Physician's Weekly Podcast

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In the second part of their conversation, Alex McDonald, MD, asks Carl Lambert, MD, to share his personal experience as the only Black student in his class and his mission to create a more inclusive environment for future physicians.

ContributorsCarl Lambert, MD
Primary Care Physician
Rush Medical Group

Director
Rush Family Medicine Leadership Program
Rush University

Alex McDonald, MDProgram Director
Fontana Family Medicine Residency
Kaiser Permanente

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Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.

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In part 1 of their conversation, Alex McDonald, MD, asks Carl Lambert, MD, about how he practices neuro-inclusive care and how all physicians can better support patients with autism and other developmental disabilities.

ContributorsCarl Lambert, MD
Primary Care Physician
Rush Medical Group

Director
Rush Family Medicine Leadership Program
Rush University

Alex McDonald, MDProgram Director
Fontana Family Medicine Residency
Kaiser Permanente

Let us know what you thought of this week’s episode on X: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

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Debra Patt, MD, PhD, MBA, discusses how electronic monitoring is reducing administrative burden for oncology clinicians and helping to keep patients comfortably at home during treatment.

Read the full transcript here.

ContributorDebra Patt, MD, PhD, MBA

Executive Vice President
Texas Oncology

President
Community Oncology Alliance

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Michael Jerkins, MD, MEd, comments on the rising burden of debt for US physicians and how tailored refinancing options can help reduce financial stress and support the move to independent practice.

Read the full Q&A here.

ContributorMichael Jerkins, MD, MEdInternal Medicine/Pediatrics PhysicianCo-Founder/PresidentPanacea Financial

Disclosure: Michael Jerkins, MD, MEd, is president of Panacea Financial.

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Anthony Auriemma, MD, discusses how economic factors, stigma within the healthcare system, and cultural factors can all influence a patient’s access to obesity treatment.

Read the Q&A here.

ContributorAnthony Auriemma, MDFamily Medicine
UChicago Medicine
Advent Health

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Dr. MedLaw returns to discuss how AI-driven change is fundamentally different from prior healthcare shifts. She also shares how clinicians can navigate the evolving requirements and practical logistics of obtaining patient consent for AI use in their medical care.

Transcript coming soon.

Let us know what you thought of this week’s episode on X: @physicianswkly

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In part 2 of their conversation, Alex McDonald, MD, asks Indira Gurubhagavatula, MD, MPH, about how physicians of any specialty can identify patients in need of a sleep study, how to manage sleep if specialists cannot be accessed, and where to learn more information.

Listen to part 1 here.

ContributorsIndira Gurubhagavatula, MD, MPH
Member, Board of Directors
American Academy of Sleep Medicine

Alex McDonald, MDProgram Director
Fontana Family Medicine Residency
Kaiser Permanente

Transcript coming soon.

Let us know what you thought of this week’s episode on X: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

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Editorial board member Alex McDonald, MD, sits down with Indira Gurubhagavatula, MD, MPH, to explore why conversations about sleep are missing in the exam room and how clinicians can help close the gaps.

Tune in next week for part 2 of their discussion.

ContributorsIndira Gurubhagavatula, MD, MPH
Member, Board of Directors
American Academy of Sleep Medicine

Alex McDonald, MDProgram Director
Fontana Family Medicine Residency
Kaiser Permanente

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

This week, editorial board member Dr. Alex McDonald speaks with Dr. Indira Gurubhagavatula about how clinicians can better address sleep in the exam room.

Dr. McDonald: Welcome everyone to today’s Physician’s Weekly PeerPOV podcast. We are here to talk about one of my favorite topics, and that is sleep. I love sleeping. I just saw a toddler recently at a family event who was crying and screaming because they didn’t want to go take a nap. I was like, “Man, what I would give to take a nap.” But anyway, I digress.

I am very excited. We have a guest here from the American Society of Sleep Medicine. I am not going to butcher her name, so I’m going to call her Dr. G. Dr. G, thank you so much for joining us, and tell us your full name because Dr. G does not suffice.

