The Podcast by KevinMD

"I think doctors are just wired that way. We are productive. We get things done. It is expected. We are supposed to do more, do it all, and be all the things to all the people. We come to a point where we try to satisfy this, and then we cannot do enough for ourselves. We cannot rest. We must keep trying to check things off the list to get things done. And it is overwhelming. It does lead to burnout. I am still a work in progress. I am writing this on a work night because it is burning in my brain, wanting to come out. Perhaps I should be doing nothing, resting for a full day. But if I do that, I will feel guilty that I have wasted this time when I could have been putting my thoughts down on paper. The mind is always going. This is me, but I think it applies to many other physicians. Look at your habits and see if you have some of my same tendencies. If you do, let's start talking about how to reverse this tide of overwhelm to create some time for yourself when you are doing nothing and not regretting it." Marion McCrary is an internal medicine physician and can be reached at Marion McCrary Wellness. She shares her story and discusses her KevinMD article, "Why doctors can't rest." (https://www.kevinmd.com/blog/2021/05/why-doctors-cant-rest.html)

"It's rare for anyone to try and tally the precise cost of unnecessary care. But when they do, the estimates are staggering. The Washington Health Alliance, a nonprofit dedicated to making care safe and affordable, analyzed insurance claims from 1.3 million patients who received one of 47 tests or services that are considered overused or unnecessary. What they found should make patients and doctors rethink that next referral. In a single year, more than 600,000 patients underwent a treatment they didn't need, costing an estimated $282 million. More than a third of the money spent on the tests went to unnecessary care, their study found. Unnecessary medical care has 'become so normalized that I don't think people in the system see it,' Dr. Vikas Saini told me. Saini is president of The Lown Institute, a Boston think tank focused on making health care more effective, affordable and just. Lown researchers have shown how overtreatment happens across the spectrum of medical care. Doctors may push for Caesarean sections for their own convenience, not so moms and babies can be healthy. Breast cancer, prostate cancer and thyroid cancer get over-diagnosed, leading to harmful and costly treatment. Around a third of colonoscopies are unnecessary, research has shown. That's not just wasting our money. It's also putting us at risk of harm." Marshall Allen is a journalist and author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. He shares his story and discusses his KevinMD article, "How to avoid treatment you don't need." (https://www.kevinmd.com/blog/2021/06/how-to-avoid-treatment-you-dont-need.html)

"A sad truth is this: Most everywhere, health care is a low-margin industry that lacks resources to invest in leadership development. Although our business's central, sacred function is caring for our fellow human beings, many who move up in the health care hierarchy do so without possessing the so-called 'soft skills' that facilitate one's ability to lead groups and motivate others. 'Soft skills,' a military term that arose in the 1960s, refers to the interpersonal savvy that it takes for organizational stakeholders to succeed. Soft skills are about more than the weaponry and the machinery; they're about the people. Whether it's academic medicine, corporate medicine, or public sector medicine, we are simply not taking enough time to focus our leaders' attention on the interpersonal dimension of their work. Excellent training and supervision enhance essential managerial skills, but most health care organizations choose not to invest in that which is 'soft.'" Steve Adelman is a psychiatrist and can be reached at his self-titled site, AdelMED. He shares his story and discusses his KevinMD article, "The joylessness of harried medical leaders." (https://www.kevinmd.com/blog/2021/07/the-joylessness-of-harried-medical-leaders.html)

"During my medical school clerkships, an attending recognized a truth within me that I'd hidden for many years. Just a few hours into my pediatrics rotation, the attending asked me, 'You had a rough childhood, didn't you?' I was astonished. How had he known? I asked him, needing to know what gave away my most deeply kept secret. And he said something that surprised me. 'You don't react. When patients tell you about risky behaviors, you treat them like regular people and just keep talking to them. You don't look shocked by anything they say.' I accepted his insight and started to notice how different my interactions with patients were. That secret part of me led to a deep, intuitive understanding of patients who were often unseen and unheard. Because for much of my early life, I was not seen or heard by people who I desperately needed to have protect me. I spent several years as a homeless teen in Hollywood before my life finally stabilized, but the scars remained." Sheryl Recinos is a hospitalist and author of Hindsight: Coming of age on the streets of Hollywood. She shares her story and discusses her KevinMD article, "The story of how a homeless teen became a physician." (https://www.kevinmd.com/blog/2019/05/the-story-of-how-a-homeless-teen-became-a-physician.html)

