The Podcast by KevinMD

"With this single word, mom had now completely altered her willingness to see the deep suffering of her child. This single word watered all of this child's five years of depression, crippling anxiety, history full of ACEs, and very significant struggle down to a simple, selfish, flippant choice. Furthermore, mom said that the nursing staff asked her about the medications. Mom informed me that: 'The nurse said maybe it's the Wellbutrin making her this way. Maybe she is suicidal because of this?' If the team had spent five minutes doing a real assessment of suicidal thinking, they would have learned her suicidal thoughts started years prior to her being on medications and have actually decreased in frequency since starting these meds in the hospital. I could see in mom's eyes. She now did not trust me when I spoke about the importance and urgency of treatment. Her child was now an inconvenience, my medication recommendations could be damaging, and our work together was now a waste of their time. Mom declined my recommendation to titrate up meds because of her concern about them now brought on by the nurse." Shivana Naidoo is a child psychiatrist. She shares her story and discusses her KevinMD article, "How one word may have harmed my patient." (https://www.kevinmd.com/blog/2021/06/how-one-word-may-have-harmed-my-patient.html)

"While we still lack a complete cause and effect model of Alzheimer's disease, there is no doubt that the etiology is multifaceted and nonlinear. This accounts for the fact that it takes an incredibly long time for Alzheimer's disease to develop. I mention this because one of the major problems with FDA approval has always been that it insists on utilizing the same framework and methodology of approving drugs designed to treat long-term diseases as it would with short-term diseases." Robert Trent is a graduate student who blogs at Medaphysics. He shares his story and discusses his KevinMD article, "Does the FDA approval of aducanumab mark the return of science-based medicine?" (https://www.kevinmd.com/blog/2021/07/does-the-fda-approval-of-aducanumab-mark-the-return-of-science-based-medicine.html)

"Dehumanizing patients can lead to indifference in physicians. It is a privilege to be trusted to take care of every patient we encounter, yet we can lose sight of this and begin to see our patients as a burden, or as units of work, rather than as individuals. When individual patients cease to matter, we cease to care. This is the precipice of burnout and invites mistakes and poor behavior, such as cutting corners or pushing the envelope by exposing patients to excessive risks. Often, physicians hold themselves to unachievable standards of perfection. No surgery is ever perfect, yet we expect perfection from ourselves and from our colleagues. Partly the result of training, these unrealistic standards also interfere with emotional connection or empathy. Complications are an inevitable part of the work we do, yet physicians often lack self-compassion. Self-compassion is a crucial component of emotional flexibility; unrelenting self-criticism does not promote learning or modification of maladaptive behaviors." Joseph D. Stern is a neurosurgeon and author of Grief Connects Us: A Neurosurgeon's Lessons on Love, Loss, and Compassion. He shares his story and discusses his KevinMD article, "Emotional agility is an essential element for patients and practitioners." (https://www.kevinmd.com/blog/2021/06/emotional-agility-is-an-essential-element-for-patients-and-practitioners.html)

"Toward the end of my clinical career, I didn't feel like I had control over much at all. The patient safety issues loomed large. We used ridiculous workarounds for broken processes. The constant vigilance to provide excellent care in a suboptimal environment was exhausting. I didn't see anything I could change. Based on my work with physicians as a coach, I think that the sense of powerlessness and being a "cog in a wheel" is now at an all-time high. While on an uninspiring stretch of road on a recent family trip, a realization came to me: There are many, many system issues over which physicians have little control. But physicians do have control over three things: How they lead in both formal and informal leadership roles How effectively they advocate for change Who they show up as every day" 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, "The sense of powerlessness and being a cog in a wheel is now at an all-time high." (https://www.kevinmd.com/blog/2021/06/the-sense-of-powerlessness-and-being-a-cog-in-a-wheel-is-now-at-an-all-time-high.html)

"Physicians have had a rough century, so far. In addition to battling COVID-19, doctors have spent the past two decades fighting the health care industry's fiercest players and losing, badly. Power in the industry now belongs to health insurance companies, major drugmakers, and hospital tycoons. Physicians feel beaten up, burned out, and abused by a system so overrun with regulations that clinicians now spend more time filling out paperwork than helping patients. Doctors long for the last century. Back then, they were paid well, revered by everyone, and largely left alone to practice as they please. As the war against COVID-19 winds down, doctors believe now is the time to demand a return to the glory days when physicians ruled medicine. To get there, doctors want more money, respect, and autonomy. They'll get none of that because our nation can't afford to give it to them." Robert Pearl is a plastic surgeon and author of Uncaring: How the Culture of Medicine Kills Doctors and Patients. He can be reached on Twitter @RobertPearlMD. He shares his story and discusses his KevinMD article, "Doctors and the 5 stages of grief." (https://www.kevinmd.com/blog/2021/07/doctors-and-the-5-stages-of-grief.html)

"Maybe it's a testament to a hardy relationship that there was no resulting argument. Without thinking, I blurted out, 'You are so sexist!' I could immediately tell by my husband's face, his upper eyelids and eyebrows lifted a bit, his mouth freeze-framed in a small 'o' — my exclamation surprised and insulted him. Maybe it was a completely unfair assessment; after all, he was standing at the sink, his hands covered in soap, washing the dinner dishes. Can you be sexist and clean up after a meal? Can you be sexist and love your spouse? Can you be sexist and a female MD?" Christine J. Ko is a dermatopathologist. She shares her story and discusses her KevinMD article, "Confession from a female doctor: I am sexist." (https://www.kevinmd.com/blog/2021/06/confession-from-a-female-doctor-i-am-sexist.html)

