The Podcast by 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)

"As I approached retirement from medical practice, I had an epiphany to take up writing and attended the Harvard CME course on Writing, Publishing, and Social Media for Healthcare Professionals. I met some extraordinary people working in the health care universe who wanted to share their insights. Through my writing as an advocate for patients and physicians on popular social media platforms, I landed a new job. I was recruited by the CEO of a health care startup to become the director of digital health communications. Sharing my experiences as a physician and helping tell the stories of the many professionals with whom I collaborate, I feel a new sense of pride in the work that I do. I am no longer personally delivering medical care, but I know what physicians go through. I intend to make their insights known to a broader audience than might be heard in grand rounds at a hospital. That is my new mission, communicating the connection between patients and physicians, a relationship that requires trust above all else. It's never too late." Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor's Prescription for a Post-Pandemic America. He shares his story and discusses his KevinMD article, "It's never too late for physicians to change directions and land new jobs." (https://www.kevinmd.com/blog/2021/02/its-never-too-late-for-physicians-to-change-directions-and-land-new-jobs.html)

"As if COVID-19 weren't bad enough during the pandemic, another public health crisis – substance use disorder (SUD) – has gone from bad to worse, while access to behavioral health services is shrinking. As of September, more than half (52%) of community behavioral health organizations have seen an increase in demand for services, and half of those that offer SUD services saw their demand jump in the previous three months. At the same time, due to lack of revenue or pandemic-related restrictions, 65% have had to cancel programs, reschedule, or turn patients away. Nearly 40% of these organizations reported they may not last six months, given the revenue shortfalls." Nishi Rawat is a critical care and emergency physician. She shares her story and discusses her KevinMD article, "The COVID-19 vaccine won't solve major substance use disorder treatment gaps." (https://www.kevinmd.com/blog/2020/12/the-covid-19-vaccine-wont-solve-major-substance-use-disorder-treatment-gaps.html)

"With my natural affinity for numbers, I analyzed the reviews' precise impact after a few years, and the results were astounding. The system generated over $225,000 during a 3-year period. My practice acquired 162 new 5-star reviews on Google, and my partner and I generated over 200 5-star reviews on Yelp. I calculated that each 5-star review was 'worth' over $900 to my practice in the form of new referrals, and the overall return on investment was 1,900 percent. Needless to say, it was a huge success." Orrin Franko is an orthopedic surgeon and hand specialist. He shares his story and discusses his KevinMD article, "How 5-star reviews generated over $225,000 in revenue for my practice." (https://www.kevinmd.com/blog/2021/01/how-5-star-reviews-generated-over-225000-in-revenue-for-my-practice.html)

"You're a clinician. You had a patient die under your care, and now your hospital is being sued. You are not named in the lawsuit, but you are being asked to give a deposition. How much of your time is this going to take? If some lawyer sends you thousands of pages to review before scheduling multiple phone calls and prep sessions and, finally, a deposition under oath … what do you say? What is your obligation to testify in court as a scientific expert?" Judy Melinek is a forensic pathologist and CEO, PathologyExpert Inc. She shares her story and discusses her KevinMD article, "What to do when physicians get subpoenaed as witnesses." (https://www.kevinmd.com/blog/2019/07/what-to-do-when-physicians-get-subpoenaed-as-witnesses.html)

"If you are happy with where you are in the current system – that is wonderful, continue what you are doing. However, if you are feeling trapped, frustrated, or like the work you are doing is no longer meaningful, then there are plenty of opportunities for you to get out of the system. Start looking at your options – start learning about them and looking for opportunities now. Whether you end up deciding on an alternative clinical career, a nonclinical career within medicine, or a career outside of medicine altogether – you have the skills you need to succeed as long as you are persistent. There are options if you want to stay employed and opportunities to start your own business. The critical thinking skills, listening skills, and drive to succeed that you need to survive training to become a physician can help you create a career that will support you and your family and allow you to live a fulfilling life. The first step is to start." Nithya Natrajan is a family physician and can be reached at Blossoming Mamas. She shares her story and discusses her KevinMD article, "How this physician escaped the system." (https://www.kevinmd.com/blog/2021/02/how-this-physician-escaped-the-system.html)

