Vital Times: The CSA Podcast

if you have any feedback, please send us a text! Thank you!Catch this episode where *both* of the Vital Times podcast hosts, Drs. Rita Agarwal and Ludwig Lin, show up, and discuss how they fell in love with Anesthesiology, and podcasting.

if you have any feedback, please send us a text! Thank you!We were all shocked by the murder of Brian Thompson the United Health Care CEO in early December. What was just as surprising was the comments deny, delay and depose written on the bullets. Once the alleged shooter was arrested, information started to trickle out that he suffered from low back pain and spondylisthesis. Speculation ran rampant that the problems with his back, inadequate treatment, or repeated insurance denials were in some way the catalyst for this terrible crime. These are not questions we know the answers to, but we thought it would be interesting to explore the causes, treatments and epidemiology of low back pain, especially in young people. Dr. Amber Borucki, a pediatric anesthesiologist and pain specialist from Stanford School of Medicine and Dr. Rahki Dayal, Chair of the CSA's Pain Committee and an anesthesiologist and pain specialist at the University of California in Irvine are joining us today to discuss pain management for back pain. 

if you have any feedback, please send us a text! Thank you!For Black History Month, Dr. Ludwig Lin is honored to speak with someone who's been through all of it. Dr. Marilyn Hill Harper, raised in the South, educated at a HBCU and then training in the Midwest, joined the prestigious UCSF faculty in the 1970s, at a time when both women and Black physicians were rare. Her story is ever relevant.To read the UCSF profile on Dr. Harper, click here. 

if you have any feedback, please send us a text! Thank you!Host: Rita Agarwal, MD, FAAP, FASAGuests: Rakhi Dayal, MD, and Amber Borucki, MDWelcome to another episode of Vital Times, the California Society of Anesthesiologists' Podcast with your host Dr. Rita Agarwal.Pain is the most common reason that people seek medical care and since the beginning of time, we have searched for better ways to treat pain. For many years opium and its derivatives were the mainstay of pain management, with local anesthetics making an appearance in this country in the past century or so. While scientists, physicians, researchers, and industry have sought to find better medications and approaches, the onset of the opioid crises in early 2000s really sped up that mandate. The FDA has committed resources and funding to help these new treatments and as a result there are now several new drugs on the market.Joining me today to explore these new modalities are Dr. Rahki Dayal who is a Professor at the University of California, Irvine, double board-certified in anesthesiology and pain medicine. She chairs the Pain Committee for the California Society of Anesthesiologists and is the Program Director of Pain Medicine at UCI. Dr. Amber Borucki is an Associate Professor of Anesthesiology at Stanford University and a pediatric anesthesiologist and pain specialist from Stanford School of Medicine. She is also the newly elected Sectrtary/Treasurer of the Society for Pediatric Pain Medicine.On January 30 the FDA approved a new non-opioid pan medication for moderate to severe pain. In the past few years several new classes and types of medications have also been approved for use. These include Zynrelef-a combination of bupivacaine ( a long acting local anesthesthetic ) and meloxicam ( a long lasting NSAID), and Vocacapsacian a prodrug to capasacian that in at ;east one study has been shown to provide up to 96 hours of pain relief , when injected locally after bunionectomy surgery.Join us as we explore these medications and the newly released suzetrigine (Journavx) with our 2 experts. ReferencesNewly Approved Painkiller Provides Relief Without Addictionhttps://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain A new long-acting analgesic formulation for postoperative pain management.Zhang W, Wu M, Shen C, Wang Z, Zhou X, Guo R, Yang Y, Zhang Z, Sun X, Gong T.Int J Pharm. 2024 Oct 25;664:124599. doi: 10.1016/j.ijpharm.2024.124599. Epub 2024 Aug 16.PMID: 39154917 Bupivacaine + meloxicam-~3 days duration-also for bunionectomySafety and Efficacy of Vocacapsaicin for Management of Postsurgical Pain: A Randomized Clinical Trial.Shafer SL, Teichman SL, Gottlieb IJ, Singla N, Minkowitz HS, Leiman D, Vaughn B, Donovan JF.Anesthesiology. 2024 Aug 1;141(2):250-261. doi: 10.1097/ALN.0000000000005027.PMID: 38662910

