The Podcast by KevinMD

"Like 9/11, we have a new reference point touching everyone on the planet: life before COVID-19 and life after. Regardless if you get it or don't, the unknowns and secondary consequences are scary. Life before COVID was scary, too, minus the urgency. Before COVID, we sensed the weight of living on a sick planet. We felt powerless to change the tide of forces affecting our lives for the worst. We normalized the slow spiral down the drain of political divisions, economic inequality, costly health care, deteriorating education, unreliable information, and unsustainable living. We let our existential fear buzz like a refrigerator's white noise. COVID innocently shines a floodlight on our curious collective permissiveness. It illuminates silent fear." Ruchi Puri is an obstetrics-gynecology physician and can be reached at her self-titled site, Ruchi Puri, MD. She shares her story and discusses her KevinMD article, "COVID illuminates silent fear." (https://www.kevinmd.com/blog/2020/07/covid-illuminates-silent-fear.html)

"The inflammatory response elicited by the novel coronavirus can do great damage to the essential function of lungs. People with underlying lung disease are more vulnerable to this coronavirus, including people with asthma, emphysema, lung fibrosis, and even people with high exposure to air pollution. Smoking and vaping are perfectly preventable forms of high-intensity air pollution. We strongly urge city, county, and state governments across the planet to place a temporary moratorium on the sale of all inhalable products to protect our lungs and our freedom." Jayshree Chander is an occupational medicine physician. She shares her story and discusses her KevinMD article, "A call for a moratorium on the sale of inhalable products." (https://www.kevinmd.com/blog/2020/08/a-call-for-a-moratorium-on-the-sale-of-inhalable-products.html)

"Holding space means being physically, mentally, and emotionally present for someone. It means putting your focus on someone to support them as they feel their feelings. An important aspect of holding space is managing judgment while you are present. Like when you tell a patient that they have stage IV pancreatic cancer and that it is nonsurgical and even with the best treatments, their time is very short. Then you hold space. You say nothing. You sit there and provide support by sitting there-next to their emotions. You don't run to offer false hope. You don't run to talk about 5 percent of the patients that respond to the newest therapy. You don't try to look at the bright side. Change the subject. Or worse, run out the room. You hold space. Sometimes, you sit for 2 minutes. Sometimes 10 minutes. While saying nothing. It feels like an impossibly long time, but I wish I could tell you how you are bearing the weight of that news by just sitting there. Holding space." Faryal Michaud is a palliative care physician and can be reached at Write Your Last Chapter. (https://writeyourlastchapter.com/) She shares her story and discusses her KevinMD article, "The importance of holding space." (https://www.kevinmd.com/blog/2020/08/the-importance-of-holding-space.html)

"The reality of being a medical practice owner is that we are small business owners and very vulnerable to the impact of COVID. Having previously worked in the telemedicine industry and because I am a psychiatrist, I initially felt that I was in a good position to adapt to this crisis – and this has been overall true, but the reality is it hasn't been so easy in other ways. I was able to transition to a full telemedicine practice rather quickly and seamlessly; I am fortunate that I have been able to work to some degree while some of my colleagues have not. On the business side, I have had a significant decline in my overall revenue because patients were, especially for the months of March through May, seeking less health care overall, didn't have sufficient privacy for telehealth sessions, or even simply preferred to wait for in-person visits to become available. As you know, New York was hit particularly hard, so this has been a prolonged situation of waiting until the coast is clear. Despite decreased revenues, operating costs remain at their pre-COVID levels – I am carrying the expense of my office rent and utilities, malpractice insurance, and other insurances, for example, accountant, biller, receptionist, and none of those expenses will be decreasing anytime soon if ever. I am the only clinician in my practice, but I would like to be able to rehire and re-expand my practice again but am facing some challenges in hiring due to poor cash flow." Sharon M. Batista is a psychiatrist. She shares her story and discusses her KevinMD article, "7 tips to balance family and professional needs during the pandemic." (https://www.kevinmd.com/blog/2020/08/7-tips-to-balance-family-and-professional-needs-during-the-pandemic.html)

