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The Clinical Problem Solvers

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The Clinical Problem Solvers is a multi-modal venture that works to disseminate and democratize the stories and science of diagnostic reasoning Twitter: @CPSolvers Website: clinicalproblemsolving.com
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The Clinical Problem Solvers is a multi-modal venture that works to disseminate and democratize the stories and science of diagnostic reasoning Twitter: @CPSolvers Website: clinicalproblemsolving.com
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Episodes

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https://clinicalproblemsolving.com/wp-content/uploads/2022/10/WDx_10.06_RTP.mp3

 

In this WDx episode, Sharmin and Dr Lekshmi Santhosh delve into the world of written evaluations: why are they important, implicit biases they can contain and how to do a better job in both writing and interpreting evaluations. 

 

Dr. Lekshmi Santhosh

Dr. Lekshmi Santhosh is an associate professor of medicine at UCSF. She specializes in adult pulmonary and critical care medicine with a focus on medical education. She attends in the Medical ICU, the Neuro ICU, on the Internal Medicine teaching wards, and has clinic at the Pulmonary Outpatient Faculty Practice at UCSF-Parnassus. She is the founder and Medical Director of the multidisciplinary long-COVID/post-ICU OPTIMAL Clinic at UCSF Health.

 

She serves as the Associate Program Director for Curriculum for the Internal Medicine Residency and the Associate Program Director of the Pulmonary and Critical Care Medicine Fellowship. She also is the Director of the Department of Medicine Grand Rounds. She obtained her Master’s in Health Professions Education from UC-Berkeley. Her primary interests in medical education research are related to ICU transitions of care, women in leadership, clinical reasoning, and subspecialty career choice.

Resources:

Analysis of Narrative Text in Evaluations of Continuing Medical Education Faculty by Gender 

Differences in Narrative Language in Evaluations of Medical Students by Gender and Under-represented Minority Status

UCSF’s Equity in Assessment Guidelines and Checklist

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/10/WDx_10.06_RTP.mp3

 

In this WDx episode, Sharmin and Dr Lekshmi Santhosh delve into the world of written evaluations: why are they important, implicit biases they can contain and how to do a better job in both writing and interpreting evaluations. 

 

Dr. Lekshmi Santhosh

Dr. Lekshmi Santhosh is an associate professor of medicine at UCSF. She specializes in adult pulmonary and critical care medicine with a focus on medical education. She attends in the Medical ICU, the Neuro ICU, on the Internal Medicine teaching wards, and has clinic at the Pulmonary Outpatient Faculty Practice at UCSF-Parnassus. She is the founder and Medical Director of the multidisciplinary long-COVID/post-ICU OPTIMAL Clinic at UCSF Health.

 

She serves as the Associate Program Director for Curriculum for the Internal Medicine Residency and the Associate Program Director of the Pulmonary and Critical Care Medicine Fellowship. She also is the Director of the Department of Medicine Grand Rounds. She obtained her Master’s in Health Professions Education from UC-Berkeley. Her primary interests in medical education research are related to ICU transitions of care, women in leadership, clinical reasoning, and subspecialty career choice.

Resources:

Analysis of Narrative Text in Evaluations of Continuing Medical Education Faculty by Gender 

Differences in Narrative Language in Evaluations of Medical Students by Gender and Under-represented Minority Status

UCSF’s Equity in Assessment Guidelines and Checklist

 

Download CPSolvers App here

Patreon website

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https://clinicalproblemsolving.com/wp-content/uploads/2022/10/Gabriel_10.4_RTP.mp3

This episode is dedicated to the loving memory of Gabriel Talledo, we reflect on how greatly he touched our lives followed by his story, as told by him in the first episode of Queer Rounds. 

Please consider donating here to the Gabriel Talledo’s Scholarship benefiting young medical students of the LGTBQIA community in hopes of financially helping them achieve their dreams. 

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/10/Gabriel_10.4_RTP.mp3

This episode is dedicated to the loving memory of Gabriel Talledo, we reflect on how greatly he touched our lives followed by his story, as told by him in the first episode of Queer Rounds. 

Please consider donating here to the Gabriel Talledo’s Scholarship benefiting young medical students of the LGTBQIA community in hopes of financially helping them achieve their dreams. 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/09/9.29.22-SLS-RTP.mp3

The SLS team tackles the case of a young woman presenting with a prolonged, inflammatory pulmonary syndrome is found to have pulmonary granulomas, headaches and hyponatremia. Join them as they apply CPSolvers schemas to real life Patient care to facilitate the diagnostic reasoning process.

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/09/9.29.22-SLS-RTP.mp3

The SLS team tackles the case of a young woman presenting with a prolonged, inflammatory pulmonary syndrome is found to have pulmonary granulomas, headaches and hyponatremia. Join them as they apply CPSolvers schemas to real life Patient care to facilitate the diagnostic reasoning process.

Download CPSolvers App here

Patreon website

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https://clinicalproblemsolving.com/wp-content/uploads/2022/09/09.27.22-Schema-Episode-RTP.mp3

Sharmin, Ann Marie, and Dan discuss a case that takes us on a journey through the pancreas and hepatobiliary systems with schemas at every stop of the way!

 

Schemas:

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/09/09.27.22-Schema-Episode-RTP.mp3

Sharmin, Ann Marie, and Dan discuss a case that takes us on a journey through the pancreas and hepatobiliary systems with schemas at every stop of the way!

 

Schemas:

 

Download CPSolvers App here

Patreon website

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Published 2022-09-14

Episode 256: RLR – Nausea with a twist

40 min
View
https://clinicalproblemsolving.com/wp-content/uploads/2022/09/RLR-104_Nausea-2.mp3

RLR discussing an intriguing case of nausea.

 

Big news

RLR are ending their time on Patreon soon and hosting content on their own website.

Stay tuned for more info.

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/09/RLR-104_Nausea-2.mp3

RLR discussing an intriguing case of nausea.

 

Big news

RLR are ending their time on Patreon soon and hosting content on their own website.

Stay tuned for more info.

 

Download CPSolvers App here

Patreon website

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We cannot wait to share the new RLR website with you as our time on Patreon is coming to an end. The website is our dream project. You will be notified once the website is up before anyone else. We are a few weeks away!!! 

And remember to reach out to us if there are any issues regarding refunds from Patreon as you cancel your annual subscriptions. It is very important to us that each of you are 100% satisfied with RR. 

We hope you will continue to follow us and support our work once the new website is up and running. None of this is possible without you. We are so grateful for your support. For now, keep your monthly $5 Patreon subscription active b/c we are uploading audio as usual until the new website is up and running.

We will be offering so much more on the website. We think you will love it.

Enjoy this episode. We hope you don’t get a headache listening to it!!!

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

We cannot wait to share the new RLR website with you as our time on Patreon is coming to an end. The website is our dream project. You will be notified once the website is up before anyone else. We are a few weeks away!!! 

And remember to reach out to us if there are any issues regarding refunds from Patreon as you cancel your annual subscriptions. It is very important to us that each of you are 100% satisfied with RR. 

We hope you will continue to follow us and support our work once the new website is up and running. None of this is possible without you. We are so grateful for your support. For now, keep your monthly $5 Patreon subscription active b/c we are uploading audio as usual until the new website is up and running.

We will be offering so much more on the website. We think you will love it.

Enjoy this episode. We hope you don’t get a headache listening to it!!!

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/09/9.08.22-Neuro-VMR-RTP.mp3

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, CPSolvers team member Rafael Medina presents a case of frequent falls for CPSolvers team member Yazmin and Alice. 

Neurology DDx Schema

 

Rafael Medina dos Santos

@Rafameed

Rafael Medina dos Santos is a Brazilian medical graduate. Before medicine, Rafael wanted to be a teacher. Unsurprisingly, he loves everything related to teaching and learning, so his passion for the CPSolvers’ mission was only natural.  He’s applying this 2023 match season for internal medicine. Beyond medicine, Rafael loves fiction books/movies, pop music, and singing Disney songs.

 

Yazmin Heredia Allegretti

@minheredia

Yazmin is a Medical Graduate from Mexico, looking forward to applying to an Internal Medicine Residency in the U.S. She is passionate about medical education, health equity, and clinical reasoning and believes knowledge (as well as healthcare) must be accessible to everyone. She looks forward to collaborating with doctors and students worldwide to create the best evidence-based resources to impulse medical practice and patient care. Aside from medicine, you will find her taking care of her wide collection of plants, developing her skills in the fine arts, volunteering for any project she can find, or learning new languages.

 

Alice Falck

 

Alice is a 5th-year medical student from Berlin, currently working on her MD doctoral thesis to contribute to the pathophysiology of temporal lobe epilepsy. She aspires to be a neurologist and is interested in neuroscience, electrophysiology, and of course clinical reasoning. She is passionate about gender equality in general and especially in Medicine. In her free time, she loves discussing movies with friends and eating great food.

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/09/9.08.22-Neuro-VMR-RTP.mp3

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, CPSolvers team member Rafael Medina presents a case of frequent falls for CPSolvers team member Yazmin and Alice. 

Neurology DDx Schema

 

Rafael Medina dos Santos

@Rafameed

Rafael Medina dos Santos is a Brazilian medical graduate. Before medicine, Rafael wanted to be a teacher. Unsurprisingly, he loves everything related to teaching and learning, so his passion for the CPSolvers’ mission was only natural.  He’s applying this 2023 match season for internal medicine. Beyond medicine, Rafael loves fiction books/movies, pop music, and singing Disney songs.

 

Yazmin Heredia Allegretti

@minheredia

Yazmin is a Medical Graduate from Mexico, looking forward to applying to an Internal Medicine Residency in the U.S. She is passionate about medical education, health equity, and clinical reasoning and believes knowledge (as well as healthcare) must be accessible to everyone. She looks forward to collaborating with doctors and students worldwide to create the best evidence-based resources to impulse medical practice and patient care. Aside from medicine, you will find her taking care of her wide collection of plants, developing her skills in the fine arts, volunteering for any project she can find, or learning new languages.

 

Alice Falck

 

Alice is a 5th-year medical student from Berlin, currently working on her MD doctoral thesis to contribute to the pathophysiology of temporal lobe epilepsy. She aspires to be a neurologist and is interested in neuroscience, electrophysiology, and of course clinical reasoning. She is passionate about gender equality in general and especially in Medicine. In her free time, she loves discussing movies with friends and eating great food.

 

Download CPSolvers App here

Patreon website

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https://clinicalproblemsolving.com/wp-content/uploads/2022/09/ClinicalUnknown9_1_22RTP-1.mp3

Dr. Rezigh presents a case of fever in a patient newly diagnosed with HIV to Dr. Woc-Colburn.

Dr. Alec Rezigh

Alec Rezigh is an academic hospitalist at Baylor College of Medicine in Houston, TX. He completed medical school at McGovern Medical School in Houston and his residency at The University of Colorado. His clinical interests include medical education and clinical reasoning. He loves all things basketball, CPSolvers, and playing with his human and doggy daughters.

Dr. Laila Woc-Colburn

Dr. Laila Woc-Colburn is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta. She is a renowned medical educator and has a wide range of clinical interests including tropical medicine, HIV, and fungal diseases.

Schemas

HIV Infection

Infection in the inpatient

Rickettsia

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/09/ClinicalUnknown9_1_22RTP-1.mp3

Dr. Rezigh presents a case of fever in a patient newly diagnosed with HIV to Dr. Woc-Colburn.

Dr. Alec Rezigh

Alec Rezigh is an academic hospitalist at Baylor College of Medicine in Houston, TX. He completed medical school at McGovern Medical School in Houston and his residency at The University of Colorado. His clinical interests include medical education and clinical reasoning. He loves all things basketball, CPSolvers, and playing with his human and doggy daughters.

Dr. Laila Woc-Colburn

Dr. Laila Woc-Colburn is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta. She is a renowned medical educator and has a wide range of clinical interests including tropical medicine, HIV, and fungal diseases.

Schemas

HIV Infection

Infection in the inpatient

Rickettsia

Download CPSolvers App here

Patreon website

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“Welcome back Clinical Problem Solvers,” Uncle Bob said.

“Wow, that is so good, so so good,” Rabih reflexively responded.

“Hey, wait a minute, I’ve given 104 intros and never received a compliment for my welcome back ‘clinical problem solvers,’ Rabih!!!” Reza quipped


We hope you have fun while learning. And Uncle Bob is the type of clinician-educator that we aspire to become.

