Primary Care Pearls: Recent Episodes

Primary Care Pearls (PCP) Podcast

A medical education podcast focused on primary care made by learners, for learners and - most importantly - led by our patients' stories. Episodes released every two weeks.

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In this episode, Dr. Vasudevan and Dr. Moreno explore the ever-expanding treatment options for Obeisty, and our patient tells us about his experience with some of these interventions.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Lifestyle Changes (Diet/Exercies)
3. Chapter 2: Weight Loss Medications
4. Chapter 3: Bariatric Surgery
5. Chapter 4: Advise to Young Clinicians and Fellow Patients
6. Conclusion

=== Learning Points ===

  1. Lifestyle modifications need to be tailored to the patient. This often involves starting with a careful dietary and activity history and helping the patient incorporate small, healthy changes that are congruent with their cultural background
  2. There are multiple medications available for weight loss and selecting the right one requires knowledge of a patient's comorbid health conditions, as well as taking into account their personal preference. Side-effects tolerance cost, and or insurance coverage
  3. Recognize how to counsel patients on when it may be appropriate to pursue bariatric surgery and what they can expect following the procedure.
  4. The most important step in helping patients manage obesity is by starting the conversation and letting patients know that you are there to support them along every step of the way.

=== Our Expert(s) ===

Dr. Jorge O. Moreno is an Assistant Professor of Medicine at Yale School of Medicine.

Dr. Moreno is originally from Mexico and is also fluent in Spanish. He grew up in New Rochelle, NY and completed his undergraduate degree at Columbia University in 2006. In 2011, he obtained his medical degree from the University of Rochester School of Medicine and Dentistry. He completed his internal medical residency at the Yale University’s Primary Care Residency Program Yale New Haven in 2014.

=== References ===

  1. Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med. 2017 Jan 19;376(3):254-266. doi: 10.1056/NEJMra1514009. PMID: 28099824. https://www.nejm.org/doi/full/10.1056/nejmra1514009
  2. Wilding, J. P. H., et al. (2021). "Once-Weekly Semaglutide in Adults with Overweight or Obesity." New England journal of medicine 384(11): 989-1002.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Maisie Orsillo
Producers: Helen Cai, JW Allen, August Allocco
Logo and Name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Corbyn Kites, Quincas Moreira, Jesse Gallagher, Patrick Patrikios

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on your favorite podcast platforms: linktr.ee/pcpearls

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In this episode, Dr. Vasudevan and Dr. Moreno unpack our patient's experience with weight and how it's impacted his life.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Personal Relationship to Weight
3. Chapter 2: Impact of Weight on Mental Health
4. Chapter 3: Relationship with PCP
5. Conclusion

=== Learning Points ===

  1. Commonly used measures of obesity include BMI and waist circumference. These measures are imperfect, since they are attempting to quantify adiposity.
  2. Patients often undergo an emotional journey that is related to their weight. Many patients prefer to move towards tangible end goals such as increased mobility, lowered risk for future adverse health events, or other factors rather than a specific weight, BMI, or waist circumference.
  3. Screening and treatment of mental health conditions such as anxiety and depression can be instrumental in the care of patients who have elevated BMI.
  4. Be sure to ask permission to discuss the patient’s weight before jumping in. Set SMART goals with your patients and set expectations early.

=== Our Expert(s) ===

Dr. Jorge O. Moreno is an Assistant Professor of Medicine at Yale School of Medicine.

Dr. Moreno is originally from Mexico and is also fluent in Spanish. He grew up in New Rochelle, NY and completed his undergraduate degree at Columbia University in 2006. In 2011, he obtained his medical degree from the University of Rochester School of Medicine and Dentistry. He completed his internal medical residency at the Yale University’s Primary Care Residency Program Yale New Haven in 2014.

=== References ===

  1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020. Retrieved from: https://www.cdc.gov/nchs/products/databriefs/db360.html
  2. https://www.cdc.gov/obesity/data/adult.html

*For additional resources discussed in the episode, check out our transcript!

