The Podcast by KevinMD

"I typed up a brief response to the no show memo, hit reply, and then deleted the original message. It's not that I am a fan of wasting time and resources, but for now, I have a general personal policy to never dismiss pregnant patients. I'd have to try to address her barriers to care. Again. Our clinic tended to be a safety net for health care in the city, if I dismissed her, where would she go? I do believe people can be changed. Also, help me when I really don't believe it." Erin Hoffman is a family physician. She shares her story and discusses her KevinMD article, "The patient who no-shows." (https://www.kevinmd.com/blog/2020/05/the-patient-who-no-shows.html)

"It seems as though the looming reality for many of us is that we will have patients who need ventilators, and none will be available. It seems like we might benefit from remembering that we can still succeed in practicing medicine by being present with those suffering before us, even when we know we cannot cure them of disease. In a more pragmatic sense, maybe in addition to logistical discussions and articles about how ERs and ICUs are going to decide who should get a ventilator, we should also discuss how we are going to communicate with empathy and compassion to the families of the critically ill and dying; there are ways to learn to do this well that alleviates heartache for families and for physicians." Elaine M. Colby is a family physician. She shares her story and discusses her KevinMD article, "When should we start having a discussion about palliative and end of life care?" (https://www.kevinmd.com/blog/2020/03/when-should-we-start-having-a-discussion-about-palliative-and-end-of-life-care.html)

"If you have an employment agreement with a provision on intellectual property, have it reviewed by an attorney before you begin applying for patents. A good attorney should be able to give you some clarity. Suppose, however, that your employment agreement has muddied the waters a bit. In that case, you have a few different options, and all of them will come with some risk. First, you may speak with your employer vaguely about your plans and attempt to get a release, or work out some other agreement so that you can pursue your project alone. In some cases, collaboration may provide you with the resources to proceed, and ease a bit of the financial burden. Of course, this may bring undesired attention to you, and may require some diplomacy and care. Second, you may sit on your invention or change your employment. Here, time is working against you and may affect the patentability of your invention. Additionally, it's possible that even after the termination of your employment, that your old employer will still claim a right to an invention that was conceived during your employment with them. Third, you can forge ahead without telling your employer. There are no easy answers, but this is the requisite analysis, and it is quite easy to make a mess. If you do intend to pursue an invention while employed, a good rule of thumb is to work on your invention on your own time, in your own house, using your own resources and your own money. You don't want to blur the lines. You want to clearly differentiate between your property and your employer's." Peter D. Sleman is an attorney. He is the author of The Physician Inventor: The Doctor's Handbook to Patenting Medical Devices and Methods. (https://amzn.to/3htbjgk) He shares his story and discusses his KevinMD articles, "Intellectual property provisions in physician employment agreements" (https://www.kevinmd.com/blog/2020/03/intellectual-property-provisions-in-physician-employment-agreements.html) and "The COVID-19 breakthroughs are coming." (https://www.kevinmd.com/blog/2020/03/the-covid-19-breakthroughs-are-coming.html)

"I find that managing chronic pain can be a bit of a dance between myself and the patient. Sometimes a little bit of a compromise. I always tell my patients that pain is subjective but many things can contribute to pain — certainly stress, lack of sleep, any emotional issues can make pain worse. Your pain is different than my pain. I don't like to use the word 'tolerance' when it comes to opioids, but certainly, some people are able to tolerate pain more than others. But it does go back to the emotional component related to pain. One of my attendings in fellowship — known to be a bit of a hard ass — used to tell our patients, you can't die from pain. Your blood pressure that's 210/110? That can kill you. The 100 percent blockage of your artery in your heart? That can most certainly kill you. Your smoking four packs a day? That may kill you. Your pain is a by-product of your experience. Snowing yourself with opioids only tricks your body into believing there's nothing more serious going on. And it's a temporary solution for a more permanent problem." Michelle Dang is an anesthesiologist and hosts the podcast, WISH Well. She shares her story and discusses her KevinMD article, "The painfully fine line of pain management." (https://www.kevinmd.com/blog/2018/06/the-painfully-fine-line-of-pain-management.html)

"I struggle for words to describe life in the season of COVID-19. Depending on the day, I need at least a few adjectives: 'peculiar,' 'fine, all things considered,' 'terrifying.' 'Joyous' and 'anxious' certainly make odd bedfellows in my brain. As a mother and physician living this new reality, I've been extra thankful for Irene, who taught me the power of 'and.' Irene is a clinical psychologist who was tasked with helping my family medicine residency classmates and me build skills for self-care and counseling. She taught me to replace 'but' with 'and' in conversation. This subtle verbal acknowledgement can reconcile what would typically be perceived as conflicting emotions or realities–like mental yoga. The shift has served me well in my medical career and in personal relationships. Imagine how different it feels to hear someone say, 'You're doing the best you can, but you can do better' versus 'You're doing the best you can, and you can do better.'" Rachel E. Hines is a family physician. She shares her story and discusses her KevinMD article, "A physician mother embraces the power of 'and' during the pandemic." (https://www.kevinmd.com/blog/2020/04/a-physician-mother-embraces-the-power-of-and-during-the-pandemic.html)

