The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2023/06/ARM_June27_RTP.mp3CPSolvers: Anti-Racism in Medicine SeriesEpisode 22 – Live from SGIM 2023: Best of Antiracism Research at the Society of General Internal Medicine’s 2023 Annual MeetingShow Notes by Alec J. CalacJune 22, 2023 Summary: This episode highlights a selection of antiracism research presentations at a live recording of the podcast at the 2023 SGIM Annual Meeting. This year’s episode, our third conducted at SGIM, is focused on the importance of language in medicine and the role it can play in perpetuating stigma and bias. During this episode, we hear from Dr. Som Saha, an internist whose research focuses broadly on the influence of race and racism in the doctor-patient relationship among other research subjects, Dr. Mary Catherine Beach, whose work has been targeted towards improving healthcare quality for patients who face systemic disadvantage especially  in the setting of HIV/AIDS and sickle cell disease, and Dr. Pooja Lagisetty, whose work is focused on  understanding how stigma impacts access to care for people living with chronic pain and opioid use disorder. This episode is hosted by Sudarshan (Sud) Krishnamurthy and Ashley Cooper. The show notes for this episode were written by Alec Calac. Episode Learning ObjectivesAfter listening to this episode, learners will be able to…Differentiate between stigma and bias in health care and the electronic health record using provided examples.Describe difficulties and examples of how to measure unconscious race bias in medical practice.Identify strategies to mitigate bias and stigma in the electronic health record as a trainee and medical practitioner. CreditsWritten and produced by: Sudarshan Krishnamurthy, Ashley Cooper, TeamHosts: Sudarshan Krishnamurthy, Ashley CooperInfographic: Creative Edge DesignAudio Edits: Madellena Conte Show Notes: Alec J. CalacGuests: Dr. Som Saha, Dr. Mary Catherine Beach, Dr. Pooja Lagisetty Time Stamps0:00 Opening00:23 Introductions01:50 Guest Introduction 102:43 Guest Introduction 204:05 Guest Introduction 305:25 Guest Career Paths and SGIM Research07:20 Anti-Racist Praxis and Sickle Cell Clinical Research/Scale Development10:00 Unconscious Race Bias16:30 Positive, Negative, Neutral Language in the Electronic Health Record19:54 Use Language to Personalize and Humanize Notes21:22 Considerations for Alternative Language25:20 “Disbelief of Pain” and Scare-Quotes26:45 Interrupt Transmission of Stigma in the Electronic Health Record29:20 Beginning of Audience Questions and “Euphemism Treadmill”35:00 Reorienting Language38:00 “Value” in the Electronic Health Record40:00 Question about “Positive Language” as a Tool42:00 Language and Intended Audiences, Context45:50 Question on Multi-Level and/or System-Level Interventions48:00 Becoming Conscious about the Unconscious49:35 “Thinking Fast and Slow”50:30 Question on Person-First Language and Artificial Intelligence53:50 Pearls and “Ending with Hope” Speaker Biographies (Abbreviated)Dr. Som Saha received his medical degree and post-graduate training in internal medicine from the University of California, San Francisco, and completed post-doctoral training in the Robert Wood Johnson Clinical Scholars Program (RWJ) at the University of Washington, where he obtained a master’s degree in public health. He subsequently worked at OHSU and the Portland VA for 2 decades before moving to Johns Hopkins University. Dr. Saha’s research focuses broadly on the influence of race and racism in the doctor-patient relationship, its relation to disparities in the quality of health care, and its implications for diversity in the healthcare workforce. He has also served as a Council member and Secretary of SGIM. He has been a research advisor or mentor for over 50 students, fellows, and junior faculty, over a third of whom have been from racial/ethnic groups underrepresented in medicine. Dr. Mary Catherine Beach is a professor in the School of Medicine, with appointments in the Center for Health Equity and the Berman Institute of Bioethics, at Johns Hopkins