The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2021/04/RTP_4.08.21-HDx-SS-Emory_Final-1.mp3Raha and Shub join #PrezSharmin to tackle a clinical unknown presented by CarlosDownload CPSolvers App herePatreon websiteWant to test your learning? Take our Episode Quiz Dr. AgrawalShub Agrawal is a PGY-2 at Emory’s J. Willis Hurst Internal Medicine Residency. She grew up in Athens, GA and attended New York University for undergraduate degrees in neuroscience and anthropology. She attended the AU UGA Medical Partnership for medical school where she first became passionate about medical education. She is currently doing medical education research about how to best use podcasts in UME and GME curriculum. She hopes to spend her career teaching and designing curriculum in academic medicine. Outside of medicine, she enjoys spending time with her family, friends and imagining all the trips she will take once it is safe to travel again! Dr. SadjadiRaha Sadjadi is a PGY2 internal medicine resident at Emory University School of Medicine. She grew up in the San Francisco Bay Area and attended UC Berkeley for undergrad. After spending her whole life in the Bay Area, she moved to Atlanta to complete medical school at Emory University. At Emory she pursued her passion for caring for underserved populations while rotating at Grady Hospital and she found wonderful mentors invested in her growth as a physician and human.  For these very reasons, she remained at Emory to complete her internal medicine residency. She is interested in transplant hepatology and in reducing healthcare disparities. Dr. RubianoCarlos Rubiano is an Inpatient Medicine chief at UNC Hospitals where he also completed his internal medicine residency training. Prior to moving to North Carolina with his wife with whom he couples matched with, he completed his medical school training at Florida State University and undergraduate training in Biology at Florida Gulf Coast University. In medicine, he has a particular interest in medical education and hopes to be a clinician-educator as a soon-to-be hospitalist and one day as an ID clinician. Outside of medicine he loves playing pickleball and invites everyone to try this booming sport. 

https://clinicalproblemsolving.com/wp-content/uploads/2021/04/April-HDx_RTP.mp3Eamonn and Ashley join Jack in tackling a clinical unknown presented by TravisTake our episode quiz hereEamonn MaherEamonn hails from Charleston, West Virginia. He attended Marshall University for medical school and is currently in his final year of Dermatology residency at SLU. He will complete a Complex Medical Dermatology fellowship at NYU next year and hopes to practice with a focus on cutaneous lymphomas, connective tissue diseases, and immunobullous disorders. Outside of work he enjoys jiu jitsu, playing soccer, and spending quality time with his wife. Ashley BoerrigterAshley Boerrigter is a third-year OBGYN resident at St. Louis University, where she will be Administrative Chief Resident for the 2021-2022 academic year. She attended medical school at the University of Kentucky and her academic interests include medically complex pregnancies and curriculum development. Hobbies include tennis, sailing, and alternating between beach sunning and mountain skiing. 

Guests Michelle Morse and Paul Farmer join the podcast to discuss global health equity amidst the COVID-19 response. They explore topics such as the US-centric approach to COVID-19, lessons from Haiti, addressing social supports, the impact of identity on anti-racism movements, decolonizing global health, and finding joy and hope in global solidarity.

Dr. Usha George, a Respiratory and General Medicine Physician, presents a complex case involving fever, cough, shortness of breath, swelling of lower limbs, and excessive thirst. The speakers discuss the investigation and diagnosis of Cushing Syndrome, reflect on lessons learned from challenging clinical cases, and analyze a case of excessive thirst and edemas.

Neurology expert Aaron Berkowitz joins the Clinical Problem Solvers team to discuss a case of unilateral sensory changes in a 19-year-old male. They explore possible causes, including changes after tick bites and discuss the diagnostic process for sensory loss and weakness.

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/RTP_Schema_Dysphagia_BST_FINAL.mp3The CPSolvers team breaks down a *bite-sized​* case of dysphagia.SchemaDownload CPSolvers App herePatreon websiteEpisode Quiz

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/WDx-Episode-8_RTP.mp3Sarah Onorato presents a case to Dr. Ann Marie Kumfer & Dr. Debra BynumWant to test your learning? Take our episode quiz hereDr Ann Marie Kumfer is a new residency graduate and academic hospitalist at UNC. After completing medical school at Texas Tech University, she moved up to North Carolina for residency. She liked UNC so much, she decided to stay as an academic hospitalist after completing residency in June. She also serves as a section editor for the Human Diagnosis project. She is passionate about diagnostic reasoning, teaching, and guacamole.Dr. Debra Bynum is the Director for the Internal Medicine Residency Program at the University of North Carolina. Originally from eastern North Carolina, she graduated from Davidson in 1990 with a degree in Biology and a focus on ecology and marine biology. From there, she came to Chapel Hill for medical school and stayed at UNC for residency training. After completing a year as Chief Resident, she joined the faculty at WakeMed hospital where she worked in the clinic caring for Raleigh’s underserved, attended on the inpatient service with UNC residents and students, and helped to found one of the first hospitalist programs in the area.After three years at WakeMed, she returned to UNC for further training as a fellow in the Geriatric Medicine program and was appointed to a faculty position in 2001. During the subsequent fourteen years, she held multiple leadership positions within the School of Medicine, the Department of Medicine, and the Geriatric Medicine Fellowship and Internal Medicine Residency programs. She directed the Acting Internship for senior students as well as co-directed the clinical skills course for second year students, served on the School of Medicine education committee, and helped to design, implement, and co-direct both a transition course for new third year students as well as a teaching elective for fourth year students. She served as the Program Director for the Geriatric Medicine Fellowship from 2008-2014 and was selected to lead the Internal Medicine residency program in May of 2014.Want to learn more about the Women in Diagnosis (WDx) series?

