The Podcast by KevinMD

"As a species, we have been an abject failure in dealing with a worldwide crisis. We politicize things for money, political reasons and some kind of weird power, even when it kills us in the process. We already have a World Health Organization (WHO). Would it be so difficult to staff it with the best scientists from every country, without any political pressure and follow their recommendation worldwide, without local bureaucratic interference? The first vaccine approved by the WHO — no prizes for guessing — mRNA Pfizer. Humans have a way of complicating life by breaking even common sense into silos guided by politics, power, hubris, and finance. We read history and shake our heads when we see some of the haunting tragedies of mankind. And yet, we continue making the same fundamental mistakes. To paraphrase, "The tragedies will continue; we just will have different entries and exits."" Dinesh Arab is a cardiologist. He shares his story and discusses his KevinMD article, "The vaccine rollout's tragic dance." (https://www.kevinmd.com/blog/2021/05/the-tragic-dance-of-the-vaccine-rollout.html)

"From a charting standpoint, the sins of commission easily outnumber the sins of omission. Our group's progress note template begins with a summary that eventually becomes the narrative for the discharge summary. Most of the time, most of the important stuff is in there. It's just obscured by what data scientists technically describe as 'oodles' of no-longer-relevant details. Like a package of cheap ramen, the single cube of chicken meat is in there. Your job is to find it. Why do we do this to ourselves? Why do we keep simply adding details to a note rather than subtracting the no-longer relevant ones?" Craig Bowron is an internal medicine physician and can be reached at his self-titled site, Craig Bowron, MD. He shares his story and discusses his KevinMD article, "Bloated notes are a huge problem and a time suck." (https://www.kevinmd.com/blog/2021/05/bloated-notes-are-a-huge-problem-and-a-time-suck.html)

"We believe optimal postoperative pain management should provide adequate pain relief, minimize adverse effects, and reduce chances of drug misuse. While we cannot undertreat pain, we also cannot go back to the practice of over-prescribing or unnecessarily prescribing opioids for minor operations. There needs to be a carefully nuanced balance in treating pain, especially for pediatric and adolescent patients. Going forward there needs to be continued parent and patient education about expectations for recovery post-surgery and proper pain management. This needs to include consistent messaging to families regarding safe use, storage, and disposal of opioids as well as the risks for non-medical use and substance use disorder. This critically important topic deserves more research and clarification so that the medical community can properly treat pediatric and adolescent pain. Stigmatizing the select use of opioids for children and adolescents after surgery is counterproductive and additional guidance should not emphasize the fear of opioid diversion or misuse over appropriate pain management." Rita Agarwal is an anesthesiologist. She shares her story and discusses the KevinMD article, "Pediatric patients need appropriate pain management after surgery." (https://www.kevinmd.com/blog/2021/03/pediatric-patients-need-appropriate-pain-management-after-surgery.html)

"The symptoms of EDS aren't limited to the musculoskeletal system and commonly affect everything from hearing and vision to integumentary issues such as prolonged wound healing and easy bruising. It also became apparent that the specialists I had seen had contributed valuable information to the overall puzzle but were simply not able to put it all together. I had accrued an impressive list of diagnoses commonly associated with EDS: migraine, gum disease, anxiety, fibromyalgia, chronic fatigue, restless leg syndrome, sleep disorder, lumbar spondylolisthesis, sacroiliac dysfunction, hiatal hernia, hearing loss, and early-onset osteoarthritis. EDS explained everything right down to the bumps on the sides of my heels called piezogenic papules and my velvety soft, delicate skin. One physician explained how she makes sense of this constellation of multi-system symptoms by using the phrase: 'If you can't connect the issues, think of connective tissues.' Finally, it all made sense." Julie Griffis is a physical therapist. Linda Bluestein is an integrative medicine physician. They share their stories and discuss this KevinMD article, "The difficult to diagnose comorbidity that plagues Ehlers-Danlos syndrome patients." (https://www.kevinmd.com/blog/2021/05/the-difficult-to-diagnose-comorbidity-that-plagues-ehlers-danlos-syndrome-patients.html)

"The impact of the pandemic on the lives of Americans will be felt for years, if not generations, to come. This includes its alarming effect on health behaviors that contribute to the already formidable challenge of obesity in this country. Now, more than ever, we must look for creative solutions within the broader health ecosystem that can help individuals adapt their behaviors, in spite of socio-environmental challenges, to prevent, manage, and maybe even reverse chronic disease. The very health of our nation depends on new solutions to our country's age-old societal, cultural, and behavioral challenges." Rami Bailony is an internal medicine physician. He shares his story and discusses his KevinMD article, "The overlooked factors driving weight gain in the pandemic." (https://www.kevinmd.com/blog/2021/03/the-overlooked-factors-driving-weight-gain-in-the-pandemic.html)

"Interviewing for medical schools was intense, excruciating, and terrifying. Despite the difficult questions, there are three that stand out to me. The first was to differentiate sympathy from empathy, where I spent 30 minutes defending my answer to be met with complete silence. He could have asked me anything, yet he sat in silence for almost my entire interview and asked me to explain emotional differences between two incredibly similar words. Or are they? I have been left to contemplate this repeatedly, and I have come to realize my first medical school lesson happened before I was even in training. That day, he taught me to see how we as physicians need to examine emotions, become aware of our capacity to both feel and heal, understand our patients, share their struggles and triumphs even if we haven't walked in their diagnoses, and take the time—even if it is painful and met with silence—to realize the gravity of our position is not only responsibility for people's lives but to be emotionally available." Erika Visser Aragona is a family physician. She shares her story and discusses her KevinMD article, "The life cycle of emotion in medicine." (https://www.kevinmd.com/blog/2021/05/the-life-cycle-of-emotion-in-medicine.html)