University. Dr. Beach’s research focuses on humanizing healthcare by promoting respect for patients as well as improved patient-clinician communication. Much of her work has been targeted toward improving healthcare quality for patients who face systemic disadvantage and in the setting of HIV/AIDS and sickle cell disease (SCD). Her research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, and the Greenwall Foundation. Dr. Beach has won numerous awards for her scholarship and mentorship, including the David Levine Mentoring Award from the Johns Hopkins School of Medicine in 2015. She also is the 2017 recipient of the George L. Engel Award for outstanding research contributions to the theory, practice, and teaching of effective healthcare communication and related skills. In 2022, Dr. Beach was elected as a Hastings Center Fellow; and in 2023 was awarded the Excellence in Ethics Award from the Society of General Internal Medicine. Dr. Pooja Lagisetty received her medical degree from the Johns Hopkins School of Medicine and completed her internal medicine residency at Massachusetts General Hospital.  Following residency, she was a Robert Wood Johnson Clinical Scholar and received health services research methodology training.  She is currently an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Michigan and also a research investigator at the Center for Clinical Management and Research at the Ann Arbor VA. Clinically, she is boarded in both Internal Medicine and Addiction Medicine and practices as a primary care physician and teaching hospitalist.  Her research focuses on understanding how stigma impacts access to care for people living with chronic pain and opioid use disorder.  She is also interested in designing multidisciplinary care models for people with comorbid pain and substance use disorders in the general medical setting.  Episode TakeawaysStigma in Healthcare: Sud begins by asking our guests what led them to their current career paths and what work they are presenting at SGIM. Many of them share intersecting interests in stigma and other factors, such as chronic pain management, language (“drug-seeking” in the electronic health record), and the patient-provider relationship. Clinician-researchers are increasingly interested in developing novel scales and measures that can quantify stigma in healthcare. As noted by our guests, it is difficult to measure invisible factors such as unconscious race bias, because it is impossible to directly measure these factors. Instead, proxy factors, and other types of experimental inquiry (e.g., qualitative methods) have to be used to describe the impact that factors like bias have in health care. Importantly, there is a lot of nuance around language. It may be difficult to discern the impact that stereotypical language can have in health care because language is very contextual and means different things to different groups. Stigma (Adverse Impact) vs. Bias (Personal Characteristic): Important to make a distinction between these two concepts. Society stigmatizes certain behaviors, such as drug injection and alcohol use. When a health care provider uses such language (e.g., a person who injects drugs), they may not have any bias against the patient, but they are using language that ascribes stigma to the patient based on societal norms. Another example of phrasing, such as “delightful” and “pleasant” may convey positive bias for one group of patients over another, depending on their racial and/or social identities, but may not be examples of stigma. It is not always clear what is an example of stigma and/or bias in the electronic health record. Learn more here: Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record | Health Affairs Use Language for Good: Think about what people will remember when they access a patient’s electronic health record. Language can be a powerful tool for good, especially in the backdrop of the opioid epidemic. Opioid Epidemic and Stigma: Providers generally have a fear or discomfort using opioid agents as treatment for individuals with substance use disorders. Coupled with stigma, bias, and language used to describe these patients in the electronic health record, this perfect storm of factors can work against efforts to help patients in need of safe, comprehensive healthcare services.  