The Podcast by KevinMD

"Looking back on these words at the end of my rotation, I understand what I had felt, and I feel confident naming it: the futility of medicine. We can comfort and treat patients, but there's nothing more we can do after a certain point. As a bright-eyed medical student who wrote on all her medical school applications that she wanted to save lives, it was and still is difficult for me to understand that." Shereen Jeyakumar is a medical student. She shares her story and discusses her KevinMD article, "My first end-of-life conversation." (https://www.kevinmd.com/blog/2020/12/my-first-end-of-life-conversation.html)

"Motherhood has been the biggest gamble of my adult life thus far. How was I going to operate for 12-plus hours while 39-weeks pregnant? Where would I be when I went into labor? How would was I going to return after three weeks? How would I pump during and in between OR cases? I did it. It certainly wasn't easy. And I would do it all over. My son is beautiful and healthy. I've never been prouder of anything I've ever done. He is the first thing I think about in the morning and the last thing I think about at night. He's made me a better clinician and surgeon." Lauren A. Umstattd is a facial plastic surgery fellow. She shares her story and discusses her KevinMD article, "Advice to a pregnant surgical resident." (https://www.kevinmd.com/blog/2019/10/advice-to-a-pregnant-surgical-resident.html)

"COVID-19 disproportionately impacts those with pre-existing conditions, and our health care system leaves one in five Americans with a pre-existing condition uninsured. Further, with multiple COVID-19 vaccines already in early but slow distribution, attaining universal coverage is critical, particularly in light of uninsurance having an inverse relationship with vaccination rates. President Biden will need to act with a legislative urgency that matches these times to pass a public option. With two-thirds of the country approving President Biden's handling of the transition, now is his opportunity. He may just need to take a few pages out of the 'Johnson treatment' playbook in crafting the 'Biden treatment.'" Jonathan Staloff is a family medicine resident and can be reached on Twitter @jonstaloff. He shares his story and discusses his KevinMD article, "How President Biden's quest for a public option mirrors LBJ's passage of Medicare and Medicaid." (https://www.kevinmd.com/blog/2021/01/how-president-bidens-quest-for-a-public-option-mirrors-lbjs-passage-of-medicare-and-medicaid.html)

"The patient knocking on your door is not your enemy. They're sick. They're scared. They're in pain. They don't know why, and they're hoping for an answer. If you can't find the source of a problem quickly, it doesn't mean it's not there." Denise Reich is a patient advocate. She shares her story and discusses her KevinMD article, "Patients don't need quick diagnoses. They need accurate ones." (https://www.kevinmd.com/blog/2021/01/patients-dont-need-quick-diagnoses-they-need-accurate-ones.html)

"I can tell you what I don't want to do. I don't want to mill through 50 patients a day, mindlessly clicking through EMR checkboxes so an insurance auditor five states away will deem that I've done my job and deserve reimbursement. That's a high volume, high overhead game, and I don't want to play it. I recently spoke with a doctor who was getting so many insurance denials that they needed to hire 14 additional billers at an estimated cost of somewhere around half a million dollars a year. Insurance companies want to make it difficult for doctors to get paid. They will only add more hoops to jump through, meaning that I need to hire more hoop jumpers as a doctor. Hiring hoop jumpers costs a lot of money, which means I need to see more patients. Seeing more patients in the same amount of time leads to shorter visits and worse care. Not to mention the pressure from hospital administrators to "expand your indications," or in layman's terms, operate on someone who may not really need it." Daniel Paull is an orthopedic surgeon. He shares his story and discusses his KevinMD article, "I am an orthopedic surgeon who decided to stop taking insurance." (https://www.kevinmd.com/blog/2021/01/i-am-an-orthopedic-surgeon-who-decided-to-stop-taking-insurance.html)

"Humanities can be seen as part of the fabric, society, and culture of human experience. In many ways, they might be seen as the disciplines that make us human and make life meaningful. They broadly encompass ancient and modern languages, literature, philosophy, religion, visual and performing arts, such as music and theater. Even more expansively, they may also include, amongst others, history, archaeology, anthropology, law, and linguistics. These diverse fields explore and foster empathy, compassion, beauty, joy, awe, love, reasoning, tolerance, curiosity, possibility, community. Are we richer as human beings or physicians without this education, or are we abandoning ourselves to the loneliness, sadness, and despair of a more sterile, rigid, negative, and dysfunctional way of thinking?" Jacqueline Huntly is a family physician and physician coach. She shares her story and discusses her KevinMD article, "Medicine for the soul: Harness the power of the humanities to counteract burnout." (https://www.kevinmd.com/blog/2020/11/medicine-for-the-soul-harness-the-power-of-the-humanities-to-counteract-burnout.html)

"Most residents are young, often in their mid to late 20s, having spent years ensconced in libraries, research labs, and classrooms learning pathophysiology and pharmacology. Upon graduation from medical school, they are now drafted to the front lines of a generational pandemic, working long hours, often in cities where they are strangers (the process of "matching" into a residency program is one where residents are not in full control of their destiny or geography). They do so while putting their own health in jeopardy. The resident's experience of the COVID-19 pandemic has been unlike any other, because on average, residents spend almost twice as much time at work as other providers. Residents are allowed to work 80 hours a week on balance, which means it's fine to log 90 hours in the ICU if the following week is a mere 70." John P. Murray is an internal medicine physician. He shares his story and discusses his KevinMD article, "In gratitude to our nation's residents." (https://www.kevinmd.com/blog/2021/01/in-gratitude-to-our-nations-residents.html)