"Mid-career colleagues: it's time to go back to the future. Time to learn again. Time to build professional and social networks at work. Take a lunch break. Bring home a few fewer RVUs. I recently started a monthly journal club for our small section of gastroenterologists as a way to recreate some of what I loved about residency. A case conference to discuss difficult cases is next. While the rewards of these diversions are not quantifiable, they are still valuable. I hope my colleagues feel the same way. Maybe I'll throw in some free movie tickets, as well." Anish Sheth is a gastroenterologist. He shares his story and discusses his KevinMD article, "Attention mid-career physicians: Let's find our ikigai." (https://www.kevinmd.com/blog/2021/04/attention-mid-career-physicians-lets-find-our-ikigai.html)

"COVID was ominously not only drowning people in their own spit but struck in different shades to alter human personality that kept helplessly getting lost in the maze of their own minds. It made the young maniacal, hearing voices and talking to walls in a schizophrenic frenzy. It made the elderly become muted in silence. The face of helpless madness. Every now and then, the balm of soothing whispers would lull them to slowly break free from this trance. This strange malady kept fogging up brains behind the faces. Faces of disintegrating seizures. Faces staring into oblivion. My penlight shining down dark pupillary tunnels, in vain, felt futile. And then there were other faces. Of hospital caregivers, faithfully grooming seemingly lifeless bodies. I would feel enriched when they shared on my rounds, updates from up close, and personal patient care moments." Ayushi Chugh is a neurologist. She shares her story and discusses her KevinMD article, "Unmasking the faces of COVID: pages from a neurologist's diary" (https://www.kevinmd.com/blog/2021/02/unmasking-the-faces-of-covid-pages-from-a-neurologists-diary.html) and "The science of compassion." (https://www.kevinmd.com/blog/2020/10/the-science-of-compassion.html)

"We all go through our early lives in the S-curve of our medical education–college, medical school, residency, early practice. As you reach the mastery phase, I would posit that there is a downward dip as we realize that we are no longer in that exciting hypergrowth phase. The search for a new curve happens, the desire to ascend the second mountain, to find a more meaningful purpose. How do you begin to find that purpose? Some people take a sabbatical or quit their job entirely. Some physicians look for leadership positions or transition to a non-clinical role. But while this may fix some of the career discontentment, you will stay in the dip, the valley, the bottom of the U-curve without a true search within yourself. It is through a reassessment of your true values that you will find your why." Beverly Joyce is an obstetrician-gynecologist and physician coach. She shares her story and discusses the KevinMD article, "Physicians and the midlife dip." (https://www.kevinmd.com/blog/2021/03/physicians-and-the-midlife-dip.html)

"We won't know until 2022 or later whether there will be an increase in claims related to the pandemic. When a medical error occurs, it's not like an automobile accident. Everybody nearby knows when there's been an automobile accident because they hear screeching tires, a loud crash, and then sirens. But when a medical error occurs, generally speaking, neither the doctor nor the patient immediately knows that something is amiss. It can take months or years for people to realize that something untoward has occurred. Claims from medical errors that occurred before the pandemic bring additional uncertainties. In 2020, we saw fewer than expected overall claims filed from events occurring 18 to 24 months before the pandemic. In total, 20 percent fewer claims were filed than in 2019. This may have had to do with courts shutting down, people being reluctant to meet with attorneys to discuss a claim, and/or lawyers working from home. We may see these claims filed later than expected, or maybe we won't see them at all." Robert E. White, Jr. is chief operating officer, The Doctors Company. He shares his story and discusses his KevinMD article, "Malpractice claims from the COVID-19 pandemic: more questions than answers." (https://www.kevinmd.com/blog/2021/04/malpractice-claims-from-the-covid-19-pandemic-more-questions-than-answers.html)

"We know this is true in our hearts and minds, but we also know it to be true in documentable terms. Studies have proven that strong, empathic engagement between doctors and their patients increases patients' willingness to report symptoms and concerns. That in turn improves diagnostic accuracy. Empathy increases patient engagement and compliance. Some studies suggest it even improves survival rates. Connection is a powerful intangible—like family, or love, or hope. So how can a doctor bring connection into the room in the small, often intense increments of time we have with our patients? Often, it's through surprising secret tools—things like laughter, empathy, and music. There's notable science to each. Laughter has been shown to reduce stress and improve immune function. Empathy strengthens patients' ability to cope with difficult treatments and eases suffering during end-of-life care. And music—wow—studies show music can lower patient anxiety levels during invasive procedures, ease the nausea caused by chemotherapy, decrease pain perception, and inspire feelings of peace and spirituality. And that's just the medical stuff. On a personal level, listening to and making music together creates a sense of shared experience and kinship. It fires up emotional receptors that otherwise remain dormant. It is an honest, authentic shortcut to connection." Steven Eisenberg is a hematologist-oncologist and author of Love Is the Strongest Medicine: Notes from a Cancer Doctor on Connection, Creativity, and Compassion. He shares his story and discusses his KevinMD article, "Love is the strongest medicine." (https://www.kevinmd.com/blog/2021/05/love-is-the-strongest-medicine.html)

"How do we combat all these beliefs that can make doctors into bad investors? I have a few thoughts. First of all, don't panic. Most of us are indeed starting behind the eight-ball when it comes to wealth accumulation. But even with a shorter runway, physicians make enough money to make up for lost time. With a well-constructed financial plan, you can hit your goals, whatever they might be. Second of all, be humble. Recognize that vast scientific knowledge doesn't always translate into financial wizardry. Take the time to educate yourself in any area where you plan to invest. For example, I only started to accelerate my real estate investment after I took a formal real estate investing course. Finally, take ownership. Realize that your financial future is your responsibility. Don't offload all the details to an advisor without having a basic understanding of what is happening to your money. Daniel Shin is a urologist who blogs at The Darwinian Doctor. He shares his story and discusses his KevinMD article, "Why doctors are such bad investors." (https://www.kevinmd.com/blog/2021/04/why-doctors-are-such-bad-investors.html)

