The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/RTP_ConsultQuestion_Murphy_Episode1_FINAL.mp3We kick off our new series, “The Consult Question”, aimed at highlighting the clinical reasoning of our subspecialty colleagues, with a case of hypoglycemia presented to master endocrinologist Dr. Elizabeth Murphy.SchemaEpisode QuizDr. Elizabeth MurphyDr. Elizabeth Murphy is a professor of Medicine at the University of California, San Francisco, where she serves as the Deborah Cowan Endowed Professor of Endocrinology and chief of the Endocrinology and Metabolism Division at Zuckerberg San Francisco General Hospital.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/RTP_Feb_NeuroVMR_FINAL.mp3We continue our mission to #EndNeurophobia with an episode of Neurology VMR with Dr. Aaron Berkowitz Download CPSolvers App herePatreon websiteEpisode QuizDhruv SrinivasacharDhruv Srinivasachar is a 4th year medical student at Virginia Commonwealth University School of Medicine (the Medical College of Virginia for all the veteran attendings out there). Introduced to medicine through research, Dhruv has shifted his passions to empathetic clinical care and medical education, as a contributor to the CPSolvers (especially through VMR as a case presenter, discussant, and compiler of cases) and team member for the Not Just Little Adults podcast (CPedsSolvers, if you will). When he’s not interviewing for Med-Peds residency, he can be found biking around Richmond, VA, gardening, and cooking.Elena VastiElena Vasti is a second-year resident at Stanford in the Department of Internal Medicine. She attended UC Davis to study Human Development and Exercise Biology and went on to UCLA Fielding School of Public Health to complete an MPH in Epidemiology and Community Health Sciences. She decided to switch careers to pursue clinical medicine and matriculated at UCSF School of Medicine in 2015. She enjoys running every day, analyzing movie trailers and both listening to and joining the CPSolvers any chance she gets! She plans to pursue a career in academic cardiology.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/2_11-BST-Mode-Thyrotoxicosis-RTP-online-audio-converter.com_.mp3Rabih, Reza, PrezSharmin, and Arsalan break down thyrotoxicosis, by revisiting a case initially presented at our December 18th VMR.SchemaPatreon websiteDownload CPSolvers App hereEpisode Quiz

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/WDx-Episode-7_RFP-1.mp3Maani, Priyanka, and Lindsey discuss a clinical unknown with Dr. Jori May.Want to test your learning? Take our episode quiz hereDr. Jori MayJori May, MD, is Assistant Professor of Medicine in the Division of Hematology/Oncology at the University of Alabama at Birmingham (UAB).  Her clinical interest is non-malignant hematology, focusing on the care of patients with thrombosis and coagulation disorders.  Additionally, she focuses on systems-based hematology, which works to improve hematologic care delivery across health systems.  Dr. May earned her M.D. from Washington University School of Medicine in St. Louis. She completed her residency, chief residency, and fellowship in Hematology/Oncology at UAB. Want to learn more about the Women in Diagnosis (WDx) series?Blog post– by Smitha

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/RTP_HDX_1.28_DanMinter_FINAL.mp3Mansour presents a case of sudden vision loss to Dan, Erica, and Kristin. Download CPSolvers App herePatreon websiteSchema 1Schema 2Want to test your learning? Take our Episode QuizDr. Erica Smith Erica Smith is a fourth year Internal Medicine-Pediatrics resident at the University of Michigan. She is from Detroit, MI and attended Wayne State University School of Medicine for medical school. She is planning to pursue a career in hospital medicine. In her free time, she enjoys golf, yoga, and hiking. Dr. Mansour AlkhunaiziMansour Alkhunaizi went to the Royal College of Surgeons in Ireland for medical school and is currently an Internal Medicine Resident at Baylor College of Medicine. He is interested in a career in pulmonary/critical care medicine. Outside of work, he enjoys hiking, working out, and watching his favorite soccer team Manchester United! Dr. Kristin AndresKristin Andres is currently a third year Internal Medicine-Pediatrics resident at the University of Michigan. She grew up in Lexington Kentucky and attended the University of Kentucky for both undergraduate and medical school. She hopes to pursue Pediatric Cardiology fellowship with a career goal of optimizing transitional care for patients with congenital heart disease.   Outside of the hospital, Kristin enjoys musical theatre, pub-style trivia, making ice-cream, and snuggling on the couch with her husband Andrew and dog Nutmeg.