Dr. Gurubhagavatula: It’s Dr. Indira Gurubhagavatula. I am professor of medicine at the University of Pennsylvania and I am on the board of directors for the American Academy of Sleep Medicine.

Dr. McDonald: Wonderful. Thank you so much. I really appreciate your being here. This conversation came out of some findings recently, with the American Academy of Sleep Medicine’s annual sleep survey, asking physicians and patients about sleep. Can you summarize some of the key findings from that sleep survey?

Dr. Gurubhagavatula: Yeah, it was an online survey of over 2,000 adults all over the US. It was done in June 2025 by an independent research agency. The results showed that nearly half of adults, 45% to be exact, have not talked about their sleep with any health professional at all. Only 15% of all adults that were surveyed reported that they discussed their sleep with an actual sleep specialist. These numbers are very low.

Dr. McDonald: Yeah. You had mentioned this before, when you were sort of the green room, that sleep is the Cinderella specialty—it’s really important, but everyone forgets about it or neglects it. As a family physician, I’m passionate about diet, sleep, exercise, and stress relief as the four foundations of a good health, regardless of what we do on top of that. So, the fact that a lot of people are not talking about sleep with their doctors is a little concerning.

We know sleep is essential. I think that’s sort of unequivocal at this point, but the question is, why aren’t people talking to their doctors? Why do you think these conversations aren’t happening?

Dr. Gurubhagavatula: Well, it takes two to have a conversation. There are probably things happening on both sides, on the patient side and on the clinician side.

As far as patients, sleep is not like a discrete localized anatomic structure. It’s not like, “Oh, my knee hurts” or “I have this rash.” It’s not a discrete organ or organ system either, like GI or heart or lung. So, I think it’s this general, vague, all-over type of a phenomenon, and people sometimes don’t think of it as something to report.

I also think that our patients underestimate how important it is, they don’t necessarily connect it to whatever morbidity or complaints they’re experiencing. I think there is that awareness piece, and the underestimation of sleep’s value. We live in a culture where there’s machismo in getting away with only a little bit of sleep.

Dr. McDonald: Especially in medicine, right?

Dr. Gurubhagavatula: Especially. We are so guilty. And then there are things on the clinician side. Have you ever done a review of systems that had sleep as a line item?

Dr. McDonald: No, not really.

Dr. Gurubhagavatula: Yeah, right? Because it’s all the physical stuff—the head, the eyes—but we don’t really ask about the sleep. As clinicians, we’re not giving it the line item that it deserves in our general overview when patients come in. That’s one thing, that it is just missing from the repertoire of questions we ask.

The other thing is that a lot of people don’t even think of sleep itself as a specialty. I mean, starting from pre-med, to medical school, residents, and fellows—they don’t know that sleep is even a specialty. Think about the last time you registered for a meeting or signed up for an event, and they asked for your name, your title, employer, and then there’s a dropdown, and sleep is missing. It’s not listed as a specialty.

But it’s been one for 20 years. We’ve been around. It’s just that people aren’t thinking of it. I think they know that it’s important. It’s just connecting the dots and then bringing it to life.

Dr. McDonald: Yeah. And as a family physician, I’ll be honest, when I’m in a patient meeting, and it’s 20 minutes, and they have their laundry list of things and I have my laundry list of things, sleep usually falls to the bottom.

In rare moments, usually with young men who are there because their wife, mom, daughter, or sister sent them, who don’t really have anything to complain about and they’re just there for a “physical,” I’ll start going into my what I call my lifestyle review systems: diet, sleep, exercise, stress relief. I will ask those things specifically, but it’s not the first thing I ask, and it’s usually only when I have time to ask those things. I’ll be honest, it’s pretty rare.

