The Clinical Problem Solvers is a multi-modal venture that works to disseminate and democratize the stories and science of diagnostic reasoning
Twitter: @CPSolvers
Website: clinicalproblemsolving.com
Episode 374: WDx #34: It’s Not a Meritocracy
Jan 23, 2025
Description:
Kaylin, Sharmin, and Cheryl are joined by Dr. Arghavan Salles. They discuss career transitions/pivots, challenging workplace experiences, social/digital media use, and thoughts on allyship and gender biases/stereotype threat as self-identified angry women.
Bio:
Dr. Salles is a minimally invasive and bariatric surgeon. She completed medical school and residency in general surgery at Stanford prior to completing her fellowship in minimally invasive surgery at Washington University in St. Louis. She stayed on faculty at Washington University for three years prior to moving back to Stanford in 2019. During the pandemic, Dr. Salles has served as a disaster relief physician, caring for patients with COVID in the ICU. Dr. Salles obtained a PhD in education from Stanford University during her residency training, and her research focuses on gender equity, implicit bias, diversity, inclusion, and physician well-being. Her R01 grant from the NIH focuses on sexual harassment. She is a sought-after speaker and has given over 100 national and international invited talks related to gender equity, physician well-being, and weight bias. She currently serves as the Special Advisor for DEI Programs at the Stanford University Department of Medicine where she is a Clinical Associate Professor.
In this Pulmonary & Critical Care episode, Dr. Meghan Nothem presents an unusual case of acute encephalopathy and unresponsiveness to Dr. Paul A. Bergl. Stay tuned to found out the final diagnosis!
Dr. Paul A. Bergl is an intensivist at Gundersen Lutheran Medical Center in La Crosse, WI and clinical adjunct assistant professor with the University of Wisconsin. He completed medical school at the University of Wisconsin-Madison, internal medicine residency at the University of Chicago, and critical care fellowship at the Medical College of Wisconsin.
Dr. Bergl is a decorated educator with over a dozen major teaching awards and honors from medical students, residents, and fellows. His foremost passions in medical eduation are critical thinking and diagnostic reasoning. His other scholarly work has focused on diagnostic error, point-of-care ultrasonography and echocardiography, and bedside teaching and rounding.
Case presenter: Dr. Meghan Nothem
Dr. Nothem is a third year Pulmonary & Critical Care Medicine fellow at The Medical College of Wisconsin in Milwaukee, Wisconsin where she also completed her Internal Medicine residency and served as Chief Resident. Prior to returning to her home city for post-graduate training, she earned her Bachelor of Science in Biology at University of Wisconsin-Madison and her medical degree at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado. Dr. Nothem will be joining a Pulmonary and Critical Care Medicine practice in Milwaukee upon completion of her fellowship in summer of 2025.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Sebastian Green presents a case of generalized weakness to Aye.
Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!
Dr. Sebastian Green ( @sebfgreen )
Dr. Sebastian Green is a neurology resident at the University of California, Los Angeles (UCLA). He was born and raised in London, England. He has degrees in Medicine from the University of Bristol and Neuroscience from the University of Oxford. He has published on neuroimaging, memory, sleep, epilepsy, and more. He is passionate about medical education in neurology, and using EEG to answer big questions about the brain.
Episode description: Welcome our new SLS team member, Seyma! The SLS team get together from four time zones across the world to discuss a challenging case of altered mental status.
Episode 369: WDx #33: Clinical Unknown Discussion with Dr Laila Woc-Colburn
Dec 11, 2024
In this episode of WDx, Sharmin, Yaz, and Kaylin are joined by Dr. Laila Woc-Colburn. Tune in to hear Dr. Woc expertly discuss a case of a young woman with a worsening headache, followed by a roundtable discussion about what drew her to infectious diseases and her passions in medicine and life.
Bio:
**Laila Woc-Colburn, MD** is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine. A graduate of Universidad Francisco Marroquín in Guatemala, she completed her internal medicine residency at Advocate Illinois Masonic Medical Center in Chicago and her fellowship in infectious diseases and HIV medicine at Case Western University in Cleveland. Dr. Woc-Colburn also holds a Diploma in Tropical Medicine and Hygiene.
Her clinical interests encompass tropical diseases in immunosuppressed individuals, including those with HIV, as well as mycotic diseases, orthopedic infections, and medical education. She is passionate about teaching the next generation of healthcare professionals about infectious diseases and is dedicated to empowering women and BIPOC individuals in medicine.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Bayan presents a case of headache and seizure to Aye.
Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!
Bayan Al Zoabu
Bayan is a senior medical student from Syria with a passion for neurology and a drive to make a difference in healthcare. From founding a screening initiative for congenital conditions in children to working with other students and residents to create the NeurAnki flashcard deck to help neurology residents prep for board exams, Bayan is all about supporting others. As a passionate advocate for ethics, she is the co-leader of the journal club team in the neuro-ethics group. Outside medicine and in her free time, Bayan loves to relax with a cup of tea and a book.
Episode description: Jas presents a fascinating case of chest pain, dyspnea, and lower extremity edema that ends up in a very different place than any of us expected. Welcome to our new teammate Elena!
Kaylin, Sharmin, Cheryl, and Jane discuss two cases of volume overload. Kaylin reviews the pathophysiology behind constrictive pericarditis and restrictive cardiomyopathy, normal pericardial and thoracic anatomy and pressure changes with respiration, and the difference in treatments between the two disease processes.
This joint rheumatology and pulmonary critical care medicine session is a collaboration between CPSolvers and The University of Colorado. This session, like all Rafa Medina Subspecialty sessions, is in honor of Dr. Rafael Medina. Dr. Melissa Griffith and Dr. Geoff Connors discuss a case of myositis presented by Dr. Sarah Haeger and Dr. Evan Zehr
Case Discussants: Geoff Connors is an associate professor in Pulmonary and Critical Care at the University of Colorado. He is the Associate Dean for Graduate Medical Education and is the former program director of the Internal Medicine Program at University of Colorado. Melissa Griffith is an Assistant Professor of Rheumatology at the University of Colorado.
Case Presenters: Sarah Haeger was a chief medical resident at the University of Colorado and is currently a nephrology fellow at the University of Washington. Evan Zehr was a chief medical resident at the University of Colorado and is currently a fellow in Pulmonary and Critical Care medicine at Vanderbilt.
Episode title: Episode 359 Neurology VMR – altered mental status
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Vale presents a case of altered mental status to Aye.
Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.
Valeria Roldan
@valeroldan23
Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.
Episode 354: Antiracism in Medicine – Episode 25 – Live from SGIM 2024: Best of Antiracism Research at the Society of General Internal Medicine’s 2024 Annual Meeting
Sep 19, 2024
Episode 25 – Live from SGIM 2024: Best of Antiracism Research at the Society of General Internal Medicine’s 2024 Annual Meeting
Show Notes by Ashley M. Cooper
September 19, 2024
Summary: This episode highlights a selection of antiracism research presentations at a live recording of the podcast at the 2024 SGIM Annual Meeting. This year’s episode, our fourth conducted at SGIM, is focused on the importance of qualitative research and the role it plays in antiracism research, community-based work, and scholarship. During this episode, we hear from Dr. S. Michelle Ogunwole, MD, PhD, an internist and social epidemiologist who specializes in the care of women with chronic medical conditions and racial disparities in maternal health outcomes, and Dr. Caroline Sloan, MD, a general internist whose research focuses on how financial considerations are imbued into medical decision-making. This episode is hosted by Ashley Cooper and Sudarshan (Sud) Krishnamurthy. The show notes for this episode were written by Ashley M. Cooper.
Episode Learning Objectives
After listening to this episode, learners will be able to…
Understand how they can better center patient experiences by engaging with, and conducting their own, qualitative research.
Describe the positive impacts of qualitative methods on healthcare provision and/or policies in clinical settings.
Identify the critical role that qualitative research plays in antiracism and health equity work.
Credits
Written and produced by: Ashley Cooper, Sudarshan Krishnamurthy, Team
Hosts: Ashley M. Cooper, Sudarshan Krishnamurthy
Infographic: Canva
Audio Edits: Ashley M. Cooper
Show Notes: Ashley M. Cooper
Guests: Dr. Michelle Ogunwole and Dr. Caroline Sloan
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
Ogunwole M, Sloan C, 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 25: Live from SGIM 2024: Best of Antiracism Research at the Society of General Internal Medicine’s 2024 Annual Meeting” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. September 19, 2023.
In this Clinical Reasoning Rafael Medina Subspecialty episode, Dr. Kuchal Agadi presents a case to Dr. John Woller and Dr. Areeb Masood of a 67 year-old male with altered mental status.
The goal of this session is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case discussant:
Dr. John Woller is an academic hospitalist working in the Johns Hopkins Hospital in the Division of Hospital Medicine. As a clinical coach and Associate Program Director for clinical reasoning and bedside medicine, John is enthusiastic about teaching medical students and Osler residents at the bedside.
And Dr. Areeb Masood, is a third-year internal medicine resident at Johns Hopkins Hospital in the Osler Internal Medicine Residency and Urban Health Track. He earned his undergraduate degree from The University of Texas at Austin and his medical degree from The University of Texas Rio Grande Valley School of Medicine. After completing his residency, he aims to practice a blend of hospital medicine and HIV primary care. @areebmasoodMD
Case presenter:
Dr. Kuchal Agadi, is first year Resident at a community hospital in Chicago. Kuchal is passionate about medical education. Apart from medicine she is a fitness enthusiast, and enjoys a good workout routine with Kettle bells.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of bilateral lower limb weakness to Valeria.
Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.
Valeria Roldan
@valeroldan23
Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.
Episode 348: WDx #31: “Guardian Angels, Mistaken Identities, and Code Blues: Stories from Intern Year”
Aug 08, 2024
https://clinicalproblemsolving.com/wp-content/uploads/2024/08/8.8-Wdx-RTP.mp3 To celebrate the new academic year, Kaylin and Sharmin sit down with Dr. Alice Mao to share a few memorable stories from their intern year. They reflect on tough days, lessons learned, power moves, and the importance of community. We hope these stories and reflections make you laugh, feel connected, and inspire you to take gentle care of yourself. Welcome to the profession—we are so excited to have you. Dr. Alice Mao is an internal medicine and geriatric medicine physician who is passionate about social equity, community empowerment, and innovations in primary care. She was born in China and grew up in Canada and the US. She completed medical school at UCSF, internal medicine residency at the University of Washington, and geriatric medicine fellowship at Stanford. She is currently a primary care provider at On Lok Program of All-Inclusive Care for the Elderly where she gets to take care of help vulnerable seniors stay home for as long as possible. Outside of medicine, she enjoys spending time with family and friends, giving her cat cheek scratches, and resurrecting her childhood dreams of learning how to freestyle dance.
In this Infectious Disease Rafael Medina Subspecialty episode, Dr. Milee Nelson presents a case to Dr. John Huang & Dr. Varun Phadke of a man presenting with a rash and shortness of breath.
The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case Discussants: Dr. Varun Phadke is an infectious disease specialist at Emory.
Dr. John Huang is an infectious disease fellow at Emory.
Case Presenter: Dr. Milee Nelson is an internal medicine resident at Emory.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of bilateral lower limb weakness to Valeria.
Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.
Valeria Roldan
@valeroldan23
Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.
Sharmin, Kaylin, and Jane interview Anu Gorukanti, MD and Laura Holford, RN MSN, the co-founders of Introspective Spaces. They discuss their journeys in healthcare and what motivated them to build an inclusive space to foster connection, cultivate contemplative practice, and empower women in healthcare through introspective and reflection.
Anu Gorukanti, MD is a public health advocate and pediatric hospitalist at a county hospital in Los Angeles, CA who is passionate about health equity and racial justice. She went to undergraduate and medical school at Saint Louis University and completed her residency at Stanford University. She is passionate about social justice and the role that reflection and contemplation play as building blocks for revolution (as inspired by many theologians, spiritual leaders, and activists before her). She strongly believes that understanding who you are, what you value, and where your values come from can lead to a meaningful and authentic life. In her perspective, social change should always honor and incorporate both the individual and systems-based approach.
Laura Holford, RN MSN, is an oncology certified nurse and public health nurse committed to working to reduce nursing burnout and moral distress, and the reassembly of responsibility and accountability in healthcare. Liberation theology led her to train as a masters prepared nurse at University of San Francisco. She works as a community health nurse in Sacramento, CA She has a background as a campus minister & was lay community pastor of an Christian Interfaith church and she enjoys nothing more than accompanying people on their healing, reflective, and spiritual paths. Like many mystics before her, she believes that contemplation and action cannot be separated and finds herself naturally helping others’ build reflective, imaginative, and spiritual practices to ground their action and work in the world.
In this Nephrology Rafael Medina Subspecialty episode, Dr. Maddie Abrams presents a case to Dr. Jai Radhakrishnan of a 28 year old woman presenting with headache and blurry vision.
The goal of this session is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case discussant: Dr. Jai Radhakrishnan is Professor of Medicine at Columbia University Medical Center in New York. He is the Director of Clinical Services of the Nephrology Division and co-director of the hypertension center of Columbia University. @jradnephro
Case presenter: Dr. Maddie Abrams is an Internal Medicine PGY-2 & an aspiring cardiologist at ColumbiaMed at NewYork-Presbyterian Hospital. She graduated from Zucker School of Medicine in 2022. @Maddie_Abrams
Episode 339: Neurology VMR – left facial numbness for 5 days
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of left facial numbness for 5 days to Andrea and Sridhara.
Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.
Andrea Mendez Colmenares
@andreamendez92
Andrea Mendez Colmenares is a Venezuelan medical doctor and cognitive neuroscientist. She recently completed her PhD and postdoctoral fellowship in Colorado and will begin her neurology residency at Duke University in North Carolina in the summer of 2024. Outside of medicine, she enjoys playing guitar, discovering new coffee shops, hiking, and climbing mountains.
Sridhara Yaddanapudi
@syaddana_neuro
Sridhara is a board-certified internist, neurologist, vascular neurologist, and hypertension specialist. Currently, he holds the position of Clinical Assistant Professor at Thomas Jefferson University Hospital and serves as the Director of Neurology for Jefferson New Jersey. As a medical professional, he is passionate about case-based learning, clinical reasoning, and teaching decision-making while avoiding the pitfalls of heuristics. His goal is to bridge the ever-growing gap between neurology and internal medicine, an area in which he has a keen interest.
In this episode of WDx, Dr Nidhi Patel joins Jane, Kaylin, and Sharmin and presents a case of a 23 yr old woman with worsening dyspnea and orthopnea.
Screenshot
Nidhi is a current CPSolvers Academy member and a PGY2 in internal medicine at Emory University. She grew up in South Florida and went to University of Miami for undergrad and for medical school. Clinically she is interested in prevention of atherosclerotic disease, cardiac imaging and women’s health in cardiology! In her free time, she loves to catch a morning sunrise, and loves being outdoors to try adventurous activities including white water rafting, kayaking, and fast roller coasters.
This case was recently presented by Nidhi on a VMR with Rabih and Reza. Check it out here!
The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case Discussant: Dr. Lianne Gensler is a rheumatologist and serves as director of the UCSF Ankylosing Spondylitis Clinic, which is dedicated to care for this inflammatory disease. Gensler’s primary research interest is the disease progression of axial spondyloarthritis (a category that includes ankylosing spondylitis).
Case Presenter: Dr. Appledene Osbourne is a current rheumatology fellow at UCSF.
Episode 331: Neurology VMR – Headaches and loss of sensation in the left leg
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Hans presents a case of headaches and loss of sensation in the left leg to Andrew and Maria.
Hans Kaus received his MD from Ross University School of Medicine. He completed his undergraduate education in Pharmacy at the University of Tübingen, Germany. Driven by a deep desire to understand patient concerns, Hans wanted to go beyond pharmaceutical care. While in medical school, the virtual morning reports, Clinical Problem Solvers, unleashed his passion for solving complex patient cases. The blend of medicine and pharmacy will markedly benefit patients. In his spare time, Hans enjoys embarking on long bicycle rides.
Andrew Sanchez
@ASanchez_PS
Andrew Sanchez is an exiting PGY-3 in internal medicine at Yale New Haven Hospital: he will soon be starting a career in academic hospital medicine at Beth Israel Deaconess Medical Center, Boston. Meeting hospitalized patients and working with them to achieve diagnostic clarity is his primary clinical passion. His interest in diagnosing the undifferentiated patient is the driving force behind deep interest in learning and teaching diagnostic reasoning. On X/Twitter – which he considers the centerpiece of his teaching portfolio – he is known for creating and sharing schemas for both common and uncommon clinical dilemmas, which are frequently accompanied by “Tweetorial” commentary, as well as diagnostic case challenges.
María Jimena Alemán
@MariaMjaleman
María Jimena Alemán was born and raised in Guatemala. After suffering from long-standing neurophobia, she has embraced her love for neurology and will soon be starting her neurology residency at the University of California San Francisco. She looks forward to dedicating her life to improving neurological care and education around the globe. Maria loves art and culture and is currently obsessed with textiles and flowers
In honor of Women’s History month in the United States, Sharmin, Kaylin, and Jane discuss the Matilda Effect, the current state of gender inequality, and reflect on some of the many incredible women scientists that came before us and helped pave the way for a better future.
In this clinical reasoning Rafael Medina Subspecialty episode, Dr. Mark Heslin presents a case to Dr. Tony Breu of a man presenting with facial swelling.
The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case Discussant: Anthony C. Breu, MD is the Director of Resident Education at the Veterans Affairs Boston Healthcare System and an Assistant Professor of Medicine at Harvard Medical School. He is also core faculty at the Center for Bioethics at Harvard Medical School. He completed his undergraduate degree in biomedical ethics at Brown University, where he also received his medical degree.
Case Presenter: Mark Heslin is a third-year internal medicine resident at the University of Pennsylvania. This summer, he will be starting his career as an academic hospitalist at Stanford. His clinical interests include medical education, clinical reasoning, diagnostic error, and the use of innovative technology to disseminate the teaching of clinical reasoning.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Valeria presents a case of visual hallucinations to Greg and Umbish.
Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine
Gregory I. Atafo
Dr. Atafo is a general physician currently practicing in Accra, Ghana. He attended undergrad at the University of Benin, Nigeria where he received his degree as a Doctor of Optometry. He then attended the University of Ghana for his medical degree. He is currently applying for residency in the United States and has interests in Neuroscience, Internal Medicine and Global health.
In his free time, Greg loves to play soccer, volunteer at medical outreach programs and is passionate about sharing medical knowledge across borders.
Umbish Dino
@UmbishD
Umbish Dino, born in New York but raised in Pakistan, embodies a blend of cultures that enrich her perspective both personally and professionally. Having lived and worked in both the United States and Pakistan, she’s set to bring her diverse experiences back to the U.S. as she embarks on her journey into the 2024 internal medicine residency match. Outside the hospital, she is a devoted mom to her four-year-old son, Rayyan, and two cats, Drogo and Luna. She is a talented singer, and a culinary enthusiast who finds joy in cooking. Her passion for clinical reasoning has drawn her to the CP Solvers Academy, where she engages with complex medical cases, reflecting her commitment to excellence in patient care and her zeal for continuous learning.
Episode 24 – Leveraging Narrative Medicine to Cultivate Antiracist Praxis
Show Notes by Sudarshan Krishnamurthy
February 13, 2024
Summary: This episode highlights the ways in which we might leverage stories, at the individual and structural levels, to reimagine medicine with a liberatory practice. During this episode, we hear from Zahra Khan, an educator and editor who has written extensively on abolition in medicine, and Dr. Sayantani DasGupta, a physician-educator, prolific children’s book author and faculty at the Center for the Study of Ethnicity and Race and the Institute for Comparative Literature and Society at Columbia University. Together, our guests offer context around how the medical and carceral systems are deeply intertwined and go hand-in-hand. Further, they expand on this to discuss how we might use stories in the form of visionary and speculative fiction to reimagine new landscapes of health care. This discussion is hosted by Sudarshan Krishnamurthy and Ashley Cooper. The show notes for this episode were written by Sudarshan Krishnamurthy.
Episode Learning Objectives
After listening to this episode, learners will be able to:
Illustrate the relationship between narrative medicine and healing relationships.
Explain the significance of abolition medicine, and the role of the medical system in upholding and perpetuating carceral logics.
Discuss how we might use narrative and stories to enact social change and reimagine medicine.
Credits
Written and produced by: Sudarshan Krishnamurthy, Ashley Cooper, Team
Hosts: Sudarshan Krishnamurthy and Ashley Cooper
Infographic: Creative Edge Design
Audio Edits: Ashley Cooper
Show Notes: Sudarshan Krishnamurthy
Guests: Dr. Sayantani DasGupta, Zahra Khan
Time Stamps
00:00 Opening
00:45 Introductions
01:03 Guest Introduction 1 – Zahra Khan
01:26 Guest Introduction 2 – Sayantani DasGupta
02:40 Background and Inspiration for Guests
13:45 Narrative Medicine in the Clinical Setting
23:45 Role of Narrative in Abolition Medicine
37:10 How does storytelling impact your clinical work and vice-versa?
42:00 Abolitionist reimaginings of Health
55:05 Democratizing Narrative Medicine
1:03:05 Closing Remarks and Clinical Pearls
Speaker biographies (Abbreviated)
Zahra Khan is an educator and editor whose work emerges at the intersection of narrative, healing and disability justice, and liberation pedagogy. Her research, writing, and community engagement focuses on shifting consciousness in medical education toward abolitionist possibilities. Zahra enjoys facilitating spaces that cultivate critical consciousness, earnest reflection, and collective care. Her work has appeared in publications such as the Lancet, Journal of Medical Ethics, and AMA Journal of Ethics. She currently works with Project NIA, a nonprofit dedicated to ending youth incarceration, and teaches in the graduate program in Narrative Medicine at Columbia University and at CUNY School of Medicine.
Sayantani DasGupta is a faculty member in the Master’s Program in Narrative Medicine, the Center for the Study of Ethnicity and Race and the Institute for Comparative Literature and Society, all at Columbia University. Originally trained in pediatrics and public health, her work has appeared in journals including The Lancet, JAMA, Pediatrics, The Hastings Center Report, Literature and Medicine, Teaching and Learning in Medicine, and The Journal of Medical Humanities. She is an associate editor of the journal Literature and Medicine, and her current interests are in issues of narrative humility in medical education and practice, racial justice and health, diaspora studies, and science fiction/health futurities. She is also a New York Times bestselling children’s author. Learn more about her work at www.sayantanidasgupta.com.
Episode Takeaways
Origin Stories – Zahra encountered abolition for the first time at the ‘Beyond the Bars’ Conference, where she encountered students and community members from all backgrounds who were dedicated to ending mass incarceration. Here, she encountered Angela Davis, where she was encouraged to reimagine and build frameworks that center justice and do not reproduce oppression. She started in the Narrative Medicine program at Columbia around Sayantani, and wanted to focus on incarceration as a healthcare issue, and has since engaged in work that attempts to decarcerate health care. Sayantani became a physician since she thought it was a concrete tool for social justice. She came from an activist family, with her mother being one of the first South Asian feminist activists in the country. She grew up among stories of activist struggle and decolonial movements, and discovered a lot around the frameworks in medicine as she navigated her medical education. She discovered narrative medicine, and to her, it was about finding and retelling individual and structural stories in antiracist ways. Now, she teaches undergraduates and graduate students at the intersections of stories, social justice, and health. Part of her journey has been imagining how abolition and medicine go together, thinking through the carceral logics that have built medicine, and reimagining a new form of medicine with a liberatory practice.
