The Podcast by KevinMD

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Samuel Shem, MD on how can we put the connection back into medicine Mar 01, 2021

Show notes

"There is a frenzy of trying to use technology to re-establish the healing human connection in the doctor-patient interaction. These efforts range from advanced transcription of voice-to-record, scribes who do the data recording during a patient encounter, and so on. The IT department at NYU Grossman Medical School, where I teach, worked with the dominant and much-loathed electronic medical record to create a patient-focused dashboard for each doctor. The dashboard both improved quality of outcomes and reduced costs.

These attempts are useful, but they don't address the root cause of this inhuman encounter: billing, the link of patient data to cash. In each of these tech improvements, the doctor is still forced by the money-people to massage the bill for the highest private insurance payments. There is a war across the screen — and like all wars, it's about money. On one side, doctors are forced by the accountants to bill the most. On the other side, insurance people are striving to pay the least. No 'program' or 'bot' could do this job. It's trapping doctors in the epidemic called burnout, moral injury, or just plain abuse. Forcing us to lie, to provide maximum payment. So long Hippocratic Oath.

I think the solution is obvious. Why are VA hospitals' electronic medical record systems widely preferred to any of the other ones out there? Because they are not-for-profit billing machines. All across the U.S., each VA diagnosis and treatment has approximately the same reimbursement. No war across the screen. No Hippocratic hypocrisy."

Samuel Shem is a psychiatrist.

He shares his story and discusses his books, the House of God (https://amzn.to/3cVEOZc) and Man's 4th Best Hospital. (https://amzn.to/3rFUhAH)

How residents can create a positive clinical learning environment Feb 28, 2021

Show notes

"For me, the team room became a safe space filled with light, stories, laughter, and food. There, my residents helped me read CT scans, interpret CBCs, come up with the differential for bradycardia, and organize my oral presentations. My residents gifted me confidence, advice on the third year and specialty selection, and Dr. Pestana's Surgery Notes. They took away from their time on the wards to go over my notes, and from their time with their loved ones at home to prepare me short and helpful whiteboard lectures."

Reem Al Shabeeb is a medical student and can be reached on Twitter @reemalshabeeb.

She shares her story and discusses her KevinMD article, "The role of residents in teaching and creating a positive clinical learning environment." (https://www.kevinmd.com/blog/2020/10/the-role-of-residents-in-teaching-and-creating-a-positive-clinical-learning-environment.html)

Is there a role for vitamin D in COVID-19? Feb 27, 2021

Show notes

"As we continue to deal with the COVID-19 pandemic causing spiking numbers of cases, the scientific and medical communities continue to search for effective treatments and preventive measures. We have clearly established the importance of wearing masks, physical distancing, and frequent handwashing.

As of this article's writing, there are over two hundred fifty articles on PubMed about the connection between vitamin D and COVID-19. As the research studies are undergoing, evidence is mounting that adequate vitamin D levels may be a protective factor against COVID-19 infection and severity. Here's what the research shows."

Teresa Fuller is a pediatrician.

She shares her story and discusses her KevinMD article, "Is there a role for vitamin D in the treatment of COVID-19?" (https://www.kevinmd.com/blog/2020/11/is-there-a-role-for-vitamin-d-in-the-treatment-of-covid-19.html)

Ruth Bader Ginsburg and Chadwick Boseman: a tale of two cancers in America Feb 26, 2021

Show notes

"Separated by less than a month (Boseman on August 28th and Ginsburg on September 18th) and both due to gastrointestinal cancers (Boseman had colon cancer and Ginsburg had pancreatic cancer), the situations of Ginsburg's and Boseman's deaths is emblematic of the racial disparity in American health outcomes. Boseman was African American/Black and was diagnosed with stage III colon cancer at the age of 39 while Ginsburg was Jewish/White and fought three separate primary cancers of different stages in multiple bouts – colon, lung, and pancreatic – starting at the age of 66."

Adeel Khan is a hematology-oncology fellow.

He shares his story and discusses his KevinMD article, "Ruth Bader Ginsburg and Chadwick Boseman: a tale of two cancers in America." (https://www.kevinmd.com/blog/2020/10/ruth-bader-ginsburg-and-chadwick-boseman-a-tale-of-two-cancers-in-america.html)

Interstate licensure for telehealth can fuel medical practice growth Feb 25, 2021

Show notes

"When it comes to using telehealth to treat patients out of state, most physicians are mindful about licensure issues. But some are not aware that if you don't have a license to practice medicine in a given state, it isn't just malpractice: It's a criminal offense.

Licensing restrictions have been eased to facilitate care during the pandemic, and the new normal of greater state-to-state cooperation for access to care may persist after the pandemic. Still, the savvy physician knows that many restrictions apply and that understanding them reduces risk.

When we talk about interstate licensure, we're not concerned with a one-time interaction with an established patient who happens to be traveling. For instance, say a physician has recently seen a patient, perhaps performed a procedure. Thereafter, the patient calls the physician with a question or a problem from another state while traveling. In such a case, the physician can simply address the patient's concerns, whether that's by a phone conversation, a telemedicine visit, a recommendation to go to the emergency room where they are, or whatever is appropriate, according to their best clinical judgment. That's just practicing good medicine."

David L. Feldman is chief medical officer, The Doctors Company.