"Suffering something similar in my career, I know the detrimental impact of not having a voice or being heard in the medical community. Medical professionals do not want to appear weak, so they continue until something breaks. As a pain physician, I understand where the frontline health care workers are coming from. The intense pain and suffering that they are experiencing. I want to help those that feel this pain before it becomes too much. In my writings, I reveal my own personal journey from burnt out to balanced life in medicine and the advice that helped me. I hope it will help you too. You are not alone." Olivia Ong is a pain and rehabilitation medicine physician in Australia. She shares her story and discusses her KevinMD article, "The unspoken pandemic in frontline health care workers." (https://www.kevinmd.com/blog/2021/06/the-unspoken-pandemic-in-frontline-health-care-workers.html)

"Extensive media coverage of the emotional and death tolls that COVID-19 inflicted on nursing homes has intensified concern for preserving the humanity of an often-overlooked population. There is an opportunity to re-examine the policies and practices that shape the nursing home experience and to add quality metrics that capture the aspects of life and community that matter most to residents and their families." Carol Podgorski is an associate professor of psychiatry. She shares her story and discusses her KevinMD article, "We need to re-examine quality-of-life metrics in nursing homes." (https://www.kevinmd.com/blog/2021/06/we-need-to-re-examine-quality-of-life-metrics-in-nursing-homes.html)

"Looking to other countries that provide universal coverage to see what works and what would fit well for the U.S. is an option. Countries like France, Australia, and England provide universal coverage and rank their health care systems very highly, and are culturally and socioeconomically similar to the U.S. Whatever health care direction the country moves toward, it is essential to prioritize universal coverage. Otherwise, Americans will eventually end up paying for inefficient, expensive services in the form of higher premiums and taxes, while millions of Americans will remain uninsured, without access to health care or life-saving medications. Many, like my friend and patient, will die. That is too high a cost to pay." Payman Sattar is a cardiologist. He shares his story and discusses his KevinMD article, "Why it is essential to prioritize universal coverage." (https://www.kevinmd.com/blog/2021/06/why-it-is-essential-to-prioritize-universal-coverage.html)

"Like many scary health scenarios where patients seek some modicum of influence, the COVID-19 pandemic has led to patient demand for 'immune-boosting' dietary supplements. Toilet paper wasn't the only essential item being limited by stores; bottles of zinc and vitamin C flew off the shelves as consumers stocked up. The role of vitamin D in COVID-19 has been conflated and deflated depending on the study-du-jour. And of the eight 'drugs' in President Trump's top-of-the line treatment, three of them were natural products. The medical professional has, for the most part, dismissed vitamins as nothing more than 'expensive pee.' But as an integrative medicine physician examining the data, I urge my colleagues to take a more thoughtful approach to supplement recommendations and consider whether unconscious biases are influencing how you counsel patients." Melinda Ring is an integrative medicine physician. She shares her story and discusses her KevinMD article, "6 unconscious biases against vitamins and supplements." (https://www.kevinmd.com/blog/2021/01/6-unconscious-biases-against-vitamins-and-supplements.html)

"Remember, board certification is supposed to be an option and not a requirement. Unfortunately, finding and keeping your dream job if you're not board certified will add unwanted stress for you and your family. And in case you're wondering, I don't work for or have anything to gain from informing you about any other board. I want you to know that you have other valid options for taking your boards, regardless of what you're made to believe during residency. So at this point, you may be asking yourself, why hasn't an article like this ever been written before? Well, the answer is quite simple: It's called monopoly." Emmanuel K. Konstantakos is an orthopedic surgeon. Jeff Morris is chief executive officer, American Board of Physician Specialties. They share their stories and discuss the KevinMD article, "You have options when it comes to board certification." (https://www.kevinmd.com/blog/2020/11/you-have-options-when-it-comes-to-board-certification.html)

"Visit a nursing home and talk with some of the residents. They are not only moms and dads, but also retired teachers, first responders, former athletes, government employees, and soldiers—the basis of our country's past lives within these walls. Older adults should be honored with the dignity they deserve. As we again open as a society after this pandemic, make that commitment and visit a nursing home. Just make sure after you enter, the door doesn't lock behind you." Gene Uzawa Dorio is an internal medicine physician who blogs at SCV Physician Report. He shares his story and discusses his KevinMD article, "The nursing home crucible." (https://www.kevinmd.com/blog/2021/07/the-nursing-home-crucible.html)

"COVID-19 has changed nearly every aspect of society as we know it, and doctors in hospitals across America are at the forefront of those changes. As a pediatric infectious diseases doctor who also writes curriculum to help the next generation of doctors prepare for their medical exams, I've seen firsthand how this current pandemic is changing our roles with patients, shifting what families and communities expect from us, and expediting advances in training and information sharing across the field. While my work at a children's hospital is obviously focused on children and adolescents, the shifts I'm observing and the lessons I've learned impact doctors in all areas of practice who want to provide exceptional care to their communities." Nicholas Rister is a pediatric infectious disease physician. He shares his story and discusses his KevinMD article, "3 lessons I've learned as a doctor during the pandemic." (https://www.kevinmd.com/blog/2021/04/3-lessons-ive-learned-as-a-doctor-during-the-pandemic.html)

"As a family physician, guest lecturer at a local medical school, and creator of a pre-med curriculum for young learners, I'm often asked by parents how to support their child who wants to be a doctor. The most important point to remember is that you don't need to have any science background or be a professional of any sort to support your child. We all want to help our children follow their dreams! Most parents know as little about supporting a budding physician as I do about how to help my son, who wants to dance professionally. That's OK! I do the same thing as you: I look for answers online. And I'm here to give you some ideas. If you know anything about dancing classical ballet professionally, you're welcome to help me in return! So here is the advice I give parents who want to do their best for their child who wants to be a doctor." Robin Dickinson is a family physician and creator, Dr. Robin's School. She shares her story and discusses her KevinMD article, "My child wants to be a doctor." (https://www.kevinmd.com/blog/2021/05/my-child-wants-to-be-a-doctor.html)