Dr. Gurubhagavatula: You’re not alone, and I appreciate you sharing that. I think the audience needs to hear that. None of us are alone in this. I think you’re absolutely right. We ask a lot of our family physicians, internal medicine, all our frontline doctors, the first line that patients come to. There’s just so much asked that it’s hard to get it all in.

Dr. McDonald: Yeah. There’s not enough time in the day, let alone time in a physician-patient appointment. One thing that kind of stuck out for me is that there’s a gender gap here in that the survey found women were 10 points less likely than men to have never discussed sleep with a healthcare professional, but we know that women tend to engage more with the healthcare system. That disconnect sort of struck me as funny. Tell me what your thoughts are, and why that may be.

Dr. Gurubhagavatula: It is fascinating that women experience sleep problems at disproportionately higher rates. They engage with healthcare more, probably because of childbirth and such. And yet, they talk about sleep with their healthcare professional even less often than men do.

Again, I think that it’s about connecting the dots. There are sleep disorders, and then there are sleep complaints. There are sleep disorders that don’t necessarily present as a sleep complaint like sleepiness, especially in women. They may just have a general sense that something’s off (eg, I’m not well, I have malaise, a lot of headaches, or even mood problems like low mood, I’m a little more edgy or irritable or anxious, not as motivated).

And then what happens if a woman reports these symptoms is that it gets attributed to a mental health disorder. They’re more likely being referred elsewhere if this come to attention at all. I’m not saying that there can’t be a comorbid mental health diagnosis; it’s just that it doesn’t rule out that there could be a primary sleep disorder. So, we just need to be less quick to write off when women do come forward, and encourage them to talk about their sleep and elicit those specific concerns.

Dr. McDonald: When a patient comes in with poor sleep or poor sleep hygiene, sometimes they’ll complain about sleep latency or frequent nighttime awakening, which helps you focus. But I think one of the challenges that I have is that when patients come in with vague, non-specific complaints, it’s hard to pin that down.

Often, I’ll talk about mental health, I’ll talk about sleep, and I’ll talk about physical activity when these complaints aren’t really adding up. But the first thing we’re trained to do is check a CBC and make sure they’re not anemic, check a TSH and make sure they’re not hypothyroid. There are all these other things we are trained to think of first, and sleep is often the last thing. Sometimes, in my experience, it takes a couple of visits and really getting to know these patients.

I think that’s one of the values of primary care and its continuity. I develop these relationships with these patients over time, and I can pick up where I left off saying, “Well, we checked your labs. We know it’s not an organic problem causing these vague symptoms. What’s next?” And we can dig down a little bit deeper.

But I know not everyone has a usual source of care or primary care doctor, which makes that even harder, when patients are working in this sort of patchwork, disjointed, dysfunctional disease-care system that we have in this country.

Dr. Gurubhagavatula: I think you’ve hit on a lot of the major points, and I also think that there’s this normalization that happens regarding what’s actually pathology. One of the groups you talked about is women. The other group where a gap was found was older adults.

We tend to think of snoring as just something we do as we get older, or that getting sleepy or falling asleep at different times is just my body aging. People who have insomnia may just say, “Well, that’s a mental health problem,” which still has stigma, and people don’t want to acknowledge that.

I think that we tend to misattribute some of these symptoms to regular aging—this is just what happens when I gain some weight, or it happens when I’m tired or if I have a beer or two—and not necessarily think that it’s something that needs further exploration.

And nobody wants a diagnosis, right? I think that there’s also not wanting the stigma of being labeled with a disease. People already have seen CPAP masks, and they have views and feelings about it, and they’re like, “Oh, I don’t want that thing.” So, there may be reluctance for all kinds of reasons.

Dr. McDonald: Yeah. I think that makes perfect sense. You touched on the age piece, which I want to go back to briefly. Again, 64% of older folks have never brought it up. It’s seen as a generational piece, where this is just part of what happens. It’s always a joke when grandpa falls asleep at the dining room table at 5:30 PM, but that’s not normal, quite frankly. Am I right?