Active Use of the Electronic Health Record: Be mindful of the use of “scare-quoting” and other phrasing that could be misinterpreted. Consider taking on an active role in interrupting the continued communication of language that is outdated and no longer relevant to the care of the patient. As mentioned earlier, humanizing the electronic health record can have a significant impact down the line. “Euphemism Treadmill”: This describes the process of replacing words that have taken on a stigmatizing, pejorative, or derogatory connotation with new words that are more humanizing, and how this is an iterative (unlearning-learning) process. An interesting conversation followed that included discussions about the DSM in psychiatry and psychology (personal failing vs. medical disorder) and how this language-shifting process is likely multi-generational in scale.Pearls“Do no harm” through language. Be conscious about the words and phrases used in the clinical encounter and electronic health record. Preserve the dignity of the patient. Small changes can have a large impact. Include personalizing and humanistic details in the electronic health record. The work begins with educating our learners, while incorporating these lessons into our clinical practice simultaneously. References Beach MC, Park J, Han D, Evans C, Moore RD, Saha S. Clinician Response to Patient Emotion: Impact on Subsequent Communication and Visit Length. Ann Fam Med. 2021 Nov-Dec;19(6):515-520. doi: 10.1370/afm.2740. PMID: 34750126; PMCID: PMC8575526. Park J, Saha S, Chee B, Taylor J, Beach MC. Physician Use of Stigmatizing Language in Patient Medical Records. JAMA Netw Open. 2021 Jul 1;4(7):e2117052. doi: 10.1001/jamanetworkopen.2021.17052. PMID: 34259849; PMCID: PMC8281008. Beach MC, Saha S. Quoting Patients in Clinical Notes: First, Do No Harm. Ann Intern Med. 2021 Oct;174(10):1454-1455. doi: 10.7326/M21-2449. Epub 2021 Aug 17. PMID: 34399061. Beach MC, Saha S, Park J, Taylor J, Drew P, Plank E, Cooper LA, Chee B. Testimonial Injustice: Linguistic Bias in the Medical Records of Black Patients and Women. J Gen Intern Med. 2021 Jun;36(6):1708-1714. doi: 10.1007/s11606-021-06682-z. Epub 2021 Mar 22. PMID: 33754318; PMCID: PMC8175470. Kosakowski S, Benintendi A, Lagisetty P, Larochelle MR, Bohnert ASB, Bazzi AR. Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering. J Gen Intern Med. 2022 May;37(7):1722-1728. doi: 10.1007/s11606-021-07210-9. Epub 2022 Jan 6. PMID: 34993861; PMCID: PMC9130417. Benintendi A, Kosakowski S, Lagisetty P, Larochelle M, Bohnert ASB, Bazzi AR. “I felt like I had a scarlet letter”: Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain. Drug Alcohol Depend. 2021 May 1;222:108664. doi: 10.1016/j.drugalcdep.2021.108664. Epub 2021 Mar 18. PMID: 33757709; PMCID: PMC8058315. Disclosures The hosts and guests report no relevant financial disclosures. CitationSaha, S, Beach, M, Lagisetty, P, Cooper A, Krishnamurthy S, Calac A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 22: Live from SGIM 2023: Best of Antiracism Research at the Society of General Internal Medicine’s 2023 Annual Meeting” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. June 25, 2023. Show Transcript  Download CPSolvers App hereRLRCPSOLVERS

https://clinicalproblemsolving.com/wp-content/uploads/2023/06/RLR-RTP.mp3Episode descriptionRR discuss a grounding case of chest pain Student discounthttps://www.rlrcpsolvers.com/student-discounts/ IMG discountUse coupon code RLRIMG at check out  https://rlrcpsolvers.com/annual-plan

https://clinicalproblemsolving.com/wp-content/uploads/2023/06/Juneteenth-episode-RTP-1.mp3 Dr. Kimberly Manning and her father, Mr. William Draper, commemorate Juneteenth, the holiday that celebrates the day when all remaining enslaved Black Americas were freed in Galveston Texas, on June 19th, 1865, with this hour-long storytelling event. 