"When a colleague in health care mentioned hesitation to get the COVID-19 vaccine in two separate instances, I was shocked and dismayed. If we recommend vaccination to our patients, how can we not take the same precautions for ourselves? With COVID-19 especially, anyone working in health care is exposed to many people and should be especially motivated to get vaccinated. As cut-and-dry as this issue seems to me, I do remember similar issues with encouraging the flu vaccine and even mammograms among health care workers. We need to remember what worked in those instances and use the same tactics to improve vaccination rates among our colleagues." Dava Gerald is a physician surveyor, The Joint Commission. She shares her story and discusses her KevinMD article, "4 steps to convincing health care colleagues to get vaccinated." (https://www.kevinmd.com/blog/2021/05/4-steps-to-convincing-health-care-colleagues-to-get-vaccinated.html)

"Our nation is at a crossroads, but one thing is clear – the health of our country depends on the health of all individuals in it, regardless of income, gender, or race. ACPM is committed to doing our part to promote and advance health and safety for all populations. On a community level, there are several options that can be taken to maintain support. As preventive medicine specialists, I call on all my colleagues, more than 10,000 across the country, to continue to bridge the gap by encouraging policymakers to strive to eradicate structural racism and inequalities in our cities and states." Stephanie Zaza is a preventive medicine physician. She shares her story and discusses her KevinMD article, "Addressing racial disparities in health begins upstream with racial equity in society." (https://www.kevinmd.com/blog/2021/05/addressing-racial-disparities-in-health-begins-upstream-with-racial-equity-in-society.html)

"I think back to the first time I ever brought Natalie to an emergency room. It was my fault. It was an odd accident. I had lifted her out of her car seat, grabbing my purse and a bag of groceries at the same time while turning and closing the car door and in doing this I also closed Natalie's foot in the door. I didn't know that I had done it until I pulled away and couldn't go any further because she was caught. I actually had to open the door with the handle to release her foot. For me, it was horrific. For Natalie, less so, because while she fussed, she wasn't nearly as hysterical as I was. I immediately put her back in the car seat and headed to the hospital. All my arrivals at the emergency room are frantic, and this one was as well. But I guess that's common. Which is why they have to weed people out according to severity and even have signs explaining that this is not a first-come first-serve establishment. After I explained the reason we were there and frantically waving Natalie's chubby little foot at everyone who would look or listen, I was escorted back pretty quickly." Christine Naman is a writer and author of About Natalie: A Daughter's Addiction. A Mother's Love. Finding Their Way Back to Each Other. She shares her story and discusses her KevinMD article, "A daughter's addiction. A mother's love." (https://www.kevinmd.com/blog/2021/05/a-daughters-addiction-a-mothers-love.html)

"If you don't ask for something you want, then you have already accepted the answer of no. Go ahead and ask for what you want and need. You may not get it this time but ask again in the future. We will change health care eventually. In the meantime, you can change your thoughts today. Reach out if I can help. Reach out to many resources on the internet, Facebook, your community. You are not alone." Dawn Sears is a gastroenterologist and can be reached on Twitter @GutGirlMD, YouTube, and at GutGirlMD Consulting. She shares her story and discusses her KevinMD article, "10 replaceable thoughts (and 15 books) to help you survive burnout." (https://www.kevinmd.com/blog/2021/05/10-replaceable-thoughts-and-15-books-to-help-you-survive-burnout.html)

"A few weeks ago, a white physical therapy colleague of mine unconsciously committed a racial microaggression. She was interviewing her patient, a middle-aged Black male, about his living environment. She asked him if his daughter was at home with him all day or if she went to work. He asked her why she would even assume that his daughter did not work. The patient was so upset that a third party intervened to help the therapist finish the assessment. How did this incident impact his care? How did their dismantled communication impair information exchange and shared decision-making? How might this encounter affect his physical therapy outcomes?" Jerenda Bond is a physical therapist and postgraduate student. She can be reached on Twitter @jerendabond. She shares her story and discusses her KevinMD article, "The white guys vs. the janitors: How racial microaggressions lead to poor care outcomes." (https://www.kevinmd.com/blog/2021/06/the-white-guys-vs-the-janitors-how-racial-microaggressions-lead-to-poor-care-outcomes.html)

"When harnessing easy-to-use technology to provide answers to frequently asked questions such as the ER wait time, or the ER's address, for instance, patients and their families are properly informed, and clinical staff are given the time to focus on their most important job: caring for patients. The use of a secure, encrypted, and HIPAA-compliant application allows registration staff to complete their clerical work, patients can obtain the answers they need through an easy-to-use app on their phone, and triage nurses can efficiently and quickly conduct their work without interruption—it's a win, win for all. Technology helps patients feel connected to their health care journeys. Prioritizing patient-centric care with AI-tools enables a better experience for patients, clinicians, and care teams. Focusing on improving a patient's journey starting from the ER creates a supported and more manageable experience for all involved, not to mention increasing patient loyalty and hospital satisfaction rates." Justin Schrager is an emergency physician. He shares his story and discusses his KevinMD article, "3 ways technology in the ER boosts the patient experience." (https://www.kevinmd.com/blog/2021/04/3-ways-technology-in-the-er-boosts-the-patient-experience.html)

