney's first steps. Therefore, documenting patient communications is a defense against suits before they are filed." Richard E. Anderson is chairman and chief executive officer, The Doctors Company and TDC Group. He shares his story and discusses his KevinMD article, "Mitigating risks from care during COVID-19." (https://www.kevinmd.com/blog/2021/05/mitigating-risks-from-care-during-covid-19.html)

"The diagnosis is well-established. A cure is within our reach, and the wisest among our practitioners of the healing arts are offering valuable counsel. When the U.S. government and science, in its most principled form, work together, insulated from a culture of insidious and invidious profiteering, they can put a man on the moon, and launch a helicopter on Mars. They can also deliver better health care in a much more equitable and cost-effective way. It is time for the patient to listen to her best doctors. They are giving it to her straight." Jeffrey Fraser is a neurologist. He shares his story and discusses his KevinMD article, "Diagnosis: malformation of a health care system." (https://www.kevinmd.com/blog/2021/07/diagnosis-malformation-of-a-health-care-system.html)