Role of Narrative Medicine in the Clinical Setting – Narrative Medicine is often called different things in different places; it is called health humanities in some places, to decenter the physician in the health care team, and Sayantani is a fan of this terminology. What the term gestures towards is the centering of the ‘story’ in healing relationships. However, it is important to think about individual stories within the broader historical and sociocultural context; for instance, you cannot highlight stories in individual physician-patient dyads, without discussing mechanisms of racialized, historical, or sociocultural power and other larger structural forces. Listening to individual stories within the context of their structural stories is important. Stories are not inherently just. It is important to be critical of stories, and we must train individuals to recognize stories that dehumanize groups of people and transform them into more just stories that humanize everyone.
For instance, Toni Morrison’s “Home” depicts scenes of a community of Black women nursing a woman who has been the victim of medical racism and violence. It helps us understand Morrison’s critiques of anti-Black racism in medicine, and better understand care, restoration, and safety too. This helps people think about how people tend to each others’ well-being in their communities as well. It also helps illustrate the power of witnessing and mutual recognition, where there is a narrative exchange between patient and provider, with a validation of patients’ suffering. Apart from this, this also helps practitioners in improving their capacity to develop empathy for their patients, to be more curious about, and appreciate the complex context of those they care for.
Narrative in Abolition Medicine: Zahra explains that structural competency is a framework that Jonathan Metzl and Helena Hansen offer to understand structural factors and barriers to care that perpetuate worse health outcomes like housing, food, and water as upstream factors that lead to worse health. Sayantani and Zahra (along with Yoshiko Iwai) have written about policing to be another one of these upstream factors that affect health, and offer ‘abolition medicine’ as a framework. Medicine often has a role in caring for those impacted by police brutality, and it should also have a role in creating new visions for violence prevention and reenvisioning healthcare without relying on carceral logics. It involves understanding stories and their relationships to power and structural oppression. Narrative medicine can offer us an imaginative space to create change. “Practicing New Worlds”, a book by Andrea Ritchie, talks about visionary fiction to help us look towards abolitionist futures, and can even help us reimagine new possibilities for health care. Sayantani expands on this to discuss the class she teaches on the relevance of visionary medicine, speculative fiction, and imagining an antiracist health system. Abolition Medicine itself involves recognizing and dismantling the carceral logics baked into medicine, and looking outside of medicine to see how we might reimagine these structures to improve health.
How does storytelling impact your clinical work, and how does clinical work impact storytelling? – As a pediatrician, Sayantani shares that physical health, corporeal health, intellectual health, and imaginative health can be thought of as a part of the same praxis. Childrens’ fiction has always been about imagination, and it creates paths forward and gives young people the ability to imagine acts of justice within the storyteller’s own stories.
Abolitionist reimaginings of health – Zahra talks about the piece she wrote with Yoshiko and Sayantani, and talks about how they wrote this piece in the backdrop of the American Medical Association recognizing systemic racism as a public health crisis, and acknowledging that police violence has severe health consequences. They realized that if policing and prisons are systems that require abolitionist reimaginings, health care does too. Ruth Wilson Gilmore, an abolitionist scholar and geographer, uses the term ‘organized abandonment’ to describe what happens when communities lose protections from the state through systems and structures that are involved in disinvestment from communities, leading to these communities being more vulnerable to increased criminalization and police presence, and resulting in these communities lacking safe and just infrastructure in the form of housing options, lack of access to clean and safe water, transportation, etc. For instance, the presence of police and ICE officials in health care settings, along with the use of restraints, are examples of the ways policing has permeated medicine as well. And we have examples of mutual aid networks and organizations that worked to improve care in the setting of organized abandonment; some of these include the Black Panther Party providing free healthcare in communities, and the Puerto Rican activist organization ‘The Young Lords’ ensuring their community receives tuberculosis screenings. There are also more contemporary organizations doing this work; Zahra works with Mental Health First, organized by the Anti Police-Terror Project, a multiracial, intergenerational, mobile, crisis-intervention team led by mental health officials to provide life-affirming treatment and deescalation assistance, without having to rely on law enforcement. This offers a framework for abolitionist and non-carceral solutions that can be implemented around the world.
Sayantani shares that the medical system and carceral system work hand-in-hand and it is not possible to decarcerate medicine or practice antiracism in medicine without acknowledging the carceral logics that permeate medicine and that the medical industrial complex is a part of the carceral system. This is a prerequisite to dismantling oppressive systems within medicine.
Democratizing Narrative Medicine – Zahra says that one of the loudest aspects of narrative medicine that is most powerful is using ‘story’, staying with narratives, and close reading and listening of story. Democratizing narrative medicine is also a matter of breaking open institutions to make knowledge and information more accessible to the public. Zahra also expresses hope around the spread of narrative medicine to the mainstream, and thinks that it might help more people organize around the story. However, institutions are only one place where actions happen, and actions within the institution often remain within the institution. So, it is important to consider how we might use narrative to advance social justice outside of institutions and in the world. Sayantani adds that there is a reason that certain voices are kept away from the fore, and that there are structural forces that are doing so intentionally. For instance, book bans around the country exist because states recognize the radical power of ‘story’ and it is the reason that they attempt to suppress the spread of these stories. Stories are imaginative playgrounds for social change. She even adds that she prescribes reading in a clinical setting, both for the parent to the child and by the child themselves. It is also important to recognize that teachers and librarians that attempt to get banned stories in the hands of their students are also engaged in this work of democratizing narrative medicine.
Pearls
Zahra says that there are so many resources that help us practice and imagine new futures now, and shares with listeners these resources. One of these include Interrupting Criminalization – Beyond Do No Harm is one network of U.S. based health practitioners, advocates, nurses, community members, educators, social workers, and others who are working across racial, gender, reproductive, migrant and disability justice, drug policy, sex worker, and anti-HIV criminalization movements. Another is an Interrupting Criminalization podcast called One Million Experiments, that shares projects that are happening all over the country that build transformative solutions to safety without relying on police and prisons. Another thing Zahra mentions is that we must all be cartographers in mapping out new possibilities of an antiracist health care that satisfies all of us. As Mariame Kaba says, this is an opportunity to shrink the space between our values and our actions, and this is a collaborative and collective project where she invites everyone to think about their role in advancing health and justice.
Sayantani encourages listeners of this podcast not to feel overwhelmed. So many times, we take care of others’ needs better than our own, and there is a sense of exhaustion, frustration, and anger that many face from medical training. We must strive to change the violent carceral logics that medical training and education inculcates, and also remember that we do not have to do everything alone and that we are not alone in this work. Rather than viewing it as one more thing to do, it is easier to become learners again, where we view antiracism as a new philosophy of living, learning, and working, and just taking it one step at a time.
Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014 Feb;103:126-133. doi: 10.1016/j.socscimed.2013.06.032. PMID: 24507917; PMCID: PMC4269606.
Khan Z, Iwai Y, DasGupta S. Military metaphors and pandemic propaganda: unmasking the betrayal of ‘Healthcare Heroes’. Journal of Medical Ethics. 2021;47:643-644.
Khan ZH, Iwai Y, DasGupta S. Abolitionist Reimaginings of Health. AMA J Ethics. 2022 Mar 1;24(3):E239-246. doi: 10.1001/amajethics.2022.239. PMID: 35325526.
Ritchie, Andrea J. Gumbs, Alexis Pauline. Brown, Adrienne Maree. (2023). Practicing new worlds: Abolition and emergent strategies. Consortium Book Sales & Dist.
The hosts and guests report no relevant financial disclosures.
Citation
Khan Z, DasGupta S, Krishnamurthy S, Cooper A, Siddiqui H, Calac A, Pitre A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Leveraging Narrative Medicine to Cultivate Antiracist Praxis.” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. February 13, 2024.
Sharmin and Kaylin sit down with Dr. Denise Davis to discuss communication as a procedure, continuous and incremental improvement, and the interrelationship between social and health justice
Denise L. Davis is a general internist and Clinical Professor of Medicine at University of California San Francisco. She serves as Associate Director for Faculty Development for the SanFrancisco VA Center of Excellence in Primary Care Education. Dr.Davis teaches locally and nationally on a range of topics, including teaching and coaching students, trainees and physicians in communication skills that increase quality, safety and improve patient experience. She is on the Executive Committee of the Academy on Communication in Healthcare and serves as VP of Diversity, Equity and Inclusion. She is also a specialist for minority medical students at UCSF School of Medicine. Dr. Denise Davis is a recipient of many awards, includingthe prestigious Kaiser Foundation Award for Excellence in Teaching and she was elected to the UCSF Academy of Medical Educators in 2015.
In this Rheumatology Rafael Medina Subspecialty episode, Dr. John Landefeld presents a case to Dr. Sarah Goglin of a 74 year old woman presenting with headache.
The goal of this session is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case discussant: Dr. Sarah Goglin is a rheumatologist and associate director at Zuckerberg San Francisco General Rheumatology clinic and at the UCSF Vasculitis Clinic. @SarahGoglinMD
Case presenter: Dr. John Landefeld is an internist and medical educator at Sacramento County Public Health & an assistant Clinical Professor at UC Davis Health. @johnlandefeld
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Kirtan presents a case of generalized weakness to Vivek and Hannah.
Kirtan Patolia is a second-year Internal Medicine resident from John H. Stroger Jr., Hospital of Cook County, Chicago. He relishes being the CPSolvers team member, as solving cases and generating differential diagnoses are his biggest passions. You will frequently find him sharing clinical cases on VMR. Outside of medicine, he likes to read fiction, particularly Agatha Christie and Nancy Drew novels. He also loves kite flying, especially using various techniques and maneuvers to fly the kites.
Vivek Paul
@vjpaul88
Vivek Paul is a medical graduate from Bharati Vidyapeeth University in Pune (India), now based in Chicago, Illinois. Having worked as a junior doctor in India after completing medical school, Vivek has more recently been involved in clinical research at Northwestern University Feinberg School of Medicine and is working towards a residency in Internal Medicine. He is also an avid musician with a Spotify account where he releases songs he has written through the years. When not working, Vivek can be found making loud and angry music, playing tennis, exploring local food joints, or on long walks with his dog, Melody.
In this Hepatology Rafael Medina Subspecialty episode, Dr. Christopher Coe presents a case to Dr. Arpan Patel of a woman presenting with fatigue and splenomegaly.
The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case Discussant: Dr. Arpan Patel is a hepatologist and researcher at UCLA. @ArpanPatelMD
Case Presenter: Dr. Christopher Coe is Chief GI fellow at UCLA. @CCoeMD
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Valeria presents a case of frequent stumbling to Nilayan and Subhangi.
Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue Neurology residency. Her interests include neuro-infectious diseases, transgender health and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine she loves running, hiking, cooking pasta and spending time with her dogs.
Nilayan Sarkar
@nilayansarkar
Nilayan is a first year Internal Medicine Resident at Lady Hardinge Medical College in New Delhi, India. He has been an avid fan of the CPSolvers since his third year of medical school. Clinically, his interests include Point of Care Ultrasound (POCUS), Critical Care, Cardiology and Medical Reasoning. Outside of work, Nilayan enjoys quiet evening walks with his family, meditation, and nature jaunts. He hopes this episode brings you as much joy as it did to him and believes Dr. Aaron Berkowitz is the best thing that has ever happened to #beatingNeurophobia.
Episode 310 – WDx Episode #26: “You are Resilient, even if You Don’t Know It”
Nov 09, 2023
https://clinicalproblemsolving.com/wp-content/uploads/2023/11/WDx-11.9.23-RTP.mp3Sharmin, Kaylin, and Jane are joined by Dr. Risheen Reejhsinghani, cardiologist extraordinaire, Clinical Associate Professor at Stanford, and Associate Program Director of the cardiology fellowship. They discuss her journey through medical training as an international medical graduate, how her love for cardiology developed, and how her career has evolved to allow her to combine her passions for medical education and mentoring into her daily work. Dr. Risheen Reejhsinghani is a Clinical Associate Professor in the Division of CardiovascularMedicine at Stanford. She was born in Mumbai, India, where she attended medical college, after spending her early school years in Sydney, Australia. Risheen moved to Boston for residency atSt. Elizabeth’s Medical Center and completed a cardiology fellowship at Baystate Medical Center, the western campus of Tufts University. She then completed an advanced echocardiography fellowship at the University of California, San Francisco.During fellowship, under combined cardiology and rheumatology mentorship, Risheen developed a clinical focus in cardio-rheumatology. This led to the creation of the StanfordCardio-Rheumatology Program, to provide specialized care to patients with cardiac pathology as a direct consequence of autoimmune disease. Risheen cares deeply about medical education and mentorship, and is an Associate Program Director for the CardiovascularMedicine Fellowship, where working closely with fellows is the absolute best part of her role. In the School of Medicine, she serves as an Associate Course Director for the pre-clerkshipPractice of Medicine Course, and is faculty co-lead for the cardiopulmonary block. Her scholarly work addresses curricular interventions and novel methods of teaching to improve education delivery, with the ultimate goal of increasing global access to education for medical trainees.Outside of medicine, Risheen enjoys writing and used to freelance for a newspaper in India.Along with her husband, she tries to travel as frequently as possible and loves learning about local cultures and traditions in the US and internationally. An ardent enthusiast of the alternative rock scene, Risheen has been an unwavering fan of the band Nirvana since well before she could read an EKG.
Episode 23 – Anti-Blackness, Anti-Fatness, and Food Shaming
Show Notes by Humza A. Siddiqui
October 31, 2023
Summary: This episode highlights the culture of food shaming and anti-fatness as it relates to anti-Blackness. During this episode, we hear from Da’Shaun L. Harrison, a community organizer and trans theorist, and Dr. Psyche A. Williams-Forson, an author and chair of the Department of American Studies at the University of Maryland. Together, our guests offer context around the history of anti-Blackness and how it is deeply intertwined with the culture around eating in America as well as the way anti-fatness manifests. Further, they expand on this to discuss how it relates to policing and the court systems in the U.S. This discussion is hosted by Sudarshan Krishnamurthy and Ashley Cooper. The show notes for this episode were written by Humza A. Siddiqui.
Episode Learning Objectives
After listening to this episode, learners will be able to
Explain how anti-fatness and food shaming culture in the U.S. is rooted in anti-Blackness.
Describe the intersection of policing and the court systems with anti-fatness and food shaming.
Identify ways to navigate clinical interactions with patients while respecting them and affirming their experiences with food and fatness.
Credits
Written and produced by: Sudarshan Krishnamurthy, Ashley Cooper, Team
Hosts: Sudarshan Krishnamurthy and Ashley Cooper
Infographic: Creative Edge Design
Audio Edits: Ashley Cooper and Noah Nakajima
Show Notes: Humza A. Siddiqui
Guests: Dr. Psyche A. Williams-Forson, Da’Shaun L. Harrison
Time Stamps
00:00 Opening
00:45 Introductions
03:07 Guest Introduction 1
04:46 Guest Introduction 2
08:15 On the Intersection of Black, Fat, and Trans Communities and the Medical-Industrial Complex
13:35 History and the Racial Underpinnings of Food Shaming in the U.S. Landscape
21:48 Policing, the Court Systems, Anti-Blackness, and Anti-fatness
46:45: Language Matters: The War On Obesity
1:02:09 On Caring For Black, Fat, and Trans Patients
1:15:37 Fatness is Not Killing People and Other Pearls
1:21:25 Closing Remarks
Speaker biographies (Abbreviated)
Dr. Psyche Williams-Forson is a Professor and Chair of the Department of American Studies at the University of Maryland College Park. She is the author of two award winning books: Eating While Black: Food Shaming and Race in America (James Beard Foundation) and Building Houses Out of Chicken Legs: Black Women, Food, and Power (American Folklore Society); as well as the co-edited Taking Food Public: Redefining Foodways in a Changing Food World. Her work can also be found in several other publications and on podcasts and documentaries. Dr. Williams-Forson received her BA from the University of Virginia and her MA and PhD in American Studies from the University of Maryland.
Da’Shaun Harrison is a trans theorist and Southern-born and bred abolitionist in Atlanta, Georgia. They are the author of Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, which won the 2022 Lambda Literary Award for Transgender Nonfiction and several other media/literary honors. As an editor, movement media and narrative strategist, and storyteller, Harrison uses their extensive history as a community organizer—which began in 2014 during their first year at Morehouse College—to frame their political thought and cultural criticism. Through the lens of what Harrison calls “Black Fat Studies,” they lecture on blackness, fatness, gender, and their intersections. Harrison currently serves as Editor-at-Large at Scalawag Magazine, is a co-host of the podcast “Unsolicited: Fatties Talk Back,” and one third of the video podcast “In The Middle.” Between the years 2019 and 2021, Harrison served as Associate Editor—and later as Managing Editor—of Wear Your Voice Magazine.
Episode Takeaways
Origin Stories – For Dr. Psyche A. Williams-Forson and Da’Shaun L. Harrison, the work that they do is deeply informed by the history of chattel slavery in the United States, through which eugenicists, white anthropologists, and racial realists created entire disorders to medicalize and bastardize enslaved folks who were interested in freedom. Natal alienation is, in part, the under-structure of the wider Medical-Industrial Complex and the gratuitous violence that fat, Black, trans folks experience. All of this contributes uniquely to social death.
Soul Food – Food cultures are more complex, multilayered, and storied than Black stereotypes will lead even Black communities to believe. For this reason, labeling food in categories, and the moralizing that follows, can be extremely dangerous. A toxic cycle of disordered eating can emerge, and treatment for recovery can be rooted in anti-Blackness as physicians view the Black habitus as out of control, unruly, not in conformance with a wider racial project as described by Michael Omi and Howard Winant. The developing attitudes about food scarcity and deficit models, and mass media’s manufacturing consent, has to be challenged, especially because there is a deep and rich history of Black people as farmers, gardeners, and ranchers that belies what Chimamanda Ngozi Adichie calls the danger of a single story.
Afterlife of Slavery – We are living in what Saidiya Hartman calls the Afterlife of Slavery, in where skewed life chances, limited access to health and education, premature death, and surveillance, incarceration, and impoverishment are overdetermined by slavery’s racial calculus. Da’Shaun L. Harrison explains the role of fatness in all of this and offers examples across medicine, law, and sociology that demonstrate fatness and Blackness cannot be divorced from each other. Dr. Williams-Forson expands on this history with respect to Black women, whose bodies are fetishized, and Black children, whose bodies are adultified, respectively. All of this contributes to various mental health challenges that are consistent with surveillance in not only a wider police-state but also the patient-physician relationship.
The War on Obesity – We cannot make recommendations to our Black and Brown patients about diet and exercise without acknowledging that white supremacy is statistically more likely to kill Black and Brown patients than obesity. The conditions through which the United States’ socio-politico-economic apparatus is maintained, and the cultural mores that we encourage as a society, make it difficult for Black and Brown patients to eat a healthy diet or move their bodies freely.
Fatness is Not Killing Black People – Historically, what is killing Black people is a medical industry that is not primarily built to offer care and is otherwise disinterested in learning more about the experiences of Black bodies. Anti-obesity initiatives that aim to reduce weight and encourage healthy diet and exercise, while they may nudge choices on a population level and put pressure on corporations in their harmful advertising, may be reductive in their understanding of fatness as a function of obesity. Fat people can lead healthy lives, and we need to think about the structural issues that keep the populace from being healthy at all sizes. This demands teleological explanations and policy interventions. On one hand, we must not moralize food choices. On the other hand, we cannot let hyper-capitalism off the hook, especially those industries that target Black and Brown communities and seek to profit from the manufactured consent that lends itself to insecurities about weight loss or weight gain.
Pearls
Respect cultural mores about diet and exercise. Acknowledge that Black and Brown patients understand their bodies at some level and what sustains them nutritionally. Be precise instead about the care we can offer beyond weight loss.
Fatness is not killing Black people. However, consider that Black patients are navigating disordered eating as a function of moralizing their food choices under white supremacy and a standard of care that was created by eugenicists, white anthropologists, and racial realists that inappropriately value the heterosexual, cis-gender, white European male habitus.
References
Cox, J. (2020). Fat girls in Black bodies: creating communities of our own. North Atlantic Books.
Harrison, D. (2021). Belly of the Beast: the politics of anti-fatness as anti-blackness. North Atlantic Books.
Taylor, S. R. (2018). The body is not an apology: the power of radical self-love (First Edition). Berrett-Koehler Publishers.
Williams-Forson, P. A. (2022). Eating while Black: food shaming and race in America. The University of North Carolina Press.
The hosts and guests report no relevant financial disclosures.
Citation
Harrison DL, Williams-Forson P, Cooper A, Krishnamurthy S, Siddiqui H, Calac A, Pitre A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Anti-Blackness, Anti-Fatness, and Food Shaming” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. November 7, 2023.
In this Infectious Disease Rafael Medina Subspecialty Episode, Dr. Navila Sharif presents a case to Dr. Natasha Spottiswoode of a patient presenting for fevers and chills.
Session facilitator: Youssef Saklawi
The goal of this series is to provide greater access to subspecialty, primary care, and internal medicine-adjacent specialty education for learners worldwide. For those interested in participating as a case presenter or discussant (or to nominate an educator or attending), the nomination form is available here.
Natasha is a fellow in the Division of Infectious Diseases at the University of California, San Francisco. Her interests include the use of combined host-pathogen metagenomics to diagnose and treat critically ill patients, and the development of better treatments for patients with rare infectious syndromes. She also loves climbing, trail running and backcountry skiing.
Case Presenter: Navila Sharif, MD
Navila is a second year internal medicine resident at Emory University in Atlanta, GA. She is passionate about health equity and advocacy, and is interested in general hospital medicine and gastroenterology, with a keen interest in transplant hepatology. Outside of work, she enjoys exploring coffee shops, binging reality TV, and any hike with the promise of a view.
To join us live on Virtual Morning Report (VMR), sign up HERE.
Sharmin, Jack, and Maddy discuss their approaches to severe acute liver injury, abdominal pain, and hyperferritinemia as they talk through a case presented by Ann-Marie.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Vaness presents a case of shallow breathing to Maria and Sridhara.
Vanessa, a proud Filipino through and through, has dedicated herself to medicine. She has been serving her countrymen since earning her medical degree. Practicing in areas of limited resources, she has sharpened her clinical eye allowing her to realize her passion for neurology where localizing lesions is as intellectually stimulating and satisfying as a daily crossword puzzle. Her interests include cognitive neurology, vascular neurology, and neurocritical care. A true “jill of all trades”, she is always down for a new adventure. She has explored dance and theater, film and photography, various musical instruments, different languages, and swimming. At home, you are most likely to find her in the kitchen preparing your new favorite meal
Maria Jimena Aleman
@MariaMjaleman
María Jimena Alemán was born and raised in Guatemala where she currently works in community and rural health care. After suffering from long standing neurophobia, she has embraced her love for neurology and will pursue a career in this field. She looks forward to dedicating her life to breaking barriers for Latin women in medical fields and improving medical care in her country. Maria is one of the creators of a medical education podcast in Spanish called Intratecal. Her life probably has a soundtrack of a mix between Shakira and Ella Fitzgerald. Outside of medicine, she enjoys modern art, 21st century literature, and having hour-long conversations over a nice hot cup of coffee or tequila.
