The Podcast by KevinMD

"In Wooster, Ohio, where I practiced, a small not-for-profit hospice agency relied on local physicians, clergy, and many other volunteers to supplement the skills and dedication of their employed staff. It was through this work with Hospice of Wayne County, in making home visits when needed, that I learned the immeasurable value of presence. By continuing to care for my cancer patients until they died, I acquired insight into the equally essential virtue of nonabandonment. When I first attended a hospice and palliative medicine conference in the early 1990s, I realized that I had found my home—a community of professionals of various disciplines who had found what I had discovered: that it is the people, not the diseases, that matter. It would be years before I would totally focus my medical practice on the care of the dying, but in the meantime, the lessons I learned from those at the end of their lives made me a better oncologist and maybe even a better person. As I mentioned above, the most important of those lessons is the realization that I also am mortal, and I too will die." Jeff Spiess is an oncologist and palliative care physician. He is the author of Dying with Ease: A Compassionate Guide for Making Wiser End-of-Life Decisions. (https://amzn.to/2NpqrSf) He shares his story and discusses his KevinMD article, "Death is personal for this physician." (https://www.kevinmd.com/blog/2020/09/death-is-personal-for-this-physician.html)

"A practicing anesthesiologist for the past 14 years, when COVID hit, and the ORs came to an abrupt halt, I needed to occupy my mind. An opportunity to learn about the business behind running a practice came to me via a good friend who is a founding member of an award-winning Fintech on a mission to make a change in the credit card processing industry. I was stunned to learn about the questionable practices common in this industry. Medical education does not include business training, leaving us particularly vulnerable – no matter how great our office manager! I've seen first-hand how a little knowledge can yield significant savings in time and money. Here are the basics about what we, as doctors, should know." Jennifer Mogan is an anesthesiologist and account executive, Park Place Payments. She shares her story and discusses her KevinMD article, "How doctors are losing money every time a patient pays a bill." (https://www.kevinmd.com/blog/2020/10/how-doctors-are-losing-money-every-time-a-patient-pays-a-bill.html)

"Just as the pandemic has forced massive technology adoption in the delivery of care, we will see the rapid, widespread implementation of innovative solutions that medical education has desperately needed for years. Technologies like computer-based training, adaptive learning using artificial intelligence, video game-based learning, and extended reality such as virtual reality and augmented reality can close the educational gap. Virtual colonoscopies can be practiced 100 times before touching an actual patient. Many companies innovating in this space are seeing tremendous market interest in the wake of the pandemic. Most of these new technology-based educational tools can be used remotely, synchronously, or asynchronously, often without a teacher or proctor present. Although training will always require clinical experience, innovations at the bedside will also provide a major advantage over the traditional educational path. Hence learning can continue, and learning losses minimized. This is the way forward for most, if not all, institutions in the foreseeable future, and institutions that adopt these technological solutions will outpace those that resist." Eric Gantwerker is a pediatric otolaryngologist. He shares his story and discusses his KevinMD article, "Health care's tech renaissance during the pandemic." (https://www.kevinmd.com/blog/2020/09/health-cares-tech-renaissance-during-the-pandemic-extends-to-medical-training.html)

"We lack the necessary signaling of the nonverbal cues when only looking at one's face. The presenter's large face only a few inches from our screen may evoke our primordial threat response with its resulting cascading transmitters. The angulation of computer and phone cameras causes facial distortions. Unless one aligns oneself to be at the same level as the camera, the camera angulation may cause one to feel either looked down upon or looked up to, but rarely on the same playing field. Our neurons are living and breathing cells, and they need to eat and rest. The brain is responsible for filtering through vast quantities of homeostatic signaling from the rest of our bodies, which may affect the limitation of information that we can process. Our neural circuitry limits our information processing capacity. Just ask why can't we pay attention to two ongoing conversations at one time? Electrical circuits have breakers for overload. We just have coffee." Lester Gottesman is a colorectal surgeon. He shares his story and discusses his KevinMD article, "Zoom is foie gras of the brain." (https://www.kevinmd.com/blog/2020/10/zoom-is-foie-gras-of-the-brain.html)

"The COVID-19 pandemic has impacted everyone, especially those of us in health care. Our way of practicing medicine has been changed; some would say forever. We find ourselves affected not only clinically but also emotionally. As a result, clinicians are experiencing more stress and anxiety than ever before. These feelings are not new but have been heightened in the face of the pandemic. Physicians are perceived as self-reliant, emotionally stoic, and pillars of the medical community. Society expects perfection from our health care system and turns to us in times of medical crisis. As clinicians, we need to recognize our humanity; doctors are people too, with the same emotional needs as any other individual. In fact, one could argue that medicine demands require an even greater level of emotional support than other professions." Susan Wilson is an emergency physician and physician coach. She shares her story and discusses her KevinMD article, "Peer-to-peer support and the second victim syndrome." (https://www.kevinmd.com/blog/2020/11/peer-to-peer-support-and-the-second-victim-syndrome.html)

