The Clinical Problem Solvers

In this discussion, Marcela Santana, a second-year resident at WashU and close friend of Noah, dives into a riveting clinical case presented by Debora. They dissect the challenges of diagnosing a 36-year-old woman suffering from right upper quadrant pain and post-operative complications following cholecystectomy. The conversation highlights the importance of differential diagnosis and a thorough evaluation. With engaging anecdotes and clinical insights, they emphasize collaborative assessment, especially when navigating complexities like neutropenic fever and discordant lab results.

Dr. Julia Armendariz, a hospitalist and clinician educator, shares her passion for feedback in medical education. She emphasizes the critical role of constructive criticism and goal-setting among learners. Julia debunks common myths about feedback and highlights strategies for creating a positive team environment. She discusses the importance of timely feedback in fostering growth and explores how to establish a feedback culture in personal relationships. Her insights shed light on mentorship, collaboration, and the joys and challenges in medical education.

In this engaging discussion, Dr. Samira Farouk, a transplant nephrologist and educator, and Dr. Douglas Farrell, an internal medicine resident and nephrology fellow, tackle the intricacies of hypotension and acute kidney injury. They highlight the importance of trending urine tests alongside traditional metrics like troponin. The duo also shares insights on managing hyperkalemia and the criteria for initiating acute dialysis, while introducing helpful mnemonics for diagnosing metabolic acidosis. Their clinical approach underscores the complexities of patient care in nephrology.

Delve into the intriguing world of bradycardia management with a focus on a 72-year-old woman's case. Discover the nuances of distinguishing true from pseudobradycardia and the critical role of ACLS algorithms. Listen as hosts analyze an EKG displaying bradycardia and explore the implications of complete heart block. Learn how to navigate EKG readouts to identify key features and block classifications. Plus, unravel the complexities of cardiac sarcoidosis through advanced imaging techniques and collaborative patient care.

A playful introduction sets the stage for a discussion on innovative medical tools. The spotlight shifts to a comical tale of a dog's chocolate binge that ends in an emergency room visit. Dive into the intricate world of dysphagia, focusing on the critical details of diagnosing swallowing difficulties. Learn about the complexities of esophageal ulcers and the importance of thorough medication histories. The episode wraps up with a deep look at diagnosing oral ulcers, showcasing the need for a nuanced approach in patient care.

Dr. Sebastian Green, a neurology resident from UCLA with a strong foundation in neuroscience, delves into a fascinating case of confusion in a patient. He and his colleagues dissect the complexities of diagnosing confusion, exploring its neurological origins. They navigate the challenges posed by progressive dementia, emphasizing thorough patient history and neuroimaging. The discussion also covers critical insights into neurological examinations and the role of brain biopsies, highlighting the need for collaboration and innovative diagnostic approaches in neurology.

Seyma Yildirim, a clinical expert, presents an intriguing case of a 60-year-old woman battling persistent cough and fatigue, leading to unexpected medical insights. The discussion dives deep into diagnosing complex symptoms like hemoptysis and explores conditions such as hypersensitivity pneumonitis and cryptogenic organizing pneumonia. The guests emphasize collaborative learning and the art of clinical reasoning, showcasing how intricate cases can inspire innovative thinking in medical diagnostics. Personal anecdotes add warmth, making for an engaging and informative session.

