The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2022/11/11.03.22-November-Neuro-VMR-RTP.mp3We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, John presents a case of diplopia to Valeria and Madellena.Neurology DDx Schema John Acquaviva@DrJAStrangeJohn Acquaviva is a fourth-year medical student attending Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. He has a passion for both clinical and academic neurology and will be starting neurology residency in the summer of 2023. He has special interests in neurophysiology, autoimmune neurology, and neuroimmunology, but is excited about all neurological fields. In his free time, he enjoys hanging out with friends, long-boarding, running, and martial arts. Valeria Roldán @valeroldan23Valeria 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.  Madellena Conte@MadellenaC Madellena Conte was born and raised in San Francisco, CA. She completed her undergraduate degree at Dartmouth College. After college, she worked at Collective Health, a healthcare insurance technology company, and then completed her Master’s of Science in Global Health at UCSF where her research focused on understanding preferences for HIV care among people experiencing unstable housing. She is a MS4 at the Zucker School of Medicine at Hofstra/Northwell in New York and is currently taking a research year in the Division of HIV, ID, and Global Medicine at UCSF. Outside of medicine, Madellena loves to travel, meet new people, run, figure skate and really do anything outdoors. She plans on applying into internal medicine residency. Download CPSolvers App hereRLRCPSOLVERS

