The Podcast by KevinMD

"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.

"Was I that different? I had severe anxiety necessitating medication, compounded by stress, my own narcissistic tendencies, and a series of life choices—but Jason had something much worse. It all gave me pause. I was now twenty-four, just barely older than Jason when the committee took residence. Would I soon begin hearing voices as well? I supposed that beginning the long and arduous road of medical education while having an infant at home with a lonely wife in a new place more than a thousand miles from our family counted as enough of a stressful event to trigger whatever may lay dormant in my brain." Kyle Bradford Jones is a family physician and can be reached on Twitter @kbjones11. He shares his story and discusses his book, Fallible: A Memoir of a Young Physician's Struggle with Mental Illness. (https://amzn.to/30oJezU)

"Could COVID-19 be an opportunity that brings the plight of health care professionals finally to the forefront? Protect us so we can protect you. Do your part and stay home. Flatten the curve to give health care professionals a chance. Donate PPE. Donate food. And yet through this war, we, health care professionals, along with the entirety of humanity, are united against a common, invisible enemy. We are all human; we all seek to be healthy and happy, all deserving of love and connection. Are we able to remind ourselves that health care professionals have never been so united before? That humanity has never been so united? Can all the health care professionals, no, all of humanity bear the weight of the world together? We can; we must. For our sake. For humanity's sake." Ni-Cheng Liang is a pulmonary physician and founder, the Mindful Healthcare Collective. She shares her story and discusses her KevinMD article, "Undergoing an appendectomy in a pandemic." (https://www.kevinmd.com/blog/2020/04/undergoing-an-appendectomy-in-a-pandemic.html)

"We are grateful to be avoiding the need to use draconian measures for resource allocation. We have been afforded the blessing of lead-time here in Los Angeles and have the chance to learn from other parts of the world, as well as other areas within the United States. We are preparing our personal protective equipment, re-organizing team structures and hospital workflow, taking new precautionary measures, and expanding the skillset of providers to maximize manpower. In case resource utilization reaches capacity, frameworks are in place to guide decisions in the most ethical and morally appropriate manner possible, and such frameworks remain available in future disaster scenarios. While we as health care providers address COVID-19 from the frontlines, there are still many ways the public at large can contribute to the battle against this pandemic that we all face, though the storm seems to slowly be calming." Alexander Connelly is an internal medicine physician. He shares his story and discusses his KevinMD article, "A Los Angeles response to the pandemic." (https://www.kevinmd.com/blog/2020/04/a-los-angeles-response-to-the-pandemic.html)

"We are in the midst of the COVID-19 pandemic, but it's already very clear that the infection prevention community in the U.S. has never faced such an enormous challenge. We have learned many things that will make us better prepared for the long term. We are far too reliant on single-use disposable products. Having a large supply of cloth surgical gowns and isolation gowns that can be laundered is essential. I'll comment on disposable face masks below. Less reliance on disposables will also be better for the environment." Michael Edmond is an infectious disease physician who blogs at Controversies in Hospital Infection Prevention. He shares his story and discusses his KevinMD article, "Infection preventionists are true heroes, and other things we've learned so far." (https://www.kevinmd.com/blog/2020/03/infection-preventionists-are-true-heroes-and-other-things-weve-learned-so-far.html)

"People remember stories in your speech. The rest fades away. I learned that pearl of wisdom from studying great literature and telling personal stories, and now teach it to students of speech. Who can forget the stories of The Iliad and The Odyssey having once read the books or heard of these tales of Homer? And when I want to tell a story of a hero, I think of the story detailed in another chapter of the life of my heroic policeman father who rescued hostages and gave wise advice about medical school that has served me well throughout life, that is, Homework; Courage; Never Give Up! Again, people remember stories. They forget statistics, graphs, and most information on slides. Stories that generate emotion have the equivalent of Velcro stickiness to your long-term memory storage." Donald J. Palmisano is a surgeon, an attorney and past president, American Medical Association. He is the author of A Leader's Guide to Giving a Memorable Speech: How to Deliver a Message and Captivate an Audience. (https://amzn.to/2VZu1DW) He shares his story and discusses his KevinMD article, "People remember stories in your speech. The rest fades away." (https://www.kevinmd.com/blog/2020/05/people-remember-stories-in-your-speech-the-rest-fades-away.html)

