The Clinical Problem Solvers

In this episode, Noah presented a surprising case with an excellent outcome to Mark and Kirtan.

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Episode description: A fascinating case that started as flank pain … ultimately seen in outpatient pulmonology! Join us for this adventure in clinical reasoning.  

Featuring: 

Priyanka Athavale

Anna Fretz

Kirtan Patolia

Seyma Yildirim

Schemas:

Flank Pain

Hypercalcemia

Granulomas

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In this Rheumatology Rafael Medina Subspecialty episode, Dr. Ana Valle presents a case of Joint pain and skin rash to Dr. Eli Miloslavsky. 

Session facilitator: Rahul Pottabathini

Case Discussant: Dr. Eli Miloslavsky is a rheumatologist and Associate Professor of Medicine at the Massachusetts General Hospital and Harvard Medical School. Dr. Eli’s Career has been focused on medical education across all stages of training. He Serves as a curriculum phase director at Harvard Medical School, Firm Chief in the MGH Internal Medicine Residency Program and an Associate Program Director in the MGH Rheumatology Fellowship. He also leads the MGH Clinician Educator Track for Department of Medicine subspecialty fellows. 

Case Presenter: Dr. Ana Valle, MD, MHS is a rheumatology fellow at Brigham and Women’s Hospital. She attended Johns Hopkins University and the Johns Hopkins Bloomberg School of Public Health where she studied public health during her undergraduate and graduate years. Afterwards, she worked as a research coordinator which introduced her to the field of rheumatology and instilled a passion for clinical research. She then obtained her medical degree from the Zucker School of Medicine at Hofstra/Northwell and completed residency at Montefiore Medical Center in the Bronx, NY, where she was awarded Intern of the Year and Ambulatory Chief. She is pursuing a clinical research career where she dedicates her time to address health inequities within rheumatology and further understand idiopathic inflammatory myopathies. In her free time, she enjoys barre, podcasts, and spending time with her two cats (Dolly & Stevie). 

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Title  – Gum bleeding

Episode description

RR discuss a case of gum bleeding

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Maddy presents a case of atraumatic rhabdomyolysis to Youssef, Andrew, and Noah.

Myopathy Schema

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We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Bayan presents a case of altered mental status to Aye. 

Neurology DDx Schema

Bayan Al Zoabu 

Bayan is a senior medical student from Syria with a passion for neurology and a drive to make a difference in healthcare. From founding a screening initiative for congenital conditions in children to working with other students and residents to create the NeuroAnki flashcard deck to help neurology residents prep for board exams, Bayan is all about supporting others. As a passionate advocate for ethics, she is the co-leader of the journal club team in the neuro-ethics group. Outside of medicine and in her free time, Bayan loves to relax with a cup of tea and a book.

Aye Chan Moe Thant (@AyeThant94)

Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.

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Illness script discussed in this episode (This will reveal the final dx)

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Welcome to another episode of the Clinical Unknown Series! Mark presented a case with a chief complaint of constipation to Debora and Mengyu, and there was an unpredictable turnover.

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Title  – Ascites

Episode description

RR discuss a case of ascites

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Description: Kaylin and Sharmin are joined once again by Dr. Julia Armendariz to learn from her approach to a “struggling” learner. The discussion focuses on the value of using low-inference statements to accurately describe the behavior, how to identify the underlying problem(s) the behavior may represent, and tailoring a path to improvement based on the learner’s level of insight.

Feedback Episodes

Julia’s bio:

Julia Armendariz, MD, is a hospitalist and clinician educator in the Bay Area who works closely with trainees on the wards and in the classroom.  She is the co-director for the Medical Education Elective for the Stanford Internal Medicine Residency, where she shares her passion for Med Ed with Stanford junior and senior residents.  Her special areas of interest within Med Ed are communication, specifically feedback, and the struggling learner. She is also a facilitator for a national CME course called MODEL (Maximizing Ongoing Development and Educational Leadership) within the Veteran’s Administration, where she delivers a feedback workshop for attending physicians.  She is currently collaborating with faculty at Stanford and other academic programs for research projects, including resident perspectives on faculty feedback delivery, how to improve feedback skills for attending physicians, and how to coach feedback givers. Outside of medicine, Julia loves gardening, the ocean, and spending time with family and friends

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In this Maternal-Fetal Medicine (MFM) Rafael Medina Subspecialty episode, Dr. Mary Peeler presents a case of headache in a pregnant patient to Dr. Greg Kirschen.