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Nate Wood
Producers: Helen Cai, JW, August Allocco
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Emily A. Sprague, Unicorn Heads, Godmode, Corbyn Kites, Ammil, Coma

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In this episode, Nate and Justin discuss ways that Tina could modify her food environment to keep moving toward her health goals. They also discuss the tricky aspect of social determinants of health and how that may (or may not?) hamper our efforts to help patients achieve healthy lifestyles.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Food Environment
3. Chapter 2: Social Determinants of Health
4. Chapter 3: Concluding the Nutrition Series
5. Conclusion

=== Learning Points ===

  1. Setting up an environment for success and encouraging new habits are the most important strategies for success in changing eating patterns.
  2. While it’s important to understand the effects of social determinants of health, our patients are resilient in enacting change and should not be underestimated.
  3. Many fad diets and trends exist within mainstream cultures. At the end of the day: point patients to an evidence-based lifestyle (such as eating a whole food, predominantly plant-based diet).
  4. Time within the office is limited. Provide patients with brief, targeted teaching while they are within the office, and additional resources for patients to explore after the visit.

=== Our Expert(s) ===

Dr. Justin Charles is a graduate of the Yale Primary Care Internal Medicine Residency Program.

His clinical interests are in Lifestyle Medicine, the use of evidence-based lifestyle interventions to not only prevent, but treat and reverse chronic disease from a root cause perspective. He has received training in Plant-Based Nutrition through the T. Colin Campbell Center for Nutrition Studies and eCornell, as well as Dr. John McDougall's Starch Solution Certification Course.

=== References ===

Re: similarities between processed foods and “illicit” drugs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334652/

Re: our environment being obesogenic: https://www.sciencedirect.com/science/article/abs/pii/S0091743599905856

Structures being a fundamental cause of disease:
https://www.jstor.org/stable/2626958

Re: systemic solutions mentioend at the White House Conference: https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/28/fact-sheet-the-biden-harris-administration-announces-more-than-8-billion-in-new-commitments-as-part-of-call-to-action-for-white-house-conference-on-hunger-nutrition-and-health/

*For additional resources discussed in the episode, check out our transcript!

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Nate Wood
Producers: Nate Wood, Helen Cai, August Allocco
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Dan Henig, Bobby Richards, Asher Fulero, Jesse Gallagher, VYEN

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In this episode, Nate and Justin discuss the powerful technique of motivational interviewing to figure out how to help Tina inch closer towards her own goals.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Taking a Dietary History
3. Chapter 2: Motivational Interviewing
4. Conclusion

=== Learning Points ===

  1. Changes in food habits and eating patterns can mean breaking patterns that have been ingrained over lifetimes
  2. Fear and shame are not effective motivators, and so should not be used to persuade patients to change behaviors. Instead, emphasize the positive benefits that are present in the short term.
  3. Taking a detailed hour-by-hour dietary history can uncover additional opportunities to change eating patterns. Be sure to ask patients how they prepare foods, dress foods with condiments, and so forth.
  4. Empowering patients and removing judgment is critical. Motivational interviewing is a technique that frames change in an actionable, self-empowering manner, while uncovering reasons for changing eating patterns that are not solely weight-centered.
  5. In addition to achieving weight loss goals, changing nutrition is an opportunity to help patients get excited about other health goals, such as improving their blood pressure or reducing their risk of developing diabetes.

=== Our Expert(s) ===

Dr. Justin Charles is a graduate of the Yale Primary Care Internal Medicine Residency Program.

His clinical interests are in Lifestyle Medicine, the use of evidence-based lifestyle interventions to not only prevent, but treat and reverse chronic disease from a root cause perspective. He has received training in Plant-Based Nutrition through the T. Colin Campbell Center for Nutrition Studies and eCornell, as well as Dr. John McDougall's Starch Solution Certification Course.

=== References ===

Arab L, Tseng CH, Ang A, Jardack P. Validity of a multipass, web-based, 24-hour self-administered recall for assessment of total energy intake in blacks and whites. Am J Epidemiol. 2011 Dec 1;174(11):1256-65. doi: 10.1093/aje/kwr224. Epub 2011 Oct 20. PMID: 22021561; PMCID: PMC3224251.

=== Recommended Reading ===

  1. Moshfegh, A.J., Rhodes, D.G., Baer, D.J., Murayi, T., Clemens, J.C., Rumpler, W.V., Paul, D.R., Sebastian, R.S., Kuczynski, K.J., Ingwersen, L.A., Staples, R.C., Cleveland, L.E. The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes. A J Clin Nutr. 2008;88:324-332
  2. Johnston CA, Stevens BE. Motivational Interviewing in the Health Care Setting. Am J Lifestyle Med. 2013;7(4):246-249. doi:10.1177/1559827613485923
  3. Hauser ME, McMacken M, Lim A, Shetty P. Nutrition—An Evidence-Based, Practical Approach to Chronic Disease Prevention and Treatment. Fam Pract. 2022;71((1 Suppl Lifestyle)). doi:10.12788/jfp.0292

*For more reading recommendations, check out our transcript!