if you have any feedback, please send us a text! Thank you!There have been a lot of questions recently regarding the appropriateness of patients scheduled for care in an ambulatory surgical center (ASCs). It appears that sicker and more complex patients are being scheduled for care in an ASC, and many anesthesiologists are increasingly concerned about the safety of anesthetizing these patients in locations that may lack resources to escalate care if needed. In today's episode we are going to discuss some of these issues with two experts in ambulatory to help navigate this quandary. Welcome Drs. Christina Menor and Basem Abdelmalak.  The discussion was fascinating and informative. Starting with why surgeons and proceduralists may want to schedule patients in an ASC, to factors that might affect the decision to safely care for a particular patient in a particular location. Along the way specific examples of patients with complicated medical conditions were presented and discussed in depth. For full guest bios and resources discussed during the podcast, click here. 

Drs. Charles Hummel and Jason Cheng explain the origin story behind their involvement in founding the drive toward collegiality for a major healthcare system in California, Kaiser Permanente.  Take a listen and be inspired by the immense possibilities when physicians join forces in the name of empathy and humanity.

Your host Dr. Rita Agarwal is joined today by two outstanding guests who have an interest in preventing and treating women's pain. Drs. Anita Gupta and Stephanie Cizek. At the California Society of Anesthesiologists' Annual Meeting in Anaheim, in April 2024, there were several posters authored by Dr. Anita Gupta looking at the literature surrounding IUD insertion pain and potential treatments for that pain. Several months later the new CDC recommendations were released recommending improved pain management techniques in patients undergoing IUD placement. Around the same time there was increased media attention to IUD related pain and the fact that women's pain has historically often been dismissed, minimized or ignored. In this episode, we discuss all of this and more! 

Your host Dr. Rita Agarwal is joined by two wonderful guests to talk about climate change and what anesthesiologists can do about it.Climate change is one of the defining challenges of our time with far reaching implications. There is evidence of the increasing numbers of deaths directly related to heat in the USA, but even more across the rest of the world. This doesn't include deaths related to the consequences of climate change such as more profound and extreme weather events, rising sea level, disruptions to ecosystems and agriculture, drought, and famine. Addressing climate change involves action at local, national, global levels and includes the efforts of individuals, society, businesses, governments, and health care and other institutions.Both guests are individuals who are committed to addressing efforts to reduce greenhouse gases at the individual, institutional, and local levels.Dr. McGain is an MBBS and PhD who practices in anesthesia and intensive care at Western Health, St Albans, Victoria, Canada and in Australia as the Associate Dean of Sustainable Healthcare at the university of Melbourne. Dr McGain has spoken and published over 100 articles on the topic of greenhouse gases, reducing carbon footprint and bringing the scientific method to comparing the environmental impact of different practices. In fact, it was as a result of an editorial that he and Drs. Gordon and Debnath Chatterjee wrote, and a presentation from my other guest Dr. Lin, that Dr. Rita Agarwal finally stopped using nitrous oxide for mask induction in children after 30 + years of practice. She had given up desflurane, embraced low flow gases, and minimizing volatile agents, but honestly thought you would have to pry nitrous oxide out of her cold dead hands, before she stopped using it. They convinced her otherwise and hopefully will convince all of you as well 

With ketamine being very prominent in the news recently, lots of questions arise about its use. Is it safe enough to be used the way it is? Why are patients being prescribed it? What are the safety guidelines, and are they being met?The California Society of Anesthesiologists' Vital Times Podcast talks with anesthesiologists and pain specialists Drs. Amber Borucki, Rakhi Dayal and Rita Agarwal to talk this over. This is a must-listen for everyone. 

Cryoneurolysis has rapidly evolved and refined itself as a viable technology for postoperative and chronic pain. Its specifications mean greater efficacy for certain scenarios, and active research means its application is about to enter warp-speed. In this episode of Vital Times, we speak with Dr. John Finneran, of UCSD, who is actively conducting research trials with this technique. Get up to date and get inspired.

Welcome to another episode of Vital Times the CSA Podcast. I am your host, Rita Agarwal. For this episode we went back to the basics and talked about something that all anesthesiologists care deeply about – managing the challenging airway. Joining me is a former colleague and friend who is an attending anesthesiologist at one of the busiest trauma centers in the country - Denver Health Medical Center. Dr. Alma Juels is an Associate Professor of Anesthesiology at the University of Colorado School of Medicine and the Director of Quality, Safety and Improvement, and the Director of OB Anesthesia at Denver Health Medical Center. She is also an Expert Consultant for the Colorado State Medical Board and has lectured extensively, presented workshops and cared for many patients with difficult airways. In this podcast, she will share some of her scarier and/or more interesting experiences. 