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/RTP_HDx_Sharmin_1.26.21_FINAL.mp3Dr. Sabal presents a case of bilateral wrist pain to Sharmin, Dr. Davey, and Dr. Singh. Download CPSolvers App herePatreon websiteWant to test your learning? Take our episode quiz hereDr. Sonya DaveySonya Davey attended medical school at the Perelman School of Medicine at the University of Pennsylvania and is currently an Internal Medicine PGY-1 at Brigham & Women’s Hospital. She loves to travel, read, and enjoy meals with family and friends.Dr. Nicky SinghNicky Singh attended medical school at the Perelman School of Medicine at the University of Pennsylvania and is a current PGY-3 resident at Massachusetts General Hospital. As a resident, he has been involved with several educational initiatives, including co-leading the Residents in Medical Education interest group and the Point of Care Ultrasound group and serving as an Education Council representative and Simulation Program Chief. He is interested in cardiology and medical education. Outside of medicine, he enjoys hiking, South Asian dance, exploring new recipes with his Instant Pot, and trying to up his Peloton numbers.Dr. Aaron SabalAaron is currently a PGY-3 at Mercy Health Muskegon aspiring for a career in hospital medicine. He was born and raised in Westland, MI (Detroit metro area) and went to Wayne State University for his undergraduate studies thinking he would be a physical therapist, massage therapist, and dietitian (yes, all three of those). However, one week prior to starting a massage therapy program, he had an epiphany and decided to go to medical school instead. He was fortunate to be accepted at MSUCOM and fell in love with Internal Medicine. His passions include all things medical. In particular, he is passionate about medical education, how best to help physicians learn, diagnostic reasoning, and creating an environment of learning where no one is afraid to express what they’re thinking. When he is not pursuing his love of learning, he is spending time with his wife and their boys (2 cats and a dog), playing with his animals, preparing to be a father to his soon-to-be-born son, crossfitting, doing DIY home-improvement projects, exploring national parks, or reading good nonmedical fiction with a cat or dog in his lap begging for his love and attention.

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/ARM-EP-5-Racism-Power-and-Policy.mp3In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Aletha Maybank MD, MPH, the American Medical Association’s (AMA) inaugural Chief Health Equity Officer and director of the AMA’s Center for Health Equity, and Camara Jones MD, PhD, MPH, thought leader in the fields of health equity and public health and former president of the American Public Health Association (APHA). We discuss policy, professional organizations, and history as they relate to advancing health equity, and imagine what the anti-racist health system of the future looks like. Learning ObjectivesAfter listening to this episode listeners will be able to…Recognize that racism is both structural and interpersonal, and that both aspects must be addressed simultaneously.Appreciate the importance of acknowledging history and sustaining institutional memory in advancing anti-racism efforts and achieving structural change.Understand that collective action and a focus on community, rather than individualism, are most effective in combating racism and achieving health equity.CreditsWritten and produced by: Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS,  Utibe R. Essien, MD, MPH, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.EdHosts: Rohan Khazanchi, LaShyra Nolen, Naomi FieldsInfographic: Creative Edge DesignShow Notes: Chioma Onuoha Guests: Aletha Maybank MD, MPH, (@DrAlethaMaybank) and Camara Jones MD, PhD, MPH (@camarajones)Download Transcript HereEpisode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the FutureShow NotesChioma OnuohaTimestamps00:00 Music/Intro01:14 Guest Introductions03:09 Framing Racism 05:15 Allegory: Cement Dust in Our Lungs 07:00 The AMA’s Declaration on Racism as a Public Health Threat 13:28 History and the AMA and APHA Movements 15:20 Barriers to Achieving Health Equity in Medicine 20:55 Documenting, Centering, and Institutionalizing “The Work” 23:30 The AMA’s Racist Past 31:00 How Do We Create Sustainable Work? 35:25 Creating and Maintaining Urgency 39:00 Racism Saps the Strength of the Whole Society 43:43 Building an Anti-Racism Health Care System from A Grassroots Level52:15 Building an Anti-Racism Health Care System from A Governmental Level 53:45 Health is Not Created with the Health Sector 56:53 Why Must All Health Workers Practice Anti-racism? 