"Being a parent in the middle of a pandemic is not easy. Sheltering in place with canceled daycare, school, and college, while also being a doctor or other healthcare worker, working in high-risk, high-intensity situations, presents many challenges. It also presents many opportunities. It is possible to choose thoughts about being a physician and a parent during the COVID-19 situation that can help it feel more like an opportunity and less like a struggle." Jessie Mahoney is a pediatrician and can be reached at Pause & Presence Coaching. She shares her story and discusses her KevinMD article, "How parenting in a pandemic is an unexpected opportunity." (https://www.kevinmd.com/blog/2020/04/how-parenting-in-a-pandemic-is-an-unexpected-opportunity.html)

"Many physicians are looking for alternative sources of income and are looking for ways to diversify their investment portfolio from the volatility of the stock market. Some have heard of real estate syndications, but what exactly is a syndication? For those who have not heard of it, real estate syndications can be an attractive investment vehicle for busy professionals who do not have the time or experience to actively manage real estate. As an investor in a syndication, you can put your capital to work for you, leveraging the benefits of investing in real estate that can provide passive income independent of your time." Cherry Chen is an internal medicine physician and founder, The Real Estate Physician. She shares her story and discusses her KevinMD article, "Real estate syndication 101: a physician's guide." (https://www.kevinmd.com/blog/2019/04/real-estate-syndication-101-a-physicians-guide.html)

"Each patient I have seen over these four decades has made me a better doctor. Books do not impact long term memory the way a real patient can. I once heard the chair of medicine at a teaching hospital say that the worst thing about being on call every other night as an intern is missing half the patients. I now know he was right. Each patient becomes a colored light in our sky." John F. McGeehan is an internal medicine physician. He shares his story and discusses his KevinMD article, "Every patient makes me a better doctor." (https://www.kevinmd.com/blog/2020/06/every-patient-makes-me-a-better-doctor.html)

"We know that the past two months haven't been easy. We know about the sleepless nights, anger, tears, depression, and anxiety. We know all of this because we know what trauma does to a person, and you are in the middle of experiencing a repeated trauma. The trauma of watching patients die in ways you've never seen, the trauma of watching colleagues die, the trauma of knowing what exactly this virus could do to you if you were to become infected. We know that some of you feel helpless in your role as a physician, and that inability to control things that you are used to controlling is disrupting your confidence. For some of you, the frustration with your institutions is making it difficult to make through each shift." Nicole B. Washington is a psychiatrist and can be reached at her self-titled site, drnicolepsych.com. She shares her story and discusses her KevinMD article, "To every physician from the psychiatrists who are here to support you." (https://www.kevinmd.com/blog/2020/05/to-every-physician-from-the-psychiatrists-who-are-here-to-support-you.html)

"The COVID-19 pandemic has upended health care, with telemedicine emerging as a strategy to reduce risk exposures for patients and clinicians. Video visits, in particular, can be effective for many types of clinical care and offer convenience and savings for patients. As care shifts to this virtual modality, however, there is a risk of jeopardizing the meaningful human interaction that is critical to clinical care and impactful to patients and clinicians alike. The communication challenges of telemedicine, further compounded by COVID-19 related stress, call for strategies to help clinicians forge meaningful interactions with patients during virtual visits. The Presence 5, published earlier this year in JAMA, comprises evidence-based guidelines to foster humanism and connection in clinical care. Reconceptualizing this framework for video visits offers several strategies aligned with the Presence 5 practices: prepare with intention, listen intently and completely, agree on what matters most, connect with the patient's story, and explore emotional cues. Prioritizing explicit humanistic practices can help clinicians foster meaningful virtual connections with patients amidst this challenging pandemic and in the future as telemedicine becomes more widely integrated into clinical care." Megha Shankar is an internal medicine physician. She shares her story and discusses the KevinMD article that she co-wrote, "Strategies to foster meaningful connection during telemedicine visits." (https://www.kevinmd.com/blog/2020/04/strategies-to-foster-meaningful-connection-during-telemedicine-visits.html)

"Faced with the prospect of not being able to provide all COVID-19 patients with the life support that they may need, physicians and nurses are working in conditions that have been described as 'hell.' How are providers to cope with the trauma they are experiencing in New York and Italy, and presumably other nations as well? How are they to cope with the moral implications of the brutal decisions they will be called on to make if two critically ill patients compete for the same life-sustaining treatment when only one is available?" Geoff Tyrrell is a palliative care chaplain. He shares his story and discusses his KevinMD article, "Faced with terrible decisions, but making the right choices." (https://www.kevinmd.com/blog/2020/04/faced-with-terrible-decisions-but-making-the-right-choices.html) This podcast represents his private opinion and not that of the VA, his endorser, or board certification organization.