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Nate Wood
Producers: Nate Wood, Helen Cai, August Allocco
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Patrick Patrikios, pATCHES, Myuu, VYEN, Reed Mathis,

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In this episode, Nate, Justin, and Tina sit around the proverbial dinner table to discuss different types of eating patterns or "diets" and why a whole food plant-based diet might deserve a spot at the top of the food chain.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Types of Eating Patterns
3. Chapter 2: Whole Food Plant-Based Diet
4. Chapter 3: Emotional and Psychological Nature of Eating
5. Conclusion

=== Learning Points ===

  1. Patients have different motivations for changing their eating habits: they may wish to lose weight as measured on the scale, change their appearance, or prevent or treat chronic disease.
  2. The keto diet, a popular eating diet, can appear to be healthful in the short term: patients are able to lose weight, decrease their blood pressure, and decrease their blood sugar. However, it is not sustainable in the long term and may lead to increased risk of adverse health outcomes.
  3. Many scientifically vetted eating patterns, including the DASH diet and Mediterranean diet, share one thing in common: eating a whole food, plant-based diet. Eating a whole food, plant-based diet does not mean the same thing as “vegan;” rather, it emphasizes eating foods in their minimally processed form and minimizing consumption of animal-based foods.

=== Our Expert(s) ===

Dr. Justin Charles is a graduate of the Yale Primary Care Internal Medicine Residency Program.

His clinical interests are in Lifestyle Medicine, the use of evidence-based lifestyle interventions to not only prevent, but treat and reverse chronic disease from a root cause perspective. He has received training in Plant-Based Nutrition through the T. Colin Campbell Center for Nutrition Studies and eCornell, as well as Dr. John McDougall's Starch Solution Certification Course.

=== Recommended Reading ===

  1. Comparison of sociodemographic and nutritional characteristics between self-reported vegetarians, vegans, and meat-eaters from the NurtiNet-Santé Study.
  2. Rosenfeld DL. The psychology of vegetarianism: Recent advances and future directions. Appetite 2018; 131:125-38;and Ruby MB. Vegetarianism. A blossoming field of study. Appetite 2012; 58:141-150.
  3. Plante CN, Rosenfeld DL, Plante M, Reysen S. The role of social identity motivation in dietary attitudes and behaviors among vegetarians. Appetite 2019; 141 https://doi.org/10.1016/j.appet.2019.05.038
  4. Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five contents (PURE): a prospective study.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Nate Wood
Producers: Nate Wood, Helen Cai, August Allocco
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: pATCHES, Unicorn Heads, Asher Fulero

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In our inaugural episode of the nutrition series, Nate, Justin and our patient, Tina, tackle nutrition myths and what it means to eat for joy. Pretty ambitious... did they bite off more than they can chew?? Listen to find out.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Tina's Story
3. Chapter 2: Eating for Joy
4. Chapter 3: Busting Nutrition Myths
5. Conclusion

=== Learning Points ===

  1. Eating behavior is deeply rooted in personal experience.
  2. Healthy eating can be a joyous experience, a message that is often lost in mass media and cultural myths.
  3. Instead of focusing on individual components of food such as macronutrient profiles, carbohydrates, or fats, focus more on what a particular food offers as a whole.
  4. Robust literature is available to guide physicians in counseling patients on their nutrition choices (more on this to come in future episodes).

=== Our Expert(s) ===

Dr. Justin Charles is a graduate of the Yale Primary Care Internal Medicine Residency Program. His clinical interests are in Lifestyle Medicine, the use of evidence-based lifestyle interventions to not only prevent, but treat and reverse chronic disease from a root cause perspective. He has received training in Plant-Based Nutrition through the T. Colin Campbell Center for Nutrition Studies and eCornell, as well as Dr. John McDougall's Starch Solution Certification Course.

=== References ===

  1. Ros E. The PREDIMED study. Endocrinol Diabetes Nutr. 2017 Feb;64(2):63-66. English, Spanish. doi: 10.1016/j.endinu.2016.11.003. Epub 2017 Feb 1. PMID: 28440779.
  2. Le LT, Sabaté J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 2014 May 27;6(6):2131-47. doi: 10.3390/nu6062131. PMID: 24871675; PMCID: PMC4073139.