"Keep it Simple is a bumper sticker slogan. Life during a pandemic has been anything but simple, and the holiday season presents (not the gift kind) its own special challenges. So does living alone and trying to stay humanized. In his book Together: The Healing Power of Human Connection in a Sometimes Lonely World, Surgeon General-elect Vivek Murphy describes loneliness as associated with increased risk of mental and health difficulties in the BC era (before COVID-19). All the more so within such a challenging year of physical separation and trying to maintain a connection with others, with ourselves. So much angst, uncertainty, loss … And yet … here we are poised at the brink of a new year with vaccines being distributed and a true sense of hope and healing. We're medical educators who teach health professions students and professionals about resilience and adapting to adversity, but here we are, needing to walk the talk. Big-time. We met via Zoom for a Virtual Tea to share about our lives and not just our work. There was some laughter, the best medicine. And we reflected on negotiating living alone and the stuff of life that sustains, even enriches. Daily "little sparks of joy" can help. We offer you our "21 for '21" and hope the simple can be profound." Hedy S. Wald is a clinical professor of family medicine, Warren Alpert Medical School, Brown University, Providence, RI. She can be reached on Twitter @hedy_wald. Monica van de Ridder is an assistant professor, College of Human Medicine, Michigan State University/Spectrum Health, Grand Rapids MI. She can be reached on Twitter @MvdRidder. They share their stories and discuss their KevinMD article, "21 for '21: little sparks of joy." (https://www.kevinmd.com/blog/2020/12/21-for-21-little-sparks-of-joy.html)

"Lights, camera, action! You get a call from your hospital's public relations office asking you to speak to the local news. Even though this isn't your first time, your heart is pounding, with a mix of nerves and excitement. You start doubting whether you have anything valuable to say about the topic, even though, yes – you went through many years of medical school and residency before this moment. You are also worried about how to avoid looking foolish or unprofessional on-air. Or worse, how to avoid having your words taken out of context. No? OK, then maybe that's just me. There are still some key tips and tricks you should know to optimize your performance." Tyeese L. Gaines is an emergency physician and branding and media coach. She shares her story and discusses her KevinMD article, "8 things physicians should know before they're interviewed by the media." (https://www.kevinmd.com/blog/2020/12/8-things-physicians-should-know-before-theyre-interviewed-by-the-media.html)

"Ultimately, patient care is at the center of medicine and is the main reason many physicians chose to go into the field. A good understanding of the business side of medicine and personal finance can help future physicians focus on just that. There are plenty of options when it comes to how we can begin to integrate these topics into medical education. There are clear benefits that come with learning these skills, and many students are eager to do so. We need more medical schools to integrate these subjects into their curriculums, and students who are given the opportunity to gain this knowledge can become more well-rounded physicians as a result." Martinus Megalla is a medical student. He shares his story and discusses his KevinMD article, "Why medical students should be taught the business side of medicine." (https://www.kevinmd.com/blog/2020/07/why-medical-students-should-be-taught-the-business-side-of-medicine.html)

"There should be no grades in medical school. Forty-something percent of applicants get accepted to one or more medical schools. To even apply to medical school, one needs to have not only graduated or be on track to graduate college, but also needs to have passed the MCAT and have the support of a pre-medical application committee. I am no mathematician, but I do not think that it is a stretch to say that less than 10 percent of those who wanted to go to medical school on their first day of college do, in fact, end up matriculating into medical school." Adam Lieber is a medical student. He shares his story and discusses his KevinMD article, "End medical school grades." (https://www.kevinmd.com/blog/2021/01/end-medical-school-grades.html)

"Have you ever watched a movie, television show, or read a book where the villain is a medical doctor? If you are a psychiatrist, you will be alarmed by how many times the villain in these stories turns out to be a psychiatrist. In all fairness, psychiatry has had its share of blunders. However, in recent years psychiatry has made a significant effort to enhance the use of evidence-based medicine and procedures. The diagnostic criteria for mental disorders continue to be revised and updated regularly. New medications and procedures are developing at an increasingly rapid rate. With all of the advances in the field, why does popular media continue to represent psychiatry as a barbaric field with poor patient outcomes and medications/treatments that do not work?" Garrett Rossi is a psychiatry resident who blogs at Shrinks in Sneakers. He shares his story and discusses his KevinMD article, "Film and television continue to depict psychiatrists as heartless swindlers." (https://www.kevinmd.com/blog/2020/10/film-and-television-continue-to-depict-psychiatrists-as-heartless-swindlers.html)

"As a Black physician, I urge you to consider taking the COVID-19 vaccine when it becomes available to you. Vaccines save lives. Preventing poor outcomes, as in death, is an exciting effect of this vaccine. I will be first in line when it is offered to me, and I hope to see you in line next to me. Masked up, of course." Erkeda DeRouen is a family physician and can be reached at her self-titled site, Dr Erkeda DeRouen. She shares her story and discusses her KevinMD article, "A letter to Black America for those who do not want to take the COVID-19 vaccine." (https://www.kevinmd.com/blog/2020/12/a-letter-to-black-america-for-those-who-do-not-want-to-take-the-covid-19-vaccine.html)