Sridhara Yaddanapudi
@syaddana_neuro
Sridhara is a board-certified internist, neurologist, vascular neurologist, and hypertension specialist. Currently, he holds the position of Clinical Assistant Professor at Thomas Jefferson University Hospital and serves as the Director of Neurology for Jefferson New Jersey.
As a medical professional, he is passionate about case-based learning, clinical reasoning, and teaching decision-making while avoiding the pitfalls of heuristics. His goal is to bridge the ever-growing gap between neurology and internal medicine, an area in which he has a keen interest.
The spaced learning series team discusses a case of a patient with hyperbilirubinemia secondary to acute alcoholic hepatitis, who then developed hypoxia and hemolysis.
Sharmin & Kaylin are joined by María Jimena Alemán, CPSolvers co-director of internal operations & future neurologist with a passion for global health. They discuss how her upbringing has informed & shaped her passions & values, how she got involved with CPSolvers, the growth that comes from being a leader, the power of community & good mentor-mentee relationships.
María Jimena Alemán was born and raised in Guatemala where she currently works in community and rural health care. After suffering from long-standing neurophobia, she has embraced her love for neurology and will pursue a career in this field. She looks forward to dedicating her life to breaking barriers for Latin women in the medical field and improving neurology care around the world. She loves being a part of The Clinical Problem Solvers where she serves as the co-director of internal operations alongside Madellena Conte. Her life soundtrack is a mix between Shakira and Ms. Lauryn Hill. Outside of medicine, she enjoys contemporary art, crossword puzzles, and having hour-long conversations over a nice hot cup of coffee or tequila.
Kaylin Nguyen is a non-invasive cardiologist with interests in medical education, women in medicine, and health disparities. She was born in Vietnam and grew up in Southern California. She completed medical school and Internal Medicine residency at UCSF. She then made her way down the peninsula to Palo Alto, where she completed cardiology fellowship at Stanford, serving as a chief fellow. She is super excited to be back in Los Angeles and to help care for the underserved community as a clinician-educator at Olive View-UCLA Medical Center. Outside of medicine, you can find her hiking with her dog, making (and eating) baked goods, and buying and neglecting plants*.
In this Gastroenterology Rafael Medina Subspecialty episode, Dr. Allyson Richardson presents a case to Dr. Ryan Flanagan of a 68 year old woman presenting with chronic diarrhea.
The goal of this session is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case discussant: Dr. Ryan Flanagan is a gastroenterologist and faculty member at the Brigham and Women’s Hospital and Instructor in Medicine at Harvard Medical School in Boston. He has a clinical focus on the inpatient GI consult service and is the Associate Program Director for the Gastroenterology Fellowship Program.
Case presenter: Dr. Allyson Richardson is a second year Gastroenterology/Hepatology fellow at Brigham and Women’s Hospital.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, María presents a case of clumsiness to Andrea and Sridhara.
Andrea is a Venezuelan medical doctor and cognitive neuroscientist specializing in advanced white matter imaging. She recently completed a Ph.D. in Cognitive Neuroscience from Colorado State University, USA, and is currently a postdoctoral researcher at the BRAiN Lab in Colorado. Andrea is also actively involved in initiatives supporting neurology applicants (e.g., @NMatch2024) and research career development for international medical graduates. In her free time, she is usually playing guitar or climbing a mountain!
Sridhara Yaddanapudi
@syaddana_neuro
Sridhara is a board-certified internist, neurologist, vascular neurologist, and hypertension specialist. Currently, he holds the position of Clinical Assistant Professor at Thomas Jefferson University Hospital and serves as the Director of Neurology for Jefferson New Jersey.As a medical professional, he is passionate about case-based learning, clinical reasoning, and teaching decision-making while avoiding the pitfalls of heuristics. His goal is to bridge the ever-growing gap between neurology and internal medicine, an area in which he has a keen interest.
Maria Jimena Aleman
@MariaMjaleman
María Jimena Alemán was born and raised in Guatemala where she currently works in community and rural health care. After suffering from long standing neurophobia, she has embraced her love for neurology and will pursue a career in this field. She looks forward to dedicating her life to breaking barriers for Latin women in medical fields and improving medical care in her country. Her life probably has a soundtrack of a mix between Shakira and Ella Fitzgerald. Outside of medicine, she enjoys modern art, 21st century literature, and having hour-long conversations over a nice hot cup of coffee or tequila.
In this episode of WDx, Dr Casey Albin joins Kiara, Jane, & Sharmin to discuss a clinical unknown. Presented by Kiara, the case starts with the chief concern of difficulty recognizing family members.
Casey Albin, MD is an Assistant Professor at Emory University School of Medicine where she is a member of the department of Neurocritical Care. She completed both her neurology residency and a fellowship in Medical Simulation at Harvard Medical School/Partners Neurology before completing a fellowship in Neurocritical Care at Emory. Dr. Albin’s research interests focus on educational innovations in acute neurologic emergencies and neurocritical care. In addition to running simulation courses, she is the editor of The Acute Neurology Survival Guide and is passionate about open access neurologic education through Twitter, EMCrit, and podcasts.
Episode 296 – RLR – A curious case of cough
Jul 19, 2023
In this Infectious Disease Rafael Medina Subspecialty episode, Dr. Jorge Salazar presents a case to Dr. Monica Gandhi of a transgender woman with a recent diagnosis of HIV presenting with fatigue and weight loss.
The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case discussant: Monica Gandhi MD, MPH is Professor of Medicine and Associate Division Chief of the Division ofHIV, Infectious Diseases, and Global Medicine at UCSF/San Francisco General Hospital. She also serves as the medical director of the HIV Clinic at SFGH (“Ward 86”).
Case presenter: Jorge Salazar is an Infectious Disease Fellow at the University of California, San Francisco. He also serves as an AIDS Research Institute Clinical Fellow and provides integrated HIV care for patients at Ward 86.
Episode 293 – Antiracism in Medicine Series – Episode 22 – Live from SGIM 2023: Best of Antiracism Research at the Society of General Internal Medicine’s 2023 Annual Meeting
Jun 27, 2023
Episode 22 – Live from SGIM 2023: Best of Antiracism Research at the Society of General Internal Medicine’s 2023 Annual Meeting
Show Notes by Alec J. Calac
June 22, 2023
Summary: This episode highlights a selection of antiracism research presentations at a live recording of the podcast at the 2023 SGIM Annual Meeting. This year’s episode, our third conducted at SGIM, is focused on the importance of language in medicine and the role it can play in perpetuating stigma and bias. During this episode, we hear from Dr. Som Saha, an internist whose research focuses broadly on the influence of race and racism in the doctor-patient relationship among other research subjects, Dr. Mary Catherine Beach, whose work has been targeted towards improving healthcare quality for patients who face systemic disadvantage especially in the setting of HIV/AIDS and sickle cell disease, and Dr. Pooja Lagisetty, whose work is focused on understanding how stigma impacts access to care for people living with chronic pain and opioid use disorder. This episode is hosted by Sudarshan (Sud) Krishnamurthy and Ashley Cooper. The show notes for this episode were written by Alec Calac.
Episode Learning Objectives
After listening to this episode, learners will be able to…
Differentiate between stigma and bias in health care and the electronic health record using provided examples.
Describe difficulties and examples of how to measure unconscious race bias in medical practice.
Identify strategies to mitigate bias and stigma in the electronic health record as a trainee and medical practitioner.
Credits
Written and produced by: Sudarshan Krishnamurthy, Ashley Cooper, Team
Hosts: Sudarshan Krishnamurthy, Ashley Cooper
Infographic: Creative Edge Design
Audio Edits: Madellena Conte
Show Notes: Alec J. Calac
Guests: Dr. Som Saha, Dr. Mary Catherine Beach, Dr. Pooja Lagisetty
Time Stamps
0:00 Opening
00:23 Introductions
01:50 Guest Introduction 1
02:43 Guest Introduction 2
04:05 Guest Introduction 3
05:25 Guest Career Paths and SGIM Research
07:20 Anti-Racist Praxis and Sickle Cell Clinical Research/Scale Development
10:00 Unconscious Race Bias
16:30 Positive, Negative, Neutral Language in the Electronic Health Record
19:54 Use Language to Personalize and Humanize Notes
21:22 Considerations for Alternative Language
25:20 “Disbelief of Pain” and Scare-Quotes
26:45 Interrupt Transmission of Stigma in the Electronic Health Record
29:20 Beginning of Audience Questions and “Euphemism Treadmill”
35:00 Reorienting Language
38:00 “Value” in the Electronic Health Record
40:00 Question about “Positive Language” as a Tool
42:00 Language and Intended Audiences, Context
45:50 Question on Multi-Level and/or System-Level Interventions
48:00 Becoming Conscious about the Unconscious
49:35 “Thinking Fast and Slow”
50:30 Question on Person-First Language and Artificial Intelligence
53:50 Pearls and “Ending with Hope”
Speaker Biographies (Abbreviated)
Dr. Som Saha received his medical degree and post-graduate training in internal medicine from the University of California, San Francisco, and completed post-doctoral training in the Robert Wood Johnson Clinical Scholars Program (RWJ) at the University of Washington, where he obtained a master’s degree in public health. He subsequently worked at OHSU and the Portland VA for 2 decades before moving to Johns Hopkins University. Dr. Saha’s research focuses broadly on the influence of race and racism in the doctor-patient relationship, its relation to disparities in the quality of health care, and its implications for diversity in the healthcare workforce. He has also served as a Council member and Secretary of SGIM. He has been a research advisor or mentor for over 50 students, fellows, and junior faculty, over a third of whom have been from racial/ethnic groups underrepresented in medicine.
Dr. Mary Catherine Beach is a professor in the School of Medicine, with appointments in the Center for Health Equity and the Berman Institute of Bioethics, at Johns Hopkins University. Dr. Beach’s research focuses on humanizing healthcare by promoting respect for patients as well as improved patient-clinician communication. Much of her work has been targeted toward improving healthcare quality for patients who face systemic disadvantage and in the setting of HIV/AIDS and sickle cell disease (SCD). Her research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, and the Greenwall Foundation. Dr. Beach has won numerous awards for her scholarship and mentorship, including the David Levine Mentoring Award from the Johns Hopkins School of Medicine in 2015. She also is the 2017 recipient of the George L. Engel Award for outstanding research contributions to the theory, practice, and teaching of effective healthcare communication and related skills. In 2022, Dr. Beach was elected as a Hastings Center Fellow; and in 2023 was awarded the Excellence in Ethics Award from the Society of General Internal Medicine.
Dr. Pooja Lagisetty received her medical degree from the Johns Hopkins School of Medicine and completed her internal medicine residency at Massachusetts General Hospital. Following residency, she was a Robert Wood Johnson Clinical Scholar and received health services research methodology training. She is currently an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Michigan and also a research investigator at the Center for Clinical Management and Research at the Ann Arbor VA. Clinically, she is boarded in both Internal Medicine and Addiction Medicine and practices as a primary care physician and teaching hospitalist. Her research focuses on understanding how stigma impacts access to care for people living with chronic pain and opioid use disorder. She is also interested in designing multidisciplinary care models for people with comorbid pain and substance use disorders in the general medical setting.
Episode Takeaways
Stigma in Healthcare: Sud begins by asking our guests what led them to their current career paths and what work they are presenting at SGIM. Many of them share intersecting interests in stigma and other factors, such as chronic pain management, language (“drug-seeking” in the electronic health record), and the patient-provider relationship. Clinician-researchers are increasingly interested in developing novel scales and measures that can quantify stigma in healthcare. As noted by our guests, it is difficult to measure invisible factors such as unconscious race bias, because it is impossible to directly measure these factors. Instead, proxy factors, and other types of experimental inquiry (e.g., qualitative methods) have to be used to describe the impact that factors like bias have in health care. Importantly, there is a lot of nuance around language. It may be difficult to discern the impact that stereotypical language can have in health care because language is very contextual and means different things to different groups.
Stigma (Adverse Impact) vs. Bias (Personal Characteristic): Important to make a distinction between these two concepts. Society stigmatizes certain behaviors, such as drug injection and alcohol use. When a health care provider uses such language (e.g., a person who injects drugs), they may not have any bias against the patient, but they are using language that ascribes stigma to the patient based on societal norms. Another example of phrasing, such as “delightful” and “pleasant” may convey positive bias for one group of patients over another, depending on their racial and/or social identities, but may not be examples of stigma. It is not always clear what is an example of stigma and/or bias in the electronic health record. Learn more here: Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record | Health Affairs
Use Language for Good: Think about what people will remember when they access a patient’s electronic health record. Language can be a powerful tool for good, especially in the backdrop of the opioid epidemic.
Opioid Epidemic and Stigma: Providers generally have a fear or discomfort using opioid agents as treatment for individuals with substance use disorders. Coupled with stigma, bias, and language used to describe these patients in the electronic health record, this perfect storm of factors can work against efforts to help patients in need of safe, comprehensive healthcare services.
Active Use of the Electronic Health Record: Be mindful of the use of “scare-quoting” and other phrasing that could be misinterpreted. Consider taking on an active role in interrupting the continued communication of language that is outdated and no longer relevant to the care of the patient. As mentioned earlier, humanizing the electronic health record can have a significant impact down the line.
“Euphemism Treadmill”: This describes the process of replacing words that have taken on a stigmatizing, pejorative, or derogatory connotation with new words that are more humanizing, and how this is an iterative (unlearning-learning) process. An interesting conversation followed that included discussions about the DSM in psychiatry and psychology (personal failing vs. medical disorder) and how this language-shifting process is likely multi-generational in scale.
Pearls
“Do no harm” through language. Be conscious about the words and phrases used in the clinical encounter and electronic health record. Preserve the dignity of the patient. Small changes can have a large impact.
Include personalizing and humanistic details in the electronic health record. The work begins with educating our learners, while incorporating these lessons into our clinical practice simultaneously.
References
Beach MC, Park J, Han D, Evans C, Moore RD, Saha S. Clinician Response to Patient Emotion: Impact on Subsequent Communication and Visit Length. Ann Fam Med. 2021 Nov-Dec;19(6):515-520. doi: 10.1370/afm.2740. PMID: 34750126; PMCID: PMC8575526.
Park J, Saha S, Chee B, Taylor J, Beach MC. Physician Use of Stigmatizing Language in Patient Medical Records. JAMA Netw Open. 2021 Jul 1;4(7):e2117052. doi: 10.1001/jamanetworkopen.2021.17052. PMID: 34259849; PMCID: PMC8281008.
Beach MC, Saha S. Quoting Patients in Clinical Notes: First, Do No Harm. Ann Intern Med. 2021 Oct;174(10):1454-1455. doi: 10.7326/M21-2449. Epub 2021 Aug 17. PMID: 34399061.
Beach MC, Saha S, Park J, Taylor J, Drew P, Plank E, Cooper LA, Chee B. Testimonial Injustice: Linguistic Bias in the Medical Records of Black Patients and Women. J Gen Intern Med. 2021 Jun;36(6):1708-1714. doi: 10.1007/s11606-021-06682-z. Epub 2021 Mar 22. PMID: 33754318; PMCID: PMC8175470.
Kosakowski S, Benintendi A, Lagisetty P, Larochelle MR, Bohnert ASB, Bazzi AR. Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering. J Gen Intern Med. 2022 May;37(7):1722-1728. doi: 10.1007/s11606-021-07210-9. Epub 2022 Jan 6. PMID: 34993861; PMCID: PMC9130417.
Benintendi A, Kosakowski S, Lagisetty P, Larochelle M, Bohnert ASB, Bazzi AR. “I felt like I had a scarlet letter”: Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain. Drug Alcohol Depend. 2021 May 1;222:108664. doi: 10.1016/j.drugalcdep.2021.108664. Epub 2021 Mar 18. PMID: 33757709; PMCID: PMC8058315.
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
Saha, S, Beach, M, Lagisetty, P, Cooper A, Krishnamurthy S, Calac A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 22: Live from SGIM 2023: Best of Antiracism Research at the Society of General Internal Medicine’s 2023 Annual Meeting” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. June 25, 2023.
Episode 291 – Juneteenth The H&P – History and Perspective – Stories and Conversations with Dr. Kimberly Manning and her Dad, Mr. William Draper, Sr
Jun 19, 2023
Dr. Kimberly Manning and her father, Mr. William Draper, commemorate Juneteenth, the holiday that celebrates the day when all remaining enslaved Black Americas were freed in Galveston Texas, on June 19th, 1865, with this hour-long storytelling event.
Episode 290 – Neurology VMR – Vertigo
Jun 15, 2023
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Gabriela Pucci presents a case of right arm weakness to Promise and Ravi.
Promise Lee @promiseflee
Promise Lee is currently a 3rd year medical student at Loyola University Chicago Stritch School of Medicine. She is an aspiring internal medicine physician with interests in GI, obesity medicine, public health, and clinical reasoning. Outside of medicine, Promise is a food and fitness enthusiast who loves enjoying the outdoors, spending time with family and friends, and experimenting with new recipes.
Gabriela Figueiredo Pucci @gabifpucci
Gabriela Figueiredo Pucci, MD, is a Neurology PGY 1 at University of Pittsburgh Medical Center. Originally from Brazil, she graduated from Unicamp and completed her first Neurology residency at UNESP. She is enthusiastic about breaking down complex Neurology topics into infographics on her website (www.Neudrawlogy.com). She is passionate about Clinical Reasoning and loves to be part of the CPSolvers. On her free time, she likes to travel, cook, bake, and watch competitive cooking and baking reality shows.
Ravi Singh @rav7ks
Ravi (Ravitej) Singh is originally from Greenwich, London U.K where he grew up playing soccer and rugby. He attended medical school at University of Debrecen, Hungary and completed residency at Medstar Harbor Hospital in Baltimore. Currently he is an associate program director for Sinai Hospital IM residency program in Baltimore as well as a Hospitalist on the teaching service. He is a faculty member at the Johns Hopkins School of Medicine and takes time out of his schedule to run a series of case-based teaching sessions as well as medical simulation with all of the medical students that rotate at Sinai throughout the year. He is also a co-chair of the ACP Maryland IMG committee where he advocates for IMG issues Jo and highlights their contributions to the healthcare system
In this episode of WDx, Dr Rebecca Berger joins Kara, Jane, & Sharmin to discuss a clinical unknown. Presented by Kara, the case starts with a young woman presenting with chronic isolated thrombocytopenia.
Dr. Rebecca Berger
Rebecca is an academic hospitalist and assistant professor of medicine at Weil Cornell Medicine and New York Presbyterian Hospital. In addition to her clinical work, she serves as the Director of Patient Safety for Inpatient Services for the Department ofMedicine and teaches medical students and residents, including leading small groups with students on their medicine clerkships focused on clinical reasoning and diagnosis.Rebecca obtained her undergraduate degree from Stanford University in 2009, her medical degree from Columbia University Vagelos College of Physicians and Surgeons in 2013, and completed her internal medicine internship and residency training at Massachusetts General Hospital (MGH) in 2016. She served as a NEJM Editorial Fellow from 2016-2017 and worked as a hospitalist at MGH before moving to Cornell in 2018.
Maddy Conte and Seyma Yildirim introduce a new series on the podcast: “The Rafael Medina Subspecialty Series,” which will always be in loving memory of our dear friend and CPSolvers family member, Dr. Rafael Medina. Rafa presents a nephrology clinical unknown to Drs. Ashita Tolwani and Mustafa Muhammad.
The goal of this series is to expand access to subspecialty, primary care and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant, fill out this form here: https://forms.gle/RLbx6A2vELp6PTYp9
Case presenter and facilitator: Dr. Rafael Medina
Rafa was a Brazilian medical graduate who proudly shared on Twitter, “Son of a tailor and confectionary vendor born and raised in rural Brazil. And now incoming internal medicine resident at the University of Colorado. Never let anyone tell you that your dreams are too big for you!” He tragically passed away last week. He impacted the lives of so many and touched every corner of the CPSolvers community, and rippled far beyond. Rafa helped spearhead the subspecialty series; this series has been renamed after Rafa and will continue strong in his honor. Rafa, we love you.
Case discussants: Dr. Ashita Tolwani, Professor of Medicine at the University of Alabama at Birmingham (UAB). She was the Nephrology Fellowship Training Program Director from 2004-2010 and is now the Associate Program Director. She is also the Director for ICU Nephrology at UAB. (Twitter: luck_urine)
Dr. Mustafa Noor Muhammad, nephrology fellow at the University of Alabama at Birmingham.
Episode 285: Anti-Racism in Medicine Series – Episode 21 – Psychosocial and Cultural Considerations for Providing Healthcare to Immigrant and Refugee Populations
May 02, 2023
Episode 21 – Psychosocial and Cultural Considerations for Providing Healthcare to Immigrant and Refugee Populations
Show Notes by Kiersten T. “Gillette” Gillette-Pierce
May 2, 2023
Summary: This episode highlights the psychosocial and cultural considerations for providing healthcare to immigrant and refugee populations. During this episode, we hear from Dr. Altaf Saadi, a neurologist who focuses on neuropsychiatric health disparities and addressing the needs of displaced populations at Mass General Hospital and Harvard Medical School, and Dr. Naweed Hayat, a child and adolescent psychiatry fellow at the University of California San Diego, who applies his own lived experience of resettlement to his clinical practice. Together, our guests explain how trauma shows up in those who experience resettlement, and the role of trauma-informed and culturally-responsive care for refugee, asylee, and immigrant population in clinical practice.. This discussion is hosted by Sudarshan Krishnamurthy, Ashley Cooper, and LaShyra Nolen.
Episode Learning Objectives
After listening to this episode, learners will be able to…
Explain how the current state at the border is informed by historical immigration injustices.
Describe how physiological and psychological trauma show up among immigrant and refugee populations as a result of the violence and injustices experienced during migration, at the border, during the resettlement process and across the lifecourse thereafter.
Identify the role of trauma-informed, culturally-responsive care for refugee, asylee, and immigrant populations and how it can be operationalized in clinical practice.
Credits
Written and produced by: Sudarshan Krishnamurthy, Ashley Cooper, LaShyra Nolen, Kiersten Gillette-Pierce, Rohan Khazanchi, MD, MPH, Dereck Paul, MD, Jazzmin Williams, Victor A. Lopez-Carmen MPH, Naomi F. Fields, Jennifer Tsai MD, MEd, Chioma Onuoha, Ayana Watkins, Michelle Ogunwole MD, Utibe R. Essien MD, MPH
Hosts: Sudarshan Krishnamurthy; Ashley Cooper, and LaShyra Nolen
Infographic: Creative Edge Design
Audio Edits: Garrett Weskamp
Show Notes: Gillette Pierce
Guests: Dr. Altaf Saadi and Dr. Naweed Hayat
Time Stamps
0:28 Introduction
0:31 Episode introduction
1:15 Guest introductions
3:50 Origin stories
8:06 The current state of the border
18:13 Culturally competent and trauma-informed care
24:50 ICE and policing
36:28 Application of teachings
Episode Takeaways
Origin Stories — For Dr. Hayat and Dr. Saadi, the work that they do is deeply informed by their lived experiences as migrants themselves as well as in their professional roles as clinicians who serve immigrant and refugee populations.
