The Podcast by KevinMD

"There are roughly 221 million people — including 48 million kids — in states where marijuana has been named a medicine. These include patients who suffer from depression and could see their symptoms worsen. Mothers who could give birth to babies with low birth weights. Children who could face an increased risk of addiction, depression, and suicide. We must allow our citizens to make informed choices. A page on a website, a label on a box. The platforms exist. It's time we use them properly." Erik Messamore is a psychiatrist and can be reached on Twitter @ErikMessamoreMD and LinkedIn. He shares his story and discusses his KevinMD article, "Many medical marijuana program websites are silent about possible risks." (https://www.kevinmd.com/blog/2020/08/many-medical-marijuana-program-websites-are-silent-about-possible-risks.html)

"While Imperial County faces a confluence of vulnerabilities that have led to its susceptibility during COVID-19, it is not alone. Like an insidious undercurrent, these deficiencies are lurking in every region of the United States. Structural issues require structural solutions—to effectively contain COVID-19, our local, state, and federal leaders must address these underlying faults in the foundation of the systems which we rely on to maintain our personal and public health. As COVID-19 continues to aptly demonstrate, when the health of part of our community is imperiled, we are all imperiled." Eric Rafla-Yuan is a psychiatrist. He shares his story and discusses the KevinMD article that he co-wrote, "A Southern California outbreak highlights failures of the American health care system." (https://www.kevinmd.com/blog/2020/08/a-southern-california-outbreak-highlights-failures-of-the-american-health-care-system.html)

"Physicians are steeped in a noxious culture that seems to be averse to creating healthy physicians. We ignore mountains of evidence that show exercise, sleep, and healthy eating is beneficial for cognitive function, learning, and performance — all aspects that physicians should optimize. But the current medical training system pushes physicians, residents, and students to the brink of their physical, emotional, and mental capabilities and leaves little room for much else other than work. The culture of medicine forces us to ignore our health. I've done it too, but it's time to focus more on our health, not just patients'." Vybhav Jetty is a cardiology fellow. He shares his story and discusses his KevinMD article, "The culture of medicine forces us to ignore our health." (https://www.kevinmd.com/blog/2020/08/the-culture-of-medicine-forces-us-to-ignore-our-health.html)

"Advocate for the children in your community. Studies show that one of the most powerful buffering factors for kids experiencing toxic stress is having at least one supportive, caring adult in their lives. Who in your circles needs you to provide this role? Studies also show that a healthy foundation of sleep, nutrition, exercise, and coping strategies can also mitigate stress effects. Don't forget to promote healthy lifestyle choices to your patients. Remember to model them yourself. Learn mindfulness. Practice yoga. Go outside. Take a deep breath. As Mahatma Gandhi said, 'We must become the change we want to see in the world.' Rather than chasing after our goals at the expense of well-being, let's care for ourselves and each other. Let the healing begin now. Have you experienced any 'aha moments' that have profoundly affected the way you practice medicine? What are some ways you support your patients in achieving overall well-being?" Mary Illions Wilde is a pediatrician. She shares her story and discusses her KevinMD article, "Even as a pediatrician, I didn't realize stress started so young." (https://www.kevinmd.com/blog/2020/04/even-as-a-pediatrician-i-didnt-realize-stress-started-so-young.html)

"The pharmacy department plays a vital role in hospitals. They prepare and dispense medications. Sometimes the pharmacist will receive an order from the doctor on a med whose written dosage he is not sure of. In some cases, the pharmacist will call the nurse in order to get clarification on this. The problem here is that the nurse did not write the order. The nurse does not have the authorization to write the order. The appropriate thing for the pharmacist to do is to call the doctor on this. We, in turn, tell the pharmacist to call the doctor. The pharmacist knows that this should have been done in the first place. The problem here is that the nurse has wasted valuable time talking to the pharmacist about something he should have never been called on, but this situation happens frequently. Here, we have a situation where the pharmacist is hoping that the nurse can do the doctor's job." Anthony Langley is a nurse. He shares his story and discusses his book, Nurses are Nuts. (https://amzn.to/3gJBiPN)

"Fraud in the health care industry is a fact of life. In 2016 alone, the federal government estimated that improper payments by Medicare and Medicaid totaled about $95 billion. And that's only a single year's amount for just two of the government's many health care programs. With an aging population, increased health care spending, the passage of the CARES Act, and the government's multi-trillion-dollar effort to mitigate the health and economic effects of the COVID-19 pandemic, health care fraud will only increase. Unfortunately, some of the readers of this article will be in the unenviable position of witnessing or even being asked to participate in billing and treatment frauds. Most will want to do the right thing and report it but will understandably be concerned about the effect on their careers. Rest assured, there are powerful laws in place to address this situation." Joseph Gentile is an attorney. He shares his story and discusses his KevinMD article, "Blowing the whistle on health care fraud: the rewards and protections of doing the right thing." (https://www.kevinmd.com/blog/2020/04/blowing-the-whistle-on-health-care-fraud-the-rewards-and-protections-of-doing-the-right-thing.html)

"In honor of one of the great classic novels, Go the F**k to Sleep, I would like to present to you my literary work: Stay the F@$k at Home. To the healthy 20 year old who asks, "Why should I stay the F@$k at home, COVID-19 is not going to kill me?" I ask: Do you want to kill your nana and grand-pops? No? Then stay the F@$k at home." Jesica Herrick is an infectious disease physician. She shares her story and discusses her KevinMD article, "An infectious disease physician says: Stay the F@$k at home." (https://www.kevinmd.com/blog/2020/03/an-infectious-disease-physician-says-stay-the-fk-at-home.html)