Dr. Gurubhagavatula: Yeah. The adolescents are the ones that have what’s called delayed sleep phase, where they’re able to stay up till two, three, four in the morning, and they sleep until noon or 4 PM the next day. There are therapies for that, to help realign your sleep schedule with what’s expected of you in the daytime.

As we get older, there’s this other type, which is you fall asleep at only five or six o’clock and you’re wide awake by 2 AM, and the sleep itself is normal. Only the timing is off. This is not normal. It is an age-related thing, usually. It’s called advanced sleep phase syndrome.

Those are the kinds of things that, if you were to seek help for it, it could give you back your time with your grandchildren, help you stay awake through a dinner conversation, or help you engage with your partner or go out for a walk or whatever it is you like to do in the evenings. It gives people a little bit of quality of life back.

Dr. McDonald: Yeah, definitely. Drilling into the age piece a little bit deeper, the group aged 35 to 44 years seems most likely to have seen a specialist. Maybe there’s more of an awareness in the—I don’t know if those are the older millennials or the younger Gen Xers—that sleep is something important, and there are sleep specialists out there. Do we think maybe there’s a culture shift happening, or is that just luck?

Dr. Gurubhagavatula: We need to study it more to be able to pin down what’s happening. I think people are much more aware now because of the many streams of information we have coming in at our fingertips. There’s misinformation coming, too, but I also think that when you look at working-age adults, that’s a different group, because they’re experiencing the problems of nonrestorative or disordered sleep at work.

They may be late or missing days, their performance may be suffering, they’re making more errors (or sustaining injuries for people who are doing physical work, requiring more days on disability). So, sometimes they’re upset. They come to us and say, “Hey, I got laid off or I got cited because I was falling asleep at my desk,” and then they’re ready to do something about it because that’s serious enough to want help.

Then, there are the people that are professional drivers. They’re in the ridesharing industry, or they drive these huge big rigs or drive a train or a truck. There is a screening process in place when they get their professional big rig and such. There is a system to pre-screen them, and screening is required before they get their commercial driving license. Some people are contemplating it, and they see their primary doctor before they go forward, and sleep can be addressed there.

Dr. McDonald: Interestingly, only 30% of adults actually talk to their primary care doctor about sleep. That’s basically one-third. What do you wish we in primary care were doing differently or better when it comes to addressing sleep?

Dr. Gurubhagavatula: Well, sleep apnea is exceedingly common in middle-aged adults, and the prevalence just keeps increasing with age. It’s also very common now in pediatric groups. Obesity is a big driver. If you see somebody before you with overweight or obesity—a man with a neck size of 17 inches or more; a lot of men know their shirt size—that should be a red flag that this person needs to be screened for sleep apnea.

Obesity, middle age, male gender, or a woman who’s postmenopausal with overweight or obesity—you can ask them, “Hey, do you snore? Are you falling asleep in the daytime? Would you like a sleep referral? There’s help available and we can help you feel better.”

Dr. McDonald: I was talking to a medical student yesterday who I was precepting, and they did a mini presentation on sleep and all these different screening tools you can use. My favorite is the STOP-Bang questionnaire. It’s pretty quick and easy. My threshold for ordering a sleep study is about this high (for those of you who can’t see my fingers, they’re nearly together).

BMI of 35 is what we call normal in my clinic, so my threshold for ordering a sleep study is very, very low, especially within my system. We can do it very easily. We mail people devices to wear at home as the initial screening test. The barriers to doing an in-lab polysomnogram are not nearly as high now as they used to be back in the day.

Dr. Gurubhagavatula: Yeah, we have home sleep apnea tests now. Patients can sleep in their own home. There are telehealth appointments. It’s all extremely convenient, so more patients can be diagnosed easily and quickly.

Even with lower BMIs, I love the STOP-Bang because it’s so easy. You either have sleep apnea or you don’t. BMI of 35 is not very sensitive. It’s probably more specific than it is sensitive. So even at lower BMIs, you can see decent amounts of sleep apnea.