https://clinicalproblemsolving.com/wp-content/uploads/2023/06/June-15-Neuro-VMR-editedwithintrooutro20220308.mp3We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Gabriela Pucci presents a case of right arm weakness to Promise and Ravi. Promise Lee @promisefleePromise Lee is currently a 3rd year medical student at Loyola University Chicago Stritch School of Medicine. She is an aspiring internal medicine physician with interests in GI, obesity medicine, public health, and clinical reasoning. Outside of medicine, Promise is a food and fitness enthusiast who loves enjoying the outdoors, spending time with family and friends, and experimenting with new recipes. Gabriela Figueiredo Pucci @gabifpucciGabriela Figueiredo Pucci, MD, is a Neurology PGY 1 at University of Pittsburgh Medical Center. Originally from Brazil, she graduated from Unicamp and completed her first Neurology residency at UNESP. She is enthusiastic about breaking down complex Neurology topics into infographics on her website (www.Neudrawlogy.com). She is passionate about Clinical Reasoning and loves to be part of the CPSolvers. On her free time, she likes to travel, cook, bake, and watch competitive cooking and baking reality shows.Ravi Singh @rav7ksRavi (Ravitej) Singh is originally from Greenwich, London U.K where he grew up playing soccer and rugby. He attended medical school at University of Debrecen, Hungary and completed residency at Medstar Harbor Hospital in Baltimore. Currently he is an associate program director for Sinai Hospital IM residency program in Baltimore as well as a Hospitalist on the teaching service. He is a faculty member at the Johns Hopkins School of Medicine and takes time out of his schedule to run a series of case-based teaching sessions as well as medical simulation with all of the medical students that rotate at Sinai throughout the year. He is also a co-chair of the ACP Maryland IMG committee where he advocates for IMG issues Jo and highlights their contributions to the healthcare system Download CPSolvers App hereRLRCPSOLVERS

https://clinicalproblemsolving.com/wp-content/uploads/2023/06/6.8.23-SLS-RTP.mp3Episode description: The spaced learning series team discusses a case of intermittent episodes of presyncope in a patient found to have hypoglycemia and polycythemia.   Featuring: Anna FretzKirtan PatoliaPriyanka Athavale Schemas:SyncopeHypoglycemiaPolycythemia Download CPSolvers App hereRLRCPSOLVERS

https://clinicalproblemsolving.com/wp-content/uploads/2023/05/WDx-05.25.23-RTP.mp3In this episode of WDx, Dr Rebecca Berger joins Kara, Jane, & Sharmin to discuss a clinical unknown. Presented by Kara, the case starts with a young woman presenting with chronic isolated thrombocytopenia. Dr. Rebecca BergerRebecca is an academic hospitalist and assistant professor of medicine at Weil Cornell Medicine and New York Presbyterian Hospital. In addition to her clinical work, she serves as the Director of Patient Safety for Inpatient Services for the Department ofMedicine and teaches medical students and residents, including leading small groups with students on their medicine clerkships focused on clinical reasoning and diagnosis.Rebecca obtained her undergraduate degree from Stanford University in 2009, her medical degree from Columbia University Vagelos College of Physicians and Surgeons in 2013, and completed her internal medicine internship and residency training at Massachusetts General Hospital (MGH) in 2016. She served as a NEJM Editorial Fellow from 2016-2017 and worked as a hospitalist at MGH before moving to Cornell in 2018. Download CPSolvers App here

https://clinicalproblemsolving.com/wp-content/uploads/2023/05/RLR-56_One-life.-So-many-dreams.mp3RR dedicate this episode to our beloved Rafa Medina. Rafa’s GoFundMe page. 