Session facilitator: Maddy Conte

Case Discussant: Dr. Greg Kirschen is a Maternal-Fetal Medicine fellow at the Hospital of the University of Pennsylvania with a particular interest in pharmacology and metabolism in pregnancy. Before fellowship, he completed an MD/PhD at Stony Brook University in New York with a PhD in molecular pharmacology and then completed residency training in Ob/Gyn at Johns Hopkins Hospital in Baltimore. Teaching and clinical reasoning are his passions and he continues to teach and mentor students from the undergraduate to medical student and resident level.

Case Presenter: Dr. Mary Peeler is originally from Memphis, Tennessee. She completed her undergraduate degree in Health Policy and Management at the University of North Carolina, Chapel Hill. She pursued medical school and residency in Ob/Gyn at Johns Hopkins in Baltimore, Maryland. She also completed a Master’s of Public Health at the Harvard TH Chan School, concentrating in Social and Behavioral Health. She is now in her first year of Maternal Fetal Medicine fellowship back at UNC. Outside of medicine, Mary loves hiking, exploring new places and gardening. 

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Maddy, Youssef and Noah discuss a case presented by Andrew and share their approach to hypercarbia.

CXR discussed in the episode: 

Link to hypercarbia schema.

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We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of behavior change, headaches, and blurry vision to Vale.

Neurology DDx Schema

Aye Chan Moe Thant (@AyeThant94)

Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.

Valeria Roldan (@valeroldan23)

Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.

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Title  – Rapid Response

Episode description

RR drop you into a rapid response

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Episode description: is a simple case of hyperglycemia hiding something sinister? Elena presents a rich teaching case on a common, but complex, chief complaint.

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CPSolvers: Anti-Racism in Medicine Series

Episode 27 – Racial and Gender Health Disparities in Youth Suicide: Part 2 

Show Notes by Asya Pitre

April 25, 2025

Summary: In this second half of a two-part series, Dr. Tami Benton and Dr. Kevin Simon discuss racial and gender health disparities in youth suicide. They explore the impact of racism, trauma, and inequities in care, while emphasizing the need for culturally grounded, community-based prevention. The episode highlights the importance of policy advocacy, culturally responsive therapy, and practicing cultural humility in mental health care.

Episode Learning Objectives

After listening to this episode, learners will be able to:

1. Identify barriers and facilitators to establishing care with a child and adolescent psychiatrist
2. Explain the shifting visibility of racial and gender health disparities in the academic literature
3. Describe the importance of cultural humility and racial concordance in health care

Credits

• Written and produced by: Ashley Cooper, Sudarshan Krishnamurthy, and Team
• Host: Ashley Cooper 
• Infographic and Audio Edits: Ashley Cooper
• Show Notes: Asya Pitre
• Guests: Dr. Tami Benton and Dr. Kevin Simon

Speaker Biographies

Dr. Tami Benton, MD, is the Frederick Allen Professor of Psychiatry at the University of Pennsylvania. She is the Psychiatrist-in-Chief and Chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia (CHOP). She is the President of The American Association of Directors of Child and Adolescent Psychiatry (AADCAP) and the President of The American Academy of Child and Adolescent Psychiatry (AACAP). She served on the National Institute of Mental Health Advisory Council and the APA’s Council for Research. Dr. Benton mentors clinical and research physicians, fellows, and postdoctoral trainees. She was awarded the Society of Biological Psychiatry Humanitarian Award and the Community Outreach Award by the American Foundation for Suicide Prevention. Dr. Benton’s career has been dedicated to developing leadership for a diverse child psychiatry workforce. Her mission — preparing the next generation of diverse physician leaders in pediatric healthcare and mental health and creating partnerships between communities and academic centers — will be critical for eliminating disparities among minority populations.

Dr. Kevin M. Simon, MD, MPH, is Boston’s inaugural Chief Behavioral Health Officer, appointed by Mayor Michelle Wu. He is a physician-scientist, health policy expert, inspirational teacher, and a gifted writer. Dr. Simon is a pediatric addiction medicine psychiatrist at Boston Children’s Hospital; an assistant professor in psychiatry at Harvard Medical School; a recent Commonwealth Fund fellow in health policy at Harvard University; and the medical director of Wayside Youth & Family Support Network. Clinically, he cares for youth and families through the Department of Psychiatry & Behavioral Sciences and the new Division of Addiction Medicine at Boston Children’s Hospital. Academically, he has won multiple awards for research on structural violence, health equity, and mental health. Additionally, he consults with federal agencies on mental health system design and practices. Dr. Simon’s writings on health equity are in notable journals like the American Journal of Public Health and the New England Journal of Medicine. National audiences regularly seek his perspectives on mental health through trusted outlets. 

