The Podcast by KevinMD

"Virtually everyone understands the importance of major medical insurance as it relates to unexpected high-dollar care for severe injuries and significant medical conditions, but the value equation for health insurance is quite different when applied to coverage for primary care services. The full potential cost for primary care services is neither expensive nor unpredictable. Routine and preventive care and the management of most acute illnesses and the majority of chronic disease processes by primary care physicians would be quite affordable for most Americans even if they had no health insurance. The involvement of health insurance in the relationship between patients and their primary care physicians introduces several major challenges and disadvantages. Here are the six primary areas of concern." Troy A. Burns is an internal medicine physician and author of Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor. He shares his story and discusses his KevinMD article, "6 major disadvantages of insurance involvement in primary care." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The data are remarkable and promising, though beyond the numbers is a bigger picture. Each data point represents a life – a mother, uncle, grandparent, loved one, friend. Technological advances in image guidance and therapeutic delivery are allowing us to extend life – and quality of life – for patients who previously thought they were facing sudden death. Seeing these patients celebrate another birthday, travel somewhere new, and achieve major milestones is humbling and what drives my work every day. I believe these improved survival findings are just the tip of the iceberg. With MRI-guided radiation therapy, we're changing the paradigm in the treatment of pancreatic cancer, and I venture to guess that through continued awareness, research and innovation, I may be fortunate enough to present findings that rival even these someday soon." Michael Chuong is a radiation oncologist. He shares his story and discusses his KevinMD article, "How MRI-guided radiation therapy is changing the paradigm in pancreatic cancer." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"The unvaccinated patient is the addicted person, the overweight patient, the smoker in the waiting room. Our antipathy toward them endangers their health, maybe their lives. The unvaccinated will not be convinced with stigma. They will be convinced with integrity, sincerity, and love. Stigmatization has never been an effective health intervention. And that's exactly what these reflexive responses to the unvaccinated are. It's not righteousness, as if righteousness ever helped in an examining room. These days, maintaining grace and an open heart to the unvaccinated is the most ethical practice a physician can undertake." Stephanie Sun is an internal medicine physician. She shares her story and discusses her KevinMD article, "Anger toward the unvaccinated will only cause more harm." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Physicians, nurses, advanced practice providers, medical assistants, and other health care workers are a finite resource. They don't grow on trees. And, though we all seem to deny it, they are human. The physicians I coach often wonder what they are doing wrong that their lives feel impossible. They are baffled by their inability to finish work on time, get the number of open charts down, clear their in-basket. They worry about the effects on their families and on their health and about whether they will later regret the long hours at work or charting at home when their children are hoping to engage with them. Poor work-life integration, when the needs of work and personal life collide, is a contributor to clinician burnout." Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon. She shares her story and discusses her KevinMD article, "Hello, health care organization leader, are you listening?" Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"Six air changes per hour and HEPA grade filtration of indoor air for our children is an investment in their futures for long beyond when the COVID-19 pandemic fades from view. We know there is poor indoor air quality in multiple schools, from inadequate ventilation to air pollution to wildfire smoke. Kids learn better and have less absenteeism in healthy air. COVID-19 has just added fuel to that fire. Let this be a torch to light our way forward to healthy indoor air- starting right now. Most importantly, we need to make sure this opportunity is available to all children, particularly those who have often been left behind in this pandemic. Heartbreakingly, there are kids who never logged on last year or showed up to school, and may have families afraid to send them this year. There are federal funds available from the COVID-19 relief bills to ensure that we can provide this assistance even to already financially-distressed schools. Nothing will ever make our children completely safe, which is the persistent ache of being a parent. However, they deserve a school year in person if possible, and we as the adults in their lives, should do our best to make sure they get it. Don't buy your kids' teachers apples this year. Get them some HEPA filters." Erika Maria Moseson is a pulmonary and critical care physician. She shares her story and discusses her KevinMD article, "Clearing the air our kids share: a prescription for healthy schools." Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