https://clinicalproblemsolving.com/wp-content/uploads/2023/05/1stSubspecialtyPodcastEpWithIntro_PostAuphonic.mp3Maddy Conte and Seyma Yildirim introduce a new series on the podcast: “The Rafael Medina Subspecialty Series,” which will always be in loving memory of our dear friend and CPSolvers family member, Dr. Rafael Medina. Rafa presents a nephrology clinical unknown to Drs. Ashita Tolwani and Mustafa Muhammad.The goal of this series is to expand access to subspecialty, primary care and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant, fill out this form here: https://forms.gle/RLbx6A2vELp6PTYp9 Case presenter and facilitator: Dr. Rafael MedinaRafa was a Brazilian medical graduate who proudly shared on Twitter, “Son of a tailor and confectionary vendor born and raised in rural Brazil. And now incoming internal medicine resident at the University of Colorado. Never let anyone tell you that your dreams are too big for you!” He tragically passed away last week. He impacted the lives of so many and touched every corner of the CPSolvers community, and rippled far beyond. Rafa helped spearhead the subspecialty series; this series has been renamed after Rafa and will continue strong in his honor. Rafa, we love you.   Case discussants: Dr. Ashita Tolwani, Professor of Medicine at the University of Alabama at Birmingham (UAB). She was the Nephrology Fellowship Training Program Director from 2004-2010 and is now the Associate Program Director. She is also the Director for ICU Nephrology at UAB. (Twitter: luck_urine)      Dr. Mustafa Noor Muhammad, nephrology fellow at the University of Alabama at Birmingham.       Download CPSolvers App hereRLRCPSOLVERS   Click here to view the weekly episode recap email!

https://clinicalproblemsolving.com/wp-content/uploads/2023/05/CPSolvers-ARM-Episode-21-Audio.mp3CPSolvers: Antiracism in Medicine SeriesEpisode 21 – Psychosocial and Cultural Considerations for Providing Healthcare to Immigrant and Refugee PopulationsShow Notes by Kiersten T. “Gillette” Gillette-PierceMay 2, 2023Summary: This episode highlights the psychosocial and cultural considerations for providing healthcare to immigrant and refugee populations. During this episode, we hear from Dr. Altaf Saadi, a neurologist who focuses on neuropsychiatric health disparities and addressing the needs of displaced populations at Mass General Hospital and Harvard Medical School, and Dr. Naweed Hayat, a child and adolescent psychiatry fellow at the University of California San Diego, who applies his own lived experience of resettlement to his clinical practice. Together, our guests explain how trauma shows up in those who experience resettlement, and the role of trauma-informed and culturally-responsive care for refugee, asylee, and immigrant population in clinical practice.. This discussion is hosted by Sudarshan Krishnamurthy, Ashley Cooper, and LaShyra Nolen. Episode Learning ObjectivesAfter listening to this episode, learners will be able to…Explain how the current state at the border is informed by historical immigration injustices.Describe how physiological and psychological trauma show up among immigrant and refugee populations as a result of the violence and injustices experienced during migration, at the border, during the resettlement  process and across the lifecourse thereafter. Identify the role of trauma-informed, culturally-responsive care for refugee, asylee, and immigrant populations and how it can be operationalized in clinical practice.CreditsWritten and produced by: Sudarshan Krishnamurthy, Ashley Cooper, LaShyra Nolen, Kiersten Gillette-Pierce, Rohan Khazanchi, MD, MPH,  Dereck Paul, MD, Jazzmin Williams, Victor A. Lopez-Carmen MPH, Naomi F. Fields, Jennifer Tsai MD, MEd, Chioma Onuoha, Ayana Watkins, Michelle Ogunwole MD, Utibe R. Essien MD, MPHHosts: Sudarshan Krishnamurthy; Ashley Cooper, and LaShyra NolenInfographic: Creative Edge DesignAudio Edits: Garrett WeskampShow Notes: Gillette PierceGuests: Dr. Altaf Saadi and Dr. Naweed HayatTime Stamps0:28 Introduction0:31 Episode introduction1:15 Guest introductions3:50 Origin stories8:06 The current state of the border18:13 Culturally competent and trauma-informed care 24:50 ICE and policing36:28 Application of teachingsEpisode TakeawaysOrigin Stories — For Dr. Hayat and Dr. Saadi, the work that they do is deeply informed by their lived experiences as migrants themselves as well as in their professional roles as clinicians who serve immigrant and refugee populations. State of the Border — Policies that happened under