The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/Episode127-VMR-111-9-29-20-4.10-PM.mp3Episode DescriptionDr. Rencic and Colin presents a clinical unknown on Virtual Morning Report to CPSolvers, Rabih and Reza.Download CPSolvers App herePatreon websiteSchema 1  Schema 2 WhiteboardWant to test your learning?Take our Episode Quiz here.

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/WDx-Episode-3_FINAL.mp3Zari Zahra, Mel Fellay, Lindsey, Emma, and Sharmin discuss gender biases through stories.Want to learn more about Women in Diagnosis (WDx) series?Blog post– by SmithaDownload CPSolvers App herePatreon websiteMelanie FellayMelanie Fellay is the CEO and Co-Founder of Spekit, the leading in-app learning and digital enablement companion that helps employees learn their tools and navigate process changes by accessing training resources in real-time, everywhere they work. Founded in 2018, Melanie and co-founder and former colleague, Zari Zahra, created Spekit to address the pain points they felt around driving adoption and continuous training that many Enablement and Operations leaders feel as well by bringing the sophistication of a modern digital adoption platform with the simplicity of a contextual knowledge base.She’s a Salesforce and BizOps enthusiast with expertise in leading operations and success teams, thinking at scale and architecting Salesforce solutions. In her role, Melanie oversees the sales, marketing, customer success, and corporate development teams at Spekit. Melanie graduated from the University of Colorado, Boulder with a degree in Accounting & Finance. In her free time, Mel enjoys seeing Odesza at Red Rocks, exploring less-traveled corners of the earth and escaping it all through meditation.Zari ZahraZari is a Pakistani-American Harvard MBA, an experienced Product Manager and builder of web and mobile apps for Pandora, SquareTrade, RealtyShares and Rakuten. Today, she is the Chief Product and Technology Officer and Co-founder of Spekit, the leading Salesforce adoption and contextual learning platform for growing orgs. Zari oversees all product and engineering departments, including a team office located in Karachi, Pakistan. In her free time, Zari spends time listening to audio books and spending time with her husband and mini-goldendoodle Rumi.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/HDx-Sept-AD-Final.mp3Dr. Varun Phadke presents a human dx case to Arsalan, Francesca Siegel, and Alec Yu.Download CPSolvers App herePatreon websiteSchemaWant to test your learning?Take our Episode Quiz here.Francesca SiegelFrancesca Siegel is a third year medical student at The Ohio State University College of Medicine. She received her masters in Nutritional Sciences from the University of Cincinnati. She’s passionate about preventive medicine, effective science communion, public health, and serving her community. Outside of her school work, she enjoys volunteering with Clinica Latina, OSU’s Hispanic free clinic, running with her husband, travel, and cooking.Alec YuAlec is medical student at the University of British Columbia in Vancouver, Canada. Prior to med school, he’s worked as an innovation officer at one of Vancouver’s tertiary care hospitals, and has served as a director and co-founder of a non-profit organization supporting youth engagement with humanitarian issues. A passionate problem-solver, Alec loves combining his interests with his lived experiences to start grassroots initiatives in his community. His current projects include investigating improvements to medical respite care for patients facing homelessness, and designing solid waste reduction strategies for improved hospital sustainability. On his down time, he loves cooking, running, and trying not to kill his plants.Varun PhadkeVarun Phadke is an Assistant Professor in the Division of Infectious Diseases at the Emory University School of Medicine. He is involved in microbiology and infectious diseases education for medical students, residents, and fellows, and his scholarly interests include subspecialty clinical reasoning and diagnostic error. He loves cooking, reading mystery novels, and spending time with his wife and son.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/HDx-Sept-SS-final.mp3Episode DescriptionDr. Joshua Inglis presents a Human Dx case to Sharmin, Vivek Nair and Joshua Morris.Human Dx Case LinkDownload CPSolvers App herePatreon websiteSchemaWant to test your learning?Take our Episode Quiz here.Joshua MorrisJosh is a proud cat dad to four kitties and a fourth year student at Dell Medical School applying Medicine-Pediatrics. He spent his third year doing an MA in design that cemented his passion for using creativity and innovation to better deliver care and information to patients and providers. In his spare time, he is active on MedTwitter (#MP4L), loves to run and be outside, and is obsessed with podcasts and audiobooks.Vivek NairVivek Nair is a second-year medical student at the University of Chicago Pritzker School of Medicine. He spent his undergraduate years at the University of Michigan. He is an avid runner and has been recently practicing his culinary skills (just in case medicine doesn’t work out).Joshua InglisDr Josh Inglis is an aspiring General Physician training at the Royal Adelaide Hospital. He obtained his medical degree from the University of Adelaide and is studying towards a Masters of Clinical Education. His academic interests include clinical reasoning, drug allergy and the electronic health record. Outside of work he enjoys playing tennis, brewing specialty coffee and walking his golden retriever.