"Although technology and disruptive innovation theoretically diminish systemic barriers and geographic isolation, in practice, they frequently widen chasms in access for vulnerable populations. The reality is telemedicine disproportionately caters to younger, wealthier, and more educated patients. Hospital systems need to ensure every patient has access to remote health care services, whether through offering landline phone visits, examining pitfalls in digital skill requirements, providing devices and/or application tutorials, or simply assessing if patients are capable of sending or replying to an email. Telehealth applications need to be designed for equitable usage and accessibility instead of automatically expecting rural, poor, minority, and elderly people to just 'get with the digital program' during a crisis." Shantel Hebert-Magee is a pathologist. She shares her story and discusses her KevinMD article, "During COVID-19, not everyone can get with the digital program." (https://www.kevinmd.com/blog/2020/05/during-covid-19-not-everyone-can-get-with-the-digital-program.html)

"Is it possible to have it all? Can you have a job that you love, helping people and using your brain and hands all at the same time; plus, a family, with a spouse and children, that you are always there for? Is it possible to have a balance between your work and your family live while working as a medical practitioner?" James A. Quinn is a physician assistant. He shares his story and discusses his KevinMD article, "Our patients matter, but at what cost to our families?" (https://www.kevinmd.com/blog/2020/07/our-patients-matter-but-at-what-cost-to-our-families.html)

"With COVID-19 raging through the nation, and limited supply of PPE at hospitals, doctors and other critical care personnel are at high risk due to their increased and daily exposure to the virus. For health care workers, the need to plan for a possible worst-case outcome for themselves and their families has become an immediate concern. Doctors are spending limited weekend time urgently completing the paperwork so that their family is protected in case of the worst outcome. If a person were to pass away intestate (with no will or living trust), the legal system makes the decision on their behalf, which can be a long and expensive process. To alleviate the stress, as a physician financial blogger, here is my suggestion on what exactly should be completed." Dewan Farhana is founder and CEO, Betternest, and blogs at Doctor Finances. She shares her story and discusses her KevinMD article, "How doctors can rush to complete their wills." (https://www.kevinmd.com/blog/2020/04/how-doctors-can-rush-to-complete-their-wills.html)

"We are blessed to work in a clinic that has a very large immigrant population. Over the years, we have cared for those who speak over 80+ languages with an even higher number of unique countries and regions represented. Arabic and Spanish are our two most commonly spoken non-English languages. We also have patients who speak unique languages such as Kurdish, Zomi, and Uyghur who do not have a corresponding recognized country affiliated with them. Several of our staff and residents are foreign-born. Many of them are first-generation or come from ethnic homes, and nearly all have a deep appreciation for world cultures. Despite this, there is no way we can know about every unique culture and every corresponding custom. Yet studies have shown that immigrant families are strongly impacted by clinic members' demeanor towards them and their perceived acceptance of them. Maybe it is the language struggles that make our unspoken actions so important, but it is a factor that needs to be accounted for, especially in COVID times, where even basic facial gestures of greeting are not seen. Families may decide if they want to come back to our clinic based on something that we did or didn't do, such as simply making them feel welcomed." Gabriella Gonzales is a pediatric resident. She shares her story and discusses her KevinMD article, "A simple act to help families struggling to find their way in a foreign culture." (https://www.kevinmd.com/blog/2020/07/a-simple-act-to-help-families-struggling-to-find-their-way-in-a-foreign-culture.html)

"Building great tech for doctors is no different from ventilator technology. In some scenarios, you will want to talk to the EMR like you talk to Siri, rather than poring over a screen littered with boxes and lists. In other cases, you will want elegant graphs intuitively laid out to show how your ICU patient is progressing. Other solutions will go unnoticed aside from the time they save by eliminating double work in the background. A great technology team builds products with all the attention to detail that we devote to our patients. This is how we will liberate doctors from EMRs." Erin Palm is a general surgeon and head of product, Suki. She shares her story and discusses her KevinMD article, "How to liberate doctors from EMRs." (https://www.kevinmd.com/blog/2020/05/how-to-liberate-doctors-from-emrs.html)

"We all knew this pandemic was going to change how we practiced medicine, but I, personally, was not prepared for how much it would challenge the 'work-life balance' that I have spent years carefully maneuvering. Female physicians are often hesitant to express individual needs for fear of being viewed as "weak." I'm finding freedom in removing the stigma of weakness and shame from my own concept of vulnerability. It can unite and connect us, giving us strength and empowerment in a time when so much seems beyond our control." Erica Gillette is a family physician. She shares her story and discusses her KevinMD article, "Vulnerability gives us strength in a time when so much seems beyond our control." (https://www.kevinmd.com/blog/2020/05/vulnerability-gives-us-strength-in-a-time-when-so-much-seems-beyond-our-control.html)