"After almost 30 years in this profession, I have come to the conclusion that there is some truth to that, as no day or week passes that I do not have a depressed, anxious or suicidal teen on my 'to see list.' Could it be my own personal history of depression and suicidal ideation? Could it be my own history of being bullied as a young child? My insecurities as a teenager? My personal history of sexual assault as a young, bright-eyed medical student? Or my own history of private pain and suffering? We may never know. But one thing is for sure I do want my patients, my teens, and tweens to stop hurting. And I plan on doing something about it. One patient's mother thinks I have a 'healing spirit.' That is why they come to me. I say: I hear the call and am ready to be sent." Uchenna Umeh is a pediatrician and can be reached at Teen Alive (https://www.teenalive.com/) and on Facebook and YouTube. She shares her story and discusses her KevinMD article, "A pediatrician's healing spirit: treating depressed, anxious, and suicidal teens." (https://www.kevinmd.com/blog/2018/07/a-pediatricians-healing-spirit-treating-depressed-anxious-and-suicidal-teens.html)

"Where did the myth of vampires come from? Like many myths, it is based partly in fact. A blood disorder called porphyria, which has has been with us for millennia, became prevalent among the nobility and royalty of Eastern Europe. A genetic disorder, it becomes more common with inbreeding. Porphyria is a malfunction in the process of hemoglobin production. Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body tissues. It seems likely that this disorder is the origin of the vampire myth. In fact, it is sometimes referred to as the 'Vampyre Disease.'" Michael Hefferon is a pediatrician and author of Of Plagues and Vampires: Believable Myths and Unbelievable Facts from Medical Practice. (https://amzn.to/3eREPeP) He shares his story and discusses his KevinMD article, "The medical basis of vampires." (https://www.kevinmd.com/blog/2020/03/the-medical-basis-of-vampires.html)

"As women physicians, especially physician-moms and women physicians of color, we have handled and achieved more than the vast majority of the population, in order to reach our current status of physician. We do because we can. We are Superwomen. Until we're not. Without thought, we take on others' responsibilities, because we can. In addition to our own personal responsibility to ourselves and to our loved ones, we take on the responsibilities of our patients' well-being, the failures of dysfunctional medical and political systems, and even the disastrous effects of diseases, such as COVID-19. Our patients hand over their poor health to us, and we accept it. Our dysfunctional medical systems hand over their inadequacies to us, and we accept them. We carry the weight of the world on our shoulders. Because we can. Until we cannot." Rebecca Elia is an obstetrics-gynecology physician and physician coach. She can be reached at her self-titled site, Rebecca Elia, MD. She shares her story and discusses her KevinMD article, "What does it mean to be responsible during the COVID-19 pandemic?" (https://www.kevinmd.com/blog/2020/06/what-does-it-mean-to-be-responsible-during-the-covid-19-pandemic.html)

What are the challenges facing psychiatry? How does psychiatry need to innovate the continue to thrive? What is the future of psychiatry What's your #1 tip for those considering the profession? What advice can you give to primary care clinicians as it relates to behavioral health issues? Owen Muir is a psychiatrist and host of the podcast, Pandemic Check In. (https://podcasts.apple.com/us/podcast/pandemic-check-in/id1503107429) He shares his story and discusses the present state and future of psychiatry as a profession.

"Death is not meant to be rushed. Saying goodbye shouldn't be rushed. Celebrating a life once lived cannot be rushed. And yet, we must. Taking a moment, a minute, an hour, maybe a day to feel something that normally takes far longer. Because we must. And in our hearts, the grief remains. Frozen in time in this state of mourning that we are all experiencing. We say the same words to our friends, to the families of patients that we ourselves have been the recipient of. The awkward moment when we realize that offering our condolences, again and again, has begun to lose meaning. There is a certain degree of numbing that occurs, perhaps protective, when faced with traumatic situations day in and day out. What do you when the tears no longer fall?" Julie B. Trivedi is an infectious disease physician. She shares her story, explores the pandemic from the perspective of a Texas-based infectious disease physician, and discusses the KevinMD article, "How do you grieve when you are still mourning?" (https://www.kevinmd.com/blog/2020/04/how-do-you-grieve-when-you-are-still-mourning.html)

"Over the last 100 years, the U.S. has had to respond to five avian flu pandemics. The most severe was the 1918 avian influenza infecting 1/3 of the world's population and killing 650,000 Americans. It was also the last time wide-spread containment, mitigation, and isolation strategies were used in the U.S. Seldom mentioned about the 1918 pandemic are the three 'waves' or cycles of resurgence and the subsequent deaths associated with them, especially in cities and towns that failed to implement timely mitigation restrictions or rescinded them too quickly. When considering the rescindment of mitigation restrictions, a bottom-to-top approach (local-state-federal governments) must be followed precisely to account for the kinetics of the virus. It is the virus that will truly dictate when American lives can return to some semblance of normal. The goal is to taper restrictions to avoid a cycle of new COVID-19 outbreaks and thus minimize the similar cycle of deaths, which followed in the 1918 pandemic." Nicolas K. Fletcher is a public health student. He shares his story and discusses his KevinMD article, "Strategies for lifting COVID-19 mitigation restrictions." (https://www.kevinmd.com/blog/2020/04/strategies-for-lifting-covid-19-mitigation-restrictions.html)