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

More description

“Welcome back Clinical Problem Solvers,” Uncle Bob said.

“Wow, that is so good, so so good,” Rabih reflexively responded.

“Hey, wait a minute, I’ve given 104 intros and never received a compliment for my welcome back ‘clinical problem solvers,’ Rabih!!!” Reza quipped


We hope you have fun while learning. And Uncle Bob is the type of clinician-educator that we aspire to become.

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/08/08.25.22-Audio-Team-Clinical-Unknown-RTP.mp3

We are excited to bring you this special Clinical Unknown episode with Eleanor, Kate, David, and Mike discussing a case of back pain.

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/08/08.25.22-Audio-Team-Clinical-Unknown-RTP.mp3

We are excited to bring you this special Clinical Unknown episode with Eleanor, Kate, David, and Mike discussing a case of back pain.

 

Download CPSolvers App here

Patreon website

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Dear Patrons,

Many times in medicine it is not one diagnosis but multiple diagnoses each contributing a different amount to the clinical problem.

This cryptic message will become clear once you listen to this jam-packed episode.

Enjoy

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

More description

Dear Patrons,

Many times in medicine it is not one diagnosis but multiple diagnoses each contributing a different amount to the clinical problem.

This cryptic message will become clear once you listen to this jam-packed episode.

Enjoy

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

Extract Knowledge
Listen elsewhere
Web
Published 2022-08-15

RLR 104 – Why so slow?

29 min
View
https://clinicalproblemsolving.com/wp-content/uploads/2022/08/RLR-8.16.22_Why-so-Slow.mp3

Reza discusses a mind-blowing case presented by Rabih.

RLR now have over 100 episode on Patreon – consider subscribing here.

Download CPSolvers App here

Patreon website 

 
More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/08/RLR-8.16.22_Why-so-Slow.mp3

Reza discusses a mind-blowing case presented by Rabih.

RLR now have over 100 episode on Patreon – consider subscribing here.

Download CPSolvers App here

Patreon website 

 
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https://clinicalproblemsolving.com/wp-content/uploads/2022/08/8.11.22-Wdx-Setbacks-in-Medicine-RTP.mp3

In this episode, Dr. Ashley McMullen, Dr. Simone Vais, and Jane Lock share stories of setbacks in medicine related to the theme, “I thought I was alone.” Session moderated by Madellena Conte.

Interested in sharing a story during a future Setbacks in Medicine discussion? Fill out this form here: https://forms.gle/hoddk5iSod1SmCbL8

 

Ashley McMullen

Dr. Ashley McMullen is an assistant professor of medicine at the University of California, San Francisco, and a primary care internist based at the San Francisco VA Hospital. She is also a Houston, TX native and lifelong book nerd, who grew up nurtured by her mother, a pediatric nurse, and grandmother, an ordained minister. Dr. McMullen’s work focuses on the role of narrative and storytelling in medical education, and as a mechanism for healing, advocacy, and improving care across differences. She served as the host and producer of The Nocturnists: Black Voices in Healthcare Series, a 2021 Webby Award Honoree, and recently launched a new story-telling podcast with Dr. Kimberly Manning called, The Human Doctor.

 

Jane Lock

Jane Lock is an MD/PhD candidate at Boston University School of Medicine, currently in her M4 year applying into internal medicine. She was born in Malaysia and grew up in Taiwan before moving to the US for college and medical school. She has a strong interest in oncology research, particularly in mechanisms of DNA damage and repair in cancer. Her PhD thesis was focused on understanding alternative telomere maintenance mechanisms in osteosarcoma. She is also passionate about teaching and improving medical education. Outside of work and studying, she loves being the cool aunt to her 2 year old nephew, reading, crocheting and watching The Office with her husband.

 

Download CPSolvers App here

Patreon website

 

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/08/8.11.22-Wdx-Setbacks-in-Medicine-RTP.mp3

In this episode, Dr. Ashley McMullen, Dr. Simone Vais, and Jane Lock share stories of setbacks in medicine related to the theme, “I thought I was alone.” Session moderated by Madellena Conte.

Interested in sharing a story during a future Setbacks in Medicine discussion? Fill out this form here: https://forms.gle/hoddk5iSod1SmCbL8

 

Ashley McMullen

Dr. Ashley McMullen is an assistant professor of medicine at the University of California, San Francisco, and a primary care internist based at the San Francisco VA Hospital. She is also a Houston, TX native and lifelong book nerd, who grew up nurtured by her mother, a pediatric nurse, and grandmother, an ordained minister. Dr. McMullen’s work focuses on the role of narrative and storytelling in medical education, and as a mechanism for healing, advocacy, and improving care across differences. She served as the host and producer of The Nocturnists: Black Voices in Healthcare Series, a 2021 Webby Award Honoree, and recently launched a new story-telling podcast with Dr. Kimberly Manning called, The Human Doctor.

 

Jane Lock

Jane Lock is an MD/PhD candidate at Boston University School of Medicine, currently in her M4 year applying into internal medicine. She was born in Malaysia and grew up in Taiwan before moving to the US for college and medical school. She has a strong interest in oncology research, particularly in mechanisms of DNA damage and repair in cancer. Her PhD thesis was focused on understanding alternative telomere maintenance mechanisms in osteosarcoma. She is also passionate about teaching and improving medical education. Outside of work and studying, she loves being the cool aunt to her 2 year old nephew, reading, crocheting and watching The Office with her husband.

 

Download CPSolvers App here

Patreon website

 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/07/SLS-8.4.22-RTP.mp3

Moses and Valeria review their approaches for fever in the inpatient and anemia, as they talk through a case presented by Simone.

 

Schema:

Fever: the journey

Anemia Thought Train 

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/07/SLS-8.4.22-RTP.mp3

Moses and Valeria review their approaches for fever in the inpatient and anemia, as they talk through a case presented by Simone.

 

Schema:

Fever: the journey

Anemia Thought Train 

 

Download CPSolvers App here

Patreon website

Extract Knowledge
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https://clinicalproblemsolving.com/wp-content/uploads/2022/07/7.21-RR.mp3Dr. Lisa Sanders joins RLR for a fascinating case of neuropathy that was published in the New York Times Magazine. Read it here.  

RLR now have over 100 episode on Patreon – consider subscribing here.

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/07/7.21-RR.mp3Dr. Lisa Sanders joins RLR for a fascinating case of neuropathy that was published in the New York Times Magazine. Read it here.  

RLR now have over 100 episode on Patreon – consider subscribing here.

 

Download CPSolvers App here

Patreon website

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Published 2022-07-17

Patreon exclusive: RLR 100

View

We have made it to 100 episodes.

We are grateful for each and everyone of you.

If you are enjoying this content, please recommend it to a friend and/or colleague.

We will have fun learning medicine together.

Thank you,

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

We have made it to 100 episodes.

We are grateful for each and everyone of you.

If you are enjoying this content, please recommend it to a friend and/or colleague.

We will have fun learning medicine together.

Thank you,

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Extract Knowledge
Listen elsewhere
Web
https://clinicalproblemsolving.com/wp-content/uploads/2022/07/7.14.22-VMR-RTP.mp3

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Valeria Roldan presents a case of tremors and myoclonus to Dr. Aaron Berkowitz.

Neurology DDx Schema

 

Valeria Roldán

@valeroldan23


Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue Neurology residency. Her interests include neuro-infectious diseases, transgender health and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine she loves running, hiking, cooking pasta and spending time with her dogs.

 

Dr. Aaron Berkowitz

@AaronLBerkowitz

Aaron recently joined the founding faculty of Kaiser Permanente Bernard J. Tyson School of Medicine as a professor of neurology and director of global health. He previously served as an associate professor of neurology at Brigham and Women’s Hospital and Harvard Medical School, where he directed the Mind-Brain-Behavior course for first-year students and was a teaching attending on the neuro-hospitalist service and in the general neurology resident clinic. As a health and policy advisor to Partners In Health and senior specialist consultant to Doctors Without Borders, he has worked tirelessly to bring neurology care and education to regions where it is limited or non-existent, including co-developing the first neurology residency in Haiti. He is the author of Clinical Pathophysiology Made Ridiculously Simple, Clinical Neurology and Neuroanatomy: A localization-based approach, and most recently One by One by One, which tells the complex, moving, and inspiring stories of patients he and colleagues brought from Haiti to Boston for neurosurgery for brain tumors. When he is not trying to #EndNeurophobia, Aaron loves hiking, backpacking, and obsessively researching outdoor camping gear.

 

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/07/7.14.22-VMR-RTP.mp3

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Valeria Roldan presents a case of tremors and myoclonus to Dr. Aaron Berkowitz.

Neurology DDx Schema

 

Valeria Roldán

@valeroldan23


Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue Neurology residency. Her interests include neuro-infectious diseases, transgender health and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine she loves running, hiking, cooking pasta and spending time with her dogs.

 

Dr. Aaron Berkowitz

@AaronLBerkowitz

Aaron recently joined the founding faculty of Kaiser Permanente Bernard J. Tyson School of Medicine as a professor of neurology and director of global health. He previously served as an associate professor of neurology at Brigham and Women’s Hospital and Harvard Medical School, where he directed the Mind-Brain-Behavior course for first-year students and was a teaching attending on the neuro-hospitalist service and in the general neurology resident clinic. As a health and policy advisor to Partners In Health and senior specialist consultant to Doctors Without Borders, he has worked tirelessly to bring neurology care and education to regions where it is limited or non-existent, including co-developing the first neurology residency in Haiti. He is the author of Clinical Pathophysiology Made Ridiculously Simple, Clinical Neurology and Neuroanatomy: A localization-based approach, and most recently One by One by One, which tells the complex, moving, and inspiring stories of patients he and colleagues brought from Haiti to Boston for neurosurgery for brain tumors. When he is not trying to #EndNeurophobia, Aaron loves hiking, backpacking, and obsessively researching outdoor camping gear.

 

Download CPSolvers App here

Patreon website

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“Is it a rare disease or a disease that is rarely diagnosed?”   

Such powerful words from Dr. Lisa Sanders.

She presented RR a case before it was published in NYT. 

Enjoy.

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

“Is it a rare disease or a disease that is rarely diagnosed?”   

Such powerful words from Dr. Lisa Sanders.

She presented RR a case before it was published in NYT. 

Enjoy.

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Extract Knowledge
Listen elsewhere
Web
https://clinicalproblemsolving.com/wp-content/uploads/2022/07/Clinical-Unknown-7.7.22-RTP.mp3

Pratik presents a case of dyspnea and RUQ pain to Fred.

Dr. Fred McLafferty

Fred McLafferty, MD is a fellow in the Division of Pulmonary and Critical Care at the University of California, San Francisco.  His research interest is in how certain environmental particles and pathogens drive lung remodeling and pulmonary fibrosis.  He is clinically interested in advanced lung disease and transplant, and will begin as the advanced fellow in lung transplant at UCSF in July 2022.  Prior to fellowship, he graduated medical school from the David Geffen School of Medicine at UCLA and then completed both his internal medicine residency and chief residency at Northwestern University. Outside the hospital he enjoys skiing in Tahoe, riding his bike through San Francisco, or spending all day cooking a (sometimes) delicious dinner.

Dr. Pratik Doshi

Pratik Doshi, MD MS is a second-year Internal Medicine Resident at the University of Southern California. He completed medical school at Duke University School of Medicine. He is interested in delivering medical content in innovative ways and aspires to be a cardiologist. He is active on Twitter, follow him @PratikDoshiMD!

Schemas: Dyspnea Pleural effusion  

Download CPSolvers App here

Patreon website

More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/07/Clinical-Unknown-7.7.22-RTP.mp3

Pratik presents a case of dyspnea and RUQ pain to Fred.

Dr. Fred McLafferty

Fred McLafferty, MD is a fellow in the Division of Pulmonary and Critical Care at the University of California, San Francisco.  His research interest is in how certain environmental particles and pathogens drive lung remodeling and pulmonary fibrosis.  He is clinically interested in advanced lung disease and transplant, and will begin as the advanced fellow in lung transplant at UCSF in July 2022.  Prior to fellowship, he graduated medical school from the David Geffen School of Medicine at UCLA and then completed both his internal medicine residency and chief residency at Northwestern University. Outside the hospital he enjoys skiing in Tahoe, riding his bike through San Francisco, or spending all day cooking a (sometimes) delicious dinner.

