"You’re a clinician. You had a patient die under your care, and now your hospital is being sued. You are not named in the lawsuit, but you are being asked to give a deposition. How much of your time is this going to take? If some lawyer sends you thousands of pages to review before scheduling multiple phone calls and prep sessions and, finally, a deposition under oath … what do you say? What is your obligation to testify in court as a scientific expert?" Judy Melinek is a forensic pathologist an...
May 09, 2021•15 min
"If you are happy with where you are in the current system – that is wonderful, continue what you are doing. However, if you are feeling trapped, frustrated, or like the work you are doing is no longer meaningful, then there are plenty of opportunities for you to get out of the system. Start looking at your options – start learning about them and looking for opportunities now. Whether you end up deciding on an alternative clinical career, a nonclinical career within medicine, or a career outside...
May 08, 2021•15 min
"When faced with an existential crisis, any organization, as large as a nation or as small as a marriage, will go one of two ways. Either it will bond together, coalesced in a common purpose, or it will collapse in a spasm of blame and shame. While our health care institutions displayed the inestimable value of coalescence, our political leaders demonstrated the catastrophic impact of divisiveness. And our national statistics confirm the result. More than a half million deaths to date from a pre...
May 07, 2021•20 min
"Coffee in hand, I decided to try and collect my thoughts. I realized that a large portion of the literature we grew up reading has in many ways tried to implant this subconscious bias that contributes to gender disparities and these ideas about women that have continued to ruminate throughout parts of society to this day. Literature in and of itself is a reflection of the times in which it is and was written. Sadly, examples of stark contrasts in comportment, demeanor, and overall health and we...
May 06, 2021•12 min
"When a patient is dissatisfied with his or her care, he or she can consult an attorney, who will enlist a physician 'expert' to determine if a doctor has deviated from the standard of care and whether that deviation caused a negative outcome. Over the past decade of reviewing cases involving medical malpractice, I have identified five categories of medical error, which has improved how I care for my patients." Scott Choi is a gastroenterologist. He shares his story and discusses his KevinMD art...
May 05, 2021•14 min
"The corporatization of medicine has destroyed primary care as a specialty. The primary care physician is supposed to be your go-to doctor, your advocate, the coordinator of your health care. Now that corporations buy out hospitals and private practices in an almost predatory fashion, the priority is turning a profit for the corporation at the expense of not only patient health but also the health and well-being of the primary care physician. Who do you think bears the brunt of patient frustrati...
May 04, 2021•17 min
"For physicians who lack experience in end-of-life counseling, the process can be daunting at the beginning. However, they can be confident that once they have obtained the proper training, preparation, and experience, these conversations will be among the most fulfilling of their careers. By regarding end-of-life planning as a shared responsibility, physicians can become more well-rounded professionally and help patients conquer their most profound fears. It’s time to start the conversation." C...
May 03, 2021•17 min
"Nowadays, I go on long walks through the city alone. I make dinner for one. When I go on bike rides, it’s a solo activity. I find comfort in myself, slowing down and making every small occasion a simple, peaceful one. I have a stronger sense of self, and through that, I have rekindled the fire that I felt during my first years of being in medicine. When I return home from the hospital, I don’t dive into the distraction of another person. Now, I write daily journal entries that help get my heart...
May 02, 2021•26 min
"Every professional I have done the exercise with admitted that their ideal patient was inspired by someone they were close to in their personal life. It was usually a family member, a best friend, or themselves. The ones who carry the most unbearable sufferings-the kind that reminds us of ourselves and our loved ones most likely would become our “ideal patients.” After all, our compassion for others’ aches comes from understanding our own pain. We heal to be healed. Healing’s mutualism continue...
May 01, 2021•14 min
"The science of complexity lays a conceptual foundation for understanding “complex adaptive systems.” What all complex adaptive systems have in common is that they are all bound by the same set of physical laws. Their “behavior,” i.e., growth, maintenance, and death, can all be described using the same set of mathematical relationships. These systems (animals, plants, ecosystems, etc.) are the most productive and functionally effective systems known to man. Unfortunately, our health care system ...