Episode Takeaways

• Rising Suicide Rates Among Black and Indigenous Girls: In this episode of the Clinical Problem Solvers Anti-Racism in Medicine Podcast, host Ashley Cooper is joined by Dr. Tami Benton and Dr. Kevin Simon to continue the conversation on racial and gender health disparities in youth suicide. The episode opens with a discussion on the rising suicide rates among Black girls. Dr. Simon stresses the importance of educational efforts to dismantle biases and calls for greater research attention to this group. Dr. Benton emphasizes the role of intersecting psychosocial factors—poverty, racism, and trauma—that contribute to suicide risk among Black and Indigenous girls and how these early life experiences impact mental health in adulthood.

• Community-Based Prevention: The conversation then moves toward community-based prevention, with Dr. Simon advocating for trusted community networks to support youth mental health. He points out that historically, some community spaces have also been sources of harm, so intentional engagement and mental health education are essential. Dr. Benton’s presidential theme, as President of the American Academy of Child and Adolescent Psychiatry, “Bringing the Village to the Children,” underscores the importance of collective responsibility. She highlights promising initiatives like suicide prevention programs in African American churches and the American Foundation for Suicide Prevention-Soul Shop.

• Dr. Simon’s Role as Chief Behavioral Health Officer: Dr. Simon shares his work as Boston’s first Chief Behavioral Health Officer, prioritizing substance use treatment and uplifting Black and Indigenous communities. The episode also explores how digital tools can help youth manage their mental health, while also noting the need for culturally relevant care providers. 

• Disparities in Restraint Practices: Disparities in restraint practices are addressed, particularly the disproportionate use of physical and pharmacologic restraints on Black people.

• Policy issues such as the need for enforcement of the Mental Health Parity and Equity Act (MHPAEA) are discussed, alongside practical clinical strategies to prevent youth suicide. These include population-specific adaptations of DBT, attachment-based family therapy, and increasing research on effective interventions for minority youth. A referenced meta-analysis questions the effectiveness of psychotherapy in communities with high levels of anti-Black racism, reinforcing the importance of environmental context in mental health outcomes.

• The Mental Health Parity and Addiction Equity Act (MHPAEA) and Youth Suicide Interventions: Racial socialization is offered as a protective intervention for youth facing racism-related trauma. 

• Key Takeaways (Awareness, Access, and Cultural Humility): The conversation ends by emphasizing awareness of mental health warning signs in youth, advocating for broader access to care, and urging healthcare professionals to practice cultural humility.

Disclosures 

The hosts and guests report no relevant financial disclosures.

References

1. Benton TD, Boyd RC, Njoroge WF. Addressing the Global Crisis of Child and Adolescent Mental Health. JAMA Pediatr. 2021;175(11):1108–1110. doi:10.1001/jamapediatrics.2021.2479

2. Benton T, Njoroge WFM, Ng WYK. Sounding the Alarm for Children’s Mental Health During the COVID-19 Pandemic. JAMA Pediatr. 2022;176(4):e216295. doi:10.1001/jamapediatrics.2021.6295

3. Benton TD. Suicide and Suicidal Behaviors Among Minoritized Youth. Child and Adolescent Psychiatric Clinics of North America. 2022;31(2):211-221. doi:10.1016/j.chc.2022.01.002

4. Benton TD. A Culturally Informed Approach to Supporting Suicidal Minoritized Patients. Focus. 2023 Apr;21(2):166-7.

5. Brent DA, Goldstein TR, Benton TD. Bridging Gaps in Follow-up Appointments After Hospitalization and Youth Suicide: Mental Health Care Disparities Matter. JAMA Netw Open. 2020;3(8):e2013100. doi:10.1001/jamanetworkopen.2020.13100

6. Bridge JA, Asti L, Horowitz LM, et al. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465

7. Fontanella CA, Hiance-Steelesmith DL, Bridge JA, Lester N, Sweeney HA, Hurst M, Campo JV. Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders. Psychiatr Serv. 2016 Mar;67(3):324-31. doi: 10.1176/appi.ps.201500104. Epub 2015 Dec 1. PMID: 26620293.