Dr. Pratik Doshi

Pratik Doshi, MD MS is a second-year Internal Medicine Resident at the University of Southern California. He completed medical school at Duke University School of Medicine. He is interested in delivering medical content in innovative ways and aspires to be a cardiologist. He is active on Twitter, follow him @PratikDoshiMD!

Schemas: Dyspnea Pleural effusion  

Download CPSolvers App here

Patreon website

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https://clinicalproblemsolving.com/wp-content/uploads/2022/06/06.30.22-TCQ-Brain-Abscess-RTP.mp3

Dr. Jenn Davis presents a consult question to Dan, Doug, Emma, Sukriti, and Dr. Laila Woc-Colburn.

Dr. Laila Woc-Colburn

Dr. Laila Woc-Colburn is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta. She is a renowned medical educator and has a wide range of clinical interests including tropical medicine, HIV, and fungal diseases.

Dr. Jennifer Davis

Dr. Jennifer Davis is a first year infectious diseases fellow at the Mass General Brigham combined infectious diseases fellowship in Boston. She’s interested in HIV and medical education.

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Dr. Jenn Davis presents a consult question to Dan, Doug, Emma, Sukriti, and Dr. Laila Woc-Colburn.

Dr. Laila Woc-Colburn

Dr. Laila Woc-Colburn is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta. She is a renowned medical educator and has a wide range of clinical interests including tropical medicine, HIV, and fungal diseases.

Dr. Jennifer Davis

Dr. Jennifer Davis is a first year infectious diseases fellow at the Mass General Brigham combined infectious diseases fellowship in Boston. She’s interested in HIV and medical education.

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Patreon website

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Vale, Brodie, and Gabriel discuss basic terminology of the LGBTQ+ community, the importance of communication in healthcare, and pieces of advice when using gender-inclusive language.

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Vale, Brodie, and Gabriel discuss basic terminology of the LGBTQ+ community, the importance of communication in healthcare, and pieces of advice when using gender-inclusive language.

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Published 2022-06-22

Episode 243: Queer Rounds – Intro

24 min
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Vale, Brodie, and Gabriel talk about their journey as LGBTQ+ members and the genesis of Queer Rounds, a platform that highlights the reality of gender and sexual diverse communities in healthcare.

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Vale, Brodie, and Gabriel talk about their journey as LGBTQ+ members and the genesis of Queer Rounds, a platform that highlights the reality of gender and sexual diverse communities in healthcare.

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Dear Patrons,

You don’t want to miss this episode. Two cases in one hour.  

CPSolvers’ team member and extraordinary diagnostician, Kirtan, presents two fascinating cases to RR that have a similar theme.  

We highly recommend you follow Kirtan on Twitter to enhance your diagnostic skills @KirtanPatolia. 

Kirtan: We wish you the best as you start your IM residency. We are incredibly proud of what you have accomplished but are even more excited about what you are going to accomplish. 

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

Dear Patrons,

You don’t want to miss this episode. Two cases in one hour.  

CPSolvers’ team member and extraordinary diagnostician, Kirtan, presents two fascinating cases to RR that have a similar theme.  

We highly recommend you follow Kirtan on Twitter to enhance your diagnostic skills @KirtanPatolia. 

Kirtan: We wish you the best as you start your IM residency. We are incredibly proud of what you have accomplished but are even more excited about what you are going to accomplish. 

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/06/6.16.2022-Wdx-RTP.mp3

In this episode, Maani and Sharmin are joined by Dr. Tara Gadde who presents a clinical unknown case to Dr. Aimee Zaas followed by a discussion on leadership, mentorship, and career transition points.

Uttara (Tara) Gadde

Uttara (Tara) Gadde is an internal medicine resident at the University of Pennsylvania. She went to Cornell University for undergrad and completed a B.S. in Human Biology, Health & Society. She then worked for a year as a research analyst and public health advocate on a CDC funded HIV testing grant in the Bronx. She decided to pursue medicine and went to medical school at Rutgers NJMS and is completing her MPH from Johns Hopkins. Her career interests include infectious disease and global health. During her free time, she loves to cook (and eat!), curl up with a good book, or do anything active (running, hiking, HIIT workouts, yelling at the TV during Nets games). 

Aimee K Zaas

Aimee K Zaas MD MHS is a Professor of Medicine in the Division of Infectious Diseases in the Department of Medicine at Duke University School of Medicine.  She has served as the Program Director for the Duke Internal Medicine Residency since 2009, a job she considers to be both the best job ever and a continuous welcome challenge! She completed her medical school at the Northwestern Feinberg School of Medicine and her internal medicine residency and chief residency (ACS) at The Johns Hopkins Hospital.  After completing her Infectious Diseases fellowship at Duke University, she joined the faculty at Duke where she has remained ever since, and has become a rather obnoxious Duke basketball fan in the process.  Her husband David is also a physician and they have two boys, Jake (18) and Jonah (16) so have spent the majority of their family life at kids sporting events and traveling related to kids sporting events. 

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More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/06/6.16.2022-Wdx-RTP.mp3

In this episode, Maani and Sharmin are joined by Dr. Tara Gadde who presents a clinical unknown case to Dr. Aimee Zaas followed by a discussion on leadership, mentorship, and career transition points.

Uttara (Tara) Gadde

Uttara (Tara) Gadde is an internal medicine resident at the University of Pennsylvania. She went to Cornell University for undergrad and completed a B.S. in Human Biology, Health & Society. She then worked for a year as a research analyst and public health advocate on a CDC funded HIV testing grant in the Bronx. She decided to pursue medicine and went to medical school at Rutgers NJMS and is completing her MPH from Johns Hopkins. Her career interests include infectious disease and global health. During her free time, she loves to cook (and eat!), curl up with a good book, or do anything active (running, hiking, HIIT workouts, yelling at the TV during Nets games). 

Aimee K Zaas

Aimee K Zaas MD MHS is a Professor of Medicine in the Division of Infectious Diseases in the Department of Medicine at Duke University School of Medicine.  She has served as the Program Director for the Duke Internal Medicine Residency since 2009, a job she considers to be both the best job ever and a continuous welcome challenge! She completed her medical school at the Northwestern Feinberg School of Medicine and her internal medicine residency and chief residency (ACS) at The Johns Hopkins Hospital.  After completing her Infectious Diseases fellowship at Duke University, she joined the faculty at Duke where she has remained ever since, and has become a rather obnoxious Duke basketball fan in the process.  Her husband David is also a physician and they have two boys, Jake (18) and Jonah (16) so have spent the majority of their family life at kids sporting events and traveling related to kids sporting events. 

Download CPSolvers App here 

Patreon website

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Hi Patrons,

You don’t want to miss this one with one our of favorite teachers, mentors, and clinician-educators, Uncle Bob!!

We hope you enjoy.

UBRLR

  

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

   
More description

Hi Patrons,

You don’t want to miss this one with one our of favorite teachers, mentors, and clinician-educators, Uncle Bob!!

We hope you enjoy.

UBRLR

  

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

   
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Dear Patrons,

We are excited for this week! We are going to bring you two back-to-back episodes.

The first one is an “eye opener!” The second one is bread and butter medicine.

Thank you for all your support.

And remember …

Keep diagnosing friends

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

Dear Patrons,

We are excited for this week! We are going to bring you two back-to-back episodes.

The first one is an “eye opener!” The second one is bread and butter medicine.

Thank you for all your support.

And remember …

Keep diagnosing friends

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Extract Knowledge
Listen elsewhere
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https://clinicalproblemsolving.com/wp-content/uploads/2022/05/ARM-EP-17_RTP.mp3

 

CPSolvers: Anti-Racism in Medicine Series

Episode 17 – ‘Just’ Births: Reproductive Justice & Black/Indigenous Maternal Health Equity

Show Notes by Ayana Watkins

May 31, 2022

Summary: This episode centers the roles of reproductive justice and anti-racist action in rectifying inequities faced by Black and Indigenous birthing persons. This discussion is hosted by Naomi Fields, MD, Chioma Onuoha, and Victor Lopez-Carmen MPH, as they interview Dr. Joia Crear-Perry—a physician, policy expert, and highly sought-after birth equity and racial health disparities expert—and  Dr. Katy B. Kozhimannil—the Distinguished McKnight University Professor in the Division of Health Policy and Management at the University of Minnesota and Director of the Rural Health Research Center. Our inspiring guests highlight liberation-oriented solutions to addressing inequities and contextualize how we can facilitate birthing experiences grounded in reproductive justice for Black & Indigenous women.

Episode Learning Objectives

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

  1. Understand the magnitude of disparities faced by Black and Indigenous birthing persons and how forces of structural racism created and perpetuate these inequities
  2. Define Reproductive Justice and understand how clinicians can promote reproductive justice during pregnancy and birth
  3. Appreciate the importance of cultural reflexivity, community-centered initiatives, and midwifery and doula care in facilitating reproductive justice
  4. Recognize the impacts of climate and land injustices on Black and Indigenous communities and know that climate justice, reproductive justice, and racial justice are all connected
 

Credits

  • Written and produced by: Naomi F. Fields MD, Chioma Onuoha, Victor A. Lopez-Carmen MPH, Rohan Khazanchi MPH, Sudarshan Krishnamurthy, Utibe R. Essien MD, MPH,  Jazzmin Williams, Alec J. Calac, LaShyra Nolen, Michelle Ogunwole MD, PhD,  Jennifer Tsai MD, MEd, Ayana Watkins
  • Hosts: Naomi F. Fields MD, Chioma Onuoha, and Victor A. Lopez-Carmen MPH
  • Infographic: Creative Edge Design
  • Audio Edits: David Hu, MD
  • Show Notes: Ayana Watkins
  • Guests: Dr. Joia Crear-Perry and Dr. Katy B. Kozhimannil
 

Time Stamps

00:00 Introduction

03:57 Magnitude of maternal health disparities for Black & Indigenous birthing people

09:31 Impact of guests’ identities and lived experiences on their work

25: 30 Defining reprodutive justice

29:42 Importance of community-centered initiatives and access to midwifery and doula care

35:15 Impact of Climate and Land Injustice on maternal health inequities

42:43 Role of family planning within reproductive justice

58:00 Key takeaways

Episode Takeaways:

  1. We have a responsibility to unlearn the harmful hierarchies that unequally value people. The institutions of science, medicine, and academia perpetuate and codify racism. We all must recognize the codification of racism within our institutions and work to unlearn these hierarchies in order to better care for Black and Indigenous patients.
  • Be present in the birthing moment and see the full humanity of the birthing person and the life-changing nature of birth. Dr. Kozhimannil reminds us that birth is transformative and a gift to witness. As healthcare providers, we must listen to our patients and use the power of our presence to see birthing people’s full humanity and empowerment.