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/RLR-19_Vulvar-Pain-.mp3Episode descriptionReza and Rabih tackle a case of Vulvar Pain.More about the RLR series here.Want to test your learning?Take our Episode Quiz here.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/WDx_Episode2_StephSherman_FINAL-2-1.mp3Dr. Steph Sherman, Lindsey, Emma, and Sharmin tackle a case presented by AnnaWant to learn more about Women in Diagnosis (WDx) series?Blog post– by SmithaWant to test your learning?Take our Episode Quiz here.Dr. Steph ShermanDr. Stephanie Sherman is a hospitalist and residency associate program director at Baylor College of Medicine (BCM) who rounds at Ben Taub General Hospital and Houston’s VA hospital. She went to medical school at the University of Michigan and did internal medicine residency at Massachusetts General Hospital. She spends her free time with her husband, fellow clinical problem solver Zaven Sargsyan, and their ever-more-mobile 8-month-old son.Associated SchemaProblem RepresentationA 35-year-old man with advanced HIV/AIDS complicated by a recent diagnosis of Pneumocystis pneumonia and cytomegalovirus esophagitis presented with progressive fevers, dyspnea, and worsening pulmonary infiltrates in the weeks after starting antiretroviral therapy. SchemasThe CPSolvers’ schema for dyspnea highlights the relative importance of the pulmonary and cardiovascular systems before considering other etiologies.DiagnosisThe patient was found to have extensive bilateral consolidations on computed tomography of the chest. Laboratory evaluation demonstrated an elevated alkaline phosphatase, an increase in his CD4 count from 22 to 43 per cubic millimeter, and a reduction in his HIV viral load from > 1 million to 3000 copies. Ultimately, a respiratory culture from his prior admission grew Mycobacterium avium complex, raising the question of whether direct infection with this pathogen or an inflammatory reaction to it in the setting of immune reconstitution could account for his clinical deterioration.Teaching pointsMycobacterium avium complex (MAC) is the most common of the nontuberculous mycobacteria (NTM) that acts as a human pathogen. Clinical manifestations are varied, most typically presenting as a chronic pulmonary infection in immunocompetent individuals and either localized (e.g., affecting the lymph nodes or other focal sites) or disseminated infection in immunocompromised patients (especially those with HIV infection). In the early HIV epidemic, disseminated MAC was the most common bacterial opportunistic infection and conferred significant morbidity and mortality even with treatment.The immune reconstitution inflammatory syndrome (IRIS) is a potential complication of antiretroviral therapy (ART), wherein patients with advanced immunosuppression related to HIV develop an inflammatory response (generally to microbial antigens) as their immune system recovers. The two main types of IRIS are (1) paradoxical IRIS, in which a patient with a known opportunistic infection on appropriate therapy appears to deteriorate clinically after starting ART, and (2) unmasking IRIS, in which a previously silent opportunistic infection becomes clinically apparent due to the newly present immune response. IRIS to MAC most commonly presents with peripheral lymphadenitis, pulmonary-thoracic manifestations, or intra-abdominal findings.Female physicians face many challenges in the clinical environment. Among the most frequently experienced microaggressions is “role misidentification,” or incorrect identification of an individual’s contribution to the health care team (e.g., assuming a female physician is a nurse). It has been suggested that frequent role misidentification (both on the part of patients as well as other healthcare team members) can lead to anxiety and a loss of sense of professional credibility among female trainees.A pilot study recently demonstrated that distribution of new staff badges with the occupational title prominently displayed (i.e., reading “Doctor”) led to a significant improvement in role identification.Additionally, others have suggested that a more deliberate use of professional titles (i.e., introducing female physicians as “Dr. X”) may also serve to combat stereotype threat and role misidentification. 