Another thing you can look for is the chin recessed back, and that’s easy. As a patient walks in, you look at their profile. You can tell if it’s recessed back a little bit when you open their mouth and say “aah,” and you can see if their tongue is large, if there’s scalloping along the edges, or if there are big tonsils. Just ask, “Hey, do you snore?” If you see that and the BMI is only 30, it’s still not something to exclude.

Unfortunately, symptoms and physical findings are probably only 50/50 sensitive at 50%. So, it’s like a coin toss. It really does need that referral and formal testing to confirm whether patients have sleep apnea or not.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

Let us know what you thought of this week’s episode on X: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

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Mehul V. Raval, MD, MS, shares how an enhanced recovery protocol reduced postsurgical opioid use, length of stay, and complications among children undergoing gastrointestinal procedures.

Read the full Q&A here.

ContributorMehul V. Raval, MD, MS

Professor of Surgery and Pediatrics
Northwestern University’s Feinberg School of Medicine

Pediatric Surgeon
Division Chief of Pediatric Surgery
Orvar Swenson Chair of Pediatric General and Thoracic Surgery
Ann & Robert H. Lurie Children’s Hospital of Chicago

Disclosure: Mehul V. Raval, MD, MS, has disclosed no relevant financial relationships.

Let us know what you thought of this week’s episode on X: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

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In the second part of their conversation, Alex McDonald, MD, and Jessica Gray, MD, discuss how physicians can navigate social media sponsorship opportunities responsibly and how to balance authenticity with privacy.

ContributorsAlex McDonald, MDProgram Director
Fontana Family Medicine Residency
Kaiser Permanente

Jessica Gray, MDFamily Medicine Physician
Co-Host, The Med Edit Podcast

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

In the second part of their conversation, Drs. Alex McDonald and Jessica Gray talk about how they navigate paid partnership opportunities on social media and how they balance authenticity with privacy.

Dr. McDonald: You mentioned you never set out to be a “doc influencer,” if you will, but there’s a line between education and entertainment, between advocacy and self-promotion. So, where do you draw that line?

I think we all know people who were well intended to begin with, and they get sucked down a road, start getting sponsorship, and start promoting questionable products or treatments, and then they lose credibility ultimately. So, how do you find that balance? Where’s the line between entertainment, education, advocacy, and self-promotion? Help me understand this. I don’t know the answer myself.

Dr. Gray: I think it’s very individualized. I am not ever going to be the doctor that’s a TikTok dancer. That’s just not my thing. I can’t do it.

I don’t even like speaking very much on social media. You’ll see most of my posts don’t have me speaking. It’s usually something else, either a voiceover or some words or something, because I just don’t feel that comfortable in that setting. I can talk on a podcast, and I can speak in front of hundreds of people and give lectures, but for some reason that avenue doesn’t feel the most comfortable and that’s okay. Don’t force it because that’s not as authentic.

If you do grow—because this wasn’t a problem when you’re very small and only for followers—but once it does grow, you’ll start to be contacted nonstop. Every day, something comes into your DMs and says, “Hey, we want you to do this. We want you to do that. We’ll pay you money for this.” You have to sit there and decide, “Where are my personal boundaries? What am I comfortable with?”

I have two friends that I talk to, both physicians, quite often about this. We’re talking about the recent doc influencer debate that’s been going on around social media lately, and specifically, we’re talking about paid partnerships. I’m not opposed to paid partnerships, honestly. I think it’s fine if you can figure out that it is something justifiable that you personally believe in, and that it is evidence-based and there’s a benefit to your community from it. I’ve seen that.

There are some things that are more education-based. I can fully disclose I’ve worked with the AAFP and I love it. I’m like, “My family med people!” I think it’s great to promote our organization. I’m fine with that.

The other thing is, it’s your extra time. Yeah, it doesn’t cost you money to run an Instagram account, but if they ask you to travel or go to a speaking event, that’s time away from your family and the clinic, and you can actually quantify the loss of revenue from some of those things. So, I think it’s fine to get paid in a very organized manner.

