The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2022/06/6.23.22-Queer-Rounds-RTP.mp3Vale, 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.Download CPSolvers App here Patreon website

https://clinicalproblemsolving.com/wp-content/uploads/2022/06/6.16.2022-Wdx-RTP.mp3In 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) GaddeUttara (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

The hosts discuss a case of a 41-year-old man with symptoms of weight gain, malaise, and whole-body swelling. They explore the relationship between nephritic syndrome and staph bacteremia, the treatment duration for staphylococcus aureus bacteremia, and the evaluation and treatment of glomerulonephritis. They also talk about the approach to infection in the inpatient setting.

https://clinicalproblemsolving.com/wp-content/uploads/2022/05/ARM-EP-17_RTP.mp3 CPSolvers: Anti-Racism in Medicine SeriesEpisode 17 – ‘Just’ Births: Reproductive Justice & Black/Indigenous Maternal Health EquityShow Notes by Ayana WatkinsMay 31, 2022Summary: 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 ObjectivesAfter listening to this episode, learners will be able to…Understand the magnitude of disparities faced by Black and Indigenous birthing persons and how forces of structural racism created and perpetuate these inequitiesDefine Reproductive Justice and understand how clinicians can promote reproductive justice during pregnancy and birthAppreciate the importance of cultural reflexivity, community-centered initiatives, and midwifery and doula care in facilitating reproductive justiceRecognize 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 CreditsWritten 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 WatkinsHosts: Naomi F. Fields MD, Chioma Onuoha, and Victor A. Lopez-Carmen MPHInfographic: Creative Edge DesignAudio Edits: David Hu, MDShow Notes: Ayana WatkinsGuests: Dr. Joia Crear-Perry and Dr. Katy B. Kozhimannil Time Stamps00:00 Introduction03:57 Magnitude of maternal health disparities for Black & Indigenous birthing people09:31 Impact of guests’ identities and lived experiences on their work25: 30 Defining reprodutive justice29:42 Importance of community-centered initiatives and access to midwifery and doula care35:15 Impact of Climate and Land Injustice on maternal health inequities42:43 Role of family planning within reproductive justice58:00 Key takeawaysEpisode Takeaways: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. PearlsBlack 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 JusticeDr. 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 equityDr. 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 justiceDr. 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 intentionsDr. 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.ReferencesHardeman 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.12462Sable-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/0Bekkar 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.2020.8243Kozhimannil 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.2012.301201National Birth Equity Collaborative. Dr. Joia on BMHW & Why Black Women & Birthing People Are Experiencing Poor Outcomes | NBEC.; 2021. https://youtu.be/GPAlyT8tuhEImproving 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/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.pdfNational Birth Equity Collaborative. Injustice Anywhere: Why Climate Justice Is Reproductive Justice.; 2021. https://youtu.be/FhakcqNs_08Katy B. Kozhimannil, PhD, MPA. https://directory.sph.umn.edu/bio/sph-a-z/katy-kozhimannilHenning-Smith C, Kozhimannil KB. Missing Voices In America’s Rural Health Narrative. Health Affairs Blog. Published April 10, 2019. 10.1377/hblog20190409.122546National Birth Equity Collaborative. National Birth Equity Collaborative Annual Report 2020-2021. https://issuu.com/gafford/docs/nbec_2020-21_annual_reportHostetter M, Klein S. Restoring Access to Maternity Care in Rural America. Published online 2021. doi:10.26099/CYCC-FF50Hardeman 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.2019.100367Plain 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/Proujansky A. The black midwives changing care for women of color – photo essay. https://www.theguardian.com/society/2019/jul/24/black-midwives-photo-essayKozhimannil 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.12474The iEJ Project. What Is Indigenous Environmental Injustice?; 2018. https://youtu.be/kswUgZ2ctO4Lopez-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#bib0044Blakemore 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-enovidNorris L. Michigan and the ACA’s Medicaid expansion. Healthinsurance.org. https://www.healthinsurance.org/medicaid/michigan/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.2015.11.030Kenneth 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.CitationCrear-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 

https://clinicalproblemsolving.com/wp-content/uploads/2022/05/Schema-5.26-PreAu-RTP.mp3Sharmin, Ann Marie, and Jack discuss a fascinating case of back pain and granulomas presented by Dan.Schemas:Low Back Pain OverviewBony Back Pain OverviewGranuloma on HistopathBone LesionsAntibiotic FailureDownload CPSolvers App herePatreon website

https://clinicalproblemsolving.com/wp-content/uploads/2022/05/5.24.22_RLR_RTP.mp3RLR discussed an intriguing case of a chronic consolidationThank you to our dear friend and colleague Dr. Kelley Chuang for her help with the production of this episode. (You are a legend, Kelley!)  @kelleychuangTo listen to more RLR episodes, consider subscribing to Patreon: https://www.patreon.com/cpsolvers

Doug Pet, a neurology resident with a background in medical anthropology and jazz, presents a compelling case of slurred speech. He dives into the nuances of dysarthria and its neurological roots, emphasizing the importance of thorough patient history. Angelita Pusparani, a junior doctor from Indonesia, shares her insights on navigating complex symptoms in cancer patients, focusing on the interplay of ongoing treatments and neurology. The conversation highlights the need for a multidisciplinary approach in diagnosing and managing such intricate cases.

https://clinicalproblemsolving.com/wp-content/uploads/2022/05/ARM-EP-16_RTP.mp3CPSolvers: Anti-Racism in Medicine SeriesEpisode 16 – Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual MeetingShow Notes by Sudarshan KrishnamurthyMay 3, 2022Summary: 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 ObjectivesAfter listening to this episode learners will be able to:Understand the association of race with the utilization of security responses in hospital settingsUnderstand the association between the use of race in medical decision-making and beliefs regarding the etiology of racial differences in health outcomesUnderstand 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 communitiesCreditsWritten 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 WatkinsHosts: Sudarshan Krishnamurthy and Utibe R. Essien MD, MPHInfographic: Creative Edge DesignAudio Edits: David HuShow Notes: Sudarshan KrishnamurthyGuests: Drs. Yannis Valtis, Ebi Okah, and Carine Davila Time Stamps0:00 Introduction4:20 Context and background of Yannis’ project7:40 Framing of Ebi’s research11:25 Inspiration for Carine’s work14:50 Yannis’ explanation of his findings and potential next steps to intervene25:45 Results from Ebi’s research33:55 Carine’s findings from her work40:00 Audience QuestionsEpisode TakeawaysOur 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. ReferencesValtis 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.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.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.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.Ogunwole SM. Without Sanctuary. N Engl J Med. 2021 Mar 4;384(9):791-793. doi: 10.1056/NEJMp2030623.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.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.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: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.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.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.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.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.CitationValtis 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, 2022Show Transcript

https://clinicalproblemsolving.com/wp-content/uploads/2022/04/4.28.22_RLR_Dysuria_RTP-1.mp3Reza 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 Patreonhttps://www.patreon.com/cpsolvers 

https://clinicalproblemsolving.com/wp-content/uploads/2022/04/RTP-WDx-4.21.22.mp3Dr. 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” TengAlexandra “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 ButlerBlythe 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 Patreon website