https://clinicalproblemsolving.com/wp-content/uploads/2020/08/post-aup-racism-police-violence-and-health.mp3We invite scholars and antiracism activists, Drs. Rhea Boyd and Rachel Hardeman, to discuss the meaning of structural racism, the health impacts of police violence, the “say her name” movement, and the ways we can ensure our country’s current antiracist movement grows beyond a moment.Learning ObjectivesAfter listening to this episode learners will be able to…Define structural racismUnderstand how police violence is a social determinant of healthExplore the relationship between policing and healthcareExplore and employ strategies to dismantle structural racism in clinical practice  CreditsWritten and produced by: Naomi Fields, Rohan Khazanchi, LaShyra Nolen, Michelle Ogunwole, MD, Chioma Onuoha, Dereck Paul, MS, and Utibe R. Essien, MD, MPH Hosts: Dereck Paul, MS, Utibe R. Essien, MD, MPH, Michelle Ogunwole, MDShow notes: LaShyra NolenWritten & Produced By: Michelle Ogunwole, MD, Naomi Fields, Rohan Khazanchi, LaShyra Nolen, Chioma Onuoha, Dereck Paul, MS, and Utibe R. Essien, MD, MPHInfographic: Creative Edge DesignGuests: Rachel Hardeman PhD, MPH (@RRHDr) and Rhea Boyd MD, MPH (@RheaBoyd) Download Transcript Here CPS-Anti-Racism Show Notes Episode 1August 26, 2020By LaShyra Nolen Time Stamps 00:00 Music/intro 01:00 Our mission and vision01:50 Introduction to the Antiracism in Medicine team 02:55 Introduction of Dr. Boyd and Dr. Hardeman04:30 Defining structural racism 10:30 Dr. Boyd’s Lancet piece on the history of police violence12:00 Police violence, communities, and health outcomes15:00 Dr. Hardeman on police brutality and a public health agenda24:00 Understanding this moment (COVID-19 and George Floyd) 29:00 The #SayHerName campaign and police brutality’s effects on women 33:00 Emmett and Mamie Till 44:00 Policing in healthcare settings54:00 What can we start doing tomorrow? 56:00 Conclusion and outro  Episode Takeaways“First do no harm and while you’re doing no harm, learn as much as you can.” -Dr. Rhea Boyd. Practitioners who benefit from the racist power structures existent in America must examine the ways they benefit from or ignore racism in their workspaces and beyond. Then we must all commit to dismantling racism with tangible policy change.TraineesWe encourage trainees to reflect on the ways they have been socialized to learn and think about racism in our country. Trainees may use this foundation to question how this might impact their medical education and think about this educational legacy may be reformed through curricular and structural changes at their institutions. FacultyRegardless of specialty or field, it is important all educators and clinicians do the work of understanding how racism is pervasive within their respective areas of expertise. This starts with self-education and a commitment to speak up when blatant examples of racism come up in the work space and beyond. Pearls Defining Structural RacismStructural racism is a term that acknowledges that racism is perpetuated beyond individual interactions and interpersonal racism, but is present in the systems and policies that govern our everyday lives. These policies and decisions are often rooted in a historical legacy of white supremacy that have led to the systematic disadvantage of racial minorities in our society. Public health advocate, leader, and scholar, Dr. Camara Phyllis Jones, is credited for creating the framework many healthcare professionals and researchers use to think about systemic racism’s impacts on Black health. Her definition centers the idea that Black individuals did not inherit the diseases they disparately suffer from, but they inherited a disadvantaged system that creates the stark health disparities we see today. It is important to understand this unequal system negatively impacts everyone and every aspect of our society. Policing and health outcomes  Evidence has shown that excessive policing not only impacts the individual health of Black and brown people who’ve interacted with the police, but it also impacts the health of their communities at large. Heightened police