Latest / Morning Medical with Dr. Chow / Malaria Vaccine Update, Mediterranean Diet Benefits, and Resident Physicians' Mental Health

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Malaria Vaccine Update, Mediterranean Diet Benefits, and Resident Physicians' Mental Health · Morning Medical with Dr. Chow

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  Welcome to another episode of Morning Medical with Dr.
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  Chow, your go-to podcast for the latest updates in the world of medicine and health.
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  I am your host, Dr.
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  Chi-Ming Chow.
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  Today, we will be discussing a groundbreaking development in the fight against malaria, a
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  disease that has long plagued many parts of the world, particularly Africa.
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  Children in Ivory Coast received the first doses of a new, relatively cheap malaria
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  vaccine on Monday, marking a significant milestone in the battle against this deadly
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  disease.
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  The R21 vaccine, developed by the Jenner Institute at the University of Oxford and the
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  Serum Institute of India, has been sent to several African countries.
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  It will also be administered in South Sudan starting Tuesday, according to a statement from
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  the University of Oxford.
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  What makes this vaccine particularly noteworthy is its cost-effectiveness.
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  The vaccine costs less than four dollars per dose, making it feasible to roll out tens of
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  millions of doses.
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  It also boasts high efficacy levels of around seventy-five to eighty percent in young
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  children, according to Professor Adrian Hill, director of the Jenner Institute at Oxford
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  University, who led the development of the vaccine.
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  The World Health Organization has modeled that up to five hundred thousand child deaths could
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  be prevented every year with the widespread implementation of R21, alongside its
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  counterpart RTS,S vaccine.
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  Despite being both preventable and curable, malaria still killed around six hundred eight
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  thousand people worldwide in 2022.
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  About ninety-five percent of those deaths occurred in Africa, where children under the
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  age of five account for around eighty percent of all malaria deaths across the continent.
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  The Serum Institute of India has already manufactured more than twenty-five million
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  doses and committed to producing up to one hundred million doses a year.
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  This scale of production allows the vaccine to remain affordable, further aiding in its
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  widespread distribution.
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  The initial vaccination campaign aims to drastically reduce the number of deaths caused
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  by malaria, with enough doses available to vaccinate two hundred fifty thousand children
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  under the age of two in Ivory Coast.
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  Other countries, including Ghana, Nigeria, Burkina Faso, and the Central African Republic,
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  have also authorized the vaccine.
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  R21 will be used alongside the RTS,S vaccine, which has already been delivered to more than
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  two million children over a four-year pilot program in Ghana, Kenya, and Malawi.
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  This program reduced all-cause mortality by thirteen percent, according to UNICEF.
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  Both vaccines have been approved by the World Health Organization and are expected to have a
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  hugely positive impact on public health, especially when used in conjunction with other
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  preventive measures like mosquito nets.
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  Professor Hill added that there is still a lot of work to be done to ensure the successful
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  distribution of the vaccine.
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  "This is a three-dose vaccine, typically given at five, six, and seven months of age, with a
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  booster a year later.
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  That is not a time point that other vaccines are usually given at, so there is training
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  required in these largely relatively low-income countries," he said.
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  The Mediterranean diet has long been associated with numerous health benefits for adults, but a
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  new study suggests that it could also be advantageous for children’s heart health.
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  An analysis of nine earlier studies, which included 577 participants aged 3 to 18, found
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  that incorporating the Mediterranean diet for at least eight weeks had a significant
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  association with lowering blood pressure and total cholesterol.
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  This study, published in the journal JAMA Network Open, further supports the idea that
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  adopting healthy dietary habits early in life can help prevent cardiovascular diseases and
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  metabolic disorders, such as high blood pressure and diabetes, which often originate in
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  childhood.
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  Dr.
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  José Francisco López-Gil, the lead author of the study and a senior researcher with One
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  Health Research Group at the University of the Americas in Quito, Ecuador, emphasized the
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  importance of early dietary habits in influencing long-term health outcomes.