Dr. Ludwig Lin has a blast discussing LGBTQ and its impact on various anesthesiologist leaders within academia and politics; drop in and listen to them discuss how this one element of their lives adds meaning and purpose to all of their pursuits. This episode features Travis Reece-Nguyen, MD, Arthur Chyan, DO, and Maricela Sanchez, MD. 

There has been much noise about famous scientists reckoning with past publications with data integrity issues. The pressures of “publish or perish”, and the need for oversight of a busy lab, are tricky. Dr. Lin talks with Harriet Hopf, MD, FASA, and Elizabeth Whitlock, MD - two lauded NIH-funded anesthesiologists-scientists to get the scoop. 

Mentorship has long been recognized as a crucial component of training physicians. Benefits of mentorship in medicine include increased productivity, improved career satisfaction, expansion of professional networks, reduction in stress, and better work-life balance. Mentorship has also been shown to aid recruitment and retention of a diverse physician workforce. The establishment of mentorship programs has been proposed as a mechanism for promoting inclusivity and diversity within academic medicine, but setting up successful programs can be challenging.Today's podcast features 3 accomplished anesthesiologists at different stages of their careers who will discuss the benefits of good mentorship programs and how to start successful programs in both academic and private practice.Scott Markowitz, MD, MSOL, is Professor of Anesthesiology and Vice-Chair for Professional Development and Diversity, Equity, and Inclusion at Washington University in St. Louis. Dr Markowitz focuses on leadership development, promoting a diverse and inclusive leadership and workplace, and promoting meaningful engagement among department members.  He serves on the ASA's ad hoc Committee on Harassment, Incivility, and Disrespect, and also works closely with other leaders on the national initiative, Raising Anesthesiology Diversity and Anti-Racism (RADAR).  Ioana Pasca, MD, is an Associate Professor, Associate Program Director and Director of Neuroanesthesia at Riverside University Health System. She is also a faculty member at the LLUMC Department of Anesthesiology, Critical Care, and Neurocritical Care UCR School of Medicine Adjunct Associate Professor and Anesthesia Interest Group Advisor. Paul Yost, MD, FASA, is the ASA Assistant Secretary, past CSA President, and past ASA Director. He trained in pediatrics at Jackson Memorial in Miami and Anesthesiology at UCLA.  He has worked at Children's Hospital Orange County and St Joseph's in private practice for 32 years.  Served as Chair of pediatric anesthesia at CHOC , Chief of Staff ad hoc, and co-director of Pediatric and Adult Cardiac Anesthesia. Additionally, he served 10 years in city government including 8 years on city council and a couple of terms as mayor of Seal Beach.   

CSA Vital Times tracked down some of the chairs running some elite Anesthesiology Departments - they just happen to be in California! They have survived and thrived the seismic changes occurring across all academic medical institutions, ie the increase in clinical need, with huge growths in anesthetic opportunities (and locations - see #NORA), the competition with community hospitals, and resulting impact on their staff. Dr. Michael Gropper (UCSF), Dr. Ron Pearl (recently retired Stanford chair), and Dr. Richard Applegate (UC Davis and now Loma Linda) get together with Dr. Ludwig Lin for an eye-opening and thought-provoking chat. 

Dr. Rita Agarwal continues the conversation about sexual and gender harassment with fellow Drs. Christine Doyle, Sydney Thomson, and Alyssa Burgart.  Gender and sexual harassment can be harmful in many ways and not just to the person/people being harassed. It can occur to all genders and is often associated with increased costs to the institution, intention to leave and job/career dissatisfaction. I discuss the problems and possible solutions with leaders from the California Society of Anesthesiologists and the American Society of Anesthesiologist, focusing on what is being done and what still needs to be done.

To amplify the message of Black History Month, CSA Vital Times Podcast series revisits the talented Ashley Oliver, MD. We spoke with her in February 2022 when she was a cardiothoracic anesthesia fellow at UCLA, after having been a resident and Chief Resident at UCSF. Dr. Oliver is now a first-year faculty at UCLA's cardiothoracic section, and we have a no-holds barred discussion about being a starting faculty, being a minority, building allies, representation, and the importance of building engagement via societies like CSA and ASA!