He shares his story and discusses the KevinMD article, "Interstate licensure for telehealth can fuel medical practice growth." (https://www.kevinmd.com/blog/2020/10/interstate-licensure-for-telehealth-can-fuel-medical-practice-growth.html)

How books influence the medical student experience Feb 24, 2021

Show notes

"I will never forget these words. This physician validated my efforts to emotionally connect with patients. This message will indelibly shape the way I allow myself to care for and become invested in the patients to come in my future. Illness is often incredibly unfair, and sometimes we cannot overcome. However unbeatable a disease may be, a doctor can always remind a patient they are not going through this alone. We can be the one to hold their hand every day and stand with them until the very end. The magic of medicine sometimes lies in the brilliance of a treatment or cleverness of a diagnosis, but most often, it stems from the empathy of one heart opening itself to another."

Claire Brown is a medical student.

She shares her story and discusses her KevinMD article, "The magic of medicine stems from the empathy of one heart opening itself to another." (https://www.kevinmd.com/blog/2020/10/the-magic-of-medicine-stems-from-the-empathy-of-one-heart-opening-itself-to-another.html)

Letizia Alto, MD on why to become a semi-retired MD Feb 23, 2021

Show notes

"Something had to give, and it would either be clinical medicine, or my business. I finally had to admit I was no longer fulfilled to the same level doing hospitalist work.

So I made the decision to leave my clinical job.

It was so terrifying that I put off making a decision for months. I thought about what it would mean for my blog readers that I wouldn't be in the trenches with them anymore. I thought about how it would affect my family if our real estate portfolio ever fell apart and I needed to be able to make money.

I had a lot of fears.

But I'd made the decision, long ago, that I would never make decisions from fear alone. So I submitted my resignation. And I threw out my Danskos."

Letizia Alto is a hospitalist and who blogs at Semi-Retired MD.

She shares her story and discusses her KevinMD article, "After 4,380 days, a pair of Danskos — and a calling — fall apart." (https://www.kevinmd.com/blog/2020/09/after-4380-days-a-pair-of-danskos-and-a-calling-fall-apart.html)

Overcome COVID vaccine hesitancy and boost vaccine confidence: How you can help Feb 22, 2021

Show notes

Vaccine hesitancy can have a negative impact on rollout. A striking example comes from long-term care facilities. Approximately 78 percent of residents received a vaccine. In contrast, only 37 percent of staff members agreed to be vaccinated. Reasons for refusal include:

perceived rapidity of vaccine development
inadequate information received about vaccine safety, side effects, and administration
skepticism regarding the clinical trials and vaccine approval process

HERO-TOGETHER is an opportunity for people working in health care to continue the fight against COVID-19. HERO-TOGETHER participants will receive learnings and study updates, and compensation for their time. Taking part is an easy way to help fight COVID-19 and learn how to keep our communities and families healthy and virus-free.

Signup at heroesresearch.org/together (https://heroesresearch.org/together/?utm_source=kevinmd&utm_medium=podcast&utm_campaign=podcast-signup)

Emily O'Brien is an epidemiologist, an associate professor in population health sciences at Duke University School of Medicine, and a faculty member of the Duke Clinical Research Institute. Emily is also the principal investigator of the HERO-TOGETHER study.

Jessica Mega is co-founder and chief medical and scientific officer at Verily. Verily's mission is to develop the infrastructure and solutions to harness the profusion of health information for good. Their data-driven solutions across research, care, and innovation aim to improve the well-being of our communities.

How technology is a weapon in the fight against COVID-19 Feb 21, 2021

Show notes

"As the COVID-19 cases continue to rise across the globe, companies are working hard to develop innovative solutions to fight the coronavirus pandemic. Chinese companies such as Alibaba have led the way using artificial intelligence, data science, and technology. Startups are teaming up with clinicians, engineers, and government entities to reduce the spread of COVID-19. As we continue our fight in the management and eventual eradication of the virus, here are innovative ways companies are helping on the frontlines."

Amita Kundra is a cardiac anesthesiologist.

She shares her story and discusses her KevinMD article, "How technology is a weapon in the fight against COVID-19." (https://www.kevinmd.com/blog/2020/09/how-technology-is-a-weapon-in-the-fight-against-covid-19.html)

Everything physicians need to know about Bitcoin Feb 21, 2021

Show notes

"It is still extremely early in the Bitcoin story. This is due to the same network effect that Facebook, Amazon, and Apple have had as adoption of new technologies rapidly expand and are adopted by society. Bitcoin has passed its 'tipping point.' Converting some of your money to Bitcoin now is like taking an ownership stake in the Internet itself back in 1995. Ultimately, Bitcoin will either have a massive price appreciation or go to zero - meaning it is a hugely asymmetric investment. A mere 1% allocation could potentially 2x the value of your portfolio; a 10% investment could 11x the value of your portfolio. Losing 1% of your portfolio is an extremely small risk given the upside to bitcoin. Finding the right allocation is up to you, but having 0% allocated to Bitcoin is a massive risk since risk in bitcoin is asymmetric to the upside."

Noah Kaufman is an emergency physician and financial planner. He is founder and CEO, Kaufman Medical Group, and can be reached on Twitter @noahkaufmanmd. He is also founder of the Facebook group, Physician Options Traders.

He shares his story and discusses his KevinMD article, "How physicians should invest in Bitcoin." (https://www.kevinmd.com/blog/2020/11/how-physicians-should-invest-in-bitcoin.html)

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