The Podcast by KevinMD

Latest Episodes:

Kids are not OK: Health care is failing them Mar 19, 2022

Show notes

"Our children are not OK. Our pediatricians are not OK. Please, let us not further ignore and jeopardize the future health of our society. Pediatrics needs a transformational change to direct primary care and other models that transition from transactional care to relational care. Encourage your employer to embrace direct primary care for children. The future health of our children is at stake."

Andrew Hertz and Keili Mistovich are pediatricians.

They share their stories and discuss the KevinMD article, "Kids are not OK: Health care is failing them."

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Managing expectations during COVID-19 Mar 18, 2022

Show notes

"I had sent an email to some key people in my organization about managing patients' expectations and how that needed to be addressed differently on an organizational level. The truth of the matter is that I am powerless to change the way the system handles a lot of things. The more personally relevant issue is managing my expectations, both how I relate to the needs/expectations of those in front of me and my own personal needs and expectations of myself in delivering that care. Since we truly only have control over ourselves, the key question becomes how do I manage my own expectations better as a way of managing my own inner resources, namely, time, energy, and mental/emotional output?"

Anne M. Miller is a psychiatrist.

She shares her story and discusses her KevinMD article, "Managing expectations in the face of COVID-19."

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How a code profoundly affected this physician Mar 17, 2022

Show notes

"There is a small amount of literature about secondary trauma. This means that the people who respond to trauma (firefighters, police, doctors, EMTs, etc.) experience PTSD from experiences they were not the primary victims of. I haven't read the literature, and I don't know what qualifies. I do know that this is the single worst experience with humanity that I have ever had, and the images from that night are as clear in my head today as they were when I first saw them. I know I will never forget that night, nor will I ever cease to feel my heart drop and stomach churn when I think about the few steps that Amanda took from her bed to the bathroom. The last few of her life.

Rehaan Shaffie is a hospitalist.

He shares his story and discusses his KevinMD article, "The worst code I ever ran."

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Unrequited: love in the time of COVID-19 Mar 16, 2022

Show notes

"If you knew we are like the 'Two Fridas,' that our hearts are connected, would you change your mind? Would you stop as you are about to cut the artery feeding your heart and mine? If you knew that when you cry because of your loneliness, because of your longing for your family, that I cry, too, (though behind your back, after I have comforted you) would you change your mind? If you knew that your isolation, with the tubes and gadgets coming from you or going into you, extend to me would you change your mind then?"

Rosemary Eseh-Logue is an internal medicine physician.

She shares her story and discusses her KevinMD article, "Unrequited: love in the time of COVID-19."

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Why do physicians stay in toxic work environments? Mar 15, 2022

Show notes

"For the most highly educated and specialized professional on the health care totem pole, physicians put up with a ridiculous amount of nonsense in the workplace.

You are pressured to see high volumes of patients in a rapid-fire fashion (15 minutes per visit) even when it interferes with the quality of care.

You are expected to complete mundane and excessive administrative tasks and generally are not directly compensated for this time.

You are given very little flexibility from your employers when it comes to rearranging your schedule and taking personal time off.

For the average physician, the working conditions are intolerable at best and inhumane at worst.

So the question is, why is this poor treatment tolerated?"

Chelsea Turgeon is a former OB/GYN resident and can be reached at Coach Chels MD.

She shares her story and discusses her KevinMD article, "Why do physicians stay in toxic work environments?"

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Are hospitals evil? A physician contract lawyer explains. Mar 14, 2022

Show notes

"Unfortunately, when negotiating with hospitals I am frequently forced to deal with individuals who need to 'explain' the importance of maintaining flexibility in their workforce (a wonderful business school phrase that appropriately dehumanizes the people who are accomplishing the purported mission of the hospital to treat the sick and injured). The hospital personnel frequently tell me that limiting patient contact hours to 'only' 32 or 36 hours per week is considered part-time. Many contend that keeping the electronic health record boxes all appropriately checked should be done on the physician's own time. I assume the hospital administrators would be pleased if a physician avoided any personal contact with the patient during whatever brief moments are allocated for a visit so that the electronic health record can be put into a condition that allows billing for the visit.