1:05:57 Outtakes TakeawaysName Racism for What It IsIf we don’t explicitly say the word racism, and identify its historical context,  then we are complicit in its denial.  Racism denial is deeply ingrained in our society and it needs to be called out and recognized as a system in order to be addressed. Though the field of medicine often fails to think systematically, it is imperative that all healthcare workers learn to recognize racism, actively practice anti-racism, and acknowledge the many systems that impact people and community’s health.Four Key Messages for Naming Racism: Racism ExistsRacism is a SystemRacism Saps the Strength of the Whole SocietyWe can Act to Dismantle RacismHistory and Documentation are Key Our country habitually denials racism by working to make its impacts invisible. Remembering history and collecting institutional memory avoids the danger of repeating work, wasting labor, and makes clear racism’s long standing effects. Part of this effort also includes learning the history of the organizations and institutions we are a part of. Focus on the Community While the health sector is where illness and ailments are often treated, a person’s health largely manifests outside of the health sector and is impacted by their community and environment. One of the biggest barriers to health equity is the narrow focus on the individual and a failure to see health as a widespread community issue. We must recognize that all policy is health policy and that which affects someone outside of the health sector may also affect their health. Our future should be grounded in our communities; our solutions cannot solely be declarative or institution-driven.Pearls Barriers to Achieving Health Equity Narrow focus on the individual – makes systems and structures invisible or irrelevantWe as a nation are ahistorical – we need to bring history into the fold Our endorsement of the myth of meritocracy – the uneven playing field White supremacist ideology To learn more, read about  Dr. Jones’ Seven Values Targets for Anti-Racism ActionInstitutionalizing Anti-Racism A movement can disappear as quickly as it arose if it is not institutionally ingrained. This means that anti-racism must be embedded into practice, performance standards and institutional culture. All policies, decisions, and behaviors should occur through the lens of anti-racism in order for its impact to be longstanding and effective. The Power of Collective Action “When we acknowledge each other’s work we acknowledge the power of collective action” – Dr. Camara Jones Addressing structural racism is a collective effort and is more effective when we shift from “what can I do” to “what can we do”. When we lift up our peers and validate/center the work of people on the margins, we recognize the power of collective action and ensure that efforts are not erased or lost. This includes recognizing the experts that have come before us and reaching out to younger generations.Addressing Structures and Values Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks. In order to address racism, we must address both the structures and the values. Structures include the ways that racism is institutionalized and systematically reinforced, and values include the way that racism manifests in our shared consciousness. Addressing values will require us to make clear that “racism saps the strength of the whole society” and to highlight the urgency of anti-racism efforts. Additionally, we should equip educators, parents, and those who will guide the next generations with the tools to operate within the framework of anti-racism. Because structural racism often operates through inaction and complacency, the work to combat it must be persistent and collective. Racism hurts all people and achieving anti-racism will require active “fellows in the struggle” not just feeling allies. References Mentioned01:55Jones, C. Camara Jones, Allegories on race and racism | Camara Jones | TEDxEmory. [Video]. YouTube. https://www.youtube.com/watch?v=GNhcY6fTyBM&ab_channel=TEDxTalks. Published June 10, 2014. Accessed January 11, 2021.03:55Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.16:20Jones, CP. (2020). Seeing the Water: Seven Values Targets for Anti-Racism Action. Harvard Medical School Primary Care Blog. Retrieved from http://info.primarycare.hms.harvard.edu/blog/seven-values-targets-anti-racism-action 27:17Berney, B., & Friedman, R. (Producers), & Burnett, C., Loewenthal, D. (Directors). (2018). Power to Heal: Medicare and the Civil Rights Revolution. Retrieved from https://www.blbfilmproductions.com/ 28:55Baker, RB., et al. Creating a segregated medical profession: African American physicians and organized medicine, 1846-1910. J Natl Med Assoc. 