=== Recommended Reading ===

  1. Zhang B, Zhai FY, Du SF, Popkin BM. The China Health and Nutrition Survey, 1989-2011. Obes Rev 2014; 15(suppl 1):2–7.
  2. Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China Study
  3. Davey GK, Spencer EA, Appleby PN, et al. EPIC–Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33,883 meat-eaters and 31,546 non meat-eaters in the UK.
  4. Wilkins JT, Karmali KN, Huffman MD, et al. Data resource profile: the cardiovascular disease lifetime risk pooling project. Alles B, Baudry J, Mejean C, et al.

=== About Us ===
The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.

Hosts: Nate Wood
Producers: Nate Wood, Helen Cai, August Alloco,
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: TrackTribe, The Tide, Patrick Patrikios, Asher Fulero, Windows of Ken, Joel Cummins

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the final episode of our hypertension series, Taylor and Dr. Gallagher discuss the causes of high blood pressure and management in special populations.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Causes of Primary Hypertension
3. Chapter 2: Secondary Hypertension
4. Chapter 3: Treating Hypertension in Special Populations
6. Conclusion

=== Learning Points ===

  1. About 90% of patients with hypertension experience primary hypertension. About 10% of patients with hypertension experience secondary hypertension due to an underlying disease or interfering medication. Causes of secondary hypertension can include pheochromocytoma, renal artery stenosis, CKD, primary hyperaldosteronism, fibromuscular dysplasia, and obstructive sleep apnea.
  2. Workup for diagnosing the cause of hypertension should include a detailed history and a focused physical exam. Basic labs should include assessment for acute nephritis (e.g. hematuria, pyuria, or proteinuria), lipid panel, and A1C to screen for type 2 diabetes.
  3. “Hypertensive urgency” is differentiated from forms of hypertensive emergency by the absence of hypertensive end organ damage. Distinguishing between the two conditions is key for determining the therapeutic goal for blood pressure.
  4. Patients who are elderly, pregnant, may become pregnant, or have chronic kidney disease require special attention and management of their hypertension.

=== Our Expert(s) ===

Benjamin Gallagher, MD, FACP is an Assistant Professor of Clinical Medicine (General Medicine) at Yale School of Medicine.

=== References ===

de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, Oliveras A, Ruilope LM. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011 May;57(5):898-902. doi: 10.1161/HYPERTENSIONAHA.110.168948. Epub 2011 Mar 28. PMID: 21444835.

Anderson TS, Jing B, Auerbach A, et al. Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge. JAMA Intern Med. 2019;179(11):1528–1536. doi:10.1001/jamainternmed.2019.3007

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Josh Onyango, Maisie Orsillo
Producers: Helen Cai, Kevin Wheelock, Danish Zaidi
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Coma Media, Defekt_Maschine, Chris Haugen, Unicorn Heads, and Slynk.

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the second episode of our hypertension series, Taylor and Dr. Gallagher discuss lifestyle modifications and medications used in the treatment of high blood pressure.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Setting goals
3. Chapter 2: Lifestyle modifications
4. Chapter 3: Initiating Pharmacotherapy
5. Chapter 4: Adherence to Medications
6. Conclusion

=== Learning Points ===

  1. Most patients with hypertension would benefit from having a low blood pressure, regardless of the degree of lowering.
  2. Recognize that asking patients to start medications can be a large ask for a patient, especially if they are otherwise healthy and have several other conditions to manage.
  3. Lifestyle modifications—such as reducing salt intake and drinking water—may lower blood pressure to some degree. However, finding such “low-hanging fruit” in lifestyle modifications is difficult, and providers should not shy away from pharmacotherapies.
  4. Firstline therapies for lowering blood pressure include long-acting calcium channel blockers, ACE inhibitors/ARBs, and diuretics. Optimizing a patient’s regimen may require a combination of therapies, and combination pills may be effective in improving adherence.

=== Our Expert(s) ===

Benjamin Gallagher, MD, FACP is an Assistant Professor of Clinical Medicine (General Medicine) at Yale School of Medicine.

=== References ===

  1. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248.
  2. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief, no 364. Hyattsville, MD: National Center for Health Statistics. 2020.
  3. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373(22):2103–16. 2015.
  4. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 14 – Effects of different classes of antihypertensive drugs in older and younger patients: Overview and meta-analysis. J Hypertens 36(8):1637–47. 2018.

