The Podcast by KevinMD

"Almost overnight, the COVID-19 pandemic has completely disrupted how we deliver primary care to patients. Before the pandemic, telehealth seemed to be a way to deliver urgent care for acute issues to a select group of tech-savvy patients. Now, at least in my practice, the majority of primary care (acute care, chronic disease management, and preventive care) is being delivered through "telehealth," meaning that we conduct visits virtually via video or telephone. While, of course, this is currently safer, many patients also seem to value the improved convenience and accessibility of these visits compared to traditional office-based care. However, as we continue to move forward providing virtual care to patients during the pandemic and beyond, we need to recognize our current deficiencies in providing this type of care and acknowledge that providing the full scope of quality telehealth will require more than just a video connection with a patient." Cara Litvin is an internal medicine physician. She shares her story and discusses her KevinMD article, "Envisioning the delivery of true primary care telehealth." (https://www.kevinmd.com/blog/2020/08/envisioning-the-delivery-of-true-primary-care-telehealth.html) This episode is sponsored by The Nuance Dragon Ambient eXperience (DAX). The Nuance DAX solution makes it possible to forget the tech-toggling and reduces documentation burdens no matter how or where care is being provided. (www.kevinmd.com/nuancedax)

"There is no single culprit responsible for this shift in medical education. However, two, in particular, should be noted. The first is the culture of defensive medicine, or more bluntly, CYA (cover-your-ass) medicine. This culture has been insidiously infusing itself within the modern health care system for decades. The fear of being sued for malpractice is ever-present. Undoubtedly, this has led to hesitations in allowing medical students to be involved in patient care. Another important consideration is our capitalistic health care system. In an era when physicians are being pressured by hospitals to see more patients, coupled with intense bureaucratic demands and documentation requirements, it is no secret that learners slow down productivity and drive down the bottom line. As a result, education suffers. What is the consequence of all of this? The 'finish line' keeps getting pushed back further and further. More resident physicians are deciding to pursue fellowship before becoming an attending. For instance, in the field of general surgery, 80 percent of residents decide to pursue a fellowship. It is unclear how this will affect patient care in the future. Undoubtedly though, it begins at the medical student level. The decision to remove medical students from the hospitals in the midst of this crisis is the ultimate reflection of a much larger problem, that being, the regression of the role of medical students." Clayton Korson is a medical student. He shares his story and discusses his KevinMD article, "Medical students are benched during the pandemic." (https://www.kevinmd.com/blog/2020/08/medical-students-are-benched-during-the-pandemic.html) This episode is sponsored by The Nuance Dragon Ambient eXperience (DAX). The Nuance DAX solution makes it possible to forget the tech-toggling and reduces documentation burdens no matter how or where care is being provided. (www.kevinmd.com/nuancedax)

"Telehealth has come into focus during the COVID-19 pandemic as physicians face an immediate need to reduce exposure by providing care—or at least triage—remotely when appropriate. Under usual circumstances, telemedicine is comparatively low risk. That said, telemedicine does bring specific risks to patient safety and physician/practice liability. Minimizing those risks calls for adapting daily practice routines around informed consent, documentation, and other standard components of a patient encounter, as well as adjusting the practice's insurance coverage." David L. Feldman is chief medical officer, The Doctors Company and Healthcare Risk Advisors. He shares his story and discusses his KevinMD article, "7 tips for telehealth during COVID-19." (https://www.kevinmd.com/blog/2020/04/7-tips-for-telehealth-during-covid-19.html) This episode is sponsored by The Nuance Dragon Ambient eXperience (DAX). The Nuance DAX solution makes it possible to forget the tech-toggling and reduces documentation burdens no matter how or where care is being provided. (www.kevinmd.com/nuancedax)

"As a physician working with human trafficking survivors, I have become accustomed to those with a history of surviving violence. But the patient in question is in my general primary care practice. This should highlight to care providers that there may be many more patients out there who have been exposed to trauma in their past, and we need to take this into account. One way to be inclusive is to incorporate the substance abuse and mental health services administration principles of trauma-informed care into practice." Andrea Reilly is an internal medicine-pediatrics physician. She shares her story and discusses her KevinMD article, "The challenge of trauma-informed care in the age of COVID." (https://www.kevinmd.com/blog/2020/07/the-challenge-of-trauma-informed-care-in-the-age-of-covid.html) This episode is sponsored by The Nuance Dragon Ambient eXperience (DAX). The Nuance DAX solution makes it possible to forget the tech-toggling and reduces documentation burdens no matter how or where care is being provided. (www.kevinmd.com/nuancedax)

"As I read about Dr. Breen, saddened by the fact that we have been robbed of yet another young, promising, motivated physician, I am reminded that as bad as this pandemic is — and truly believe it is awful — when it gets better (and I have to believe that it will), we can't forget. Because all the other things that have always been there but got shoved to the back burner by COVID will be there again. And no matter what kind of medicine you practice, there will be unique (and some not-so-unique) stressors. We are always expected to be kind to our patients. But my plea to you is to be kind to each other and, more importantly, yourself. You're worth it. And I promise there is someone out there who understands what you are going through. Sometimes you just have to ask." Annalise Sorrentino is a board-certified pediatrician and pediatric emergency medicine physician. She can be reached at her website, on LinkedIn, and on Twitter @BlazerMD. She shares her story and discusses her KevinMD article, "A message for health care workers: Be kind to yourself." (https://www.kevinmd.com/blog/2020/08/a-message-for-health-care-workers-be-kind-to-yourself.html) This episode is sponsored by The Nuance Dragon Ambient eXperience (DAX). The Nuance DAX solution makes it possible to forget the tech-toggling and reduces documentation burdens no matter how or where care is being provided. (www.kevinmd.com/nuancedax)

