The Podcast by KevinMD

"One of the calls you dread making as a doctor is telling a family member their loved one is dying. That was the call I received when my grandfather decompensated. We grow accustomed to making the call as clinicians, but we never expect to get it ourselves. I felt for his pulse. Slow but faint. As a doctor, you become desensitized over time. You frantically think of the next steps that will save this body's life, until you realize that body is someone you know. Death here during this time has no dignity. I've experienced a lot in my career by trade. But this one feels particularly brutal. Patients are not allowed to have visitors and often die scared. Someone codes, someone dies, and on you go to save the next life. A few days later, I prepared to head back to work. I thought about all the patients I treated for COVID, never thinking my grandfather would be one. As I headed into work at around 7 p.m., I hear the sounds of people cheering outside. At that moment, I was no hero. I had just lost a war. And back I went to the battlegrounds that altered my family forever. Society needs to redirect energy to alleviating the struggles of workers rather than glorifying it. The government faltered, but it is community advocates and organizers of grass-root campaigns that create reproducible change. The fact of the matter is, nobody wants to be a hero right now. We just want to live to see another day." Zaki Y. Azam is an internal medicine resident. He shares his story and discusses his KevinMD article, "How coronavirus took my grandfather's life." (https://www.kevinmd.com/blog/2020/05/how-coronavirus-took-my-grandfathers-life.html)

"Living the surreal experience of the COVID-19 pandemic challenges us on multiple levels. As a physician, I feel the responsibility to understand the magnitude of the situation and implement the best measures to protect my patients, trainees, my family, and myself. I experience the fear of getting sick or losing a loved one and the sadness and frustration of seeing millions of lives affected by illness, desperation, isolation, and death. COVID-19 has challenged me even more in my role as a mother. Living the quarantine with two energetic boys has transformed motherhood into an emotional rollercoaster. The combination of COVID-19, taking care of two boys, and continuing working has, at times, been overwhelming, even while having the support of my wonderful husband. I have found myself being absorbed by the challenges, almost forgetting the positive things that still surround me." Miriam Zylberglait Lisigurski is an internal medicine physician. She shares her story and discusses her KevinMD article, "COVID-19 through the eyes of my kids." (https://www.kevinmd.com/blog/2020/07/covid-19-through-the-eyes-of-my-kids.html)

Explore why this general surgeon wrote a novel, and how writing helps with the stresses that accompany a surgery career. What is his #1 tip for those interested in surgery? What are the challenges facing the profession today? How can surgeons find that elusive work-play balance? And why should aspiring doctors start a journal? Arthur Williams is a surgeon. He shares his story and discusses his book, The Surgeon's Obol. (https://amzn.to/2FIdDmz)

"To the people who say that wearing a mask perpetuates the conspiracy: Tell that to the health care workers who have put their lives at risk to face firsthand an unknown disease. Tell that to the families of frontline workers who have contracted and succumbed to COVID-19 while their loved ones save everyone else. To the people who say that COVID-19 does not exist; that COVID-19 is just another cold or flu: Tell that to the families who did not have the opportunity to hold the hands of their loved ones as they passed; the families that had to say goodbye to their loved ones through a video chat or a phone call; the families who never dreamed that when they dropped their mothers, fathers, spouses, and siblings off at the ER, the next time they'd see them would be in a casket." Fady Youssef is a pulmonary and critical care physician. He shares his story and discusses his KevinMD article, "A frontline physician has a message for you." (https://www.kevinmd.com/blog/2020/07/a-frontline-physician-has-a-message-for-you.html)

What is caregiver burnout? How can you recognize the symptoms? What are tips for new caregivers? What can caregivers teach clinicians? R. Lynn Barnett is the author of What Patients Want: Anecdotes and Advice and My Mother has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale. She can be reached on Twitter @rlynnbarnett1. She shares her story and discusses her book, My Mother has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale. (https://amzn.to/2ZXHq1u)