I think where we come into some sketchy stuff is when people are saying, “Hey, I will send you a massage chair, and you can have this massage chair worth $5,000 and then you can post about it.” I’m like, “No, that’s not a line that I’m going to cross.”

I think that there are definitely some ways to do this. There are also some companies out there that you can partner with that can help vet some of these things, that have ethics boards and that are made up of physicians that will say yes or no. Because the other thing is, these people with these paid partnerships—some of them are really great. We want them to be more out there in the community and be well known because the opposite is happening, where somebody else that’s not a doctor is getting paid for their influence, and they have even larger outreach, and it’s for something that’s completely the opposite of what we want our patients and our physician colleagues to go for. Educating first is probably most important. I’m not a performer. I am happy to see the physicians who are funny and make little skits. I like it for entertainment value, but I don’t think that’s bad. I think you just have to be transparent about what you’re doing.

There are a lot of rules that you have to follow as well, like government-set rules. So, if you’re going to go down this avenue, you might want to make sure that you have a partnership with a company that can help you vet sponsorships because, again, we didn’t learn this in med school or residency, and I think this line can get blurred really quickly.

Dr. McDonald: To your point of it being individual, every individual physician needs to figure out where their line is, what their goals are, what their focus is, and how any potential partnerships help or hinder that. Then, I think the ethics piece is really important, including conflicts of interest and being transparent about it.

I think that’s the biggest issue: knowing that it’s a paid promotion or partnership. There’s nothing wrong with that. Last time I checked, we still live in a capitalist society. But, at the same time, that does also potentially open you up for criticism, which, for better or for worse, is part of it and comes with the territory. So, I love that point about how everyone has to figure out their own individual line and not do it by themselves.

You talked about this before, and this kind of goes a little bit with the ugly side, the nuances between entertainment and self-promotion: the authenticity, and navigating professionalism versus safety. I remember this very clearly, I felt like I had to be this Norman Rockwell physician—very professional, very proper. Then in residency, I think I was probably an intern or a second-year resident, I was like, I can’t do this.

I’m a goofy, outgoing person at baseline. So, when I started doing that in the exam room with patients, it just felt so much more natural. I felt like I enjoyed the practice of medicine more. And that extends to my social media. Some of my posts are a bit more serious, but a lot of them are a little goofy or silly because that’s just who I am and what feels right for me.

When physicians use social media, do they need to put on a persona? Do they need to be themselves? Do they have to perform? What are your thoughts?

Dr. Gray: I think that you said it perfectly. I think you have to figure out who you are and how much of your life you want to expose. I think setting some boundaries is really important. For me, I don’t want to show anything with my family. That’s my line. I do know that I probably would have a lot more followers if I showed pictures of my really cute kids and showed me going shopping or something. No offense to those that do that; that’s just my line.

I have really small kiddos. I don’t want them to be at school like—I mean, they already have. My sweet kid at school, one of his teachers is like, “I follow you on social media and I listen to your podcast,” which I think is great, but I’m also like, “Oh gosh, that’s the principal.”

So, I think there are some lines there. You want to be authentic, but you don’t have to show your entire life. I think showing some emotion and not acting like you have everything together is a good piece to let people in. I always say, if you’re going to talk to patients, you also have to consider who your audience is.

For me, it was interesting to learn that the majority of my audience is actually in the healthcare world, which is cool. I think the majority are physicians, nurses, med students, or something medically related, which is awesome. I do have a large number of patients as well, and I love what my patients say that they watch on social media. But if you’re talking to mostly the lay public that are not medical-based, you need to be able to communicate in a way that’s authentic to you and to them.

You don’t want to talk over their heads. You want to talk the same way you would talk to a patient in the clinic. It needs to feel unlike a true performance for them. I always tell people that if you wouldn’t defend what you’re saying in a room of your peers or the medical board, then definitely don’t post it either. You want to make sure that you’re being authentic.