"In the Spring semester of my final year as a football player, my college team faced necessary coaching, staff, and player position changes. At this point in my college career, we had yet to have a winning season. These changes were made to shift our program's culture and give us new life going into the upcoming Fall season. My new position coach, our team's former linebacker coach, greeted us all in the defensive line room during our very first Spring position meeting with a stark message that, to this day, has changed my way of thinking about the hardships, especially now as a medical student during the COVID-19 pandemic. During his message, he put up the Japanese symbol kiki (危機) on the overhead screen and questioned if any of us in the meeting room knew its meaning. As my teammates and I looked at each other thinking, what the heck is this guy up to … our coach informed us the symbol is written in kanji and translates to 'crisis.' (We thought he was only foreshadowing the imminent torture we were about to face that Spring as we prepared to change the trajectory of our program.)" Casey Paul Schukow is a medical student. He shares his story and discusses his KevinMD article, "In crisis, danger and opportunity are present." (https://www.kevinmd.com/blog/2021/06/in-crisis-danger-and-opportunity-are-present.html)

"As a former hospitalist who transitioned out of clinical practice in 2015, I've been deep in the physician wellness space for years. Far and away, the most effective way I've supported health care professionals during this time (often in my role as a founding board member of the mindful health care collective) is with a tool called tapping, otherwise known as the emotional freedom technique or EFT. Tapping is a powerful, evidence-based stress-reduction and healing technique that uses the same meridians as acupuncture (without the needles). By tapping on these meridians, you can induce profound changes in the brain and nervous system, which send calming signals to the stress center of the brain (the amygdala and hippocampus) in the face of stress. The results are astonishing." Jill Wener is an internal medicine physician and can be reached at her self-titled site, Jill Wener, MD. She shares her story and discusses her KevinMD article, "Tap — yes, tap — to relieve stress." (https://www.kevinmd.com/blog/2021/06/tap-yes-tap-to-relieve-stress.html)

"The primary benefits for mobile care units are the fact that they decrease patient travel times by arriving at their residences and ensuring that appointments are never missed. It also relieves the stress of finding transportation for dialysis patients, outright eliminating the need for the CMS to find alternative transport methods for patients. By utilizing mobile care units alongside health IT solutions for preventive care services, the CMS can finally do the impossible and establish a basic health care standard for rural citizens." Thanh Tran is a health IT executive. He shares his story and discusses the KevinMD article, "Will U.S. health care match Native Americans' treatment of chronic kidney disease?" (https://www.kevinmd.com/blog/2021/05/will-u-s-health-care-match-native-americans-treatment-of-chronic-kidney-disease.html)

"While physicians provide a vital service to the U.S., they often have blind spots when it comes to maintaining their own financial health. Many in the medical field believe that financial planning is as simple as having an IRA account and that estate planning will be taken care of by a will. Unfortunately, particularly for those in this profession, financial planning is more important than ever, and President Biden's proposed tax changes could have a profound effect on physicians' financial planning in particular. Working with a fiduciary financial advisor to understand how the new laws affect physicians and implementing strategies that can lessen the impact is key to navigating these changes." Syed Nishat and Aadil Zaman are partners, Wall Street Alliance Group. They are regularly quoted and interviewed in media outlets like Medical Economics, Forbes, US News, Bloomberg, and Yahoo Finance. This special episode is the audio version of the webinar, "President Biden's tax proposal and its effects on estate and income tax planning for physicians," sponsored by Wall Street Alliance Group. (http://www.wallstreetag.com/) Watch the full webinar. (https://www.kevinmd.com/blog/2021/07/president-bidens-tax-proposal-and-its-effects-on-estate-and-income-tax-planning-for-physicians.html)

"President Joe Biden recently signaled that a multi-trillion-dollar spending plan for our country should be paid for by the rich corporations and wealthy individual Americans who make over $400,000. Doctors fit the latter category and should tune in. Beyond the government, the unique qualities of doctors make us a target for many who want to access our high income and our business revenue. Our passivity to these poachers places us at great risk because they recognize that we lack the time and proficiency to avoid them. Add our financial illiteracy to this, and you have a recipe for stakeholders reaching into our paycheck every pay period and inconspicuously taking their share from us. Let's take a look at the stakeholders who are targeting us." Tod Stillson is a rural family physician who does surgical obstetrics and teaches residents and medical students. He is also founder, SimpliMD, Doctor Incorporated, and The Employed Physician's World Facebook group. He is also the author of You Are a Target Strategies For Doctors to Keep More of Their Money. He shares his story and discusses his KevinMD article, "Doctors beware: There's a $400,000 target on your back." (https://www.kevinmd.com/blog/2021/06/doctors-beware-theres-a-400000-target-on-your-back.html)

"What if I had access to real solutions? What if I had resources to provide to a person to help them overcome their problem? As a primary care provider with over 20 years of experience, I know viscerally that I will never "fix" anyone. I can teach, I can guide, I can comfort; but I'm never going to fix a single person. Still, I wish I had more to offer. In my current iteration, I take care of people experiencing homelessness. Having spent much of my career taking care of people with homes, I'm currently grant-funded to care for people experiencing homelessness. The problems, I find, are not fundamentally different, but the phenotype, the manifestation of common, universal problems, such as social isolation, poor nutrition, insecurity, addiction, comes with sharper edges." Nancy Connolly is an internal medicine physician. She shares her story and discusses her KevinMD article, "What if this physician had access to real solutions?" (https://www.kevinmd.com/blog/2021/05/what-if-this-physician-had-access-to-real-solutions.html)