"When faced with an existential crisis, any organization, as large as a nation or as small as a marriage, will go one of two ways. Either it will bond together, coalesced in a common purpose, or it will collapse in a spasm of blame and shame. While our health care institutions displayed the inestimable value of coalescence, our political leaders demonstrated the catastrophic impact of divisiveness. And our national statistics confirm the result. More than a half million deaths to date from a preventable pandemic. Is there any hope for our nation? Can we learn an important lesson from the health care industry? Can we find the will to coalesce as health professionals have done? I believe we can. We have done so many times in our history, and the current administration is already displaying a penchant for facing the truth, learning from science, and promoting the collaboration needed to overcome our common foe. Coalescence. Let's support our leaders in this welcome change." Nate Link is chief medical officer, Bellevue Hospital, New York City, NY, and author of The Ailing Nation: Lessons from the Bedside for America's Leaders. He shares his story and discusses his KevinMD article, "Responding to the COVID pandemic: a lesson in coalescence." (https://www.kevinmd.com/blog/2021/02/responding-to-the-covid-pandemic-a-lesson-in-coalescence.html)

"Coffee in hand, I decided to try and collect my thoughts. I realized that a large portion of the literature we grew up reading has in many ways tried to implant this subconscious bias that contributes to gender disparities and these ideas about women that have continued to ruminate throughout parts of society to this day. Literature in and of itself is a reflection of the times in which it is and was written. Sadly, examples of stark contrasts in comportment, demeanor, and overall health and well-being amongst men and women are nowadays ever-present and are all around us. It is of paramount importance that we as physicians now take a step back and analyze how subconscious bias affects us in all aspects of medicine." Theodore Klug is a clinical research fellow. He shares his story and discusses the KevinMD article, "Gender disparities in medicine: How popular literature mirrors 2020 society." (https://www.kevinmd.com/blog/2021/02/gender-disparities-in-medicine-how-popular-literature-mirrors-2020-society.html)

"When a patient is dissatisfied with his or her care, he or she can consult an attorney, who will enlist a physician 'expert' to determine if a doctor has deviated from the standard of care and whether that deviation caused a negative outcome. Over the past decade of reviewing cases involving medical malpractice, I have identified five categories of medical error, which has improved how I care for my patients." Scott Choi is a gastroenterologist. He shares his story and discusses his KevinMD article, "How reviewing medical malpractice claims made me a better gastroenterologist." (https://www.kevinmd.com/blog/2021/04/how-reviewing-medical-malpractice-claims-made-me-a-better-gastroenterologist.html)

"The corporatization of medicine has destroyed primary care as a specialty. The primary care physician is supposed to be your go-to doctor, your advocate, the coordinator of your health care. Now that corporations buy out hospitals and private practices in an almost predatory fashion, the priority is turning a profit for the corporation at the expense of not only patient health but also the health and well-being of the primary care physician. Who do you think bears the brunt of patient frustration and public misconception? The PCP." Alexis Gopal is an internal medicine physician and can be reached at Vitality Medicine of New York. She shares her story and discusses her KevinMD article, "Rest in peace, primary care." (https://www.kevinmd.com/blog/2021/01/rest-in-peace-primary-care.html)

"For physicians who lack experience in end-of-life counseling, the process can be daunting at the beginning. However, they can be confident that once they have obtained the proper training, preparation, and experience, these conversations will be among the most fulfilling of their careers. By regarding end-of-life planning as a shared responsibility, physicians can become more well-rounded professionally and help patients conquer their most profound fears. It's time to start the conversation." Caroline DeFilippo is an internal medicine physician. She shares her story and discusses her KevinMD article, "End-of-life conversations: Why physicians should embrace the responsibility." (https://www.kevinmd.com/blog/2020/11/end-of-life-conversations-why-physicians-should-embrace-the-responsibility.html)

