The Podcast by KevinMD

"Our country is facing a voting crisis with multiple layers: chronically low overall voter participation, even lower voter participation among physicians and — to add insult to injury — an increasing number of laws that make voting more difficult, especially for those with chronic health conditions. Voter registration in health care settings can be part of the solution to all these problems — problems that threaten the health of a democratic society. Through these civic health conversations, both physicians and patients will increase their awareness and be empowered to raise their voices by voting. It is time for the clinic be a place for civic health as well as physical health." This episode mentions the non-partisan organization, Vot-ER (https://vot-er.org/), which integrates voter registration into the health care delivery system. Rio Barrere-Cain is a medical student. She shares her story and discusses her KevinMD article, "Doctors: You can increase voting in the U.S." (https://www.kevinmd.com/blog/2021/06/doctors-you-can-increase-voting-in-the-u-s.html)

"Currently working in a COVID ICU in a tertiary center in Kathmandu, I have experienced how difficult it is for the health system to manage the patient load. A month ago, ICU beds were fully occupied, ventilator alarms would set off time and again, indicating low flow as the hospitals faced shortages of oxygen supplies, emergency rooms were over-occupied, and patients waited in queues to receive oxygen or just to be checked up by a doctor. At such a desperate time, telemedicine is a noble initiative. I thank my patients who taught me more than just mere medical knowledge and my dedicated fellow volunteer doctors who teamed up in this project to help the nation in these dire times." Astha Prasai is a physician in Nepal. She shares her story and discusses her KevinMD article, "Telemedicine in Nepal during COVID-19." (https://www.kevinmd.com/blog/2021/07/telemedicine-in-nepal-during-covid-19.html)

"Until recently, voice changes from menopause and aging have been almost unmentionable. If a woman talked about her challenges, especially if she was a professional singer, it could have meant decreased opportunities and even the end of her career. Most women have stayed silent, coping as best as they can, assuming that they have to deal with their baffling voice issues by themselves. But that is not the case. Millions of women around the world are on the same path, and we no longer need to walk that path alone. Working together gives us a better understanding of the vocal issues women might face and how to minimize them. So how exactly do menopause and the changing hormonal landscape that women experience impact the voice? Estrogen is a major player, vocally speaking." Nancy Bos is a vocologist and co-author of the book Singing Through Change: Women's Voices in Midlife, Menopause, and Beyond. She shares her story and discusses the KevinMD article, "Menopause changes women's singing voices." (https://www.kevinmd.com/blog/2021/07/menopause-changes-womens-singing-voices.html)

"A rough career transition in 2019 followed by the pandemic highlighted how I was still financially tethered to my job — after 10 years of practicing as a subspecialty trained radiologist, saving, maxing out my retirement accounts, and investing in the stock market and in real estate. Looking around, I saw other physicians in a similar predicament. After years dedicated to rigorous training, we were still trapped by "golden handcuffs." High income was not necessarily translating to high net worth or financial freedom. It didn't seem fair or necessary. There had to be a smarter way to financial freedom — without having to live on a shoestring budget or work more shifts. I poured time and money into educating myself — really understood my financial independence numbers, learned the impact of asset allocation and taxes on my retirement nest egg, and put strategies and systems in place to optimize returns." Param Baladandapani is a radiologist and can be reached at GenerationalwealthMD. She shares her story and discusses her KevinMD article, "How doctors think about financial independence is dead wrong." (https://www.kevinmd.com/blog/2021/07/how-doctors-think-about-financial-independence-is-dead-wrong.html)

"With this single word, mom had now completely altered her willingness to see the deep suffering of her child. This single word watered all of this child's five years of depression, crippling anxiety, history full of ACEs, and very significant struggle down to a simple, selfish, flippant choice. Furthermore, mom said that the nursing staff asked her about the medications. Mom informed me that: 'The nurse said maybe it's the Wellbutrin making her this way. Maybe she is suicidal because of this?' If the team had spent five minutes doing a real assessment of suicidal thinking, they would have learned her suicidal thoughts started years prior to her being on medications and have actually decreased in frequency since starting these meds in the hospital. I could see in mom's eyes. She now did not trust me when I spoke about the importance and urgency of treatment. Her child was now an inconvenience, my medication recommendations could be damaging, and our work together was now a waste of their time. Mom declined my recommendation to titrate up meds because of her concern about them now brought on by the nurse." Shivana Naidoo is a child psychiatrist. She shares her story and discusses her KevinMD article, "How one word may have harmed my patient." (https://www.kevinmd.com/blog/2021/06/how-one-word-may-have-harmed-my-patient.html)