"It is not enough to say we are anti-racist; we have to modify our systems to recognize that we have placed individuals of color at risk of poorer outcomes. Lack of insurance, lack of finances, or even the presence of certain diagnoses may reflect less about the person and more about our society, our infrastructure, and our systems. As members of smaller communities and a larger society, we must make adjustments in our attitudes and knowledge as well as the services we provide to individuals who have experienced harm by insidious but ever-present racist structures. Glaring disparities in treatment aren't only happening in protests. They are happening in all of society, and in our hospitals. Only when we address systemic racism will we be able to realize the ethical imperatives of safe and equitable health care for all." Jane Gagliardi is an internal medicine physician and a psychiatrist. She shares her story and discusses her KevinMD article, "It is not enough to say we are anti-racist. We must address glaring disparities in treatment." (https://www.kevinmd.com/blog/2021/01/it-is-not-enough-to-say-we-are-anti-racist-we-must-address-glaring-disparities-in-treatment.html)

"Just a few seconds after the needle penetrated my arm, I felt a mild soreness, kind of like a flu shot. But as I sat for the required 15 minutes of observation time, a wave of something engulfed my body. It was such a strange, unfamiliar sensation that I didn't realize what was happening. I looked around the room at the other medical personnel getting their shots, and no one seemed to pay me any attention. I wasn't changing color, short of breath, or breaking out into a sweat. I did harbor reservations about the safety of this new vaccine that seemed rushed to market. Was I about to become a statistic in the next FDA safety bulletin? It seemed like forever, but finally, I divined what was happening to me. I felt different inside. A fundamental change had occurred deep within my body. I sensed that others in the room experienced a similar feeling. I struggled to recall the name of the emotion. It had been so long. It was happiness." Andrew N. Wilner is a neurologist. He shares his story and discusses his KevinMD article, "An unexpected COVID-19 vaccine side effect." (https://www.kevinmd.com/blog/2021/01/an-unexpected-covid-19-vaccine-side-effect.html)

"Many colleagues in medicine already talk about medicine never going back to its state pre-COVID-19 – be it telehealth for patients, new flexibility to work/life scheduling, or a new acceptance of telecommuting outside of direct patient care. There has been too much suffering as a result of the COVID-19 pandemic and stressors of 2020 to progress through 2021 and beyond without lessons learned. New recognition of the need to broaden the definition of what 'counts' in careers, be it in health care or beyond, along with a means to articulate that, must be a lasting outcome of our nation's response to the pandemic if we want to avoid losing more of our best and brightest in these fields." Avital O'Glasser is an internal medicine physician. She shares her story and discusses her KevinMD article, "The COVID-19 pandemic brought many new challenges in medicine. A novel tool may help to overcome some of them." (https://www.kevinmd.com/blog/2021/02/the-covid-19-pandemic-brought-many-new-challenges-in-medicine-a-novel-tool-may-help-to-overcome-some-of-them.html)

"The tragedy that's happening in medicine today is that the loss of respect and the constant threats to fair payment are making physicians regret that they ever chose medicine. They were fascinated with science and wanted to help people, and their reward is insult. It's no wonder that some newly trained physicians leave anesthesiology quickly; there's little risk to running a hangover clinic in Las Vegas. Many physicians from all specialties get MBAs because they see that the real rewards in healthcare lie in becoming a CEO. Look at the salaries of top executives: the CEO of Anthem made more than $14 million in 2018, as an example, while insurance companies did everything they could to avoid or delay signing fair contracts and paying clinical physicians for patient care. There is a growing shortage of physicians, not just in primary care but in specialties too. The American Association of Medical Colleges (AAMC) estimates that the U.S. will be desperately seeking surgeons in the next 10 to 12 years, and looking for more anesthesiologists to work with them. As older physicians retire, and younger ones aren't willing to work the long hours that used to be routine, this will only get worse, while increasing numbers of older Americans will need more complex medical care. Maybe your barber will learn to operate on you, just like the barber surgeons of old, and your local gun store will sell you a bullet to bite on. Best of luck." Karen S. Sibert is an anesthesiologist who blogs at A Penned Point. She shares her story and discusses her KevinMD article, "Keep insulting doctors, and good luck finding a physician in 10 years." (https://www.kevinmd.com/blog/2020/01/keep-insulting-doctors-and-good-luck-finding-a-physician-in-10-years.html)

"This is our call to action. I have the experience, knowledge, expertise, and deep passion for teaching every medical student these skills. I cannot do it alone. I need you. We need to do this together. I am seeking those of you who are caring, innovative clear thinkers involved in medical school curriculum creation. We owe it to our physician seedlings. We owe it to their future patients. Who out there can now see 20/20? It is time to change the culture of medicine and focus on prevention. I am 100 percent in. Who is with me?" Robyn Tiger is a radiologist and can be reached at Stress Free MD. She shares her story and discusses her KevinMD article, "The Rx we were never taught to write." (https://www.kevinmd.com/blog/2021/01/the-rx-we-were-never-taught-to-write.html)

"We need full transparency and empowerment of patients and doctors to make wise decisions. We must renew and restore the sanctity of the patient-doctor relationship. We need to stop pretending that health care can be 'free,' stop calling premium price prepaid care 'insurance,' and use market forces like choice and competition to cut our bloated costs. 'Insurance' needs to 'insure' against the unexpected, not pay for the routine. I am a proud independent physician. Taking care of patients is what I know. It is what I do best. Get the government and the insurance company out of my exam room and let us all do what we do best. Patients will be the ultimate winners." Mary Tipton is an internal medicine-pediatrics physician. She shares her story and discusses her KevinMD article, "Why socialized health care is not right for America." (https://www.kevinmd.com/blog/2020/10/why-socialized-health-care-is-not-right-for-america.html)