8. Lindsey MA, Sheftall AH, Xiao Y, Joe S. Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017. Pediatrics. 2019;144(5):e20191187. doi:10.1542/peds.2019-1187

9. Lindsey MA, Brown DR, Cunningham M. Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal of Orthopsychiatry. 2017;87:377-383. doi:10.1037/ort0000198

10. Molock, Sherry Davis et al. “Developing suicide prevention programs for African American youth in African American churches.” Suicide & life-threatening behavior vol. 38,3 (2008): 323-33. doi:10.1521/suli.2008.38.3.323

11. Price JH, Khubchandani J. The Changing Characteristics of African-American Adolescent Suicides, 2001–2017. J Community Health. 2019;44(4):756-763. doi:10.1007/s10900-019-00678-x

12. Price, Maggi A et al. “Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?.” Journal of the American Academy of Child and Adolescent Psychiatry vol. 61,6 (2022): 754-763. doi:10.1016/j.jaac.2021.07.808

13. Sheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(5):662-675. doi:10.1016/j.jaac.2021.08.021

14. Sheftall AH, Miller AB. Setting a Ground Zero Research Agenda for Preventing Black Youth Suicide. 2021;175(9):890-892. doi:10.1001/jamapediatrics.2021.1112

15. Simon KM. Daughters’ Keeper—The Care and Treatment of Black Girls in America. New England Journal of Medicine. 2022 Jun 2;386(22):2067-9.

16. Simon KM. Mitigating the Negative Mental Health Impact of Racism on Black Adolescents—A Preventive Perspective. JAMA Netw Open. 2023;6(11):e2340577. doi:10.1001/jamanetworkopen.2023.40577

17. Simon KM. Them and Me – The Care and Treatment of Black Boys in America. N Engl J Med. 2020 Nov 12;383(20):1904-1905. doi: 10.1056/NEJMp2022606. PMID: 33176082.

18. Congressional Black Caucus: Emergency Task Force on Black Youth Suicide and Mental Health. Ring the Alarm. The Crisis of Black Youth Suicide in America. U.S. Congress. Published December 17, 2019. Accessed 2024. https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf 

19. American Foundation for Suicide Prevention. Soul Shop. https://afsp.org/soul-shop/. Accessed 2025.

Citation

Benton T, Simon K, Cooper A, Krishnamurthy S, Calac A, Pitre A, Pierce G, Onuoha C, Watkins A, Khazanchi R. “Episode 27: Racial and Gender Health Disparities in Youth Suicide: Part 2” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. April 25, 2025.

Show Transcript

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In this episode, Noah and Marcela explored a compelling case presented by Debora, engaging in a thoughtful discussion. At the end, Mark shared the key teaching points from the case, inspiring us all to reflect and grow.

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Description: Dr. Julia Armendariz joins Kaylin, Sharmin, and Cheryl to discuss feedback. She shares why giving feedback is so critical as well as an approach to feedback and goal-setting with learners. She also debunks common myths, highlights potential pitfalls, and shares her strategies to create a positive team learning environment.

Julia’s bio:

Julia Armendariz, MD, is a hospitalist and clinician educator in the Bay Area who works closely with trainees on the wards and in the classroom.  She is the co-director for the Medical Education Elective for the Stanford Internal Medicine Residency, where she shares her passion for Med Ed with Stanford junior and senior residents.  Her special areas of interest within Med Ed are communication, specifically feedback, and the struggling learner. She is also a facilitator for a national CME course called MODEL (Maximizing Ongoing Development and Educational Leadership) within the Veteran’s Administration, where she delivers a feedback workshop for attending physicians.  She is currently collaborating with faculty at Stanford and other academic programs for research projects, including resident perspectives on faculty feedback delivery, how to improve feedback skills for attending physicians, and how to coach feedback givers. Outside of medicine, Julia loves gardening, the ocean, and spending time with family and friends.

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In this Nephrology episode, Dr.Samira Farouk discusses the nuances of AKI, why you should be trending Urine like you trend Troponin. Stay tuned to find out the final diagnosis!

Session facilitator: Dr.Elena Storz

Case Discussants:

Dr.Douglas Farrell MD: Nephrology Fellow, Icahn School of Medicine at Mount Sinai

Dr. Samira Farouk MD: Associate Professor of Medicine and medical Education, Associate Program Director of  the Nephrology Fellowship Program, Icahn School of Medicine at Mount Sinai

Case Presenter: Kuchal

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Maddy, Youssef and Andrew discuss a case presented by Noah and share their approach to bradycardia.

View the bradycardia schema here.

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Episode description

RR discusses a case of dysphagia

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Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Sebastian presents a case of confusion to Aye.

Aye Chan Moe Thant ( @AyeThant94 )

Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!

Dr. Sebastian Green ( @sebfgreen )

Dr. Sebastian Green is a neurology resident at the University of California, Los Angeles (UCLA). He was born and raised in London, England. He has degrees in Medicine from the University of Bristol and Neuroscience from the University of Oxford. He has published on neuroimaging, memory, sleep, epilepsy, and more. He is passionate about medical education in neurology, and using EEG to answer big questions about the brain. 

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Episode description: Seyma presents a case of persistent cough and fatigue that ends up in an unexpected place.