 

Pearls

  • Black and Indigenous birthing people are 3-13 times more likely to die in childbirth, with the rate varying by location and level of investment in communities.
  • Dr. Crear-Perry describes the magnitude of maternal health disparities faced by Black and Indigenous birthing people. The exact statistics vary by location and by the overall level of investment in services such as childcare and parental leave within each community. For example, in New York City, Black birthing persons are 8-12 times more likely to die in childbirth, while in other areas, such as in areas in the Deep South where Dr. Crear-Perry is from, the increased likelihood of death in childbirth for Black birthing persons is lower, around 2-3x.
  • Dr. Kozhimannil reminds us to look past the statistics and zoom into the personal level. She urges us to recognize that maternal mortality changes the life trajectories of individuals and communities. These statistics not only reflect the number of birthing people dying in childbirth but also evince the number of children growing up without a parent and the number of families losing a loved one. She also reminds us that while mortality is the worst possible outcome, it is not the only thing we should be concerned about; that we must also ask the question: What are we doing to ensure that birth is as beautiful and empowering as possible?
  • “I have worked to imbue the credibility of my lived knowledge into the credibility that I now receive as a fancy person with a Ph.D. and a professor.”
  • Dr. Kozhimannil describes that her identity and her background—growing up in a rural area, having family living on tribal lands, and the intergenerational impact maternal mortality has had on her family and on her people—inform and motivate her work. She recognizes that academia and medicine traditionally do not listen to the people closest to the harm of structural racism and thus aims to use the credibility and privilege she receives from academia as a “Distinguished Professor” to persuade people with power to change the way they allocate power, resources, and opportunities.
  • Both Dr. Crear-Perry and Dr. Kozhimannil describe experiencing rejection when submitting their work to journals because of academia’s resistance to acknowledging racism as a cause of disparities.
  • Defining Reproductive Justice
  • Dr. Crear-Perry explains that the term “reproductive justice” was coined in 1994 by 12 Black women and is defined as the fundamental human right to personal bodily autonomy, to have children, to not have children, and to have safe and sustainable communities in which to parent children. 
  • Reproductive justice first requires birthing people to be viewed as fully human. As Dr. Crear-Perry notes, Black women and other marginalized people in the United States have never been viewed as fully human. The second tenet of reproductive justice is the right to have children, and the third is the right to not have children. Certain policies have impeded birthing people’s ability to choose to not have children by taking away rights if people do not bear children. For example, at one time in Louisiana, only childbearing adults qualified for Medicaid. This policy reflects a societal belief that humans are not valuable unless they provide a service. Dr. Crear-Perry discusses a policy proposed in Michigan grounded in a similar notion: it required people living in urban areas to have a job in order to qualify for Medicaid. (To expand, this provision in Michigan was initially included in a State Senate bill for Medicaid expansion, but the work requirement was scrapped before the policy passed.) The final tenet of reproductive justice is the right to parent children in a safe, sustainable community. Parents deserve to raise their children in communities that value human life. For example, safe and sustainable communities have access to paid leave and equal pay, parks, and walkways, and lack dangerous aspects, like police violence and mass incarceration. 
  • Impact of climate and land injustices on maternal health equity
  • Dr. Crear-Perry discusses previous research detailing the impact of climate injustice on maternal health transnationally. For example, Black babies born in communities that experienced redlining were more likely to die, and heat is known to cause premature birth. Additionally, scientists have used climate change to promote population control and to codify eugenics by falsely blaming climate change on high birth rates within poor, Indigenous communities around the world rather than uber-consumptive corporations.
  • Dr. Kozhimannil asserts that “climate justice and reproductive justice and racial justice are completely the same thing.” The climate crisis indicates a tear in the connection between humans and the earth and between us and one another. Dr. Kozhimannil believes the most powerful way to reconnect humans to each other and to the earth is through a good birth, in which we are connected to the land and are surrounded by loved ones. 
  • Dr. Kozhimannil also describes an Indigenous philosophy of honoring the seven generations of ancestors that came before you and striving to be a good ancestor for the seven generations that will come after you. The process of childbirth is transformative for the birthing person and their community. Clinicians are able to shape the environment in which people give birth by caring for the earth and their patients.
  • The extent to which “family planning” fits within reproductive justice
  • Dr. Crear-Perry outlines the history of the term “family planning” and states that the idea of family planning stems from population control and eugenics. She urges us to remember that the abiltity to plan anything, is determined by generational access to power; and calls for discontinuing the use of this term. We should instead prioritize reproductive and sexual well-being and seeing Black and Indigenous birthing people as fully human.
  • Dr. Kozhimannil discusses her work on rural maternity care and the lack of hospital-based obstetric services. The places with the least access to hospitals in which they can give birth are also the places where people have experienced forced sterilization, where people do not have access to choices surrounding contraception, sexuality, or termination of pregnancies. Dr. Kozhimannil asks what moms and families can do if they do not have access to pregnancy prevention or termination and yet also have no place to give birth.
  • Asking the right questions, having the right intentions
  • Dr. Kozhimannil shares an important story about how her groundbreaking work showing maternity deserts in rural areas only came about by centering and engaging community members. In research we always begin with the research question and perhaps wonder if we are asking the “right” question. Dr. Kozhimannil offers a different approach, and stresses the importance of  “answering the right question, from the people [communities impacted], who know the right question.”
  • Dr. Crear-Perry offers additional wisdom about interventions: “If your intention is off, your outcome is going to be off.”

 

Clarification: In this episode, Dr. Crear-Perry talks about eligibility for Medicaid expansion in Michigan requiring folks who lived in urban areas to have a job vs folks who lived in rural areas not needing to meet this requirement. What Dr. Crear-Perry mentions was a proposal that the State Senate wanted,  but ended up doing away with before passing Medicaid expansion.  See Reference 20 below for additional information.

References

  1. Hardeman RR, Karbeah J, Kozhimannil KB. Applying a critical race lens to relationship-centered care in pregnancy and childbirth: An antidote to structural racism. Birth. 2020;47(1):3-7. doi:10.1111/birt.12462
  2. Sable-Smith B. As Rural Counties Lose Obstetrics, Women Give Birth Far From Home. https://www.kcur.org/agriculture/2017-10-02/as-rural-counties-lose-obstetrics-women-give-birth-far-from-home#stream/0
  3. Bekkar B, Pacheco S, Basu R, DeNicola N. Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review. JAMA Network Open. 2020;3(6):e208243-e208243. doi:10.1001/jamanetworkopen.2020.8243
  4. Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health. 2013;103(4):e113-e121. doi:10.2105/AJPH.2012.301201
  5. National Birth Equity Collaborative. Dr. Joia on BMHW & Why Black Women & Birthing People Are Experiencing Poor Outcomes | NBEC.; 2021. https://youtu.be/GPAlyT8tuhE
  6. Improving Equity in Birth Outcomes, a Community-based, Culturally-centered Approach. Robert Wood Johnson Foundation Interdisciplinary Research Leaders Program. Published January 16, 2019. https://irleaders.org/team/improving-equity-in-birth-outcomes/
  7. Improving Racial Equity in Birth Outcomes: The Roots Model of Care. Published online August 2020. https://2jywg813w195318ee51g9iti-wpengine.netdna-ssl.com/wp-content/uploads/2020/10/IRL-Issue-Brief02-Minneapolis-1.pdf
  8. National Birth Equity Collaborative. Injustice Anywhere: Why Climate Justice Is Reproductive Justice.; 2021. https://youtu.be/FhakcqNs_08
  9. Katy B. Kozhimannil, PhD, MPA. https://directory.sph.umn.edu/bio/sph-a-z/katy-kozhimannil
  10. Henning-Smith C, Kozhimannil KB. Missing Voices In America’s Rural Health Narrative. Health Affairs Blog. Published April 10, 2019. 10.1377/hblog20190409.122546
  11. National Birth Equity Collaborative. National Birth Equity Collaborative Annual Report 2020-2021. https://issuu.com/gafford/docs/nbec_2020-21_annual_report
  12. Hostetter M, Klein S. Restoring Access to Maternity Care in Rural America. Published online 2021. doi:10.26099/CYCC-FF50
  13. Hardeman RR, Karbeah J, Almanza J, Kozhimannil KB. Roots Community Birth Center: A culturally-centered care model for improving value and equity in childbirth. Healthcare. 2020;8(1):100367. doi:10.1016/j.hjdsi.2019.100367
  14. Plain C. Study shows growth of certified nurse-midwives practice in rural U.S. hospitals could improve access to high-quality maternity care. Published April 20, 2016. https://www.sph.umn.edu/news/study-shows-growth-certified-nurse-midwives-practice-rural-u-s-hospitals-improve-access-high-quality-maternity-care/
  15. Proujansky A. The black midwives changing care for women of color – photo essay. https://www.theguardian.com/society/2019/jul/24/black-midwives-photo-essay
  16. Kozhimannil KB, Henning‐Smith C, Hung P. The practice of midwifery in rural US hospitals.. Journal of Midwifery & Women’s Health. 2016;61(4):411-418. doi:10.1111/jmwh.12474
  17. The iEJ Project. What Is Indigenous Environmental Injustice?; 2018. https://youtu.be/kswUgZ2ctO4
  18. Lopez-Carmen VA, Erickson TB, Escobar Z, Jensen A, Cronin AE, Nolen LT, Moreno M, Stewart AM. United States and United Nations pesticide policies: Environmental violence against the Yaqui indigenous nation. The Lancet Regional Health – Americas. https://www.sciencedirect.com/science/article/pii/S2667193X22000722#bib0044
  19. Blakemore E. The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs. History. Published March 11, 2019. https://www.history.com/news/birth-control-pill-history-puerto-rico-enovid
  20. Norris L. Michigan and the ACA’s Medicaid expansion. Healthinsurance.org. https://www.healthinsurance.org/medicaid/michigan/
  21. Kozhimannil KB, Casey MM, Hung P, Prasad S, & Moscovice IS. (2016). Location of childbirth for rural women: implications for maternal levels of care. American journal of obstetrics and gynecology, 214(5), 661.e1–661.e10. https://doi.org/10.1016/j.ajog.2015.11.030
  22. Kenneth J, Okun T. White Supremacy Culture. Excerpt from Dismantling Racism: A Workbook for Social Change Groups, by Kenneth Jones and Tema Okun, ChangeWork, 2001. https://www.thc.texas.gov/public/upload/preserve/museums/files/White_Supremacy_Culture.pdf

 

Disclosures 

The hosts and guests report no relevant financial disclosures.

Citation

Crear-Perry J, Kozhimannil KB, Fields NF, Onuoha C, Lopez-Carmen VA, Krishnamurthy S, Calac A, Nolen L, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 17: ‘Just’ Births: Reproductive Justice & Black/Indigenous Maternal Health Equity.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. May 31, 2022.

Show Transcript 

More description

https://clinicalproblemsolving.com/wp-content/uploads/2022/05/ARM-EP-17_RTP.mp3

 

CPSolvers: Anti-Racism in Medicine Series

Episode 17 – ‘Just’ Births: Reproductive Justice & Black/Indigenous Maternal Health Equity

Show Notes by Ayana Watkins

May 31, 2022

Summary: This episode centers the roles of reproductive justice and anti-racist action in rectifying inequities faced by Black and Indigenous birthing persons. This discussion is hosted by Naomi Fields, MD, Chioma Onuoha, and Victor Lopez-Carmen MPH, as they interview Dr. Joia Crear-Perry—a physician, policy expert, and highly sought-after birth equity and racial health disparities expert—and  Dr. Katy B. Kozhimannil—the Distinguished McKnight University Professor in the Division of Health Policy and Management at the University of Minnesota and Director of the Rural Health Research Center. Our inspiring guests highlight liberation-oriented solutions to addressing inequities and contextualize how we can facilitate birthing experiences grounded in reproductive justice for Black & Indigenous women.

Episode Learning Objectives

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

  1. Understand the magnitude of disparities faced by Black and Indigenous birthing persons and how forces of structural racism created and perpetuate these inequities
  2. Define Reproductive Justice and understand how clinicians can promote reproductive justice during pregnancy and birth
  3. Appreciate the importance of cultural reflexivity, community-centered initiatives, and midwifery and doula care in facilitating reproductive justice
  4. Recognize the impacts of climate and land injustices on Black and Indigenous communities and know that climate justice, reproductive justice, and racial justice are all connected
 

Credits

  • Written and produced by: Naomi F. Fields MD, Chioma Onuoha, Victor A. Lopez-Carmen MPH, Rohan Khazanchi MPH, Sudarshan Krishnamurthy, Utibe R. Essien MD, MPH,  Jazzmin Williams, Alec J. Calac, LaShyra Nolen, Michelle Ogunwole MD, PhD,  Jennifer Tsai MD, MEd, Ayana Watkins
  • Hosts: Naomi F. Fields MD, Chioma Onuoha, and Victor A. Lopez-Carmen MPH
  • Infographic: Creative Edge Design
  • Audio Edits: David Hu, MD
  • Show Notes: Ayana Watkins
  • Guests: Dr. Joia Crear-Perry and Dr. Katy B. Kozhimannil
 

Time Stamps

00:00 Introduction

03:57 Magnitude of maternal health disparities for Black & Indigenous birthing people

09:31 Impact of guests’ identities and lived experiences on their work

25: 30 Defining reprodutive justice

29:42 Importance of community-centered initiatives and access to midwifery and doula care

35:15 Impact of Climate and Land Injustice on maternal health inequities

42:43 Role of family planning within reproductive justice

58:00 Key takeaways

Episode Takeaways:

  1. We have a responsibility to unlearn the harmful hierarchies that unequally value people. The institutions of science, medicine, and academia perpetuate and codify racism. We all must recognize the codification of racism within our institutions and work to unlearn these hierarchies in order to better care for Black and Indigenous patients.
  • Be present in the birthing moment and see the full humanity of the birthing person and the life-changing nature of birth. Dr. Kozhimannil reminds us that birth is transformative and a gift to witness. As healthcare providers, we must listen to our patients and use the power of our presence to see birthing people’s full humanity and empowerment.