=== Recommended Reading ===

  1. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006 Feb;47(2):296-308. doi: 10.1161/01.HYP.0000202568.01167.B6. PMID: 16434724.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Josh Onyango, Maisie Orsillo
Producers: Helen Cai, Kevin Wheelock, Danish Zaidi
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Dan Lebowitz, penguinmusic, future mono, Jesse Gallagher, VYEN, madriFan,

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the first episode of our hypertension series, our patient Taylor joins us for a discussion on receiving and coming to terms with a diagnosis of high blood pressure.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction
2. Chapter 1: Taylor's Story/Hypertensive Urgency
3. Chapter 2: Defining Hypertension
4. Chapter 3: Measuring Blood Pressure
5. Chapter 4: White Coat Hypertension
6. Conclusion

=== Learning Points ===

  1. The ideal target for a patient’s blood pressure is based on their risk score for cardiovascular events and mortality in the long term.
  2. Measurement of blood pressure in an office setting is often performed in nonideal conditions.Out-of-office monitoring of blood pressure monitoring should be used whenever possible.
  3. The “white coat effect” refers to high blood pressure that is above a patient’s treatment goal in the office, but below their treatment goal at home. This effect is still clinically significant.

=== Our Expert(s) ===

Benjamin Gallagher, MD, FACP is an Assistant Professor of Clinical Medicine (General Medicine) at Yale School of Medicine.

=== References ===

  1. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248.
  2. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief, no 364. Hyattsville, MD: National Center for Health Statistics. 2020.
  3. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373(22):2103–16. 2015.
  4. Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med. 2011 Jun 21;154(12):781-8, W-289-90. doi: 10.7326/0003-4819-154-12-201106210-00005. PMID: 21690592.
  5. de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, Oliveras A, Ruilope LM. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011 May;57(5):898-902. doi: 10.1161/HYPERTENSIONAHA.110.168948. Epub 2011 Mar 28. PMID: 21444835.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.

Hosts: Josh Onyango, Maisie Orsillo
Producers: Helen Cai, Kevin Wheelock, Danish Zaidi
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: The Mini Vandals, Asher Fuller, Astron, Joel Cummins, penguinmusic, Unicorn heads, Dan Bodan,

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the third episode of our type II diabetes series, our patient Tabby joins us to speak about her experience with insulin, monitoring blood glucose, and lifestyle modifications. We wrap up the mini-series with some specific advice from both our patient and expert interviewees.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===

  1. Introduction
  2. Chapter 9 - Starting Insulin
  3. Chapter 10 - Day-to-Day Management
  4. Chapter 11 - Hypoglycemia and Difficult Conversations
  5. Chapter 12 - Lifestyle Changes
  6. Chapter 13 - Advice to Patients and Practitioners
  7. Conclusion

=== Learning Points ===

  1. When adding a new insulin therapy, consider factors such as cost, the patient’s eating habits, and their attitude toward injections
  2. The ADA recommends starting insulin if the A1c is over 10% when symptoms of hyperglycemia are under poor control, or in patients with ESRD.
  3. When teaching patients how to monitor their own glucose, take the time to teach them how to use a glucometer and record their blood sugars
  4. Educate patients and loved ones on how to identify hypoglycemia and how to treat it.

=== Our Expert(s) ===

Dr. Tracy Rabin is an Internist and Pediatrician who joined the Yale faculty in 2011 as a member of the Section of General Internal Medicine (YSM Department of Internal Medicine), and currently serves as the Associate Program Director for Global and Community Health in the Yale Primary Care Internal Medicine Residency Program (YPC). She attends and teaches on the medical wards at the St. Raphael's Campus (SRC) of Yale-New Haven Hospital; directs care and precepts residents in the SRC Adult Primary Care Diabetes Clinic.

=== References ===

  1. [American Diabetes Association] Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers: https://diabetesjournals.org/clinical/article/40/1/10/139035/Standards-of-Medical-Care-in-Diabetes-2022
  2. HUSKY Health Program | Providers | Continuous Glucose Monitors (CGM) Policy: https://www.huskyhealthct.org/providers/provider_postings/policies_procedures/Continuous_Glucose_Monitors_Policy.pdf
  3. [American Diabetes Association] Hypoglycemia: https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible medical education podcast episodes that center on a patient's lived experience with a disease.