"Health care delivery will always be inherently unpredictable and challenging. Those drawn to medicine are among our most resilient, but the current landscape reveals acutely a rise in burnout that exceeded acceptable levels even before the COVID-19 outbreak. Such innate resilience in clinicians and clinical care teams is an individual and strategic asset worthy of recognition, protection, and system-wide approaches that nurture and potentiate it. Such system-wide advocacy serves to proactively promote the vitality of health care delivery, quality of care, individual and group purpose, life-work satisfaction, and balance. Ultimately, these all are recognized as antidotes to burnout." Pennie Sempell is an attorney and co-founder and CEO, StressPal. She shares her story and discusses the KevinMD article, "Persistent stressors and resilience: a new way forward for health care communities." (https://www.kevinmd.com/blog/2020/12/persistent-stressors-and-resilience-a-new-way-forward-for-health-care-communities.html)

"This is not what I signed up for. Have you ever said this when you are rushing home 1.5 hours after the last patient left and you still haven't finished all your charting? You grab a handful of forms to take home with you with the hopeful expectation that you will get them done tonight too. After you have done 'enough' to appear to be a present parent and prepared supper and said goodnight to the kids, that is. You sink into the couch at the end of the household rush with the guilty constant 'should be' invading your every breath. I should be finishing my notes. I should go empty that inbox. I should tackle one or two of those forms. But your body feels heavy, and your couch entraps you with its soft embrace, you open Facebook and disappear." Sarah J. Smith is a family physician and can be reached at the Charting Coach. She shares her story and discusses her KevinMD article, "You didn't sign up for this. You don't have to drown in the paperwork." (https://www.kevinmd.com/blog/2021/01/you-didnt-sign-up-for-this-you-dont-have-to-drown-in-the-paperwork.html)

"I now say getting divorced was one of the best things that ever happened to me. Through that painful circumstance, I rediscovered me. I learned more about myself and my ability to do hard things than at any point in my life since medical training. I'm not the same person that I was before my divorce, and that's OK. I'm more confident, decisive, and self-assured. Those are all qualities that not only benefit me, but benefit my patients as well. Because of my divorce, my patients now get Dr. Trina Dorrah, version 2.0, and we are all better off because of that." Trina E. Dorrah is an internal medicine physician and can be reached at Dr Trina Dorrah Life Coaching. She shares her story and discusses her KevinMD article, "How divorce helped this physician." (https://www.kevinmd.com/blog/2021/02/how-divorce-helped-this-physician.html)

"One of the best solutions to rising obesity and non-communicable disease rates lie in primary care. Medical professionals can influence the U.S. food system indirectly through demand and collective purchasing power by educating their patients to choose and purchase healthier options. Merely improving nutrition education succeeds in shifting people's thinking about food. Simultaneous with the WHO's declaration of the Decade of Action on Nutrition is the "food is medicine" movement that has been growing in response to mounting evidence that a nutritionally-sound diet and access to quality foods improve health outcomes. The theory behind food is medicine is that food is a preventative public health system. This movement includes prescription meals to people with multiple chronic conditions and low income, food delivery services, and community food quality assessment. So far, the food is medicine solution has proven cost-effective, and one study reported a 16 percent reduction in health care costs in meal recipients. We know that widening health disparities are partially diet-dependent. Integrating nutrition into primary care is really a social necessity. Just as everyone should have access to medical care, all Americans should have equal access to proper nutritional guidance and nutritious food." Melinda Mesmer is an internal medicine physician. She shares her story and discusses her KevinMD article, "Put nutrition counseling in primary care." (https://www.kevinmd.com/blog/2020/10/put-nutrition-counseling-in-primary-care.html)

"I have closed my practice, but I have no plans to retire at the age of 52. I have started the journey to become a high school science teacher. There are frequent internet postings and blogs by physicians with strategies to retire young. I suspect that many of us, not near traditional retirement age, still desire to work. At this point, I do not yet have a passion for traveling the world or for driving around the country in an RV like many former physicians. Furthermore, I still have two children who are not yet college age. I enjoy working, and I fear mental stagnation were I to retire at this point. Currently, I am pursuing a Master of Arts in Teaching degree. From pre-school through hand fellowship, I have had 28 years of formal education. It is time for me to reciprocate and to honor the extraordinary minds of my teachers and mentors. I am excited to become a high school teacher. I was a chemistry major in college, and it will be a smooth transition to teach high school science. I judge success not by financial wealth, but by contributing to the community and finding happiness in life. I don't miss my pager." Timothy Bill is a plastic surgeon. He shares his story and discusses his KevinMD article, "Why this plastic surgeon closed his practice to become a high school science teacher." (https://www.kevinmd.com/blog/2020/12/why-this-plastic-surgeon-closed-his-practice-to-become-a-high-school-science-teacher.html)

"Definitions ground us in our profession and in our world. Definitions matter because they help us pause, give our body a moment to settle, and our breath time to move in and out. Our racist actions, inactions, and comments are invasive throughout our waking hours, but we can change them if we can define them. Racist. Anti-racist. Microaggression. Institutional racism. Don't let the words keep you tense. Let's move forward together and breathe." Joy Eberhardt De Master is a pediatrician. She shares her story and discusses her KevinMD article, "Racist. Anti-racist. Microaggression. Institutional racism. The power of a definition." (https://www.kevinmd.com/blog/2020/12/racist-anti-racist-microaggression-institutional-racism-the-power-of-a-definition.html)