State of the Border — Policies that happened under the Trump administration and now under the Biden administration have left people vulnerable to injustices in Mexico and other Central American nations. People are fleeing persecution, gang violence, and other violence such as sexual or other violent assaults and now they must also face the additional burden of the lack of access to basic necessities like food, water and shelter. A lot of compounding trauma occurs at the border that has potential downstream mental health implications for individuals and their families.
Culturally Competent and Trauma-Informed Care — Interpersonal components such as screening for trauma exposure and providing resources to families are an important aspect of trauma-informed care, and it should also include efforts at the organization level to create sanctuary or immigrant-friendly spaces and implement immigration-informed care, which builds on the concept of trauma-informed care by honing in on the unique factors associated with immigrant populations, e.g. protocols for broaching sensitive topics like immigration status and policies to ensure people are safe from immigration enforcement.
ICE and Policing — Instances of immigration enforcement in healthcare settings are rare, and when they do happen they can look like patients being interrogated at the bedside or even being arrested as they step out of the hospital just after visiting someone. These instances contribute to immense fear that can act as a deterrent from seeking care or engaging with any other helping professional institutions in the future–this goes for the individual(s) directly impacted and the people within their communities.
Impact of Health Records — The impact of health records within the context of healthcare for immigrant populations is complex because migration status really should not be documented explicitly as it can open people up to harms such as stigma from providers or being turned over to law enforcement agencies who may cooperate with immigration enforcement. Many organizations, such as the American Medical Association Journal of Ethics, recommend against documenting immigration status in medical records.
Application of teachings — It is advised to amplify the work that is already being done in communities and identify what areas at the systems level need to change as well as the key stakeholders.
Pearls
Dr. Hayat discusses the five major waves of migration in the last fifty years, resulting from the Soviet-Afghan War, the Afghan Civil War, the Fall of the Taliban, August 2021 US and western forces departure, and how he grew up during the 1990s right after the collapse of the government. He recounts street fights in Kabul as well as an overall theme of people going back to a focus on survival, or the need for food, shelter, water and safety.
Dr. Saadi discusses how her parents left Iraq under Saddam Hussein’s dictatorship, where he was targeting many Iraqis with Iranian ancestry and Shi’a Muslims–which included members of her family. She notes she was born in Iran and her family emigrated to Canada and then to the United States just a month before 9/11. She recounts this time as particularly tumultuous for not only Muslim Americans but also South Asian Americans, Sikh Americans, as well as Arab Americans who were not Muslims.
Dr. Saadi highlights that the majority of immigrants do not come through the US-Mexico border, even for undocumented folks. Additionally, in the case of folks who are undocumented, it is likely the case that they attained this status as a result of overstaying their previously valid visa.
Dr. Saadi discusses the Biden administration rule proposal that would essentially prohibit refugees from seeking asylum in the US, making them ineligible for asylee status.
Dr. Saadi highlights that there needs to be a greater focus on the continuum of experiences when we discuss patients who are immigrants or forcibly displaced because there is not often a clear pre-post distinction. Many people’s journeys can involve being in an encampment, being detained in immigration prisons, or stopping in multiple countries before reaching the final destination.
Dr. Saadi also uplifts the fact that while we focus primarily on those we have clinical encounters with, it is always important to mention that there are many people that did not make it to clinic for an amalgam of reasons — many people lost their lives in the quest for better lives and freedom from persecution.
Dr. Hayat stresses the difference that cultural psychiatry, cultural competency, and the biopsychosocial model make in building rapport and there is a lot that goes on in between pre- and post-resettlement and those experiences have to be taken into account, especially in cases where there are language and cultural barriers. He highlighted the DSM-5 Cultural Formulation Interviews.
Dr. Saadi recommends avoiding documentation of immigration status in medical records, or having clear guidelines on what to do if immigration enforcement is present at the clinical setting.
Dr. Saadi notes that we must not see people as the sum of their traumas, they are so much more than that — especially in the case of forcibly displaced peoples and immigrants. We must not reduce people to their trauma exposure alone.
Dr. Hayat interestingly mentions that some organizations have been able to build relationships with law enforcement, educate them, and share different challenges to help realize a common goal.
Dr. Hayat notes that while organizations recommend against documenting immigration status in medical records, needs can still be met through partnerships with community organizations. Dr. Saadi adds that we can collect this data, and there is immense groundwork that must be done to develop protections for immigrant and refugee populations and ensure the data are protected.
Dr. Saadi mentioned a toolkit around policies and actions that can be implemented at an organizational level that is publicly available at www.doctorsforimmigrants.com. She also mentions additional organizational-level policies and actions that can take place beyond what is mentioned in the toolkit such as setting up a medical legal partnership where people can connect to attorneys that can help them with their immigration case or civic engagement promotion. She also mentioned Dr. Mark Kuczewski’s sanctuary doctrine toolkit that focuses more on the individual level. Refer to Good Sanctuary Doctoring for Undocumented Patients for more information. Dr. Hayat mentioned his colleague, Dr. Olivia Shadid, who does work on mental health evaluations for asylum seekers, which can be found here.
References
Morris JE, Saadi A. The Biden administration’s unfulfilled promise of humane border policies. Lancet. 2022 May 28;399(10340):2013. doi: 10.1016/S0140-6736(22)00741-3. Erratum in: Lancet. 2022 Jun 2;: PMID: 35644152.
Shi M, Stey A, Tatebe LC. Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees. Curr Trauma Rep. 2021;7(4):83-91. doi: 10.1007/s40719-021-00217-x. Epub 2021 Nov 13. PMID: 34804764; PMCID: PMC8590436.
Valtis 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, 2022
Berkman JM, Rosenthal JA, Saadi A. Carotid Physiology and Neck Restraints in Law Enforcement: Why Neurologists Need to Make Their Voices Heard. JAMA Neurol. 2021;78(3):267–268. doi:10.1001/jamaneurol.2020.4669
James J, Heard-Garris N, Krishnamurthy S, Cooper A, Calac A, Watkins A, Onuoha C, Lopez-Carmen VA, Krishnamurthy S, Calac A, Nolen L, Williams J, Tsai J, Ogunwole M, Khazanchi R, Fields NF, Gillette-Pierce K. “Episode 18: Remedying Health Inequities Driven by the Carceral System” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. October 18, 2022.
Chiesa V, Chiarenza A, Mosca D, Rechel B. Health records for migrants and refugees: A systematic review. Health Policy. 2019 Sep;123(9):888-900. doi: 10.1016/j.healthpol.2019.07.018. Epub 2019 Jul 30. PMID: 31439455.
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
Saadi A, Hayat N, Krishnamurthy S, Cooper, A, Nolen L, Gillette-Pierce K, Calac A, Essien UR, Fields NF, Lopez-Carmen VA, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 21: Antiracist Healthcare for Immigrant and Refugee Populations ” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. April 25, 2023
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Ravi Singh presents a case of right arm weakness to Yazmin and Sridhara.
Yazmin is a Mexican Graduate from the Universidad Autonoma de Yucatan. During her medical training, she developed a strong interest in Public Health, Medical Education, and Health Equity and is looking forward to pursuing a career in Internal Medicine. When she is not volunteering on a project, she likes taking care of her plants, developing her skills in the fine arts, or learning a new language.
Sridhara is a board-certified internist, neurologist, vascular neurologist, and hypertension specialist. Currently, he holds the position of Clinical Assistant Professor at Thomas Jefferson University Hospital and serves as the Director of Neurology for Jefferson New Jersey.
As a medical professional, he is passionate about case-based learning, clinical reasoning, and teaching decision-making while avoiding the pitfalls of heuristics. His goal is to bridge the ever-growing gap between neurology and internal medicine, an area in which he has a keen interest.
Ravi (Ravitej) Singh is originally from Greenwich, London U.K where he grew up playing soccer and rugby. He attended medical school at University of Debrecen, Hungary and completed residency at Medstar Harbor Hospital in Baltimore. Currently he is an associate program director for Sinai Hospital IM residency program in Baltimore as well as a Hospitalist on the teaching service. He is a faculty member at the Johns Hopkins School of Medicine and takes time out of his schedule to run a series of case-based teaching sessions as well as medical simulation with all of the medical students that rotate at Sinai throughout the year. He is also a co-chair of the ACP Maryland IMG committee where he advocates for IMG issues Jo and highlights their contributions to the healthcare system
Episode 20 – Medical Racism and Indigenous Peoples
Show Notes by Sudarshan (“Sud”) Krishnamurthy
April 4, 2023
Summary: This episode highlights the checkered past of medicine and the advancements in the field that have occurred at the expense of the humanity of Indigenous peoples. During this episode, we hear from Dr. Nav Persaud, a staff physician in the Department of Family and Community Medicine at St. Michael’s Hospital in Unity Health Toronto, and Dr. Alika Lafontaine, the current President of the Canadian Medical Association. Together, our guests explain how Indigenous knowledge systems are the foundation of modern medicine and also share strategies to promote truth and reconciliation with Indigenous Peoples in North America. This discussion is hosted by Alec Calac and Gillette Pierce.
Episode Learning Objectives
After listening to this episode, learners will be able to…
Explain how the dark legacy of discrimination and deliberate oppression of Indigenous Peoples has led to present-day disparities across the world
Describe how medicine has held some white men to high esteem, even when they harbored significant racist and sexist notions
Identify the role of Indigenous knowledge systems in shaping much of modern medicine today, yet experiencing erasure from the mainstream
Credits
Written and produced by: Alec J. Calac, Gillette Pierce, Sudarshan Krishnamurthy, Rohan Khazanchi, MD, MPH, Dereck Paul, MD, Jazzmin Williams, Victor A. Lopez-Carmen MPH, Ashley Cooper, Naomi F. Fields, LaShyra Nolen, Jennifer Tsai MD, MEd, Chioma Onuoha, Ayana Watkins, Michelle Ogunwole MD, Utibe R. Essien MD, MPH
Hosts: Alec J. Calac and Gillette Pierce
Infographic: Creative Edge Design
Audio Edits: Caroline Cao
Show Notes: Sudarshan (“Sud”) Krishnamurthy
Guests: Dr. Nav Persaud and Dr. Alika Lafontaine
Time Stamps
0:00 Introduction
0:45 Episode Introduction
1:10 Guest Introductions
3:30 Existing global disparities among Indigenous Peoples
6:00 How access to medications are impacted among Indigenous Peoples in Canada
8:30 Framing around the Design of Structures in Canada to suppress Indigenous voices
13:30 Legacy of Osler and the importance of rediscovering forgotten dark histories
16:20 Dehumanization of individuals belonging to marginalized groups by the healthcare system
27:50 Modern medicine and its roots in Indigenous knowledge systems
31:30 Provision of healthcare to Indigenous Peoples in Canada
34:50 Alec’s own advocacy around renaming a campus parking garage
36:55 Weaponization of professionalism
45:00 Clinical takeaways and practical tools for clinician listeners
Episode Takeaways
Indigenous communities around the world experience significant disparities in life expectancy, burden of disease, and socioeconomic status, due to deliberate exclusion of Indigenous Peoples from the mainstream and suppression of their voices in the design of the system.
Within medicine, we tend to hold white men from history books in high esteem, often without recognizing the dark legacy that accompanied their lives. William Osler is one such example who, along with numerous other sexist and racist misconducts, took remains of Indigenous people with him as a gift to his mentor in Germany, that is still held by a German museum who refuses to return it.
The dehumanization of individuals of color at the margins of society by the healthcare system is not simply a thing of the past, and is certainly a persistent phenomenon. Cindy Gladue, Brian Sinclair, and Joyce Echaquan are three Indigenous individuals who suffered immense harm at the hands of the healthcare system.
There is strength in reconciling Indigenous history, and we must prevent further erasure of Indigenous knowledge systems. The solutions to these issues do not fall upon one community’s shoulders, but instead on the shoulders of all of us along with the oppressive systems that have led us here.
Pearls
Alec begins by contextualizing this episode with the fact that although Indigenous people make up 6% of the global population, they compose 15% of the global population experiencing extreme poverty. Additionally, Indigenous communities experience lower life expectancy, higher burden of disease, and lower socioeconomic status compared to non-Indigenous Peoples. These disparities are likely attributable, in part, to the disruption of Indigenous knowledge systems, inadequate infrastructure, and poor identification of health data among these groups, rather than individual behavior. [Supplementary Resource for Listeners: CPSolvers Episode 12: Addressing Anti-Indigenous Racism in Medicine with team members Alec Calac and Victor Anthony Lopez-Carmen]
Nav discusses that despite publicly funded healthcare systems in Canada and federal protections in place for certain Indigenous groups, Indigenous populations and other groups facing discrimination and historic oppression are much more likely to report not being able to take medications due to cost. Although healthcare services are publicly funded, access to medications depends on private or public insurance and is linked with employment. While some have the impression that there is a safety net in Canada for life-saving medications, Nav still sees patients in his practice who are harmed by the system and not able to afford life-saving medications, many of them Indigenous, and this is a violation of their right to access essential medicines.
Alika expands on Nav’s framing by highlighting the three broad demographics in Canada: the Inuit, the Métis, and the First Nations. In contrast to settlers in the United States where “conquering” through deception was a priority, the spread of settlers was more so through the signing of agreements that were never lived up to. Indigenous peoples in Canada have deliberately been left out of the mainstream to ensure their voices were suppressed in the design of the system.
Alika elaborates on the history of Indigenous populations in Canada and how they would conduct X-Rays on the Inuit children, and ship these kids away for 3 to 10 years if they found tuberculosis in the lungs, without even allowing the children to say goodbye to their parents. Alika recalls stories of individuals in Ottawa who were on the same floor for several years, only to realize that they were members of the same family after being placed in these TB sanatoriums and crossing paths there.
Nav begins to discuss how Osler is still revered as one of the most prominent historical physicians in Canada and the United States. A colleague brought information to Nav that Osler had brought remains of Indigenous people as a gift to one of his mentors in Germany. This led him to look into Osler’s history a little further, and Nav found it easy to find other instances of racist and sexist misconduct by William Osler. These remains are still in a museum in Germany, with no plan of return to Indigenous communities. [Supplementary Resource for Listeners: Read Dr. Persaud’s initial article on Osler here]
Osler lived in the time of Numbered Treaties and the North-West Rebellion under Louis Riel, when Indigenous rights were front and center. It is ridiculous to consider that a physician brought Indigenous remains with him as a gift during this period in history, when Osler knew Indigenous people were fighting for their rights and lives. So, we must rethink the esteem that we hold white men like Osler in, and rediscover the forgotten history that accompanies them. [Supplementary Resource for Listeners: You can read more about the North-West Rebellion here]
Alika discusses the dehumanization of individuals of color and other identities who exist at the margins within the healthcare system and emphasizes that these are not phenomena of the past. He highlights the hostility within the healthcare system and how healthcare must be a service that is available equally to everybody, and not treated as a favor being done to individuals. He narrates the stories of Cindy Gladue, Brian Sinclair, and Joyce Echaquan, all of whom suffered immense harm at the hands of the healthcare system as Indigenous individuals. [Supplementary Resource for Listeners: You can read about Cindy Gladue, Brian Sinclair, and Joyce Echaquan here]
Nav expands on this aspect of dehumanization of Indigenous peoples and speaks about how the Indigenous remains are being treated in Germany today. Although there is guidance that they must be returned, they have decided to retain them. In addition, there is writing within these skulls with numbers written on the inside, as if to catalog them. The museum has also added multiple barriers for those who wish to rightfully receive these remains, and has placed the onus on these communities for these remains to be returned.
Alec importantly highlights that while these harms might seem historical and like things of the past, they have taken place within one or two generations and even today. He discusses his experiences as an Indigenous person in California who attends a medical school that begrudgingly decided to return Indigenous remains, from one of the largest collections in the world.
Alika talks about strength in knowing his history. He discusses the medical knowledge of settlers in Canada believing in four humors and the practice of bloodletting to relieve sickness. At that time, Indigenous Peoples were harvesting plants at their peak potency and concentrating these plants in teas, and delivering medications through oral and transdermal routes. He talks about how Atropine, a commonly used drug by anesthesiologists like Alika, is derived from Belladonna and how folks practicing traditional medicine use Belladonna.
Alika also delves deeper into the provision of healthcare to Indigenous peoples in Canada. He mentions that healthcare was provided to Indigenous peoples rooted in a charitable effort, rather than as a basic human right. It is important to move beyond being nice to each other, and begin to think about the requirements and obligations we have to each other as human beings.
Alec goes on to highlight that as much as we have gained, we have much more to fight for. In episode 12, we discussed how the American Indian and Alaskan Native life expectancy as of 2021 was equivalent to that of the American public in the 1940s. The solution to these issues shouldn’t fall upon one or a few of our shoulders, but instead upon the shoulders of all of us along with the systems that have the resources and infrastructures to inform change.
Alec used Nav’s article to advocate for the renaming of a parking garage on campus that was named after William Osler. Our spaces reflect our values, so the question he asked was why they had a parking garage named after an individual who has no relation to the local community in San Diego? We think about the legacy in medicine, but forget about the community we are in. [Supplementary Resource for Listeners: Read Alec’s Editorial about his advocacy related to renaming a street and parking structure in his medical school campus here.]
Nav describes professionalism as a vague concept that is often used to oppress individuals from racialized and marginalized backgrounds. Professionalism is often antithetical to a rights-based approach to medicine, where every member of a team feels comfortable to speak up when everything is not right with a patient’s care and professionalism can scare people from speaking out when needed.
Alika expands on this explanation of professionalism in terms of what is acceptable, decided by whoever is in control. It can be used to amplify what leaders think is important and suppress what leaders do not like, demonstrating the importance of leadership from diverse backgrounds and varied lived experiences. Retaliation can be severe to violations of professionalism, and it’s hard to know the effects of retaliation unless one has experienced these themselves. [Supplementary Resource for Listeners: Read about the experience Dr. Lafontaine describes regarding his own experience with reporting unprofessional and unacceptable conduct here]
Nav states that it is important for us to reflect on what has happened and recollect all of the work people have done to chronicle anti-Indigenous racism. Racism is not new, and there have been numerous reports that document racism and anti-Indigenous discrimination over decades and centuries. We must respect what has happened, and recognize as non-Indigenous people that we benefit from advocacy and efforts of Indigenous peoples for Indigenous rights over generations.
Alika emphasizes that the point of this conversation is not to make anyone feel like they are a bad person, but instead to help them acknowledge that in this healthcare system we provide both health and harm. Providing our patients with more space and ensuring our patients feel human again is a great first step. It is also important to remember that in the course of restructuring power, there are winners and losers and we may not all have the same voice around the table that we did before. We entered medicine to help people, and sometimes the best way to help people is by getting out of the way and allowing for others to step forward.
References
Persaud N, Butts H, Berger P. William Osler: saint in a “White man’s dominion”. CMAJ. 2020;192(45):E1414-E1416. doi:10.1503/cmaj.201567
Reid P, Cormack D, Paine SJ. Colonial histories, racism and health-The experience of Māori and Indigenous peoples. Public Health. 2019;172:119-124. doi:10.1016/j.puhe.2019.03.027
Redvers N, Blondin B. Traditional Indigenous medicine in North America: A scoping review. PLoS One. 2020;15(8):e0237531. Published 2020 Aug 13. doi:10.1371/journal.pone.0237531
Fredericks CF. Mapping the Sustainable Development Goals onto Indian Nations. In: Miller RJ, Jorgensen M, Stewart D, eds. Creating Private Sector Economies in Native America: Sustainable Development through Entrepreneurship. Cambridge: Cambridge University Press; 2019:185-194. doi:10.1017/9781108646208.011
Browne AJ, Lavoie JG, McCallum MJL, Canoe CB. Addressing anti-Indigenous racism in Canadian health systems: multi-tiered approaches are required. Can J Public Health. 2022;113(2):222-226. doi:10.17269/s41997-021-00598-1
Persaud N, Ally M, Woods H, et al. Racialised people in clinical guideline panels. Lancet. 2022;399(10320):139-140. doi:10.1016/S0140-6736(21)02759-8
Lafontaine AT, Lafontaine CJ. A retrospective on reconciliation by design. Healthc Manage Forum. 2019;32(1):15-19. doi:10.1177/0840470418794702
Lafontaine A. Indigenous health disparities: a challenge and an opportunity. Can J Surg. 2018;61(5):300-301. doi:10.1503/cjs.013917
Durand-Moreau Q, Lafontaine J, Ward J. Work and health challenges of Indigenous people in Canada. Lancet Glob Health. 2022;10(8):e1189-e1197. doi:10.1016/S2214-109X(22)00203-0
Okpalauwaekwe U, Ballantyne C, Tunison S, Ramsden VR. Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review. BMC Public Health. 2022;22(1):1630. Published 2022 Aug 29. doi:10.1186/s12889-022-14047-2
Berger P. Canadian Physicians’ Breach of Duty to Patients and Communities from the Acquisition of Indigenous Skulls in the 19th Century to the Abandonment of People with AIDS in the 20th Century. J Biocommun. 2021;45(1):E13. Published 2021 Aug 15. doi:10.5210/jbc.v45i1.10849
The hosts and guests report no relevant financial disclosures.
Citation
Persaud N, Lafontaine A, Calac A, Pierce G, Krishnamurthy S, Essien UR, Fields NF, Lopez-Carmen VA, Cooper A, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Ogunwole M, Khazanchi R. “Episode 20: Advancing Medicine at the Expense of Indigenous Humanity” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. April 4, 2023
Episode 281: The Consult Question #8 – Pancytopenia and Rash
Mar 23, 2023
https://clinicalproblemsolving.com/wp-content/uploads/2023/03/3.23.23-TCQ-RTP.mp3Dr. Vipul Kumar presents a fascinating case of pancytopenia and rash to guest discussant, Dr. Anand Patel. Dr. Vipul Kumar MD PhD is a hematology-oncology fellow at UCSF. He is currently in his second year of fellowship and has a clinical interest in oncology of all forms as well as a passion for teaching. Dr. Anand Patel is an assistant professor of medicine at University of Chicago where he treats patients with leukemia and myeloid malignancies. He also serves as medical director of the inpatient leukemia service. His research focuses on the development of clinical trials to help improve the standard of care for patients with high risk leukemias and myeloid malignancies. Twitter: @Anand_88_Patel
Simone and Moses review their approach to chronic lower extremity weakness in a patient with new-onset jaundice, as Vale presents them a case with a neuro flavor to it.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Yazmin presents a case of lethargy and myoclonus to Kiara and Maria.
María Jimena Alemán was born and raised in Guatemala where she currently works in community and rural health care. After suffering from long standing neurophobia, she has embraced her love for neurology and will pursue a career in this field. She looks forward to dedicating her life to breaking barriers for Latin women in medical fields and improving medical care in her country. Maria is one of the creators of a medical education podcast in Spanish called Intratecal. Her life probably has a soundtrack of a mix between Shakira and Ella Fitzgerald. Outside of medicine, she enjoys modern art, 21st century literature, and having hour-long conversations over a nice hot cup of coffee or tequila.