A recent study from the Association of Academic Medical Colleges reported tht sexual harassment is common in the medical profession and that anesthesiologist (both men and women) reported the highest incidence of harassment. Harassment led to decreased morale, decreased engagement and a higher intention to leave. Join me for a fascinating and engaging conversation with Diana Lautenberger the author of the AAMC article for suggestion on how to prevent harassment.

The utilization of physician extenders in the UK healthcare system has been quite controversial recently, with topics like training and validation requirements, impact on training and staffing, all bubbling to the surface. In addition, the lack of funding for physicians and residency slots has contrasted with the increasing spending on physician assistants. Dr. Ramey Assaf, resident and leader within Anesthetists United and Dr. Richard Marks, former Vice President for the Royal College of Anesthetists speak with Dr. Ludwig Lin on this topic.  

US and Californian Maternal morbidity is alarmingly high, especially in Black and Hispanic women. How did this happen, and how do we become active change agents in reversing the trend?Leaders in healthcare equity - Drs. Amanda Williams (OB), Jennifer Lucero (OB Anesthesia), and Mofya Diallo (Pedi Anesthesia) join host Dr. Ludwig Lin for this important podcast episode. 

Dr. Rita Agarwal interviews Drs. Jay Brodsky and John Brock Utne, the authors of a new book on the history of anesthesia at Stanford during the Larson Years. They share funny and moving anecdotes about the people, the department, and the events that shaped one of the top anesthesia programs in the country. 

October 1 was Latino Physician Day. For anyone interested in the health of Californians, this is important, because a large portion of our population is Latin-X, and the physicians who care for them should reflect that demographic. We at CSA are excited to bring together a panel of Latinx anesthesiologist at different stages and areas of their professional careers to speak on their journeys to Anesthesiology. This conversation is inspiring - for everyone - and is a call to action.

Those few precious minutes in the Preoperative area spent speaking with a patient and their significant others are essential to the initiation of a successful anesthetic, as is the “vibe” generated during the entire time until the induction agent for General Anesthesia goes in.  What are the keys to success? We speak with Dr. Phil Jones, a cardiac anesthesiologist now in Toronto, Canada, who nearly trained as an actor in Britain before enrolling in Medicine studies at Cambridge. He was a consultant in Anesthesia and Critical Care Medicine at the prestigious St. Bart's Hospital in London. He is passionate about this topic, and about the importance of communication to improve the patient's perioperative experience. Follow Dr. Jones (@philjones6) and Dr. Lin (@LudwigLin) on Twitter.   

This is Part 2 of Debriefing on the Kindness and Empathy Deficit in the Medical Profession featuring Professor Doug Hollan of UCLA Anthropology, Dr. Wes Ely of Vanderbilt University Medical Center, and Dr. David Elkin of UCSF. 

Anthropologist, Intensivist, Anesthesiologist, and Psychiatrist, convene to talk about the anthropological concept of empathy, why it's missing in modern-day medicine, and how to go about reclaiming it. Professor Doug Hollan of UCLA Anthropology, Dr. Wes Ely of Vanderbilt University Medical Center, and Dr. David Elkin of UCSF.  

In Part 2 of Dr. Lin's interview with Dr. Conte, they discuss how you can get involved in CSA advocacy and what led Dr. Conte to becoming President of the society.  Dr. Conte also discusses his diverse upbringing, what led him to becoming an anesthesiologist, and his love for competitive figure skating.  

This episode of the CSA Vital Times Podcast is with Antonio Hernandez Conte, MD, MBA, FASA, President-Elect and one of the current member advocates for the CSA in the State Capitol.  Dr. Hernandez Conte, along with CSA's legislative advocate, make our voices heard on decisions about the way medicine is practiced and reimbursed in California. All of us benefit from advocacy that helps us to care for our patients. Dr. Hernandez Conte tells us how he came to be a leader in this space and discusses the easy ways each one of us can contribute to this advocacy effort.  