presence in communities of color can be perceived as a threat by community members which can result in sustained increases in stress and cortisol levels. This pathologic process can lead to adverse health outcomes affecting the cardiovascular, neurological, and endocrine systems.Police brutality Police brutality should be thought of as the ways state-sanctioned violence leads to the physical, psychological, and emotional harm of its victims. It is important to understand that police brutality not only impacts individuals with direct relationships to those afflicted by this violence but also has widespread effects on the entire Black community. It impacts the health of our colleagues who constantly have to witness this injustice play on television, often without consequence. It also leads to decreased productivity in Black communities as they deal with the aftermath and ongoing challenges of police brutality. #SayHerName Campaign As we continue conversations around police brutality, antiracism, and health equity, we must remember to not exclude women, children, the LGBTQ community, and the disabled community, among other communities of intersecting marginalized identities who continue to be impacted by police brutality. Social media and public response to police brutality traditionally center cis-gendered men, but people like Breonna Taylor, Tony McDade, and Tamir Rice, along with so many others, need our voices too. Policing in Schools and Hospitals Health care systems must actively advocate and protect their patients and that means we have to also reevaluate the presence of police in our spaces. This includes thinking about our roles as mandated reporters and police presence in emergency departments. Police presence in medical spaces can add to Black patients’ feelings of not having a “safe space” and we must consider our roles in potentially perpetuating violence in this way. LinksReferences discussed throughout episode Hardeman 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.12462Boyd RW. Police violence and the built harm of structural racism. Lancet. 2018;392(10144):258-259. doi:10.1016/S0140-6736(18)31374-6Alang S, McAlpine D, McCreedy E, Hardeman R. Police Brutality and Black Health: Setting the Agenda for Public Health Scholars. Am J Public Health. 2017;107(5):662-665. doi:10.2105/AJPH.2017.303691Hardeman RR, Medina EM, Kozhimannil KB. Structural Racism and Supporting Black Lives – The Role of Health Professionals. N Engl J Med. 2016;375(22):2113-2115. doi:10.1056/NEJMp1609535Alyasah Ali Sewell, Justin M. Feldman, Rashawn Ray, Keon L. Gilbert, Kevin A. Jefferson & Hedwig Lee (2020) Illness spillovers of lethal police violence: the significance of gendered marginalization. Ethnic and Racial Studies. 2020. doiI: 10.1080/01419870.2020.1781913Britton BV, Nagarajan N, Zogg CK, et al. US Surgeons’ Perceptions of Racial/Ethnic Disparities in Health Care: A Cross-sectional Study. JAMA Surg. 2016;151(6):582–584. doi:10.1001/jamasurg.2015.4901Hardeman RR, Medina EM, Boyd RW. Stolen Breaths. N Engl J Med 2020; 383:197-199. doi: 10.1056/NEJMp2021072 Bor J, Venkataramani AS, Williams DR, Tsai AC, Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet. 2018. doi: 10.1016/S0140-6736(18)31130-9. Additional references and papers as mentioned in episode Link to the work of Dr. Rupa Marya as mentioned by Dr. Boyd: https://medium.com/@radiorupa/health-and-justice-the-path-of-liberation-through-medicine-86c4c1252fb9Link to African-American Policy Forum #SayHerName Campaign: https://aapf.org/sayhernameLink to latest work of Dr. Rachel Hardeman: Physician-patient racial concordance and disparities in birthing mortality for newborns. Brad N. Greenwood, Rachel R. Hardeman, Laura Huang, Aaron Sojourner. Proceedings of the National Academy of Sciences Aug 2020, 201913405; DOI: 10.1073/pnas.1913405117 Disclosures The hosts and guests report no relevant financial disclosures.Episode CitationBoyd R, Hardeman R, Ogunwole M, Fields N, Khazanachi R, Nolen L, Onuoha C, Paul D, Essien UR. “#120 Racism, Police Violence, and Health.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes/ August 26, 2020.