2009 Jun;101(6):501-12. doi: 10.1016/s0027-9684(15)30935-4. PMID: 19585918.Washington, HA., et al. Segregation, civil rights, and health disparities: the legacy of African American physicians and organized medicine, 1910-1968. J Natl Med Assoc. 2009 Jun;101(6):513-27. doi: 10.1016/s0027-9684(15)30936-6. PMID: 19585919.Additional References Boyd RW, Krieger N, Jones CP. In the 2020 US election, we can choose a just future. Lancet. 2020;396(10260):1377-1380. doi:10.1016/S0140-6736(20)32140-1Crear-Perry J, Maybank A, Keeys M, Mitchell N, Godbolt D. Moving towards anti-racist praxis in medicine. Lancet. 2020;396(10249):451-453. doi:10.1016/S0140-6736(20)31543-9Ford CL, Airhihenbuwa CO. The public health critical race methodology: praxis for antiracism research. Soc Sci Med. 2010 Oct;71(8):1390-8. doi: 10.1016/j.socscimed.2010.07.030. Epub 2010 Aug 11. PMID: 20822840.Jaffe S. Aletha Maybank: AMA’s Chief Health Equity Officer. The Lancet. 2020;395(10242):1963. doi:10.1016/S0140-6736(20)31408-2Jones CP, Holden KB, Belton A. Strategies for Achieving Health Equity: Concern about the Whole Plus Concern about the Hole. Ethn Dis. 2019;29(Suppl 2):345-348. doi:10.18865/ed.29.S2.345Jones CP, Jones CY, Perry GS, Barclay G, Jones CA. Addressing the social determinants of children’s health: a cliff analogy. J Health Care Poor Underserved. 2009;20(4 Suppl):1-12. doi:10.1353/hpu.0.0228Jones CP. Allegories on “Race,” Racism, and Antiracism. 2019. Accessed December 7, 2020. https://www.radcliffe.harvard.edu/video/allegories-race-racism-and-antiracism-camara-phyllis-jonesJones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22. Jones CP. Overcoming Helplessness, Overcoming Fear, Overcoming Inaction in the Face of Need. Am J Public Health. 2016;106(10):1717. doi:10.2105/AJPH.2016.303406Jones CP. Systems of Power, Axes of Inequity: Parallels, Intersections, Braiding the Strands. Medical Care. 2014;52:S71. doi:10.1097/MLR.0000000000000216Jones CP. Toward the Science and Practice of Anti-Racism: Launching a National Campaign Against Racism. Ethn Dis. 2018;28(Suppl 1):231-234. doi:10.18865/ed.28.S1.231Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.Jones, CP [@CamaraJones]. (2020, Nov 28). My map with the 28 states (in red) with at least one city/county/state-level body declaring “Racism is a public health crisis.” Each state name is followed by the number of jurisdictions making these declarations. State name is in CAPS if there is a state-level declaration. [Tweet]. Twitter. https://twitter.com/CamaraJones/status/1332729107952627712?s=20Maybank A. A Historic Day For Black Women, A Historic Day For The American Medical Association. Essence. Published November 18, 2020. Accessed December 7, 2020. https://www.essence.com/lifestyle/health-wellness/black-women-american-medical-association-racism/Maybank A. The Pandemic’s Missing Data. The New York Times. https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Published April 7, 2020. Accessed December 7, 2020.Metzl JM, Maybank A, De Maio F. Responding to the COVID-19 Pandemic: The Need for a Structurally Competent Health Care System. JAMA. 2020;324(3):231-232. doi:10.1001/jama.2020.9289O’Reilly KB. AMA: Racism is a threat to public health. American Medical Association. Published November 16, 2020. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-healthPrioritizing Equity video series. American Medical Association. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/prioritizing-equity-video-seriesDisclosuresDr. Maybank is the AMA’s Chief Health Equity Officer and director of the Center for Health Equity. Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education. The views presented herein represent their own and not necessarily those of the AMA. The hosts and guests report no other relevant financial disclosures.CitationJones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D,  Essien UR, Khazanchi, R. “Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. January 19, 2021.  