I’m not going to swear. I’m even careful about what music I post. It’s still authentic to me; I just may find the nonexplicit version of that Nikki Minaj song. I think that there are definitely ways to tailor it to you without stepping over a boundary you’re not 100% comfortable with.

Like you, I did the same thing, where all of a sudden I started realizing I don’t have to be in the same box as everyone else. I can make medicine look the way I want it to look and feel better about it. When people come into my office, everybody loves it because the whole office is decked out in pink. I have white desks, and I have art everywhere, and it’s very calming. There are plants and it smells like eucalyptus.

People are always like, “Oh my goodness, this is such a cool place.” I tell them it started with a keyboard. I got a pink keyboard and then realized I don’t have to live in the world of brown, traditional, commercial-type decor and furniture. So, now I have a pink office with flowers. That’s just authentically me, and suddenly, I get to translate that into the social media world too.

Dr. McDonald: Yeah. I love a post you recently made about showing the physician I am and who I want to be and not necessarily conforming to stereotypes. You said it much more eloquently than that, but I love that post and I love that concept.

Dr. Gray: Thank you. Yeah, it’s been interesting. I think the other thing we’ve got to mention to people who are starting this journey, if this is your journey or you’re interested, is that you will grow and change over this time period as well. The person I was when I started this nine years ago is not the same person I am now.

I am a different physician. I work slightly differently than I used to. I have different opportunities. I do speaking and teaching engagements. I’m also now a mom and have two kids. You change, and it’s okay if your social media style changes with you. There are going to be people that love it and people that hate it. I think that’s fine. That’s the authenticity that comes with it as well.

Dr. McDonald: Yeah, I think that makes perfect sense.

Where are we headed? In five or 10 years, do we think that physicians still will have a role in social media? Do we think we need to do more education regarding how social media impacts patients’ perceptions coming and leaving the exam room? Tell me your thoughts.

Dr. Gray: I have lots of thoughts. I’m really hopeful. Lately, there’s been a viral post that people just keep redoing over and over. It’s the same reel that’s saying, “Why are doctors all trying to become influencers?” It’s because influencers trying to be doctors and give advice. I like to see that being a viral post that people keep reenacting and redoing. It’s great.

I think we need to have our physician voices be expected and not optional. I want it to be that we are supposed to comment on it. It’s kind of the same way in the news: if they were talking about the measles outbreak, we would expect that they interview a physician. At some point in time, they would ask a physician, “What’s your opinion on it?” I’m hoping it’s the same way with social media, that we are expected to be involved and not optional.

I have noticed recently, at one of the fertility centers that I utilized, one of their physicians who is a little more mature was using social media. I was like, “This is awesome. I’m so excited to see one of the founding members of this great institution join the social media conversation.” I think we need to start this from education in medical school. I would love to teach in medical schools about the ethics of social media, the legal parameters, and partnerships.

Unfortunately, we had another viral moment this last 90 days with a medical student who crossed some pretty big lines. Then he had every doc influencer out there commenting and reposting his thing and telling him how terrible he was. Yes, his stuff was awful, but I also think it’s on us as a physician community on social media to go to the medical schools.

And the medical schools need to be inviting us. That’s the other problem. They have to open the doors, be understanding, and let us in to have these conversations. Hopefully, we can help them and prevent some of these things. Because when you’re a starving med student, loaded in student loans, those paid partnerships, even for the massage chair, are going to be really hard to turn down.

I think that if we can meet them there and help train them and make this the best education possible starting there, it would be amazing. And we’ll have way better content creators than you and me by that point. It’ll be awesome for us to learn from them.

Dr. McDonald: Yeah. I think the piece here is that our current undergrads, medical students, and even a lot of our residents grew up with social media. They’re used to it. It’s just part of who they are and what they do. Understand the ramifications, that once you post something online, even if you take it down two minutes later, it’s still out there and it’s still forever.