"Nowadays, I go on long walks through the city alone. I make dinner for one. When I go on bike rides, it's a solo activity. I find comfort in myself, slowing down and making every small occasion a simple, peaceful one. I have a stronger sense of self, and through that, I have rekindled the fire that I felt during my first years of being in medicine. When I return home from the hospital, I don't dive into the distraction of another person. Now, I write daily journal entries that help get my heart on a page, where I can set it aside and leave it be for some time before revisiting it. I put music on in my apartment, and dance and dance and dance. My new self-soothing methods aren't perfect (none are), but at least they are now focused on nurturing and strengthening myself. No distractions, just facing my feelings head-on. It's an art I am starting to get the hang of." Fae Kayarian is a medical scribe. She shares her story and discusses her KevinMD article, "Falling in love during a pandemic: a lesson in self-soothing." (https://www.kevinmd.com/blog/2021/01/falling-in-love-during-a-pandemic-a-lesson-in-self-soothing.html)

"Every professional I have done the exercise with admitted that their ideal patient was inspired by someone they were close to in their personal life. It was usually a family member, a best friend, or themselves. The ones who carry the most unbearable sufferings-the kind that reminds us of ourselves and our loved ones most likely would become our "ideal patients." After all, our compassion for others' aches comes from understanding our own pain. We heal to be healed. Healing's mutualism continues to amaze me every day. It's a gesture of kindness and love that elevates both the giver and the receiver." Tedi Zeng is an acupuncturist. She shares her story and discusses her KevinMD article, "Who is the ideal patient?" (https://www.kevinmd.com/blog/2021/01/who-is-the-ideal-patient.html)

"The science of complexity lays a conceptual foundation for understanding "complex adaptive systems." What all complex adaptive systems have in common is that they are all bound by the same set of physical laws. Their "behavior," i.e., growth, maintenance, and death, can all be described using the same set of mathematical relationships. These systems (animals, plants, ecosystems, etc.) are the most productive and functionally effective systems known to man. Unfortunately, our health care system has not been bound by the same physical laws and mathematical relationships as other complex adaptive systems. Thus, it has not been able to implement the same mechanisms that our ecosystems and cells have in order to obtain optimization in their ability to perform a function. This is most blatantly highlighted by the fact that 100,000 to 400,000 (depending on the source) Americans die each year due to medical errors." Robert Trent is a graduate student. He shares his story and discusses his KevinMD article, "What role does the science of complexity play in medicine?" (https://www.kevinmd.com/blog/2019/08/what-role-does-the-science-of-complexity-play-in-medicine.html)

"As health professionals, we have the platform to enact change within our own institutions, as well as local and federal governments. We must elect leaders and officials who spearhead climate action. We must reduce the carbon footprint of healthcare. And we must educate our colleagues and our patients about the impact of climate change on health. We need every single one of us to take action. Our patients' health depends on it." Sarah Hsu is a medical student. She shares her story and discusses the KevinMD article, "5 things medical professionals can do to take climate action." (https://www.kevinmd.com/blog/2020/10/5-things-medical-professionals-can-do-to-take-climate-action.html)

"Instead of focusing on one organ system, I want to know everything. The diagnostic challenge is to discern patterns of insults, symptoms, and lab tests that correlate with specific microbes, specific organ dysfunction, specific diet issues, and environmental exposures. We keep asking questions until we detect patterns in the chronically ill patient that correlate with any number of overlapping issues such as infections, hormone deficiencies, immune dysregulation, toxic exposures, and diminished capacity to detoxify. And then we explore the interrelationship of all these problems. Differentiation then integration." Daniel Kinderlehrer is a physician and author of Recovery from Lyme Disease: The Integrative Medicine Guide to Diagnosing and Treating Tick-Borne Illness. He shares his story and discusses his KevinMD article, "Our work as physicians and healers is to see the whole patient." (https://www.kevinmd.com/blog/2021/03/our-work-as-physicians-and-healers-is-to-see-the-whole-patient.html)