Featuring: 

Priyanka Athavale

Anna Fretz

Kirtan Patolia

Seyma Yildirim

Schemas:

Syncope

Pulmonary renal syndromes

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CPSolvers: Anti-Racism in Medicine Series

Episode 26 – Racial and Gender Health Disparities in Youth Suicide: Part 1

Show Notes by Alec J. Calac

March 14, 2025

Summary: In this first half of a two-part series, we discuss the growing rates of suicide amongst child and adolescent populations in the United States, with a focus on historically underserved groups. In particular, our guests, Dr. Tami Benton and Dr. Kevin Simon, elucidate the disturbing rises in suicidality—suicide attempts and suicidal ideation—and suicide fatality amongst Indigenous and Black youth. Drs. Benton and Simon recount the pervasive nature of the suicide crisis impacting Black and Indigenous youth and offer insights into how we may begin ameliorating these harrowing inequities. 

Episode Learning Objectives

After listening to this episode, learners will be able to:

1. Identify barriers and facilitators to establishing care with a child and adolescent psychiatrist
2. Explain the shifting visibility of racial and gender health disparities in the academic literature
3. Describe the importance of cultural humility and racial concordance in health care

Credits

• Written and produced by: Ashley Cooper, Sudarshan Krishnamurthy, Asya Pitre, and Team
• Hosts: Ashley Cooper and Sudarshan Krishnamurthy
• Infographic and Audio Edits: Ashley Cooper
• Show Notes: Alec J. Calac
• Guest: Dr. Tami Benton and Dr. Kevin Simon

Time Stamps

0:00 Opening and Guest Biographies

3:15 Personal Guest Introductions (Dr. Simon)

6:50 Personal Guest Introductions (Dr. Benton)

13:08 Youth Suicide Crisis Discussion, “Ringing the Alarm”

20:10 Shift in Issue Framing in the Literature 

24:31 The Network Begins with Primary Care

28:42  Diversifying your Outreach

30:54 Cultural Humility

Speaker Biographies

Dr. Tami Benton, MD, is the Frederick Allen Professor of Psychiatry at the University of Pennsylvania. She is the Psychiatrist-in-Chief and Chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia (CHOP). She is the President of The American Association of Directors of Child and Adolescent Psychiatry (AADCAP) and the President of The American Academy of Child and Adolescent Psychiatry (AACAP). She served on the National Institute of Mental Health Advisory Council and the APA’s Council for Research. Dr. Benton mentors clinical and research physicians, fellows, and postdoctoral trainees. She was awarded the Society of Biological Psychiatry Humanitarian Award and the Community Outreach Award by the American Foundation for Suicide Prevention. Dr. Benton’s career has been dedicated to developing leadership for a diverse child psychiatry workforce. Her mission — preparing the next generation of diverse physician leaders in pediatric healthcare and mental health and creating partnerships between communities and academic centers — will be critical for eliminating disparities among minority populations.

Dr. Kevin M. Simon, MD, MPH, is Boston’s inaugural Chief Behavioral Health Officer, appointed by Mayor Michelle Wu. He is a physician-scientist, health policy expert, inspirational teacher, and a gifted writer. Dr. Simon is a pediatric addiction medicine psychiatrist at Boston Children’s Hospital; an assistant professor in psychiatry at Harvard Medical School; a recent Commonwealth Fund fellow in health policy at Harvard University; and the medical director of Wayside Youth & Family Support Network. Clinically, he cares for youth and families through the Department of Psychiatry & Behavioral Sciences and the new Division of Addiction Medicine at Boston Children’s Hospital. Academically, he has won multiple awards for research on structural violence, health equity, and mental health. Additionally, he consults with federal agencies on mental health system design and practices. Dr. Simon’s writings on health equity are in notable journals like the American Journal of Public Health and the New England Journal of Medicine. National audiences regularly seek his perspectives on mental health through trusted outlets. 

Episode Takeaways

• Community health centers play an important role in access to evidence-based psychiatric care rooted in community values. They are often the first interface for patients experiencing mental health crises, not academic medical centers. 

• The youth suicide crisis is disproportionately shouldered by Indigenous and Black and African American communities. Historical challenges include inadequate data surveillance and reporting systems and “hidden” trends brought to the attention of academics by Dr. Jeffrey Bridge, a leading researcher at the Nationwide Children’s Hospital. Among these groups, youth suicide is particularly more prominent at younger ages when compared to other racial and ethnic groups.

• Groups experiencing severe morbidity and mortality–due to any psychiatric cause–often do not reflect the demographics of inpatient hospital censuses. Comprehensive mental health interventions are often beyond reach of those uninsured and underinsured.