https://clinicalproblemsolving.com/wp-content/uploads/2020/08/HDx_SS_Baylor_FINAL.mp3Dr. Krishan Sharma presents a Human Dx case to Sharmin & Baylor residents – Drs. Iqbal and Rana.Download CPSolvers App hereTake our Episode Quiz here.Patreon websiteCyrus IqbalCyrus is a PGY-3 internal medicine resident at Baylor College of Medicine. He loves sports, hip-hop, exploring new restaurants and coffee shops, and writing. He’s an aspiring hematologist/oncologist with a passion for medical education.Ruchit RanaRuchit Rana is currently a third-year internal medicine resident at Baylor College of Medicine. Ruchit completed medical school at Baylor College of Medicine. He has a passion for practicing and improving medical education at all levels. In his free time, he enjoys cooking and baking dishes across all ethnicities and maintaining his multiple freshwater aquariums at home. He is a proud co-founder of the Schema Squad alongside his co-resident, Cyrus Iqbal.Krishan SharmaKrishan Sharma is currently an internal medicine resident at Massachusetts General Hospital. He earned his medical degree at Harvard Medical School, where he also pursued a Masters in Medical Sciences in medical education. His academic interests include cardiology, critical care, and clinical reasoning. His hobbies include basketball, drumming, and entering spice eating competitions.

https://clinicalproblemsolving.com/wp-content/uploads/2020/08/Wake-Forest-Human-Dx-FINAL__.m4aDr. Meredith Lash Dardia presents a Human Dx case to Arsalan & Wake Forest residents – Drs. Maus and Brooks.Download CPSolvers App herePatreon websiteHuman Dx CaseWant to test your learning?Take our Episode Quiz here.Dr. Meredith Lash DardiaDr. Meredith Lash-Dardia is an internist at Weill Cornell Medical Associates in NYC. She graduated with a BA from Rutgers University and an MD from Rutgers Medical School (formerly UMDNJ). She did her training at Mount Sinai in NYC. Her areas of interest include preventative wellness, medical student teaching, as well as quality and patient safety initiatives. In her spare time, she works on local political campaigns and is involved in grassroots activismDr. Taylor BrooksTaylor Brooks is in his third year of residency at Wake Forest School of Medicine’s Internal Medicine Residency (let’s go Deacs!). Originally from Ohio, Taylor spent his college years at The Ohio State University (let’s go Bucks!). He then completed medical school at the University of Cincinnati College of Medicine (let’s go Bearcats!). Aside from loving all of his alma maters equally, Taylor’s professional goals are to become a physician scientist, researching blood cancers and treating the patients who have them. He also hopes to one day teach the joys of academic hematology to internal medicine residents. In his free time, Taylor enjoys traveling the world with his amazing wife Cassandra, and throwing a ball around with his awesome Bernedoodle, WinstonDr. Sarah MausSarah Maus is currently a third year Internal Medicine resident at Wake Forest School of Medicine. She grew up in Springfield, IL before heading to Lexington, KY to complete undergraduate and medical school. She will be staying at Wake Forest next year as a Chief Resident, and hopes to pursue Hematology Oncology fellowship after her chief year. Outside of medicine, Sarah enjoys hiking in the mountains of North Carolina, playing tennis with friends, and spending quality time with family and her dog, Mila.

https://clinicalproblemsolving.com/wp-content/uploads/2020/08/SLS_Abdominal-Pain-and-Jaundice_Arsalan_FINAL.mp3The CPSolvers share a case of abdominal pain and jaundice – let’s practice those schemas together!Patreon websiteSchemas: abdominal pain, jaundiceThought Train: abdominal pain