"Grandma Lilly is 87-years-old and in the ICU. She's on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered. Her family can't talk to her as she phases in and out of existence. For her, end-stage renal disease means dialysis. And respiratory failure equals ventilator. She's a brittle diabetic with uncontrolled fluctuating blood sugars. Grandma Lilly can't eat, and we feed her by a tube that goes into her nose and to her stomach. Tomorrow, she gets a PEG tube surgically inserted to feed her. She's been on the ventilator too long. Next comes the ICU package: ventilator, dialysis, pressers, restraints, trach, PEG tube. Any second of clarity or awareness is pure brutality. There's no pretty ending to this torture except through death. Poor Grandma Lilly." Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate. She shares her story and discusses her KevinMD article, "Go quiet into the night." (https://www.kevinmd.com/blog/2019/01/go-quiet-into-the-night.html)

"Lifestyle medicine equips practitioners with the tools to affect change. One of the biggest job satisfiers for physicians is positively impacting the trajectory of their patients' lives. Having a parent tell you that their child is 'a different person' because of the time you spent with them is priceless. This is why I believe if more physicians studied and applied the principles of lifestyle medicine to their lives and their practices, we could put a dent into the burnout many of us face. We can build up resilience to the rigors of our work and experience higher levels of job satisfaction as we see our patients get better. In essence, lifestyle medicine is a prescription for physician burnout. In many ways, I feel that my journey into lifestyle medicine is the legacy my mom gave to me. Arising from the emptiness of my early motherhood, I landed on a path leading me to flourish personally and professionally. I will be forever grateful to her not just for the life that she gave me, but for the life she is giving me." Cherie Chu is a pediatrician who blogs at Wellness Pediatrician. She shares her story and discusses her KevinMD article, "Lifestyle medicine is a prescription to treat physician burnout." (https://www.kevinmd.com/blog/2020/07/lifestyle-medicine-is-a-prescription-for-physician-burnout.html)

"As an oncologist, perhaps the hardest part I play is as witness. I am there to give a diagnosis that, more often than not, will alter someone's life forever. For some, I see resignation—a sense that they've known something was wrong and that it's what they thought they had. For others, I see an almost immediate acceptance and, with it, perseverance; they are prepared to fight, to win. But for those where cancer comes without much warning, I see terror. Cancer is a threat to who they are, how they live, and yes—how long they have. It's hard to see someone struggle this way, knowing that no matter how much time I spend with them, holding their hand, crafting a way forward, they leave my office with cancer." Don S. Dizon is an oncologist. He shares his story and discusses his KevinMD article, "As an oncologist, this is the hardest role I play." (https://www.kevinmd.com/blog/2020/07/as-an-oncologist-this-is-the-hardest-role-i-play.html)

"Grocery shopping is not optional; it's necessary. But if you go every day and to multiple stores, you are increasing the chance you will be exposed. From my informal survey, this practice is extremely common. Yet, experts advise to consolidate shopping. In fact, in my experience, there is always at least one person (shoppers AND workers) in every store I have visited who is either not masked or masked incorrectly. Many people report that they are going stir-crazy without seeing friends and family members or being among others. So the trade-off is clear: maintaining sanity is prioritized. Everyone wants things to return to normal, so they are doing normal things, albeit with precautions. In reality, there is still so much that is unknown about coronavirus transmission, so it is too soon to attempt 'normalcy.'" Sara L. Merwin is an epidemiologist and co-author of The Informed Patient: A Complete Guide to a Hospital Stay. She shares her story and discusses her KevinMD article, "Incremental risk amid COVID-19 re-openings: What do we value most?" (https://www.kevinmd.com/blog/2020/08/incremental-risk-amid-covid-19-re-openings-what-do-we-value-most.html)

"Advocacy by moms is not new, but advocacy by physicians has been less common. Moms have been fierce advocates on a variety of causes ranging from Mothers Against Drunk Driving to Moms Demand Action, the anti-gun violence mom activist group led by Shannon Watts that has now helped launch moms into public office. As physician moms navigating a global pandemic, we are invested in ensuring that our patients, communities, and our children are safe. So, when misinformation threatens basic and effective public health measures, subsequently risking the health and safety of the public and of children, expect a wall of physician moms." Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain. She can be reached on Twitter @ShikhaJainMD. She shares her story and discusses the KevinMD article that she co-wrote, "Physician-moms fight back against anti-maskers and anti-vaxxers." (https://www.kevinmd.com/blog/2020/08/physician-moms-fight-back-against-anti-maskers-and-anti-vaxxers.html)