Apr 30, 2021•14 min
"As health professionals, we have the platform to enact change within our own institutions, as well as local and federal governments. We must elect leaders and officials who spearhead climate action. We must reduce the carbon footprint of healthcare. And we must educate our colleagues and our patients about the impact of climate change on health. We need every single one of us to take action. Our patients’ health depends on it." Sarah Hsu is a medical student. She shares her story and discusses ...
Apr 29, 2021•11 min
"Instead of focusing on one organ system, I want to know everything. The diagnostic challenge is to discern patterns of insults, symptoms, and lab tests that correlate with specific microbes, specific organ dysfunction, specific diet issues, and environmental exposures. We keep asking questions until we detect patterns in the chronically ill patient that correlate with any number of overlapping issues such as infections, hormone deficiencies, immune dysregulation, toxic exposures, and diminished...
Apr 28, 2021•19 min
"Suicide is a path, whether fast or slow, that a person chooses to take because of their own reasons. We certainly can never predict suicide or truly understand it. But with that said, every time it happens, it is a tragic loss of life that time can and will never heal. We must do more to support our physicians in training, residents, and established clinicians. Like how we sit at the bedside with patients and listen to their stories, someone needs to listen to what doctors have to say. This is ...
Apr 27, 2021•23 min
"Our relationship with Big Pharma is a dangerous, nasty, and abusive one, and it can prove to be fatal too. Benzos aren’t limited to a specific class, race, gender, creed, etc. Many stars have died from mixing benzodiazepines with opioids or illegal drugs. It has been a little over a year that I have been off of Klonopin, and I’m happy to report that most of my withdrawal symptoms are gone. I handle stress better now, and I feel emotions more deeply and genuinely. Please be patient with the proc...
Apr 26, 2021•13 min
"Had I understood the nature of my struggles and felt permitted and supported in actively addressing them, I would have been more effective, a better learner, and more fulfilled. After trying out a few clinical settings, a lot of reading, and some much-needed coaching, I found my identity as a healthy, inspired physician. Eventually, by setting boundaries and understanding my patterns, I discovered what I needed to thrive. So, maybe we need to reimagine medical education. From medical school onw...
Apr 25, 2021•16 min
"Dr. Fauci navigated the delicate balance between his obligation to the American people as one of our most respected physician-scientists and holding on to his job in a federal government whose leader doesn’t take kindly to independent thought that potentially upstages his own. Dr. Fauci not only survived multiple appearances on the national stage with Trump, as the task force morphed into charade, but he even emerged as a popular folk hero, all the while maintaining his status as a respected me...
Apr 24, 2021•16 min
"I am a nurse who has worked at a rural hospital. My husband is a board-certified family medicine doctor. In the fall of 2020, I was raped by my massage therapist. I know that everyone has an opinion of what they would do in that situation, and I was probably one of those people. However, to my complete shock (quite literally), I didn’t behave in any manner that I would have thought. Much to my embarrassment, I was a nurse who had no idea what to do when I was raped on top of the previously ment...
Apr 23, 2021•17 min
"When the public was made aware of the risk of transmitting the virus and the far-reaching measures of social distancing, closing schools, and lock-down, most Americans willingly complied. After all, they became aware, for the first time, of the risk of aerosolized viral particles present in theatres, churches, restaurants, and classrooms. But we physicians already knew that. We knew that when we went into the operating room or the bedside to repair a laceration in the emergency department, we w...
Apr 22, 2021•15 min
"Now the room is silent as if nothing at all occurred. I stand watching the red stain forming on the pristine white sheet, mocking me in my failure. I trained at excellent institutions, survived residency, and served in combat. Now, here at a Level 1 trauma center, I could not save this life with every possible medical tool at my disposal. This injury, this particular injury, always has, and forever will, haunt my dreams. The hubris to think that I could be the difference, that I am better than ...
Apr 21, 2021•19 min
"I really shouldn’t complain. I haven’t lost my housing or job. I have plenty of food and toilet paper, and so far, no close friend or family have died from COVID. That said, this pandemic is hard. In fact, it is exhausting. During the spring and summer, I gave positive COVID results to a number of patients from my home’s safety, thanks to telehealth. But the reality of telling patients how to self-quarantine when six people live in two rooms with one bathroom, or giving resources about food and...