"I think doctors are just wired that way. We are productive. We get things done. It is expected. We are supposed to do more, do it all, and be all the things to all the people. We come to a point where we try to satisfy this, and then we cannot do enough for ourselves. We cannot rest. We must keep trying to check things off the list to get things done. And it is overwhelming. It does lead to burnout. I am still a work in progress. I am writing this on a work night because it is burning in my brain, wanting to come out. Perhaps I should be doing nothing, resting for a full day. But if I do that, I will feel guilty that I have wasted this time when I could have been putting my thoughts down on paper. The mind is always going. This is me, but I think it applies to many other physicians. Look at your habits and see if you have some of my same tendencies. If you do, let's start talking about how to reverse this tide of overwhelm to create some time for yourself when you are doing nothing and not regretting it." Marion McCrary is an internal medicine physician and can be reached at Marion McCrary Wellness. She shares her story and discusses her KevinMD article, "Why doctors can't rest." (https://www.kevinmd.com/blog/2021/05/why-doctors-cant-rest.html)

"It's rare for anyone to try and tally the precise cost of unnecessary care. But when they do, the estimates are staggering. The Washington Health Alliance, a nonprofit dedicated to making care safe and affordable, analyzed insurance claims from 1.3 million patients who received one of 47 tests or services that are considered overused or unnecessary. What they found should make patients and doctors rethink that next referral. In a single year, more than 600,000 patients underwent a treatment they didn't need, costing an estimated $282 million. More than a third of the money spent on the tests went to unnecessary care, their study found. Unnecessary medical care has 'become so normalized that I don't think people in the system see it,' Dr. Vikas Saini told me. Saini is president of The Lown Institute, a Boston think tank focused on making health care more effective, affordable and just. Lown researchers have shown how overtreatment happens across the spectrum of medical care. Doctors may push for Caesarean sections for their own convenience, not so moms and babies can be healthy. Breast cancer, prostate cancer and thyroid cancer get over-diagnosed, leading to harmful and costly treatment. Around a third of colonoscopies are unnecessary, research has shown. That's not just wasting our money. It's also putting us at risk of harm." Marshall Allen is a journalist and author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. He shares his story and discusses his KevinMD article, "How to avoid treatment you don't need." (https://www.kevinmd.com/blog/2021/06/how-to-avoid-treatment-you-dont-need.html)

"A sad truth is this: Most everywhere, health care is a low-margin industry that lacks resources to invest in leadership development. Although our business's central, sacred function is caring for our fellow human beings, many who move up in the health care hierarchy do so without possessing the so-called 'soft skills' that facilitate one's ability to lead groups and motivate others. 'Soft skills,' a military term that arose in the 1960s, refers to the interpersonal savvy that it takes for organizational stakeholders to succeed. Soft skills are about more than the weaponry and the machinery; they're about the people. Whether it's academic medicine, corporate medicine, or public sector medicine, we are simply not taking enough time to focus our leaders' attention on the interpersonal dimension of their work. Excellent training and supervision enhance essential managerial skills, but most health care organizations choose not to invest in that which is 'soft.'" Steve Adelman is a psychiatrist and can be reached at his self-titled site, AdelMED. He shares his story and discusses his KevinMD article, "The joylessness of harried medical leaders." (https://www.kevinmd.com/blog/2021/07/the-joylessness-of-harried-medical-leaders.html)

"During my medical school clerkships, an attending recognized a truth within me that I'd hidden for many years. Just a few hours into my pediatrics rotation, the attending asked me, 'You had a rough childhood, didn't you?' I was astonished. How had he known? I asked him, needing to know what gave away my most deeply kept secret. And he said something that surprised me. 'You don't react. When patients tell you about risky behaviors, you treat them like regular people and just keep talking to them. You don't look shocked by anything they say.' I accepted his insight and started to notice how different my interactions with patients were. That secret part of me led to a deep, intuitive understanding of patients who were often unseen and unheard. Because for much of my early life, I was not seen or heard by people who I desperately needed to have protect me. I spent several years as a homeless teen in Hollywood before my life finally stabilized, but the scars remained." Sheryl Recinos is a hospitalist and author of Hindsight: Coming of age on the streets of Hollywood. She shares her story and discusses her KevinMD article, "The story of how a homeless teen became a physician." (https://www.kevinmd.com/blog/2019/05/the-story-of-how-a-homeless-teen-became-a-physician.html)

"On a recent call with a small health organization in rural Uganda, I asked the director about the C-section rate in the community. In some private maternity centers, this procedure is performed far more often than one might expect. I've learned that while this practice may be financially motivated, the extra fees also pay for staff and encourage doctors to maintain practices in these remote areas. This, in turn, keeps more pre- and post-natal care in those communities, including family planning and HIV care. For almost every 'best practice' cost in global health care, there is a benefit. One of the fascinating aspects of my work is to discern those rationales." Ann Messer is a family physician. She shares her story and discusses her KevinMD article, "Don't push harsh health care realities under the rug." (https://www.kevinmd.com/blog/2021/04/dont-push-harsh-health-care-realities-under-the-rug.html)

"Excited by the promise our research holds for PKD patients, we have been packaging a variety of PKD drugs into our nanoparticles, testing their ability to act as a courier service for renal drug delivery. We've been testing this process on drugs that show therapeutic benefits in animal models but are shadowed by off-target side effects. Because our nanoparticles can carry more than one drug — and even gene therapy — we can help develop and deploy a therapeutic combination that may soon offer patients more benefit than any single drug. Because the biology of ADPKD is not entirely understood, drug discovery has been slow. As we are seeing with the dramatic success of the COVID-19 vaccines, however, nanomedicine can catalyze research efforts. Nanoparticles offer a promising new way to deliver medicine, making it simultaneously less toxic and more effective." Eun Ji Chung is a biomedical engineer. She shares her story and discusses her KevinMD article, "Using nano 'couriers' to deliver PKD drugs to just the right address." (https://www.kevinmd.com/blog/2021/05/using-nano-couriers-to-deliver-pkd-drugs-to-just-the-right-address.html)