Recently CSA Vital Times published a poignant first-person account by Dr. Zeest Khan, cardiac anesthesiologist, of her struggles with #LongCOVID. This is a follow-up, with Drs. Khan and Wes Ely, MD, a prominent critical care medicine specialist at Vanderbilt University and leader in ICU delirium management, who is now directing efforts in Long COVID. They sit down to discuss the therapeutic approaches. Follow Dr. Wes Ely on Twitter @WesElyMD and Dr. Zeeest Khan at @doctor_zeest. 

Hosted by Dr. Ludwig Lin, listen to Part 2 of this fascinating discussion panel featuring: Alyssa Burgart, MD, MA, FAAPElizabeth Duggan, MDJina Sinskey, MD, FASAAmy Vinson, MD, FAAP It's no secret that being a healthcare professional in the United States right now, even more so within Anesthesiology, is stressful. The attrition rate is high. One of the factors that impact us daily is the high level of tension in the Perioperative setting in which anesthesiologists are required to practice. It's a given that we provide superior and professional clinical care; however, we are doing this while dealing oftentimes with a non-collaborative environment.This multi-episode podcast arc gets together experts in the areas of well-being, organizational behavior, and ethics, and challenges them to help think of proactive ways that each anesthesiologist can take ACTION to improve their work life. Wellness isn't only self-care; it needs to be a proactive, call-to-arm to our healthcare organizations to create better work environments. Our experts rise to the occasion, and not only discuss the factors resulting in our broken work space, but the language and asks that we can take to our administrations to demand improvement.Part 2 brings the panelists' list of action steps for us to take back to our own institutions to initiate change. Additional Links:Washington Post Nov 14 – Opinion: How the pandemic ended America's bad romance with workNEJM Humanism before HeroismASA Statement on Creating a Culture of Well-Being for Health Care Workers (October 2021)

In support of Black History Month, California Society of Anesthesiologists is proud to present a podcast conversation with Dr. Ashley Oliver, currently a cardiac anesthesiology fellow at UCLA. Dr. Oliver is a former PhD candidate in film studies, having received a Masters in it. However, she had an epiphany while working abroad, and pivoted to medicine. She has had a star-studded career ever since, including being Chief Resident at UCSF's anesthesia residency. Dr. Ludwig Lin and Dr. Oliver have a wide ranging conversation about black identity, representing that identify, the importance of diversity in medicine, bringing equity to healthcare, and being well-rounded and merging one's various life passions into one's life work.

Dr. Ludwig Lin hosts a discussion panel featuring: Alyssa Burgart, MD, MA, FAAPElizabeth Duggan, MDJina Sinskey, MD, FASAAmy Vinson, MD, FAAP It's no secret that being a healthcare professional in the United States right now, even more so within Anesthesiology, is stressful. The attrition rate is high. One of the factors that impact us daily is the high level of tension in the Perioperative setting in which anesthesiologists are required to practice. It's a given that we provide superior and professional clinical care; however, we are doing this while dealing oftentimes with a non-collaborative environment.This multi-episode podcast arc gets together experts in the areas of well-being, organizational behavior, and ethics, and challenges them to help think of proactive ways that each anesthesiologist can take ACTION to improve their work life. Wellness isn't only self-care; it needs to be a proactive, call-to-arm to our healthcare organizations to create better work environments. Our experts rise to the occasion, and not only discuss the factors resulting in our broken work space, but the language and asks that we can take to our administrations to demand improvement.Additional Links:Washington Post Nov 14 – Opinion: How the pandemic ended America's bad romance with workNEJM Humanism before HeroismASA Statement on Creating a Culture of Well-Being for Health Care Workers (October 2021)

Dr. Zeest Khan is a Stanford-trained cardiac anesthesiologist. Very early in 2020, she fell ill with COVID, but the worse was to come - she developed “Long COVID”. To be a physician used to crises, there can't be a scenario worse than feeling disempowered and unable. To add to that, Dr. Khan encountered skepticism from the healthcare system she sought for care and treatment. As an articulate and driven healthcare professional, Dr. Khan's personal account of her experience as a Long COVID survivor is a powerful testimonial. You can also access the article she wrote in 2022 for the CSA Online First Blog: https://bit.ly/3VXJm4h and follow her on Twitter @doctor_zeest. 

