The Podcast by KevinMD

40 Episodes
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By: Kevin Pho, MD

Social media's leading physician voice, Kevin Pho, MD, shares the stories of the many who intersect with our health care system but are rarely heard from. 15 minutes a day. 7 days a week. Welcome to The Podcast by KevinMD.

Gender disparities in medicine: How popular literature mirrors society
Today at 8:00 AM

"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 well-being amongst men and women are nowadays ever-present and are all around us.<...


How reviewing medical malpractice claims made me a better gastroenterologist
Yesterday at 8:00 AM

"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 article, "How reviewing medical malpractice claims made me a better gastroenterologist." (https...


Rest in peace, primary care
Last Tuesday at 8:00 AM

"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 frustration and public misconception? The PCP."

Alexis Gopal is an internal medicine physician and can be r...


End-of-life conversations: Embrace the responsibility
Last Monday at 8:00 AM

"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."

Caroline DeFilippo is an internal medicine physician.

She shares her story and discusses her KevinMD article, "End-of-life conversations: Why physicians should emb...


Falling in love during a pandemic: a medical scribe's story
Last Sunday at 8:00 AM

"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 on a page, wher...


An acupuncturist's take on the doctor-patient relationship
Last Saturday at 8:00 AM

"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 continues to amaze me every day. It’s a gesture of kindness and love that elevates both the giver...


What role does the science of complexity play in medicine?
Last Friday at 8:00 AM

"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 has not been bound by the same physical laws and mathematical relationships as other complex adaptive systems. Thus, it has not been able to...


What medical professionals can do to take climate action
04/29/2021

"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 the KevinMD article, "5 things medical professionals can do to take climate ac...


Our work as physicians and healers is to see the whole patient
04/28/2021

"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 capacity to detoxify. And then we explore the interrelationship of all these problems. Differentiation then integration."

Daniel Kinderlehrer is a physician and author of Recovery from Ly...


Physician suicide: We need safe spaces to talk about it
04/27/2021

"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 an epidemic that we...


My Klonopin withdrawal story
04/26/2021

"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 process and with yourself. It gets bett...


Focus medical education on training the whole person
04/25/2021

"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 onward, physician education and training should be conceptualized as a career-long process supporting the holistic development of life-long...


Leadership lessons from Dr. Fauci
04/24/2021

"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 medical authority.

Despite having ample opportunity to confront the president on his misinformation, Dr. Fauci fo...


A nurse shares her story of sexual assault
04/23/2021

"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 mentioned humiliation."

...


Don't forget about influenza and the lessons learned from COVID
04/22/2021

"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 wore masks to protect our patients from the microorganisms living in our noses and mouths. We already knew that the...


Expressing grief through the power of story
04/21/2021

"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 those who came before me, was answered tonight, as it has...


How essential workers cope with COVID
04/20/2021

"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 other basics because the household provid...


Physician morale and the doctor's voice
04/19/2021

"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 again proven to be safe and effective. It’s not a big ask."

Sheetal Khed...


PCPs could counter virtual plans by increasing telehealth visits
04/18/2021

"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 visits, and they could also reduce their spending on staff and office space if they...


My first end-of-life conversation
04/17/2021

"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 article, "My first end-of-life conversation." (https://ww...


Advice to pregnant surgical residents
04/16/2021

"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 la...


President Biden’s quest for a public option
04/15/2021

"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 two-thirds of the country approving President Biden’s handling of the transition, now is his opportunity. He may just need to take a few pages out of th...


Patients don’t need quick diagnoses. They need accurate ones.
04/14/2021

"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)


Meet the orthopedic surgeon who stopped taking insurance and does house calls
04/13/2021

"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. Insurance companies want to make it difficult...


Harness the power of the humanities to counteract burnout
04/12/2021

"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, compassion, beauty, joy, awe, love, reasoning, tolerance, curiosity, possibility, community. Are we richer as human beings or physicians without this education, or are we abandoning...


In gratitude to our nation’s residents
04/11/2021

"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 their own health in jeopardy. The resident’s experience of the COVID-19 pandemic has been unlike any other, because on averag...


How to find sparks of joy
04/10/2021

"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 such a challenging year of physical separation and trying to maintain a connection with others, with ourselves. So...


What physicians should know before they’re interviewed by the media
04/09/2021

"Lights, camera, action!

You get a call from your hospital’s public relations office asking you to speak to the local news. Even though this isn’t your first time, your heart is pounding, with a mix of nerves and excitement. You start doubting whether you have anything valuable to say about the topic, even though, yes – you went through many years of medical school and residency before this moment. You are also worried about how to avoid looking foolish or unprofessional on-air. Or worse, how to avoid having your words taken out of context.

No? OK...


Why medical students should be taught the business side of medicine
04/08/2021

"Ultimately, patient care is at the center of medicine and is the main reason many physicians chose to go into the field. A good understanding of the business side of medicine and personal finance can help future physicians focus on just that. There are plenty of options when it comes to how we can begin to integrate these topics into medical education. There are clear benefits that come with learning these skills, and many students are eager to do so. We need more medical schools to integrate these subjects into their curriculums, and students who are given the opportunity...


End medical school grades
04/07/2021

"There should be no grades in medical school. Forty-something percent of applicants get accepted to one or more medical schools. To even apply to medical school, one needs to have not only graduated or be on track to graduate college, but also needs to have passed the MCAT and have the support of a pre-medical application committee. I am no mathematician, but I do not think that it is a stretch to say that less than 10 percent of those who wanted to go to medical school on their first day of college do, in fact, end up matriculating into...