"COVID-19 has given all of us the opportunity to live in extremely challenging times. We can choose to run away from this challenge or decide to acknowledge it as part of our journey to grow and transform. So, will you face your habitual reactions, biases, and unpleasant emotions and turn these COVID-19 related challenges into opportunities for personal development and growth? It's up to you." Francis Yoo is a family physician and the author of Physician Freedom: Living Your Authentic Physician Life and COVID Contemplations for Self-Awareness and Personal Development. He can be reached at his self-titled site, Dr. Francis Yoo. He shares his story and discusses his KevinMD article, "Personal development and growth during COVID times." (https://www.kevinmd.com/blog/2020/08/personal-development-and-growth-during-covid-times.html)

"I know I am not alone in my thoughts; I am just echoing sentiments of other female physicians. We are mothers, wives, patient advocates, and educators. And we're all suddenly finding ourselves in unchartered waters. In weathering this pandemic, I've taken time to reflect. I wish I could say I emerged from this introspection having conquered all my fears. Instead, I have discovered the immense strength it takes to be vulnerable. I can admit I do not have all the answers, and the uncertainty of tomorrow gnaws at me. I also know that despite the upheaval, I wouldn't trade my job for anything in the world." Shweta Akhouri is a family physician. She shares her story and discusses her KevinMD articles, "I have discovered the immense strength it takes to be vulnerable." (https://www.kevinmd.com/blog/2020/05/i-have-discovered-the-immense-strength-it-takes-to-be-vulnerable.html)

"Through my coaching of girl's basketball in California's Central Valley, my daughter and I were fortunate enough to know Kobe as a mentor and coach, and a person who inspired my daughter to be the best through hard work, dedication, and passion. While Kobe will live on as one of the game's greatest athletes, he wanted to be remembered for much more than his championships and scoring records. It's clear that he's left a legacy greater than his legendary basketball career, and I thank him for inspiring me to strive for greatness while honoring what matters most in life." Imamu Tomlinson is an emergency physician and CEO, Vituity. He shares his story and discusses his KevinMD article, "What I learned from Kobe Bryant as a parent, coach, and doctor." (https://www.kevinmd.com/blog/2020/03/what-i-learned-from-kobe-bryant-as-a-parent-coach-and-doctor.html)

"It is time to stop being spectators. We are at a critical turning point in our fight against this disease, and our actions now will determine whether we stay on the sidelines, or put an effective end to the scourge of the disease. If we want to avoid a deadlier and costlier battle for the years to come, students, and the general public, have to take steps to work together to disrupt disease transmission and increase cooperation. In the case these steps are not taken, humanity may soon be facing its own Civil War, where our societal fabric may be further ripped apart." Adithya Sivakumar is a medical student. He shares his story and discusses his KevinMD article, "Medical students: It is time to stop being spectators." (https://www.kevinmd.com/blog/2020/03/medical-students-it-is-time-to-stop-being-spectators.html)

"We need to stay healthy for our patients, but also for ourselves and our families. We need to mobilize the faction not just with regard to this pandemic, but by anticipating the arrival of others. So how do we advocate for ourselves? A great way to start is continuing our conversations amongst our colleagues and sharing experiences, looking to local businesses in our communities who are helping us procure masks and other supplies (several salons have already started contributing their supplies to local hospitals), and demanding more from our government going forward. Our government is prepared to increase spending when it comes to the military (in 2019, Congress authorized 716 billion in military spending), but health care workers are now in the midst of a devastating war, and all we are offered are substandard responses, 'there aren't enough tests,' 'do what you can with what you have,' 'wear bandanas' etc. Remember these moments going forward. Remember the failure of the system to support us. Remember the fear, the anxiety, the guilt for not being able to do more. Take these wartime memories and harness them into political power because we are far more powerful as a unit than we are as lone warriors." Jessica Kiarashi is a neurologist and can be reached on Twitter @jkiarashimd. She shares her story and discusses her KevinMD articles, "Physician advocacy in the age of COVID-19" (https://www.kevinmd.com/blog/2020/03/physician-advocacy-in-the-age-of-covid-19.html) and "Why doctors should get political." (https://www.kevinmd.com/blog/2020/03/why-doctors-should-get-political.html)

"Physicians are trained to do what is best for their patients and to do no harm. Independent practices have sat quietly watching, feeling hopeless as our communities cannot access the care they need, shamefully shutting our doors to spend hours on the phone with insurers. But no more. We can no longer remain quiet: Our pediatric patients may not be suffering from COVID-19 at the alarming rate of adults, but this pandemic will send long-standing shockwaves to future generations if our voices are not heard." Nidhi Kukreja is a pediatrician. She shares her story and discusses her KevinMD article, "How COVID-19 will close pediatric practices." (https://www.kevinmd.com/blog/2020/05/how-covid-19-will-close-pediatric-practices.html)

"We care for patients suffering from addictions every shift and are often the only care providers they can turn to. Despite our best efforts, we are often forced to watch as these patients continually succumb to their addiction, sacrificing their bodies as collateral damage in the battle. What frustrates me the most is that every time one of these patients leaves against medical advice, they are deemed to have the capacity to refuse medical treatment. I suppose in the strictest legal sense they do. They understand and can repeat back the risks of leaving without proper treatment. They understand that forgoing this treatment can ultimately lead to their death." Gregory Jasani is an emergency medicine resident. He shares his story and discusses his KevinMD articles, "Do patients addicted to drugs truly have capacity?" (https://www.kevinmd.com/blog/2020/03/do-patients-addicted-to-drugs-truly-have-capacity.html) and "Please don't make physicians choose." (https://www.kevinmd.com/blog/2020/04/please-dont-make-physicians-choose.html)

