The Podcast by KevinMD

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Our extraordinary lungs' power and fragility Jun 17, 2021

Show notes

"With the obvious accounted for, we turned to the obscure, the area of medicine where judgment and experience come into play. Fortunately, we received sound advice and guidance from the infectious disease physicians. Stick to the basics, they stressed, only do them better. We continued our patient on the first-line anti-TB drugs he had been on, this time at a slightly higher dose, and added one dose intravenously since he had inflammation in his abdomen and likely wasn't absorbing a lot of the medicine he had been taking. We supported his immune system with appropriate calories through a feeding tube and kept the pressure in his lungs low on the ventilator. In this case, there could have been an urge to change the plan radically, to alter the anti-TB drugs or give steroids or other immune modulators. The art of medicine is knowing when to give up and start anew versus when to stay with the basic plan, executed better. In this case, we stuck with the basic plan.

Gradually, the inflammation in the chest and abdomen calmed down. We were able to give the patient physical therapy, and he got off the ventilator and went to the general medical floor. We stuck to the basics of antibiotics and nutrition, and he did well. When in doubt in medicine, stick to the basics are indeed words to live by."

Michael J. Stephen is a pulmonary physician and author of Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs.

He shares his story and discusses his KevinMD article, "The lungs and the common good." (https://www.kevinmd.com/blog/2021/01/the-lungs-and-the-common-good.html)

Advice from graduating medical students to new ones Jun 16, 2021

Show notes

"We need you to join the ranks of this time-honored profession with new eyes and determined minds and eyes that see medicine's problematic foundations and minds that are willing to act on it. Because it is you, future medical students, who will soon take up the mantle of pushing medicine to change — as medical students have done for generations. We look forward to working alongside you. Welcome to medicine."

Kathryn Crofton, Jay Hwang, and Catherine Jay are medical students.

They share their stories and discuss their KevinMD article, "From future doctors to new ones: We need you." (https://www.kevinmd.com/blog/2021/04/from-future-doctors-to-new-ones-we-need-you.html)

In memory of Bernard Lown Jun 15, 2021

Show notes

"Ever the teacher, the Dr. Lown we knew modeled 'The Lost Art of Healing' (the title of one of his books) in the clinic, the laboratory, and the halls of power. As health professionals, we watched him listen carefully to his patients; as citizens, we saw him listen deeply to our neighbors. We heard him importune our health care enterprise to do what is best for democracy with an eye on the future, instead of what helps today's bottom line. And he entreated us to bear witness to the harms and risks of our social choices, to shine a light on the possible, and to lead toward a future that is better than the past. 'If you can see the invisible,' Dr. Lown said, 'you can do the impossible.'

Dr. Bernard Lown was the best of his generation. Kind and wise. A listener, a thinker, a doer. A teacher and prodder. A challenger and inspirer. Impossible to equal. And impossible to ignore."

Michael Fine is a family physician.

He shares his story and discusses the KevinMD article, "In memory of Bernard Lown." (https://www.kevinmd.com/blog/2021/04/in-memory-of-bernard-lown.html)

Why it's time to split the autism spectrum Jun 14, 2021

Show notes

"Legislative advocacy has become difficult for the severe autism population since the DSM-5 lumped Asperger's syndrome with autism spectrum disorders (ASD). Further complicating the matter, a new population recently emerged who identify as "autistic" without having a diagnosis from a qualified health care professional.

Without a clear distinction for various parts of the spectrum, we are comparing apples and oranges. We will not render meaningful information, and we make it difficult for the entire spectrum, but especially for those most affected."

Irene Tanzman is a patient advocate and author of Abie and Arlene's Autism War. Jill Escher is president, National Council on Severe Autism (NCSA).

They share their stories and discuss the KevinMD article, "Why health care professionals must call for splitting the autism spectrum." (https://www.kevinmd.com/blog/2021/02/why-health-care-professionals-must-call-for-splitting-the-autism-spectrum.html)

Estate planning mistakes for physicians to avoid Jun 13, 2021

Show notes

"My thoughts immediately went to the tragic loss of one of my best clients, a physician who recently passed away after battling COVID-19. I remember him not only as an excellent physician but even more so as a great person.

Unlike many physicians I speak to in the course of my work, this client had the foresight to do some careful estate planning. While his loss cannot be measured, this planning has provided his grieving family with some financial peace of mind and allowed them to focus on him during his illness. According to the latest CDC data, physicians on the front lines throughout this pandemic have been some of the most affected by COVID-19; over 460,000 health care professionals have been diagnosed with COVID-19.

Estate plans are not one-size-fits-all, and the various strategies may not work for everyone. Without some experienced professional guidance, anyone might make some mistakes in decisions that seem unimportant at the time but could have huge ramifications on your family's financial future. Here are some of the most common mistakes that are best to avoid."

Syed Nishat is a partner, Wall Street Alliance Group. He can be reached on LinkedIn and on Twitter @syedmnishat.

He shares his story and discusses his KevinMD article, "8 estate planning mistakes for physicians to avoid." (https://www.kevinmd.com/blog/2021/04/8-estate-planning-mistakes-for-physicians-to-avoid.html)

Teaching young children about the existence and acceptance of LGBTQ people Jun 12, 2021

Show notes

"Even though there has been a lot of progress, LGBTQ youth are still struggling with discrimination. I am disheartened that 40 percent of LGBTQ youth surveyed by the Trevor project in 2020 seriously considered suicide in the previous 12 months, and the amount of LGBTQ youth reaching out to the Trevor project crisis centers has doubled at times during the COVID 19 pandemic.