"In the time of the COVID-19 pandemic, I am both hopeful and inspired as well as disappointed. I see those angry that their ideas or opinions conflict with science. Instead of the steady path and hard work of building bridges, they create division. I see many capitalizing on fear and uncertainty, weaving a compelling story and drawing in the desperate ones who need a scapegoat, an explanation, or some form of certainty. It's OK to be a dissenter. It's OK to challenge what seems to be the status quo. It's OK to ask questions about why we do things the way we do them. But if you really want to see a meaningful conversation, you must go about it in the right way. The right way is usually slow and painful but full of the promise of refinement that only comes through allowing our work and our perspectives to pass through the filters of those who see the world differently. Only then can the purest form of our questions be answered, and our message be heard." Jaclyn Lewis Albin is an internal medicine-pediatrics physician. She shares her story and discusses her KevinMD article, "Dissent in the time of COVID-19." (https://www.kevinmd.com/blog/2020/05/dissent-in-the-time-of-covid-19.html)

"Billroth spent long hours dissecting cadavers and planning on surgical interventions. He was able to pioneer abdominal surgery with careful preparation and strict adherence to meticulous antiseptic technique. Animal experimentation and cadaveric-rehearsed surgery emboldened the Viennese professor; perhaps the abdomen could be entered. Nothing short of a 'godlike creative spirit,' as Mukherjee calls it, would suffice when it came to intestinal surgery. Vienna has a centuries' old reputation for virtuoso performances; with Imperial spirit, maestro Billroth would take his place for master class performances in the greatest theater in the City of Music: the Allgemeines Krankenhaus operative theater. In 1872 Billroth resected a portion of the esophagus and joined the ends together. In 1873, he performed the first complete excision of a larynx. Even more amazing, he became the first surgeon to excise a rectal cancer, and by 1876, he had performed thirty-three such operations. What seems commonplace today (abdominal surgery) is nothing short of a stupendous magic act, in reality." David J. Schneider is an orthopedic surgeon and author of The Invention of Surgery: A History of Modern Medicine: From the Renaissance to the Implant Revolution. (https://amzn.to/2CtzDQb) He shares his story and discusses his KevinMD article, "Surgery is nothing short of a stupendous magic act." (https://www.kevinmd.com/blog/2020/03/surgery-is-nothing-short-of-a-stupendous-magic-act.html)

"As COVID-19 devastates America and the world, I hope that fundamental change to our health care system results from its horrific exposé. Without COVID-19, the pressures placed on physicians are already immense. In the age of COVID-19, these pressures are proving to be insurmountable. Being a physician is difficult, but it does not have to be deadly. Physicians deserve proper stigma- and repercussion-free mental health care as much as they deserve proper personal protective equipment. By definition, a hero is the offspring of a god and a mortal; if we physicians are to be known as heroes, we deserve to have our human mental health care needs met.​" Sarah Bridge is an emergency medicine resident. She shares her story and discusses her KevinMD article, "Physicians and the psychological trauma of COVID-19." (https://www.kevinmd.com/blog/2020/05/physicians-and-the-psychological-trauma-of-covid-19.html)

"COVID-19 has rapidly spread across the nation, leading to the implementation of stringent social distancing guidelines by local and regional authorities. In a desperate effort to limit infection rates, in-person social interactions have been reduced, and many have turned towards indoor hobbies and online platforms to connect with their loved ones. Still, this solution to mitigate the spread of the virus deeply impacts vulnerable groups. Specifically, social isolation of the elderly population, already deemed a neglected issue, is an exacerbated side effect of the coronavirus pandemic." Vismaya Bachu is a medical student. She shares her story and discusses her KevinMD article, "The exacerbation of social isolation among the elderly." (https://www.kevinmd.com/blog/2020/05/the-exacerbation-of-social-isolation-among-the-elderly.html)

"They needed the final story to let go of her body, yet retain her spirit. Looking back on it, that's when I saw the greatest honor of all — the everyday honor of storytelling for our patients. Maybe that's the only cure we have for death … translating what happens from the body into the world. Perhaps that is the last frontier of care: sharing the understanding of how we get to the end — just as much as how we got to the beginning. Maybe, we should reframe the last note we write for our patients — and make it the last story we share instead." Giannina L. Garces-Ambrossi Muncey is a critical care physician. She shares her story and discusses her KevinMD article, "Your greatest role as a doctor? Storyteller." (https://www.kevinmd.com/blog/2018/10/your-greatest-role-as-a-doctor-storyteller.html)