https://clinicalproblemsolving.com/wp-content/uploads/2022/10/CP1-10-18-22_v2.mp3CPSolvers: Anti-Racism in Medicine Series Episode 18 – Remedying Health Inequities Driven by the Carceral SystemShow Notes by Ayana WatkinsOctober 18, 2022Summary: This episode highlights the history and roots of the carceral system, as well as its far-reaching impacts on the health of women and children today. During this episode, we gain insight from special guests Dr. Jennifer James—a qualitative researcher, a Black Feminist scholar, and an assistant professor in the Institute for Health and Aging, the Department of Social and Behavioral Sciences, and the Bioethics program at the University of California San Francisco—and Dr. Nia Heard-Garris—a pediatrician and researcher in the Department of Pediatrics at Feinberg School of Medicine at Northwestern University and in the Division of Academic General Pediatrics and Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center at the Ann & Robert H. Lurie Children’s Hospital of Chicago. This discussion is hosted by Sudarshan Krishnamurthy, Ashley Cooper, and Alec J. Calac.Episode Learning ObjectivesAfter listening to this episode, learners will be able to…Understand the history of mass incarceration and its effect on healthRecognize how cultures of punishment and control within carceral spaces and within clinical settings impact healthLearn how to best care for and support those experiencing violence at the hands of the carceral systemConsider how we enact carceral structures and act as agents of the state in our clinical practicesCreditsWritten and produced by: Sudarshan Krishnamurthy, Ashley Cooper, Alec J. Calac, Michelle Ogunwole MD, PhD, Ayana Watkins, Chioma Onuoha, Naomi F. Fields MD, Victor A. Lopez-Carmen MPH, Rohan Khazanchi MPH, Sudarshan Krishnamurthy, Utibe R. Essien MD, MPH,  Jazzmin Williams, LaShyra Nolen,  Jennifer Tsai MD, MEd, Zahada (Kiersten) Gillette -PierceHosts: Sudarshan Krishnamurthy, Ashley Cooper, and Alec J. CalacInfographic: Creative Edge DesignAudio Edits: Isabella GauShow Notes: Ayana WatkinsGuests: Dr. Nia Heard-Garris, MD, MSc and Dr. Jennifer James, PhD, MS, MSWTime Stamps00:00 Introduction of episode and guests04:01 History of  mass incarceration and its relationship with health11:38 Understanding healthcare decision-making in carceral spaces22:27 Substance Use and Treatment/Diversion vs. Incarceration of BIPOC mothers29:30 Health Impacts on Children and Young Adults with History of Parental Incarceration35:24 Remedying Health of Women and Children Impacted by the Criminal Legal System45:55 Key takeaways Episode Takeaways:Prisons are not places of healing. Incarceration negatively affects the physical and mental health of people who are incarcerated as well as their family members and loved ones, and limits access to healthcare before, during, and after incarceration. All healthcare professionals will have patients who are directly or indirectly impacted by the carceral system. Our guests remind us to think critically about our role in the carceral system and in imposing systems of control and punishment within clinical settings. Additionally, our guests urge us to recognize the ways in which our patients are impacted by incarceration and to ask our patients about these impacts in order to better care for them.The ways to remedy the negative impacts of incarceration are to incarcerate fewer people and to invest in communities. Providing communities with the resources they need to survive, such as educational opportunities, jobs, and quality healthcare, will eliminate the need for incarceration. Additionally, decarceration and abolition will remedy the far-reaching health effects of the criminal legal system.Pearls “Prisons and jails are not healing spaces [. . .] They are not spaces designed for healing or care, they are designed for punishment and control.”Dr. James explains that the culture of punishment, control, and violence within jails and prisons impedes healthcare for people who are incarcerated. People who are incarcerated are dehumanized and feel they are treated as inmates, rather than as patients. Correctional officers act as gatekeepers, deciding who does and does not need medical care. This means that people who are incarcerated are often not believed when they say they need medical care. As a result of this dehumanization and mistreatment, people who are incarcerated may forgo seeking medical care because they do not trust that the system and healthcare professionals will do anything but harm them further.Dr. Heard-Garris draws parallels between the culture within the carceral system and that within hospitals and clinics. For clinicians who do not work within jails or prisons, it is important to recognize the presence of these same issues within other clinical spaces. Hospitals and clinics also have security, armed guards, and police whose roles are to impose control, and their presence can impact health outcomes for patients. Dr. Heard-Garris also added that having a family member in the carceral system makes it more likely that a person will lose confidence in the medical system and will not seek care, so this mistrust in healthcare reverberates in generations post-incarceration.Substance Use and Society’s focus on incarceration and punishment over treatment, diversion, and healing for BIPOC womenDr. Heard-Garris explained that systems such as capitalism, politics, and white supremacy are the reasons our society focuses on incarceration and punishment rather than on substance use treatment. She discusses how it’s easier to incarcerate people than it is to invest in treatment because investment requires time, money, and the dismantling of our current systems.Dr. James adds that reproductive justice and the rights to family, and having the resources and support to raise children have never existed for people of color and people experiencing poverty. Current-day familial structures reflect policies dating back to slavery, the forced displacement of Native Americans, and the way immigrant families have been treated. Today, the carceral system plays a pivotal role in modern-day eugenics and in reproductive and family control. Health Impacts on Children and Young Adults with History of Parental Incarceration & Juvenile Justice InvolvementDr. Heard-Garris explains that the health impacts that affect people who are incarcerated also impact children and adolescents with parents who have been incarcerated. This exposure to the carceral system negatively impacts the physical and mental health of these children and young adults and reduces their access to healthcare.She also reminds us that children with parents who are incarcerated are not doomed to poor outcomes. Many of these children and young adults are resilient and are still able to thrive. However, they should not have to undergo these adverse childhood experiences and traumas. The carceral system needs to be changed and these children need to be supported and have their healthcare and education needs met. Remedying the Health of Women and Children Impacted by the Criminal Legal SystemBoth Dr. James and Dr. Heard-Garris agree that the best way to remedy the health impacts of the carceral system is to incarcerate fewer people.Dr. James discusses changes that can be made if we assume the current carceral system will remain. We need a system, such as a single-payer healthcare system, that provides people with consistent access to high-quality care before, during, and after incarceration. Additionally, we should provide people who are incarcerated with better ways to communicate with their families. For healthcare specifically, it is important to believe people when they say they need care and provide them with access to trauma-informed care.Dr. Heard-Garris adds that a good place to start is to decarcerate people and offer them support. Additionally, we need to prevent incarceration by investing in communities and providing communities with resources, education, jobs, healthcare, etc. The goal is to create a society in which prisons and jails aren’t necessary because every person has what they need to survive.Practices Clinicians can Incorporate to Reduce the Impacts of Mass Incarceration on PatientsDr. James reminds us that no matter where we work or what specialty we work in, we will see people who are impacted by incarceration. As physicians and healthcare professionals, we should ask people about their histories of trauma and about the impact of incarceration on their lives. Additionally, we need to be cognizant of the ways we as providers enact a carceral state and think critically about the way these systems impact patient care.Dr. Heard-Garris encourages us to ask patients about their interactions with the carceral system. Asking these questions provides us with an opportunity to better care for our patients. It can allow us to offer more support systems to patients and to connect patients with resources that have worked for others. We also have to be aware of our power and privilege and recognize that we do not treat all our patients equitably in order to change and do better.ReferencesBlack Feminist Bioethics: Centering Community to Ask Better Questions. Hastings Cent Rep. 2022 03; 52 Suppl 1:S21-S23. James JE. PMID: 35470879.Race, Racism, and Bioethics: Are We Stuck? Am J Bioeth. 2022 03; 22(3):22-24. James JE. PMID: 35258424.Heard-Garris N, Sacotte KA, Winkelman TNA, Cohen A, Ekwueme PO, Barnert E, Carnethon M, Davis MM. Association of Childhood History of Parental Incarceration and Juvenile Justice Involvement With Mental Health in Early Adulthood. JAMA Netw Open. 2019 Sep 4;2(9):e1910465. doi: 10.1001/jamanetworkopen.2019.10465. PMID: 31483468.Heard-Garris N, Winkelman TNA, Choi H, Miller AK, Kan K, Shlafer R, Davis MM. Health Care Use and Health Behaviors Among Young Adults With History of Parental Incarceration. Pediatrics. 2018 Sep;142(3):e20174314. doi: 10.1542/peds.2017-4314. Epub 2018 Jul 9. Pediatrics. 2019 May;143(5): PMID: 29987170.Heard-Garris N, Johnson TJ, Hardeman R. The Harmful Effects of Policing—From the Neighborhood to the Hospital. JAMA Pediatr. 2022;176(1):23–25. doi:10.1001/jamapediatrics.2021.2936Heard-Garris, N., Boyd, R., Kan, K., Perez-Cardona, L., Heard, N. J., & Johnson, T. J. (2021). Structuring poverty: how racism shapes child poverty and child and adolescent health. Academic pediatrics, 21(8), S108-S116.Kaba, Mariame, et al. No More Police: A Case for Abolition. The New Press, 2022.Roberts, Dorothy. Torn Apart: How the Child Welfare System Destroys Black Families–and How Abolition Can Build a Safer World. Basic Books, 2022.Wilkerson, Isabel. Caste (Oprah’s Book Club): The origins of our discontents. Random House, 2020.Disclosures The hosts and guests report no relevant financial disclosures.CitationJames 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.Show Transcript 