Why should we reform the health care system to a physician-led approach? How will that look like? Would a Medicare for all system cure what ails the system? What are some obstacles to implementation? Ken Terry is a journalist. He shares his story and discusses his book, Physician-Led Health Care Reform: A New Approach to Medicare for All. (https://amzn.to/2ZxhqtE)

"There are two battles waging from the COVID-19 virus this year: the obvious fight for human life but also the attack on science. During philosophical and political debates, one steadfast weapon has been the scientific method. Opinion doesn't matter. State the facts. The thing about facts are, though, that one has to be willing to change previously held points of view with new information. One of the most devastating things observed during this pandemic with regard to human behavior is an absent quest for verity. Instead, it's 'click, copy, and paste.' Somewhere in there, the part where the information is evaluated was lost." Alicia Billington is a plastic surgeon. She shares her story and discusses the KevinMD article that she co-wrote, "In the age of misinformation, don't be a contributor to the problem." (https://www.kevinmd.com/blog/2020/07/in-the-age-of-misinformation-dont-be-a-contributor-to-the-problem.html)

"For the past six months, I've spent my free time becoming a certified life coach. I'm a hospitalist, but a little more than a year ago, I was introduced to life coaching. I love the changes it has produced in my life – particularly how it's changed me as a mother. Coaching helps me to be more present for my family and more emotionally available for my kids. It's changed the way I approach life, and it's changed what I teach my children." Trina E. Dorrah is an internal medicine physician and the author of Physician's Guide to Surviving CGCAHPS & HCAHPS. She can be reached at Dr Trina Dorrah Life Coaching. She shares her story and discusses the KevinMD article that she co-wrote, "When we coach, we change the lives of our children." (https://www.kevinmd.com/blog/2020/09/when-we-coach-we-change-the-lives-of-our-children.html)

"Both clinical and direct-to-consumer genetic testing have become significantly less costly and more common, providing people with access to a wealth of information about everything from their ethnicity and family lineage to their risk for certain diseases and how they will respond to medications such as blood thinners and antidepressants. But before you decide to take the plunge into your gene pool, there are a number of issues you should carefully consider. Genetic testing can have unintended consequences, both personal and medical, so it's wise to weigh the value of any information you may gain against the potential issues that the testing may raise." Miles J. Varn is chief executive officer, PinnacleCare, and can be reached on LinkedIn. He shares his story and discusses his KevinMD article, "Genetic testing: Could there be unintended consequences?" (https://www.kevinmd.com/blog/2020/04/genetic-testing-could-there-be-unintended-consequences.html)

"Locum tenens means 'to hold the place of, to substitute for' and locum tenens contracts are a common form of agreement for physicians who provide temporary medical services in place of full-time physicians. Now, during the COVID-19 pandemic, increased demand puts physicians in a better position to negotiate their locum tenens contracts. However, too many practitioners sign them without fully understanding their implications. This is a mistake. A well-drafted locum tenens contract (a) protects the physician's interests beyond compensation, (b) anticipates and addresses disputes, and (c) limits risks." Jack A. Gordon and Andrew E. Sarti are attorneys, Kent, Beatty, & Gordon, LLP. They share their story and discuss the KevinMD article that they co-wrote, "Anatomy of locum tenens contracts: a physician's guide to understanding contractual provisions to maximize opportunities and minimize risks." (https://www.kevinmd.com/blog/2020/07/anatomy-of-locum-tenens-contracts-a-physicians-guide-to-understanding-contractual-provisions-to-maximize-opportunities-and-minimize-risks.html)

"Misinformation about COVID-19, if propagated, can be deadly. The stakes are high. Physicians need to have a voice in this discussion and work towards impacting policy in a positive way. Physician-led groups such as IMPACT aim to advocate for evidence-based solutions for the protection of communities and serve an advisory role to those in charge of public policies. As physicians, our primary purpose is the well-being of our patients. We owe it to them to share not only information about sinus infections and sore throat, but how to protect themselves from COVID-19. We must share what we know. We can and should begin to reintegrate into society, but as physicians, our responsibility to the community is to educate and protect. We should not shy away from sharing our expertise with others. This may include uncomfortable conversations with friends and family whose views differ from our own, but if we come from a place of respect and understanding, we can and will get through this together." Inna Husain is an otolaryngologist. She shares her story and discusses the KevinMD article that she co-wrote, "Physicians' role in bridging the COVID-19 health recommendations divide." (https://www.kevinmd.com/blog/2020/07/physicians-role-in-bridging-the-covid-19-health-recommendations-divide.html)