Hosts: Katie Gielissen, Maisie Orsillo
Post-Production Assistant: Christina Liu
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: The Tides, Yen, Joel Cummins, Underbelly & Ty Mayer, Bobby Richards, DJ Williams, Dan Henig, Surviving the Asteroid Belt

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the second episode of our type II diabetes series, our patient Tabby joins us for a discussion on non-insulin therapies.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===

  1. Introduction
  2. Chapter 5 - Patient Centered Approach
  3. Chapter 6 - Medication
  4. Chapter 7 - Comorbidities
  5. Chapter 8 - Barriers to medication
  6. Conclusion

=== Learning Points ===

  1. There are several non-insulin medications for diabetes that can be differentiated by their mechanisms and all have different indications on when to use them
  2. A patient’s comorbidities may guide your choice for starting a non-insulin therapy.
  3. Explaining the side effects of a medication in the context of its mechanism of action may go a long way in helping the patient manage expectations around new medications.
  4. Addressing mental health comorbidities such as depression and anxiety can be key to initiating and maintaining the management of diabetes.
  5. Create adestigmatizing environment when asking patients about their medication consistency

=== Our Expert(s) ===

Dr. Tracy Rabin is an Internist and Pediatrician who joined the Yale faculty in 2011 as a member of the Section of General Internal Medicine (YSM Department of Internal Medicine), and currently serves as the Associate Program Director for Global and Community Health in the Yale Primary Care Internal Medicine Residency Program (YPC). She attends and teaches on the medical wards at the St. Raphael's Campus (SRC) of Yale-New Haven Hospital; directs care and precepts residents in the SRC Adult Primary Care Diabetes Clinic

=== References ===

  1. [American Diabetes Association] Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers: https://diabetesjournals.org/clinical/article/40/1/10/139035/Standards-of-Medical-Care-in-Diabetes-2022
  2. Figure depicting patient and disease factors that may be used to determine optimal HbA1C targets: Inzucchi, S.E., Bergenstal, R.M., Buse, J.B. et al. Management of hyperglycaemia in type 2 diabetes, 2015. Diabetologia 58, 429–442 (2015). https://doi.org/10.1007/s00125-014-3460-0
  3. Herkert D, Vijayakumar P, Luo J, Schwartz JI, Rabin TL, DeFilippo E, Lipska KJ. Cost-Related Insulin Underuse Among Patients With Diabetes. JAMA Intern Med. 2019 Jan 1;179(1):112-114. doi: 10.1001/jamainternmed.2018.5008. PMID: 30508012; PMCID: PMC6583414.

=== Recommended Reading ===

  1. American Diabetes Association; 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021. Diabetes Care 1 January 2021; 44 (Supplement_1): S111–S124. https://doi.org/10.2337/dc21-S009

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine where give patients the autonomy to participate as experts of the lived experience of their condition.

Hosts: Katie Gielissen, Maisie Orsillo
Post-Production Assistant: Christina Liu, Helen Cai
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Other background music: Mini Vandals, Kevin MacLeod, Patrick Patrikios, Dan Bodan, Nate Blaze

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the first episode of our type II diabetes series, our patient Tabby joins us for a discussion on receiving and coming to terms with a diagnosis of diabetes.

Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===

  1. Introduction
  2. Chapter 1 - Screening for Diabetes
  3. Chapter 2 - Diagnosis/Breaking the News
  4. Chapter 3 - Setting Expectations After the Diagnosis
  5. Chapter 4 - Shame, Stigma, and Support
  6. Conclusion

=== Learning Points ===

  1. Screen all adults >35yo for diabetes every 3 years. You might screen other patients if they have risk factors placing them at higher risk
  2. Begin conversation about diabetes before ordering tests
  3. Ensure that you have enough time to listen to and address patient's concerns about a new diabetes diagnosis
  4. Be attentive for signs of distress in patients with diabetes, which could affect their care.

=== Our Expert(s) ===

Dr. Tracy Rabin is an Internist and Pediatrician who joined the Yale faculty in 2011 as a member of the Section of General Internal Medicine (YSM Department of Internal Medicine), and currently serves as the Director of the Office of Global Health, and the Associate Program Director for Global and Community Health in the Yale Primary Care Internal Medicine Residency Program (YPC). She co-directs the Makerere University-Yale University (MUYU) medical education capacity building collaboration which is based at the Makerere University College of Health Sciences/Mulago National Referral & Teaching Hospital in Kampala, Uganda.

=== References ===

  1. [American Diabetes Association] Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers: https://diabetesjournals.org/clinical/article/40/1/10/139035/Standards-of-Medical-Care-in-Diabetes-2022
  2. Diabetes Distress Scale: https://diabetesdistress.org/take-dd-survey

=== Recommended Reading ===

  1. [CDC] 10 Tips for Coping with Diabetes Distress: https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-diabetes-distress.html

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.