"These are extraordinary times. Leaders have the opportunity to seize the day, to lean into this turning point in health care delivery, to drive organizational transformation, and to emerge from the devastation of the pandemic with an organization in which patients and clinicians thrive. You simply have to ask yourself, are you willing to change? Are you willing to dive into the fray and adapt to save your clinicians with the same commitment that your clinicians have demonstrated throughout the pandemic? If you are, your organization will succeed beyond what you think is possible." Paul DeChant is a family physician and health care consultant. He shares his story and discusses his KevinMD article, "Caring for caregivers post-pandemic." (https://www.kevinmd.com/blog/2021/05/caring-for-caregivers-post-pandemic.html)

"We can move from being a reactor to creator. Creators think of the future and make it start happening today. Reactors are just dealing with the crisis at hand, not progressing, feeling stuck, feeling like life is unfair. Reactors are people-pleasing, reacting to everything said, constantly worrying about how to win the approval of others. That's the trouble with people-pleasing: You are always reacting. We think we are making others happy, but we despise ourselves and resent others. We should start taking the time to please ourselves. It is only from this space that we can start helping others. If you think this will be a waste, or you can't take a break because there is work to do, your brain will find ways to prove this thought true. If you tell yourself this is stupid and a waste of time, then you will squander the day and prove yourself right. If you tell yourself they can't live without out you (and your confidence depends on them wanting you), you will allow the interruptions. If you find yourself saying you really can't take the time off, then you have a non-sustainable job. Give yourself permission. Start to develop strong boundaries. Understanding what we can and cannot do in a day. Setting aside days for us to reflect, listen deeply to our inner thoughts, and strategize the path we are meant to live are keys to a successful life. If we're too busy and never take time to stop, we will never see the path in front of us." Amy Vertrees is a general surgeon and co-founder, The Common Thread Women Surgeon Coaching. She shares her story and discusses her KevinMD article, "Physicians need growth days." (https://www.kevinmd.com/blog/2021/02/physicians-need-growth-days.html)

"With the obvious accounted for, we turned to the obscure, the area of medicine where judgment and experience come into play. Fortunately, we received sound advice and guidance from the infectious disease physicians. Stick to the basics, they stressed, only do them better. We continued our patient on the first-line anti-TB drugs he had been on, this time at a slightly higher dose, and added one dose intravenously since he had inflammation in his abdomen and likely wasn't absorbing a lot of the medicine he had been taking. We supported his immune system with appropriate calories through a feeding tube and kept the pressure in his lungs low on the ventilator. In this case, there could have been an urge to change the plan radically, to alter the anti-TB drugs or give steroids or other immune modulators. The art of medicine is knowing when to give up and start anew versus when to stay with the basic plan, executed better. In this case, we stuck with the basic plan. Gradually, the inflammation in the chest and abdomen calmed down. We were able to give the patient physical therapy, and he got off the ventilator and went to the general medical floor. We stuck to the basics of antibiotics and nutrition, and he did well. When in doubt in medicine, stick to the basics are indeed words to live by." Michael J. Stephen is a pulmonary physician and author of Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs. He shares his story and discusses his KevinMD article, "The lungs and the common good." (https://www.kevinmd.com/blog/2021/01/the-lungs-and-the-common-good.html)

"We need you to join the ranks of this time-honored profession with new eyes and determined minds and eyes that see medicine's problematic foundations and minds that are willing to act on it. Because it is you, future medical students, who will soon take up the mantle of pushing medicine to change — as medical students have done for generations. We look forward to working alongside you. Welcome to medicine." Kathryn Crofton, Jay Hwang, and Catherine Jay are medical students. They share their stories and discuss their KevinMD article, "From future doctors to new ones: We need you." (https://www.kevinmd.com/blog/2021/04/from-future-doctors-to-new-ones-we-need-you.html)

"Ever the teacher, the Dr. Lown we knew modeled 'The Lost Art of Healing' (the title of one of his books) in the clinic, the laboratory, and the halls of power. As health professionals, we watched him listen carefully to his patients; as citizens, we saw him listen deeply to our neighbors. We heard him importune our health care enterprise to do what is best for democracy with an eye on the future, instead of what helps today's bottom line. And he entreated us to bear witness to the harms and risks of our social choices, to shine a light on the possible, and to lead toward a future that is better than the past. 'If you can see the invisible,' Dr. Lown said, 'you can do the impossible.' Dr. Bernard Lown was the best of his generation. Kind and wise. A listener, a thinker, a doer. A teacher and prodder. A challenger and inspirer. Impossible to equal. And impossible to ignore." Michael Fine is a family physician. He shares his story and discusses the KevinMD article, "In memory of Bernard Lown." (https://www.kevinmd.com/blog/2021/04/in-memory-of-bernard-lown.html)

"Legislative advocacy has become difficult for the severe autism population since the DSM-5 lumped Asperger's syndrome with autism spectrum disorders (ASD). Further complicating the matter, a new population recently emerged who identify as "autistic" without having a diagnosis from a qualified health care professional. Without a clear distinction for various parts of the spectrum, we are comparing apples and oranges. We will not render meaningful information, and we make it difficult for the entire spectrum, but especially for those most affected." Irene Tanzman is a patient advocate and author of Abie and Arlene's Autism War. Jill Escher is president, National Council on Severe Autism (NCSA). They share their stories and discuss the KevinMD article, "Why health care professionals must call for splitting the autism spectrum." (https://www.kevinmd.com/blog/2021/02/why-health-care-professionals-must-call-for-splitting-the-autism-spectrum.html)