"When doctors ignore the evidence showing that a support system doesn't have to be traditional in order to be effective, that's not a medical judgment. It's a personal prejudice that puts singles at serious risk. Classifying patients as married or unmarried when studying the effects of social support undoubtedly makes research easier, with groups determined by a simplistic either-or. But since social support is not, in fact, limited to marriage, the results of such studies are bound to be flawed — not to mention perpetuating discriminatory treatment that can cost single people our lives." Joan DelFattore is a writer. She shares her story and discusses her KevinMD article, "Patients without partners, and the doctors who stereotype us." (https://www.kevinmd.com/blog/2016/11/patients-without-partners-doctors-stereotype-us.html)

"Single payer is the solution. And the time for it is now. A single-payer system would guarantee health care coverage immediately to every American. So whether a loved one gets sick from COVID, has a heart attack, or gets in a car accident, she will receive the care she needs without it causing financial hardship. A single-payer system will eliminate employer health insurance contributions. This will provide huge relief to hundreds of thousands of struggling small businesses across the country. The money saved can go towards paying their employees a living wage or hiring new workers, which will help get our economy back on track. A single-payer system will relieve the burden of finding health insurance from individuals. Freelancers and gig, self-employed, and per diem workers can pursue employment without having to worry about providing health coverage for their families. And with families relieved of the insecurities created by surprise medical bills and massive out-of-pocket costs, they will be more likely to contribute to our consumer-driven economy. COVID has absolutely quelled consumerism; single payer can help to bring it back." Toby Terwilliger is an internal medicine-pediatric resident. He shares his story and discusses his KevinMD article, "Is now the time for single payer?" (https://www.kevinmd.com/blog/2020/07/is-now-the-time-for-single-payer.html)

"Doctors are people, and people are capable of prejudice and discrimination. But, in medicine, there is no place for prejudice and discrimination because a patient's life is at stake. Stereotyping a customer and assuming that they cannot afford a certain product is emotionally hurtful, but it is far less dangerous than stereotyping a patient and misdiagnosing a life-threatening condition. The nature of the medical profession is handling a patient's life; doctors are the last line of defense between life and death. As such, doctors have to balance every aspect of the patient when choosing the right treatment, and ample evidence suggests that a patient's culture, including race, ethnicity, and class, is an important factor in determining a health outcome. With the stakes this high, it is vital that doctors understand the intersection of culture and medicine, and they understand it as soon as their journey into medicine begins." Shvetali Thatte is a premedical student. She shares her story and discusses her KevinMD article, "Why cultural competency courses should be requisites for medical school." (https://www.kevinmd.com/blog/2020/07/why-cultural-competency-courses-should-be-requisites-for-medical-school.html)

"My experience with recent knee surgery that left me significantly disabled for over a month brought this to my attention yet again. I was completely dependent on others for basic self-care since I was unable to get in and out of the tub/shower without help. I was only able to walk with significant pain on crutches and was completely incapable of navigating stairs. Driving was out of the question. I experienced acutely the loss of independence that my older patients feel about having to surrender their driving license. I was unable to cook, clean, and interact with family since I was fairly bed-bound and sedentary until I regained my mobility. I learned several important lessons from this experience." Rizwana Khan is a pulmonary and critical care physician. She shares her story and discusses her KevinMD article, "When physicians get sick: We are just as human as the patients we treat." (https://www.kevinmd.com/blog/2020/08/when-physicians-get-sick-we-are-just-a-human-as-the-patients-we-treat.html)