 https://clinicalproblemsolving.com/wp-content/uploads/2025/03/The-Clinical-Problem-Solvers-Episode-384-Antiracism-in-Medicine-–-Episode-26-–-Racial-and-Gender-Health-Disparities-in-Youth-Suicide-Part-1-Dr.-Tami-Benton-and-Dr.-Kevin-Simon.mp3CPSolvers: Anti-Racism in Medicine SeriesEpisode 26 – Racial and Gender Health Disparities in Youth Suicide: Part 1Show Notes by Alec J. CalacMarch 14, 2025Summary: In this first half of a two-part series, we discuss the growing rates of suicide amongst child and adolescent populations in the United States, with a focus on historically underserved groups. In particular, our guests, Dr. Tami Benton and Dr. Kevin Simon, elucidate the disturbing rises in suicidality—suicide attempts and suicidal ideation—and suicide fatality amongst Indigenous and Black youth. Drs. Benton and Simon recount the pervasive nature of the suicide crisis impacting Black and Indigenous youth and offer insights into how we may begin ameliorating these harrowing inequities. Episode Learning ObjectivesAfter listening to this episode, learners will be able to:Identify barriers and facilitators to establishing care with a child and adolescent psychiatristExplain the shifting visibility of racial and gender health disparities in the academic literatureDescribe the importance of cultural humility and racial concordance in health careCreditsWritten and produced by: Ashley Cooper, Sudarshan Krishnamurthy, Asya Pitre, and TeamHosts: Ashley Cooper and Sudarshan KrishnamurthyInfographic and Audio Edits: Ashley CooperShow Notes: Alec J. CalacGuest: Dr. Tami Benton and Dr. Kevin SimonTime Stamps0:00 Opening and Guest Biographies3:15 Personal Guest Introductions (Dr. Simon)6:50 Personal Guest Introductions (Dr. Benton)13:08 Youth Suicide Crisis Discussion, “Ringing the Alarm”20:10 Shift in Issue Framing in the Literature 24:31 The Network Begins with Primary Care28:42  Diversifying your Outreach30:54 Cultural HumilitySpeaker BiographiesDr. Tami Benton, MD, is the Frederick Allen Professor of Psychiatry at the University of Pennsylvania. She is the Psychiatrist-in-Chief and Chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia (CHOP). She is the President of The American Association of Directors of Child and Adolescent Psychiatry (AADCAP) and the President of The American Academy of Child and Adolescent Psychiatry (AACAP). She served on the National Institute of Mental Health Advisory Council and the APA’s Council for Research. Dr. Benton mentors clinical and research physicians, fellows, and postdoctoral trainees. She was awarded the Society of Biological Psychiatry Humanitarian Award and the Community Outreach Award by the American Foundation for Suicide Prevention. Dr. Benton’s career has been dedicated to developing leadership for a diverse child psychiatry workforce. Her mission — preparing the next generation of diverse physician leaders in pediatric healthcare and mental health and creating partnerships between communities and academic centers — will be critical for eliminating disparities among minority populations.Dr. Kevin M. Simon, MD, MPH, is Boston’s inaugural Chief Behavioral Health Officer, appointed by Mayor Michelle Wu. He is a physician-scientist, health policy expert, inspirational teacher, and a gifted writer. Dr. Simon is a pediatric addiction medicine psychiatrist at Boston Children’s Hospital; an assistant professor in psychiatry at Harvard Medical School; a recent Commonwealth Fund fellow in health policy at Harvard University; and the medical director of Wayside Youth & Family Support Network. Clinically, he cares for youth and families through the Department of Psychiatry & Behavioral Sciences and the new Division of Addiction Medicine at Boston Children’s Hospital. Academically, he has won multiple awards for research on structural violence, health equity, and mental health. Additionally, he consults with federal agencies on mental health system design and practices. Dr. Simon’s writings on health equity are in notable journals like the American Journal of Public Health and the New England Journal of Medicine. National audiences regularly seek his perspectives on mental health through trusted outlets. Episode TakeawaysCommunity health centers play an important role in access to evidence-based psychiatric care rooted in community values. They are often the first interface for patients experiencing mental health crises, not academic medical centers. The youth suicide crisis is disproportionately shouldered by Indigenous and Black and African American communities. Historical challenges include inadequate data surveillance and reporting systems and “hidden” trends brought to the attention of academics by Dr. Jeffrey Bridge, a leading researcher at the Nationwide Children’s Hospital. Among these groups, youth suicide is particularly more prominent at younger ages when compared to other racial and ethnic groups.Groups experiencing severe morbidity and mortality–due to any psychiatric cause–often do not reflect the demographics of inpatient hospital censuses. Comprehensive mental health interventions are often beyond reach of those uninsured and underinsured.Resources are often directed to the largest group by number, not necessarily the group with the highest incidence and prevalence per capita. This can have devastating effects on public health and impede timely policy and program development. Literature has also shown that youth beneficiaries in Medicaid are not prioritized for mental health services when compared to other programs, which impedes continuity of care.There are a growing number of Child