Kiara Camacho-Caballero was born in Lima, Perú and she is a medical doctor at Universidad Científica del Sur. She is passionate about Internal Medicine, Cardiology, and medical education. Her research interests are cardiology, neurology, and, geriatrics. Her plans are to apply for Internal Medicine residency in the US this year. Outside medicine, she is a past triathlete and her dream is to perform an IRONMAN 70.3 someday. Kiara enjoys running, and spending time with her dog named Zack and her favorite food is turkey legs.
Yazmin Heredia
@minheredia
Yazmin is a Mexican Graduate from the Universidad Autonoma de Yucatan. During her medical training, she developed a strong interest in Public Health, Medical Education, and Health Equity and is looking forward to pursuing a career in Internal Medicine. When she is not volunteering on a project, she likes taking care of her plants, developing her skills in the fine arts, or learning a new language.
Episode 275: Anti-Racism in Medicine Series – Episode 19 – Reframing the Opioid Epidemic: Anti-Racist Praxis, Racial Health Inequities, and Harm Reduction
Feb 09, 2023
Episode 19 – Reframing the Opioid Epidemic: Anti-Racist Praxis, Racial Health Inequities, and Harm Reduction
Show Notes by Alec Calac
February 9, 2022
Summary: This episode highlights racialized disparities in addiction treatment. During this episode, we hear from Dr. Jessica Isom, a board-certified community psychiatrist and faculty leader in the Yale Department of Psychiatry’s Social Justice and Health Equity Curriculum, and Dr. Ayana Jordan, the endowed Barbara Wilson Associate Professor in the Department of Psychiatry, Addiction Psychiatrist and Associate Professor in the Department of Population Health at New York University (NYU) Grossman School of Medicine. Together, our guests explore and unpack how the criminalization and racialization of substance use builds to the present-day opioid epidemic and shapes inequities in care. There is a special emphasis on the use of public health models that prioritize harm reduction and person-centered care to prevent drug-related fatalities and curb the opioid epidemic along lines of race and class. This discussion is hosted by Ashley Cooper, Sudarshan Krishnamurthy, and new team member Gillette Pierce.
Episode Learning Objectives:
After listening to this episode, learners will be able to…
Explain how the criminalization and racialization of substance use builds to the present-day opioid epidemic and shapes inequities in care.
Describe how the media shapes public sentiment toward substance use and addiction treatment.
Identify realistic solutions to drug policy reform that promote health equity among marginalized communities living in the United States.
Credits:
Written and produced by: Ashley Cooper, MPhil; Sudarshan Krishnamurthy; Gillette Pierce; Alec J. Calac; Michelle Ogunwole, MD, PhD; Ayana Watkins; Chioma Onuoha; Naomi F. Fields, MD; Victor A. Lopez-Carmen, MPH; Rohan Khazanchi, MPH; Sudarshan Krishnamurthy; Utibe R. Essien, MD, MPH; Jazzmin Williams; LaShyra Nolen; Jennifer Tsai MD, MEd
Hosts: Ashley Cooper, Sudarshan Krishnamurthy, and Gillette Pierce
Infographic: Creative Edge Design
Audio Edits: Caroline Cao and Ashley Cooper, MPhil
Show Notes: Alec Calac
Guests: Jessica Isom, MD, MPH and Ayana Jordan, MD, PhD
Time Stamps:
1:30 Guest Introductions
4:15 Framing the Sociohistorical Context of the Opioid Epidemic
10:47 Racialization of Substance Use and Medicalization of the Human Experience
14:28 Changing “Faces of Addiction” and Impact on U.S. Drug Policy
16:35 United States, Chinese Laborers, and Anti-Chinese Sentiment (“Opium Fiends”)
19:30 “Moral Panic”
23:00 Separating Minoritized Individuals from the Majority
23:40 Cocaine Possession Sentencing Disparities
26:50 Shifting Social Attitudes Toward Substance Use and Addiction
30:30 (Mis)framing of Substance Use as a White Problem to Enact Change
33:15 Rectifying Racial Health Inequities in Opioid Addiction Treatment
36:10 Take-Home Methadone and a Less Clear Need for Methadone Clinics
40:40 Understanding Substance Use Disparities with Racially Disaggregated Data
47:00 Pushing Back Against “One Size Fits Most”
49:30 Harm Reduction Practices
53:00 Narrowing the Empathy Gap and Connecting with Patients
55:25 Spirit of Sankofa: Looking Back to Move Forward
59:15 Reducing Harm and “Optimizing Safety”
1:08:00 Community-Centered Solutions
1:10:20 Drug Policy Reform
1:15:42 Episode Takeaways
Episode Takeaways:
Health care providers, especially physicians, cannot be equity-ignorant or egalitarian in our racialized society. They can use their training and privilege to advocate for meaningful policy reform.
The opioid epidemic is more than a white problem. Demographic data in research and practice must always be disaggregated by race and ethnicity.
Screening for substance use and offering connections to treatment and community-based services are important strategies that clinicians can implement in their own practice today.
Pearls:
In 2020, American Indian and Alaska Native (Indigenous) communities experienced the highest drug overdose mortality rate of any racial or ethnic group, also surpassing rates among the non-Hispanic white population. Between 2007 – 2019, Black individuals experienced a higher death rate for opioid overdose deaths than any other racial or ethnic group. [Supplementary Resource for Listeners: CPSolvers Episode 12: Addressing Anti-Indigenous Racism in Medicine with team members Alec Calac and Victor Anthony Lopez-Carmen]
Dr. Jordan begins our episode by framing the racialization and criminalization of substance use in the larger history of the United States, emphasizing that American society has seen substance use as “criminal behavior” or a moral failing, rather than as a medical condition, which began towards the early 2000s. She mentions that academia, as well as the media, have contributed to this complex social phenomenon by tying together race, gender, and substance use, especially in the context of maternal health and neonatal abstinence syndrome. The foundational literature in this area has furthered stigma and bias, especially towards Black birthing persons. These narratives have vilified individuals who would benefit from comprehensive, person-centered substance use treatment, rather than incarceration and other adverse harms.
Dr. Isom continues the conversation around the intentionality of these structural processes and the language that frames the racialization of substance use in the United States by lawmakers, media, and the healthcare profession. This parallels another process, which is the medicalization of human experiences, especially those relating to childbirth and pregnancy. A more Western perspective on health care emphasizes the role of physicians and health care providers and marginalizes the role and contributions of doulas and midwives. She then ties this back to Dr. Jordan’s conversation about the criminalization of substance use and how resources and infrastructure are dedicated to incarceration, rather than psychotherapy and related treatments. [Supplementary Resource for Listeners: Advancing Health Equity: A Guide to Language, Narrative and Concepts]
Sudarshan goes further into the changing “faces of addiction” and asks our guests to describe its impact on drug policy in the United States. Dr. Isom first challenges our listeners to engage with anti-racist praxis and challenge dominant racial narratives about substance use, policing, and other encounters. She then goes into how the racialization of substance use drove positive public sentiment for the adoption of punitive outcomes for substance use. One example that is presented involves the complicated relationship between the United States and Chinese immigrants and farmworkers in California. Once the need for labor was largely met, anti-Chinese narratives (e.g., opium fiends) emerged around opium, gambling, and prostitution, which fits into this pattern or formula of associating specific racial and ethnic groups with substance use as a rhetorical threat to the “most valued demographic” in the United States (white women and children) to drive the adoption of punitive measures. This largely obscures the reality that substance use rates are similar among different racial and ethnic groups. [Supplementary Resource for Listeners: San Francisco Opium Ordinance described in Race and the Criminalization of Drugs – National Press Foundation | NPF featuring Dr. Jessica Isom and Dr. Helena Hansen]
Dr. Jordan echoes these thoughts and posits that divergence from the “ideal” American identity (i.e., white, cisgender, heterosexual) makes it possible to other (verb) individuals and enact policies and laws that punish individuals with marginalized identities. She shared that rhetoric used by Nixon and the subsequent war on drugs has similarities to Trumpism and messaging associated with Make America Great Again (MAGA). This is then reaffirmed during the Reagan Administration and is later codified into sentencing structures, in which we see vastly different amounts of cocaine possession (100:1 crack versus powder cocaine possession offenses) amounting to similar sentences, with crack cocaine use most prevalent among minoritized individuals and powder cocaine use most prevalent among the white majority. Involvement with the carceral system further intersects with issues around employment, household income, and other related disparities. To our listeners, how might we begin redressing these harms and reinvest in minority communities adversely affected by the war on drugs? [Supplementary Resource for Listeners: Cracks in the System: 20 Years of the Unjust Federal Crack Cocaine Law | American Civil Liberties Union]
The conversation then shifts into changing social attitudes toward substance use and addiction. Dr. Isom breaks down media messaging and the varying tones and contexts used to describe substance use disparities and how that contributes to social stigma. She explains how different types of stigma intersect with media messaging to craft narratives that encourage sympathy or even a lack of sympathy towards certain racial and ethnic groups and health behaviors. Dr. Isom then discusses that policy reform and changing attitudes toward substance use and addiction are largely driven by the hurt and pain of those in the white majority with substance use disorder, further minimizing the experiences of marginalized communities.
Dr. Jordan agrees with this characterization and goes more into the historical media coverage of substance use and the dehumanizing language that was (and is still) used to describe drug use among minority individuals. This segues into a conversation about the legacy of the war on drugs and today’s racial inequities in opioid addiction treatment. Ashley delineates that methadone has been disproportionately prescribed in predominantly Black communities, as a means to drive down crime, whereas white patients undergoing substance use treatment are more likely to receive buprenorphine. Dr. Jordan highlights the harm that these prescribing practices cause as they falsely associate race and substance use with criminal activity and neighborhood safety. She further goes into the stigma and stereotyping that continues to this day with the incessant and inhumane need to pick up prescription treatment once daily, submit “clean” urine samples under direct supervision, and submit to oral examinations. Dr. Jordan then questions the utility and continued operation of methadone clinics, especially as the United States largely moves on from the COVID-19 pandemic. She highlights actions taken by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) to expand access to take-home methadone doses, which promoted patient autonomy and had comparable adherences outcomes and no significant changes in potential adverse harms, such as overdose and diversion. Other actions include elimination of the United States Drug Enforcement Administration (DEA) X waiver which was needed to prescribe buprenorphine. Dr. Jordan concludes by thinking about incentive strategies that would encourage health care providers to change their prescribing practices and minimize racial inequities in opioid addiction treatment [Supplementary Resource for Listeners: Lessons from COVID 19: Are we finally ready to make opioid treatment accessible? – PMC]
Dr. Isom highlights the differences in substance use disparities and infrastructure utilization from the national level moving into discrete communities. Using an equity lens, she shares her own experiences in Massachusetts examining treatment utilization and encourages health care providers to examine racially disaggregated data to make sure that services offering suboxone (buprenorphine and naloxone) are reaching and being used in the most impacted communities. She also discusses the importance of the patient-provider relationship and shared-decision making, which helps ensure that a full range of services are being offered to patients. Dr. Jordan and Dr. Isom both agree that simply offering treatment services and having an “open door” are not enough. Dr. Jordan discusses the importance of de-centering the majority and identifying the factors that are most relevant to minoritized individuals and communities. Oftentimes, researchers and practitioners working to implement addiction treatment programs and interventions are not from those same communities. Dr. Jordan pushes back on the notion that “one size fits most” is the optimal approach for treating substance use disorder and that the evidence we rely on for patients undergoing substance use treatment was largely informed by the experiences of white individuals. Therefore, traditional settings of addiction care may unintentionally cause harm to individuals with marginalized identities.
Gillette moves the conversation into strategies addressing substance use disparities, particularly those that emphasize the importance of harm reduction. Dr. Isom begins by sharing her experiences in the clinic and how harm reduction approaches such as offering fentanyl test strips humanize substance use treatment and place individual and community health and well-being at the center of treatment. To her dismay, she also learned that her racially and linguistically diverse patient population was one of most affected by the opioid epidemic in the Commonwealth of Massachusetts. Reflecting on these health data and rethinking “traditional” addiction treatment strategies helped her connect with her patients and close a self-described empathy gap that she says patients accessing treatment often have with their health care provider. Dr. Jordan enters into the conversation and also shares how she best connects with her patients who often feel unheard and marginalized by the health care system. She discusses the strengths and limitations of harm reduction approaches and the continued need for a clinician-researcher workforce that reflects the diversity seen in communities experiencing hardship. An important part of her discussion includes the contributions of community health workers and a need not just to focus on harm reduction, but also to optimize safety among individuals using substances such as alcohol and opioids. This complementary approach has the potential to increase the positive impact that the harm reduction movement has made over time.
The group briefly discusses Dr. Isom’s article Nothing About Us Without Us in Policy Creation and Implementation | Psychiatric Services (2021) which highlights the need for patients and communities to be included in the creation and implementation of drug policy. This approach has the potential to best direct resources to the most impacted communities and may be more impactful than traditional community engagement models. Dr. Jordan has also written about culturally-responsive programs benefiting Black communities affected by the opioid epidemic and has completed a pilot study providing addiction treatment in partnership with faith-based organizations. Both guests acknowledge that academics do not always have the right solutions and that practitioners have to listen openly to community knowledge holders.
Towards the end of the episode, Dr. Jordan highlights opportunities for meaningful drug policy reform, including examining federal methadone regulations (e.g., dosing, availability), investing in harm reduction and safety optimization, and decreasing police involvement in mental health crisis response and police presence in substance use treatment settings.
New Host! Kiersten TâLeigh (Ta-Lee) “Gillette” Gillette-Pierce (she/they) is currently a student at Johns Hopkins School of Public Health pursuing a Master of Science in Public Health with a double concentration in Maternal, Fetal, and Perinatal Health and Women, Sexual and Reproductive Health. As an academic researcher, they focus on transnational racial/ethnic and gender disparities in pregnancy-related, sexual, and reproductive health outcomes for all persons with gynecologic organs, with a specific interest in people of African descent. She is published in the Journal of Advanced Nursing and Medicine, Science, and Law. Gillette has also published work with Rewire News Group and the Center for American Progress focusing on sexual and reproductive health and rights policy, reproductive justice, and health outcomes for Black birthing persons. With almost ten years of experience in the global sexual and reproductive health, rights, and justice field, Gillette aims to improve sexual and reproductive health care and outcomes for disenfranchised communities and significantly improve pregnancy-related outcomes for people of African descent.
Speaker Biographies
Dr. Jessica Isom, MD, MPH, is a board-certified community psychiatrist and faculty leader in the Yale Department of Psychiatry’s Social Justice and Health Equity Curriculum. She primarily works in Boston as an attending psychiatrist at Codman Square Health Center where she is leading a grant effort to infuse antiracism in Opioid Use Disorder (OUD) services. She is a nationally recognized expert on racial equity and justice in psychiatry with a focus on workforce development and organizational transformation. Her professional interests include working toward eradicating racial and ethnic mental health disparities, mitigating the impact of implicit racial bias on clinical care, and the use of a community-centered population health approach in psychiatric practice. She serves on multiple advisory boards and is a consultant, curriculum developer and presenter to a variety of organizations including Fortune 500 companies and medical societies through her company, Vision for Equity LLC. Dr. Isom received her MD from the University of North Carolina School of Medicine, and completed her residency at Yale University.
Ayana Jordan, MD, PhD, is the Barbara Wilson Associate Professor in the Department of Psychiatry, Addiction Psychiatrist and Associate Professor in the Department of Population Health at New York University (NYU) Grossman School of Medicine. She also serves as Pillar Co-Lead for Community Engagement at NYU Langone’s Institute for Excellence in Health Equity. As Principal Investigator for the Jordan Wellness Collaborative (JWC), she leads a research, education, and clinical program that partners with community members to provide optimal access to evidence-based treatments for racial and ethnic minoritized patients with mental health disorders. Through her multifaceted work, she provides addiction treatment in faith settings, studies health outcomes for people with opioid use disorder in the carceral system, and trains addiction specialists to provide culturally-informed treatment. Dr. Jordan is dedicated to creating spaces and opportunities for more people of color, specifically Black women in academia who are vastly underrepresented. She has numerous peer-reviewed publications, has been featured at international conferences, and is the proud recipient of various clinical and research awards. The fundamental message of equity and inclusion has informed her research, clinical work, and leadership duties at NYU and beyond.
References
Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2022. Designed by LM Rossen, A Lipphardt, FB Ahmad, JM Keralis, and Y Chong: National Center for Health Statistics.
Balasuriya, L., Isom, J., Cyrus, K., Ali, H., Sloan, A., Arnaout, B., Steinfeld, M., DeSouza, F., Jordan, A., Encandela, J., & Rohrbaugh, R. (2021). The Time Is Now: Teaching Psychiatry Residents to Understand and Respond to Oppression through the Development of the Human Experience Track. Academic Psychiatry, 45(1), 78–83. https://doi.org/10.1007/s40596-021-01399-x
Castillo, E. G., Isom, J., DeBonis, K. L., Jordan, A., Braslow, J. T., & Rohrbaugh, R. (2020). Reconsidering Systems-Based Practice: Advancing Structural Competency, Health Equity, and Social Responsibility in Graduate Medical Education. Academic Medicine, 95(12), 1817–1822. https://doi.org/10.1097/ACM.0000000000003559
DeSouza, F., Mathis, M., Lastra, N., & Isom, J. (2021). Navigating Race in the Psychotherapeutic Encounter: A Call for Supervision. Academic Psychiatry, 45(1), 132–133. https://doi.org/10.1007/s40596-020-01328-4
Friedman, J. R., & Hansen, H. (2022). Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity Before and During the COVID-19 Pandemic. JAMA Psychiatry, 79(4), 379. https://doi.org/10.1001/jamapsychiatry.2022.0004
Godkhindi P, Nussey L, O’Shea T. “They’re causing more harm than good”: a qualitative study exploring racism in harm reduction through the experiences of racialized people who use drugs. Harm Reduct J. 2022 Aug 25;19(1):96. doi: 10.1186/s12954-022-00672-y. PMID: 36008816; PMCID: PMC9406271.
Goldman, M. L., Swartz, M. S., Norquist, G. S., Horvitz-Lennon, M., Balasuriya, L., Jorgensen, S., Greiner, M., Brinkley, A., Hayes, H., Isom, J., Dixon, L. B., & Druss, B. G. (2022). Building Bridges Between Evidence and Policy in Mental Health Services Research: Introducing the Policy Review Article Type. Psychiatric Services, 73(10), 1165–1168. https://doi.org/10.1176/appi.ps.202100428
Hansen H, Jordan A, Plough A, Alegria M, Cunningham C, Ostrovsky A. Lessons for the Opioid Crisis-Integrating Social Determinants of Health Into Clinical Care. Am J Public Health. 2022 Apr;112(S2):S109-S111. doi: 10.2105/AJPH.2021.306651. PMID: 35349328; PMCID: PMC8965192.
Hughes M, Suhail-Sindhu S, Namirembe S, Jordan A, Medlock M, Tookes HE, Turner J, Gonzalez-Zuniga P. The Crucial Role of Black, Latinx, and Indigenous Leadership in Harm Reduction and Addiction Treatment. Am J Public Health. 2022 Apr;112(S2):S136-S139. doi: 10.2105/AJPH.2022.306807. PMID: 35349317; PMCID: PMC8965189.
Isom, J., & Balasuriya, L. (2021). Nothing About Us Without Us in Policy Creation and Implementation. Psychiatric Services, 72(2), 121–121. https://doi.org/10.1176/appi.ps.72202
Isom, J., Jordan, A., Goodsmith, N., Medlock, M. M., DeSouza, F., Shadravan, S. M., Halbert, E., Hairston, D., Castillo, E., & Rohrbaugh, R. (2021). Equity in Progress: Development of Health Equity Curricula in Three Psychiatry Residency Programs. Academic Psychiatry, 45(1), 54–60. https://doi.org/10.1007/s40596-020-01390-y
James K, Jordan A. The Opioid Crisis in Black Communities. J Law Med Ethics. 2018 Jun;46(2):404-421. doi: 10.1177/1073110518782949. PMID: 30146996.
Jordan, A., Mathis, M. L., & Isom, J. (2020). Achieving Mental Health Equity: Addictions. Psychiatric Clinics of North America, 43(3), 487–500. https://doi.org/10.1016/j.psc.2020.05.007
Jordan A, Babuscio T, Nich C, Carroll KM. A feasibility study providing substance use treatment in the Black church. J Subst Abuse Treat. 2021 May;124:108218. doi: 10.1016/j.jsat.2020.108218. Epub 2020 Dec 3. PMID: 33771290.
Lagisetty, P. A., Ross, R., Bohnert, A., Clay, M., & Maust, D. T. (2019). Buprenorphine Treatment Divide by Race/Ethnicity and Payment. JAMA Psychiatry, 76(9), 979. https://doi.org/10.1001/jamapsychiatry.2019.0876
Nweke, N., Isom, J., & Fashaw-Walters, S. (2022). Health Equity Tourism: Reckoning with Medical Mistrust. Journal of Medical Systems, 46(5), 27. https://doi.org/10.1007/s10916-022-01812-4
Portnoy, G. A., Doran, J. M., Isom, J. E., Wilkins, K. M., DeViva, J. C., & Stacy, M. A. (2021). An evidence-based path forward for diversity training in medicine. The Lancet Psychiatry, 8(3), 181–182. https://doi.org/10.1016/S2215-0366(21)00024-9
Roxas, N., Ahuja, C., Isom, J., Wilkinson, S. T., & Capurso, N. (2021). A Potential Case of Acute Ketamine Withdrawal: Clinical Implications for the Treatment of Refractory Depression. American Journal of Psychiatry, 178(7), 588–591. https://doi.org/10.1176/appi.ajp.2020.20101480
Townsend, T., Kline, D., Rivera-Aguirre, A., Bunting, A. M., Mauro, P. M., Marshall, B. D. L., Martins, S. S., & Cerdá, M. (2022). Racial/Ethnic and Geographic Trends in Combined Stimulant/Opioid Overdoses, 2007–2019. American Journal of Epidemiology, 191(4), 599–612. https://doi.org/10.1093/aje/kwab290
Wyatt JP, Suen LW, Coe WH, Adams ZM, Gandhi M, Batchelor HM, Castellanos S, Joshi N, Satterwhite S, Pérez-Rodríguez R, Rodríguez-Guerra E, Albizu-Garcia CE, Knight KR, Jordan A. Federal and State Regulatory Changes to Methadone Take-Home Doses: Impact of Sociostructural Factors. Am J Public Health. 2022 Apr;112(S2):S143-S146. doi: 10.2105/AJPH.2022.306806. PMID: 35349318; PMCID: PMC8965186.
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
Isom J, Jordan A, Cooper A, Krishnamurthy S, Pierce G, Calac A, Watkins A, Onuoha C, Lopez-Carmen VA, Nolen L, Williams J, Tsai J, Ogunwole M, Khazanchi R, Fields NF. “Episode 19: Reframing the Opioid Epidemic: Anti-Racist Praxis, Racial Health Inequities, and Harm Reduction”. The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. February 9, 2022.
Sukriti and Maani present a clinical unknown to Dr. Reza, followed by a brief discussion about addressing roadblocks that women in medicine face.