Welcome to the latest episode of the CSA Podcast, Vital Times. Dr. Ron George interviews his friend, mentor, fellow Obstetric Anesthesiologist, and a highly engaged member of the California Society of Anesthesiologists, Brendan Carvalho, MD, FRCA, from Stanford University. Dr. Carvalho is Professor and Chief of the Division of Obstetric Anesthesia and the Vice Chair for Faculty Development at Stanford University School of Medicine. He is a Past-President of SOAP, the Society for Obstetric Anesthesia and Perinatology and during his tenure on the executive he started the development of the foundation for the SOAP Centers of Excellence designation: https://soap.memberclicks.net/. This was created to recognize institutions that demonstrate excellence in obstetric anesthesia care and to set a benchmark of expected care to improve standards nationally and internationally. You can find Dr. Carvalho on Twitter @CarvalB. 

In honor of #CRPSAwarenessMonth, Dr. Lin interviews physician scientist Vivianne Tawfik, MD, PhD, who just won the ASA James Cottrell Presidential Scholar's Award for her work with Complex Regional Pain Syndrome (CRPS). Dr. Tawfik has a successful lab studying causes such as glial function,  her clinical work with CRPS, as well as her work mentoring upcoming physicians and scientists. The topic is one that is intellectually challenging, with life-changing implications for people with CRPS, and one that the CSA Podcast is proud to call attention to.So many people with CRPS struggle to see the possibilities of living and thriving despite it - the podcast has pulled in an amazing advocate who managed to return to her international sports career after proper diagnosis and management - by Dr. Tawfik!This is the story of Coco Vandeweghe, an American professional tennis player. She achieved a career high world ranking of #9 in 2017, when she made the semifinals of two Grand Slam tournaments, the Australian Open and US Open. She was knocked out of her sport in early 2019 with mysterious symptoms which, after a lot of uncertain times, was diagnosed by Dr. Vivianne Tawflik at Stanford as CRPS, and she has beaten all odds to return to an elite level of professional tennis. This August, she won a professional tennis tournament in Concord, Massachusetts. 

Welcome to the latest episode of the CSA Podcast, Vital Times. Today's guest is likely a well-known name to many in the California Society of Anesthesiologists - Dr. Ed Mariano who happens to be the current President of the CSA. If you have not met him in person, you may feel you know him from his prolific digital presence, web-blogs, and through various social media platforms. Dr. Mariano is Professor and Senior Vice Chair of Clinical Operations and Value in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine and Chief of the Anesthesiology and Perioperative Care Service at the Veterans Affairs Palo Alto Health Care System. During our conversation Dr. Mariano shares with our listeners his vision of the physician anesthesiologist, physician leadership and finally some discussion of his hopes for his year as President of the California Society of Anesthesiologists. 

In honor of Women in Medicine Month, Dr. Ludwig Lin interviews anesthesiologist and intensivist Sue Carlisle, MD, PhD, who recently retired as UCSF Dean for the Zuckerberg San Francisco General Hospital campus.  In this chat, Dr. Carlisle talks about her unconventional - yet entirely intentional - way she arrived at each step of her career, and talks about how her values system helped her develop her richly varied and successful academic career. It's an inspirational call for all of us to reach for the best versions of ourselves.   

Welcome to the second episode of the CSA Podcast, Vital Times. Physician well-being has certainly been pushed into the forefront of our practices during the COVID-19 pandemic. This episode Ronald George, MD, FRCPC, speaks with the Vice Chair, for the ASA Committee on Physician Well-Being and Associate Professor at UCSF, Jina Sinskey, MD. Physician well-being is important to all anesthesiologists and ultimately, the patients we serve. Dr. Sinskey plays a vital role in her departments initiatives to address physician well-being at UCSF where she practices Pediatric Anesthesia. During this episode Dr. Sinskey highlights some her and the ASA's work in this field. Find Dr. Sinskey on Twitter @JinaSinskeyMD. 

To kick off the new CSA Podcast, Vital Times, we are going with a surefire crowd pleaser: Dr. Merlin Larson, the man behind the popular posts about History of Anesthesia on Twitter. He talks to Dr. Ludwig Lin about the relevance of history to every anesthesiologist. He also discusses his favorite bits of anesthesia history, picks out some incredible advances as well as shameful bits, and basically makes everyone want to sit up and pay attention. Want to get reacquainted with why we all fell in love with our specialty? You need to revisit the past, with Dr. Larson himself. Find Dr. Larson on Twitter @MerlinLarsonMD1