"With COVID-19, all of those memories have come flooding back. It is as if I am back in the NICU staring at that tiny infant and worried that she would get sick. Only now I have to pull myself out of that horrific daydream and stare at my teenager and pray that she will get through this. I am not alone in this. Parents of premature babies worldwide and some of whom had children on the very edge of viability are absolutely terrified. I also worry about the parents in the NICU now. I worry about the preemies that are now teens, young adults, adults, and in the elderly years. Each of them has at least one underlying health condition that can turn COVID-19 into a severe and yes, fatal case. To health responders and the health care professionals on the front end: I hear you on the seriousness of this illness. Thank you for guiding us on the challenges with COVID-19. You have us parents of vulnerable children and your former tiny patients backing up your concerns completely. To the general public heeding that concern to #stayhome and do the right thing by the young and the old and the immunocompromised, again, we are grateful. You are all our heroes." Deb Discenza is co-author of the Preemie Parent's Survival Guide to the NICU and founder, PreemieWorld. She shares her story and discusses her KevinMD article, "COVID-19 is rattling the nerves of preemie parents everywhere." (https://www.kevinmd.com/blog/2020/03/covid-19-is-rattling-the-nerves-of-preemie-parents-everywhere.html)

"As a runner, my pulse rests around fifty, but the ICU team had worried when it dipped to thirty-five, and my blood pressure hovered around ninety over fifty. Understandably, bags of saline were hung, and steroids were added. My headache improved, but my ankles disappeared, and I was often short of breath. Upon discharge, I went into full diuresis mode and spent the whole night after Thanksgiving toddling to and from the bathroom. As I passed through my parents' room, my mom, brows furrowed, muttered: 'You are going to pass out if you keep going like this.' Early in the morning, I was shaky and frail but wanted to take full advantage of the large oval bathtub with the delicious array of bath oils and loofas. I crept to my mother's side and informed her that I was going to take a bath, ignoring the nausea that was just starting to burn deep in my throat. I sat astride the tub and felt the warm stream of water flowing into the lattice of bubbles." Eve Makoff is an internal medicine physician. She shares her story and discusses her KevinMD article, "A physician's story: 'Please come quickly. My brain is bleeding.'" (https://www.kevinmd.com/blog/2020/06/a-physicians-story-please-come-quickly-my-brain-is-bleeding.html)

"I called the locum agency in the morning to air my concerns. To their credit, they admitted that the COVID-19 pandemic is an unprecedented event for which no one could have planned. They had developed a fund through which they could support health workers in need. If I took ill, I would have to call them for support. My health care will depend on the benevolence of the locum agency. My other concern predates COVID-19, but the potential of getting sick helps to clarify all sorts of work-related risks. If I were to develop a cough with sniffles and unable to work around children, I wouldn't have a timesheet to submit, and that would mean no income for the week to ten days while I am off sick. Now that my locum contract is over, but the COVID-19 pandemic rages on, I'd be hard-pressed to take another locum contract without health insurance and income protections. Locum agencies must be as meticulous with asking that their contractors have health and disability insurance, with the protection of incomes, as they are with credentialing and malpractice protections. These benefits should be offered by the agency just as they provide medical liability coverage." Koye Oyerinde is a pediatrician. He shares his story and discusses his KevinMD article, "The COVID-19 pandemic reveals gaping holes in locum tenens contracts." (https://www.kevinmd.com/blog/2020/07/the-covid-19-pandemic-reveals-gaping-holes-in-locum-tenens-contracts.html)

"COVID-19 is a tragedy that could have easily been prevented if our leaders cared more about the well-being of their citizens instead of economies, stock markets, and their political campaigns. To all those arguing about how the economy is more important, I ask, how will sick and dead people contribute to an economy? How will sick and dead health care workers contribute to our already broken health care system, which is a critical part of any economy? Before we decide to sacrifice our loved ones for the economy, we must remember that a nation cannot flourish if its citizens are not healthy." Rabia Jalal is a physician. She shares her story and discusses her KevinMD article, "Health care should be apolitical, but it isn't." (https://www.kevinmd.com/blog/2020/07/health-care-should-be-apolitical-but-it-isnt.html)

"I suppose those of us between zero and ninety-three are blessed in our own way as well. We are here, swirling in a jumble of the inconsequential and consequential. We've enjoyed some of the world's beauty and reserve the potential to experience more. Some of us will have longer than others, but perhaps we should focus on savoring rather than quantitating it. Even if it's only one more year. That's life. I have it on good authority that you can't get through it without a little pain. In the meantime, let us remember that it's never too late to chase dreams." Hailey Amick is an anesthesiologist who blogs at Facing Monsters. She shares her story and discusses her KevinMD article, "Anesthesia touches nearly every area of medicine." (https://www.kevinmd.com/blog/2020/07/anesthesia-touches-nearly-every-area-of-medicine.html)

"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)