• Resources are often directed to the largest group by number, not necessarily the group with the highest incidence and prevalence per capita. This can have devastating effects on public health and impede timely policy and program development. Literature has also shown that youth beneficiaries in Medicaid are not prioritized for mental health services when compared to other programs, which impedes continuity of care.

• There are a growing number of Child Psychiatric Access Programs, including one in Massachusetts, which provide quick access to psychiatric consultation and facilitates referrals for accessing ongoing behavioral health care. These programs recognize the increasing difficulties in having to first see a community-based primary care provider before seeing a specialized psychiatrist.

• Diversifying your mental health outreach goes hand in hand with diversifying your providers. This is directly related to the importance of cultural humility in mitigating health disparities among racial and gender minority youth, as well as literature highlighting the benefits of racial concordance between providers and patients.

• According to a 2019 study published by Price and Khubchandani, the suicide rate among Black girls increased by a striking 182% over the course of 2001 to 2017. Despite these increases there remains a paucity of literature addressing this critical disparity. 

• Language plays an important role in obtaining a thorough mental health history. Youth are often not familiar with medical jargon on questionnaires and intake forms, which can work against important conversations and opportunities for shared decision-making. 

• Large language models and artificial intelligence technologies are likely biased by the documentation we place in the electronic health record, which may reinforce youth health disparities.

Disclosures 

The hosts and guests report no relevant financial disclosures.

References

1. Benton TD, Boyd RC, Njoroge WF. Addressing the Global Crisis of Child and Adolescent Mental Health. JAMA Pediatr. 2021;175(11):1108–1110. doi:10.1001/jamapediatrics.2021.2479
2. Benton T, Njoroge WFM, Ng WYK. Sounding the Alarm for Children’s Mental Health During the COVID-19 Pandemic. JAMA Pediatr. 2022;176(4):e216295. doi:10.1001/jamapediatrics.2021.6295
3. Benton TD. Suicide and Suicidal Behaviors Among Minoritized Youth. Child and Adolescent Psychiatric Clinics of North America. 2022;31(2):211-221. doi:10.1016/j.chc.2022.01.002
4. Benton TD. A Culturally Informed Approach to Supporting Suicidal Minoritized Patients. Focus. 2023 Apr;21(2):166-7.
5. Brent DA, Goldstein TR, Benton TD. Bridging Gaps in Follow-up Appointments After Hospitalization and Youth Suicide: Mental Health Care Disparities Matter. JAMA Netw Open. 2020;3(8):e2013100. doi:10.1001/jamanetworkopen.2020.13100
6. Bridge JA, Asti L, Horowitz LM, et al. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465
7. Fontanella CA, Hiance-Steelesmith DL, Bridge JA, Lester N, Sweeney HA, Hurst M, Campo JV. Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders. Psychiatr Serv. 2016 Mar;67(3):324-31. doi: 10.1176/appi.ps.201500104. Epub 2015 Dec 1. PMID: 26620293.
8. King, C. A., Brent, D., Grupp-Phelan, J., Shenoi, R., Page, K., Mahabee-Gittens, E. M., Chernick, L. S., Melzer-Lange, M., Rea, M., McGuire, T. C., Littlefield, A., & Casper, T. C. (2020). Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use. Journal of the American Academy of Child & Adolescent Psychiatry, 59(9), 1058-1068.e5. https://doi.org/10.1016/j.jaac.2019.10.015
9. Lindsey MA, Sheftall AH, Xiao Y, Joe S. Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017. Pediatrics. 2019;144(5):e20191187. doi:10.1542/peds.2019-1187
10. Lindsey MA, Brown DR, Cunningham M. Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal of Orthopsychiatry. 2017;87:377-383. doi:10.1037/ort0000198
11. Price JH, Khubchandani J. The Changing Characteristics of African-American Adolescent Suicides, 2001–2017. J Community Health. 2019;44(4):756-763. doi:10.1007/s10900-019-00678-x
12. Sheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(5):662-675. doi:10.1016/j.jaac.2021.08.021
13. Sheftall AH, Miller AB. Setting a Ground Zero Research Agenda for Preventing Black Youth Suicide. 2021;175(9):890-892. doi:10.1001/jamapediatrics.2021.1112
14. Simon KM. Daughters’ Keeper—The Care and Treatment of Black Girls in America. New England Journal of Medicine. 2022 Jun 2;386(22):2067-9.
15. Simon KM. Mitigating the Negative Mental Health Impact of Racism on Black Adolescents—A Preventive Perspective. JAMA Netw Open. 2023;6(11):e2340577. doi:10.1001/jamanetworkopen.2023.40577
16. Simon KM. Them and Me – The Care and Treatment of Black Boys in America. N Engl J Med. 2020 Nov 12;383(20):1904-1905. doi: 10.1056/NEJMp2022606. PMID: 33176082.
17. Congressional Black Caucus: Emergency Task Force on Black Youth Suicide and Mental Health. Ring the Alarm. The Crisis of Black Youth Suicide in America. U.S. Congress. Published December 17, 2019. Accessed 2024. https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf 