"While we still lack a complete cause and effect model of Alzheimer's disease, there is no doubt that the etiology is multifaceted and nonlinear. This accounts for the fact that it takes an incredibly long time for Alzheimer's disease to develop. I mention this because one of the major problems with FDA approval has always been that it insists on utilizing the same framework and methodology of approving drugs designed to treat long-term diseases as it would with short-term diseases." Robert Trent is a graduate student who blogs at Medaphysics. He shares his story and discusses his KevinMD article, "Does the FDA approval of aducanumab mark the return of science-based medicine?" (https://www.kevinmd.com/blog/2021/07/does-the-fda-approval-of-aducanumab-mark-the-return-of-science-based-medicine.html)

"Dehumanizing patients can lead to indifference in physicians. It is a privilege to be trusted to take care of every patient we encounter, yet we can lose sight of this and begin to see our patients as a burden, or as units of work, rather than as individuals. When individual patients cease to matter, we cease to care. This is the precipice of burnout and invites mistakes and poor behavior, such as cutting corners or pushing the envelope by exposing patients to excessive risks. Often, physicians hold themselves to unachievable standards of perfection. No surgery is ever perfect, yet we expect perfection from ourselves and from our colleagues. Partly the result of training, these unrealistic standards also interfere with emotional connection or empathy. Complications are an inevitable part of the work we do, yet physicians often lack self-compassion. Self-compassion is a crucial component of emotional flexibility; unrelenting self-criticism does not promote learning or modification of maladaptive behaviors." Joseph D. Stern is a neurosurgeon and author of Grief Connects Us: A Neurosurgeon's Lessons on Love, Loss, and Compassion. He shares his story and discusses his KevinMD article, "Emotional agility is an essential element for patients and practitioners." (https://www.kevinmd.com/blog/2021/06/emotional-agility-is-an-essential-element-for-patients-and-practitioners.html)

"Toward the end of my clinical career, I didn't feel like I had control over much at all. The patient safety issues loomed large. We used ridiculous workarounds for broken processes. The constant vigilance to provide excellent care in a suboptimal environment was exhausting. I didn't see anything I could change. Based on my work with physicians as a coach, I think that the sense of powerlessness and being a "cog in a wheel" is now at an all-time high. While on an uninspiring stretch of road on a recent family trip, a realization came to me: There are many, many system issues over which physicians have little control. But physicians do have control over three things: How they lead in both formal and informal leadership roles How effectively they advocate for change Who they show up as every day" Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon. She shares her story and discusses her KevinMD article, "The sense of powerlessness and being a cog in a wheel is now at an all-time high." (https://www.kevinmd.com/blog/2021/06/the-sense-of-powerlessness-and-being-a-cog-in-a-wheel-is-now-at-an-all-time-high.html)

"Physicians have had a rough century, so far. In addition to battling COVID-19, doctors have spent the past two decades fighting the health care industry's fiercest players and losing, badly. Power in the industry now belongs to health insurance companies, major drugmakers, and hospital tycoons. Physicians feel beaten up, burned out, and abused by a system so overrun with regulations that clinicians now spend more time filling out paperwork than helping patients. Doctors long for the last century. Back then, they were paid well, revered by everyone, and largely left alone to practice as they please. As the war against COVID-19 winds down, doctors believe now is the time to demand a return to the glory days when physicians ruled medicine. To get there, doctors want more money, respect, and autonomy. They'll get none of that because our nation can't afford to give it to them." Robert Pearl is a plastic surgeon and author of Uncaring: How the Culture of Medicine Kills Doctors and Patients. He can be reached on Twitter @RobertPearlMD. He shares his story and discusses his KevinMD article, "Doctors and the 5 stages of grief." (https://www.kevinmd.com/blog/2021/07/doctors-and-the-5-stages-of-grief.html)

"Maybe it's a testament to a hardy relationship that there was no resulting argument. Without thinking, I blurted out, 'You are so sexist!' I could immediately tell by my husband's face, his upper eyelids and eyebrows lifted a bit, his mouth freeze-framed in a small 'o' — my exclamation surprised and insulted him. Maybe it was a completely unfair assessment; after all, he was standing at the sink, his hands covered in soap, washing the dinner dishes. Can you be sexist and clean up after a meal? Can you be sexist and love your spouse? Can you be sexist and a female MD?" Christine J. Ko is a dermatopathologist. She shares her story and discusses her KevinMD article, "Confession from a female doctor: I am sexist." (https://www.kevinmd.com/blog/2021/06/confession-from-a-female-doctor-i-am-sexist.html)