Hosts: Katie Gielissen, Maisie Orsillo
Post-Production Assistant: Helen Cai, Christina Liu
Logo and name: Eva Zimmerman Theme music and Editing: Josh Onyango
Other background music: the Mini Vandals, Wes Hutchinson, E's Jammy Jams, Futuremono, Ammil, Emmit Fenn, Humam-Huma, Patrick Patrikios, Jesse Gallagher, Emily A. Sprague, Corbyn Kites

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the third episode of our opioid use disorder series, we explore therapy, sponsors, and return to use with our patient TJ and Expert Dr. Chan. Share your reactions and questions with us at Speak Pipe. We might feature you on a future episode!

=== Outline ===

  1. Introduction (0:00)
  2. Chapter 9: Therapy (individual vs group) (3:29)
  3. Chapter 10: Sponsors (17:33)
  4. Chapter 11: Return to Use (21:40)
  5. Conclusion: (34:39)

=== Learning Points ===

  1. While resources such as group therapy, NA, and other 12-step programs are not for everyone, they can be important tools to offer our patients.
  2. Sponsors can often relate to a patient’s struggles with opioid use disorder more authentically than we can as their providers. While a sponsor may not be for everyone, they can be invaluable to walk alongside some patients on their journey.
  3. Return to use is hard, both for patients and providers. We must accept that return to use is part of the disease of addiction, and this is not an excuse to pull back on medication treatment or to give up on our patients.

=== Our Expert(s) ===

Dr. Carolyn Chan is an academic hospitalist at Yale New-Haven Hospital with interests in medical humanities, quality improvement, and addiction medicine. You can reach her on twitter @CarolynAChan.

Dr. Lisa Sanders, MD, FACP, associate professor of medicine (general medicine) and author of the popular Diagnosis column for the New York Times Magazine offers her media expertise to the PCP team as a production consultant for the podcast.

=== References ===

  1. SAMHSA’s National Helpline: https://www.samhsa.gov/find-help/national-helpline

=== Recommended Reading ===

  1. Buresh M, Stern R, Rastegar D. Treatment of opioid use disorder in primary care. BMJ. 2021 May 19;373:n784. doi: 10.1136/bmj.n784. PMID: 34011512.
  2. Alexander GC, Stoller KB, Haffajee RL, Saloner B. An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19. Ann Intern Med. 2020 Jul 7;173(1):57-58. doi: 10.7326/M20-1141. Epub 2020 Apr 2. PMID: 32240283; PMCID: PMC7138407.
  3. Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Serv Res. 2019 Nov 25;19(1):884. doi: 10.1186/s12913-019-4751-4. PMID: 31767011; PMCID: PMC6876068.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.

Hosts: Nate Wood, Maisie Orsillo, Addy Feibel
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Producers: Helen Cai, Addy Feibel
Other Background music: Slynk, Astron, Nathan Moore, Dream-Protocol, Emmit Fenn, and Arcadia

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In the second episode of our opioid use disorder series, we’ll explore medications and treatment options for the disease. Our patient TJ joins and continues to offer her perspective. Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===

  1. Introduction (0:00)
  2. Chapter 5 - Risk Assessment and Harm Reduction (3:43)
  3. Chapter 6 - Medication Assisted Treatment (11:31)
  4. Chapter 7 - Counseling on Treatment Options (15:47)
  5. Chapter 8 - How PCPs can start treating OUD (28:16)
  6. Conclusion (33:04)

=== Learning Points ===

  1. The RIP-TEAR mnemonic can assist in taking a good history of a patient with an opioid use disorder.
  2. There are three FDA-approved medications for the treatment of opioid use disorder: methadone, buprenorphine (i.e. Suboxone), and naltrexone.
  3. Physicians who would like to prescribe for up to 30 patients do not require additional training to receiving an X-waiver, thus removing one barrier to treating opioid use disorder within the primary care setting.

=== Our Expert(s) ===

Dr. Carolyn Chan is an academic hospitalist at Yale New-Haven Hospital with interests in medical humanities, quality improvement, and addiction medicine. You can reach her on twitter @CarolynAChan.

Dr. Lisa Sanders, MD, FACP, associate professor of medicine (general medicine) and author of the popular Diagnosis column for the New York Times Magazine offers her media expertise to the PCP team as a production consultant for the podcast.