Dr. Nosheen Reza
Dr. Nosheen Reza is a cardiologist and translational researcher at the University of Pennsylvania focusing on advanced heart failure and transplant cardiology and cardiovascular genetics. She obtained her medical degree from the University of Virginia School of Medicine and completed internal medicine residency at the Massachusetts General Hospital. She then completed both her Cardiovascular Disease and Advanced Heart Failure and Transplant Cardiology fellowships at the University of Pennsylvania. At Penn, Dr. Reza pursued additional scholarship in genomic medicine as an NIH T32-funded postdoctoral fellow and in healthcare quality as a Penn Benjamin & Mary Siddons Measey Fellow in Quality Improvement and Patient Safety. Now, as an Assistant Professor of Medicine, she cares for patients in the Penn Center for Inherited Cardiovascular Disease and in the Section of Heart Failure, Transplantation, and Mechanical Support. Dr. Reza is also an Assistant Program Director of the Cardiovascular Disease Fellowship and the Director of the Penn Women in Cardiology program.
The spaced learning series team tackles the case of a patient with a non-resolving pulmonary inflammatory syndrome, found to have a cavitary lesion on lung imaging with glomerulonephritis.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time,Valeria presents a case of headache and altered mental status to Joy and Mattia.
Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue Neurology residency. Her interests include neuro-infectious diseases, transgender health and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine she loves running, hiking, cooking pasta and spending time with her dogs.
Joy Glanton
@joytibalan
Joy is a neuro enthusiast who has completed her neuroscience undergrad and medical studies in the Philippines. She is passionate about neurology and believes “the brain is everything; it’s what makes us who we are.” She is hoping to match into Neurology in 2023, and is currently in NYC completing clinical externships/rotations in neurology. Post residency, she aspires to do translational/clinical research work or pursue a career in academic/general neurology. Joy enjoys running, swimming, literary art, debates in neuroscience, and listening to rock and roll and classical music.
Mattia Rosso
@MattiaRosso3
Mattia Rosso is a neurology resident at the Medical University of South Carolina (MUSC) in Charleston, South Carolina. He is interested in movement disorders, behavioral neurology, and autoimmune neurology. He is also passionate about the intersection between the humanities and medicine. He started a Neurohumanities group at MUSC, which meets monthly and features internal and guest speakers. This group focuses on the role of the Arts, Cinema, Literature, Philosophy, and Music in medicine and neurosciences. Outside work, he enjoys photography, cinema, and discovering new music. Since starting residency, the Clinical Problem Solvers have been an irreplaceable source of learning and inspiration.
Episode 268: WDx #21 – Clinical Unknown with Dr. Rachael Lee
Dec 14, 2022
Dr. Lee joined the UAB Division of Infectious Diseases at UAB in 2016 and is currently an Associate Professor. She is the UAB Chief Healthcare Epidemiologist and in this role, she utilizes evidence based medicine to prevent the spread of healthcare-associated infections. Her research focuses on multi-drug resistant pathogens as they relate to infection prevention and control.
Reza and Rabih discuss a fascinating case of AMS, infection and polyuria.
rlrCPSOLVERS.COM
RLR have transitioned from Patreon to have their website rlrCPSolvers.com. Check out this virtual classroom full of bonus schemas, illness scripts, teaching videos and case challenges
Get a personalized clinical reasoning curriculum to take your skills to the next level AND support the CPSolvers while you are at it.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, John presents a case of diplopia to Valeria and Madellena.
John Acquaviva is a fourth-year medical student attending Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. He has a passion for both clinical and academic neurology and will be starting neurology residency in the summer of 2023. He has special interests in neurophysiology, autoimmune neurology, and neuroimmunology, but is excited about all neurological fields. In his free time, he enjoys hanging out with friends, long-boarding, running, and martial arts.
Valeria Roldán
@valeroldan23
Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue Neurology residency. Her interests include neuro-infectious diseases, transgender health and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine she loves running, hiking, cooking pasta and spending time with her dogs.
Madellena Conte
@MadellenaC
Madellena Conte was born and raised in San Francisco, CA. She completed her undergraduate degree at Dartmouth College. After college, she worked at Collective Health, a healthcare insurance technology company, and then completed her Master’s of Science in Global Health at UCSF where her research focused on understanding preferences for HIV care among people experiencing unstable housing. She is a MS4 at the Zucker School of Medicine at Hofstra/Northwell in New York and is currently taking a research year in the Division of HIV, ID, and Global Medicine at UCSF. Outside of medicine, Madellena loves to travel, meet new people, run, figure skate and really do anything outdoors. She plans on applying into internal medicine residency.
Episode 18 – Remedying Health Inequities Driven by the Carceral System
Show Notes by Ayana Watkins
October 18, 2022
Summary: This episode highlights the history and roots of the carceral system, as well as its far-reaching impacts on the health of women and children today. During this episode, we gain insight from special guests Dr. Jennifer James—a qualitative researcher, a Black Feminist scholar, and an assistant professor in the Institute for Health and Aging, the Department of Social and Behavioral Sciences, and the Bioethics program at the University of California San Francisco—and Dr. Nia Heard-Garris—a pediatrician and researcher in the Department of Pediatrics at Feinberg School of Medicine at Northwestern University and in the Division of Academic General Pediatrics and Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center at the Ann & Robert H. Lurie Children’s Hospital of Chicago. This discussion is hosted by Sudarshan Krishnamurthy, Ashley Cooper, and Alec J. Calac.
Episode Learning Objectives
After listening to this episode, learners will be able to…
Understand the history of mass incarceration and its effect on health
Recognize how cultures of punishment and control within carceral spaces and within clinical settings impact health
Learn how to best care for and support those experiencing violence at the hands of the carceral system
Consider how we enact carceral structures and act as agents of the state in our clinical practices
Credits
Written and produced by: Sudarshan Krishnamurthy, Ashley Cooper, Alec J. Calac, Michelle Ogunwole MD, PhD, Ayana Watkins, Chioma Onuoha, Naomi F. Fields MD, Victor A. Lopez-Carmen MPH, Rohan Khazanchi MPH, Sudarshan Krishnamurthy, Utibe R. Essien MD, MPH, Jazzmin Williams, LaShyra Nolen, Jennifer Tsai MD, MEd, Zahada (Kiersten) Gillette -Pierce
Hosts: Sudarshan Krishnamurthy, Ashley Cooper, and Alec J. Calac
Infographic: Creative Edge Design
Audio Edits: Isabella Gau
Show Notes: Ayana Watkins
Guests: Dr. Nia Heard-Garris, MD, MSc and Dr. Jennifer James, PhD, MS, MSW
Time Stamps 00:00 Introduction of episode and guests 04:01 History of mass incarceration and its relationship with health 11:38 Understanding healthcare decision-making in carceral spaces 22:27 Substance Use and Treatment/Diversion vs. Incarceration of BIPOC mothers 29:30 Health Impacts on Children and Young Adults with History of Parental Incarceration 35:24 Remedying Health of Women and Children Impacted by the Criminal Legal System 45:55 Key takeaways
Episode Takeaways:
Prisons are not places of healing. Incarceration negatively affects the physical and mental health of people who are incarcerated as well as their family members and loved ones, and limits access to healthcare before, during, and after incarceration.
All healthcare professionals will have patients who are directly or indirectly impacted by the carceral system. Our guests remind us to think critically about our role in the carceral system and in imposing systems of control and punishment within clinical settings. Additionally, our guests urge us to recognize the ways in which our patients are impacted by incarceration and to ask our patients about these impacts in order to better care for them.
The ways to remedy the negative impacts of incarceration are to incarcerate fewer people and to invest in communities. Providing communities with the resources they need to survive, such as educational opportunities, jobs, and quality healthcare, will eliminate the need for incarceration. Additionally, decarceration and abolition will remedy the far-reaching health effects of the criminal legal system.
Pearls
“Prisons and jails are not healing spaces [. . .] They are not spaces designed for healing or care, they are designed for punishment and control.”
Dr. James explains that the culture of punishment, control, and violence within jails and prisons impedes healthcare for people who are incarcerated. People who are incarcerated are dehumanized and feel they are treated as inmates, rather than as patients. Correctional officers act as gatekeepers, deciding who does and does not need medical care. This means that people who are incarcerated are often not believed when they say they need medical care. As a result of this dehumanization and mistreatment, people who are incarcerated may forgo seeking medical care because they do not trust that the system and healthcare professionals will do anything but harm them further.
Dr. Heard-Garris draws parallels between the culture within the carceral system and that within hospitals and clinics. For clinicians who do not work within jails or prisons, it is important to recognize the presence of these same issues within other clinical spaces. Hospitals and clinics also have security, armed guards, and police whose roles are to impose control, and their presence can impact health outcomes for patients.
Dr. Heard-Garris also added that having a family member in the carceral system makes it more likely that a person will lose confidence in the medical system and will not seek care, so this mistrust in healthcare reverberates in generations post-incarceration.
Substance Use and Society’s focus on incarceration and punishment over treatment, diversion, and healing for BIPOC women
Dr. Heard-Garris explained that systems such as capitalism, politics, and white supremacy are the reasons our society focuses on incarceration and punishment rather than on substance use treatment. She discusses how it’s easier to incarcerate people than it is to invest in treatment because investment requires time, money, and the dismantling of our current systems.
Dr. James adds that reproductive justice and the rights to family, and having the resources and support to raise children have never existed for people of color and people experiencing poverty. Current-day familial structures reflect policies dating back to slavery, the forced displacement of Native Americans, and the way immigrant families have been treated. Today, the carceral system plays a pivotal role in modern-day eugenics and in reproductive and family control.
Health Impacts on Children and Young Adults with History of Parental Incarceration & Juvenile Justice Involvement
Dr. Heard-Garris explains that the health impacts that affect people who are incarcerated also impact children and adolescents with parents who have been incarcerated. This exposure to the carceral system negatively impacts the physical and mental health of these children and young adults and reduces their access to healthcare.
She also reminds us that children with parents who are incarcerated are not doomed to poor outcomes. Many of these children and young adults are resilient and are still able to thrive. However, they should not have to undergo these adverse childhood experiences and traumas. The carceral system needs to be changed and these children need to be supported and have their healthcare and education needs met.
Remedying the Health of Women and Children Impacted by the Criminal Legal System
Both Dr. James and Dr. Heard-Garris agree that the best way to remedy the health impacts of the carceral system is to incarcerate fewer people.
Dr. James discusses changes that can be made if we assume the current carceral system will remain. We need a system, such as a single-payer healthcare system, that provides people with consistent access to high-quality care before, during, and after incarceration. Additionally, we should provide people who are incarcerated with better ways to communicate with their families. For healthcare specifically, it is important to believe people when they say they need care and provide them with access to trauma-informed care.
Dr. Heard-Garris adds that a good place to start is to decarcerate people and offer them support. Additionally, we need to prevent incarceration by investing in communities and providing communities with resources, education, jobs, healthcare, etc. The goal is to create a society in which prisons and jails aren’t necessary because every person has what they need to survive.
Practices Clinicians can Incorporate to Reduce the Impacts of Mass Incarceration on Patients
Dr. James reminds us that no matter where we work or what specialty we work in, we will see people who are impacted by incarceration. As physicians and healthcare professionals, we should ask people about their histories of trauma and about the impact of incarceration on their lives. Additionally, we need to be cognizant of the ways we as providers enact a carceral state and think critically about the way these systems impact patient care.
Dr. Heard-Garris encourages us to ask patients about their interactions with the carceral system. Asking these questions provides us with an opportunity to better care for our patients. It can allow us to offer more support systems to patients and to connect patients with resources that have worked for others. We also have to be aware of our power and privilege and recognize that we do not treat all our patients equitably in order to change and do better.
References
Black Feminist Bioethics: Centering Community to Ask Better Questions. Hastings Cent Rep. 2022 03; 52 Suppl 1:S21-S23. James JE. PMID: 35470879.
Race, Racism, and Bioethics: Are We Stuck? Am J Bioeth. 2022 03; 22(3):22-24. James JE. PMID: 35258424.
Heard-Garris N, Sacotte KA, Winkelman TNA, Cohen A, Ekwueme PO, Barnert E, Carnethon M, Davis MM. Association of Childhood History of Parental Incarceration and Juvenile Justice Involvement With Mental Health in Early Adulthood. JAMA Netw Open. 2019 Sep 4;2(9):e1910465. doi: 10.1001/jamanetworkopen.2019.10465. PMID: 31483468.
Heard-Garris N, Winkelman TNA, Choi H, Miller AK, Kan K, Shlafer R, Davis MM. Health Care Use and Health Behaviors Among Young Adults With History of Parental Incarceration. Pediatrics. 2018 Sep;142(3):e20174314. doi: 10.1542/peds.2017-4314. Epub 2018 Jul 9. Pediatrics. 2019 May;143(5): PMID: 29987170.
Heard-Garris N, Johnson TJ, Hardeman R. The Harmful Effects of Policing—From the Neighborhood to the Hospital. JAMA Pediatr. 2022;176(1):23–25. doi:10.1001/jamapediatrics.2021.2936
Heard-Garris, N., Boyd, R., Kan, K., Perez-Cardona, L., Heard, N. J., & Johnson, T. J. (2021). Structuring poverty: how racism shapes child poverty and child and adolescent health. Academic pediatrics, 21(8), S108-S116.
Kaba, Mariame, et al. No More Police: A Case for Abolition. The New Press, 2022.
Roberts, Dorothy. Torn Apart: How the Child Welfare System Destroys Black Families–and How Abolition Can Build a Safer World. Basic Books, 2022.
Wilkerson, Isabel. Caste (Oprah’s Book Club): The origins of our discontents. Random House, 2020.
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
James J, Heard-Garris N, Krishnamurthy S, Cooper A, Calac A, Watkins A, Onuoha C, Lopez-Carmen VA, Krishnamurthy S, Calac A, Nolen L, Williams J, Tsai J, Ogunwole M, Khazanchi R, Fields NF, Gillette-Pierce K. “Episode 18: Remedying Health Inequities Driven by the Carceral System” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. October 18, 2022.
In this WDx episode, Sharmin and Dr Lekshmi Santhosh delve into the world of written evaluations: why are they important, implicit biases they can contain and how to do a better job in both writing and interpreting evaluations.
Dr. Lekshmi Santhosh
Dr. Lekshmi Santhosh is an associate professor of medicine at UCSF. She specializes in adult pulmonary and critical care medicine with a focus on medical education. She attends in the Medical ICU, the Neuro ICU, on the Internal Medicine teaching wards, and has clinic at the Pulmonary Outpatient Faculty Practice at UCSF-Parnassus. She is the founder and Medical Director of the multidisciplinary long-COVID/post-ICU OPTIMAL Clinic at UCSF Health.
She serves as the Associate Program Director for Curriculum for the Internal Medicine Residency and the Associate Program Director of the Pulmonary and Critical Care Medicine Fellowship. She also is the Director of the Department of Medicine Grand Rounds. She obtained her Master’s in Health Professions Education from UC-Berkeley. Her primary interests in medical education research are related to ICU transitions of care, women in leadership, clinical reasoning, and subspecialty career choice.
This episode is dedicated to the loving memory of Gabriel Talledo, we reflect on how greatly he touched our lives followed by his story, as told by him in the first episode of Queer Rounds.
Please consider donating here to the Gabriel Talledo’s Scholarship benefiting young medical students of the LGTBQIA community in hopes of financially helping them achieve their dreams.
Episode 258: Spaced Learning Series – Pulmonary Granulomas, Headache, and Hyponatremia
Sep 28, 2022
The SLS team tackles the case of a young woman presenting with a prolonged, inflammatory pulmonary syndrome is found to have pulmonary granulomas, headaches and hyponatremia. Join them as they apply CPSolvers schemas to real life Patient care to facilitate the diagnostic reasoning process.
Sharmin, Ann Marie, and Dan discuss a case that takes us on a journey through the pancreas and hepatobiliary systems with schemas at every stop of the way!
We cannot wait to share the new RLR website with you as our time on Patreon is coming to an end. The website is our dream project. You will be notified once the website is up before anyone else. We are a few weeks away!!!
And remember to reach out to us if there are any issues regarding refunds from Patreon as you cancel your annual subscriptions. It is very important to us that each of you are 100% satisfied with RR.
We hope you will continue to follow us and support our work once the new website is up and running. None of this is possible without you. We are so grateful for your support. For now, keep your monthly $5 Patreon subscription active b/c we are uploading audio as usual until the new website is up and running.
We will be offering so much more on the website. We think you will love it.
Enjoy this episode. We hope you don’t get a headache listening to it!!!
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, CPSolvers team member Rafael Medina presents a case of frequent falls for CPSolvers team member Yazmin and Alice.
Rafael Medina dos Santos is a Brazilian medical graduate. Before medicine, Rafael wanted to be a teacher. Unsurprisingly, he loves everything related to teaching and learning, so his passion for the CPSolvers’ mission was only natural. He’s applying this 2023 match season for internal medicine. Beyond medicine, Rafael loves fiction books/movies, pop music, and singing Disney songs.
Yazmin Heredia Allegretti
@minheredia
Yazmin is a Medical Graduate from Mexico, looking forward to applying to an Internal Medicine Residency in the U.S. She is passionate about medical education, health equity, and clinical reasoning and believes knowledge (as well as healthcare) must be accessible to everyone. She looks forward to collaborating with doctors and students worldwide to create the best evidence-based resources to impulse medical practice and patient care. Aside from medicine, you will find her taking care of her wide collection of plants, developing her skills in the fine arts, volunteering for any project she can find, or learning new languages.
Alice Falck
Alice is a 5th-year medical student from Berlin, currently working on her MD doctoral thesis to contribute to the pathophysiology of temporal lobe epilepsy. She aspires to be a neurologist and is interested in neuroscience, electrophysiology, and of course clinical reasoning. She is passionate about gender equality in general and especially in Medicine. In her free time, she loves discussing movies with friends and eating great food.
Dr. Rezigh presents a case of fever in a patient newly diagnosed with HIV to Dr. Woc-Colburn.
Dr. Alec Rezigh
Alec Rezigh is an academic hospitalist at Baylor College of Medicine in Houston, TX. He completed medical school at McGovern Medical School in Houston and his residency at The University of Colorado. His clinical interests include medical education and clinical reasoning. He loves all things basketball, CPSolvers, and playing with his human and doggy daughters.
Dr. Laila Woc-Colburn
Dr. Laila Woc-Colburn is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta. She is a renowned medical educator and has a wide range of clinical interests including tropical medicine, HIV, and fungal diseases.
In this episode, Dr. Ashley McMullen, Dr. Simone Vais, and Jane Lock share stories of setbacks in medicine related to the theme, “I thought I was alone.” Session moderated by Madellena Conte.
Dr. Ashley McMullen is an assistant professor of medicine at the University of California, San Francisco, and a primary care internist based at the San Francisco VA Hospital. She is also a Houston, TX native and lifelong book nerd, who grew up nurtured by her mother, a pediatric nurse, and grandmother, an ordained minister. Dr. McMullen’s work focuses on the role of narrative and storytelling in medical education, and as a mechanism for healing, advocacy, and improving care across differences. She served as the host and producer of The Nocturnists: Black Voices in Healthcare Series, a 2021 Webby Award Honoree, and recently launched a new story-telling podcast with Dr. Kimberly Manning called, The Human Doctor.
Jane Lock
Jane Lock is an MD/PhD candidate at Boston University School of Medicine, currently in her M4 year applying into internal medicine. She was born in Malaysia and grew up in Taiwan before moving to the US for college and medical school. She has a strong interest in oncology research, particularly in mechanisms of DNA damage and repair in cancer. Her PhD thesis was focused on understanding alternative telomere maintenance mechanisms in osteosarcoma. She is also passionate about teaching and improving medical education. Outside of work and studying, she loves being the cool aunt to her 2 year old nephew, reading, crocheting and watching The Office with her husband.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Valeria Roldan presents a case of tremors and myoclonus to Dr. Aaron Berkowitz.
Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue Neurology residency. Her interests include neuro-infectious diseases, transgender health and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine she loves running, hiking, cooking pasta and spending time with her dogs.
Dr. Aaron Berkowitz
@AaronLBerkowitz
Aaron recently joined the founding faculty of Kaiser Permanente Bernard J. Tyson School of Medicine as a professor of neurology and director of global health. He previously served as an associate professor of neurology at Brigham and Women’s Hospital and Harvard Medical School, where he directed the Mind-Brain-Behavior course for first-year students and was a teaching attending on the neuro-hospitalist service and in the general neurology resident clinic. As a health and policy advisor to Partners In Health and senior specialist consultant to Doctors Without Borders, he has worked tirelessly to bring neurology care and education to regions where it is limited or non-existent, including co-developing the first neurology residency in Haiti. He is the author of Clinical Pathophysiology Made Ridiculously Simple, Clinical Neurology and Neuroanatomy: A localization-based approach, and most recently One by One by One, which tells the complex, moving, and inspiring stories of patients he and colleagues brought from Haiti to Boston for neurosurgery for brain tumors. When he is not trying to #EndNeurophobia, Aaron loves hiking, backpacking, and obsessively researching outdoor camping gear.
Pratik presents a case of dyspnea and RUQ pain to Fred.
Dr. Fred McLafferty
Fred McLafferty, MD is a fellow in the Division of Pulmonary and Critical Care at the University of California, San Francisco. His research interest is in how certain environmental particles and pathogens drive lung remodeling and pulmonary fibrosis. He is clinically interested in advanced lung disease and transplant, and will begin as the advanced fellow in lung transplant at UCSF in July 2022. Prior to fellowship, he graduated medical school from the David Geffen School of Medicine at UCLA and then completed both his internal medicine residency and chief residency at Northwestern University. Outside the hospital he enjoys skiing in Tahoe, riding his bike through San Francisco, or spending all day cooking a (sometimes) delicious dinner.
Dr. Pratik Doshi
Pratik Doshi, MD MS is a second-year Internal Medicine Resident at the University of Southern California. He completed medical school at Duke University School of Medicine. He is interested in delivering medical content in innovative ways and aspires to be a cardiologist. He is active on Twitter, follow him @PratikDoshiMD!
Dr. Jenn Davis presents a consult question to Dan, Doug, Emma, Sukriti, and Dr. Laila Woc-Colburn.
Dr. Laila Woc-Colburn
Dr. Laila Woc-Colburn is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta. She is a renowned medical educator and has a wide range of clinical interests including tropical medicine, HIV, and fungal diseases.
Dr. Jennifer Davis
Dr. Jennifer Davis is a first year infectious diseases fellow at the Mass General Brigham combined infectious diseases fellowship in Boston. She’s interested in HIV and medical education.
Vale, Brodie, and Gabriel discuss basic terminology of the LGBTQ+ community, the importance of communication in healthcare, and pieces of advice when using gender-inclusive language.
Vale, 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.
Patreon exclusive: RLR 97_2 Cases (Anasarca, Hemoptysis) with Kirtan!!
Jun 22, 2022
Dear Patrons,
You don’t want to miss this episode. Two cases in one hour.
CPSolvers’ team member and extraordinary diagnostician, Kirtan, presents two fascinating cases to RR that have a similar theme.