Citation

Benton T, Simon K, Cooper A, Krishnamurthy S, Calac A, Pitre A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Khazanchi R. “Episode 26: Racial and Gender Health Disparities in Youth Suicide: Part 1” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. March 14, 2025.

Show Transcript

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Noah, Mark, and Debora received Rabih Geha for a fantastic case discussion in this episode.

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Episode description

Reza interviews his mentor and master clinician Dr. Elmer Holzinger

Title  – Distention – why?

Episode description

RR discusses 2 cases of abdominal distention

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Maddy, Youssef and Andrew share their approach to neuropathy and frequent falls as they discuss a case presented by Sharmin.

Polyneuropathy Framework

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Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of double vision to Vale.

Aye Chan Moe Thant ( @AyeThant94 )

Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!

Valeria Roldan

@valeroldan23

Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.

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Frameworks discussed in the episode

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Episode description: Valeria presents a very unique neurological finding amidst a case of cachexia to the SLS team.

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Title  – The same start, but a different ending

Episode description

RR discusses 2 cases of fatigue

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Mark presented a case to Debora and Noah in the year’s first episode.

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Description:

Kaylin, Sharmin, and Cheryl are joined by Dr. Arghavan Salles. They discuss career transitions/pivots, challenging workplace experiences, social/digital media use, and thoughts on allyship and gender biases/stereotype threat as self-identified angry women.

Bio:

Dr. Salles is a minimally invasive and bariatric surgeon. She completed medical school and residency in general surgery at Stanford prior to completing her fellowship in minimally invasive surgery at Washington University in St. Louis. She stayed on faculty at Washington University for three years prior to moving back to Stanford in 2019. During the pandemic, Dr. Salles has served as a disaster relief physician, caring for patients with COVID in the ICU. Dr. Salles obtained a PhD in education from Stanford University during her residency training, and her research focuses on gender equity, implicit bias, diversity, inclusion, and physician well-being. Her R01 grant from the NIH focuses on sexual harassment. She is a sought-after speaker and has given over 100 national and international invited talks related to gender equity, physician well-being, and weight bias. She currently serves as the Special Advisor for DEI Programs at the Stanford University Department of Medicine where she is a Clinical Associate Professor.

Articles: 

https://www.usatoday.com/story/opinion/voices/2018/10/24/angry-women-voting-discrimination-column/1696287002/

https://shows.acast.com/the-house-of-pod-a-medical-podcast/episodes/epsiode-235-masculinity

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In this Pulmonary & Critical Care episode, Dr. Meghan Nothem presents an unusual case of acute encephalopathy and unresponsiveness to Dr. Paul A. Bergl. Stay tuned to found out the final diagnosis!

Session facilitator: Dr. Hui Ting Ruan

Case discussant: 

Dr. Paul A. Bergl is an intensivist at Gundersen Lutheran Medical Center in La Crosse, WI and clinical adjunct assistant professor with the University of Wisconsin. He completed medical school at the University of Wisconsin-Madison, internal medicine residency at the University of Chicago, and critical care fellowship at the Medical College of Wisconsin.

Dr. Bergl is a decorated educator with over a dozen major teaching awards and honors from medical students, residents, and fellows. His foremost passions in medical eduation are critical thinking and diagnostic reasoning. His other scholarly work has focused on diagnostic error, point-of-care ultrasonography and echocardiography, and bedside teaching and rounding.

Case presenter: Dr. Meghan Nothem

Dr. Nothem is a third year Pulmonary & Critical Care Medicine fellow at The Medical College of Wisconsin in Milwaukee, Wisconsin where she also completed her Internal Medicine residency and served as Chief Resident. Prior to returning to her home city for post-graduate training, she earned her Bachelor of Science in Biology at University of Wisconsin-Madison and her medical degree at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado. Dr. Nothem will be joining a Pulmonary and Critical Care Medicine practice in Milwaukee upon completion of her fellowship in summer of 2025.

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Title  – A Sudden Problem – but where is it?

Episode description

RR discuss a fascinating case of abrupt onset abdominal pain

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Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Sebastian Green presents a case of generalized weakness to Aye.