"The unparalleled and pervasive nature of the evolving COVID-19 pandemic has touched all of us in some way. There is limited, albeit growing, research on the mental health effects of disasters. A recent review article pointed out the potentially negative consequences of prolonged quarantine, while other research from Wuhan, China, highlighted the impact of COVID-19, particularly amongst healthcare personnel. Psychiatrists and mental health professionals will play a critical role in the aftermath of the pandemic, but this requires a shift in perception of who a psychiatrist is and what they have to offer." Chinenye Onyemaechi is a psychiatrist. She shares her story and discusses the KevinMD article that she co-wrote, "Redefining the role of psychiatrists in the time of COVID-19." (https://www.kevinmd.com/blog/2020/04/redefining-the-role-of-psychiatrists-in-the-time-of-covid-19.html)

"Recent articles have accused some physicians of hoarding medications for themselves during our international medical crisis. Authors such as these should be ashamed of their coverage and wasted ability on sensationalism when they could be spending their time informing the public about the dangers of COVID-19 and the actions communities, hospitals, physicians, businesses, and public servants are taking on a daily basis to protect our great nation and the world from the perils of this invisible enemy. As a physician, I urge my colleagues to keep fighting to help restore order and health in our nation and to remember the promise we made in our Hippocratic Oath: 'So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. There is hope we will defeat this invisible enemy and return to the normal way of American life: travel, commerce, vacation, celebrations, and sports. I ask that we help each other and not spread fear and disinformation during this period. Many people are in need, so reach out to your local hospital or medical school and ask how you can help by donating food or funds to help medical students, physician trainees, and other health care workers. This is a time of national unity and to rise as one and to share resources with each other, help the elderly, and listen to the advice of medical experts." Shady Henien is an interventional cardiology fellow and CEO, Physician Promise. (https://www.physicianpromise.com/) He shares his story, explores the cardiology-coronavirus connection, and discusses KevinMD article, "This is a time for national unity, not sensationalism." (https://www.kevinmd.com/blog/2020/03/this-is-a-time-for-national-unity-not-sensationalism.html)

"This pandemic presents a unique opportunity for senior anesthesiologists to see the benefit of accommodating the health care needs of our workforce. Just as I tried to avoid the teratogenic effects of certain cases when pregnant, we should consider the most effective ways to protect senior anesthesiologists from a life-threatening infection. When the pandemic has passed, anesthesiologists of all ages can take into account times when each of us is more susceptible than others. I hope that we will work to accommodate the age dynamics of our profession and protect each other. For now, while we still have a full roster of healthy anesthesiologists, an effort should be made to spare older colleagues who are at higher risk. After all, this is at the heart of what we do as physicians: care for and protect those who are in need." Becky Wong is an anesthesiologist and can be reached on Twitter @BeckyWongMD. She shares her story and discusses her KevinMD article, "Spare older anesthesiologists COVID-19 coronavirus risk." (https://www.kevinmd.com/blog/2020/03/spare-older-anesthesiologists-covid-19-coronavirus-risk.html)

"Being present is a wonderful thing. It relieves stress caused by focusing on failures of the past and worries of the future. Both realms are unreachable, largely unchangeable. But at the same time, they both entice and tease our minds such that we often find ourselves everywhere, but at the moment as we focus on changing what has already passed or what may (or may not) come to be. Living as our children model so well, at the moment, has an immediate influence on our health and wellness. Tuning out the constant barrage of news about coronavirus and tuning into what is before you will bring calm, serenity, and a sense that all is okay. It will allow you to enjoy the moment, the small pleasures our senses offer us, things that pass us by when we are lost somewhere else on the time continuum. The touch of an elder, the smell of a blossoming fruit tree, the way the wind feels against our cheek – open up to the present, and it is all there for you. Just ask the two year olds." Anthony Fleg is a family physician who blogs at Writing to Heal. He shares his story and discusses his KevinMD article, "Take a gratitude perspective on coronavirus" (https://www.kevinmd.com/blog/2020/05/take-a-gratitude-perspective-on-coronavirus.html) and "The superpower of being present." (https://www.kevinmd.com/blog/2020/05/the-superpower-of-being-present.html)