"The good news is that imposter syndrome can be quieted with increased awareness and replacing negative internal messages with positive ones. In our work together, I helped Sheila identify the voices, understand the positive role the voices fill (and there is always a positive or protective role), and find specific mechanisms for turning down the volume. Imposter syndrome may crop up again, but she now has a toolkit to quiet the intrusive thoughts and move ahead with confidence. Not only is Sheila now waking up without dread, she's explored several career paths and settled on one that she's excited about. You don't need to stay imprisoned in the dank dungeon of imposter syndrome. With the right tools, freedom is possible. Think of all you can accomplish, and how much lighter you will feel, when a more positive set of voices fills your head." Here's a questionnaire to assess imposter syndrome. (https://paulineroseclance.com/pdf/IPTestandscoring.pdf) Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon. She shares her story and discusses her KevinMD article, "Solving imposter syndrome in physicians." (https://www.kevinmd.com/blog/2020/12/solving-imposter-syndrome-in-physicians.html)

"In the world of medicine, inordinate stress is instead accepted as just part of the job. If you can't handle the heat, get out of the kitchen- or see a therapist on your own time and dime. I strongly believe that traditional therapy and psychiatry are vital and valuable disciplines- I might not be here without them. But not everyone who needs help living through this crisis (or pre-coronavirus life) is mentally ill or needs a diagnosis in order to qualify for guidance and support. No one should have to go through this pandemic, or life itself, alone. Literally or metaphorically. Not even doctors. As we wait for scientists to develop a vaccine and improve the reliability of testing, it is a good time to confront the obvious: in order to come out intact, healthy and whole on the other side of this pandemic, we are going to have to build our emotional intelligence and learn how to be vulnerable again. The only way to heal is to feel." 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, "Vulnerability is challenging but necessary for health care professionals." (https://www.kevinmd.com/blog/2020/05/vulnerability-is-challenging-but-necessary-for-health-care-professionals.html)

"As a young girl, I'd stand on my tiptoes, craning my neck to watch her sweep cerulean eye shadow across lids and smear foundation on sunken cheeks. While my high school friends resorted to secondhand eye shadow instruction from the pages of Teen magazine, I learned by watching my mom transform the face of a corpse with her skilled makeup application. My mother's gentle and methodical lipstick application entranced me. Back and forth. Slowly outlining the cupid's bow of a mouth. Delicately tracing of the arch in a feathery eyebrow. Until, wondrously, the corpse's vacant mask appeared serenely lifelike. With her artistry complete, no one could spot the thin line of super glue keeping the embalmed lips from springing open, or the plastic eye caps that gave the appearance of eyeballs peacefully resting in sockets. As I grew older, I pondered their last moments before this transition. What was the final word they spoke? Who received their last hug? What were they thinking when they realized their mortal roller-coaster ride was coming to a full and complete stop?" Lara Salyer is a family physician and author of Right Brain Rescue: One physician's journey from burnout to bliss reveals the creative muse in all of us. (https://amzn.to/3bw5XiQ) She shares her story and discusses her KevinMD article, "One physician's journey from burnout to bliss reveals the creative muse in all of us." (https://www.kevinmd.com/blog/2020/10/one-physicians-journey-from-burnout-to-bliss-reveals-the-creative-muse-in-all-of-us.html)

"I just started laughing. It was early on Monday morning during our COVID surge. I couldn't help myself. Phones were not on yet, but I already had triage COVID calls. "Put on your roller skates" was all I was thinking. I questioned my laughter. The day and a life of a primary care physician during COVID. Not a fun one by any means. Certainly not one to laugh at. But, if we don't laugh, we would cry. Everyone knows that cliche. Our days never end. We don't leave. The EMR has made sure of that. The nurses and staff are expected to smile and be respectful. They have, in fact, been so amazing during this pandemic. They have shown up every day with smiles on their faces." Kelly Lisciandro is an internal medicine physician. She shares her story and discusses her KevinMD article, "Why do I laugh during a pandemic?" (https://www.kevinmd.com/blog/2021/01/why-do-i-laugh-during-a-pandemic.html)

"As a professional woman who most identifies as a physician more than any other title, I know that I run the risk of losing myself to this disease. I am not ignorant to the risk. I understand that my identity is supposed to be separate from my achievements and that my babies are supposed to make me value something greater than my career. But my oath runs through me in a way that I can only describe as visceral. And for this reason, the pain is that much worse. Because as much as I miss them. And as much as I miss me. I can't not keep going. Because they deserve the best we have to offer. And those of us who have stood here on the front lines for over 10 months know more than anyone else, that if we don't do it, then who will?" Nicole M. King is an anesthesiologist. She shares her story and discusses her KevinMD article, "I keep going because I miss them. And I miss me." (https://www.kevinmd.com/blog/2021/01/i-keep-going-because-i-miss-them-and-i-miss-me.html)

"Research conducted by the Center for Talent Innovation (CTI), a nonprofit research organization in New York, defines the three pillars of executive presence (EP) as gravitas, communication, and image. Stated differently, EP reflects how you act, how you speak, and how you look. CTI concluded that when people are perceived as capable of becoming leaders, they are more likely to be promoted into leadership roles. This is particularly important for aspiring female leaders who continue to battle both conscious and unconscious gender bias. Studies show that men are more often associated with leadership qualities and women with nurturing qualities. This forces women to confront the need to master an intricate balancing act that simultaneously conveys both softness and strength." Nandita C. Gupta is a cardiologist. She shares her story and discusses her KevinMD article, "Executive presence for women leaders." (https://www.kevinmd.com/blog/2020/10/executive-presence-for-women-leaders.html)