"While preparing to assist our patients in the emergency rooms and dedicated COVID-19 wards, our clinic continues to triage patient concerns, creates new care plans, and provides a necessary layer of support, reassurance, and education in a chaotic and stressful time. Like all of you, my colleagues and I look forward to resuming our normal lives as once this pandemic is resolved. But, the resolution of this unprecedented public health emergency should not be a reason for CMS to revert back to its old rules. As these first weeks have shown, telemedicine is a valuable, proven, and effective tool for our patients, their families, and our medical community." Magdalena Bednarczyk is a geriatric medicine physician. She shares her story and discusses her KevinMD article, "CMS needs to permanently eliminate barriers preventing routine use of telemedicine." (https://www.kevinmd.com/blog/2020/04/cms-needs-to-permanently-eliminate-barriers-preventing-routine-use-of-telemedicine.html)

"I initially fell into the dangerous grief and shame spiral. I shoved these feelings of loss deep down and let shame bubble up. How could I legitimize my feelings when people are dying? However, I have been working through the idea that comparative pain and its conflicting feelings do not help. To a toddler, their worst grief is not being able to see their friends at preschool graduation. To a high school senior, perhaps prom. To a college athlete, the inability to finish their senior season. To a new business owner, the shuttering of their barbershop opening. Denouncing one's own suffering does not benefit health care workers, those who are sick, or those who have "greater" losses. A grocery store worker's 14-hour shift does not get any easier. A nurse does not magically get a mask. So, allow yourself to feel wholeheartedly, to lament without embarrassment. Feel sad. Be scared. Yell. Have a pity party. Then, when you have a moment of strength, reach out and lift someone up (virtually for now). Together we celebrate milestones, together we grieve, and together we are strong." Emily Masterson is a pediatric resident. She shares her story and discusses her KevinMD article, "A medical student about to graduate. And a lack of closure." (https://www.kevinmd.com/blog/2020/04/a-medical-student-about-the-graduate-and-a-lack-of-closure.html)

"I propose Zooming while driving be added to the DSM criteria for ADHD. I have gotten a new glimpse into the world of some of my patients. One patient even mentioned it's hard for them to come to appointments, even with transportation, and we were able for the first time to talk at length about those psychological factors that prevent them from getting consistent follow up leading to lapses in effective treatment. Is this the first step toward more consistent care? Better outcomes? Some in my center therapists hate it as much as I do, but some really love it. Is this just not going to be everyone's color? There is room for yellows, blues, greens, reds, and all our mixtures. My experience is not representative of the entire tele field. Maybe there is even a place for it in my practice going forward, and our ability to bill for these encounters should continue. (Can you hear me, CMS!) But this cannot be my full-time practice. I hope there is a place for all of us. I hope when I retire, the money and screens haven't ultimately won over the best care for all patients. The optimist in me is hopeful, but the fast-talking irreverent realist in me says we will have to fight for our places." Allie Thomas-Fannin is a psychiatrist. She shares her story and discusses her KevinMD article, "A psychiatrist crashes into telemedicine during the pandemic." (https://www.kevinmd.com/blog/2020/05/a-psychiatrist-crashes-into-telemedicine-during-the-pandemic.html)

"I wrote a 55-word story in solidarity with my medical students and colleagues I had invited to share their lived experiences during COVID-19 on our Stories in Medicine blog. I wrote out of a need to "unmask" the guilt and angst of some of my colleagues and myself who, though practicing physicians, do not find ourselves directly on the front lines during these tumultuous times. Rather, we are dismayed to alternate between waves of anguish and guilt. Anguish for the suffering of our brothers and sisters in places like New York and New Orleans. Guilt, for not being shoulder to shoulder on the front lines. Guilt, because we are able to do things to take care of ourselves and our families in ways others are not. Our hearts break for our colleagues and families, their patients, and the families of their patients. We can only try to imagine a small portion of what they have gone through and will go through in the aftermath." Jennifer R. Hartmark-Hill is a family physician. She shares her story and discusses her KevinMD article, "Confessions in the time of COVID-19." (https://www.kevinmd.com/blog/2020/05/confessions-in-the-time-of-covid-19.html)

"With COVID-19, we have both the unique opportunity and need to deregulate buprenorphine prescriptions. The Substance Abuse and Mental Health Services Administration (SAHMSA) recently updated guidelines for buprenorphine prescriptions. There are new provisions for telephonic initiation of buprenorphine and scripts up to 28 days for stable patients. Unfortunately, this does not circumvent the major issue: redeployed providers will not be able to fill scripts. With just 7 percent of providers nationally able to even prescribe buprenorphine, this is a particularly vulnerable window for care. We must instead take the current crisis as an opportunity to reform and strengthen MAT access." Megana Dwarakanath is a pediatrician. She shares her story and discusses her KevinMD article, "With COVID-19, we have a unique opportunity and need to deregulate buprenorphine prescriptions." (https://www.kevinmd.com/blog/2020/05/with-covid-19-we-have-a-unique-opportunity-and-need-to-deregulate-buprenorphine-prescriptions.html)

"Children are being encouraged to take on the superhero persona and help protect others. They do this in true average-person-as-the-superhero style by wearing a facemask alone, without any superhero powers or words. Just as wearing a facemask in public has been the norm for years in many Asian countries, it may become the norm worldwide. For this to happen, we need buy-in by the younger generations who are less likely to wear a mask in public but are equally likely to unknowingly spread infection. In this group, the ability to make a fashion statement may motivate them to give up their laissez-faire view of their personal risk of harm in favor of the ethically favorable and trendy decision to protect others." Lauren Fine is an allergy-immunology physician and a medical educator. She shares her story and discusses her KevinMD article that she co-authored, "The superhero within during the time of COVID-19." (https://www.kevinmd.com/blog/2020/06/the-superhero-within-during-the-time-of-covid-19.html) She would like to thank her co-author and colleague, Dr. Vijay Rajput.