"To help the reader understand the issues better, I would like to relate some stories. A friend of mine was dying of pancreatic cancer. He had an implantable morphine pump and was on both hospice and palliative care. Still, he found that his suffering was unbearable and wanted to die sooner. Doctors told him that his only option to end his suffering was to voluntarily stop eating and drinking, which he did. As a result, he developed psychosis, and his loving family has been scarred by the experience. He died after 10 agonizing days. I heard about an individual with ALS (Lou Gehrig's disease), which is incurable and causes the death of neurons that control muscles and eventually leads to the inability to move and then the ability to breathe. This person killed himself with a gun before he lost the use of his arms. I had a number of patients with cancer that we were not able to control their pain, and I gave them palliative sedation (a morphine drip that caused them to become unconscious) to control their suffering. Had it been available, medical aid in dying could have helped all these people. When my cancer gets worse, I expect to have a great deal of pain. I would like the option of having medication to put me to sleep, end my suffering, and to die, at home, with my family and friends around me." The author would like to correct the following statistics from the podcast: 17 percent of terminally Ill individuals discuss medical aid in dying with family and friends. 2 to 10 percent discuss medical aid in dying with a physician. 0.6 percent get medical aid in dying prescriptions. 0.3 to 0.4 percent use a medical aid in dying drug. Roger Kligler is an internal medicine physician. He shares his story and discusses his KevinMD article, "Medical aid in dying is not assisted suicide." (https://www.kevinmd.com/blog/2020/10/medical-aid-in-dying-is-not-assisted-suicide.html)

"There are some things that we are living through as a result of COVID-19 that I did not imagine in my fictional account. For example: the timeline. As we are now four full months into this pandemic in the U.S., some experts estimate that we are still early in the game. As one doctor put it, we are only at about the twenty-yard line of the football field. My imagined timeline was much shorter. Another thing I didn't foresee was the perception of danger dividing along political lines. In fact, I imagined the opposite: that people would, in the name of self-preservation, view with suspicion any political down-playing of the danger of a global pandemic and insist on any means possible of protecting themselves. And among the most devastating consequences of this pandemic that I hadn't imagined for my novel was the situation of people dying alone in hospitals without their loved ones. Not being able to hold the hand, give a final hug, say goodbye. Undoubtedly, penning an imaginary pandemic is much less stressful than living through one. Living through a pandemic day by day has carried with it a chronic anxiety that I did not anticipate: not just the fear of contracting the illness, but the constant worry of pre-symptomatically transmitting it, thus second-guessing every errand, every visit to loved ones. As we all work through this unprecedented medical crisis, I hope we continue to make steady progress in treatment and prevention of this devastating illness. Stay safe." Teresa Fuller is a pediatrician. She shares her story and discusses her KevinMD article, "Imagining a pandemic as a physician novelist." (https://www.kevinmd.com/blog/2020/07/imagining-a-pandemic-as-a-physician-novelist.html)

"As our office begins to return to pre-COVID operations, it has been uplifting to have a relative sense of normalcy, even though morale seems to be reduced. It is difficult to promote team building and improve morale when everyone has to maintain social distancing. I would love to go out for a meal with my staff, hug my patients, and lecture our trainees face-to-face in a classroom. While the hope is that all of these distancing measures are temporary, avoiding despair is another layer added onto an already heightened level of stress. I think all of us in medicine who have survived the pandemic thus far are grateful, even as we mourn the tremendous loss of life. There are signs that we can overcome this new normal moral injury involving fear, stress, and work-life imbalance. Several things that were burdensome pre-COVID such as licensing regulations, charting requirements, being unable to do telemedicine, for example, all were revised in some positive way as a result of the pandemic. In the same way that protests for social justice are rising, so are voices in medicine that will hopefully use this time of uncertainty to potentially change and improve health care systems. As we continually provide hope to our patients, perhaps there is hope for our profession to improve when we come out of this challenging time." Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein. He shares his story and discusses his KevinMD articles, "My new normal moral injury" (https://www.kevinmd.com/blog/2020/07/my-new-normal-moral-injury.html) and "Practicing oncology during COVID-19." (https://www.kevinmd.com/blog/2020/03/practicing-oncology-during-covid-19.html)