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/RTP_SLS_March_FINAL.mp3Jack presents a case of abdominal pain and hypotension to Steph and DanDownload CPSolvers App herePatreon websiteSchema 1Schema 2Episode Quiz

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/RTP_HDx_Lindsey_March_FINAL.mp3Lindsey, Kiara (#bossladies), and Scott discuss a clinical unknown presented by DevikaDownload CPSolvers App herePatreon websiteWant to test your learning? Take our episode quizScott WalkerScott Walker grew up in Knoxville, Tennessee (Go Vols) where he completed his Bachelors in Kinesiology and Nutrition. He currently attends The University of Central Florida College of Medicine as a third year medical student. He is interested in entering the field of Emergency Medicine and is passionate about medical education and medical mission trips. He spends his spare time watching The Office with his wife or weight lifting.Dr. Devika GandhiDevika Gandhi is a third-year internal medicine resident at Indiana University. She is originally from Dayton, Ohio and received her undergraduate degree from the University of Akron. She earned her medical degree from Northeast Ohio Medical University in Rootstown, Ohio (Go Walking Whales!). After residency she will be an incoming gastroenterology/hepatology fellow at Loma Linda University in California. During her free time, she enjoys reading, cooking, and going out to trivia with friends.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/ARM-EP-6-Manning-Corbie-Smith-FINAL-2_19_21-8.53-PM.mp3In Episode 6 of the Antiracism in Medicine series, “Racism, Trustworthiness, and the #COVID19 vaccine,” we are joined by two forces in the field of health equity and academic medicine, Dr. Giselle Corbie-Smith and Dr. Kimberly Manning, to discuss why the pandemic is the moment to ensure trust in medicine.Learning ObjectivesAfter listening to this episode listeners will be able to…Recognize the importance of yielding privilege and power to better center marginalized voices and communities through individual, interpersonal, institutional, and systemic actions.Understand the importance of looking beyond isolated and individual instances of mistrust, in recognition that the continued and ubiquitous insults of structural and systemic racism are the primary forces perpetuating mistrust among minoritized communities.Identify potential individual, institutional, and policy-level actions to address COVID-19 vaccine inequities.CreditsWritten and produced by: Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.EdHosts: Utibe, Lash, JennyInfographic: Creative Edge DesignShow Notes: Rohan KhazanchiGuests: Kimberly Manning MD (@gradydoctor) and Giselle Corbie-Smith MD, MSc (@gcsmd)Download Transcript Here Show Notes – Episode 6: Racism, Trustworthiness, and the COVID-19 VaccineRohan KhazanchiFebruary 23rd, 2021SummaryIn this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Dr. Kimberly Manning, Professor of Medicine and Associate Vice Chair for Diversity, Equity, and Inclusion at Emory University, and Dr. Giselle Corbie-Smith, the Kenan Distinguished Professor of Social Medicine and Director of the Center for Health Equity Research at University of North Carolina-Chapel Hill. We dig into Dr. Manning’s leading perspectives on trust in the Black community and Dr. Corbie-Smith’s longstanding community-engaged research agenda, and we discuss implications for ongoing discourse about COVID-19 vaccine equity. Timestamps00:00 Music/Intro1:25 Guest Introductions02:34 Reflecting upon the current “moment of hope” in the COVID-19 pandemic07:46 Why is Mistrust the “Tip of a 400-Year-Old Iceberg”?12:04 Getting to the Individual “Why” of Declining the COVID-19 Vaccine13:01 Is Mistrust the True Root Cause?16:28 Moving past our preconceptions about vaccine mistrust19:01 “When your immune system is knuckin’ and buckin’, it’s gonna be a little raucous!”22:43 Shifting our framing  from “vaccine hesitant” to vaccine deliberations27:58 Recognizing our biases, centering the margins, and avoiding diluted generalizations37:20 Valuing diversity rather than classifying minoritized groups as monoliths43:34 Why Dr. Manning chose to participate in the Moderna vaccine trial49:20 The “allostatic load” of the minority tax in a white supremacist system55:45 Performative advocacy and the “musical chairs” of representation in medicine58:12 The fallacy of the meritocracy59:10 What can health systems do to reduce vaccine disparities?1:06:20 Takeaways and conclusions1:08:51 OuttakesTakeawaysMedical Mistrust in the Black Community is More than Tuskegee Framing medical mistrust solely around watershed incidents like the U.S. Public Health Service Study of Untreated Syphilis at Tuskegee is harmful. It treats Black Americans as a monolith, when there is an enormous diversity and heterogeneity within the Black community. It treats mistrust as an isolated construct, when medical mistrust is intertwined with broader societal injustices. Lastly, our rhetoric often treats mistrust as an individual failing or “uninformed belief”, rather than a consequence of structural inequity.In contrast, scholarship and clinical care which acknowledges within-group differences and shifts from a deficit-based to an asset-based view of marginalized groups can help us better serve our minoritized patients. Dr. Manning reaffirmed what Dr. Camara Jones told us last episode– that solutions lie in simultaneously emphasizing the importance of individual humanity and value in “hard to reach” (hardly reached) communities and dismantling the structures which push those communities down.