 

Pearls

  • Black and Indigenous birthing people are 3-13 times more likely to die in childbirth, with the rate varying by location and level of investment in communities.
  • Dr. Crear-Perry describes the magnitude of maternal health disparities faced by Black and Indigenous birthing people. The exact statistics vary by location and by the overall level of investment in services such as childcare and parental leave within each community. For example, in New York City, Black birthing persons are 8-12 times more likely to die in childbirth, while in other areas, such as in areas in the Deep South where Dr. Crear-Perry is from, the increased likelihood of death in childbirth for Black birthing persons is lower, around 2-3x.
  • Dr. Kozhimannil reminds us to look past the statistics and zoom into the personal level. She urges us to recognize that maternal mortality changes the life trajectories of individuals and communities. These statistics not only reflect the number of birthing people dying in childbirth but also evince the number of children growing up without a parent and the number of families losing a loved one. She also reminds us that while mortality is the worst possible outcome, it is not the only thing we should be concerned about; that we must also ask the question: What are we doing to ensure that birth is as beautiful and empowering as possible?
  • “I have worked to imbue the credibility of my lived knowledge into the credibility that I now receive as a fancy person with a Ph.D. and a professor.”
  • Dr. Kozhimannil describes that her identity and her background—growing up in a rural area, having family living on tribal lands, and the intergenerational impact maternal mortality has had on her family and on her people—inform and motivate her work. She recognizes that academia and medicine traditionally do not listen to the people closest to the harm of structural racism and thus aims to use the credibility and privilege she receives from academia as a “Distinguished Professor” to persuade people with power to change the way they allocate power, resources, and opportunities.
  • Both Dr. Crear-Perry and Dr. Kozhimannil describe experiencing rejection when submitting their work to journals because of academia’s resistance to acknowledging racism as a cause of disparities.
  • Defining Reproductive Justice
  • Dr. Crear-Perry explains that the term “reproductive justice” was coined in 1994 by 12 Black women and is defined as the fundamental human right to personal bodily autonomy, to have children, to not have children, and to have safe and sustainable communities in which to parent children. 
  • Reproductive justice first requires birthing people to be viewed as fully human. As Dr. Crear-Perry notes, Black women and other marginalized people in the United States have never been viewed as fully human. The second tenet of reproductive justice is the right to have children, and the third is the right to not have children. Certain policies have impeded birthing people’s ability to choose to not have children by taking away rights if people do not bear children. For example, at one time in Louisiana, only childbearing adults qualified for Medicaid. This policy reflects a societal belief that humans are not valuable unless they provide a service. Dr. Crear-Perry discusses a policy proposed in Michigan grounded in a similar notion: it required people living in urban areas to have a job in order to qualify for Medicaid. (To expand, this provision in Michigan was initially included in a State Senate bill for Medicaid expansion, but the work requirement was scrapped before the policy passed.) The final tenet of reproductive justice is the right to parent children in a safe, sustainable community. Parents deserve to raise their children in communities that value human life. For example, safe and sustainable communities have access to paid leave and equal pay, parks, and walkways, and lack dangerous aspects, like police violence and mass incarceration. 
  • Impact of climate and land injustices on maternal health equity
  • Dr. Crear-Perry discusses previous research detailing the impact of climate injustice on maternal health transnationally. For example, Black babies born in communities that experienced redlining were more likely to die, and heat is known to cause premature birth. Additionally, scientists have used climate change to promote population control and to codify eugenics by falsely blaming climate change on high birth rates within poor, Indigenous communities around the world rather than uber-consumptive corporations.
  • Dr. Kozhimannil asserts that “climate justice and reproductive justice and racial justice are completely the same thing.” The climate crisis indicates a tear in the connection between humans and the earth and between us and one another. Dr. Kozhimannil believes the most powerful way to reconnect humans to each other and to the earth is through a good birth, in which we are connected to the land and are surrounded by loved ones. 
  • Dr. Kozhimannil also describes an Indigenous philosophy of honoring the seven generations of ancestors that came before you and striving to be a good ancestor for the seven generations that will come after you. The process of childbirth is transformative for the birthing person and their community. Clinicians are able to shape the environment in which people give birth by caring for the earth and their patients.
  • The extent to which “family planning” fits within reproductive justice
  • Dr. Crear-Perry outlines the history of the term “family planning” and states that the idea of family planning stems from population control and eugenics. She urges us to remember that the abiltity to plan anything, is determined by generational access to power; and calls for discontinuing the use of this term. We should instead prioritize reproductive and sexual well-being and seeing Black and Indigenous birthing people as fully human.
  • Dr. Kozhimannil discusses her work on rural maternity care and the lack of hospital-based obstetric services. The places with the least access to hospitals in which they can give birth are also the places where people have experienced forced sterilization, where people do not have access to choices surrounding contraception, sexuality, or termination of pregnancies. Dr. Kozhimannil asks what moms and families can do if they do not have access to pregnancy prevention or termination and yet also have no place to give birth.
  • Asking the right questions, having the right intentions
  • Dr. Kozhimannil shares an important story about how her groundbreaking work showing maternity deserts in rural areas only came about by centering and engaging community members. In research we always begin with the research question and perhaps wonder if we are asking the “right” question. Dr. Kozhimannil offers a different approach, and stresses the importance of  “answering the right question, from the people [communities impacted], who know the right question.”
  • Dr. Crear-Perry offers additional wisdom about interventions: “If your intention is off, your outcome is going to be off.”

 

Clarification: In this episode, Dr. Crear-Perry talks about eligibility for Medicaid expansion in Michigan requiring folks who lived in urban areas to have a job vs folks who lived in rural areas not needing to meet this requirement. What Dr. Crear-Perry mentions was a proposal that the State Senate wanted,  but ended up doing away with before passing Medicaid expansion.  See Reference 20 below for additional information.

References

  1. Hardeman RR, Karbeah J, Kozhimannil KB. Applying a critical race lens to relationship-centered care in pregnancy and childbirth: An antidote to structural racism. Birth. 2020;47(1):3-7. doi:10.1111/birt.12462
  2. Sable-Smith B. As Rural Counties Lose Obstetrics, Women Give Birth Far From Home. https://www.kcur.org/agriculture/2017-10-02/as-rural-counties-lose-obstetrics-women-give-birth-far-from-home#stream/0
  3. Bekkar B, Pacheco S, Basu R, DeNicola N. Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review. JAMA Network Open. 2020;3(6):e208243-e208243. doi:10.1001/jamanetworkopen.2020.8243
  4. Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health. 2013;103(4):e113-e121. doi:10.2105/AJPH.2012.301201
  5. National Birth Equity Collaborative. Dr. Joia on BMHW & Why Black Women & Birthing People Are Experiencing Poor Outcomes | NBEC.; 2021. https://youtu.be/GPAlyT8tuhE
  6. Improving Equity in Birth Outcomes, a Community-based, Culturally-centered Approach. Robert Wood Johnson Foundation Interdisciplinary Research Leaders Program. Published January 16, 2019. https://irleaders.org/team/improving-equity-in-birth-outcomes/
  7. Improving Racial Equity in Birth Outcomes: The Roots Model of Care. Published online August 2020. https://2jywg813w195318ee51g9iti-wpengine.netdna-ssl.com/wp-content/uploads/2020/10/IRL-Issue-Brief02-Minneapolis-1.pdf
  8. National Birth Equity Collaborative. Injustice Anywhere: Why Climate Justice Is Reproductive Justice.; 2021. https://youtu.be/FhakcqNs_08
  9. Katy B. Kozhimannil, PhD, MPA. https://directory.sph.umn.edu/bio/sph-a-z/katy-kozhimannil
  10. Henning-Smith C, Kozhimannil KB. Missing Voices In America’s Rural Health Narrative. Health Affairs Blog. Published April 10, 2019. 10.1377/hblog20190409.122546
  11. National Birth Equity Collaborative. National Birth Equity Collaborative Annual Report 2020-2021. https://issuu.com/gafford/docs/nbec_2020-21_annual_report
  12. Hostetter M, Klein S. Restoring Access to Maternity Care in Rural America. Published online 2021. doi:10.26099/CYCC-FF50
  13. Hardeman RR, Karbeah J, Almanza J, Kozhimannil KB. Roots Community Birth Center: A culturally-centered care model for improving value and equity in childbirth. Healthcare. 2020;8(1):100367. doi:10.1016/j.hjdsi.2019.100367
  14. Plain C. Study shows growth of certified nurse-midwives practice in rural U.S. hospitals could improve access to high-quality maternity care. Published April 20, 2016. https://www.sph.umn.edu/news/study-shows-growth-certified-nurse-midwives-practice-rural-u-s-hospitals-improve-access-high-quality-maternity-care/
  15. Proujansky A. The black midwives changing care for women of color – photo essay. https://www.theguardian.com/society/2019/jul/24/black-midwives-photo-essay
  16. Kozhimannil KB, Henning‐Smith C, Hung P. The practice of midwifery in rural US hospitals.. Journal of Midwifery & Women’s Health. 2016;61(4):411-418. doi:10.1111/jmwh.12474
  17. The iEJ Project. What Is Indigenous Environmental Injustice?; 2018. https://youtu.be/kswUgZ2ctO4
  18. Lopez-Carmen VA, Erickson TB, Escobar Z, Jensen A, Cronin AE, Nolen LT, Moreno M, Stewart AM. United States and United Nations pesticide policies: Environmental violence against the Yaqui indigenous nation. The Lancet Regional Health – Americas. https://www.sciencedirect.com/science/article/pii/S2667193X22000722#bib0044
  19. Blakemore E. The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs. History. Published March 11, 2019. https://www.history.com/news/birth-control-pill-history-puerto-rico-enovid
  20. Norris L. Michigan and the ACA’s Medicaid expansion. Healthinsurance.org. https://www.healthinsurance.org/medicaid/michigan/
  21. Kozhimannil KB, Casey MM, Hung P, Prasad S, & Moscovice IS. (2016). Location of childbirth for rural women: implications for maternal levels of care. American journal of obstetrics and gynecology, 214(5), 661.e1–661.e10. https://doi.org/10.1016/j.ajog.2015.11.030
  22. Kenneth J, Okun T. White Supremacy Culture. Excerpt from Dismantling Racism: A Workbook for Social Change Groups, by Kenneth Jones and Tema Okun, ChangeWork, 2001. https://www.thc.texas.gov/public/upload/preserve/museums/files/White_Supremacy_Culture.pdf

 

Disclosures 

The hosts and guests report no relevant financial disclosures.

Citation

Crear-Perry J, Kozhimannil KB, Fields NF, Onuoha C, Lopez-Carmen VA, Krishnamurthy S, Calac A, Nolen L, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 17: ‘Just’ Births: Reproductive Justice & Black/Indigenous Maternal Health Equity.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. May 31, 2022.

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RLR discussed an intriguing case of a chronic consolidation

Thank you to our dear friend and colleague Dr. Kelley Chuang for her help with the production of this episode. (You are a legend, Kelley!)  @kelleychuang

To listen to more RLR episodes, consider subscribing to Patreon: https://www.patreon.com/cpsolvers

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https://clinicalproblemsolving.com/wp-content/uploads/2022/05/5.24.22_RLR_RTP.mp3

RLR discussed an intriguing case of a chronic consolidation

Thank you to our dear friend and colleague Dr. Kelley Chuang for her help with the production of this episode. (You are a legend, Kelley!)  @kelleychuang

To listen to more RLR episodes, consider subscribing to Patreon: https://www.patreon.com/cpsolvers

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Dear Patrons!!!

We wish you a lovely week full of learning.

Huge shout out to our guest and dear friend, Anand, on this week’s episode. Anand is a trail blazer in making the invisible, in clinical reasoning, visible for undergradute medical trainees. https://twitter.com/AnandJag1

The final dx is a doozy. Keep diagnosing friends.

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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Dear Patrons!!!

We wish you a lovely week full of learning.

Huge shout out to our guest and dear friend, Anand, on this week’s episode. Anand is a trail blazer in making the invisible, in clinical reasoning, visible for undergradute medical trainees. https://twitter.com/AnandJag1

The final dx is a doozy. Keep diagnosing friends.