"My thoughts immediately went to the tragic loss of one of my best clients, a physician who recently passed away after battling COVID-19. I remember him not only as an excellent physician but even more so as a great person. Unlike many physicians I speak to in the course of my work, this client had the foresight to do some careful estate planning. While his loss cannot be measured, this planning has provided his grieving family with some financial peace of mind and allowed them to focus on him during his illness. According to the latest CDC data, physicians on the front lines throughout this pandemic have been some of the most affected by COVID-19; over 460,000 health care professionals have been diagnosed with COVID-19. Estate plans are not one-size-fits-all, and the various strategies may not work for everyone. Without some experienced professional guidance, anyone might make some mistakes in decisions that seem unimportant at the time but could have huge ramifications on your family's financial future. Here are some of the most common mistakes that are best to avoid." Syed Nishat is a partner, Wall Street Alliance Group. He can be reached on LinkedIn and on Twitter @syedmnishat. He shares his story and discusses his KevinMD article, "8 estate planning mistakes for physicians to avoid." (https://www.kevinmd.com/blog/2021/04/8-estate-planning-mistakes-for-physicians-to-avoid.html)

"Even though there has been a lot of progress, LGBTQ youth are still struggling with discrimination. I am disheartened that 40 percent of LGBTQ youth surveyed by the Trevor project in 2020 seriously considered suicide in the previous 12 months, and the amount of LGBTQ youth reaching out to the Trevor project crisis centers has doubled at times during the COVID 19 pandemic. I have pediatric patients in my clinic tell me that they are nervous to reveal their sexual identities to family and friends. Many of my young LGBTQ patients have mental health issues. According to a recent Human Rights Campaign survey, only 26 percent of LGBTQ teens say they always feel safe in their school classrooms. Only five percent of LGBTQ teens say all of their teachers and school staff support LGBTQ people. Additionally, sixty-seven percent of LGBTQ teens report that they have heard family members make negative comments about LGBTQ people. Many LGBTQ youths are still homeless. It is clear that there is much more work that needs to be done." Alexis Smith is a family physician. She shares her story and discusses her KevinMD article, "The importance of teaching young children about the existence and acceptance of LGBTQ people." (https://www.kevinmd.com/blog/2021/03/the-importance-of-teaching-young-children-about-the-existence-and-acceptance-of-lgbtq-people.html)

"Taking control of distress is done by embracing the concept of 'mental fitness.' Being mentally fit enables one to overcome the negative emotions that have traditionally sabotaged our lives, both personally and professionally. Similar to physical fitness optimizing our bodily strength, mental fitness promotes achievement in our performance, relationships, and sense of well-being. Much research has been done in neuroscience, cognitive and positive psychology, and performance science, showing the true benefit of mental fitness. In particular, the concept of neuroplasticity suggests that with the continued strengthening of certain neural pathways in the brain, modifications in brain architecture can be achieved. These changes have been shown with functional MRI, demonstrating increased density of grey matter in areas that correspond to certain thought processes." Susan Wilson is an emergency physician and physician coach. She shares her story and discusses her KevinMD article, "It's time to reframe second victim syndrome." (https://www.kevinmd.com/blog/2021/04/its-time-to-reframe-second-victim-syndrome.html)

"Before COVID-19, I left the practice of medicine for what would turn out to become an entire year. While away, I found a new way of seeing our hearts and bodies as humans in the medical profession, allowing me to return. Here are five lessons I learned in the hope they might help others." Jennifer Lycette is a hematology-oncology physician and can be reached on Twitter @jl_lycette. She shares her story and discusses her KevinMD article, "What I learned from stepping away from medicine for a year." (https://www.kevinmd.com/blog/2021/03/what-i-learned-from-stepping-away-from-medicine-for-a-year.html)

"Don't be the patient that says: 'Doc, just tell me what to do …' Instead, you should ask for information to empower yourself to make decisions about your healing process. Framing questions around the clinician's experience is always a good starting point; pretend to be the doctor for just a moment and consider the difference in how you might answer the following questions: 'Is there something wrong with the X-rays of my spine?' 'In your experience with patients like me, do most people get back to all normal activities following being rear-ended in an accident with findings on an X-ray like this?' The first question does not give the clinician an opportunity to see you as an individual and truly help you on your path forward. Instead, it sets up a situation where the doctor is free to look at the X-ray in a general way and give a vague and simple answer. She might say: 'No, everything looks fine,' even though your back still hurts, or '… Well, I see you have some scoliosis here,' without giving you any actionable steps to take moving forward. If you keep the focus on the experience of the clinician from their work treating a large number of other individuals with similar patterns of findings, it encourages both of you to keep the bigger picture in mind. But David, you might be thinking, what's wrong with being told the findings of some specific test or measure? Simple, it's because one specific test or measure rarely tells the full story. Imaging, for example, is just an illustration of shadows that lay beneath the skin, and has limited capability to depict underlying issues, especially when it comes to a holistic view of the body. In fact, there are specific cases when performing imaging is required by insurance before they are willing to reimburse the clinician for certain procedures to be performed. Unfortunately, this can skew their clinical decision-making. This is yet another reason why you must be the one in control, and work with people you trust." David Meyer is a physical therapist and author of Injured to Elite: A Guide To Empowering Yourself to Transform Your Life After Injury. He shares his story and discusses his KevinMD article, "Don't be the patient that says this." (https://www.kevinmd.com/blog/2021/04/dont-be-the-patient-that-says-this.html)

"Continuing to do this work the way I was doing it was not sustainable. I needed to get off the merry-go-round. I just didn't know how. I didn't think I could stop myself—transplant was my duty, my responsibility, and what I was trained and programmed to do. It was hard to imagine leaving my post, but I needed to find a graceful exit, an elegant off-ramp that would satisfy my need for a tidy conclusion. One way or another, I wanted off the roller coaster, so I could never again be crushed by a patient like Tina. That had been my life for nearly twenty years. That was enough. I felt yanked around by the ups and downs of the job, my emotions seesawed, and all the while I had to make rational decisions for my patients. But for me, the job was no longer a pure and simple exercise in rationality. I had mastered the mechanics of being a transplant doctor— that was the easy part. But now, from an emotional standpoint, every wife was my wife, every child was my child, and every father was my father. And I needed to save them all." David Weill is a pulmonary and transplant physician and author of Exhale: Hope, Healing, and a Life in Transplant. He shares his story and discusses his KevinMD article, "A transplant physician faces facts about his career." (https://www.kevinmd.com/blog/2021/05/a-transplant-physician-faces-facts-about-his-career.html)