Film and television continue to depict psychiatrists as heartless swindlers
04/06/2021

"Have you ever watched a movie, television show, or read a book where the villain is a medical doctor? If you are a psychiatrist, you will be alarmed by how many times the villain in these stories turns out to be a psychiatrist. In all fairness, psychiatry has had its share of blunders. However, in recent years psychiatry has made a significant effort to enhance the use of evidence-based medicine and procedures. The diagnostic criteria for mental disorders continue to be revised and updated regularly. New medications and procedures are developing at an increasingly rapid rate. With all of...


A letter to Black America for those who do not want the COVID-19 vaccine
04/05/2021

"As a Black physician, I urge you to consider taking the COVID-19 vaccine when it becomes available to you. Vaccines save lives. Preventing poor outcomes, as in death, is an exciting effect of this vaccine.  I will be first in line when it is offered to me, and I hope to see you in line next to me. Masked up, of course."

Erkeda DeRouen is a family physician and can be reached at her self-titled site, Dr Erkeda DeRouen.

She shares her story and discusses her KevinMD article, "A letter to Black America for those who...


We must address glaring disparities in treatment
04/04/2021

"It is not enough to say we are anti-racist; we have to modify our systems to recognize that we have placed individuals of color at risk of poorer outcomes.  Lack of insurance, lack of finances, or even the presence of certain diagnoses may reflect less about the person and more about our society, our infrastructure, and our systems. As members of smaller communities and a larger society, we must make adjustments in our attitudes and knowledge as well as the services we provide to individuals who have experienced harm by insidious but ever-present racist structures.

Glaring disparities i...


An unexpected COVID-19 vaccine side effect
04/03/2021

"Just a few seconds after the needle penetrated my arm, I felt a mild soreness, kind of like a flu shot. But as I sat for the required 15 minutes of observation time, a wave of something engulfed my body. It was such a strange, unfamiliar sensation that I didn’t realize what was happening. I looked around the room at the other medical personnel getting their shots, and no one seemed to pay me any attention. I wasn’t changing color, short of breath, or breaking out into a sweat. I did harbor reservations about the safety of this new...


We need to broaden the definition of what "counts" in careers
04/02/2021

"Many colleagues in medicine already talk about medicine never going back to its state pre-COVID-19 – be it telehealth for patients, new flexibility to work/life scheduling, or a new acceptance of telecommuting outside of direct patient care. There has been too much suffering as a result of the COVID-19 pandemic and stressors of 2020 to progress through 2021 and beyond without lessons learned. New recognition of the need to broaden the definition of what 'counts' in careers, be it in health care or beyond, along with a means to articulate that, must be a lasting outcome of our nation’s response to t...


Keep insulting doctors, and good luck finding a physician
04/01/2021

"The tragedy that’s happening in medicine today is that the loss of respect and the constant threats to fair payment are making physicians regret that they ever chose medicine. They were fascinated with science and wanted to help people, and their reward is insult.

It’s no wonder that some newly trained physicians leave anesthesiology quickly; there’s little risk to running a hangover clinic in Las Vegas. Many physicians from all specialties get MBAs because they see that the real rewards in healthcare lie in becoming a CEO. Look at the salaries of top executives: the CE...


Self-care is the Rx we were never taught to write
03/31/2021

"This is our call to action. I have the experience, knowledge, expertise, and deep passion for teaching every medical student these skills. I cannot do it alone. I need you. We need to do this together. I am seeking those of you who are caring, innovative clear thinkers involved in medical school curriculum creation. We owe it to our physician seedlings. We owe it to their future patients. Who out there can now see 20/20? It is time to change the culture of medicine and focus on prevention. I am 100 percent in. Who is with me?"

Robyn Tiger i...


Why socialized health care is not right for America
03/30/2021

"We need full transparency and empowerment of patients and doctors to make wise decisions. We must renew and restore the sanctity of the patient-doctor relationship. We need to stop pretending that health care can be 'free,' stop calling premium price prepaid care 'insurance,' and use market forces like choice and competition to cut our bloated costs. 'Insurance' needs to 'insure' against the unexpected, not pay for the routine.

I am a proud independent physician. Taking care of patients is what I know. It is what I do best.

Get the government and the...


How to protect your resilience
03/29/2021

"Health care delivery will always be inherently unpredictable and challenging. Those drawn to medicine are among our most resilient, but the current landscape reveals acutely a rise in burnout that exceeded acceptable levels even before the COVID-19 outbreak. Such innate resilience in clinicians and clinical care teams is an individual and strategic asset worthy of recognition, protection, and system-wide approaches that nurture and potentiate it. Such system-wide advocacy serves to proactively promote the vitality of health care delivery, quality of care, individual and group purpose, life-work satisfaction, and balance. Ultimately, these all are recognized as antidotes to burnout."

<...


You don’t have to drown in the paperwork
03/28/2021

"This is not what I signed up for.

Have you ever said this when you are rushing home 1.5 hours after the last patient left and you still haven’t finished all your charting? You grab a handful of forms to take home with you with the hopeful expectation that you will get them done tonight too. After you have done 'enough' to appear to be a present parent and prepared supper and said goodnight to the kids, that is.

You sink into the couch at the end of the household rush with the guilty constant 's...