"We are health care workers. We are doctors, advanced care practitioners, nurses, pharmacists, social workers, and so much more. We are on the frontlines. We are our parents' children, and we are parents to our young children. For the first time, we are at an extremely high risk of being quarantined by the same beast we are trying to conquer. We are experiencing moral distress, guilt, and frustration, knowing our colleagues and patients need us when we can't be there. And now, for the first time, we feel like you need to know what we are truly feeling. For the first time, there is no you or I. No famous or average. There is no difference in race, sex, religion, or culture. We are one and the same, and for the first time, we all know what it feels like to be in each other's shoes. You are me, and I am you. We are you and I. For the first time, we are all equal in the eyes of this virus as it challenges us all physically, emotionally, socially, and spiritually." Simran Malhotra is a palliative care physician and can be reached on Instagram @drsimran.malhotra and on Twitter @simranm15. She shares her story and discusses her KevinMD article, "The many firsts of coronavirus." (https://www.kevinmd.com/blog/2020/03/the-many-firsts-of-coronavirus.html)

"It's maddening to see the differences in health outcomes between the rich and the poor. Even more unsettling is reflecting upon the psychological pain accumulated when living in a fad-obsessed materialistic comparison-creating society, the postponed dreams, and the day to day compromise that those with less have to endure – thoughts that may be far removed from the ruminations of the those who have abundance. I don't mean to stereotype, and this is not intended to be a polemic, but the country is divided, and many are living in two different worlds. The resultant health consequences should be contemplated upon, especially in the midst of a pandemic where the differences have the opportunity to be most blatantly highlighted." Harsh Bhavsar is an internal medicine resident. He shares his story and discusses his KevinMD article, "Coronavirus exposes the reality of income-driven health inequality." (https://www.kevinmd.com/blog/2020/04/coronavirus-exposes-the-reality-of-income-driven-health-inequality.html)

Since the coronavirus outbreak, reports of anxiety have increased, especially among physicians. Physicians face numerous stressors, including fears of contracting the coronavirus, concerns about potentially infecting loved ones, PPE shortages, testing delays, and frequently making quick decisions with limited information. Common symptoms of anxiety are increased worrying about one's self and/or loved ones, difficulty sleeping, difficulty eating, poor concentration, increased heart rate, hyperventilation, and struggling to control worrying. Christine Tran-Boynes is a psychiatrist. She shares her story and discusses her KevinMD article, "5 ways to manage anxiety during the coronavirus pandemic." (https://www.kevinmd.com/blog/2020/03/5-ways-to-manage-anxiety-during-the-coronavirus-pandemic.html)

"As the COVID-19 pandemic unfolds day by day at an exponential rate, we as doctors have been called to duty in unprecedented ways. Speak with any physician in the last few weeks, and you will be hard-pressed to find one who didn't feel an intrinsic obligation- indeed, wish- to rise to the occasion with an all-hands-on-deck attitude, despite the taxing and indefinite toll this will take. Speak with any physician mother, and you will quickly see that our intense drive to lead on the frontlines is matched with an equally intense anxiety about protecting and preserving the wellbeing of our families. Indeed, for most of us, the conflict between being a physician and mother has never felt greater." Tamara Goldberg is an internal medicine physician. She shares her story and discusses her KevinMD article, "The duality of being a physician-mom in the age of COVID-19." (https://www.kevinmd.com/blog/2020/04/the-duality-of-being-a-physician-mom-in-the-age-of-covid-19.html)

"Based on the evidence of the effects of trauma, we can predict that our health care teams, patients and families will exhibit signs of this assault through a variety of symptoms–sleeplessness, apathy, depression, and anxiety. The warning signs are already here. We read the desperate accounts and pleas of frontline workers describing the indescribable, holding the hands of patients dying alone, communicating with stunned and distraught families isolated away from death beds of their loved ones. Dr. Breen is symptomatic of a larger undercurrent of the fatal moral injury of the system currently at work. We need to face it head-on or risk additional losses as tragic as this." Mary R. Talen is a psychologist. Deborah Edberg is a family physician. They share their stories and discuss their KevinMD article, "Flattening the curve of COVID's emotional impact." (https://www.kevinmd.com/blog/2020/05/flattening-the-curve-of-covids-emotional-impact.html)