"I am grateful that I work in a small rural hospital that is like a family. I am grateful that my organization has done everything in its power to protect us… but I hope we can do better. I hope medical workers have enough left within them to give their all for the coming months. Now we are in November with cases on the rise throughout the country: I hope we are more prepared. As the medical community, we do everything we can to protect our patients, our loved ones, and ourselves. Life in the emergency department during COVID has been some of the most emotionally and physically taxing of my career, but I remain optimistic that there is hope." Andrew Tisser is an emergency physician. He shares his story and discusses his KevinMD article, "Life in the emergency department during COVID: a rural physician's perspective." (https://www.kevinmd.com/blog/2020/11/life-in-the-emergency-department-during-covid-a-rural-physicians-perspective.html)

"Let's meet in the middle and listen to what's happening in communities. All across U.S. communities, there are pockets of promise and programs focused on family interventions, behavior change, and health disparities, but there are many obstacles to true change. Currently, the work relies on visionary champions within a community, but when the champion leaves the work, the work often goes away. There is a lack of resources on every level, from public health, research, primary care, specialty care, and advocacy, especially to sustain and scale effective efforts. The burden of sustainability must not be placed on one champion's shoulders, but rather viewed as an opportunity for sustainability and must be a shared effort among multiple partners representing multiple sectors." Karla Lester is a pediatrician. She shares her story and discusses the KevinMD article, "When it comes to weight stigma in children and teens, let's meet in the middle." (https://www.kevinmd.com/blog/2020/12/when-it-comes-to-weight-stigma-in-children-and-teens-lets-meet-in-the-middle.html)

"When you're applying to medical school, it's remarkable how much four years or more of intense work can come down to one single day. The medical school interview is high stakes: studies have found that interview performance is the most important factor in admissions decisions. While your MCAT score and your GPA can help secure an interview invitation, it's your interview performance that matters most when it comes to acceptance to medical school. I've advised many students who are prepping for their interviews, and what I've found is that overall they're great about avoiding certain common mistakes. They practice their handshake, know what to wear, and already researched the school's interview format. But I've found that many talented and highly accomplished applicants still make several other (very common) mistakes in their interview preparation." Rajani Katta is a dermatologist and author of Conquer the Medical School Interview and The Successful Match. She shares her story and discusses her KevinMD article, "5 common and commonly overlooked mistakes in the medical school interview." (https://www.kevinmd.com/blog/2020/11/5-common-and-commonly-overlooked-mistakes-in-the-medical-school-interview.html)

"Despite forces not within our control, namely the thoughts and actions of others, headway has been made in my local practice area: the decline in mortality, the advances in clinical knowledge about the pathophysiology, more efficient testing, more PPE, an uprooting and great revealing of the need for prioritization of health care worker wellness, the impact of stress and isolation on health, the magnification of health care disparities, racism, and sexism, an opportunity for the interweaving connection of humanity for some, along with the stark divisiveness that continues to exist. But we get to choose how this pandemic plays out for us. I choose extreme caution, gratitude for this opportunity for temporary seclusion, an opportunity to recharge while reconnecting. I wait in the uncertainty." Ni-Cheng Liang is a pulmonary physician and founder, the Mindful Healthcare Collective. She shares her story and discusses her KevinMD article, "A physician waits in uncertainty." (https://www.kevinmd.com/blog/2020/11/a-physician-waits-in-uncertainty.html)

"At the start of the pandemic when hospitals were overrun, testing and PPE were scarce, and unknowns about COVID-19 transmission abound, such restrictions were reasonable, perhaps even essential. But we have made progress since then; most hospitals test most if not all admitted patients for COVID-19; most Americans own a mask, and hospitals are able to provide to those without one. We must still take reasonable precautions. Allowing only one visitor at bedside, placing restrictions on movement of visitors throughout the hospital, and ensuring they practice social distancing from other hospital staff. With this, we can maintain patient and staff safety but also prioritize a part of care that is currently being undervalued. And as hospitals and cities across the country continue to try and get a handle on the pandemic, we must also continually re-examine what aspects of care we determine to be essential and must preserve in some way. And we must realize that family at the bedside is part of that essential care our patients need to heal." Taimur Safder is a cardiology fellow. He shares his story and discusses his KevinMD article, "It's time to end draconian hospital visitation policies during COVID-19." (https://www.kevinmd.com/blog/2021/02/its-time-to-end-draconian-hospital-visitation-policies-during-covid-19.html)

"A scientific achievement can never have success on its own unless if it has acceptance in the social context by the masses. I think that the concerns brought forward by the vaccine-doubters cannot be dismissed as ignorance, and it is hard to convince people. As a physician, it is not uncommon that I see a patient become indecisive and anxious about various treatment decisions facing them. I don't shy away from asking them to put their faith in me as their physician at moments like this. There is a simple strategy that makes the decision-making relatively easier, and that is to think of each patient as your own family member and recommend to them what you would want done if they were your own mother or grandfather. When presented this way, it usually goes very well with the patient, and a bond of trust is built, which ends up in successful care for the patient. I would say the same thing to a vaccine-doubter. If I am being vaccinated myself as a health care worker and if I agree to vaccinate my children, please trust me that you should do the same." Farhan S. Imran is a hematology-oncology physician. He shares his story and discusses his KevinMD article, "What this physician says to vaccine-doubters." (https://www.kevinmd.com/blog/2020/12/what-this-physician-says-to-vaccine-doubters.html)