"I imagine I would have, as I'm sure so many others do, headed to the Internet, reading both accurate and inaccurate information. While much of my visit with my genetic counselor feels like a blur, I left that meeting with a list of answered questions, referrals to specialists, contact information for virtual support groups, and a friend by my side holding my hand. I am grateful that I know about my mutation and live by the phrase "knowledge is power." But when I imagine the thousands of people receiving the news that they have Lynch through a report, I prefer to believe that knowledge is power only when it is accompanied by context and support. March is colon cancer awareness month, and March 22nd is Lynch Syndrome Awareness Day. There is no better time to make a plan to talk about the history of cancer in your family with your loved ones, including the tough topic of colon and rectal cancers; consult a genetic counselor. And arm yourself not only with knowledge but context and support." Kerry E. Evers is a psychologist. She shares her story and discusses her KevinMD article, "With Lynch Syndrome, knowledge alone isn't power."

"The medical profession hasn't changed. Our credibility hasn't changed. Our commitment to care for you – to adore you, to grieve your diagnosis and what it means for you and your family – hasn't changed. Our advice hasn't changed. I'm grateful for your trust in me. I wish it didn't require a cancer diagnosis to win it." Cynthia Cooper is a hospitalist. She shares her story and discusses her KevinMD article, "I'm grateful for your trust in me. I wish it didn't require a cancer diagnosis to win it."

"When you enter medical school, you put your trust into an unspoken promise: Work hard, pass all your classes, and you'll come out as a doctor after four years. While mostly true, this perception doesn't take into account the residency application process and the possibility of graduating without a position as a physician-in-training. This thought didn't cross my mind until I decided to apply for otolaryngology, one of the most competitive specialties. I went into the application season hoping for the best, knowing that the number of applicants was higher than ever. On the Monday of Match Week, I opened my email from the NRMP to be met with the words, 'We're sorry, you did not match into a residency position.'" Katherine Yu and Shaan Somani are clinical research fellows. They share their stories and discuss the KevinMD article, "Unsolicited advice from unmatched residency applicants."

"I am sitting in hot springs deep in the dark and crisp air woods – naked. It has been a day of lectures and workshops at a retreat with my fellow physicians. We are all naked in the effervescent, warm bubbles of the springs. In the dark, I can recognize who people are by the fluorescent necklace each wears. You know, the kind that you crunch and shake to activate that the kids get at a party. The kind you give the kids to be safe when trick or treating in the neighborhood. In many ways, these were our safety lights, worn around the neck to give a glow – but not too much light that would allow us to realize our nakedness. Funny how doctors are about nakedness. If you think about it, we deal with naked or partially naked bodies all the time, day in and day out. We take it for granted that our patients are willing to disrobe and be examined. As an OB/GYN, I saw at least twenty naked women a day. They did have a drape for their comfort, but I certainly gave it no thought. I tend to think of fellow physicians as floating heads full of information that we exchange – certainly not as embodied butt – naked humans. This is so weird. Naked with my fellow physicians that I barely know? What? What am I doing here? The thought fades for a few moments with the fading tension in my body as the warmth of the water envelopes me." Robyn Alley-Hay is a retired obstetrician-gynecologist and life coach. She can be reached at her self-titled site, Dr. Robyn Alley-Hay. She shares her story and discusses her KevinMD article, "The profound experience of being naked with other doctors."

"I recognize that finding time for staff training and making sure the training is effectively practiced are challenges in a busy clinical setting. But taking care of patients means that both goals must be met to ensure safety, quality, and best possible clinical outcomes. As one who speaks and writes regularly about patient advocacy, I am more comfortable than most when it comes to finding my voice and speaking up – professionally and constructively. It may not be so easy for others. The bottom line is that clinical staff have an obligation to make sure all patients are well cared for from the time they walk in the door until they are ready to leave. The Joint Commission's 2021 Ambulatory Health Care National Patient Safety Goals address four critical areas of health care safety: patient identification, medication management, infection control, and prevention of medical errors. Based on my experience, two more areas are needed: patient communication and discharge protocols. In the meantime, I will keep my advocacy sword polished and ready, honoring the spirit of Alexander Cockburn who died at age 71 of cancer. I'd like to think he advocated for himself as long as he could until his death." Bonnie Friedman is the author of Hospital Warrior: How to Get the Best Care for Your Loved One and can be reached at Hospital Warrior. She shares her story and discusses her KevinMD article, "The advocate's sword stands polished and ready."