We highly recommend you follow Kirtan on Twitter to enhance your diagnostic skills @KirtanPatolia.
Kirtan: We wish you the best as you start your IM residency. We are incredibly proud of what you have accomplished but are even more excited about what you are going to accomplish.
In 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) Gadde
Uttara (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.
Summary: 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 Objectives
After 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 inequities
Define Reproductive Justice and understand how clinicians can promote reproductive justice during pregnancy and birth
Appreciate the importance of cultural reflexivity, community-centered initiatives, and midwifery and doula care in facilitating reproductive justice
Recognize 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
Credits
Written 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 Watkins
Hosts: Naomi F. Fields MD, Chioma Onuoha, and Victor A. Lopez-Carmen MPH
Infographic: Creative Edge Design
Audio Edits: David Hu, MD
Show Notes: Ayana Watkins
Guests: Dr. Joia Crear-Perry and Dr. Katy B. Kozhimannil
Time Stamps
00:00 Introduction
03:57 Magnitude of maternal health disparities for Black & Indigenous birthing people
09:31 Impact of guests’ identities and lived experiences on their work
25: 30 Defining reprodutive justice
29:42 Importance of community-centered initiatives and access to midwifery and doula care
35:15 Impact of Climate and Land Injustice on maternal health inequities
42:43 Role of family planning within reproductive justice
58:00 Key takeaways
Episode 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.
Pearls
Black 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 Justice
Dr. 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 equity
Dr. 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 justice
Dr. 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 intentions
Dr. 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.
References
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.12462
Bekkar 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.2020.8243
Kozhimannil 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.2012.301201
National Birth Equity Collaborative. Dr. Joia on BMHW & Why Black Women & Birthing People Are Experiencing Poor Outcomes | NBEC.; 2021. https://youtu.be/GPAlyT8tuhE
Improving 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/
Henning-Smith C, Kozhimannil KB. Missing Voices In America’s Rural Health Narrative. Health Affairs Blog. Published April 10, 2019. 10.1377/hblog20190409.122546
Hostetter M, Klein S. Restoring Access to Maternity Care in Rural America. Published online 2021. doi:10.26099/CYCC-FF50
Hardeman 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.2019.100367
Kozhimannil 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.12474
Lopez-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#bib0044
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.2015.11.030
The hosts and guests report no relevant financial disclosures.
Citation
Crear-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.
RLR discussed an intriguing case of a chronic consolidation
Thank you to our dear friend and colleague Dr. Kelley Chuang for her help with the production of this episode. (You are a legend, Kelley!) @kelleychuang
Patreon exclusive: RLR 93_Live from San Diego!!!
May 23, 2022
Dear Patrons!!!
We wish you a lovely week full of learning.
Huge shout out to our guest and dear friend, Anand, on this week’s episode. Anand is a trail blazer in making the invisible, in clinical reasoning, visible for undergradute medical trainees. https://twitter.com/AnandJag1
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time Dr. Doug Pet presents a case of slurred speech to Angelita and Diane.
Doug is a resident in neurology at UCSF. He grew up surrounded by cow farms and crab-apple trees in New Milford, CT. He completed a dual-degree program at Tufts and the New England Conservatory studying medical anthropology, community health, and jazz saxophone. He later worked for a non-profit in Berkeley, CA on bioethical and social justice issues related to genetic and reproductive technologies. Doug attended Vanderbilt University School of Medicine, after which he returned to the Bay Area for neurology residency at UCSF. He loves Brazilian music, playing Spikeball, and making custom wooden pens on his lathe.
Angelita Pusparani is a junior doctor (2ndY+) working in a small town in Indonesia. She is interested in discussing any cases (from neonate to geriatric), all patients inspire her. In her free time, Angelita is a basketball and marvel fan. She can also be found making a coffee or fried rice.
Diane Lebrun
Diane is an Internal Medicine Physician from Haiti. Her interest in Neurology started when she was a PGY-3 resident at Hopital Universitaire de Mirebalais (HUM), during her rotation in the Neurology Clinic. She has a special interest for Neuro-ICU, clinical reasoning, and medical education. In her free time, she enjoys spending quality time with family and friends, listening to faith-based music or podcasts, and dancing.
RR often discuss their fortune in finding such a supportive community.
We hope you enjoy the 2nd episode of the week. Huge shout out to the residents at Legacy Health in Portland. They are smart, kind, and hungry for diagnostic expertise. #Gratitude
Next Sunday we will learn what happened to part 2 of the Mathematician’s presentation – the patient w/ alc hep who returned with blood “per orum.”
Your grateful Mathematician and Magician (math + magic = RLR)
Patreon exclusive: RLR 90 w/ Krishna Ravindra
May 09, 2022
Hi Patrons,
You won’t want to miss this episode. Trust us. #EpicCase
Krishna is finishing his last week of MS3 year @ VCU School of Medicine. He did a PHENOMENAL job presenting the case.
Huge shout out to Dr. Patrick Fadden @ptfaddenMD, a superb clinician-educator, for guiding Krishna and being a great colleague to RR and CPSolvers.
RR are grateful to Krishna for his kindness, preparation, and stellar execution. Krishna, we will cheer on Madrid in the UEFA Champions League Final b/c we owe you for this special hour.
Episode 236: ARM Episode 16 – Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual Meeting
May 03, 2022
Episode 16 – Live from SGIM: Best of Antiracism Research at the Society of General Internal Medicine’s 2022 Annual Meeting
Show Notes by Sudarshan Krishnamurthy
May 3, 2022
Summary: 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 Objectives
After listening to this episode learners will be able to:
Understand the association of race with the utilization of security responses in hospital settings
Understand the association between the use of race in medical decision-making and beliefs regarding the etiology of racial differences in health outcomes
Understand 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 communities
Credits
Written 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 Watkins
Hosts: Sudarshan Krishnamurthy and Utibe R. Essien MD, MPH
Infographic: Creative Edge Design
Audio Edits: David Hu
Show Notes: Sudarshan Krishnamurthy
Guests: Drs. Yannis Valtis, Ebi Okah, and Carine Davila
Time Stamps
0:00 Introduction
4:20 Context and background of Yannis’ project
7:40 Framing of Ebi’s research
11:25 Inspiration for Carine’s work
14:50 Yannis’ explanation of his findings and potential next steps to intervene
25:45 Results from Ebi’s research
33:55 Carine’s findings from her work
40:00 Audience Questions
Episode Takeaways
Our 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.
References
Valtis 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.
The hosts and guests report no relevant financial disclosures.
Citation
Valtis 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, 2022
Dr. 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” Teng
Alexandra “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 Butler
Blythe 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.
The only way we significantly grow is through reflection! Listen to this episode, reflect, and become better for the patient you treat tomorrow and the student you teach tomorrow.
We thank you for your support.
Is it Reza loves Rabih or Rabih loves Reza … it is the best palindrome …
In this case, Anna and Moses work through the schemas of dyspnea, AMS, HIV & infection, and lymphocytic pleocytosis as they discuss a case presented by Simone.
Episode 232: Anti-Racism in Medicine Series – Episode 15 – Housing is Health: Racism and Homelessness – Clinician + Community Perspectives
Apr 05, 2022
Episode 15: Housing is Health: Racism and Homelessness – Clinician + Community Perspectives
Show Notes by: Victor Anthony Lopez-Carmen, MPH
April 5, 2022
Summary: This episode highlights homelessness’ impact on health, the structural and racialized nature of homelessness, and practical interventions to address housing inequities. This is the last of three episodes interrogating the relationships between race, place, housing, and health. During this episode, we gained insight from special guests Dr. Margot Kushel and Mr. Bobby Watts about what brought them into their fields, how their work reaches the most marginalized, and what can be done at the community and structural level to address homelessness. Dr. Margot Kushel is a Professor of Medicine and Division Chief at the Division of Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center and Director of the UCSF Center for Vulnerable Populations and UCSF Benioff Homelessness and Housing Initiative. Mr. Bobby Watts is the chief executive officer of the National Health Care for the Homeless Council. This episode was hosted by Sudarshan Krishnamurthy, Jazzmin Williams, and Alec Calac.
Episode Learning Objectives:
After listening to this episode, learners will be able to:
Learn about non-stigmatizing language for healthcare providers when talking about individuals experiencing homelessness
Understand how systemic racism, including injust housing policies and over-policing, are at the root of homelessness and its disproportionate impact on Black and Brown communities
Understand the systemic factors that have increasingly led to the aging population experiencing homelessness today
Learn how homelessness contributes to adverse health outcomes, especially in the context of the COVID-19 pandemic
Describe the utility of medical respite care when working with patients experiencing homelessness
Credits
Written and produced by: Sudarshan Krishnamurthy, Jazzmin Williams, Alec J. Calac, Victor A. Lopez-Carmen, MPH, Naomi F. Fields, LaShyra Nolen, Rohan Khazanchi, MPH, Michelle Ogunwole, MD, Utibe R. Essien, MD, MPH, Jennifer Tsai MD, MEd, Chioma Onuoha, Ayana Watkins
Hosts: Sudarshan Krishnamurthy, Jazzmin Williams, Alec J. Calac
Infographic: Creative Edge Design
Audio edits: David Hu
Show notes: Victor Anthony Lopez-Carmen, MPH
Guests: Dr. Margot Kushel and Mr. Bobby Watts
Time Stamps
00:00 Introduction
04:31 Guest career paths
11:58 Non-stigmatizing language around homelessness
19: 30 Structural racism and homelessness
33:09 Increasingly older population experiencing homelessness
42:01 Medical respite care
48:30 Criminalizing and over-policing homelessness
53:19 Key takeaways
Episode Takeaways
We must know the housing status of our patients, and how to ask about it.
Our guests remind us to ask our patients about their housing status using non-judgmental and non-stigmatizing language. If we do not know the housing status of our patients, then we do not know one of the most fundamental things that is going to affect their health and wellbeing.
2. Know your community resources.
Our guests emphasize that physicians must be familiar with community resources. Do you have a medical respite center? Do you have a coordinated entry system (CES) in your community? Can you refer your patient there?
3. If we are not part of the solution, we are complicit in structural injustice.
Dr. Kushel and Mr. Watts remind healthcare providers to speak out about the structural causes of homelessness. Push back against individual narratives that blame individuals for systemic injustice. Push back against dehumanizing language. Push back against discussions that homelessness is caused by substance use or mental health problems.
4. Disaggregated data on homelessness is vital.
Missing racial and ethnic data on homelessness is an example of structural racism. We must know who we are serving to truly be able to tackle the systemic injustices that cause disproportionate rates of homelessness in America.
Pearls
Formative Career Moments:
Dr. Kushel explained how discharging patients experiencing homelessness only for them to come back a few days later in worse shape was unacceptable. This pattern led Dr. Kushel towards work on solving the systemic failures causing “catastrophic” health outcomes in populations experiencing homelessness.
Mr. Watts added a tangible example where people experiencing homelessness would be dropped off by ambulances in front of the center for homelessness where he worked, which was not equipped to deal with their medical circumstances. They would eventually end up back at where the hospitals they came from. Experiences like this made him want to contribute to solutions in the community.
Speaking about Homelessness:
Dr. Kushel encouraged people to go past the textbooks and learn from people on the frontlines of homelessness. This humanizes the crisis and also centers the lived experiences of persons experiencing homelessness as the experts who can teach us more than any textbook.
Dr. Kushel emphasized that we should use person-first language because homelessness is an experience and there is no such thing as an inherently homeless person. Some people also prefer to use unhoused instead of homeless.
Mr. Watts encouraged use of the term neighbor, such as “neighbors without homes, unhoused neighbors, or neighbors experiencing homelessness. Another term he uses is “people with the lived expertise of homelessness,” which centers them as experts in solution-making.
Dr. Kushel detailed how the use of dehumanizing language equates to complicity in a narrative that systemically harms our neighbors with lived expertise in homelessness.
Dr. Kushel emphasized that we must speak to the structural racism at the root of disproportionate rates of homelessness in communities of color, instead of just focusing on mental health and substance use.
Restrictive Housing Policy and Homelessness Today:
Mr. Watts described how property tax laws give more public funding to school districts in higher socioeconomic neighborhoods than poorer neighborhoods, leading to worse educational outcomes and thus higher rates homelessness in low-income neighborhoods.
Dr. Kushel and Mr. Watts remarked that housing, especially expensive house ownership, is massively subsidized in comparison to apartment renting, meaning populations who are less likely to own houses receive less financial support from state and federal housing programs.
Dr. Kushel described how the wealth gap created by discriminatory housing policies also means that more racial minorities are renting properties, making them more vulnerable to gentrification and eviction, contributing further to the housing crisis.
Mr. Watts explained that predatory home or apartment lending targets Black and Brown people, leading to higher rates of poverty and homelessness in those communities. He also described how other policies like redlining and racist policing practices contribute to the mass incarceration of Black and Brown people, increasing homelessness in those communities.
Aging Compositions of the Population Experiencing homelessness across the US:
Dr. Kushel explained that in the early ’90s in San Francisco, 11% of those experiencing homelessness were 50 and older. By 2003, 37% were 50 and older. Now, among single adults experiencing homelessness, the median age is much closer to 50, meaning about half are under 50 and half are over 50. 44% had never once been homeless before the age of 50. So, the population experiencing homelessness is increasingly older.
Mr. Watts noted that the aging population experiencing homelessness came of age during mass incarceration, over policing, and thus many of them had histories with the prison system. Most were due to drug-related non-violent crimes that haunted them and limited employment opportunities throughout their lives.
Dr. Kushel also noted that housing became less and less affordable, adding on to the vulnerability of those in this generation who could not obtain well-paying jobs due to non-violent criminal histories.
Mr. Watts described how life expectancy among those experiencing homelessness is 20-30 years shorter than those with stable housing. This means they don’t benefit from social security because they are dying before they can receive it.
Health and Homelessness:
Dr. Kushel emphasized that people experiencing homelessness have elevated hospitalization rates and longer stays due to more comorbidities, and are more likely to be re-hospitalized.
Mr. Watts described how care for people experiencing homelessness needs to take into account the realities of being without a house, such as having medications stolen or going bad because of lack of refrigeration (e.g. insulin), greater decompensation after discharge because of a lack of a place to rest, and other factors that lead to poorer health outcomes.
Our guests explained that inpatient and outpatient treatment plans need to prioritize knowing the patients’ housing status, shared decision-making, and creating plans that take homelessness into account so treatment regimens are effective.
Dr. Kushel commented that in order to create systemic changes that will decrease rates of homelessness and improve the health outcomes of those experiencing homelessness we need disaggregated data to fully understand which groups in society are most impacted and why.
Medical Respite Care:
Mr. Watts advocated for medical respite, a safe place to heal and “short circuit” the street-emergency room-street-emergency room cycle as a way to treat people experiencing homelessness who are not sick enough for inpatient service, but too sick to send back out to the streets, only for their sickness to worsen. Because of less hospitalization return rates, Dr. Kushel emphasized that medical respite programs also save taxpayer money.
Dr. Kushel and Mr. Watts emphasized that respite medical care needs to be integrated into the continuum of care and homeless response systems.
Dr. Kushel explained that medical respite care via the National Institute for Medical Respite Care was very successful during the COVID-19 pandemic and is inspiring more and more communities to integrate respite care into their practices.
Policing:
Mr. Watts noted how the crack cocaine epidemic shifted the race demographics of homelessness in NYC from largely older, white drinkers to “50/50 young African American and Latinx”, with many cycling in and out of the carceral system due to over-policing and mass incarceration, which only made the crisis worse.
Mr. Watts emphasized that to this day, you are still more likely to be arrested for drug charges if you are Black or Brown, even though rates of drug use are equal across races. This is due to over policing of Black and Brown communities, which leads to higher rates of homelessness in those populations.
Mr. Watts and Dr. Kushel described how criminalizing homelessness is counter-productive and increases stigma, especially when the media focuses on one’s homelessness in the context of a crime. He states that people who are experiencing homelessness are actually more vulnerable to crimes happening to them, so they deserve more protection and service from the criminal justice system. Mr. Watts highlighted a program called CAHOOTS (Crisis Assistance Helping Out On The Streets) as a great, evidence-based mobile response model for addressing urgent needs among those experiencing homelessness.
Hahn JA, Kushel MB, Bangsberg DR, Riley E, Moss AR. BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco. J Gen Intern Med. 2006;21(7):775-778. doi:10.1111/j.1525-1497.2006.00493.x
Semere W, Kaplan L, Valle K, Guzman D, Ramsey C, Garcia C, Kushel M. Caregiving Needs Are Unmet for Many Older Homeless Adults: Findings from the HOPE HOME Study. J Gen Intern Med. 2022 Feb 15:1–9. doi:10.1007/s11606-022-07438-z
Kushel M. Older homeless adults: can we do more?. J Gen Intern Med. 2012;27(1):5-6. doi:10.1007/s11606-011-1925-0
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
Watts B, Kushel M, Krishnamurthy S, Williams J, Calac AJ, Lopez-Carmen VA, Fields NF, Nolen L, Tsai J, Ogunwole SM, Onuoha C, Watkins A, Essien UR, Khazanchi R. “Episode 15: Housing is Health: Racism and Homelessness – Clinician and Community Perspectives.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. April 5, 2022.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Vijay presents a case of left upper extremity weakness to Vale and John.
Valeria is a medical student at Universidad Peruana Cayetano Heredia. She was born and lives in Lima, Perú. She hopes to pursue a Neurology residency. Her interests include neuro-infectious diseases, transgender health, and medical education. Her work with CPSolvers involves being a part of the Virtual Morning Report team and serving on the Spanish schemas team. Outside of Medicine, she loves running, hiking, cooking pasta, and spending time with her dogs.
John Acquaviva
@DrJAStrange
John Acquaviva is a third-year medical student attending Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. He has a passion for both clinical and academic neurological concepts and plans to practice neurology after medical school. He has a special interest in autoimmune neurology and neuroimmunology, but is excited about all neurological clinical presentations. In his free time, he enjoys hanging out with friends, long-boarding, and running while listening to neurology podcasts.
Vijay Balaji
@VijayBramhan
Vijay is currently a third-year internal medicine resident at Ramaiah Medical College & Hospital, Bangalore, India, and has interests in medical education and clinical reasoning. Outside academics, his interests include playing basketball, cooking, and philosophy.
Dr. Aisha Rehman, thank you for taking the time to present your patient’s case.
We are still awaiting a final diagnosis. Dr. Rehman and RR would appreciate any thoughts you might have regarding her patient. Please comment below or send us a private message. There will definitely be a part 2 as more data returns.
Patreon exclusive: RLR 80 with Uncle Bob – Hyperkalemia
Feb 28, 2022
It is hard to believe we are already at 80 episodes with 719 patrons. We cannot thank each of you enough for allowing RR to chase their dream of teaching/learning diagnostic reasoning. We all are on an epic journey together.
This episode is very special because we feature a mentor, advisor, and supporter of CPSolvers’ effort from day 1 and episode 2 (hyponatremia). We feel lucky to know Uncle Bob. He is a great human being, physician, and teacher.
Make sure to listen after our outro theme song for case updates by UB.
Cardionerds, Tommy and Dinu, present a case to Dr. Vaidya, Lindsey, and Dan.
Dr. Anjali Vaidya
Dr. Vaidya is a heart failure and transplant cardiologist at the Lewis Katz School ofMedicine at Temple University, where she serves as the co-director of the Pulmonary Hypertension, right heart failure, and CTEPH program, as well as APD for the cardiology fellowship program and residency advisor for the internal medicine residency.
Episode 14: Race, Place, and Health: Clinician and Community Perspectives
Show Notes by Alec Calac
February 15th, 2022
Summary: This episode highlights how racism manifests in the built environment, and how community and individual-level efforts can mitigate these inequities. This discussion is the second of three planned conversations around the connections between race, place, and health. Our latest episode welcomes first-time guests Dr. Eugenia South, a physician-scientist and Vice Chair for Inclusion, Diversity, and Equity in the Department of Emergency Medicine at the Perelman School of Medicine, and Noelle Warford, Executive Director of the grassroots organization Urban Tree Connection. Hosted by team members Naomi Fields and LaShyra Nolen,our guests present their community-based work in Pennsylvania and lay bare the connections between race, place, and health.
Episode Learning Objectives:
After listening to this episode, learners will be able to…
Understand the historical and present-day role of land dispossession and property rights in determining health along lines of race and place.
Learn how advancing individual agency and distributive justice can empower community organizers and initiatives.
Understand the factors that promote and inhibit long-term resiliency and sustainability of place-based initiatives.
Learn how we can reimagine health by decolonizing wealth and philanthropy in modern society.
Credits
Written and produced by: Naomi F. Fields, LaShyra Nolen, Rohan Khazanchi, MPH, Michelle Ogunwole, MD, Alec Calac, Victor Lopez Carmen, MPH, Utibe R. Essien, MD, MPH, Jennifer Tsai MD, MEd, Sudarshan Krishnamurthy, Chioma Onuoha, Dereck Paul, MD, MS, Ayana Watkins, Jazzmin Williams
Hosts: Naomi F. Fields, LaShyra Nolen
Infographic: Creative Edge Design
Audio edits: David Hu
Show notes: Alec Calac
Guests: Dr. Eugenia South, MD, MSPH, and Noelle Warford, MSW
Time Stamps
00:00 Introduction
05:40 Built environments and structural racism
11:18 Agricultural perspective, land rights, and settler colonialism
15:00 Responsible community engagement and catalyzing individual agency
21:58 Engaging communities outside of the ivory tower
27:00 Scaling up interventions to the community level
32:29 Intervention sustainability
37:18 Decolonizing philanthropy and place-based investments
42:40 Navigating trade-offs and mitigating ethical tensions
49:20 Key takeaways
Episode Takeaways
1. Your “why” has to be clear before you engage in community-based work.
Ms. Warford reminds us that we need strong, sound ideological positions and guiding principles before engaging with the communities around us. She asks to think about what we are doing today to make it easier for people to live in the future. Our ancestors considered our present to be impossible, so how can we use our ideas and experiences to effect positive change in our communities? These movements require action, not passivity.
2. Take time to learn from your patients. Be curious.
Clinicians are incredibly privileged individuals. Dr. South reminds us that it is our great honor to talk to people in an exam room. Our patients are not just a list of problems. They are individuals who interact with environments that affect their health. She encourages us to see beyond these problems, and ask patients about their lives, challenges, and successes. Everything is important. Unfortunately, medical practice does not always allow us to slow down and take this time to listen. But, finding ways to do so can prove illuminating as well as rewarding.
Pearls
Built Environment, Physical Health, and Mental Health
Dr. South detailed that there are clear physical health benefits associated with place-based interventions, but unfortunately many lots and buildings sit vacant and destitute across the US. There’s also more. When interviewing community members in Philadelphia, she shared that longstanding disinvestments in their communities made them feel “unimportant” and “neglected” by society, which had effects on their mental health.
The 2021 Build Back Better Act recognized the impact that the built environment has on health, calling for environmental improvements such as planting trees.
Ms. Warford is the Executive Director of Urban Tree Connection, a grassroots organization in West Philadelphia that uses land-based strategies and urban agriculture as tools for fostering community leadership and power. She presented a powerful argument that connected settler colonialism, Indigenous genocide, and chattel slavery with modern-day property rights and tax codes. By preventing Black and Brown people from developing relationships with the land and using it as a way of forming social connection, as well as communal sustenance, structural racism manifests along lines of race and place.