"Someday, I suspect I will recount this time of fear with mixed emotions. Sadly, there are people who have died and more to come, and this time will also lead us to reassess our way of life and make changes for the better. I work from home, juggling the management of patients by telemedicine with homeschooling my daughters, still working to find meaning and direction to do the right thing. With movie theaters all shuttered right now, and likely to struggle after this crisis, I hope the simple pleasure of watching these pictures in the theater can still be my escapist comfort. I yearn to go to the movies, and for me, streaming on Netflix can't match that theater experience. Still, I find purpose and meaning in reminding myself that we are characters in this movie, and just as in Hitchcock's thriller, the deeper meaning is in how we as people respond to extreme circumstances." Jules Lipoff is a dermatologist. He shares his story and discusses his KevinMD article, "Alfred Hitchcock, COVID-19, and the MacGuffin." (https://www.kevinmd.com/blog/2020/05/alfred-hitchcock-covid-19-and-the-macguffin.html)

"All of our patients, but especially our most vulnerable Spanish-speaking patients, need to hear concrete, meaningful, and practical instructions on how to care for each other when they live in large multi-generational families, and positive stories from people who have successfully managed infection with COVID-19. They need to hear that, as their physicians, we are here for them. I want them to know that when they are sick, their immigration or insurance status is not my concern. My concern and my oath are to the patient in front of me, and to the community I love." Susan Lopez is an internal medicine physician. She shares her story and discusses her KevinMD article, "The impact of COVID on the Hispanic community." (https://www.kevinmd.com/blog/2020/05/the-impact-of-covid-on-the-hispanic-community.html)

"Trainees like myself travel great distances from home in pursuit of higher edification. Yet the coronavirus makes us worry about the aged family we leave behind – parents and grandparents. A WhatsApp message ensuring they've stocked up on acetaminophen, toilet paper and canned soup (low sodium, of course) the only assuage to our anguish. The rigors of medicine often demand sacrifice, sometimes in the form of long-distance relationships. Residents and fellows work overtime and trade shifts in chess-like strategy to ensure a 'golden weekend' with their significant other. Now with travel being high risk, golden weekends will likely be swapped for Facetime dinner dates. Today the malefactor may be COVID-19; the only certitude is that the future will bring another. And yet, despite the perils that may exist, we toil on, for the sake of our patients and to satisfy the seraphic thirst of our higher calling. As in the end, love conquers all." Mrinali Shetty and Yuvraj Chowdhury are cardiology fellows. They can be reached on Twitter @YChowdhuryMD and @MrinShettyMD, respectively. They share their stories and discuss their KevinMD article, "Love in the time of coronavirus." (https://www.kevinmd.com/blog/2020/03/love-in-the-time-of-coronavirus.html)

"We do not have to continue to blame external forces for the stresses upon us now. By organizing, mobilizing, and finding solutions to the problems facing us and our adopted community today, we can meet the current challenge to be of help, however we can. Perhaps, in this way, we can stop making pandemics a future generation's problem to solve, and instead become the leaders we once needed ourselves." Pratik Doshi is a medical student. He shares his story and discusses the KevinMD article that he co-wrote, "The opportunities for medical students in a pandemic." (https://www.kevinmd.com/blog/2020/04/the-opportunities-for-medical-students-in-a-pandemic.html)

"It is OK to be scared, but it is not OK to let our own anxieties harm our patients. As we tackle the numerous crises created by the COVID-19 pandemic, let's acknowledge our fear and draw on the logic and clinical reasoning that we have spent years cultivating. We can be scared and scientific, anxious, but courageous. Let's not create two causalities from one disease, the patient who dies from coronavirus and the patient who dies waiting for surgery because they could have had coronavirus." Sami El-Dalati is an infectious disease physician. He shares his story and discusses his KevinMD article, "It is OK to be scared, but it is not OK to let our own anxieties harm our patients." (https://www.kevinmd.com/blog/2020/04/it-is-ok-to-be-scared-but-it-is-not-ok-to-let-our-own-anxieties-harm-our-patients.html)

"Although I personally hope to continue to be at or near the frontlines, I understand those that are in a compromised position, and they shouldn't feel ashamed for wanting to protect themselves or their family. There is no portion of the Hippocratic Oath that implicitly or explicitly states that physicians have a duty to patients above their own safety. Even though we're in the midst of the pandemic, I've found it to be a beneficial practice to reflect and think about the way we can improve the safety and efficacy of those delivering care. While it may be commendable to rush to be directly involved in patient care, we need to take a step back and review the role that residents play: who is being put on the frontlines, how is that being decided, and how is this impacting resident burnout? This is one of the many questions I hope can be thoughtfully revisited after the emergency of the pandemic is over." Jon Zaid is an internal medicine physician who blogs at 34justice. He shares his story and discusses his KevinMD article, "Doctors shouldn't feel ashamed for wanting to protect themselves or their family." (https://www.kevinmd.com/blog/2020/04/doctors-shouldnt-feel-ashamed-for-wanting-to-protect-themselves-or-their-family.html)

"I typed up a brief response to the no show memo, hit reply, and then deleted the original message. It's not that I am a fan of wasting time and resources, but for now, I have a general personal policy to never dismiss pregnant patients. I'd have to try to address her barriers to care. Again. Our clinic tended to be a safety net for health care in the city, if I dismissed her, where would she go? I do believe people can be changed. Also, help me when I really don't believe it." Erin Hoffman is a family physician. She shares her story and discusses her KevinMD article, "The patient who no-shows." (https://www.kevinmd.com/blog/2020/05/the-patient-who-no-shows.html)