"Hypertensive disorders with onset during pregnancies are among the leading causes of maternal and infant mortality and morbidity in the U.S. and can have far-reaching consequences for the long-term health of the mother and child. In Dr. Jerome Adams' recent Call to Action to recognize and address hypertension control as a public health priority, the former Surgeon General referenced the success of health care providers who have promoted shared management of hypertension through self-measured blood pressure monitoring (SMBP), empowering patients through blood pressure (BP) management and goal setting. It's not an unusual recommendation— SMBP is well accepted in primary care for managing hypertension — but its use in pregnancy has not been routine. That's beginning to change for several reasons." Lauren Demosthenes is an obstetrician-gynecologist. She shares her story and discusses her KevinMD article, "Hypertension is killing pregnant mothers. Blood pressure monitoring can help." (https://www.kevinmd.com/blog/2021/03/hypertension-is-killing-pregnant-mothers-blood-pressure-monitoring-can-help.html)

"As working women, we have an opportunity to be an example of living with passion and priorities, of working hard, of staying committed, not necessarily to work itself but to the priorities we set around our work and our personal lives. When we work and parent simultaneously, we have a chance to teach our kids resilience — letting our kids see that even if they struggle with something they can handle it and get stronger from it — and to embrace a village mentality, not in a better way than stay-at-home moms can but in a very different way. Above all, we have the unique pleasure of encouraging our own kids to find real balance and real joy as they live their lives and as they go on to work and parent the next generation." Whitney Casares is a pediatrician and author of The Working Mom Blueprint: Winning at Parenting Without Losing Yourself. She shares her story and discusses her KevinMD article, "Winning at parenting without losing yourself." (https://www.kevinmd.com/blog/2021/05/winning-at-parenting-without-losing-yourself.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22.

"Doctors undergo mandatory training sessions in medical school to prepare for unexpected medical emergencies. Health care workers are mandated reporters who have to undergo specific training for the purpose of identifying child and elder abuse or neglect. Bystander intervention should also be on that continuum of responsibility and training. I urge bystander intervention training to be widely adopted by health care workers, professional workplaces, and the broader community to end everyday harassment and racism, for microaggressions and violence, alike. In medical simulations, health care professionals are always taught to ask two questions first that can be useful to keep in mind in any situation: 1) Is the scene safe, and 2) Should I call for help?" Michelle Lee is a resident physician and can be reached on Twitter @MichelleLeeMD. She shares her story and discusses her KevinMD article, "Bystander intervention training can save a life." (https://www.kevinmd.com/blog/2021/05/bystander-intervention-training-can-save-a-life.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22. This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Applications close on July 22.

"The FDA recommended an updated boxed warning and standardization of product labels across the drug class. They recommended judicious prescribing and a gradual taper to mitigate withdrawal reactions. While I am optimistic about these changes, the updated warning doesn't tell the whole story. After reviewing the newly updated Xanax Medication Guide, I have some concerns." Christy Huff is a cardiologist and co-director, Benzodiazepine Information Coalition. She can be reached on Twitter @christyhuffMD. She shares her story and discusses her KevinMD article, "The updated benzodiazepine boxed warning: What you need to know." (https://www.kevinmd.com/blog/2021/03/the-updated-benzodiazepine-boxed-warning-what-you-need-to-know.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22.

"This is a message to any medical doctor who is unhappy with their career. The individual reasons for this dissatisfaction will vary. Whatever the issue, it is important to ask, 'Is the problem correctable?' If yes, then you must act and secure your happiness. If no, you must consider other options. One uncomplicated choice is to stay in medicine and practice somewhere else. However, you may also be unhappy in your career because you don't like medicine. Maybe you are burnt out or no longer feel challenged. Then again, maybe you just don't want to do it anymore or explain (for the 7,000th time) why a patient doesn't need antibiotics. This means your options are now down to pursuing a nonclinical medical career or leaving medicine altogether. Regardless, if you don't like clinical medicine, then why are you still doing it? Perhaps reality is teaching you a lesson: that once you're in medicine, it's hard to leave it. This begs the question: Why is medicine so hard to quit?" Elijah Sadaphal is an emergency physician. He shares his story and discusses his KevinMD article, "Why quitting medicine is hard." (https://www.kevinmd.com/blog/2021/04/why-quitting-medicine-is-hard.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22.

"American medicine is facing an identity crisis. The COVID-19 pandemic brought renewed attention to socioeconomic health disparities and turned up the heat on the question of whether health care is a right or a privilege. The financial strain on hospitals resulting from the temporary postponement of scheduled surgeries exposed a vulnerability caused by an inherently flawed payment system. The answer to the right versus privilege question has much more significant implications than the resolution of a philosophical debate. It determines which economic model — that of a public good, a private good, or a common good — makes the most sense for the delivery of medical services. For health care to be what we want it to be, broadly accessible, with no socioeconomic disparities, and long-term affordability, it must eventually be recognized as a common good, with all of the economic implications that come with such a recognition." Tom Robertson is a health care economist. He shares his story and discusses his KevinMD article, "Health care as an uncommon good." (https://www.kevinmd.com/blog/2021/04/health-care-as-an-uncommon-good.html)