Lash echoed this and also reaffirmed points made by Dr. South that the built environment changes how individuals see themselves, limiting their ability to push back on the status quo.
Individual Agency and Redistribution of Resources
Ms. Warford centered the conversation and reminded the audience that it is not just healthcare systems that are being pushed to the brink. Non-profit organizations are experiencing the same organizational stress. Working with Dr. South and others, Urban Tree Connection is helping community members realize their inherent agency and leadership capacity.
In the process of redesigning the Memorial Garden in West Philadelphia, Ms. Warford and Dr. South foregrounded the reality that spaces have to be rooted in people’s experiences. There is often a sentiment that “If you build it, they will come”; however, one should not make assumptions about what community members want. It is important to get their perspectives and figure out what the “little things” are. The vision for any community-informed project has to meet community members where they are. What are their priorities? What are their needs?
Continuing this conversation, Dr. South shared that “solutions have to be solutions, not fantasies.” Approaching community problems with an academic approach will not necessarily have community interests in mind (or prioritize them). By moving outside of this academic mindset, organizers and facilitators can work to effect meaningful, long-lasting change in the community.
Sustainability
Dr. South has studied a variety of place-based interventions including vacant lot greening, abandoned house remediation, tree planting, and structural repairs to homes. She was recently awarded a $10 million grant from the National Institutes of Health that will allow her and her team to conduct a randomized-controlled trial that combines many interventions instead of just one. A serious concern that she and many others have is the sustainability of interventions after grant funding ends. Funding structures, especially from government agencies, are not exactly permissive of this.
To promote sustainability, Dr. South and Ms. Warford encouraged the audience to confront the ethical tension between place-based interventions and long-term sustainability after funding streams dry up. It is important to educate and engage key stakeholders such as policymakers who can work to address these limitations.
Ms. Warford shared that funding priorities are not necessarily community priorities. In limited funding environments, non-profit organizations often apply for any and all available funding streams, which may gradually shift the organization’s priorities, a phenomenon often referred to as mission creep.
Decolonizing Wealth and Philanthropy
Our panelists detailed how much wealth is generated from the labor of Black and Brown people. Unfortunately, it is difficult for that wealth to be reinvested in those very same communities. Ms. Warford encouraged our listeners to think about how we can decolonize wealth and philanthropy, noting that place-based investments have to be gradual and intentional. She shared that funding entities must recognize the labor of community members and provide funds for their work. “People power” is a resource that must be cultivated, respected, and valued.
Recognizing Your Role
Naomi recapped much of the discussion and shared that it was clear that “there is no quick fix.” Much of the work involves education, finances, time, and people power. Dr. South shared that there are many ways to be a part of dismantling structural racism. Some people are more front-facing, while others work behind-the-scenes. All perspectives and skillsets are welcome in this process. Ms. Warford shared that it will take time to navigate away from capitalist structures and extractive economies. It is important to celebrate the small wins and strive for the greater vision. LaShyra shared some personal reflections to this effect. The goal for this work will always be liberation and agency. When you’re just trying to make it every day, you don’t always have the privilege to do anything else.
“A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health.” National Institutes of Health RePORTER. Accessed January 2, 2022. https://reporter.nih.gov/project-details/10413510#description
The hosts and guests report no relevant financial disclosures.
Citation
South E, Warford N, Fields NF, Nolen L, Calac A, Lopez-Carmen V, Tsai J, Krishnamurthy S, Ogunwole M, Onuoha C, Watkins A, Williams J, Paul D, Essien UR, Khazanchi R. “Episode 14: Race, Place, and Health: Clinician and Community Perspectives.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. February 15, 2022.
Patreon exclusive: RLR 77 – Jaundice and weight loss
Feb 03, 2022
Dear Patrons,
We enjoyed this tremendously. It was an honor to discuss a case at the University of Pittsburgh Medical Center.
We hope you enjoy it.
Ryan, we cannot thank you enough for being such an amazing friend and colleague. You put the case together expertly. You presented it flawlessly. You made it an experience we will cherish forever.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Maria presents a case of increased drowsiness to Dr. Mathieu Brunet and Dr. Mattia Rosso.
Maria Jimena Aleman María Jimena Alemán was born and raised in Guatemala where she currently works in community and rural health care. After suffering from long standing neurophobia, she has embraced her love for neurology and will pursue a career in this field. She looks forward to dedicating her life to breaking barriers for Latin women in medical fields and improving medical care in her country. Maria is one of the creators of a medical education podcast in Spanish called Intratecal. Her life probably has a soundtrack of a mix between Shakira and Ella Fitzgerald. Outside of medicine she enjoys modern art, 21st century literature, and having hour long conversations over a nice hot cup of coffee or tequila.
Mathieu Brunet
Mathieu Brunet is an emergency physician and trauma team leader at the Hôpital du Sacré-Coeur-de-Montréal and an assistant professor of emergency medicine at Université de Montréal in Canada. After his emergency medicine training, he completed a Fellowship in Resuscitation & Reanimation at Queen’s University in Canada and a Master of Traumatology with the University of Newcastle in Australia. Mathieu has been a regular listener of the podcast and the daily Virtual Morning Reports. He finds The Clinical Problem Solvers to be an invaluable resource to progress and maintain motivation on the lifelong journey toward clinical reasoning expertise.
Mattia Rosso
Mattia Rosso is a neurology resident at the Medical University of South Carolina (MUSC) in Charleston. He is interested in movement disorders, behavioral neurology, and autoimmune neurology. He is also passionate about the intersection between the humanities and medicine, with a focus on the fields of medical history and bioethics. Outside work, he enjoys photography, cinema, and discovering new music. Since starting residency, Clinical Problem Solvers have been an irreplaceable source of learning and inspiration.
In this episode, Dr. Elliot Tapper discusses a clinical unknown case presented by Dr. Jennifer Mundell
Jennifer Mundell
Jennifer Mundell, MD FACP is the associate program director for Ascension St Vincent Internal Medicine Residency Program. She graduated from University of Louisville School of Medicine and completed IM residency at Ascension St. Vincent in 2016. The residents best know her for building differentials, baking cakes, and owning more cars than garage spaces. During her free time, she enjoys writing up interesting cases with residents, taking her family to a beach, and planning next year’s Halloween decorations.
Elliot Tapper, MD is an Assistant Professor in the Division of Gastroenterology at the University of Michigan in 2016. His clinical activity and research efforts focus on the outcomes of patients with cirrhosis, particularly those with hepatic encephalopathy. He did his residency and was resident, chief resident, and a fellow in gastroenterology and transplant hepatology, at Beth Israel Deaconess Medical Center where he served as Director of Quality Improvement for the Liver Center. He is very active on twitter and tweets at @ebtapper
Emma presents a case to Dr. Yao Heng, followed by a discussion about her experience as a woman in Internal Medicine procedural subspecialty.
Dr. Yao Heng
Dr. Yao Heng was born in Bangkok, Thailand. She immigrated to the US in her 20’s. After graduating from the University of California, Berkeley with a Bachelor of Arts in Biochemistry, she received her medical degree at the University of California, San Francisco. She completed her residency in Internal Medicine at the University of California, San Francisco and specialty fellowship in Gastroenterology at the University of Washington. She went to University of Brugmann in Brussel, Belgium for special training in biliary tract disorders. She has been practicing gastroenterology and hepatology at Kaiser Permanente since 1992. She is currently in charge of the capsule endoscopy and balloon enteroscopy programs at San Francisco Kaiser. She has a strong interest in small bowel disorders, the microbiome and gut directed hypnotherapy.
Doug presents an unknown case of vision loss to Dr. Cherayil, Lindsey and Dan.
Dr. Neena Cherayil. Dr. Cherayil is an Assistant Professor of Neurology in the Departments of Neurology and Ophthalmology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. She completed her neurology residency followed by a neuro-ophthalmology fellowship at the University of Pennsylvania. She is currently associate clerkship director of the neurology clerkship at Feinberg as well as co-module leader for the MS2 Neurosciences course. She enjoys leading morning report every week with the neurology residents and students and seeing the fascinating spectrum of afferent and efferent neuro-ophthalmic complaints in clinic. Her particular academic interests include diagnostic reasoning and curricular development with a focus on neuro-anatomic localization. Her favorite cranial nerve is, of course, CN III – the oculomotor nerve.
Episode 215: Vaccine Hesitancy – with Dr. Davis and Dr. Villela
Dec 27, 2021
CPSolvers team members Rafael Medina and Simone Vais take a moment to reflect on what is going on in the world of medicine focusing on vaccine uptake with two incredible experts on the matter about what their experiences have been.
Dr. Davis is the Director of Health for the City of St. Louis. Dr. Hlatshwayo Davis received her medical degree from Cleveland Clinic Lerner College of Medicine and a Master’s in Public Health Degree from Case Western Reserve University. She completed her internal medicine residency at University Hospitals Case Medical Center. She went on to complete her Infectious Diseases fellowship at the Washington University School of Medicine (WUSM), also completing a one year HIV fellowship and a Sexually Transmitted Infections (STI) fellowship. She has held many, many positions throughout her illustrious career in medicine. Dr. Hlatshwayo Davis is now a national and international medical contributor on COVID-19 with a particular focus on marginalized populations, as well as the Director of Health for the city of St. Louis (among much else). Her career passions include community engagement, the care of people living with HIV and the impact of COVID-19 infection in marginalized populations.
Dr. Villela is a graduate of Tucson High School, Yale University, and the University of Connecticut School of Medicine. She currently serves as Chief of Family and Community Medicine at San Francisco General Hospital and is Professor and Vice Chair in the UCSF Department of Family and Community Medicine.
Her interests include chronic illness care, family medicine education, reproductive health, health of Latinxs in the U.S., and health care disparities. Her clinical practice includes inpatient adult medicine, short-term nursing home care, and ambulatory family medicine. She lives with her partner in the Mission district of San Francisco; they have a daughter who is a junior in college. All three are vaccinated against COVID and 2 of 3 have had boosters.
Patreon exclusive: RLR 73 – the case of a patient phone call…
Dec 26, 2021
Episode 13: Centering Asian Americans: Racism, Violence, and Health
Show Notes by Naomi F. Fields
December 21, 2021
Summary: This episode is about racism faced by Asian-Americans, why it often goes unrecognized, and how we can work to rectify these wrongs. This discussion is hosted by Jazzmin Williams, Rohan Khazanchi, MPH, and Jennifer Tsai MD, MEd, as they interview Thu Quach, PhD, an epidemiologist and galvanizing leader who has led the Asian Health Services (Oakland, CA) in addressing racial disparities in COVID-19, and Tung Nguyen, MD, a Professor of Medicine at the University of California, San Francisco, and a nationally-renowned health disparities researcher. Our inspiring guests help us to contextualize struggles faced by Asian-Americans even as they outline and energize within us a path forward – together.
Content Warning: This episode contains themes of violence, trauma-induced mental health concerns, and brief mentions of suicide. If you or someone you know is struggling with suicidal thoughts, please call the National Suicide Prevention Hotline at 800-273-8255, that’s 800-273-TALK.
Episode Learning Objectives:
After listening to this episode learners will be able to…
Define the myth of the “Model Minority” and explain how it impacts the racism experienced by Asian-Americans.
Describe how divisiveness amongst minoritized groups was and remains politically orchestrated, and how minority groups can work together in solidarity against White oppression.
Appreciate how intergenerational trauma may surface amongst Asian-Americans, and how these intergenerational relationships may also offer fertile ground for generating understanding.
Highlight how structural racism against Asian-Americans surfaces in clinical settings, and describe means of counteracting such structures.
Understand how engaged community-based work, centered on trust and accountability, has supported the health of communities served by Oakland, CA’s Asian Health Service.
Reckon with the health disparities that exist amongst Asian-Americans, how such disparities are related (in part) to insufficient data-gathering, inequitable clinical settings, and violence, and how they were further exacerbated by the COVID-19 pandemic.
Credits
Written and produced by: Jazzmin Williams, Rohan Khazanchi, MPH, Jennifer Tsai MD, MEd, Alec Calac, Victor Lopez-Carmen, MPH, Utibe R. Essien, MD, MPH, Sudarshan Krishnamurthy, Naomi F. Fields, LaShyra Nolen, Chioma Onuoha, Ayana Watkins, and Michelle Ogunwole, MD
Hosts: Jazzmin Williams, Rohan Khazanchi, MPH, and Jennifer Tsai MD, MEd
Infographic: Creative Edge Design
Audio edits: David Hu
Show notes: Naomi F. Fields
Guests: Thu Quach, PhD, and Tung Nguyen, MD
Time Stamps
00:00 Introduction
04:00 How Dr. Thu Quach’s and Dr. Tung Nguyen’s journeys shape their work
11:40 Policy work as a way of mitigating burnout
12:55 Balancing individual and communal focus (include?)
16:35 Impact of the COVID-19 pandemic on Asian communities in Oakland
17:40-17:50 Content Warning: Mention of suicide
22:25 Forms of Anti-Asian racism
25:17 The danger of gaslighting Asian-Americans and of comparing oppressions
27:51 Explanation of the model minority myth and a deeper dive into comparative oppressions
30:03 Engaging with community members via validation, and operationalizing means of working against anti-Asian racism
33:58 Dr. Jennifer Tsai reflecting on her father’s experience
37:10 Dr. Nguyen on pathways to intergenerational connection and combatting erasure
39:45 Dr. Quach on intergenerational trauma and reconciliation
43:56 Rohan Khazanchi reflecting on Asian-American disparities in Nebraska and community strength
46:30 Data collection and disaggregation: strengths, challenges, and insufficiencies
56:14 Structural anti-Asian racism in clinical settings
59:22 Clinical tools and takeaways
Episode Takeaways:
Recognize that structural barriers can embed anti-Asian racism into clinical settings.
Insufficient language services (i.e., provision in only English +/- Spanish), limitations of medical technology (i.e., difficulty of sending patient messages through the electronic medical record in languages other than English), limited healthcare literacy, and English-only signage on healthcare campuses are just a few of the structurally racist barriers faced by many Asian folks seeking healthcare. Dr. Nguyen encourages us to recognize how such barriers represent assumptions about people’s capabilities, how they can worsen people’s healthcare, and how they communicate exclusion to our Asian patients.
See the world through others’ eyes, and act.
Dr. Nguyen calls us to ask ourselves: “If [my] mother and father were like this person, how would they negotiate the system that I’m in? What can I do to either ameliorate those problems, or to fix those problems behind the scenes, so they don’t have to deal with them on a day to day basis?” This can help us reach the goal of taking care of patients in the ways that they want to be taken care of, by operationalizing the vision Dr. Quach shared for “letting lived experiences guide us.”
Create spaces to have conversations about the broader contexts affecting patients.
Dr. Quach reminds us that environmental factors and the political landscape affect patients’ wellbeing everyday. Creating spaces where these experiences can be shared by patients as well as by practitioners can highlight the structural nature of seemingly individualized problems. By appreciating the impact of factors affecting entire communities, we can be better positioned to act upon them.
Remember that more deeply understanding your patients can provide meaning!
Seeking to more deeply understand your patients is not an additional burden: ultimately, it is an additional benefit. Dr. Nguyen describes that in his experience, striving for understanding deepens the patient-provider relationship over time and offers fulfillment to him as well as to his patients.
Pearls
Case study: Oakland, CA’s Asian Health Services’ origin, ethos, and lessons
Dr. Quach describes the community- and advocacy-based origins of Asian Health Services, a Federally Qualified Health Center in Oakland, CA. She also describes their role in detecting and relaying the double-bind of challenges (COVID-19 and racism) being faced by community members throughout the pandemic, and how her team generated solutions that signaled their ongoing responsibility to the communities they served.
Asian-Americans face both apparent and enshrouded forms of racism, both of which have directly related health effects.
Dr. Nguyen goes on to expand on these forms. One form includes the eye-catching racist acts that explicitly manifest anti-Asian sentiments, such as violence toward elders, verbal abuse, and gun violence. In addition to the physical wrongs done to the victims, these acts function as community stressors that harm the mental, emotional, and physical wellbeing of so many others.
Another more insidious form of racism is erasure. This often manifests in a glaring lack of recognition of many of the problems faced by many Asian Americans. In the healthcare space, it can also result in a lack of data collection to demonstrate and understand issues faced by these groups. As a result, there are often failures to address their unique needs.
The “Model Minority” myth engenders both the racist erasure of Asian-Americans and division amongst minority groups.
Created in the 1960s by conservatives seeking to divide minority groups during the Civil Rights Movement, the model minority myth projects the relative success of some Asian-Americans onto all Asian-Americans; and subsequently casts them as an “ideal” group unaffected by the problems and negative stereotypes that plague other minority groups. In so doing, the model minority myth obscures how White supremacy actually affects Asian-Americans, and perpetuates a zero-sum game which pits minority groups against each other rather than alongside each other in solidarity.
Data on the problems faced by Asian Americans is lacking. This perpetuates further erasure of Asian-American health disparities, and there are multiple needed interventions to redress this injustice disparity.
Erasure often conceals the need for the collection of information that would spotlight challenges/inequities faced by Asian-Americans. For instance, Dr. Nguyen describes how the National Academy of Medicine and the Centers for Disease Control, amongst other major health organizations, issued valid and needed statements about the impact of COVID-19 on other minority groups, but did not mention the problems faced by Asian- Americans – nor the fact that the data was insufficient. The resulting message implied to the public was that no problems existed.
Additionally, data collection practices often do not capture all experiences due to usage of inaccessible language, or neglecting to spotlight voices from the most marginalized community members.
Data disaggregation, which seeks to spotlight specific ethnic groups within the Asian diaspora, can be a helpful step in better understanding the experiences unique to Asian-American communities we serve. It requires recognizing the diversity of experiences and gaining buy-in from community members.
“You don’t fight fire with fire, you fight fire with water.” – Fred Hampton
Dr. Nguyen mentioned this quote, and expounded upon it to say, “You don’t fight racism, with more racism you fight racism with solidarity and partnership and coalition building.” Although the Model Minority myth has generated divisiveness amongst minority groups, true power can come from folks turning away from gaslighting and the wrly named “Oppression Olympics” to recognize that we all need to work together against the real enemy: Oppression writ large by White supremacy.
Within Asian-American communities, intergenerational relationships can be a critical strength.
Multiple members of this episode describe challenging experiences with bridging understanding of their elder family members that may mirror dynamics within Asian-American communities more broadly.
On the one hand, these relationships convey the intergenerational traumas (of migration, of racism, and the like) that impact elders’ experiences, yet may differ from those of younger individuals.
Simultaneously, these relationships present opportunities to connect interpersonally as “genuine human beings,” and to find solution-generating commonalities.
Relatedly, our guests both describe experiences acting as “cultural brokers” to assist with healthcare needs of their elders that impacted their own journeys into medicine. These insights primed them to understand what challenges community members might be facing now.
Public Broadcasting Service. “Asian Americans: The history of identity, contributions, and challenges experienced by Asian Americans.” https://www.pbs.org/show/asian-americans/
Chu JN, Stewart SL, Gildengorin G, et al. Effect of a media intervention on hepatitis B screening among Vietnamese Americans. Ethn Health. 2019;1-14. doi:10.1080/13557858.2019.1672862
Quach T, Von Behren J, Tsoh J, et al. Improving the knowledge and behavior of workplace chemical exposures in Vietnamese-American nail salon workers: a randomized controlled trial. Int Arch Occup Environ Health. 2018;91(8):1041-1050. doi:10.1007/s00420-018-1343-2
Yan BW, Hwang AL, Ng F, Chu JN, Tsoh JY, Nguyen TT. Death Toll of COVID-19 on Asian Americans: Disparities Revealed. J Gen Intern Med. 2021 Nov;36(11):3545-3549. doi: 10.1007/s11606-021-07003-0.
Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D, Essien UR, Khazanchi, R. “Antiracism in Medicine – Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/antiracism-in-medicine/. January 19, 2021.
Kawai, Yuko. (2005). Stereotyping Asian Americans: The Dialectic of the Model Minority and the Yellow Peril, Howard Journal of Communications, 16:2, 109-130, DOI: 10.1080/10646170590948974
Smith, Andrea. “Chapter Six: Heteropatriarchy and the Three Pillars of White Supremacy: Rethinking Women of Color Organizing”. Color of Violence: The INCITE! Anthology, edited by INCITE! Women of Color Against Violence, New York, USA: Duke University Press, 2016, pp. 66-73. https://doi.org/10.1515/9780822373445-008
The hosts and guests report no relevant financial disclosures.
Citation
Quach T, Nguyen T, Williams J, Tsai J, Fields NF, Calac A, Lopez-Carmen V, Krishnamurthy S, Nolen L, Onuoha C, Watkins A, Williams J, Essien UR, Ogunwole M, Khazanchi R. “Antiracism in Medicine – Episode 13: Centering Asian Americans: Racism, Violence, and Health.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/antiracism-in-medicine/. December 21, 2021.
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Dr. Risheen Reejhsinghani is a Clinical Associate Professor in the Division of CardiovascularMedicine at Stanford. She was born in Mumbai, India, where she attended medical college, after spending her early school years in Sydney, Australia. Risheen moved to Boston for residency atSt. Elizabeth’s Medical Center and completed a cardiology fellowship at Baystate Medical Center, the western campus of Tufts University. She then completed an advanced echocardiography fellowship at the University of California, San Francisco.During fellowship, under combined cardiology and rheumatology mentorship, Risheen developed a clinical focus in cardio-rheumatology. This led to the creation of the StanfordCardio-Rheumatology Program, to provide specialized care to patients with cardiac pathology as a direct consequence of autoimmune disease. Risheen cares deeply about medical education and mentorship, and is an Associate Program Director for the CardiovascularMedicine Fellowship, where working closely with fellows is the absolute best part of her role. In the School of Medicine, she serves as an Associate Course Director for the pre-clerkshipPractice of Medicine Course, and is faculty co-lead for the cardiopulmonary block. Her scholarly work addresses curricular interventions and novel methods of teaching to improve education delivery, with the ultimate goal of increasing global access to education for medical trainees.Outside of medicine, Risheen enjoys writing and used to freelance for a newspaper in India.Along with her husband, she tries to travel as frequently as possible and loves learning about local cultures and traditions in the US and internationally. An ardent enthusiast of the alternative rock scene, Risheen has been an unwavering fan of the band Nirvana since well before she could read an EKG. 
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Dr. Ashita Tolwani, Professor of Medicine at the University of Alabama at Birmingham (UAB). She was the Nephrology Fellowship Training Program Director from 2004-2010 and is now the Associate Program Director. She is also the Director for ICU Nephrology at UAB. (Twitter: luck_urine)
Dr. Vipul Kumar MD PhD is a hematology-oncology fellow at UCSF. He is currently in his second year of fellowship and has a clinical interest in oncology of all forms as well as a passion for teaching. 
Dr. Anand Patel is an assistant professor of medicine at University of Chicago where he treats patients with leukemia and myeloid malignancies. He also serves as medical director of the inpatient leukemia service. His research focuses on the development of clinical trials to help improve the standard of care for patients with high risk leukemias and myeloid malignancies.