"In the best of times (and these are certainly not), all patients need advocates all the time; now more than ever, vulnerable patients need them more but don't have access to them. Vulnerable populations have more at stake when visitors are limited or prohibited. What's more, vulnerability may be exacerbated due to youth, advanced age, disability, cognitive impairment, illness acuity, language – or, as we have come to realize of late – implicit bias. Advocacy can take many forms. For the patient who cannot report accurately on their medical history and symptoms, the furnishing of information to health care professionals can speed accurate diagnosis and minimize test and imaging fishing expeditions. Personal advocates, when present, may provide comfort and be a conduit to nursing staff when pain is present, and other physical needs are unmet. Equally important, vigilant personal advocates can be instrumental in offsetting nursing responsibilities by feeding and mobilizing patients, preventing falls, and even initiating rapid response codes. Finally, for patients limited by expressive disorders or constraints, the personal advocate can inform staff about individual preferences, priorities, and values, so that goals of care are aligned with patient wishes." Bonnie Friedman is the author of Hospital Warrior: How to Get the Best Care for Your Loved One. She shares her story and discusses the KevinMD article that she co-wrote, "Making time for patient advocacy is more important now than ever." (https://www.kevinmd.com/blog/2020/07/making-time-for-patient-advocacy-is-more-important-now-than-ever.html) This episode is sponsored by The Nuance Dragon Ambient eXperience (DAX). The Nuance DAX solution makes it possible to forget the tech-toggling and reduces documentation burdens no matter how or where care is being provided. (www.kevinmd.com/nuancedax)

"As a medical student, you find potential patients everywhere. Whether you're on an airplane or on a romantic dinner date, we've all heard those famous words, 'Is there a doctor in the house?!' Here are some of my favorite 'patient' encounters. The best friend curbside. I was playing ball with my boys – that's right FIFA on the PlayStation – when my buddy drops the question, 'So listen man, you're a doctor, right? I need some advice about my knee; it's been killing me! I landed weird after jumping during soccer the other week, and now it's been aching ever since.' Assessment and Plan: 27-year-old man, clearly delusional as he thinks I'm a doctor, presents to FIFA night complaining of right knee pain. Obviously, he should rest, ice it, use compression, and elevate the leg, right? He continued, 'So I went to my primary care doc, and he told me to rest, ice it, use compression, and elevate the leg! Isn't that the dumbest thing you ever heard?' Uh oh, I couldn't blow my cover, 'Yeah totally … maybe you should get that checked out!'" Daniel Azzam and Ajay N. Sharma are medical students and founders and editors-in-chief, Diary of a Medical Student. They share their stories and discuss their KevinMD article, "As a medical student, you find potential patients everywhere." (https://www.kevinmd.com/blog/2020/09/as-a-medical-student-you-find-potential-patients-everywhere.html)

"One of the calls you dread making as a doctor is telling a family member their loved one is dying. That was the call I received when my grandfather decompensated. We grow accustomed to making the call as clinicians, but we never expect to get it ourselves. I felt for his pulse. Slow but faint. As a doctor, you become desensitized over time. You frantically think of the next steps that will save this body's life, until you realize that body is someone you know. Death here during this time has no dignity. I've experienced a lot in my career by trade. But this one feels particularly brutal. Patients are not allowed to have visitors and often die scared. Someone codes, someone dies, and on you go to save the next life. A few days later, I prepared to head back to work. I thought about all the patients I treated for COVID, never thinking my grandfather would be one. As I headed into work at around 7 p.m., I hear the sounds of people cheering outside. At that moment, I was no hero. I had just lost a war. And back I went to the battlegrounds that altered my family forever. Society needs to redirect energy to alleviating the struggles of workers rather than glorifying it. The government faltered, but it is community advocates and organizers of grass-root campaigns that create reproducible change. The fact of the matter is, nobody wants to be a hero right now. We just want to live to see another day." Zaki Y. Azam is an internal medicine resident. He shares his story and discusses his KevinMD article, "How coronavirus took my grandfather's life." (https://www.kevinmd.com/blog/2020/05/how-coronavirus-took-my-grandfathers-life.html)

"Living the surreal experience of the COVID-19 pandemic challenges us on multiple levels. As a physician, I feel the responsibility to understand the magnitude of the situation and implement the best measures to protect my patients, trainees, my family, and myself. I experience the fear of getting sick or losing a loved one and the sadness and frustration of seeing millions of lives affected by illness, desperation, isolation, and death. COVID-19 has challenged me even more in my role as a mother. Living the quarantine with two energetic boys has transformed motherhood into an emotional rollercoaster. The combination of COVID-19, taking care of two boys, and continuing working has, at times, been overwhelming, even while having the support of my wonderful husband. I have found myself being absorbed by the challenges, almost forgetting the positive things that still surround me." Miriam Zylberglait Lisigurski is an internal medicine physician. She shares her story and discusses her KevinMD article, "COVID-19 through the eyes of my kids." (https://www.kevinmd.com/blog/2020/07/covid-19-through-the-eyes-of-my-kids.html)

Explore why this general surgeon wrote a novel, and how writing helps with the stresses that accompany a surgery career. What is his #1 tip for those interested in surgery? What are the challenges facing the profession today? How can surgeons find that elusive work-play balance? And why should aspiring doctors start a journal? Arthur Williams is a surgeon. He shares his story and discusses his book, The Surgeon's Obol. (https://amzn.to/2FIdDmz)