This episode is sponsored by the Dragon Ambient eXperience at Nuance. The exam of the future has arrived with clinical documentation that writes itself. Recently, I participated in a virtual webinar, "How AI technologies improve the patient experience," along with Dr. Jesse Affonso, orthopedic surgeon at Cape Cod Orthopedics. We discussed the difference between patient experience and patient satisfaction, the correlation between the two, and the role technology plays. In a nutshell, I think it's this: A poor patient experience can lead to low patient satisfaction. A good patient experience can lead to high patient satisfaction. According to the Agency of Healthcare Research and Quality, the patient experience encompasses the range of interactions patients have with the health care system and includes several aspects of health care delivery such as timely appointments, easy access to information, and good communication with health care providers. At the same time, patient satisfaction is about whether a patient's expectations about a health encounter were met. This all begs the question: How can one improve the patient experience and satisfaction? Patients want the best care possible. And physicians want to provide the best care possible. The fusion of art and medicine can deliver a better patient experience with AI-powered, voice-enabled documentation that's revolutionizing health care. Jared Pelo is an emergency physician and chief medical information officer, Dragon Ambient eXperience at Nuance. https://www.nuance.com/healthcare/campaign/demo/dax-group-demos.html?cid=7010W000002T9aqQAC&utm_campaign=DHX_AO_202008_DAX_livesteam_demo_digital&utm_medium=Display&utm_source=kevinmd

"Machine learning is only as good as the information provided to train the machine. Models trained on partial datasets can skew toward demographics that often turned up in the data—for example, Caucasians or men over 60. There is concern that "analyses based on faulty or biased algorithms could exacerbate existing racial gaps and other disparities in health care." Already during the pandemic's first waves, multiple AI systems used to classify x-rays have been found to show racial, gender, and socioeconomic biases. Such bias could create a high potential for poor recommendations, including false positives and false negatives. It's critical that system builders are able to explain and qualify their training data and that those who best understand AI-related system risks are the ones who influence health care systems or alter applications to mitigate AI-related harms." Richard E. Anderson is chairman and chief executive officer, The Doctors Company and leader, TDC Group of companies. He shares his story and discusses his KevinMD article, "Artificial intelligence, COVID-19, and the future of pandemics." (https://www.kevinmd.com/blog/2020/11/artificial-intelligence-covid-19-and-the-future-of-pandemics.html)

"The future of health care will be focused on prevention rather than focused on performing excessive medical treatments, diagnostic tests, and procedures. Many centralized processes, services, products, and entities will become unbundled, including insurance, hospitalization, inpatient and outpatient coding, medical billing, payments, patient care, medical education, licensure, and certification. Physicians, including Leah Houston, MD, are developing blockchain-based platform technologies for improved physician credentialing. The current applications of blockchain technology that are currently being worked on in the field of health care include enhanced data security, transparency to financial operations, eliminating excessive administrative burden and waste, decreasing billing cycle complexity, improved methods for recording, storing, and access data records, credentialing, and supply chain management. Obviously, with blockchain just still a nascent technology, a whole host of other unnamed applications are possible, as the sky is the limit." Christopher H. Loo is a physician and author of How I Quit My Lucrative Medical Career and Achieved Financial Freedom Using Real Estate. He shares his story and discusses his KevinMD article, "What does blockchain mean for health care?" (https://www.kevinmd.com/blog/2020/12/what-blockchain-mean-for-health-care.html)

"In addition to leaking private information to an unauthorized individual who just happened to ask for Ms. Mann by name, Larry commanded Nigel to worsen this HIPAA violation. Given the tone of his command, Larry must have felt right proud of his informing an aggressive, unconfirmed querent. If so, perhaps he should have paged Nigel prior to blindly succumbing to clamorous callers. During all of his back-patting, did Larry consider that maybe the unauthorized querent was unauthorized for a reason; that maybe the querent's aggressive nature may overwhelm even Ms. Mann who may have hoped not naming that person would prompt staff to shield her from the unwelcomed? With that in mind, can Larry be certain he expertly met Ms. Mann's needs? By jeopardizing Ms. Mann's privacy (or safety), did Larry meet patient satisfaction goals?" Adedotun Adewusi is a hospitalist and co-author of Under the Collar: Frank Conversations about Healing that Harms: Simply Speaking. She shares her story and discusses her KevinMD article, "By jeopardizing privacy, did this physician meet patient satisfaction goals?" (https://www.kevinmd.com/blog/post-author/adedotun-adewusi)

"Even though prostate cancer patients are anxious to receive treatment, they still want to minimize their exposure to anyone outside their COVID bubble. One procedure that is especially attractive to our patients is focal therapy high intensity focused ultrasound (HIFU). Focal therapy HIFU is appropriate for patients whose prostate cancer is diagnosed at a higher grade and stage, but is still confined to the prostate. We use guided imagery to locate and destroy only the diseased portion of the prostate. It is done quickly (approximately two to three hours), in a single session. Patients like the ability to get in and out, with minimal exposure to the health care system. Focal therapy HIFU is ideal for this." David A. Silver is a urologist. He shares his story and discusses his KevinMD article, "The ideal elective surgery during a pandemic." (https://www.kevinmd.com/blog/2021/02/the-ideal-elective-surgery-during-a-pandemic.html)