Neurology DDx Schema

Aye Chan Moe Thant ( @AyeThant94 )

Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!

Dr. Sebastian Green ( @sebfgreen )

Dr. Sebastian Green is a neurology resident at the University of California, Los Angeles (UCLA). He was born and raised in London, England. He has degrees in Medicine from the University of Bristol and Neuroscience from the University of Oxford. He has published on neuroimaging, memory, sleep, epilepsy, and more. He is passionate about medical education in neurology, and using EEG to answer big questions about the brain. 

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Episode description: Welcome our new SLS team member, Seyma! The SLS team get together from four time zones across the world to discuss a challenging case of altered mental status. 

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In this episode, Mukund presents a fantastic case to Jasdeep and Ibrahim.

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In this episode of WDx, Sharmin, Yaz, and Kaylin are joined by Dr. Laila Woc-Colburn. Tune in to hear Dr. Woc expertly discuss a case of a young woman with a worsening headache, followed by a roundtable discussion about what drew her to infectious diseases and her passions in medicine and life.

Bio:

**Laila Woc-Colburn, MD** is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine. A graduate of Universidad Francisco Marroquín in Guatemala, she completed her internal medicine residency at Advocate Illinois Masonic Medical Center in Chicago and her fellowship in infectious diseases and HIV medicine at Case Western University in Cleveland. Dr. Woc-Colburn also holds a Diploma in Tropical Medicine and Hygiene.

Her clinical interests encompass tropical diseases in immunosuppressed individuals, including those with HIV, as well as mycotic diseases, orthopedic infections, and medical education. She is passionate about teaching the next generation of healthcare professionals about infectious diseases and is dedicated to empowering women and BIPOC individuals in medicine.

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In this dermatology episode, Dr. Eamonn Maher presents a case of eruptive nodules to Dr. Steven Chen.

Session facilitator: Dr. Maddy Conte 

Case Discussant: Dr. Steven Chen

Case Presenter: Dr. Eamonn Maher

Evolution of Skin Lesions: Link here

Skin Biopsies: Link here

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Title  – Photophobia and diarrhea

Episode description

RR discuss a fascinating case of fever, photophobia and diarrhea

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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Maddy, Youssef and Andrew share their approach to acute coronary syndrome as they discuss a case presented by Sharmin.

Acute Coronary Syndrome Framework

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Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Bayan presents a case of headache and seizure to Aye.

Neurology DDx Schema

Aye Chan Moe Thant ( @AyeThant94 )

Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!

Bayan Al Zoabu

Bayan is a senior medical student from Syria with a passion for neurology and a drive to make a difference in healthcare. From founding a screening initiative for congenital conditions in children to working with other students and residents to create the NeurAnki flashcard deck to help neurology residents prep for board exams, Bayan is all about supporting others. As a passionate advocate for ethics, she is the co-leader of the journal club team in the neuro-ethics group. Outside medicine and in her free time, Bayan loves to relax with a cup of tea and a book.

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Episode description: Jas presents a fascinating case of chest pain, dyspnea, and lower extremity edema that ends up in a very different place than any of us expected. Welcome to our new teammate Elena! 

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Lea and Şeyma discuss this fascinating non-productive cough, fever and dyspnea case presented by Elena.

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Title  – Dr. Centor joins RR for a case of diarrhea

Episode description

Robert Centor, Reza and Rabih discuss a case of diarrhea

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Kaylin, Sharmin, Cheryl, and Jane discuss two cases of volume overload. Kaylin reviews the pathophysiology behind constrictive pericarditis and restrictive cardiomyopathy, normal pericardial and thoracic anatomy and pressure changes with respiration, and the difference in treatments between the two disease processes.

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This joint rheumatology and pulmonary critical care medicine session is a collaboration between CPSolvers and The University of Colorado. This session, like all Rafa Medina Subspecialty sessions, is in honor of Dr. Rafael Medina. Dr. Melissa Griffith and Dr. Geoff Connors discuss a case of myositis presented by Dr. Sarah Haeger and Dr. Evan Zehr

Session facilitator: Maddy Conte

Case Discussants: Geoff Connors is an associate professor in Pulmonary and Critical Care at the University of Colorado. He is the Associate Dean for Graduate Medical Education and is the former program director of the Internal Medicine Program at University of Colorado. Melissa Griffith is an Assistant Professor of Rheumatology at the University of Colorado. 

Case Presenters: Sarah Haeger was a chief medical resident at the University of Colorado and is currently a nephrology fellow at the University of Washington. Evan Zehr was a chief medical resident at the University of Colorado and is currently a fellow in Pulmonary and Critical Care medicine at Vanderbilt. 

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