https://clinicalproblemsolving.com/wp-content/uploads/2022/10/RLR-for-podcast_Syncope.mp3Reza discussed a mind-blowing case presented by RabihrlrCPSOLVERS.COMRLR have transitioned from Patreon to have their website rlrCPSolvers.comCheck out this virtual classroom full of bonus schemas, illness scripts, teaching videos and case challenges.Rlrcpsolvers.com

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 SanthoshDr. 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 StatusUCSF’s Equity in Assessment Guidelines and Checklist Download CPSolvers App herePatreon website

https://clinicalproblemsolving.com/wp-content/uploads/2022/10/Gabriel_10.4_RTP.mp3This 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. 

https://clinicalproblemsolving.com/wp-content/uploads/2022/09/9.29.22-SLS-RTP.mp3The 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 herePatreon website

In this episode, the hosts discuss a case involving a 68-year-old man with recurrent pancreatitis and jaundice. They cover the diagnosis and complications of acute pancreatitis, the clinical presentation and diagnostic approach for jaundice, the causes of liver dysfunction, and the challenges of diagnosing a pancreatic mass. They also reflect on the relationship between alcohol use disorder and pancreatic health.

https://clinicalproblemsolving.com/wp-content/uploads/2022/09/RLR-104_Nausea-2.mp3RLR discussing an intriguing case of nausea. Big newsRLR are ending their time on Patreon soon and hosting content on their own website.Stay tuned for more info. Download CPSolvers App herePatreon website

https://clinicalproblemsolving.com/wp-content/uploads/2022/09/9.08.22-Neuro-VMR-RTP.mp3We 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@RafameedRafael 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 herePatreon website

https://clinicalproblemsolving.com/wp-content/uploads/2022/09/ClinicalUnknown9_1_22RTP-1.mp3Dr. Rezigh presents a case of fever in a patient newly diagnosed with HIV to Dr. Woc-Colburn.Dr. Alec RezighAlec 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-ColburnDr. 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.SchemasHIV InfectionInfection in the inpatientRickettsiaDownload CPSolvers App herePatreon website