"Doctors are indeed noble for what they do. Their work is undoubtedly physically intense and emotionally taxing. But the notion that they are 'superhuman' and 'different' from the rest of society is exactly the trap that we fall into the moment we don our white coats as medical students. It is because of this trap that we get tunnel vision and let mistakes during our medical school training define our self-worth. We forget that there is a world outside of our flashcards, PowerPoint slides, exams, and clerkships teeming with people, adventures, and stories that, if we so choose, we can enrich our lives with, intellectually, physically, and spiritually. There's a reason depression, anxiety, and burnout is disproportionately higher among medical students and physicians. In fact, nearly 400 physicians commit suicide a year, the highest of any profession. Might it be because we are anchored to one thing and one thing only? Those of us who pursue medicine have built our entire personhood around the goal of becoming a doctor. If that is all that is meaningful to us, should we really be surprised at the statistics on mental health?" King Pascual is a medical student. He shares his story and discusses his KevinMD article, "Why medical students should not let medicine define them." (https://www.kevinmd.com/blog/2018/10/why-medical-students-should-not-let-medicine-define-them.html)

"I am left wondering what would have happened if I was the patient's daughter, niece (who she said I reminded her of), or friend. The nurse made a quick judgment based on my physical characteristics, and she was completely incorrect. I am blessed to be able to challenge people's implicit bias on a daily basis. When I walk down a hall in the hospital with my medical student badge, I feel both proud and out of place. Medicine has a long way to go in terms of making sure that people of color who are underrepresented in medicine feel comfortable, welcomed, and included wherever they go. It starts with making sure we do not make quick judgments when we see Black people and assume that they are there to take out the trash." Akosua Y. Oppong is a medical student. She shares her story and discusses her KevinMD article, "A medical student's story of racism and bias." (https://www.kevinmd.com/blog/2020/10/a-medical-students-story-of-racism-and-bias.html)

"My own dream-induced pain started at the same time this child was mowed down. Then and there is when and where my faith in God died because God, the higher power, had allowed this unspeakable nightmare to happen. My hope for the future evaporated, all while helplessness chewed through my guts From Left to Right. This was the same moment I realized that humanity is connected in a definitive, tangible, and spiritual way. A trigger-happy and scared Marine was likewise connected. He made an understandable mistake in the heat of the moment and accidentally destroyed this innocent little girl. His solitary action grew into horror, altering all of our lives. We are all intrinsically connected, and yet, we point weapons at each other, pulling triggers, and then we deal with a fragmented, amputated existence. War eviscerates us all." Reagan Anderson is a dermatologist and author of Universal Death Care. (https://amzn.to/38u63Ht) He shares his story and discusses his KevinMD article, "The trauma of a combat doctor in Iraq." (https://www.kevinmd.com/blog/2020/11/the-trauma-of-a-combat-doctor-in-iraq.html)

"The new American Medical Association policy recognizing racism as a public health threat and providing an anti-racist approach to equitable care will have no effectiveness unless health care organizations get their own houses in order and actively do anti-racism work in their own institutions. Although I'm not a health care provider, as a health care communicator whose role is dedicated to diversity, equity, and inclusion, I sit in rooms where health disparities in hard-hit communities due to systemic racism are regular topics of conversations. But in the hallways, on Zoom meetings, in texts and email conversations, I also learn about all how disparities due to systemic racism are rampant inside an institution and make organizational health equity seem like a faraway dream. How can you fight to advance health equity and racial justice out in the community when you're not doing the same within your own organization?" Nikki Hopewell is a communications strategist. She shares her story and discusses her KevinMD article, "Health care organizations: Clean up your house first, then you can tackle racism in patient care." (https://www.kevinmd.com/blog/2020/12/health-care-organizations-clean-up-your-house-first-then-you-can-tackle-racism-in-patient-care.html)

"To understand how to create good shifts irrespective of external factors, I turned to the ancient philosophy of Stoicism. One of its core tenets is that we must focus on what is within our control. Epictetus said: 'Happiness and freedom begin with a clear understanding of one principle: Some things are within our control, and some things are not. It is only after you have faced up to this fundamental rule and learned to distinguish between what you can and can't control that inner tranquility and outer effectiveness become possible.' Too often, we ignore his admonitions, and we focus our efforts on things that are outside our control while paradoxically relinquishing control of things that are within our control. Things within our control, per the Stoics, are our own thoughts, emotions, and actions. We relinquish control of them by allowing our emotions to be unduly affected by external things. 'That person said something that made me upset,' or 'I'm angry because I couldn't get something I needed.' On the other hand, we try to control things that are outside our circle of control, such as other people's actions or opinions, politics, coronavirus, or even the weather. We try to control them in our minds by resisting their presence, continuously wishing them away, or perseverating that they should be different. In order to have the inner tranquility and outer effectiveness Epictetus encouraged, we must give up the fiction that we can control things outside ourselves and maintain better control of ourselves." Christina Shenvi is an emergency physician and can be reached on Twitter @clshenvi. She shares her story and discusses her KevinMD article, "How to (almost) never have a bad shift." (https://www.kevinmd.com/blog/2020/10/how-to-almost-never-have-a-bad-shift.html)