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/Clinical-Unknown-Armitage_RTP.mp3Dr. Dayyan Adoor and Dr. Keith Albrektson present a clinical unknown case to Dr. ArmitageDownload CPSolvers App herePatreon websiteWant to test your learning? Take our episode quiz hereDr. Dayyan AdoorDayyan Adoor is a 2nd year internal medicine resident at Case Western Reserve/University Hospitals. Following residency, he hopes to pursue a fellowship in Gastroenterology! In his free time, he likes to spend his time outdoors, often exploring the beautiful parks in Cleveland, and lately, learning how to ski!  Dr. Keith ArmitageDr. Keith Armitage is a professor of medicine in the division of infectious diseases at the Case Western Reserve University School of medicine. He is also the program director for the internal medicine residency at the Case Western Reserve/University hospitals internal medicine residency program where he is currently serving his 29th year as program director. In his free time Dr Armitage enjoys cheering on his beloved Arsenal Football Club and spending time with his wife and three daughters.  Dr. Keith Albrektson Keith Albrektson is a current chief resident at the Case Western Reserve/University hospitals internal medicine residency where he completed his internship and residency in internal medicine. Following his chief year he will be continuing his training in pulmonary and critical care at the University of New Mexico Medical Center.  

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/RTP_JanNeuroVMR.mp3Our campaign to #EndNeurophobia continues with a neuro VMR featuring one of our favorite chief complaints, AMS!Download CPSolvers App herePatreon websiteSchemaWant to test your learning? Take our Episode QuizKaitlyn ThomasKaitlyn Thomas is a 3rd year medical student at Lake Erie College of Osteopathic Medicine at their Seton Hill campus in Greensburg, Pennsylvania. She is interested in medical education, advocacy and assisting underserved populations. She has contributed to the CPSolvers on Virtual Morning Report on several occasions and produced a few videos for their illness scripts. In her free time, she enjoys hiking, spending time with family, and finding new recipes to cook.Ninad BhatNinad Bhat is a third-year medical student at UCSF. He has always been fascinated by communication and the brain, seeking to combine his interests by becoming a neurologist involved in medical education. In his free time, he writes poetry and works to keep his obligatory medical student plants alive. Andrew LevyAndrew Levy is a 4th-year medical student at the University of Colorado SOM applying to Family Medicine with interests in Primary Care, Global Health, and Population Health. After taking a year off to help implement a WHO educational community-based first aid response program, he is now pursuing further public health training through UCSF in Implementation Sciences. He has been a fan of CPSolvers since being turned onto it, as well as the general topic of diagnostic reasoning, through Juan Lessing, an IM attending at the University of Colorado Hospital. In his free time, he enjoys exploring the great outdoors with his wife, Emily a fourth-year medical student at RVU in Colorado, and their three dogs Layla, Jade, and Avalanche.

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/RTP_-Glomerulonephritis-Schema-Epidose-online-audio-converter.com_.mp3Sharmin, Rabih, Reza, and Arsalan tackle a schema for glomerulonephritis Patreon websiteDownload CPSolvers App hereSchemaWant to test your learning? Take our Episode Quiz