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/05/5.19.22-Neuro-VMR-RTP.mp3

 We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time Dr. Doug Pet presents a case of slurred speech to Angelita and Diane. 

Neurology DDx Schema

Doug Pet

@doug_pet

Doug is a resident in neurology at UCSF. He grew up surrounded by cow farms and crab-apple trees in New Milford, CT. He completed a dual-degree program at Tufts and the New England Conservatory studying medical anthropology, community health, and jazz saxophone. He later worked for a non-profit in Berkeley, CA on bioethical and social justice issues related to genetic and reproductive technologies. Doug attended Vanderbilt University School of Medicine, after which he returned to the Bay Area for neurology residency at UCSF. He loves Brazilian music, playing Spikeball, and making custom wooden pens on his lathe.

Angelita Pusparani

@pusparani10

 Angelita Pusparani is a junior doctor (2ndY+) working in a small town in Indonesia. She is interested in discussing any cases (from neonate to geriatric), all patients inspire her. In her free time, Angelita is a basketball and marvel fan. She can also be found making a coffee or fried rice.

 

Diane Lebrun

Diane is an Internal Medicine Physician from Haiti. Her interest in Neurology started when she was a PGY-3 resident at Hopital Universitaire de Mirebalais (HUM), during her rotation in the Neurology Clinic. She has a special interest for Neuro-ICU, clinical reasoning, and medical education. In her free time, she enjoys spending quality time with family and friends, listening to faith-based music or podcasts, and dancing.

 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/05/5.19.22-Neuro-VMR-RTP.mp3

 We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time Dr. Doug Pet presents a case of slurred speech to Angelita and Diane. 

Neurology DDx Schema

Doug Pet

@doug_pet

Doug is a resident in neurology at UCSF. He grew up surrounded by cow farms and crab-apple trees in New Milford, CT. He completed a dual-degree program at Tufts and the New England Conservatory studying medical anthropology, community health, and jazz saxophone. He later worked for a non-profit in Berkeley, CA on bioethical and social justice issues related to genetic and reproductive technologies. Doug attended Vanderbilt University School of Medicine, after which he returned to the Bay Area for neurology residency at UCSF. He loves Brazilian music, playing Spikeball, and making custom wooden pens on his lathe.

Angelita Pusparani

@pusparani10

 Angelita Pusparani is a junior doctor (2ndY+) working in a small town in Indonesia. She is interested in discussing any cases (from neonate to geriatric), all patients inspire her. In her free time, Angelita is a basketball and marvel fan. She can also be found making a coffee or fried rice.

 

Diane Lebrun

Diane is an Internal Medicine Physician from Haiti. Her interest in Neurology started when she was a PGY-3 resident at Hopital Universitaire de Mirebalais (HUM), during her rotation in the Neurology Clinic. She has a special interest for Neuro-ICU, clinical reasoning, and medical education. In her free time, she enjoys spending quality time with family and friends, listening to faith-based music or podcasts, and dancing.

 

Download CPSolvers App here

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We hope you enjoy this episode as much as we did recording it.

Let us know what you think! 

Press pause after each aliquot, analyze the data, unpause, listen to RR, and repeat.

Thank you for your support.

RLR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

More description

We hope you enjoy this episode as much as we did recording it.

Let us know what you think! 

Press pause after each aliquot, analyze the data, unpause, listen to RR, and repeat.

Thank you for your support.

RLR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

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We are grateful to each of you.

RR often discuss their fortune in finding such a supportive community.

We hope you enjoy the 2nd episode of the week. Huge shout out to the residents at Legacy Health in Portland. They are smart, kind, and hungry for diagnostic expertise. #Gratitude

Next Sunday we will learn what happened to part 2 of the Mathematician’s presentation – the patient w/ alc hep who returned with blood “per orum.”

Your grateful Mathematician and Magician (math + magic = RLR) 

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

We are grateful to each of you.

RR often discuss their fortune in finding such a supportive community.

We hope you enjoy the 2nd episode of the week. Huge shout out to the residents at Legacy Health in Portland. They are smart, kind, and hungry for diagnostic expertise. #Gratitude

Next Sunday we will learn what happened to part 2 of the Mathematician’s presentation – the patient w/ alc hep who returned with blood “per orum.”

Your grateful Mathematician and Magician (math + magic = RLR) 

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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Hi Patrons,

You won’t want to miss this episode. Trust us. #EpicCase

Krishna is finishing his last week of MS3 year @ VCU School of Medicine. He did a PHENOMENAL job presenting the case. 

Huge shout out to Dr. Patrick Fadden @ptfaddenMD, a superb clinician-educator, for guiding Krishna and being a great colleague to RR and CPSolvers.

RR are grateful to Krishna for his kindness, preparation, and stellar execution. Krishna, we will cheer on Madrid in the UEFA Champions League Final b/c we owe you for this special hour.

Enjoy everyone,

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

Hi Patrons,

You won’t want to miss this episode. Trust us. #EpicCase

Krishna is finishing his last week of MS3 year @ VCU School of Medicine. He did a PHENOMENAL job presenting the case. 

Huge shout out to Dr. Patrick Fadden @ptfaddenMD, a superb clinician-educator, for guiding Krishna and being a great colleague to RR and CPSolvers.

RR are grateful to Krishna for his kindness, preparation, and stellar execution. Krishna, we will cheer on Madrid in the UEFA Champions League Final b/c we owe you for this special hour.

Enjoy everyone,

RR

 

This episode is available on Patreon only.

Why? 

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CPSolvers: Anti-Racism in Medicine Series

Episode 16 – Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual Meeting

Show Notes by Sudarshan Krishnamurthy

May 3, 2022

Summary: This episode was recorded in front of a live audience at the Society of General Internal Medicine’s 2022 Annual Meeting in Orlando, FL. In this episode, we gain insights from three antiracism scholars, Drs. Yannis Valtis, Ebi Okah, and Carine Davila, about research in their respective fields. Dr. Valtis is a 4th year Med-Peds Resident at Brigham & Women’s Hospital and Boston Children’s Hospital, and his research focuses on race and the utilization of security responses in the inpatient hospital setting. Dr. Okah is a family medicine clinician and NRSA research fellow at the University of North Carolina School of Medicine, and she studies the association between the use of race in medical decision-making and beliefs regarding the etiology of disparities in health outcomes. Dr. Davila is a palliative care physician at Massachusetts General Hospital and her work examines racial and ethnic inequities in patient-clinician communication. This episode was led by Rohan Khazanchi, and was hosted by Sudarshan Krishnamurthy and Utibe R. Essien.

Episode Learning Objectives

After listening to this episode learners will be able to:

  1. Understand the association of race with the utilization of security responses in hospital settings
  2. Understand the association between the use of race in medical decision-making and beliefs regarding the etiology of racial differences in health outcomes
  3. Understand racial/ethnic inequities in trust-building healthcare experiences and describe the importance of improving trust in the healthcare system through trust-building experiences with historically marginalized communities

Credits

  • Written and produced by: Rohan Khazanchi MPH, Sudarshan Krishnamurthy, Utibe R. Essien MD, MPH,  Jazzmin Williams, Alec J. Calac, Victor A. Lopez-Carmen MPH, Naomi F. Fields, LaShyra Nolen, Michelle Ogunwole MD, Jennifer Tsai MD, MEd, Chioma Onuoha, Ayana Watkins
  • Hosts: Sudarshan Krishnamurthy and Utibe R. Essien MD, MPH
  • Infographic: Creative Edge Design
  • Audio Edits: David Hu
  • Show Notes: Sudarshan Krishnamurthy
  • Guests: Drs. Yannis Valtis, Ebi Okah, and Carine Davila

 

Time Stamps

0:00 Introduction

4:20 Context and background of Yannis’ project

7:40 Framing of Ebi’s research

11:25 Inspiration for Carine’s work

14:50 Yannis’ explanation of his findings and potential next steps to intervene

25:45 Results from Ebi’s research

33:55 Carine’s findings from her work

40:00 Audience Questions

Episode Takeaways

  • Our Black patients are nearly twice as likely to experience a security utilization as our White patients.

Along with previous literature demonstrating a higher use of restraints in our Black patients in the emergency department setting, Yannis’ work shows a higher use of security responses in Black patients compared to White patients. Simulation-based training interventions are currently being studied to help combat these inequities.

  • Individuals who believe that genetic differences explain racial differences in health outcomes are more likely to practice race-based medicine.

Ebi’s research found that those physicians who possessed the belief that the etiology of racial differences in health outcomes was rooted in genetic differences were more likely to practice race-based medicine. On the other hand, those who believed that differences in social conditions explain racial differences in health outcomes were less likely to practice race-based medicine.

  • Our Black and Hispanic patients are less likely to have had trust-building experiences and more likely to have had trust-eroding experiences with the healthcare system.

Carine’s research illustrated the presence of trust-building experiences and trust-eroding experiences at every touchpoint with the health care system. Further, her research shows that Black and Hispanic patients are less likely to have had positive experiences and more likely to have had negative experiences. In addition to a need for culturally competent interpersonal communication, health systems and structures must actively work to build trust with historically marginalized communities.

Pearls 

  • “When we heard the Code Gray bell go off in the hospital, all of us knew that there was a very high likelihood that we would be entering the room a Black patient.”

In the landscape of the murder of George Floyd, Yannis described how his team began to ask questions about how they could better protect their Black patients from police brutality. Although they began with a large focus on police brutality as a whole, they realized that the presence of police within the hospital had not been sufficiently examined. Although it had not been objectively measured, their clinical and personal experiences indicated that security responses were more often utilized for minoritized patients in the hospital.

  • “It did not make sense that an innate risk for poor health was attributed to Blackness, instead of thinking about how society assigns privileges and benefits by race that results in varying health outcomes.”

Ebi discussed the context behind what inspired her project, explaining that her journey began in medical school when students challenged race-based medical curricula and the use of race as a risk factor for disease. While starting residency, she was exposed to the use of race in clinical risk calculators and was confused by the rhetoric around the innate risk conferred by Blackness, instead of the influences of racism and inequitably distributed social determinants on health outcomes.

  • “There are known inequities in patient-clinician communication in historically marginalized populations that have immediate and downstream effects on health outcomes for these patients.”

Carine talked about her expertise in empathically communicating with patients as a palliative care physician. As she embarked on her project, she realized that improving serious illness care would require improving serious illness communication. She explained that the willingness for patients to engage in communication is rooted in how much they have been listened to in the past. Importantly, there is literature demonstrating inequities in patient-clinician communication with impacts on immediate outcomes, such as patient satisfaction and trust-building, along with downstream health outcomes 

  • “… we found that the chance of having security called on our Black patients was nearly double that of our White patients.”

Yannis described previous studies demonstrating that Black patients have a higher likelihood of being restrained than White patients in the emergency department and  psychiatric settings. However, there seemed to be a lack of literature exploring this in the inpatient hospital setting, where patient clinical presentations are more varied and management depends more on clinician behaviors. His team found that 1.5% of White patients had a security response called, in comparison to almost twice as many (2.8%)  Black patients. Yannis posited that this difference was due to explicit and implicit biases rooted in racism in our broader societal context. When thinking about an intervention to combat these inequities, Yannis described a project at the Brigham leveraging simulation-based training on  interacting with agitated patients followed by a debrief session to have clinicians reflect on their actions towards patients and the role of race.

  • “… we found that the belief in genetic differences explaining racial differences in health outcomes is associated with the practice of race-based medicine.”

Ebi’s work focused on how physicians think about race and how they engage in race-based medicine. Her project asks three main questions: 1) To what extent do racial differences in genetics explain racial differences in health outcomes? 2) How do values related to diet, exercise, and other cultural differences between racial groups explain racial differences in health outcomes? and 3) How do differences in social conditions, such as the environment and socioeconomic status, influence racial differences in health outcomes? Ebi found that the belief in genetic differences as an explanation for racial health disparities was associated with use of race-based clinical practices. Additionally, the belief that social inequalities explained racial health disparities was not associated with race-based practice. 

  • “Our Black and Hispanic patients are less likely to have had positive experiences and more likely to have had negative experiences with the healthcare system.”