Apr 20, 2021•14 min
"It is dangerously unfortunate that the use of masks has been politicized in many parts of our nation. The Dakotas (or North and South COVID as they were recently called on Saturday Night Live) are far from exempt from this phenomenon. Likely, if Governor Burgum’s decision was less influenced by fear of criticism from his constituents and political retaliation, he would have required a mask mandate long before making it acceptable for infected individuals to leave their home. Masks have time and...
Apr 19, 2021•17 min
"If PCPs want to meet the new competition from virtual primary care plans, I suggest that they gradually increase the percentage of their visits that they do through telehealth. Now that payers are reimbursing those visits at the same level as in-person visits, they have nothing to lose financially. Of course, there are some ancillary services that might be performed in their offices, such as lab tests, X-rays or bone density scans. But PCPs could order some of these when patients came in for vi...
Apr 18, 2021•18 min
"Looking back on these words at the end of my rotation, I understand what I had felt, and I feel confident naming it: the futility of medicine. We can comfort and treat patients, but there’s nothing more we can do after a certain point. As a bright-eyed medical student who wrote on all her medical school applications that she wanted to save lives, it was and still is difficult for me to understand that." Shereen Jeyakumar is a medical student. She shares her story and discusses her KevinMD artic...
Apr 17, 2021•12 min
"Motherhood has been the biggest gamble of my adult life thus far. How was I going to operate for 12-plus hours while 39-weeks pregnant? Where would I be when I went into labor? How would was I going to return after three weeks? How would I pump during and in between OR cases? I did it. It certainly wasn’t easy. And I would do it all over. My son is beautiful and healthy. I’ve never been prouder of anything I’ve ever done. He is the first thing I think about in the morning and the last thing I t...
Apr 16, 2021•17 min
"COVID-19 disproportionately impacts those with pre-existing conditions, and our health care system leaves one in five Americans with a pre-existing condition uninsured. Further, with multiple COVID-19 vaccines already in early but slow distribution, attaining universal coverage is critical, particularly in light of uninsurance having an inverse relationship with vaccination rates. President Biden will need to act with a legislative urgency that matches these times to pass a public option. With ...
Apr 15, 2021•20 min
"The patient knocking on your door is not your enemy. They’re sick. They’re scared. They’re in pain. They don’t know why, and they’re hoping for an answer. If you can’t find the source of a problem quickly, it doesn’t mean it’s not there." Denise Reich is a patient advocate. She shares her story and discusses her KevinMD article, " Patients don’t need quick diagnoses. They need accurate ones ." ( https://www.kevinmd.com/blog/2021/01/patients-dont-need-quick-diagnoses-they-need-accurate-ones.html...
Apr 14, 2021•15 min
"I can tell you what I don’t want to do. I don’t want to mill through 50 patients a day, mindlessly clicking through EMR checkboxes so an insurance auditor five states away will deem that I’ve done my job and deserve reimbursement. That’s a high volume, high overhead game, and I don’t want to play it. I recently spoke with a doctor who was getting so many insurance denials that they needed to hire 14 additional billers at an estimated cost of somewhere around half a million dollars a year. Insur...
Apr 13, 2021•17 min
"Humanities can be seen as part of the fabric, society, and culture of human experience. In many ways, they might be seen as the disciplines that make us human and make life meaningful. They broadly encompass ancient and modern languages, literature, philosophy, religion, visual and performing arts, such as music and theater. Even more expansively, they may also include, amongst others, history, archaeology, anthropology, law, and linguistics. These diverse fields explore and foster empathy, com...
Apr 12, 2021•16 min
"Most residents are young, often in their mid to late 20s, having spent years ensconced in libraries, research labs, and classrooms learning pathophysiology and pharmacology. Upon graduation from medical school, they are now drafted to the front lines of a generational pandemic, working long hours, often in cities where they are strangers (the process of “matching” into a residency program is one where residents are not in full control of their destiny or geography). They do so while putting the...
Apr 11, 2021•16 min
"Keep it Simple is a bumper sticker slogan. Life during a pandemic has been anything but simple, and the holiday season presents (not the gift kind) its own special challenges. So does living alone and trying to stay humanized. In his book Together: The Healing Power of Human Connection in a Sometimes Lonely World, Surgeon General-elect Vivek Murphy describes loneliness as associated with increased risk of mental and health difficulties in the BC era (before COVID-19). All the more so within suc...
Apr 10, 2021•18 min