“Black Why’s Matter”“Simply telling people what to do doesn’t work on your children, and it doesn’t work on your patients.”  – Dr. Kimberly Manning Every person who declines a COVID-19 vaccine has a reason to do so which is theirs, and theirs alone. As clinicians, we need to slow down and demonstrate our willingness to hear the “why’s” of our patients, colleagues, neighbors, and community members. In particular, racial concordance is a key piece of doing this work; authentic communication styles from people who personally understand the needs of their community and can better help motivate a “slow yes” through shared decision-making.Addressing Racial Vaccine Inequities Requires Race and Community-Informed SolutionsThis pandemic has highlighted a faultline between public health and medicine. Crossing that breach must involve organizing with faith-based and community-based organizations, community health workers, and beyond. Geographically-based interventions need to prioritize individuals from those communities, rather than allowing outsiders to take designated slots. Scapegoating mistrust can no longer be an excuse for not meeting people where they are and addressing longstanding, long-understood barriers.Pearls Reframe “Vaccine Hesitancy” as “Vaccine Deliberations”“Vaccine hesitancy” is a symptom of a larger, chronic issue about the way Black and Brown people are treated in the United States. Yet, our narrow focus on the individual drives us to assign blame to those who decline a vaccine as “hesitant” or “distrusting” when there are a plurality of reasons why. Deliberating on big decisions is quite normal, especially when the lived experiences of individuals in historically marginalized groups inform their reasonable apprehension about inequities in U.S. systems writ large.Minority Tax and the “Musical Chairs” of Representation in Medicine“My taxation is not without representation… [musical chairs] is all fun and games until somebody has to give up their seat. If everything has been built on privilege, you have to be willing to give something up” – Dr. Kimberly ManningDr. Manning presented an analogy to us about a game of musical chairs, in which everyone is happy to participate and speak up for marginalized groups until the music stops and only one seat is left. Minoritized clinicians and researchers face the allostatic burden of stepping up to fix a broken system designed within a white supremacist culture. Performative activism only goes so far; when our colleagues with privilege aren’t willing to give up that power, the needle doesn’t get moved.“I’m not interested in changing hearts and minds; I’m interested in seeing behavior change and changes in policies, practices, and norms.”  – Dr. Giselle Corbie-Smith References Mentioned08:14Manning KD. More than medical mistrust. The Lancet. 2020 Nov; 396(10261): 1481-1482. doi:10.1016/S0140-6736(20)32286-8.13:01Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002 Nov 25;162(21):2458-63. doi: 10.1001/archinte.162.21.2458. PMID: 12437405.32:18Corbie-Smith G, Miller WC, Ransohoff DF. Interpretations of ‘appropriate’ minority inclusion in clinical research. Am J Med. 2004 Feb 15;116(4):249-52. doi: 10.1016/j.amjmed.2003.09.032. PMID: 14969653.33:56Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002 Nov 25;162(21):2458-63. doi: 10.1001/archinte.162.21.2458. PMID: 12437405.Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999 Sep;14(9):537-46. doi: 10.1046/j.1525-1497.1999.07048.x. PMID: 10491242; PMCID: PMC1496744.39:42Wilkerson, I. (2020). Caste: The origins of our discontents.59:10Corbie-Smith, G. “A Different Kind of Leader” Podcast. Retrieved from https://adifferentkindofleader.buzzsprout.com/  Additional References Sengupta S, Corbie-Smith G, Thrasher A, Strauss RP. African American elders’ perceptions of the influenza vaccine in Durham, North Carolina. N C Med J. 2004 Jul-Aug;65(4):194-9. PMID: 15481486.Quinn SC, Jamison A, An J, Freimuth VS, Hancock GR, Musa D. Breaking down the monolith: Understanding flu vaccine uptake among African Americans. SSM Popul Health. 2017 Nov 14;4:25-36. doi: 10.1016/j.ssmph.2017.11.003. PMID: 29349270; PMCID: PMC5769118. DisclosuresThe hosts and guests report no relevant financial disclosures. CitationManning 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. https://clinicalproblemsolving.com/episodes. February 23, 2021.