"We need to crawl before we walk and walk before we run. The first step is to establish your why. Why do you want the financial freedom to practice medicine because you want to, the way you want to instead of because you have to? Without a why, even achieving financial freedom can be an empty victory. After this, start your financial education. Pick a personal finance book and read 10 pages a day. Read one finance blog post each day. Small efforts will lead to big rewards. After this, you are ready to develop your own written financial plan and start your financial well-being journey!" Jordan Frey is a plastic surgeon and can be reached at The Prudent Plastic Surgeon and on Twitter @jordanfreymd. He shares his story and discusses his KevinMD article, "Why do physicians fail to focus on their personal finances?" (https://www.kevinmd.com/blog/2020/12/why-do-physicians-fail-to-focus-on-their-personal-finances.html)

"My children are embarking on their own lives now. While their paths are not taking them into medicine, I see how medicine has influenced their lives. They are committed to investing in themselves to reach their desired outcomes. They understand the value of dreaming big as they create a life and career they may not envision before. They help others. They enjoy the process through the long hours of study and hard work. From that perspective, it was worth it all." Stephanie Wellington is a physician and can be reached at Nurturing MDs. She shares her story and discusses her KevinMD article, "Medicine's contribution to my family." (https://www.kevinmd.com/blog/2021/03/medicines-contribution-to-my-family.html)

"Decreasing the burden of combustion material, whether from a cigarette, a power plant, or an engine, will not only pay off now in reducing COVID-19 but also in future pandemics and in reaping the health care benefits of decreasing the constant toll of tobacco and air pollution in our communities. As physicians and others in health care who want to do all we can to bring an end to this pandemic and build healthier futures for our patients and loved ones, we should make sure to reach out to our local city council, county, and other elected officials to take fuel away from COVID-19 by advocating for clean air. " Erika Maria Moseson is a practicing, board-certified pulmonary and critical care physician. She is founder, Air Health Our Health, an educational website and podcast on the importance of healthy air and a stable climate, and can be reached on Facebook and Instagram. She shares her story and discusses her KevinMD article, "An anniversary: Reflecting on COVID-19 and combustion." (https://www.kevinmd.com/blog/2021/03/an-anniversary-reflecting-on-covid-19-and-combustion.html)

"My world tumbled upside down. I was managing taking care of three children from home, helping them navigate the realities of our new world while trying to keep my staff employed and safe. I sadly said goodbye to many team members as they made the difficult choice to stay home. We had to figure out how to deliver health care in this new world, where PPE was not widely available, and so many questions lingered about the virus. I had to put the needs of patients, staff, and my children before my own. That's what we all do as mothers and as physicians. I underestimated how long the sacrifices would last. I watched my schedule increase from three days of patient care to five, along with running the business and managing employees, recording podcasts, and holding educational events. We run a health care business to educate, advocate for, and empower our patients. Yet, in the midst of all this, here I was at the helm, the unhealthiest I had ever been. I had abdominal pain, insomnia, anxiety. I had walked away from working out and was not careful about the food I was choosing to put into my body." Somi Javaid is an obstetrician-gynecologist and founder and CEO, HERmd. She shares her story and discusses her KevinMD article, "How I lost sight of my own health care while creating a women's health care company." (https://www.kevinmd.com/blog/2021/02/how-i-lost-sight-of-my-own-health-care-while-creating-a-womens-health-care-company.html)

"We can't escape shame. But don't despair, dear reader, because shame resilience can be cultivated. There are mental-fitness skills that can be learned which are self-perpetuating. I taught myself these skills and, in doing so, healed my own wounds – you can, too. Once you have the skills to recognize and manage shame in a healthy way, you'll no longer be held hostage by the perceived need to betray yourself by pretending to be someone other than who you are. An enormous weight is lifted, and the world feels safer when viewed through a lens of self-trust. There's no better investment you can make in yourself." Tracey O'Connell is a radiologist and physician coach. She can be reached at her self-titled site, Tracey O'Connell, M.D. She shares her story and discusses her KevinMD article, "Why we deny our imperfections in medicine." (https://www.kevinmd.com/blog/2021/04/no-one-taught-us-the-skills-to-cope-with-feeling-bad-about-ourselves.html)

"There were many things to be processed about that event. It happened within the context of the COVID-19 pandemic, its disproportional effects on the African American community, and a few days after the murder of George Floyd, an African American man killed at the hands of a Minneapolis police officer by asphyxiation. His murder was the third in a row of recent and widely publicized, unjust killings around the country. First, Ahmaud Arbery; second, Breonna Taylor; and third, George Floyd — all within a few short months. Their deaths sparked a social zeitgeist that exposed America's divisions and systemic racism at a level we haven't seen in a long time." Toba Bolaji is a surgery resident and can be reached on Twitter @tobabolaji. He shares his story and discusses his KevinMD article, "The day my patient called me the N-word." (https://www.kevinmd.com/blog/2021/03/the-day-my-patient-called-me-the-n-word.html)

"We created a core team of individuals from different levels and functions who met daily. This team's purpose was to receive and synthesize department-wide information and transform it into new ways of working for our doctors, nurses, ancillary, and support staff. We had a compelling vision which was shared with our department. We made it clear to everyone that they were supported and valued and that we would do everything we could to save as many lives as possible. We knew the importance of making sure that our staff felt heard, and we communicated our change while building upon the positive in our department. We used the facts in combination with the sentiment and feedback received from our co-workers prior to making decisions." Josh Schwarzbaum is an emergency physician. He shares his story and discusses his KevinMD article, "How COVID accelerates change: Bridging business principles with emergency medicine." (https://www.kevinmd.com/blog/2021/01/how-covid-accelerates-change-bridging-business-principles-with-emergency-medicine.html)

"Where do we go from here? Conventional wisdom suggests that we can only transform ourselves. This is why I propose that we attempt to recognize the Trump that lies within each of us and to heal him. We are plagued not just by the pandemic but by the human condition—and no part of us should be left behind. We often persuade ourselves we have outsmarted the Leviathan by traveling to a far-off land, only to find that the beast followed by sea, swimming clumsily but steadily along in our wake." Beck Ballentine is an internal medicine physician. She shares her story and discusses her KevinMD article, "Recognize the Trump that lies within each of us and try to heal him." (https://www.kevinmd.com/blog/2020/11/recognize-the-trump-that-lies-within-each-of-us-and-try-to-heal-him.html)