"Suicide is a path, whether fast or slow, that a person chooses to take because of their own reasons. We certainly can never predict suicide or truly understand it. But with that said, every time it happens, it is a tragic loss of life that time can and will never heal. We must do more to support our physicians in training, residents, and established clinicians. Like how we sit at the bedside with patients and listen to their stories, someone needs to listen to what doctors have to say. This is an epidemic that we must address right now. We must shine a light on the underpinnings of stress, dissatisfaction, grief, guilt, and pain. And we must drag out of the shadows a broken healthcare system that burdens many of our physicians. It starts with making it OK to talk about suicide and to foster an environment where it is safe for medical students and physicians to share their stories privately and publicly. We absolutely must create safe spaces for conversations to be had at all levels of medical education." Ton La, Jr. is a medical student and can be reached on LinkedIn. He shares his story and discusses his KevinMD article, "Physician suicide: We need safe spaces to talk about it." (https://www.kevinmd.com/blog/2021/03/physician-suicide-we-need-safe-spaces-to-talk-about-it.html)

"Our relationship with Big Pharma is a dangerous, nasty, and abusive one, and it can prove to be fatal too. Benzos aren't limited to a specific class, race, gender, creed, etc. Many stars have died from mixing benzodiazepines with opioids or illegal drugs. It has been a little over a year that I have been off of Klonopin, and I'm happy to report that most of my withdrawal symptoms are gone. I handle stress better now, and I feel emotions more deeply and genuinely. Please be patient with the process and with yourself. It gets better, I promise." Bethany Silverman is a writer. She shares her story and discusses her KevinMD article, "My Klonopin withdrawal story." (https://www.kevinmd.com/blog/2021/01/my-klonopin-withdrawal-story.html)

"Had I understood the nature of my struggles and felt permitted and supported in actively addressing them, I would have been more effective, a better learner, and more fulfilled. After trying out a few clinical settings, a lot of reading, and some much-needed coaching, I found my identity as a healthy, inspired physician. Eventually, by setting boundaries and understanding my patterns, I discovered what I needed to thrive. So, maybe we need to reimagine medical education. From medical school onward, physician education and training should be conceptualized as a career-long process supporting the holistic development of life-long learners, leaders, and healers. Certainly, there has got to be a better way than my circuitous, self-designed, and at times, painful and exhausting pathway." Tracy Asamoah is a child and adolescent psychiatrist and can be reached at Tracy Asamoah Coaching. She shares her story and discusses her KevinMD article, "It's time to focus medical education on training the whole person." (https://www.kevinmd.com/blog/2021/01/its-time-to-focus-medical-education-on-training-the-whole-person.html)

"Dr. Fauci navigated the delicate balance between his obligation to the American people as one of our most respected physician-scientists and holding on to his job in a federal government whose leader doesn't take kindly to independent thought that potentially upstages his own. Dr. Fauci not only survived multiple appearances on the national stage with Trump, as the task force morphed into charade, but he even emerged as a popular folk hero, all the while maintaining his status as a respected medical authority. Despite having ample opportunity to confront the president on his misinformation, Dr. Fauci focused his unwavering attention on mitigation of the virus, refuting Trump's often puzzling and sometimes harmful pronouncements, without even having to directly acknowledge them." Michael Miyamoto is a cardiologist. He shares his story and discusses his KevinMD article, "Dealing with a bad boss: lessons from Dr. Fauci." (https://www.kevinmd.com/blog/2021/01/dealing-with-a-bad-boss-lessons-from-dr-fauci.html)

"I am a nurse who has worked at a rural hospital. My husband is a board-certified family medicine doctor. In the fall of 2020, I was raped by my massage therapist. I know that everyone has an opinion of what they would do in that situation, and I was probably one of those people. However, to my complete shock (quite literally), I didn't behave in any manner that I would have thought. Much to my embarrassment, I was a nurse who had no idea what to do when I was raped on top of the previously mentioned humiliation." The guest is an anonymous nurse who shares her story and discusses her KevinMD article, "There needs to be a better approach to victims of sexual violence." (https://www.kevinmd.com/blog/2020/12/there-needs-to-be-a-better-approach-to-victims-of-sexual-violence.html)