"It seems as though the looming reality for many of us is that we will have patients who need ventilators, and none will be available. It seems like we might benefit from remembering that we can still succeed in practicing medicine by being present with those suffering before us, even when we know we cannot cure them of disease. In a more pragmatic sense, maybe in addition to logistical discussions and articles about how ERs and ICUs are going to decide who should get a ventilator, we should also discuss how we are going to communicate with empathy and compassion to the families of the critically ill and dying; there are ways to learn to do this well that alleviates heartache for families and for physicians." Elaine M. Colby is a family physician. She shares her story and discusses her KevinMD article, "When should we start having a discussion about palliative and end of life care?" (https://www.kevinmd.com/blog/2020/03/when-should-we-start-having-a-discussion-about-palliative-and-end-of-life-care.html)

"If you have an employment agreement with a provision on intellectual property, have it reviewed by an attorney before you begin applying for patents. A good attorney should be able to give you some clarity. Suppose, however, that your employment agreement has muddied the waters a bit. In that case, you have a few different options, and all of them will come with some risk. First, you may speak with your employer vaguely about your plans and attempt to get a release, or work out some other agreement so that you can pursue your project alone. In some cases, collaboration may provide you with the resources to proceed, and ease a bit of the financial burden. Of course, this may bring undesired attention to you, and may require some diplomacy and care. Second, you may sit on your invention or change your employment. Here, time is working against you and may affect the patentability of your invention. Additionally, it's possible that even after the termination of your employment, that your old employer will still claim a right to an invention that was conceived during your employment with them. Third, you can forge ahead without telling your employer. There are no easy answers, but this is the requisite analysis, and it is quite easy to make a mess. If you do intend to pursue an invention while employed, a good rule of thumb is to work on your invention on your own time, in your own house, using your own resources and your own money. You don't want to blur the lines. You want to clearly differentiate between your property and your employer's." Peter D. Sleman is an attorney. He is the author of The Physician Inventor: The Doctor's Handbook to Patenting Medical Devices and Methods. (https://amzn.to/3htbjgk) He shares his story and discusses his KevinMD articles, "Intellectual property provisions in physician employment agreements" (https://www.kevinmd.com/blog/2020/03/intellectual-property-provisions-in-physician-employment-agreements.html) and "The COVID-19 breakthroughs are coming." (https://www.kevinmd.com/blog/2020/03/the-covid-19-breakthroughs-are-coming.html)

"I find that managing chronic pain can be a bit of a dance between myself and the patient. Sometimes a little bit of a compromise. I always tell my patients that pain is subjective but many things can contribute to pain — certainly stress, lack of sleep, any emotional issues can make pain worse. Your pain is different than my pain. I don't like to use the word 'tolerance' when it comes to opioids, but certainly, some people are able to tolerate pain more than others. But it does go back to the emotional component related to pain. One of my attendings in fellowship — known to be a bit of a hard ass — used to tell our patients, you can't die from pain. Your blood pressure that's 210/110? That can kill you. The 100 percent blockage of your artery in your heart? That can most certainly kill you. Your smoking four packs a day? That may kill you. Your pain is a by-product of your experience. Snowing yourself with opioids only tricks your body into believing there's nothing more serious going on. And it's a temporary solution for a more permanent problem." Michelle Dang is an anesthesiologist and hosts the podcast, WISH Well. She shares her story and discusses her KevinMD article, "The painfully fine line of pain management." (https://www.kevinmd.com/blog/2018/06/the-painfully-fine-line-of-pain-management.html)

"I struggle for words to describe life in the season of COVID-19. Depending on the day, I need at least a few adjectives: 'peculiar,' 'fine, all things considered,' 'terrifying.' 'Joyous' and 'anxious' certainly make odd bedfellows in my brain. As a mother and physician living this new reality, I've been extra thankful for Irene, who taught me the power of 'and.' Irene is a clinical psychologist who was tasked with helping my family medicine residency classmates and me build skills for self-care and counseling. She taught me to replace 'but' with 'and' in conversation. This subtle verbal acknowledgement can reconcile what would typically be perceived as conflicting emotions or realities–like mental yoga. The shift has served me well in my medical career and in personal relationships. Imagine how different it feels to hear someone say, 'You're doing the best you can, but you can do better' versus 'You're doing the best you can, and you can do better.'" Rachel E. Hines is a family physician. She shares her story and discusses her KevinMD article, "A physician mother embraces the power of 'and' during the pandemic." (https://www.kevinmd.com/blog/2020/04/a-physician-mother-embraces-the-power-of-and-during-the-pandemic.html)

"In the time of the COVID-19 pandemic, I am both hopeful and inspired as well as disappointed. I see those angry that their ideas or opinions conflict with science. Instead of the steady path and hard work of building bridges, they create division. I see many capitalizing on fear and uncertainty, weaving a compelling story and drawing in the desperate ones who need a scapegoat, an explanation, or some form of certainty. It's OK to be a dissenter. It's OK to challenge what seems to be the status quo. It's OK to ask questions about why we do things the way we do them. But if you really want to see a meaningful conversation, you must go about it in the right way. The right way is usually slow and painful but full of the promise of refinement that only comes through allowing our work and our perspectives to pass through the filters of those who see the world differently. Only then can the purest form of our questions be answered, and our message be heard." Jaclyn Lewis Albin is an internal medicine-pediatrics physician. She shares her story and discusses her KevinMD article, "Dissent in the time of COVID-19." (https://www.kevinmd.com/blog/2020/05/dissent-in-the-time-of-covid-19.html)