"Social connectedness is the remedy to the COVID fatigue that is running rampant in the United States. We need to stay connected to those we love. At the same time, we must also recognize that life is going on in the age of COVID-19, which means what happened to Mariana is occurring in all of our communities. Vulnerable populations need our help, and in our case, NSRN is working to be there for them through this uncertain time. We encourage all Americans to seek out opportunities to become more socially connected through volunteering. There are opportunities all across the country to provide much-needed support both remotely and in person. Just giving a little of your time can be a game-changing decision for people like Mariana, especially during the upcoming holiday season." Ashten Duncan is a medical student. He shares his story and discusses his KevinMD article, "Social connectedness, volunteerism, and the remedy for COVID fatigue." (https://www.kevinmd.com/blog/2020/12/social-connectedness-volunteerism-and-the-remedy-for-covid-fatigue.html)

"As I leaned against the pristine wall, my vision suddenly dimmed. Everything turned gray. I gulped for air. My arms and legs went numb. I felt that drowning sensation I'd had in third grade when a nun pushed my head between my legs to keep me from fainting in church on a brutally hot June day. Or like the time when I was eight months pregnant, took a hot shower at the university gym, and almost belly-flopped onto the concrete floor. I prayed that I wouldn't pass out on my first day of medical school classes. I didn't want those MDs-to-be, all smarter and younger than I, to know I couldn't handle this, that I didn't belong." Anne McTiernan is an internal medicine physician and epidemiologist. She is the author of Cured: A Doctor's Journey from Panic to Peace. She shares her story and discusses her KevinMD article, "A panic attack brought on by the stress of medical school." (https://www.kevinmd.com/blog/2021/02/a-panic-attack-brought-on-by-the-stress-of-medical-school.html)

"Clinicians want specific things from a pathology consultation. They want a short turnaround time and a clear and coherent report, which can be discussed with the patient and correlates with the clinical findings. Unfortunately, this does not always come to pass, particularly with some smaller or disrupted specimens, resulting from minimally invasive surgery. It takes a cultural change to reach that balance between what pathology and pathologists are, and what the perception about the field is. Medicine has changed dramatically in recent years regarding disease understanding and test diagnosis. In the past year, pathologists played a crucial part during the COVID-19 pandemic and the laboratory medicine field has taken huge responsibility in our hospitals to support every clinical department. Addressing the pathologist's role on the patient care team should be addressed in medical school early on." Albert Alhatem is a pathology resident. He shares his story and discusses the KevinMD article, "Is pathology an ATM machine?" (https://www.kevinmd.com/blog/2021/01/is-pathology-an-atm-machine.html)

"Yoga therapy differs from contemporary yoga in that the profession has a defined scope of practice based on educational standards and accreditation requirements for training schools and yoga therapists. In dealing with pain conditions, certified yoga therapists possess understanding and knowledge of pain theories and pain physiology and may collaborate with a patient's health care team to develop an individualized care plan. While pain and musculoskeletal conditions represent the most common reasons for referral, yoga therapists may also see clients with chronic conditions, such as diabetes, heart disease, post-traumatic stress disorder, and addiction." Jaime Lewis is an internal medicine and palliative care physician. She shares her story and discusses her KevinMD article, "Recommending yoga to your patients? Consider this first." (https://www.kevinmd.com/blog/2021/02/recommending-yoga-to-your-patients-consider-this-first.html)

"We eventually got the news that Dr. Rathburn had hung himself from one of those beautiful trees that the wind made dance. How sad. It adds to my own grief. Who had found him? How did he look? Babies born with a nuchal cord have the cord wrapped around their neck. That's the closest I have seen to a hanging. I once delivered a baby who had it wrapped around three times, and by the time he was born, his little face looked bloated and bruised, tongue swollen and sticking out, and he had petechiae (small dots of microscopic veins that burst) on his face. I wonder if he looked similar. Did he have petechiae? How would even do that? I wish I knew. I wish I had said goodbye. I wish the image of him shuffling by me would leave my head. Would every warm and beautiful summer afternoon with the tree limbs dancing remind me of him; of this place; of this horrible feeling? That was something to look forward to. At least I was thinking of a future. That had not been possible just a few short weeks ago. When it's dark, it is bleak, like black silence and extraordinary effort to move and operate the body. The pain of my empty feeling heart and just holding my head on my neck seemed unbearable at times. Right, I am here, and I am feeling better. At least the empty blackness is gone most of the time. I light another cigarette. It's better than crying. Dr. Rathburn, you haunt me still. I was so close. It could have been me." Robyn Alley-Hay is an obstetrician-gynecologist and physician coach. She can be reached at her self-titled site, Dr. Robyn Alley-Hay. She shares her story and discusses her KevinMD article, "A physician hung himself. That could have been me." (https://www.kevinmd.com/blog/2021/01/a-physician-hung-himself-that-could-have-been-me.html)

"Why else should a person become a doctor? Because there is always something to learn. Because holding someone's hand when they're scared is a profound gift that feels as good to give as it does to receive. Because your job will call on you to be brave, honest, and the best human you can be. Because you can work with people who are as devoted to and optimistic about our fellow humans as you are. Because you can choose your patient populations, your clinical settings, the procedures that you do, and the way that you practice. So, yes, good luck, young friend. Keep your focus on what brings you joy, and pursue that. You'll be great at it." Rebekah Rollston is a family physician. She shares her story and discusses the KevinMD article, "So you want to be a doctor? Here are 10 truths." (https://www.kevinmd.com/blog/2020/09/so-you-want-to-be-a-doctor-here-are-10-truths.html)