"When the public was made aware of the risk of transmitting the virus and the far-reaching measures of social distancing, closing schools, and lock-down, most Americans willingly complied. After all, they became aware, for the first time, of the risk of aerosolized viral particles present in theatres, churches, restaurants, and classrooms. But we physicians already knew that. We knew that when we went into the operating room or the bedside to repair a laceration in the emergency department, we wore masks to protect our patients from the microorganisms living in our noses and mouths. We already knew that the spread of norovirus and other food-borne illness can be mitigated by the use of hand-washing and the use of sanitizing cleaners. Physicians already knew that the world was a rather naïve and scary place in terms of infectious disease." Joan Naidorf is an emergency physician. She shares her story and discusses her KevinMD article, "Influenza: a deadly risk in schools before COVID." (https://www.kevinmd.com/blog/2021/03/influenza-a-deadly-risk-in-schools-before-covid.html)

"Now the room is silent as if nothing at all occurred. I stand watching the red stain forming on the pristine white sheet, mocking me in my failure. I trained at excellent institutions, survived residency, and served in combat. Now, here at a Level 1 trauma center, I could not save this life with every possible medical tool at my disposal. This injury, this particular injury, always has, and forever will, haunt my dreams. The hubris to think that I could be the difference, that I am better than those who came before me, was answered tonight, as it has been before, by this deserved slap in the face. I absorb the charged silence; my mind wanders back to my third year of medical school. I was doing well, a moderate prodigy of the medical department. I was ready for every conference, every patient, well-read and well prepared, until that fateful day." Richard Morand is a trauma surgeon. Melissa Fournier is a social worker. They are, respectively, contribute and co-editor, The Healer's Burden: Stories and Poems of Professional Grief. They share their stories and discuss the KevinMD article, "I could not save this life with every possible medical tool at my disposal." (https://www.kevinmd.com/blog/2020/11/i-could-not-save-this-life-with-every-possible-medical-tool-at-my-disposal.html)

"I really shouldn't complain. I haven't lost my housing or job. I have plenty of food and toilet paper, and so far, no close friend or family have died from COVID. That said, this pandemic is hard. In fact, it is exhausting. During the spring and summer, I gave positive COVID results to a number of patients from my home's safety, thanks to telehealth. But the reality of telling patients how to self-quarantine when six people live in two rooms with one bathroom, or giving resources about food and other basics because the household provider lost a job, or can't work because s/he is COVID positive, is tough. Tough on the recipient of the advice and tough on me." Therese Zink is a family physician and can be reached at her self-titled site, ThereseZink.com. She is the author of COVID Chronicles: How Essential Workers Cope. She shares her story and discusses her KevinMD article, "The long journey of COVID." (https://www.kevinmd.com/blog/2020/11/the-long-journey-of-covid.html)

"It is dangerously unfortunate that the use of masks has been politicized in many parts of our nation. The Dakotas (or North and South COVID as they were recently called on Saturday Night Live) are far from exempt from this phenomenon. Likely, if Governor Burgum's decision was less influenced by fear of criticism from his constituents and political retaliation, he would have required a mask mandate long before making it acceptable for infected individuals to leave their home. Masks have time and again proven to be safe and effective. It's not a big ask." Sheetal Khedkar Rao is an internal medicine physician. She shares her story and discusses her KevinMD article, "The problem with allowing COVID-positive health care workers to continue working." (https://www.kevinmd.com/blog/2020/11/the-problem-with-allowing-covid-positive-health-care-workers-to-continue-working.html)

"If PCPs want to meet the new competition from virtual primary care plans, I suggest that they gradually increase the percentage of their visits that they do through telehealth. Now that payers are reimbursing those visits at the same level as in-person visits, they have nothing to lose financially. Of course, there are some ancillary services that might be performed in their offices, such as lab tests, X-rays or bone density scans. But PCPs could order some of these when patients came in for visits, and they could also reduce their spending on staff and office space if they saw fewer patients in-house. Such a move would represent a big change for PCPs. But they've already adopted telehealth to a much greater extent than ever before. A fuller embrace of the technology could help them survive financially, and it might even improve chronic disease care if virtual follow-ups were combined with regular office visits." Ken Terry is a journalist and author of Physician-Led Health Care Reform: A New Approach to Medicare for All. He shares his story and discusses his KevinMD article, "PCPs could counter virtual plans by increasing telehealth visits." (https://www.kevinmd.com/blog/2021/03/pcps-could-counter-virtual-plans-by-increasing-telehealth-visits.html)