=== References ===

  1. [FDA] Information about Medication-Assisted Treatment (MAT): https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat
  2. [SAMHSA] Become a Buprenorphine Waivered Practitioner: https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner

=== Recommended Reading ===

  1. Buresh M, Stern R, Rastegar D. Treatment of opioid use disorder in primary care. BMJ. 2021 May 19;373:n784. doi: 10.1136/bmj.n784. PMID: 34011512.
  2. Alexander GC, Stoller KB, Haffajee RL, Saloner B. An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19. Ann Intern Med. 2020 Jul 7;173(1):57-58. doi: 10.7326/M20-1141. Epub 2020 Apr 2. PMID: 32240283; PMCID: PMC7138407.
  3. Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Serv Res. 2019 Nov 25;19(1):884. doi: 10.1186/s12913-019-4751-4. PMID: 31767011; PMCID: PMC6876068.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers that include contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.

Hosts: Nate Wood, Maisie Orsillo, Addy Feibel
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Producers: Helen Cai, Addy Feibel
Other background music: OfShane, Lesfm, ComaStudio, penguinmusic, Ammil, Lauren Duski, and Slynk

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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In a quick bonus episode, our hosts Nate and Maisie introduce themselves and encourage, you, our listeners, to share your reactions and questions with us at  Speak Pipe. If you do, we might feature you on a future Mailbox episode!

=== About Us ===
The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.

Hosts: Nate Wood, Maisie Orsillo
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Producers: Helen Cai
Other background music: penguinmusic

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

View Details

Our first episode explores how our patient, TJ, developed an opioid use disorder, and the steps providers need to take in order to diagnose the disease. Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!

=== Outline ===
1. Introduction: 0:00
2. Chapter 1 - First experience with Opioids: 4:23
3. Chapter 2 - Transition to OUD/Taking a History and Physical: 10:11
4. Chapter 3 - Neurobiology of OUD: 22:23
5. Chapter 4 - Opioid Dependence and Withdrawal: 27:00
6. Conclusion: 35:07

=== Learning Points ===

  1. Rremember to use the 3 C’s: control, craving, and consequences when meeting a patient with potential OUD for the first time. Use the DSM-V criteria to quantify the severity
  2. Stay away from language such as opioid abuse and instead use patient-centered language such as opioid use disorder or substance use disorder. Instead of clean urine, say negative urine drug screen.
  3. A history and physical are key parts of the evaluation for a patient with OUD, looking for signs of recent use, complications of use (such as infections) or signs of withdrawal.
  4. It is essential to the safety and wellbeing of our patients that we promptly treat the symptoms of opioid withdrawal, as this can lead to using a batch of opioids that could cause overdose.

=== Our Expert(s) ===

Dr. Carolyn Chan is an academic hospitalist at Yale New-Haven Hospital with interests in medical humanities, quality improvement, and addiction medicine. You can reach her on twitter @CarolynAChan.

Dr. Lisa Sanders, MD, FACP, associate professor of medicine (general medicine) and author of the popular Diagnosis column for the New York Times Magazine offers her media expertise to the PCP team as a production consultant for the podcast.

=== References ===

  1. CDC Drug Overdose Prevention: https://www.cdc.gov/drugoverdose/prevention/index.html
  2. CDC Newsroom report on Overdose Deaths Accelerating During COVID-19: https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

=== Recommended Reading ===

  1. Buresh M, Stern R, Rastegar D. Treatment of opioid use disorder in primary care. BMJ. 2021 May 19;373:n784. doi: 10.1136/bmj.n784. PMID: 34011512.
  2. Alexander GC, Stoller KB, Haffajee RL, Saloner B. An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19. Ann Intern Med. 2020 Jul 7;173(1):57-58. doi: 10.7326/M20-1141. Epub 2020 Apr 2. PMID: 32240283; PMCID: PMC7138407.
  3. Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Serv Res. 2019 Nov 25;19(1):884. doi: 10.1186/s12913-019-4751-4. PMID: 31767011; PMCID: PMC6876068.

=== About Us ===
The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts on various primary care topics, allowing patients the autonomy to share their stories with our audience and for young clinicians to learn from their experiences.

Music
Theme music and Editing by Josh Onyango
Background music: TrackTribe, Jesse Gallagher, Madirfan, The Tides, Corbyn Kites, and pATCHES

Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls

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An introduction to the primary care pearls podcast with Dr. Joshua Onyango, MD EdM (@drjomax) and Dr. Katie Gielissen, MD MHS-MedEd (@katie-g-md)!

Outline:
1. Introduction (00:00)
2. Defining Primary Care (00:50)
3. Why we're pumped about primary care (02:10)
4. "YOBM Brainchild" (03:10)
5. Sneek Peak (04:45)
6. Outro (06:18)

Music composed by: Josh Onyango

=== Social Media ===
Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms

=== About Us ===
The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.