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  He stated, 'The key takeaway for parents is the importance of promoting a diet rich in whole
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  foods and healthy fats to optimize their children’s health and reduce the risk of
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  developing chronic diseases.'
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  Dr.
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  Stuart Berger, division head of pediatric cardiology at the Ann and Robert H.
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  Lurie Children’s Hospital of Chicago, who was not involved with the study, noted that while
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  the findings are not surprising given the known benefits of the Mediterranean diet for adults,
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  they underscore the importance of a diet rich in unprocessed foods such as fruits,
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  vegetables, lean meats, and fish for all stages of life.
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  The Mediterranean diet emphasizes plant-based cooking with an emphasis on healthy fats, and
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  includes fruits, vegetables, beans, seeds, nuts, whole grains, lean meats, and fish.
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  Dr.
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  Natalie Muth, a spokesperson for the American Academy of Pediatrics, who was also not
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  involved with the research, pointed out that while not every child needs to adopt the
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  Mediterranean diet, it is important to increase 'real foods' in children’s diets and decrease
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  highly processed foods that have added sugars and sodium.
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  Dr.
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  Muth noted that calories from ultraprocessed foods make up about seventy percent of a
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  typical teenager’s intake.
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  'Any change that can lower intake of things like chips, cookies, and sodas and increase
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  intake of fruits and vegetables is a big win,' she said.
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  However, it is essential to consider a child’s preferences and incorporate cultural traditions
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  into any guidance around food choices.
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  For those looking to shift to the Mediterranean eating plan, following age-appropriate dietary
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  plans and exercise recommended by a child’s pediatrician is also key.
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  Dr.
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  Berger, who is also a professor of pediatrics at Northwestern University’s Feinberg School of
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  Medicine, emphasized the importance of family meals as a way to connect and lead by example.
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  Dr.
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  Tamara Hannon, director of the clinical pediatric diabetes program at Riley Hospital
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  for Children at Indiana University Health, added that parents should offer structured
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  meals and snacks and exercise daily.
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  She also recommends limiting children’s eating between structured meals and snacks and
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  eliminating sugary beverages and juices to improve blood glucose and weight management.
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  The study authors found some variation in results across the earlier studies analyzed,
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  which can be attributed to the differing factors of diet and physical activity each
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  study displayed.
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  Despite these variations, the Mediterranean diet consistently improved blood pressure
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  levels and lipid profiles, which can lower the risk of cardiometabolic problems later in life
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  such as heart attacks, strokes, and diabetes.
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  Dr.
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  López-Gil noted that the researchers did not find evidence of any effects on glucose and
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  insulin levels, suggesting that the impact of the Mediterranean diet on these health factors
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  could be less pronounced or require a longer time frame to manifest.
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  Future research should include larger sample sizes and more diverse populations, as well as
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  longitudinal studies to assess the long-term effects of the Mediterranean diet on children’s
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  cardiometabolic health.
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  Dr.
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  Muth concluded, 'The growing research shows the value of the Mediterranean diet to be the same
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  for children and adolescents as it is for adults.
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  One of the most impactful steps a parent can take to help improve kids’ nutrition is to
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  commit to regular family meals and try to prepare foods at home as often as possible.
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  The more kids are exposed to fruits, vegetables, and fish, the more likely they will
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  try them and like them eventually.'
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  "I have not slept in the past 28 hours." "My 5-month-old daughter spends more time at
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  daycare than at home." "I have been moonlighting every free weekend for extra
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  income." These distressing sentiments are frequently shared by the resident physicians I
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  have worked with, especially amid the start of the new academic year for residents.
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  Of course, seasoned physicians may also recount tough working conditions during their training,
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  and those in fields outside of medicine cite examples of enduring long and exhausting work
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  hours too.
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  But does that justify the devaluation of current resident physicians who put in
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  eighty-hour work weeks in constant high-stress environments?
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  The United States has made great strides in placing greater emphasis on mental health and
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  well-being.
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  A simple search for "well-being" on the web returns an overwhelming number of results.
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  However, when it comes to physicians, there appears to be an attitude of indifference,
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  encapsulated in sentiments such as, "You should tough it out because that is what you signed up
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  for, and you are well-compensated." But is this fair?