the Trump administration and now under the Biden administration have left people vulnerable to injustices in Mexico and other Central American nations. People are fleeing persecution, gang violence, and other violence such as sexual or other violent assaults and now they must also face the additional burden of the lack of access to basic necessities like food, water and shelter. A lot of compounding trauma occurs at the border that has potential downstream mental health implications for individuals and their families. Culturally Competent and Trauma-Informed Care — Interpersonal components such as screening for trauma exposure and providing resources to families are an important aspect of trauma-informed care, and it should also include efforts at the organization level to create sanctuary or immigrant-friendly spaces and implement immigration-informed care, which builds on the concept of trauma-informed care by honing in on the unique factors associated with immigrant populations, e.g. protocols for broaching sensitive topics like immigration status and policies to ensure people are safe from immigration enforcement.ICE and Policing — Instances of immigration enforcement in healthcare settings are rare, and when they do happen they can look like patients being interrogated at the bedside or even being arrested as they step out of the hospital just after visiting someone. These instances contribute to immense fear that can act as a deterrent from seeking care or engaging with any other helping professional institutions in the future–this goes for the individual(s) directly impacted and the people within their communities. Impact of Health Records — The impact of health records within the context of healthcare for immigrant populations is complex because migration status really should not be documented explicitly as it can open people up to harms such as stigma from providers or being turned over to law enforcement agencies who may cooperate with immigration enforcement. Many organizations, such as the American Medical Association Journal of Ethics, recommend against documenting immigration status in medical records.Application of teachings — It is advised to amplify the work that is already being done in communities and identify what areas at the systems level need to change as well as the key stakeholders. PearlsDr. Hayat discusses the five major waves of migration in the last fifty years, resulting from the Soviet-Afghan War, the Afghan Civil War, the Fall of the Taliban, August 2021 US and western forces departure, and how he grew up during the 1990s right after the collapse of the government. He recounts street fights in Kabul as well as an overall theme of people going back to a focus on survival, or the need for food, shelter, water and safety. Dr. Saadi discusses how her parents left Iraq under Saddam Hussein’s dictatorship, where he was targeting many Iraqis with Iranian ancestry and Shi’a Muslims–which included members of her family. She notes she was born in Iran and her family emigrated to Canada and then to the United States just a month before 9/11. She recounts this time as particularly tumultuous for not only Muslim Americans but also South Asian Americans, Sikh Americans, as well as Arab Americans who were not Muslims. Dr. Saadi highlights that the majority of immigrants do not come through the US-Mexico border, even for undocumented folks. Additionally, in the case of folks who are undocumented, it is likely the case that they attained this status as a result of overstaying their previously valid visa. Dr. Saadi discusses the Biden administration rule proposal that would essentially prohibit refugees from seeking asylum in the US, making them ineligible for asylee status. Dr. Saadi highlights that there needs to be a greater focus on the continuum of experiences when we discuss patients who are immigrants or forcibly displaced because there is not often a clear pre-post distinction. Many people’s journeys can involve being in an encampment, being detained in immigration prisons, or stopping in multiple countries before reaching the final destination.Dr. Saadi also uplifts the fact that while we focus primarily on those we have clinical encounters with, it is always important to mention that there are many people that did not make it to clinic for an amalgam of reasons — many people lost their lives in the quest for better lives and freedom from persecution.Dr. Hayat stresses the difference that cultural psychiatry, cultural competency, and the biopsychosocial