"Before COVID-19, clinical research was a little-known part of health care. Despite this process being responsible for determining the safety and efficacy of all the drugs, medical devices, vaccines, and other medical therapies available, less than 5 percent of the U.S. population actually participates in clinical research. One reason why clinical research has little awareness and even lower participation is that, unlike other major industries, the pharmaceutical industry and many regulatory bodies never fully embraced technology to reduce the burdens of participation. We use our mobile devices to do our banking and place retail orders. Why can't we use similar technology in clinical research?" Kent Thoelke is a science executive. He shares his story and discusses his KevinMD article, "Accelerated by COVID-19, technology carves new pathways for everyone to access health care." (https://www.kevinmd.com/blog/2021/03/accelerated-by-covid-19-technology-carves-new-pathways-for-everyone-to-access-health-care.html)

"I have a form of genetic primary immunodeficiency and several heart issues, among other things. I know that I need to be far more vigilant than someone with a fully armed and operational immune system, so I try to take as much responsibility for that as I can. First tactic: Not going out at all. I've followed doctors' orders on this one and have only left my home for medical care since March 2020. Most medical appointments have been conducted online for the past year. More than a few conversations with my doctors have included some variation of the phrase "we'll schedule this when it's safer." But some, such as my infusions, imaging, and bloodwork, must be done in person. Second: I try to get the first appointment in the morning, no matter how early that might be. I've been scheduled for MRIs at 6:30 in the morning. Being there early usually means that there are fewer people in the facility. Third: I ask if there's an isolated place where I can wait. I'm not trying to cut the line. That needs to be understood. I'll wait as long as you need me to. 'Patient' is both a noun and an adjective. I just need to do that somewhere that is not a crowded waiting room. I have an immune deficiency, I pick up infections a bit more easily than some of your other patients, and we're in a pandemic." Denise Reich is a patient advocate. She shares her story and discusses her KevinMD article, "Medical facilities: Please keep your immune-deficient patients safe." (https://www.kevinmd.com/blog/2021/04/medical-facilities-please-keep-your-immune-deficient-patients-safe.html)

"For thousands of generations, parents, relatives, and the extended community raised and prepared children to become successful adults, to acquire knowledge, and strengthen the abilities needed to meet the challenges of their time. How did they do it? Until relatively recent times in human history there were no schools or organized institutions, nor were there self-help or parenting books. We believe the foundation of this process was accomplished by drawing upon seven important instincts that evolved over tens if not hundreds of thousands of years in ours and other hominid species. In some species instincts are fixed patterns of behavior leading to a certain outcome such as a bird building a nest for the first time or a salmon returning upriver to its birthplace to spawn. We believe that in our species instincts represent an intuitive way of thinking and/or acting that increase the chances of survival and success. In viewing instincts in this way we appreciate that knowing what to do and doing what you know are not synonymous and are very much dependent on experience. These instincts are more important than ever in preparing today's children for tomorrow's successes. Tenacity provides the power to build self-discipline and resilience. For these instincts to develop and flourish they require the nurturing and support of caring, knowledgeable adults. In short, it is our job to help children harness the power of their instincts." Robert B. Brooks is a psychologist and co-author of Tenacity in Children: Nurturing the Seven Instincts for Lifetime Success. He shares his story and discusses his KevinMD article, "Tenacity in children and the 7 instincts." (https://www.kevinmd.com/blog/2021/05/tenacity-in-children-and-the-7-instincts.html)

"When I was diagnosed as gene-positive for HD, just over ten years ago, there wasn't anything promising on the horizon in terms of a cure. It has only been since new clinical trials were announced in the past few years that I have allowed myself to feel a tiny bit of hope, that maybe there will be a treatment on time for me. How is it possible to be hopeful for a cure while still remaining realistic and preparing for my future with the disease? Even though I do not have any disease symptoms yet, genetic testing has completely changed my life. Living with the knowledge that my future includes HD is a huge challenge. It has only been with time that I have learned how to balance many opposing views. With the plethora of genetic testing available these days (even the mail-in kits), it is so important for people to consider the impacts such tests might have on their lives. Quite often, there are unforeseen consequences that one can struggle to come to terms with for years to come." Erin Paterson is a writer. She shares her story and discusses her KevinMD article, "A patient's perspective on genetic testing." (https://www.kevinmd.com/blog/2021/05/a-patients-perspective-on-genetic-testing.html)

"I've been semi-retired in clinical medicine for almost four years now. Initially, I found myself coaching burned out physicians: Helping them recover, finding careers they love, and even starting their own businesses outside the box. However, as I listened to my inner voice, I was led back to my healing roots, and that opened up a career opportunity I would have never imagined to have. Let me back up a bit. I'm a regular old family doc by training. Well, that's the way things began, anyway. I remember choosing the specialty the summer after the first year. I worked with a rural family doc who was a full spectrum doc. For those of you who are family medicine like me, you know what this means. He did everything! For me, that was fascinating. However, as you know, what we see as med students is often a sliver of the real world as it pertains to practice. As I progressed, I discovered integrative and functional medicine, and that is where my real love settled as a family physician. However, after seven years of having a private practice (even one where I set my own hours and ran my own ship) became less than fulfilling after a while. I felt like I had outgrown that purpose." Maiysha Clairborne is an integrative family physician and is the co-author of Conscious Anti-Racism: Tools for Self-Discovery, Accountability and Meaningful Change. She shares her story and discusses her KevinMD article, "How deep mindset work helped me find the courage to make my career transition." (https://www.kevinmd.com/blog/2021/04/how-deep-mindset-work-helped-me-find-the-courage-to-make-my-career-transition.html)