"The rapid change-over to telemedicine in March of 2020 brought predictable challenges to health care at large and substance use disorder treatment in particular: patients without the skill set to navigate HIPAA-compliant apps, phones with too little smarts to handle video conferencing, lack of connectivity in rural and economically depressed areas. But telemedicine brought unexpected benefits: the no-show rate plummeted. Patients were more empowered by their own motivation to engage in care than limited by bus schedules' vagaries. Suboptimal face-to-face interactions among individuals in the throes of addiction (otherwise known as "mayhem in the parking lot") ceased immediately. Most of all, telemedicine mitigates the stigma associated with substance use treatment." Julie Craig is an addiction medicine specialist. She shares her story and discusses her KevinMD article, "Telemedicine reduces the stigma in substance use disorder patients." (https://www.kevinmd.com/blog/2020/12/telemedicine-reduces-the-stigma-in-substance-use-disorder-patients.html)

"While behavioral health integration (BHI) has been a long-standing conversation in collaborative care or health's team-based approach, it hasn't always been clearly defined and rarely means more than referring a patient in need to a specialist. The biggest shift over the past twenty years has simply been recognizing just how vital behavioral health is to overall wellness. To effectively and efficiently achieve true BHI, we must engage people in the digital age we currently live in. This modernization begins with innovative technology at its core to drive connected care." Chris Molaro is a health care entrepreneur and CEO, Neuroflow. He shares his story and discusses his KevinMD article, "Pandemic or not, we're failing patients when it comes to behavioral health." (https://www.kevinmd.com/blog/2020/11/pandemic-or-not-were-failing-patients-when-it-comes-to-behavioral-health.html)

"When we think about holistic medicine, many assume that it requires human-to-human touch points and, therefore, doesn't lend itself well to technology and innovations such as artificial intelligence. In fact, holistic medicine and whole-person care advocates often view technology as manufactured or impersonal and therefore dismiss its utility for health care. This is because there is a perception that health care tech values the human experience only for the purpose of developing better widgets or to refine machine learning algorithms. As a result, it can be difficult to envision high-tech holistic medicine that is supported by a whole-person care model. Nevertheless, I see a future where both technology and holistic medicine can complement each other for the advancement of whole-person care." Trisha Swift is a health care executive. She shares her story and discusses her KevinMD article, "The future of whole-person care: high-tech holistic medicine." (https://www.kevinmd.com/blog/2020/08/the-future-of-whole-person-care-high-tech-holistic-medicine.html)

"I would encourage you to see amazing women on social media for who they are in the future. Maybe figure out where they have been and what they are working toward. Maybe even figure out how ways to help each other solve the problems this country faces. Instead of looking at someone's appearance, listen to their story. You got unlucky with me; you can't intimidate someone who has lived through the war. I'm hoping that you choose to go in a more professional direction with the next woman you message because of these words. We are not transactions. We are intelligent, determined, passionate, and persistent people. It's far better to be our ally than our foe." Kellie Lease Stecher is an obstetrician-gynecologist. She shares her story and discusses her KevinMD article, "When a colleague asks you for nude photos." (https://www.kevinmd.com/blog/2021/01/when-a-colleague-asks-you-for-nude-photos.html)

"Yearly physicals are usually afforded a longer time than regular visits. If I can use most of that time focusing the discussion on what a healthy life means to each of my patients and what they need to achieve it, I feel that I've accomplished more than doing palpation, range of motion, and auscultation. Discussing medications and finding opportunities for de-prescribing, and discussing annual routine labs' futility is also an equally important and welcome part of my yearly rituals. As our population ages and we are faced with more chronic diseases, our goal is to maximize our patients' abilities to function, relate to family and community, and live a life of purpose. Expanding the visit to discuss health status, strengths, weaknesses, and goals is a good time investment in achieving healthier people and enriching our relationship with patients. For my part, it also adds joy and purpose to my life." Alina Urriola is a family physician. She shares her story and discusses her KevinMD article, "What are your health goals for the coming year?" (https://www.kevinmd.com/blog/2021/01/what-are-your-health-goals-for-the-coming-year.html)

"For a vaccination campaign to be highly effective, we need to be open to having difficult conversations with people who disagree with our perspective. If we don't, the result will be a polarization of philosophical ideas and not an unbiased and unemotional assessment of the data where maybe we can meet in the middle. As we share our pictures and experiences regarding getting our vaccines, let's try to admit what we know and, more importantly, what we don't know. Let's not speak down to those who have questions. And let's not be afraid to say that maybe we are a little afraid ourselves of some of these unknowns but that we are willing to take the potential risk of getting a vaccine because over the past then months, there are a few more knowns about the actual virus that scare us even more. Happy conscientious and kind posting." Alicia Billington is a plastic surgeon. She shares her story and discusses her KevinMD article, "The COVID vaccine selfie: The caption matters as much as the picture." (https://www.kevinmd.com/blog/2020/12/the-covid-vaccine-selfie-the-caption-matters-as-much-as-the-picture.html)

"In addition to being a pediatrician, I am Jewish and the granddaughter of a sole Holocaust survivor. My grandfather's family perished in Auschwitz, a concentration camp in Poland. My grandfather alone escaped, skiing through the night, to his safety and ultimate survival. The request from my hospital, the presidential debate, and the seeming dismissal of parentless children reminds me of a quote from Elie Wiesel, a Nobel Prize-winning writer, and Holocaust survivor. "What hurts the victim most is not the cruelty of the oppressor, but the silence of the bystander." I will not tone it down. I will not be silent. I believe a medical institution that is dedicated to the well-being of all people would not ask me to do otherwise." Ariana Witkin is a pediatrician. She shares her story and discusses her KevinMD article, "Why politics has a place in medicine." (https://www.kevinmd.com/blog/2020/10/why-politics-has-a-place-in-medicine.html)