Psychiatric Access Programs, including one in Massachusetts, which provide quick access to psychiatric consultation and facilitates referrals for accessing ongoing behavioral health care. These programs recognize the increasing difficulties in having to first see a community-based primary care provider before seeing a specialized psychiatrist.Diversifying your mental health outreach goes hand in hand with diversifying your providers. This is directly related to the importance of cultural humility in mitigating health disparities among racial and gender minority youth, as well as literature highlighting the benefits of racial concordance between providers and patients.According to a 2019 study published by Price and Khubchandani, the suicide rate among Black girls increased by a striking 182% over the course of 2001 to 2017. Despite these increases there remains a paucity of literature addressing this critical disparity. Language plays an important role in obtaining a thorough mental health history. Youth are often not familiar with medical jargon on questionnaires and intake forms, which can work against important conversations and opportunities for shared decision-making. Large language models and artificial intelligence technologies are likely biased by the documentation we place in the electronic health record, which may reinforce youth health disparities.Disclosures The hosts and guests report no relevant financial disclosures.ReferencesBenton TD, Boyd RC, Njoroge WF. Addressing the Global Crisis of Child and Adolescent Mental Health. JAMA Pediatr. 2021;175(11):1108–1110. doi:10.1001/jamapediatrics.2021.2479Benton T, Njoroge WFM, Ng WYK. Sounding the Alarm for Children’s Mental Health During the COVID-19 Pandemic. JAMA Pediatr. 2022;176(4):e216295. doi:10.1001/jamapediatrics.2021.6295Benton TD. Suicide and Suicidal Behaviors Among Minoritized Youth. Child and Adolescent Psychiatric Clinics of North America. 2022;31(2):211-221. doi:10.1016/j.chc.2022.01.002Benton TD. A Culturally Informed Approach to Supporting Suicidal Minoritized Patients. Focus. 2023 Apr;21(2):166-7.Brent DA, Goldstein TR, Benton TD. Bridging Gaps in Follow-up Appointments After Hospitalization and Youth Suicide: Mental Health Care Disparities Matter. JAMA Netw Open. 2020;3(8):e2013100. doi:10.1001/jamanetworkopen.2020.13100Bridge JA, Asti L, Horowitz LM, et al. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465Fontanella CA, Hiance-Steelesmith DL, Bridge JA, Lester N, Sweeney HA, Hurst M, Campo JV. Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders. Psychiatr Serv. 2016 Mar;67(3):324-31. doi: 10.1176/appi.ps.201500104. Epub 2015 Dec 1. PMID: 26620293.King, C. A., Brent, D., Grupp-Phelan, J., Shenoi, R., Page, K., Mahabee-Gittens, E. M., Chernick, L. S., Melzer-Lange, M., Rea, M., McGuire, T. C., Littlefield, A., & Casper, T. C. (2020). Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use. Journal of the American Academy of Child & Adolescent Psychiatry, 59(9), 1058-1068.e5. https://doi.org/10.1016/j.jaac.2019.10.015Lindsey MA, Sheftall AH, Xiao Y, Joe S. Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017. Pediatrics. 2019;144(5):e20191187. doi:10.1542/peds.2019-1187Lindsey MA, Brown DR, Cunningham M. Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal of Orthopsychiatry. 2017;87:377-383. doi:10.1037/ort0000198Price JH, Khubchandani J. The Changing Characteristics of African-American Adolescent Suicides, 2001–2017. J Community Health. 2019;44(4):756-763. doi:10.1007/s10900-019-00678-xSheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(5):662-675. doi:10.1016/j.jaac.2021.08.021Sheftall AH, Miller AB. Setting a Ground Zero Research Agenda for Preventing Black Youth Suicide. 2021;175(9):890-892. doi:10.1001/jamapediatrics.2021.1112Simon KM. Daughters’ Keeper—The Care and Treatment of Black Girls in America. New England Journal of Medicine. 2022 Jun 2;386(22):2067-9.Simon KM. Mitigating the Negative Mental Health Impact of Racism on Black Adolescents—A Preventive Perspective. JAMA Netw Open. 2023;6(11):e2340577. doi:10.1001/jamanetworkopen.2023.40577Simon KM. Them and Me – The Care and Treatment of Black Boys in America. N Engl J Med. 2020 Nov 12;383(20):1904-1905. doi: 10.1056/NEJMp2022606. PMID: 33176082.Congressional Black Caucus: Emergency Task Force on Black Youth Suicide and Mental Health. Ring the Alarm. The Crisis of Black Youth Suicide in America. U.S. Congress. Published December 17, 2019. Accessed 2024. https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf CitationBenton T, Simon K, Cooper A, Krishnamurthy S, Calac A, Pitre A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Khazanchi R. “Episode 26: Racial and Gender Health Disparities in Youth Suicide: Part 1” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. March 14, 2025.Show TranscriptDownload CPSolvers App hereRLRCPSOLVERS

Rabih Geha, representing the CP Solvers Academy, joins the discussion to tackle a captivating clinical case. The conversation navigates life transitions and the importance of diagnostic reasoning while sharing personal anecdotes. Geha uncovers the complexities of diagnosing rhabdomyolysis versus myositis, highlighting critical lab evaluations. The hosts engage in light-hearted banter while emphasizing the crucial role of patient history in understanding ambiguous symptoms. Listeners are encouraged to deepen their clinical skills through the exploration of these challenging cases.

https://clinicalproblemsolving.com/wp-content/uploads/2025/03/Holzinger.mp3Episode descriptionReza interviews his mentor and master clinician Dr. Elmer Holzinger