"This plea for help is on behalf of every hospital worker who has been on the front lines of the COVID-19 pandemic — from the environmental services staff and medical assistants who are often not recognized, to the social workers and chaplains who are surrounded by distress, to the physicians and nurses who continue to stand and receive the sick — we need more time off in the coming year. Some hospital workers will need to continue to be paid; others will just need permission and people to back-fill their roles until they return. If you are a business leader who makes logistical, technological, charitable, and financial decisions every day: I am asking for your time, financial wherewithal, personal connections, commitment, and expertise in strategic planning in order to give every front line COVID-19 hospital worker more time off in the next year than they can and will be allotted by their health systems. Consider using your unique talents to radically change how our country's health care system moves on from this crisis. Please help us. Help my friends and my colleagues. Help us do the thing we diligently, faithfully, and without hesitation tried to do for over half a million Americans this year. Help us survive." Kristin Adams Forner is an anesthesiologist and palliative medicine physician who blogs at Mending the Fractured Story. She shares her story and discusses her KevinMD article, "A plea for help from the front lines of the COVID-19 pandemic." (https://www.kevinmd.com/blog/2021/05/a-plea-for-help-from-the-front-lines-of-the-covid-19-pandemic.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22, 2021.

"The right choice of words, at the right time, can lift a person out of despair and literally save a person's life, while an ill-chosen word, or worse, a purposely harsh one, can scar a person. The entire field of narrative medicine is formed around the principle of reviving empathy in doctors towards patients and their colleagues so that we keep the inner human alive in us as we treat the obstacles we are faced with daily. If you are a physician seeing a multitude of patients daily, try spending time with the patient and offer them a word or two to heal." Natasha Khalid is a physician in Pakistan. She shares her story and discusses her KevinMD article, "I'm a doctor who had COVID. Did I deserve this? Does anyone?" (https://www.kevinmd.com/blog/2021/05/im-a-doctor-who-had-covid-did-i-deserve-this-does-anyone.html)

"'That's great. You want to start a women in medicine program! How are you going to pay for it?' This is the most common question and potential barrier from colleagues, leaders, and those who understand the value of these programs. We found that our two-year Women Leaders in Medicine program improved burnout, retention, and engagement of the over 400 women physicians who participated. However, funding remained the chronic barrier to sustainability. I will introduce you to ten possible funding strategies to get your creative strategy-building blood pumping." Dawn Sears is a gastroenterologist and can be reached on Twitter @GutGirlMD, YouTube, and at GutGirlMD Consulting. She shares her story and discusses her KevinMD article, "10 ways to pay for women in medicine programs." (https://www.kevinmd.com/blog/2021/04/10-ways-to-pay-for-women-in-medicine-program.html)

"We know the ER's revolving door will continue to spin for so many children and adolescents who seek help in the heat of their personal crisis. Some will need to stay in the hospital – to heal their bodies and minds and even fight for their lives. Some – the lucky ones – will be able to go home, but by no means are they out of danger. Their lives too are threatened, and they will need ongoing support from parents, family, friends, teachers, and mental health providers – who will likely care for them across a virtual platform. Human contact has been gravely compromised this past year, and we, as pediatric ER doctors, as members of our community, and as parents, are seeing the fallout in the children we care for." Rachel Kowalsky and Shari Platt are pediatric emergency physicians. They share their stories and discuss the KevinMD article, "Dying of loneliness: the COVID-19 epidemic in children and adolescents." (https://www.kevinmd.com/blog/2021/04/dying-of-loneliness-the-covid-19-epidemic-in-children-and-adolescents.html)

Listen to psychiatrist Emily Watters' work with the homeless population and how she got her start writing cartoons, educating patients using out-of-the-box communication strategies. Emily Watters is a psychiatrist and can be reached at The Cartoon Shrink. She shares her story and discusses her KevinMD articles, "Blood clots and the Johnson & Johnson vaccine: a comic explanation" (https://www.kevinmd.com/blog/2021/05/blood-clots-and-the-johnson-johnson-vaccine-a-comic-explanation.html) and "If the COVID vaccines don't make you sick, why do some people feel sick?" (https://www.kevinmd.com/blog/2021/03/if-the-covid-vaccines-dont-make-you-sick-why-do-some-people-feel-sick.html)

"For the folks who are either physicians or becoming care providers, I hope you choose to familiarize yourself with this odd yet common form of loss. I encourage you to respect a woman's right to decide at what point and to what degree her fetus and its life or loss has meaning to both her regardless of your views. I implore you to become familiar with laws, regulations, and general procedures surrounding fetal death and disposal of remains in the state(s) in which you choose to practice and how it may vary in pregnancy. Last, I hope this helps the women who yearn to know the personal experience of someone with VTS, as I did during my pregnancy." Nichole Cubbage is a biomedical researcher. She shares her story and discusses her KevinMD article, "Let's talk about vanishing twin syndrome." (https://www.kevinmd.com/blog/2021/04/lets-talk-about-vanishing-twin-syndrome.html)

"I often think about how I can make you see these things about yourself that others see. I think about the ways I can tell you that things will get better even though the darkest of days is upon you right now. But I know I can't make you see these things; no one can. I know these things may not be helpful to hear, irrelevant, noisy. So instead of trying to convince you, dear one, I'm going to be here for you. I'm going to listen to you. I'm going to advocate for you. I'm going to help pull you out of this depression. I'm going to help you live a valued life with chronic pain. I'm not going anywhere. Please, please stay here too." Melissa Geraghty is a psychologist and can be reached on Twitter @mindfuldrg. She shares her story and discusses her KevinMD article, "To the patient who wants to die: a psychologist's perspective." (https://www.kevinmd.com/blog/2021/04/to-the-patient-who-wants-to-die-a-psychologists-perspective.html)