"I firmly believe that if physicians leveraged themselves and their knowledge of medicine, there would be no need to for them to undertake ventures in the fields that they know little about. The old adage goes like this: Physician, heal thyself. I call on my fellow physicians to heal themselves by dropping the cloak of victimhood and taking charge of their professional and personal destiny. We all spent years in medical school, residency, and for many, fellowship to become experts in our field. Let's apply that expertise and regain control of the practice of medicine by understanding the business of medicine in order to secure the integrity of medical practice and our financial future. If I could do this, so can everyone else. Audentes Fortuna Juvat." Sandra R. Weitz is an anesthesiologist. She shares her story and discusses her KevinMD article, "Fortune favors the bold: How a physician lives up to that motto." (https://www.kevinmd.com/blog/2020/10/fortune-favors-the-bold-how-a-physician-lives-up-to-that-motto.html)

"The hospital systems ignored us by putting us lowest on the totem pole for the COVID vaccine. The pharmaceutical companies overlooked the strains on us and increased our vaccine prices. The medical supply companies took advantage of us by limiting our supplies and increasing prices astronomically. Worst of all, the insurance companies (knowing we are already the lowest reimbursed field) changed coding and billing requirements and reimbursements in 2021, ultimately decreasing our reimbursements even further. So now we are paid even lower than we were prior to the pandemic." Jamie S. Hutton is a pediatrician. She shares her story and discusses her KevinMD article, "Being a pediatrician in a pandemic." (https://www.kevinmd.com/blog/2021/01/being-a-pediatrician-in-a-pandemic.html)

"As members of the health care workforce, we must recognize the crucial role we play in influencing vaccine uptake. With the death toll over rising in the U.S., the stakes could not be higher as the final death count will hinge on how quickly we can translate the vaccine's efficacy into real-world effectiveness through optimizing uptake. We should aim to increase vaccine uptake at 'warp speed.' Now is the time to harness the power of social media to combat disinformation. Now is the time to use creative content to put an end to this pandemic. This is our lane. Will you join us in this fight?" Emmanuel Ohuabunwa is an emergency medicine resident. He shares his story and discusses the KevinMD article, "COVID-19 vaccine and disinformation: How health care providers can leverage social media to combat this trend." (https://www.kevinmd.com/blog/2020/12/covid-19-vaccine-and-disinformation-how-health-care-providers-can-leverage-social-media-to-combat-this-trend.html)

"Dr. Good's willing intervention and active interest in my development kept me in medical school and led me to become an academic anesthesiologist. When his career took a turn toward administration, his mentor, Dr. J. S. Gravenstein, took over. He convinced me to stay at the University of Florida, and a couple of years later, when I mentioned a need for a good introductory anesthesia textbook geared to medical students, he suggested we co-write one. So we did. Writing Essential Anesthesia: From Science to Practice together was an incredible journey. Not just through selecting topics and writing and choosing diagrams and writing and working with publishers and proofs and reviews, but through his innumerable stories about the evolution of anesthesia during his career and the story of his remarkable life. But that's a topic for another article, or a full-length book, or series, on its own. Sadly, Dr. J. S. Gravenstein did not live to see the publication of the 2nd Edition of our book. Instead, two of his sons wrote it with me. But Dr. Gravenstein made me into the educator I became." Tammy Euliano is an anesthesiologist and author of Fatal Intent. She shares her story and discusses her KevinMD article, "The inestimable value of a mentor." (https://www.kevinmd.com/blog/2021/02/the-inestimable-value-of-a-mentor.html)

"I realized that training in psychiatry would give me the opportunity to understand suicide far better, and hopefully allow me to make a difference at an earlier stage. My exposure to psychiatry in medical school was clearly not enough. I was ill-equipped to fully grasp when individuals begin to have thoughts of suicide and when those thoughts progress into planning or researching methods – and then acting on them. As I thought back to the numbers of dead-on-arrival patients that I attended to in Detroit – dead by overdoses, self-inflicted gunshot wounds or stabbings, electrocution, asphyxia, drowning or jumping from tall buildings – I knew that I wanted to do more than pronounce people and fill out death certificates. Becoming a psychiatrist could help me save some of these despairing souls." Michael F. Myers is a psychiatrist and author of Becoming a Doctors' Doctor: A Memoir. He shares his story and discusses his KevinMD article, "Training in psychiatry would give me the opportunity to understand suicide far better." (https://www.kevinmd.com/blog/2021/01/training-in-psychiatry-would-give-me-the-opportunity-to-understand-suicide-far-better.html)

"Medical professionals face uniquely challenging pressures. Our work itself is extremely demanding, and always has high stakes for those we care for. External circumstances that impact our work carry uncertainties that add more stress. Constantly feeling targeted as the financial solutions to greater health system issues compounds our burden. While some choose to talk about their struggles openly, many stay silent and suffer in solitude. There is reluctance to share for fear of being judged negatively in some way. This culture of silence is harmful, and it works against medical professionals' wellness. It is time that we address our difficulties head-on." Nina Ahuja is an ophthalmologist and author of Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond. She shares her story and discusses her KevinMD article, "The culture of silence works against medical professionals' wellness." (https://www.kevinmd.com/blog/2021/02/the-culture-of-silence-works-against-medical-professionals-wellness.html)

"I hope being a parent will now equip me to be a better pediatrician. I hope I can teach them whatever I know about safe sleeping, breastfeeding, and newborn care, but I also hope to acknowledge the reality and struggles of parenting. I hope my statements and recommendations do not sound generic and rehearsed. I hope I can tell them every child is different and will not follow the book. I hope I can be more understanding and empathetic towards the angry and worried parents and applaud them all for what an amazing job they are doing. I hope they can remember me as a friendly face who understands their struggles and not just their doctor who tells them what to do." Saba Fatima is a pediatric hospitalist. She shares her story and discusses her KevinMD article, "Being a pediatrician did not prepare me for parenting." (https://www.kevinmd.com/blog/2021/01/being-a-pediatrician-did-not-prepare-me-for-parenting.html)