"There is a unique non-clinical consulting opportunity any physician can learn to do full-time, as part of your existing practice, or in lieu of retiring. I'm Dr. Armin Feldman, and I'm a full-time medical-legal consultant in legal cases. A little over 13 years ago, I started and now, through the years, have been refining a new subspecialty of forensic medicine. I've trained over 1,600 physicians to do this consulting work. When doctors and lawyers think about lawyers hiring doctors, they only think of one thing: Hiring doctors to be expert witnesses. It's important to know, you won't act as a medical expert, and you won't participate in medical malpractice cases. There is a big difference between a medical-legal consultant and a medical expert witness in legal matters. In fact, they are two completely different things." Armin Feldman is a medical consultant to attorneys. He shares his story and discusses his KevinMD article, "An introduction to medical-legal consulting." (https://www.kevinmd.com/blog/2020/12/an-introduction-to-medical-legal-consulting.html)

"Children cannot afford to wait, especially our youngest learners who have difficulty engaging on a screen. We need to all work together to help schools reopen, especially in low-income communities that are disproportionately suffering and may lack the resources. I stand with the AAP, CDC, European CDC, WHO, and UNICEF to support safe school re-opening." Lekha M. Rao is a pediatric neurologist. She shares her story and discusses her KevinMD article, "Children cannot afford to wait: We need to all work together to help schools reopen." (https://www.kevinmd.com/blog/post-author/lekha-m-rao)

"We, as a profession, must accept some blame for many of the developing problems in health care delivery. No, I am not suggesting that we caused the problem. I am stating that we have had ample opportunities to manage the debacle and even to reverse some of the disturbing trends, yet we rarely allow our voices to be heard. Is health care reform impossible? It certainly isn't. But we, as doctors, need to step up to the plate, to stand up to the growing bureaucracy in the system, and make sure our voices are heard. The change will be long, slow, and painful, but we can't allow the system to continue to swallow us whole. The change must come from us." Alejandro Badia is an orthopedic surgeon and author of Healthcare from the Trenches. He can be reached at Healthcare from the Trenches and on Facebook and Instagram @badiahandtoshouldercenter. He shares his story and discusses his KevinMD article, "Health care from the trenches: Change must come from us." (https://www.kevinmd.com/blog/2020/10/health-care-from-the-trenches-change-must-come-from-us.html)

"Many friends have asked for my perspective on the COVID vaccine. Answering this requires both an explanation of clinical trials and an understanding of what normally slows down pharmaceutical development. Importantly, COVID vaccines are required to go through the same process as every other pharmaceutical. Vaccination is a personal choice, but I 100 percent recommend it. Personally, I can't wait to get vaccinated and am so grateful to the thousands of heroes who made this possible." Alexandra Fairchok is a medical student. She shares her story and discusses her KevinMD article, "Why can I trust the COVID vaccine?" (https://www.kevinmd.com/blog/2020/12/why-can-i-trust-the-covid-vaccine.html)

"With 2020 behind us and the pandemic still raging, it is incumbent upon us to take a close look in the rear-view mirror. While the vaccines' approval gives us all hope, the vaccination initiative's slow rollout should worry us. Physicians, health care providers, nurses, and essential workers, and patients and family members have borne the brunt of the pandemic. On the last count, about 3,000 health care workers had lost their lives due to COVID-19. The toll that the pandemic is wrecking on the health care community's emotional and mental health is only starting to become apparent. Health care systems, local, state, and federal governments have responded in different ways to ease the pandemic burden. While we can debate the level and adequacy of the response, we may have a larger problem on our hands if we fail to learn lessons and make the necessary changes going forward. I want to offer my perspective on the changes that physicians and health care providers should pursue that would allow us to emerge stronger." Manish Thapar is a gastroenterologist. He shares his story and discusses his KevinMD article, "2020 in hindsight: What we can learn." (https://www.kevinmd.com/blog/2021/01/2020-in-hindsight-what-we-can-learn.html)

"There is a frenzy of trying to use technology to re-establish the healing human connection in the doctor-patient interaction. These efforts range from advanced transcription of voice-to-record, scribes who do the data recording during a patient encounter, and so on. The IT department at NYU Grossman Medical School, where I teach, worked with the dominant and much-loathed electronic medical record to create a patient-focused dashboard for each doctor. The dashboard both improved quality of outcomes and reduced costs. These attempts are useful, but they don't address the root cause of this inhuman encounter: billing, the link of patient data to cash. In each of these tech improvements, the doctor is still forced by the money-people to massage the bill for the highest private insurance payments. There is a war across the screen — and like all wars, it's about money. On one side, doctors are forced by the accountants to bill the most. On the other side, insurance people are striving to pay the least. No 'program' or 'bot' could do this job. It's trapping doctors in the epidemic called burnout, moral injury, or just plain abuse. Forcing us to lie, to provide maximum payment. So long Hippocratic Oath. I think the solution is obvious. Why are VA hospitals' electronic medical record systems widely preferred to any of the other ones out there? Because they are not-for-profit billing machines. All across the U.S., each VA diagnosis and treatment has approximately the same reimbursement. No war across the screen. No Hippocratic hypocrisy." Samuel Shem is a psychiatrist. He shares his story and discusses his books, the House of God (https://amzn.to/3cVEOZc) and Man's 4th Best Hospital. (https://amzn.to/3rFUhAH)