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  Is it even accurate?
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  As their title suggests, residents have historically been expected to reside in the
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  hospital, sacrificing sleep, exercise, social interactions, and significant life events of
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  their loved ones.
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  They receive minimal compensation under the promise of delayed gratification.
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  Perhaps it is unsurprising, then, that a meta-analysis published in 2015 reported that
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  nearly twenty-nine percent of residents screened positive for depression.
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  As a current fourth-year medical student, this adds stress and alarm to my already overloaded
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  mind.
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  Unfair compensation stands out as a significant contributor to resident burnout.
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  According to an online survey, seventy-six percent of residents feel they are inadequately
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  compensated for their work.
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  Despite working up to eighty hours per week, first-year residents typically earn a median
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  salary of sixty-two thousand seven hundred twenty-two dollars.
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  During some grueling weeks, this equates to as little as twelve dollars per hour, and
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  sixty-four percent of residents report that their compensation fails to cover the cost of
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  living, often making them resort to moonlighting to make ends meet.
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  Adding to the financial strain is the burden of medical school debt, coupled with the
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  relentless rise in inflation.
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  So, how is resident pay decided?
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  About eighty-six percent of each resident's salary is funded by the Centers for Medicare
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  and Medicaid Services and the Department of Veterans Affairs, with less than twelve percent
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  coming from individual states, and only two percent from hospitals and philanthropy.
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  The Centers for Medicare and Medicaid Services calculates the hospital's cost to train each
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  resident using a formula derived from data dating back to 1984.
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  This outdated compensation framework persists due to the unique structure of medical
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  residency.
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  Unlike industries operating within a free market economy, where competitive salaries
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  attract qualified employees, medical students go through the residency match process to
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  secure placement in a program, eliminating their negotiating power.
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  This, paired with lack of benefits -- such as complimentary meals, family and medical leave,
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  and adequate vacation days -- in certain programs can exacerbate residents' feelings of
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  being treated as cheap labor, despite all their hard work.
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  While it is true that physicians earn more than an average household, many residents must
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  initially face significant financial challenges with a promise of potential income contingent
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  upon successful completion of their extensive training.
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  Nowadays, it is not uncommon to encounter residents with median student loan debt ranging
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  from two hundred thousand to a whopping five hundred thousand dollars.
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  Based on income-driven plans, this could translate to monthly payments of three thousand
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  dollars or more, posing a financial strain that might influence crucial life decisions, such as
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  career choice to stay in academia, or family planning.
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  Income inequality and lack of an economic safety net is not unique to residents, however;
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  it is important that other healthcare professionals responsible for high-stakes
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  patient care decisions, such as nurse practitioners and physician assistants, are
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  also adequately compensated.
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  Beyond fair compensation, there are several other avenues to enhance resident well-being.
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  While evidence on effective wellness curricula in medical training is limited, it is clear
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  that meaningful changes must involve both individual residents and their institutions.
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  Successful programs have implemented practical benefits such as discounted access to fitness
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  centers and personal trainers, ensuring access to healthy foods, and providing increased time
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  off for wellness activities.
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  A survey revealed that the most popular benefits among residents were health insurance,
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  paid time off, and meal allowances.
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  Enhancing resident well-being does not require much and can be effectively achieved with
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  institutional resources.
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  The unhappiness of residents should not be seen in a vacuum.
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  Resident burnout correlates with higher rates of medical errors and adverse events.
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  The economic impact of physician burnout is estimated at close to five billion dollars
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  annually from loss of productivity and frequent job turnover.
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  Ensuring the well-being of resident physicians is not solely about individual satisfaction; it
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  is about cultivating a positive cycle where fulfilled residents evolve into competent
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  physicians, which results in improved patient satisfaction.
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  With a physician shortage looming, it is crucial that we prioritize the care and support
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  of our young medical workforce.
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  As I near residency, I will keep pushing to improve the situation for myself and my peers.
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  Our final story today takes us back in time to a dramatic moment in American political
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  history.