"The duty of physician officials in the government exceeds that of other officials. As physicians, they have a unique moral obligation to do more than protect the constitution from enemies, foreign and domestic. They have a duty to be unambiguously truthful, to use their power to do good, and to avoid harm. If they fail in any of those regards, they must be held accountable by their peers, and by society. This is especially urgent when those who appointed them to these positions of authority fail to manifest in their actions the moral necessity of telling the truth, doing good, and avoiding harm. In that case, peer and public accountability are all that is left to uphold these essential ethical standards. If this level of peer accountability seems extreme, imagine the consequences if the most powerful and public-facing physicians in the country continue to erode public trust in their own profession. Physicians have always held one another accountable to the highest ethical standards of medicine. The need is more urgent than ever. The potential for great human suffering demands that the unified voice of medicine muster its moral courage and act as though its life depends on it." Charles E. Binkley is a bioethicist and general surgeon. He shares his story and discusses his KevinMD article, "The failure of the U.S. government's physicians to do good, avoid harm, and tell the truth." (https://www.kevinmd.com/blog/2020/09/the-failure-of-the-u-s-governments-physicians-to-do-good-avoid-harm-and-tell-the-truth.html)

"Growing up, my family sheltered and protected me with everything related to vitiligo. People never really asked me what happened to my skin. And, if I did get questions, I honestly did not know how to answer them, so I would say 'oh, they're just sunburn scars' or some version of that story, and moved on. Thinking back, I probably was too supported and busy to really have an opportunity to be bothered by it. That, in itself, was a blessing. I pursued many years of schooling and training to ultimately become a practicing physician. Now that I've been in medicine for many years, I primarily value and cherish the connection with my patients, as I sincerely believe medicine is fundamentally about the human experience. But, when I hear statements like 'you don't look Indian' from patients, I am constantly reminded each time that I have vitiligo. Reflecting on how best to answer this question, I ask myself if I should react and explain the skin condition, or just let it go. The truth is that the majority of the time, I do 'let it go' when it comes to discussing my skin condition with patients. I simply don't want to explain to patients that I have vitiligo." Dhaval Desai is a hospitalist. He shares his story and discusses his KevinMD article, "The story of an Indian doctor with vitiligo." (https://www.kevinmd.com/blog/2020/06/the-story-of-an-indian-doctor-with-vitiligo.html)

"The daily email update on COVID-19 affecting our hospital system is a glaring reflection of the health disparities amongst those in marginalized groups. The farther south you go, generally in San Diego, the higher the number of socioeconomically disadvantaged persons, and that tends to include a disproportionate number of persons of color. These populations may be unable to physically distance due to living conditions and job conditions. Perhaps there is a higher number of persons living together per household, in a smaller space, along with the inability to work from home. And the mortality rates of those from COVID-19 amongst these persons is higher than white counterparts. Sometimes there is an inherent distrust in the medical system. COVID-19 and racism intersect. However, this is not a unique situation in health care—many chronic illnesses portend worse outcomes for those in marginalized groups. Marginalization means just that: glaringly apparent in health outcomes and socioeconomic disparities." Ni-Cheng Liang is a pulmonary physician and founder, the Mindful Healthcare Collective. She shares her story and discuss her KevinMD article, "COVID-19 becomes a magnifying glass for health disparities." (https://www.kevinmd.com/blog/2020/07/covid-19-becomes-a-magnifying-glass-for-health-disparities.html) Resources mentioned in the show: Implicit bias test: https://implicit.harvard.edu/implicit/takeatest.html Health Disparities Widget: https://www.healthypeople.gov/2020/data-search/health-disparities-data/health-disparities-widget Strategies for Reducing Health Disparities: https://www.cdc.gov/minorityhealth/strategies2016/index.html Conscious Anti-Racism: https://www.jillwener.com/consciousantiracism