"Billroth spent long hours dissecting cadavers and planning on surgical interventions. He was able to pioneer abdominal surgery with careful preparation and strict adherence to meticulous antiseptic technique. Animal experimentation and cadaveric-rehearsed surgery emboldened the Viennese professor; perhaps the abdomen could be entered. Nothing short of a 'godlike creative spirit,' as Mukherjee calls it, would suffice when it came to intestinal surgery. Vienna has a centuries' old reputation for virtuoso performances; with Imperial spirit, maestro Billroth would take his place for master class performances in the greatest theater in the City of Music: the Allgemeines Krankenhaus operative theater. In 1872 Billroth resected a portion of the esophagus and joined the ends together. In 1873, he performed the first complete excision of a larynx. Even more amazing, he became the first surgeon to excise a rectal cancer, and by 1876, he had performed thirty-three such operations. What seems commonplace today (abdominal surgery) is nothing short of a stupendous magic act, in reality." David J. Schneider is an orthopedic surgeon and author of The Invention of Surgery: A History of Modern Medicine: From the Renaissance to the Implant Revolution. (https://amzn.to/2CtzDQb) He shares his story and discusses his KevinMD article, "Surgery is nothing short of a stupendous magic act." (https://www.kevinmd.com/blog/2020/03/surgery-is-nothing-short-of-a-stupendous-magic-act.html)

"As COVID-19 devastates America and the world, I hope that fundamental change to our health care system results from its horrific exposé. Without COVID-19, the pressures placed on physicians are already immense. In the age of COVID-19, these pressures are proving to be insurmountable. Being a physician is difficult, but it does not have to be deadly. Physicians deserve proper stigma- and repercussion-free mental health care as much as they deserve proper personal protective equipment. By definition, a hero is the offspring of a god and a mortal; if we physicians are to be known as heroes, we deserve to have our human mental health care needs met.​" Sarah Bridge is an emergency medicine resident. She shares her story and discusses her KevinMD article, "Physicians and the psychological trauma of COVID-19." (https://www.kevinmd.com/blog/2020/05/physicians-and-the-psychological-trauma-of-covid-19.html)

"COVID-19 has rapidly spread across the nation, leading to the implementation of stringent social distancing guidelines by local and regional authorities. In a desperate effort to limit infection rates, in-person social interactions have been reduced, and many have turned towards indoor hobbies and online platforms to connect with their loved ones. Still, this solution to mitigate the spread of the virus deeply impacts vulnerable groups. Specifically, social isolation of the elderly population, already deemed a neglected issue, is an exacerbated side effect of the coronavirus pandemic." Vismaya Bachu is a medical student. She shares her story and discusses her KevinMD article, "The exacerbation of social isolation among the elderly." (https://www.kevinmd.com/blog/2020/05/the-exacerbation-of-social-isolation-among-the-elderly.html)

"They needed the final story to let go of her body, yet retain her spirit. Looking back on it, that's when I saw the greatest honor of all — the everyday honor of storytelling for our patients. Maybe that's the only cure we have for death … translating what happens from the body into the world. Perhaps that is the last frontier of care: sharing the understanding of how we get to the end — just as much as how we got to the beginning. Maybe, we should reframe the last note we write for our patients — and make it the last story we share instead." Giannina L. Garces-Ambrossi Muncey is a critical care physician. She shares her story and discusses her KevinMD article, "Your greatest role as a doctor? Storyteller." (https://www.kevinmd.com/blog/2018/10/your-greatest-role-as-a-doctor-storyteller.html)

"If you are finding yourself with trouble studying or focusing due to the state of the world, or due to changing circumstances in your own household, remember that a delay in this test or in any part of your application is not the end of the world. You need to focus on your health and well-being first so that you have the ability to keep pushing through this marathon of a process (and I don't just mean the application to medical school—there's a whole bunch to do once you get there as well!) Dive into meditation, exercise, and staying in contact with your friends and family. The MCAT, the application, and your dreams of being a physician will still be there when this is all over, so priority #1 is making sure that you are able to jump back into all of this when that time comes." Elisabeth Fassas is a medical student and author of Making Pre-Med Count: Everything I Wish I'd Known Before (Successfully) Applying to Medical School. (https://amzn.to/2DXWu73) She shares her story and discusses her KevinMD article, "COVID-19 and the MCAT: What should premedical students do?" (https://www.kevinmd.com/blog/2020/04/covid-19-and-the-mcat-what-should-premedical-students-do.html)

"Much is written about the advantages for primary care physicians and patients of working within a retainer model, direct primary care, concierge-type care model. Little is written about the downside or disadvantages. It is time to shine a light on the benefits and challenges of concierge and standard models through an experienced lens, particularly as drivers of burnout and the primary care shortage loom so large. The phase of a career may be an important factor." Annie Moore is an internal medicine physician. She shares her story and discusses her KevinMD article, "A physician leaves concierge medicine after 13 years." (https://www.kevinmd.com/blog/2020/03/a-physician-leaves-concierge-medicine-after-13-years.html)

What should patients know about diet and its effects on the microbiome? How should primary care clinicians address diet and its effects on the microbiome? What are your tips to address obesity? What are the gastroenterological manifestations of COVID-19? Supriya Rao is a gastroenterologist. She shares her story and her expertise in obesity and the diet-microbiome connection.