model make in building rapport and there is a lot that goes on in between pre- and post-resettlement and those experiences have to be taken into account, especially in cases where there are language and cultural barriers. He highlighted the DSM-5 Cultural Formulation Interviews.Dr. Saadi recommends avoiding documentation of immigration status in medical records, or having clear guidelines on what to do if immigration enforcement is present at the clinical setting. Dr. Saadi notes that we must not see people as the sum of their traumas, they are so much more than that — especially in the case of forcibly displaced peoples and immigrants. We must not reduce people to their trauma exposure alone.   Dr. Hayat interestingly mentions that some organizations have been able to build relationships with law enforcement, educate them, and share different challenges to help realize a common goal. Dr. Hayat notes that while organizations recommend against documenting immigration status in medical records, needs can still be met through partnerships with community organizations. Dr. Saadi adds that we can collect this data, and there is immense groundwork that must be done to develop protections for immigrant and refugee populations and ensure the data are protected. Dr. Saadi mentioned a toolkit around policies and actions that can be implemented at an organizational level that is publicly available at www.doctorsforimmigrants.com. She also mentions additional organizational-level policies and actions that can take place beyond what is mentioned in the toolkit such as setting up a medical legal partnership where people can connect to attorneys that can help them with their immigration case or civic engagement promotion.  She also mentioned Dr. Mark Kuczewski’s sanctuary doctrine toolkit that focuses more on the individual level. Refer to Good Sanctuary Doctoring for Undocumented Patients for more information. Dr. Hayat mentioned his colleague, Dr. Olivia Shadid, who does work on mental health evaluations for asylum seekers, which can be found here.ReferencesMorris JE, Saadi A. The Biden administration’s unfulfilled promise of humane border policies. Lancet. 2022 May 28;399(10340):2013. doi: 10.1016/S0140-6736(22)00741-3. Erratum in: Lancet. 2022 Jun 2;: PMID: 35644152.Saadi, A. Undark. Opinion: Covid-19 Shows Us Why We Should Keep ICE Out of Hospitals. https://undark.org/2020/03/25/covid-19-immigration-hospitals/ Saadi. A. Boston Globe. The invasion of Ukraine reminds me of growing up in Iran. The trauma is lasting. https://www.bostonglobe.com/2022/03/16/magazine/invasion-ukraine-reminds-me-growing-up-iran-trauma-is-lasting/?outputType=ampShi M, Stey A, Tatebe LC. Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees. Curr Trauma Rep. 2021;7(4):83-91. doi: 10.1007/s40719-021-00217-x. Epub 2021 Nov 13. PMID: 34804764; PMCID: PMC8590436.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, 2022Berkman JM, Rosenthal JA, Saadi A. Carotid Physiology and Neck Restraints in Law Enforcement: Why Neurologists Need to Make Their Voices Heard. JAMA Neurol. 2021;78(3):267–268. doi:10.1001/jamaneurol.2020.4669James J, Heard-Garris N, Krishnamurthy S, Cooper A, Calac A, Watkins A, Onuoha C, Lopez-Carmen VA, Krishnamurthy S, Calac A, Nolen L, Williams J, Tsai J, Ogunwole M, Khazanchi R, Fields NF, Gillette-Pierce K. “Episode 18: Remedying Health Inequities Driven by the Carceral System” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. October 18, 2022.Chiesa V, Chiarenza A, Mosca D, Rechel B. Health records for migrants and refugees: A systematic review. Health Policy. 2019 Sep;123(9):888-900. doi: 10.1016/j.healthpol.2019.07.018. Epub 2019 Jul 30. PMID: 31439455.Disclosures The hosts and guests report no relevant financial disclosures.CitationSaadi A, Hayat N, Krishnamurthy S, Cooper, A, Nolen L, Gillette-Pierce K, Calac A, Essien UR, Fields NF, Lopez-Carmen VA, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 21: Antiracist Healthcare for Immigrant and Refugee Populations ” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. April 25, 2023Show Transcript Download CPSolvers App hereRLRCPSOLVERS

https://clinicalproblemsolving.com/wp-content/uploads/2023/04/RLR.mp3RR recap a mystery case presented by Aaron.Student discounthttps://www.rlrcpsolvers.com/student-discounts/IMG discountUse coupon code RLRIMG at check out  https://rlrcpsolvers.com/annual-planGlassHealth sponsorshiphttps://twitter.com/GlassHealthHQhttps://glass.health/cpsolversUse promo code CPSOLVERS for one month free!