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  As reporters gathered in Milwaukee for this week's Republican National Convention, their
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  attention was drawn to a historical plaque on a hotel wall.
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  This plaque commemorates an assassination attempt on a former president who was
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  campaigning to return to the White House after years in political exile.
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  The president in question was none other than Theodore Roosevelt.
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  Much like former President Donald Trump, who recently survived an assassination attempt,
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  Theodore Roosevelt also faced a similar life-threatening situation while on the
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  campaign trail in 1912.
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  The story of Roosevelt's medical care during this episode is a fascinating tale of
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  resilience, medical expertise, and the uncertainties of early 20th-century medicine.
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  The would-be assassin, John Schrank, was an unemployed saloonkeeper from Germany who had
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  been stalking Roosevelt across the country during his third-party campaign.
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  On the evening of October 14, 1912, as Roosevelt exited his hotel in Milwaukee to head
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  to a speaking engagement, Schrank fired a single shot from a .38-caliber revolver at
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  close range.
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  The bullet struck Roosevelt's right chest, causing him to sway and nearly stumble, but he
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  managed to keep his balance.
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  Remarkably, Roosevelt's reaction was composed.
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  He felt under his heavy overcoat and noticed his fingers were red with blood.
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  'It looks as if I had been hit,' he reportedly said.
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  Knowing that the absence of blood when he coughed was a good sign, indicating the bullet
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  had not hit his lungs, Roosevelt pressed on with his plans.
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  He refused immediate medical attention and instead placed a handkerchief over the wound
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  before proceeding to give his speech as scheduled.
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  In a dramatic moment during his speech, Roosevelt announced to the audience that he had
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  been shot and revealed his blood-stained shirt.
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  Despite the crowd's gasps and one man's shout of 'Fake, fake!' Roosevelt proclaimed, 'It
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  takes more than one bullet to kill a Bull Moose,' referring to the name of the third
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  party under which he was running.
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  Eventually, Roosevelt did agree to seek medical care, but only after completing his speech,
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  which lasted approximately 90 minutes.
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  He was taken to a Milwaukee emergency hospital where x-rays showed that the bullet had stopped
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  just short of his lungs.
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  Still concerned about the quality of care, Roosevelt opted to travel to Chicago for
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  further treatment, fearing the fate of former President James Garfield, whose death was
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  attributed to inadequate medical care following a gunshot wound.
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  In Chicago, Roosevelt was met by a prominent surgeon, John Murphy, who was one of the most
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  influential surgeons of his time.
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  Murphy's examination and subsequent x-rays revealed that the bullet had lodged between
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  Roosevelt's fourth and fifth ribs and had not penetrated the pleural cavity.
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  Given the circumstances, the medical team decided to leave the bullet in place, a
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  decision that made sense at the time and would still be considered valid today in similar
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  situations.
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  Roosevelt's recovery was closely monitored by the media, who provided detailed accounts of
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  his temperature, pulse, and the anti-tetanus serum he received.
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  Despite the severity of the injury, Roosevelt never had the bullet removed and continued his
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  campaign, though he ultimately lost the election to Woodrow Wilson.
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  Interestingly, Roosevelt's life ended unexpectedly in 1919 at the age of 60,
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  apparently due to an embolism, although some theories suggest a tropical parasite may have
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  been the cause.
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  As for his would-be assassin, John Schrank was declared insane and spent the rest of his life
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  in an asylum, where he died in 1943 at the age of 67.
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  Dr.
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  Theodore N.
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  Pappas, a surgeon and presidential medical historian at Duke University, noted the
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  similarities between Roosevelt and Trump, describing them as 'united by their narcissism,
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  outspokenness, and boldness.' He also referenced a quote often attributed to Mark
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  Twain: 'History may not repeat itself.
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  But it often rhymes.'
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  That wraps up today's episode of Morning Medical with Dr.
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  Chow.
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  Thank you for joining us as we explored these compelling stories from the world of medicine.
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  Stay tuned for more updates and insights in our next episode.
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  Until then, stay healthy and informed.