People engage in positive trust-building and negative trust-eroding experiences at every touch point or every interaction with someone in the healthcare system. Carine explains that this forms the framework for how experiences within the healthcare system can be evaluated. Unsurprisingly,  it was found that Black and Hispanic patients were less likely to have had trust-building experiences and more likely to have had trust-eroding experiences with the healthcare system. Trust in the healthcare system is dependent on so many factors, and boils down to what the system has done to demonstrate that they are trustworthy. The onus is on us as a system to build and earn the trust of our patients through trustworthy behaviors, especially when the system has historically not done that. An important way of improving trust in the system within historically marginalized communities includes the recruitment of clinicians to the healthcare system from within these communities, to increase representation and better reflect the diversity of our patient population. The presence of these diverse clinicians also changes the inherent nature of the space that healthcare occupies. 

References

  1. Valtis YK, Stevenson K, Murphy E, Hong J, Ali M, Shah S, Taylor AD, Sivashanker K, Shannon E. Race and the Utilization of Security Responses in a Hospital Setting. Oral Presentation at Society of General Internal Medicine 2022 Annual Meeting. Orlando, FL.
  2. Okah E, Cronholm P, Crow B, Persaud A, Westby A, Bonham V. The use of race in medical decision-making is associated with beliefs regarding the etiology of racial differences in health outcomes. Oral Presentation at Society of General Internal Medicine 2022 Annual Meeting. Orlando, FL.
  3. Davila C, Ravicz M, Jaramillo C, Wilson E, Chan S, Arenas Z, Kavanagh J, Feltz B, McCarthy B, Gosline A. Talking the Talk: Examining racial and ethnic inequities in patient-clinician communication. Oral Presentation at Society of General Internal Medicine 2022 Annual Meeting. Orlando, FL.
  4. Okah E, Thomas J, Westby A, Cunningham B. Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making. J Racial Ethn Health Disparities. 2021 Sep 7:10.1007/s40615-021-01141-1. doi: 10.1007/s40615-021-01141-1.
  5. Ogunwole SM. Without Sanctuary. N Engl J Med. 2021 Mar 4;384(9):791-793. doi: 10.1056/NEJMp2030623.
  6. Corbie-Smith G, Henderson G, Blumenthal C, Dorrance J, Estroff S. Conceptualizing race in research. J Natl Med Assoc. 2008 Oct;100(10):1235-43. doi: 10.1016/s0027-9684(15)31470-x.
  7. Nash KA, Tolliver DG, Taylor RA, Calhoun AJ, Auerbach MA, Venkatesh AK, Wong AH. Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department. JAMA Pediatr. 2021 Dec 1;175(12):1283-1285. doi: 10.1001/jamapediatrics.2021.3348.
  8. Carreras Tartak JA, Brisbon N, Wilkie S, Sequist TD, Aisiku IP, Raja A, Macias-Konstantopoulos WL. Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis. Acad Emerg Med. 2021 Sep;28(9):957-965. doi: 10.1111/acem.14327.

 

Previous Episodes Discussed:

  1. Lindo E, Nolen L, Paul D, Ogunwole M, Fields N, Onuoha C, Williams J, Essien UR, Khazanchi R. “Episode 2: Dismantling Race-Based Medicine, Part 1: Historical & Ethical Perspectives.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2020/11/17/episode-141-antiracism-in-medicine-series-episode-1-dismantling-race-based-medicine-part-1-historical-and-ethical-perspectives-with-edwin-lindo/ November 17, 2020.
  2. Eneanya A, Tsai J, Williams J, Essien UR, Paul D, Fields NF, Nolen L, Ogunwole M, Onuoha C, Khazanchi R. “Episode 4: Dismantling Race-Based Medicine, Part 2: Clinical Perspectives.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2020/12/16/episode-148-antiracism-in-medicine-series-episode-4-dismantling-raced-based-medicine-clinical-perspectives/. December 17, 2020.
  3. Manning KD, Corbie-Smith G, Khazanchi R, Nolen L, Fields N, Ogunwole M, Onuoha C, Tsai J, Paul D,  Essien UR. “Episode 6: Racism, Trustworthiness, and the COVID-19 Vaccine.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2021/02/25/episode-162-antiracism-in-medicine-series-episode-6-racism-trustworthiness-and-the-covid-19-vaccine/. February 23, 2021.
  4. Roberts, DE, Onuoha C, Khazanchi R, Nolen L, Fields N, Tsai J, Essien UR, Paul D, Ogunwole M,. “Episode 8: Dismantling Race Based Medicine Part 3: Towards Justice and Race-Conscious Medicine.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2021/05/10/episode-176-antiracism-in-medicine-series-episode-8-towards-justice-and-race-conscious-medicine/. May 10, 2021.
  5. Onuoha C, Khazanchi R, Fields N, Ogunwole M, Williams J, Essien UR, Tsai J,  Nolen L, Paul D. “Episode 9: Moving Towards Antiracism in Medical Education.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2021/06/10/episode-181-antiracism-in-medicine-series-episode-9-moving-towards-antiracism-in-medical-education/. June 10, 2021.

 

Disclosures 

The hosts and guests report no relevant financial disclosures.

Citation

Valtis Y, Okah E, Davila C, Krishnamurthy S, Essien UR, Calac A, Fields NF, Lopez-Carmen VA, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 16: Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual Meeting” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. May 3, 2022

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CPSolvers: Anti-Racism in Medicine Series

Episode 16 – Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual Meeting

Show Notes by Sudarshan Krishnamurthy

May 3, 2022

Summary: This episode was recorded in front of a live audience at the Society of General Internal Medicine’s 2022 Annual Meeting in Orlando, FL. In this episode, we gain insights from three antiracism scholars, Drs. Yannis Valtis, Ebi Okah, and Carine Davila, about research in their respective fields. Dr. Valtis is a 4th year Med-Peds Resident at Brigham & Women’s Hospital and Boston Children’s Hospital, and his research focuses on race and the utilization of security responses in the inpatient hospital setting. Dr. Okah is a family medicine clinician and NRSA research fellow at the University of North Carolina School of Medicine, and she studies the association between the use of race in medical decision-making and beliefs regarding the etiology of disparities in health outcomes. Dr. Davila is a palliative care physician at Massachusetts General Hospital and her work examines racial and ethnic inequities in patient-clinician communication. This episode was led by Rohan Khazanchi, and was hosted by Sudarshan Krishnamurthy and Utibe R. Essien.

Episode Learning Objectives

After listening to this episode learners will be able to:

  1. Understand the association of race with the utilization of security responses in hospital settings
  2. Understand the association between the use of race in medical decision-making and beliefs regarding the etiology of racial differences in health outcomes
  3. Understand racial/ethnic inequities in trust-building healthcare experiences and describe the importance of improving trust in the healthcare system through trust-building experiences with historically marginalized communities

Credits

  • Written and produced by: Rohan Khazanchi MPH, Sudarshan Krishnamurthy, Utibe R. Essien MD, MPH,  Jazzmin Williams, Alec J. Calac, Victor A. Lopez-Carmen MPH, Naomi F. Fields, LaShyra Nolen, Michelle Ogunwole MD, Jennifer Tsai MD, MEd, Chioma Onuoha, Ayana Watkins
  • Hosts: Sudarshan Krishnamurthy and Utibe R. Essien MD, MPH
  • Infographic: Creative Edge Design
  • Audio Edits: David Hu
  • Show Notes: Sudarshan Krishnamurthy
  • Guests: Drs. Yannis Valtis, Ebi Okah, and Carine Davila

 

Time Stamps

0:00 Introduction

4:20 Context and background of Yannis’ project

7:40 Framing of Ebi’s research

11:25 Inspiration for Carine’s work

14:50 Yannis’ explanation of his findings and potential next steps to intervene

25:45 Results from Ebi’s research

33:55 Carine’s findings from her work

40:00 Audience Questions

Episode Takeaways

  • Our Black patients are nearly twice as likely to experience a security utilization as our White patients.

Along with previous literature demonstrating a higher use of restraints in our Black patients in the emergency department setting, Yannis’ work shows a higher use of security responses in Black patients compared to White patients. Simulation-based training interventions are currently being studied to help combat these inequities.

  • Individuals who believe that genetic differences explain racial differences in health outcomes are more likely to practice race-based medicine.

Ebi’s research found that those physicians who possessed the belief that the etiology of racial differences in health outcomes was rooted in genetic differences were more likely to practice race-based medicine. On the other hand, those who believed that differences in social conditions explain racial differences in health outcomes were less likely to practice race-based medicine.

  • Our Black and Hispanic patients are less likely to have had trust-building experiences and more likely to have had trust-eroding experiences with the healthcare system.

Carine’s research illustrated the presence of trust-building experiences and trust-eroding experiences at every touchpoint with the health care system. Further, her research shows that Black and Hispanic patients are less likely to have had positive experiences and more likely to have had negative experiences. In addition to a need for culturally competent interpersonal communication, health systems and structures must actively work to build trust with historically marginalized communities.

Pearls 

  • “When we heard the Code Gray bell go off in the hospital, all of us knew that there was a very high likelihood that we would be entering the room a Black patient.”

In the landscape of the murder of George Floyd, Yannis described how his team began to ask questions about how they could better protect their Black patients from police brutality. Although they began with a large focus on police brutality as a whole, they realized that the presence of police within the hospital had not been sufficiently examined. Although it had not been objectively measured, their clinical and personal experiences indicated that security responses were more often utilized for minoritized patients in the hospital.

  • “It did not make sense that an innate risk for poor health was attributed to Blackness, instead of thinking about how society assigns privileges and benefits by race that results in varying health outcomes.”

Ebi discussed the context behind what inspired her project, explaining that her journey began in medical school when students challenged race-based medical curricula and the use of race as a risk factor for disease. While starting residency, she was exposed to the use of race in clinical risk calculators and was confused by the rhetoric around the innate risk conferred by Blackness, instead of the influences of racism and inequitably distributed social determinants on health outcomes.

  • “There are known inequities in patient-clinician communication in historically marginalized populations that have immediate and downstream effects on health outcomes for these patients.”

Carine talked about her expertise in empathically communicating with patients as a palliative care physician. As she embarked on her project, she realized that improving serious illness care would require improving serious illness communication. She explained that the willingness for patients to engage in communication is rooted in how much they have been listened to in the past. Importantly, there is literature demonstrating inequities in patient-clinician communication with impacts on immediate outcomes, such as patient satisfaction and trust-building, along with downstream health outcomes 

  • “… we found that the chance of having security called on our Black patients was nearly double that of our White patients.”

Yannis described previous studies demonstrating that Black patients have a higher likelihood of being restrained than White patients in the emergency department and  psychiatric settings. However, there seemed to be a lack of literature exploring this in the inpatient hospital setting, where patient clinical presentations are more varied and management depends more on clinician behaviors. His team found that 1.5% of White patients had a security response called, in comparison to almost twice as many (2.8%)  Black patients. Yannis posited that this difference was due to explicit and implicit biases rooted in racism in our broader societal context. When thinking about an intervention to combat these inequities, Yannis described a project at the Brigham leveraging simulation-based training on  interacting with agitated patients followed by a debrief session to have clinicians reflect on their actions towards patients and the role of race.

  • “… we found that the belief in genetic differences explaining racial differences in health outcomes is associated with the practice of race-based medicine.”

Ebi’s work focused on how physicians think about race and how they engage in race-based medicine. Her project asks three main questions: 1) To what extent do racial differences in genetics explain racial differences in health outcomes? 2) How do values related to diet, exercise, and other cultural differences between racial groups explain racial differences in health outcomes? and 3) How do differences in social conditions, such as the environment and socioeconomic status, influence racial differences in health outcomes? Ebi found that the belief in genetic differences as an explanation for racial health disparities was associated with use of race-based clinical practices. Additionally, the belief that social inequalities explained racial health disparities was not associated with race-based practice. 

  • “Our Black and Hispanic patients are less likely to have had positive experiences and more likely to have had negative experiences with the healthcare system.”

People engage in positive trust-building and negative trust-eroding experiences at every touch point or every interaction with someone in the healthcare system. Carine explains that this forms the framework for how experiences within the healthcare system can be evaluated. Unsurprisingly,  it was found that Black and Hispanic patients were less likely to have had trust-building experiences and more likely to have had trust-eroding experiences with the healthcare system. Trust in the healthcare system is dependent on so many factors, and boils down to what the system has done to demonstrate that they are trustworthy. The onus is on us as a system to build and earn the trust of our patients through trustworthy behaviors, especially when the system has historically not done that. An important way of improving trust in the system within historically marginalized communities includes the recruitment of clinicians to the healthcare system from within these communities, to increase representation and better reflect the diversity of our patient population. The presence of these diverse clinicians also changes the inherent nature of the space that healthcare occupies. 