"On a recent call with a small health organization in rural Uganda, I asked the director about the C-section rate in the community. In some private maternity centers, this procedure is performed far more often than one might expect. I've learned that while this practice may be financially motivated, the extra fees also pay for staff and encourage doctors to maintain practices in these remote areas. This, in turn, keeps more pre- and post-natal care in those communities, including family planning and HIV care. For almost every 'best practice' cost in global health care, there is a benefit. One of the fascinating aspects of my work is to discern those rationales." Ann Messer is a family physician. She shares her story and discusses her KevinMD article, "Don't push harsh health care realities under the rug." (https://www.kevinmd.com/blog/2021/04/dont-push-harsh-health-care-realities-under-the-rug.html)

"Excited by the promise our research holds for PKD patients, we have been packaging a variety of PKD drugs into our nanoparticles, testing their ability to act as a courier service for renal drug delivery. We've been testing this process on drugs that show therapeutic benefits in animal models but are shadowed by off-target side effects. Because our nanoparticles can carry more than one drug — and even gene therapy — we can help develop and deploy a therapeutic combination that may soon offer patients more benefit than any single drug. Because the biology of ADPKD is not entirely understood, drug discovery has been slow. As we are seeing with the dramatic success of the COVID-19 vaccines, however, nanomedicine can catalyze research efforts. Nanoparticles offer a promising new way to deliver medicine, making it simultaneously less toxic and more effective." Eun Ji Chung is a biomedical engineer. She shares her story and discusses her KevinMD article, "Using nano 'couriers' to deliver PKD drugs to just the right address." (https://www.kevinmd.com/blog/2021/05/using-nano-couriers-to-deliver-pkd-drugs-to-just-the-right-address.html)

"Hypertensive disorders with onset during pregnancies are among the leading causes of maternal and infant mortality and morbidity in the U.S. and can have far-reaching consequences for the long-term health of the mother and child. In Dr. Jerome Adams' recent Call to Action to recognize and address hypertension control as a public health priority, the former Surgeon General referenced the success of health care providers who have promoted shared management of hypertension through self-measured blood pressure monitoring (SMBP), empowering patients through blood pressure (BP) management and goal setting. It's not an unusual recommendation— SMBP is well accepted in primary care for managing hypertension — but its use in pregnancy has not been routine. That's beginning to change for several reasons." Lauren Demosthenes is an obstetrician-gynecologist. She shares her story and discusses her KevinMD article, "Hypertension is killing pregnant mothers. Blood pressure monitoring can help." (https://www.kevinmd.com/blog/2021/03/hypertension-is-killing-pregnant-mothers-blood-pressure-monitoring-can-help.html)

"As working women, we have an opportunity to be an example of living with passion and priorities, of working hard, of staying committed, not necessarily to work itself but to the priorities we set around our work and our personal lives. When we work and parent simultaneously, we have a chance to teach our kids resilience — letting our kids see that even if they struggle with something they can handle it and get stronger from it — and to embrace a village mentality, not in a better way than stay-at-home moms can but in a very different way. Above all, we have the unique pleasure of encouraging our own kids to find real balance and real joy as they live their lives and as they go on to work and parent the next generation." Whitney Casares is a pediatrician and author of The Working Mom Blueprint: Winning at Parenting Without Losing Yourself. She shares her story and discusses her KevinMD article, "Winning at parenting without losing yourself." (https://www.kevinmd.com/blog/2021/05/winning-at-parenting-without-losing-yourself.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22.

"Doctors undergo mandatory training sessions in medical school to prepare for unexpected medical emergencies. Health care workers are mandated reporters who have to undergo specific training for the purpose of identifying child and elder abuse or neglect. Bystander intervention should also be on that continuum of responsibility and training. I urge bystander intervention training to be widely adopted by health care workers, professional workplaces, and the broader community to end everyday harassment and racism, for microaggressions and violence, alike. In medical simulations, health care professionals are always taught to ask two questions first that can be useful to keep in mind in any situation: 1) Is the scene safe, and 2) Should I call for help?" Michelle Lee is a resident physician and can be reached on Twitter @MichelleLeeMD. She shares her story and discusses her KevinMD article, "Bystander intervention training can save a life." (https://www.kevinmd.com/blog/2021/05/bystander-intervention-training-can-save-a-life.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22. This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Applications close on July 22.

"The FDA recommended an updated boxed warning and standardization of product labels across the drug class. They recommended judicious prescribing and a gradual taper to mitigate withdrawal reactions. While I am optimistic about these changes, the updated warning doesn't tell the whole story. After reviewing the newly updated Xanax Medication Guide, I have some concerns." Christy Huff is a cardiologist and co-director, Benzodiazepine Information Coalition. She can be reached on Twitter @christyhuffMD. She shares her story and discusses her KevinMD article, "The updated benzodiazepine boxed warning: What you need to know." (https://www.kevinmd.com/blog/2021/03/the-updated-benzodiazepine-boxed-warning-what-you-need-to-know.html) This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program (https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp). Applications close on July 22.