"Recently, I realized that something needed to change in my family life. With three busy daughters at three different schools who participate in multiple activities along with my full-time job as an anesthesiologist, my life depended on accurate and concise communication. However, this was the third time in a week that a ball had been dropped between my husband and me. This time it resulted in my middle daughter, Laini, being left at practice, and the coach calling to figure out who was picking up this last straggler. It was enough to make me realize that something had to change. The previous day, I had run a code in the GI suite at the hospital where I work. Everything had gone smoothly with team members, all understanding each other perfectly. If I could communicate effectively with a team of five health care members, why couldn't I use these strategies to communicate with my own husband more effectively?" Maria Michaelis is a pediatric anesthesiologist. She shares her story and discusses her KevinMD article, "Closed-loop communications: Good for codes and for marriage." (https://www.kevinmd.com/blog/2020/03/closed-loop-communications-good-for-codes-and-for-marriage.html)

"All too often, physicians and other health care providers have tried to do the right things for our patients to ultimately have had our hand slapped. So pause for a second, get the questions answered, know what future implications are for today's actions. Make the right choice for your patient, and for yourself, especially if it means amending your contract before you start something that may limit your talent/potential as a health care provider. We are taught to feel powerless, which is why our burnout rate is so high. Words are disguised to mean another: patient volume/productivity disguised as patient access, EHR checkboxes that are clinically meaningless disguised as quality measures, your bedside manner, and ability to relate disguised as patient satisfaction surveys. And yet, as we see, despite being made to feel powerless, at the end of the day, we are the only ones with the ability to provide medical care when people need it. An anesthesia machine, scalpel, laboratory, and stethoscope are all useless without the person with it. So get out there and wear your warrior uniform and help your patients! But don't have it be a disguise for being made to wear shackles tomorrow." Vasanth Kainkaryam is an internal medicine-pediatrics physician. He shares his story, explores his direct primary care decision, and discusses KevinMD article, "Advice to employed physicians plunging into telemedicine." (https://www.kevinmd.com/blog/2020/03/advice-to-employed-physicians-plunging-into-telemedicine.html)

"Obesity is a topic that literally hits home for me. For the past two years, the website WalletHub has voted the McAllen-Edinburg-Mission TX metroplex as the 'fattest city in America.' As a health care provider, this is deeply disturbing because it puts my community at high risk for a wide variety of health problems, including but not limited to coronary artery disease, diabetes, stroke, and several cancers such as liver, kidney, breast, endometrial, prostate, and colon. Not surprisingly, we also rank third for the highest percentage of diabetic (type 2) adults. In a local news article published just after our unceremonious coronation, city officials were quoted as saying that WalletHub's findings were, '… extremely misleading about the actual activities and health and wellness and well-being of our community.' I've seen all of the strides that this area has taken to make exercise more accessible, with increasing healthy food options, gyms seemingly everywhere, and miles of paved paths for running and biking. Each city hosts a number of races yearly, including marathons. We even live an hour from South Padre Island, where there's a wide variety of water sports available to enjoy. Yet, the fact remains that our obesity rates still rank at the very top in the country. So, what's to blame for this health epidemic? The plate is full when it comes to contributors, but we are missing out on the main dish." Henry Herrera is a gastroenterologist. He shares his story and discusses his KevinMD article, "What's to blame for the obesity epidemic?" (https://www.kevinmd.com/blog/2020/03/whats-to-blame-for-the-obesity-epidemic.html)

"We are in the midst of a crisis in humanity. While we are still dealing with COVID pandemic and its deleterious health, economic and societal consequences, our troubling past of racism and inequality is rearing its ugly head. The senseless killings at the hands of police, the shameful subjugation of persons of color, the systemic prejudice of a person based upon gender, sexual orientation, or disability have placed us at a tipping point in society. We are vulnerable as a community, as a state, and as a nation. As I am writing this, I am disheartened, disillusioned, and spiritually broken. Our children are witnesses and possibly victims of this inequity. So we as persons of all ways of life and ethnicity must do right for our current generation of highly impressionable minds. As I pen this 'call to care,' I ask you all to consider the following important actions." Nicolo Geralde is a neonatologist. He shares his story and discusses his KevinMD articles, "We are in the midst of a crisis in humanity" (https://www.kevinmd.com/blog/2020/06/we-are-in-the-midst-of-a-crisis-in-humanity.html) and "A different perspective on PPE during the COVID-19 crisis." (https://www.kevinmd.com/blog/2020/04/a-different-perspective-on-ppe-during-the-covid-19-crisis.html)