I have pediatric patients in my clinic tell me that they are nervous to reveal their sexual identities to family and friends. Many of my young LGBTQ patients have mental health issues. According to a recent Human Rights Campaign survey, only 26 percent of LGBTQ teens say they always feel safe in their school classrooms. Only five percent of LGBTQ teens say all of their teachers and school staff support LGBTQ people. Additionally, sixty-seven percent of LGBTQ teens report that they have heard family members make negative comments about LGBTQ people. Many LGBTQ youths are still homeless. It is clear that there is much more work that needs to be done."

Alexis Smith is a family physician.

She shares her story and discusses her KevinMD article, "The importance of teaching young children about the existence and acceptance of LGBTQ people." (https://www.kevinmd.com/blog/2021/03/the-importance-of-teaching-young-children-about-the-existence-and-acceptance-of-lgbtq-people.html)

It's time to reframe second victim syndrome Jun 11, 2021

Show notes

"Taking control of distress is done by embracing the concept of 'mental fitness.' Being mentally fit enables one to overcome the negative emotions that have traditionally sabotaged our lives, both personally and professionally. Similar to physical fitness optimizing our bodily strength, mental fitness promotes achievement in our performance, relationships, and sense of well-being. Much research has been done in neuroscience, cognitive and positive psychology, and performance science, showing the true benefit of mental fitness. In particular, the concept of neuroplasticity suggests that with the continued strengthening of certain neural pathways in the brain, modifications in brain architecture can be achieved. These changes have been shown with functional MRI, demonstrating increased density of grey matter in areas that correspond to certain thought processes."

Susan Wilson is an emergency physician and physician coach.

She shares her story and discusses her KevinMD article, "It's time to reframe second victim syndrome." (https://www.kevinmd.com/blog/2021/04/its-time-to-reframe-second-victim-syndrome.html)

What I learned from stepping away from medicine for a year Jun 10, 2021

Show notes

"Before COVID-19, I left the practice of medicine for what would turn out to become an entire year. While away, I found a new way of seeing our hearts and bodies as humans in the medical profession, allowing me to return.

Here are five lessons I learned in the hope they might help others."

Jennifer Lycette is a hematology-oncology physician and can be reached on Twitter @jl_lycette.

She shares her story and discusses her KevinMD article, "What I learned from stepping away from medicine for a year." (https://www.kevinmd.com/blog/2021/03/what-i-learned-from-stepping-away-from-medicine-for-a-year.html)

Don't be the patient that says these words Jun 09, 2021

Show notes

"Don't be the patient that says: 'Doc, just tell me what to do …' Instead, you should ask for information to empower yourself to make decisions about your healing process. Framing questions around the clinician's experience is always a good starting point; pretend to be the doctor for just a moment and consider the difference in how you might answer the following questions:

'Is there something wrong with the X-rays of my spine?'
'In your experience with patients like me, do most people get back to all normal activities following being rear-ended in an accident with findings on an X-ray like this?'

The first question does not give the clinician an opportunity to see you as an individual and truly help you on your path forward. Instead, it sets up a situation where the doctor is free to look at the X-ray in a general way and give a vague and simple answer. She might say: 'No, everything looks fine,' even though your back still hurts, or '… Well, I see you have some scoliosis here,' without giving you any actionable steps to take moving forward. If you keep the focus on the experience of the clinician from their work treating a large number of other individuals with similar patterns of findings, it encourages both of you to keep the bigger picture in mind. But David, you might be thinking, what's wrong with being told the findings of some specific test or measure? Simple, it's because one specific test or measure rarely tells the full story. Imaging, for example, is just an illustration of shadows that lay beneath the skin, and has limited capability to depict underlying issues, especially when it comes to a holistic view of the body. In fact, there are specific cases when performing imaging is required by insurance before they are willing to reimburse the clinician for certain procedures to be performed. Unfortunately, this can skew their clinical decision-making. This is yet another reason why you must be the one in control, and work with people you trust."

David Meyer is a physical therapist and author of Injured to Elite: A Guide To Empowering Yourself to Transform Your Life After Injury.

He shares his story and discusses his KevinMD article, "Don't be the patient that says this." (https://www.kevinmd.com/blog/2021/04/dont-be-the-patient-that-says-this.html)

A transplant physician faces facts about his career Jun 08, 2021

Show notes

"Continuing to do this work the way I was doing it was not sustainable. I needed to get off the merry-go-round. I just didn't know how. I didn't think I could stop myself—transplant was my duty, my responsibility, and what I was trained and programmed to do. It was hard to imagine leaving my post, but I needed to find a graceful exit, an elegant off-ramp that would satisfy my need for a tidy conclusion. One way or another, I wanted off the roller coaster, so I could never again be crushed by a patient like Tina. That had been my life for nearly twenty years. That was enough.

I felt yanked around by the ups and downs of the job, my emotions seesawed, and all the while I had to make rational decisions for my patients. But for me, the job was no longer a pure and simple exercise in rationality. I had mastered the mechanics of being a transplant doctor— that was the easy part. But now, from an emotional standpoint, every wife was my wife, every child was my child, and every father was my father. And I needed to save them all."

David Weill is a pulmonary and transplant physician and author of Exhale: Hope, Healing, and a Life in Transplant.

He shares his story and discusses his KevinMD article, "A transplant physician faces facts about his career." (https://www.kevinmd.com/blog/2021/05/a-transplant-physician-faces-facts-about-his-career.html)

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