Physicians, of course, spend their visits treating the patient as a human being rather than a unit on the assembly line that is their schedule. Doing so requires significant outside time polishing the record so that the hospital may bill. Hospital executives apparently view this as an inefficient use of resources, and therefore frequently insist upon 40 patient contact hours per week."

Dennis Hursh is a physician contract lawyer. He blogs at Physicians Contracts Blog.

He shares his story and discusses his KevinMD article, "Are hospitals evil? A physician contract lawyer explains."

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COVID and obstetrics: a physician shares her story Mar 13, 2022

Show notes

"I thought of her with each miscarriage I saw in COVID+ mothers, and during each delivery of premature rupture of membranes due to infection. I thought of her every time I gave steroids, increased the oxygen flow for someone struggling to breathe, or held the hand of someone before their emergency delivery. I saw her face when I was frantically calling a pulmonologist to help me manage oxygen on a deteriorating patient on the unit. She stayed with me through each obstetric emergency.

She probably never thought of me. I was the doctor who made her cry when she was most excited to tell me that she wanted children.

I don't know if she'll be back, and I don't know if I am better or worse at explaining the urgency. All I know is that we all make choices. With COVID, some choices will save lives, whereas other choices might end with the unimaginable."

Yuliya Malayev is an obstetrician-gynecologist.

She shares her story and discusses her KevinMD article, "What does it even mean to work through the unimaginable?"

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Requesting disability accommodations in medical school Mar 12, 2022

Show notes

"I failed my Step 1 medical school board exam by 1 point. This was very hard for me to process, and I consistently wondered if I would have passed if I had just waited an additional week. This new challenge led me to reach out to a new resource: the disability office.

Never before had I considered my medical diagnosis of endometriosis and anxiety as a 'disability.' I had obviously done well enough to graduate college and get into medical school. Although, I never seemed to be able to achieve top grades in my class. I had always believed this was an explanation for being less intelligent than my peers. However, the disability office helped me realize that the standardized testing system was not equitable and did not allow me to do my very best in these exams. Through this experience, I realized that I do have a disability. All a disability means is that one is not able to achieve what other people without the disability can achieve."

Stephanie E. Moss is a medical student.

She shares her story and discusses her KevinMD article, "Requesting disability accommodations in medical school."

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What doctors and soldiers have in common Mar 11, 2022

Show notes

"What makes soldiers and doctors good at their jobs are also the very things that make it hard to leave work at work. My former husband was, and is, very good at his job, especially when it comes to compassion and care for his patients. At work, he gives his all. He sits with grieving families, helping them understand what's happening with their loved ones and even crying with them as they die. To ask one more thing of him when he'd given every ounce of his soul all day seemed selfish and childish. So I tried to be civilized and grown-up, swallowing my need for love, to be seen and cared for the way his patients were. By the end of the day, he was so drained; he must have felt that no story he could tell me could bridge the huge divide between the battlefield of the hospital and the home we shared. This is what many doctors do: go back and forth between the battlefield and whatever "home" they've created. They are soldiers in everyday life."

Susan Hart Gaines is an executive coach specializing in physician wellbeing.

She shares her story and discusses her KevinMD article, "The difficulty in coming home: What doctors and soldiers have in common."

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Cancer treatment and tumor-informed residual disease testing Mar 10, 2022

Show notes

"Life can feel full of uncertainty when battling cancer, with few guarantees. 'Is there still cancer in my body?' and 'Will it come back?' are common questions that have long been difficult to answer confidently until recently. Advances in next-generation sequencing — and a growing understanding of how our bodies respond to illness and treatment — have brought us closer than ever to predicting our individual futures, at least when it comes to cancer.

In recent years, cancer researchers have embraced new noninvasive technologies that can detect small amounts of DNA shed by tumors into the blood, also known as circulating tumor DNA (ctDNA). This is no easy feat, as ctDNA is extremely scarce after surgery and treatment — as low as a single molecule in a tube of blood. But by broadly sequencing one's tumor, we can identify its unique genetic signature, allowing for the creation of a highly sensitive and personalized assay that can track cancer in the body over time."

Alexey Aleshin is a hematology-oncology physician and health care executive. He can be reached on Twitter @aaleshin.

He shares his story and discusses his KevinMD article, "Tumor-informed residual disease testing can help inform cancer treatment."

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