References

  1. Valtis YK, Stevenson K, Murphy E, Hong J, Ali M, Shah S, Taylor AD, Sivashanker K, Shannon E. Race and the Utilization of Security Responses in a Hospital Setting. Oral Presentation at Society of General Internal Medicine 2022 Annual Meeting. Orlando, FL.
  2. Okah E, Cronholm P, Crow B, Persaud A, Westby A, Bonham V. The use of race in medical decision-making is associated with beliefs regarding the etiology of racial differences in health outcomes. Oral Presentation at Society of General Internal Medicine 2022 Annual Meeting. Orlando, FL.
  3. Davila C, Ravicz M, Jaramillo C, Wilson E, Chan S, Arenas Z, Kavanagh J, Feltz B, McCarthy B, Gosline A. Talking the Talk: Examining racial and ethnic inequities in patient-clinician communication. Oral Presentation at Society of General Internal Medicine 2022 Annual Meeting. Orlando, FL.
  4. Okah E, Thomas J, Westby A, Cunningham B. Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making. J Racial Ethn Health Disparities. 2021 Sep 7:10.1007/s40615-021-01141-1. doi: 10.1007/s40615-021-01141-1.
  5. Ogunwole SM. Without Sanctuary. N Engl J Med. 2021 Mar 4;384(9):791-793. doi: 10.1056/NEJMp2030623.
  6. Corbie-Smith G, Henderson G, Blumenthal C, Dorrance J, Estroff S. Conceptualizing race in research. J Natl Med Assoc. 2008 Oct;100(10):1235-43. doi: 10.1016/s0027-9684(15)31470-x.
  7. Nash KA, Tolliver DG, Taylor RA, Calhoun AJ, Auerbach MA, Venkatesh AK, Wong AH. Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department. JAMA Pediatr. 2021 Dec 1;175(12):1283-1285. doi: 10.1001/jamapediatrics.2021.3348.
  8. Carreras Tartak JA, Brisbon N, Wilkie S, Sequist TD, Aisiku IP, Raja A, Macias-Konstantopoulos WL. Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis. Acad Emerg Med. 2021 Sep;28(9):957-965. doi: 10.1111/acem.14327.

 

Previous Episodes Discussed:

  1. Lindo E, Nolen L, Paul D, Ogunwole M, Fields N, Onuoha C, Williams J, Essien UR, Khazanchi R. “Episode 2: Dismantling Race-Based Medicine, Part 1: Historical & Ethical Perspectives.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2020/11/17/episode-141-antiracism-in-medicine-series-episode-1-dismantling-race-based-medicine-part-1-historical-and-ethical-perspectives-with-edwin-lindo/ November 17, 2020.
  2. Eneanya A, Tsai J, Williams J, Essien UR, Paul D, Fields NF, Nolen L, Ogunwole M, Onuoha C, Khazanchi R. “Episode 4: Dismantling Race-Based Medicine, Part 2: Clinical Perspectives.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2020/12/16/episode-148-antiracism-in-medicine-series-episode-4-dismantling-raced-based-medicine-clinical-perspectives/. December 17, 2020.
  3. Manning KD, Corbie-Smith G, Khazanchi R, Nolen L, Fields N, Ogunwole M, Onuoha C, Tsai J, Paul D,  Essien UR. “Episode 6: Racism, Trustworthiness, and the COVID-19 Vaccine.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2021/02/25/episode-162-antiracism-in-medicine-series-episode-6-racism-trustworthiness-and-the-covid-19-vaccine/. February 23, 2021.
  4. Roberts, DE, Onuoha C, Khazanchi R, Nolen L, Fields N, Tsai J, Essien UR, Paul D, Ogunwole M,. “Episode 8: Dismantling Race Based Medicine Part 3: Towards Justice and Race-Conscious Medicine.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2021/05/10/episode-176-antiracism-in-medicine-series-episode-8-towards-justice-and-race-conscious-medicine/. May 10, 2021.
  5. Onuoha C, Khazanchi R, Fields N, Ogunwole M, Williams J, Essien UR, Tsai J,  Nolen L, Paul D. “Episode 9: Moving Towards Antiracism in Medical Education.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/2021/06/10/episode-181-antiracism-in-medicine-series-episode-9-moving-towards-antiracism-in-medical-education/. June 10, 2021.

 

Disclosures 

The hosts and guests report no relevant financial disclosures.

Citation

Valtis Y, Okah E, Davila C, Krishnamurthy S, Essien UR, Calac A, Fields NF, Lopez-Carmen VA, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 16: Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual Meeting” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. May 3, 2022

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Extract Knowledge
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Dear dear dear patrons,

We hope you enjoy part 1 of this 2 part series. The RIDDLER aka the mathematician is at it again.

“Make  each day your masterpiece.” Joshua Wooden (father of teacher and coach John Wooden)

Enjoy,

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

Dear dear dear patrons,

We hope you enjoy part 1 of this 2 part series. The RIDDLER aka the mathematician is at it again.

“Make  each day your masterpiece.” Joshua Wooden (father of teacher and coach John Wooden)

Enjoy,

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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Published 2022-04-27

Episode 235: RLR – A case of dysuria

35 min
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Reza discussed a case that begins with dysuria, but ends in a way you will not believe.

To listen to more RLR episodes, consider subscribing to Patreon
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Reza discussed a case that begins with dysuria, but ends in a way you will not believe.

To listen to more RLR episodes, consider subscribing to Patreon
https://www.patreon.com/cpsolvers 

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Dear Patrons,


We hope you enjoy this episode as much as we enjoyed recording it. 

It doesn’t matter whether you get the dx or not. What matters is that you are (slightly) better tomorrow than you are today.  

Thank you to our dear friend and colleague Dr. Kelley Chuang for her help with the production of this episode. (You are a legend, Kelley!)

With gratitude to each and every one of you.

Keeping diagnosing friends.

Rabih and Reza aka RLR 

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

Dear Patrons,


We hope you enjoy this episode as much as we enjoyed recording it. 

It doesn’t matter whether you get the dx or not. What matters is that you are (slightly) better tomorrow than you are today.  

Thank you to our dear friend and colleague Dr. Kelley Chuang for her help with the production of this episode. (You are a legend, Kelley!)

With gratitude to each and every one of you.

Keeping diagnosing friends.

Rabih and Reza aka RLR 

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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https://clinicalproblemsolving.com/wp-content/uploads/2022/04/RTP-WDx-4.21.22.mp3

Dr. Blythe Butler presents a case to Dr. Alexandra “Jay” Teng, followed by a discussion about her experience as a woman in an Internal Medicine procedural subspecialty.

Alexandra “Jay” Teng

Alexandra “Jay” Teng hails from Berkeley and graduated from Harvard with a bachelor’s degree in history and science. After college, she worked at UCSF as a clinical research coordinator and patient navigator for women newly diagnosed with breast cancer, helping them prepare questions for their doctor and accompanying them to appointments. That experience helped convince her to pursue medicine. Dr. Teng earned her medical degree from UCSF, then completed internal medicine residency at UCLA. A competitive skier, she was originally interested in orthopedics, but she had a dramatic pivot at the end of her first year of medical school. “On the morning of my last final, I went into cardiac arrest and was admitted to Moffitt Hospital,” she said. The hospital team did an extensive workup, eventually diagnosing her with a rare condition called congenital long QT syndrome and implanting a cardiac defibrillator to prevent future life-threatening complications. “I was incredibly lucky, and feel a very personal connecting to cardiology,” she said. “I feel fortunate to train in the place and with the people who saved my life.”She completed Cardiology and Interventional Cardiology subspecialty fellowship at UCSF. She now works at Kaiser.

Blythe Butler

Blythe Butler is a first-year internal medicine resident at the University of California, San Francisco. She grew up in Spokane, Washington and attended Dartmouth College where she studied chemistry and mathematics. She went on to pursue a career in education and spent four years teaching general and AP chemistry as a high school teacher in San Jose, CA. She decided to switch careers to pursue medicine and completed medical school at UCSF. She enjoys running through Golden Gate Park, hiking and backpacking, and baking. Her career interests include medical education, communication in medicine, and health equity.

 

Download CPSolvers App here 

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More description
https://clinicalproblemsolving.com/wp-content/uploads/2022/04/RTP-WDx-4.21.22.mp3

Dr. Blythe Butler presents a case to Dr. Alexandra “Jay” Teng, followed by a discussion about her experience as a woman in an Internal Medicine procedural subspecialty.

Alexandra “Jay” Teng

Alexandra “Jay” Teng hails from Berkeley and graduated from Harvard with a bachelor’s degree in history and science. After college, she worked at UCSF as a clinical research coordinator and patient navigator for women newly diagnosed with breast cancer, helping them prepare questions for their doctor and accompanying them to appointments. That experience helped convince her to pursue medicine. Dr. Teng earned her medical degree from UCSF, then completed internal medicine residency at UCLA. A competitive skier, she was originally interested in orthopedics, but she had a dramatic pivot at the end of her first year of medical school. “On the morning of my last final, I went into cardiac arrest and was admitted to Moffitt Hospital,” she said. The hospital team did an extensive workup, eventually diagnosing her with a rare condition called congenital long QT syndrome and implanting a cardiac defibrillator to prevent future life-threatening complications. “I was incredibly lucky, and feel a very personal connecting to cardiology,” she said. “I feel fortunate to train in the place and with the people who saved my life.”She completed Cardiology and Interventional Cardiology subspecialty fellowship at UCSF. She now works at Kaiser.

Blythe Butler

Blythe Butler is a first-year internal medicine resident at the University of California, San Francisco. She grew up in Spokane, Washington and attended Dartmouth College where she studied chemistry and mathematics. She went on to pursue a career in education and spent four years teaching general and AP chemistry as a high school teacher in San Jose, CA. She decided to switch careers to pursue medicine and completed medical school at UCSF. She enjoys running through Golden Gate Park, hiking and backpacking, and baking. Her career interests include medical education, communication in medicine, and health equity.

 

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Dear friends,

The only way we significantly grow is through reflection! Listen to this episode, reflect, and become better for the patient you treat tomorrow and the student you teach tomorrow.

We thank you for your support.

Is it Reza loves Rabih or Rabih loves Reza … it is the best palindrome …

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

 

More description

Dear friends,

The only way we significantly grow is through reflection! Listen to this episode, reflect, and become better for the patient you treat tomorrow and the student you teach tomorrow.

We thank you for your support.

Is it Reza loves Rabih or Rabih loves Reza … it is the best palindrome …

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

 

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Hello friends,

We hope you enjoy this episode. It features three short cases! 

We appreciate your continued support of RLR.

And remember … keep diagnosing lovely people

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

More description

Hello friends,

We hope you enjoy this episode. It features three short cases! 

We appreciate your continued support of RLR.

And remember … keep diagnosing lovely people

RR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

 

Extract Knowledge
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https://clinicalproblemsolving.com/wp-content/uploads/2022/04/SLS-4.14.22_RTP.mp3

In this case, Anna and Moses work through the schemas of dyspnea, AMS, HIV & infection, and lymphocytic pleocytosis as they discuss a case presented by Simone.

Schema

DyspneaAMS 2.0HIV & infectionLymphocytic pleocytosis  

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https://clinicalproblemsolving.com/wp-content/uploads/2022/04/SLS-4.14.22_RTP.mp3

In this case, Anna and Moses work through the schemas of dyspnea, AMS, HIV & infection, and lymphocytic pleocytosis as they discuss a case presented by Simone.

Schema

DyspneaAMS 2.0HIV & infectionLymphocytic pleocytosis  

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Patreon website

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We hope you enjoy this episode recorded on Reza’s birthday, April 3rd. 

The best gift you could give us is to share RLR series with your friends and family.

Thank you for supporting CPSolvers.

Rabih and Reza aka RLR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

More description

We hope you enjoy this episode recorded on Reza’s birthday, April 3rd. 

The best gift you could give us is to share RLR series with your friends and family.

Thank you for supporting CPSolvers.

Rabih and Reza aka RLR

 

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

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