Smartphones didn’t exist when I was a teenager, thank goodness, because there are some moments that I’m not really proud of as a teenager. I think we can all think back to those moments. Helping educate even our teenagers in high school about the potential ramifications long-term is a huge need. I completely agree with you.

Who knows what’s going to happen next, but I love the idea that if we can take all the physicians in the country, and we can either like and share, repost, or comment on good content, or we can create our own content—if we all do something, we can make a huge impact.

I use the analogy of Finding Nemo. My youngest is nine years old. In that scene during Finding Nemo when all the fish are caught in the net, and they’re all swimming around and freaking out, Nemo says, “Everyone swim down. Everyone swim down.” They all start swimming in the same direction, and they almost tip over the fishing boat, and they break the net open. Individually, yes, we have a tremendous amount of responsibility and authority, but if all the physicians in the country start speaking up and sharing, I think we can have a tremendous impact.

Dr. Gray: I love that analogy. I want to see us break that net open, have all of us swimming in the same direction, and then our message is just going out to the rest of the ocean. I think that’d be perfect.

Dr. McDonald: This has been a phenomenal conversation. We could go on forever, but we’ll try to wrap it up here just for time purposes. If you could give one piece of advice for a doctor who’s thinking about social media, is in the contemplative stage but feels overwhelmed or doesn’t know where to start, what would that piece of advice be?

Dr. Gray: I count two things. You’re never going to be 100% ready, so maybe start before you feel ready, but do it responsibly. Pick a topic you care really about, speak clearly, be consistent. Consistency does not mean posting every single day. It means being consistent that you’re there and not leaving it alone for two months, but also, set those boundaries ahead of time. It’s harder to walk them back than it is to expand something later. Then, you really don’t need to go viral to make an impact. You just need to be credible.

Dr. McDonald: Yep. I think that’s wonderful advice. Just pick something. There are so many platforms and so many things out there. Just picking one little thing can really, really helpful. Stick with that one piece and start small. I think that’s great advice.

Remind us again where people can find your work, where they can learn more about you, and where they can follow you.

Dr. Gray: Yeah, of course. You can find me on Instagram, TikTok, Facebook, whatever your preference is, @DrJessicaGrayMD. That’s where I’m going to share some evidence-based health content, some behind-the-scenes looks at medicine. And then, of course, The Med Edit Podcast—you can find that wherever you listen to podcasts as well as on Instagram and TikTok. We talk about complex topics and how to make them into practical real-world conversations.

Dr. McDonald: Awesome. Thank you so much for your time today. I really appreciate your insights, and I love what you do. Keep doing it. I know I love learning from, watching, and sharing your content personally. I hope that all of our listeners do the same.

Dr. Gray: Thank you.

Dr. McDonald: Lastly, thanks to all of you out there listening. I appreciate it. It means a lot to us that you’re listening and sharing. Tell your friends. Have a great day.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

Let us know what you thought of this week’s episode on X: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

Thanks for listening.

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Editorial board member Alex McDonald, MD, talks with Jessica Gray, MD, of The Med Edit Podcast, about why it is important for physicians to engage the public through social media.

ContributorsAlex McDonald, MDProgram Director
Fontana Family Medicine Residency
Kaiser Permanente

Jessica Gray, MDFamily Medicine Physician
Co-Host, The Med Edit Podcast

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

This week, Physician’s Weekly editorial board member Dr. Alex McDonald returns to talk with Dr. Jessica Gray about why it is important for physicians to maintain a social media presence.

Dr. McDonald: Welcome everyone to today’s Physician’s Weekly podcast. Thanks for listening wherever you may be, between patients, in the car or wherever it is you listen. We appreciate you jumping on.

Today I’m excited for a conversation with Dr. Jessica Gray. We’re going to be talking about social media, one of my personal favorite topics. Dr. Gray, thank you so much for joining us today.

Dr. Gray: Thank you for having me. This is going to be fun.

Dr. McDonald: It’s going to be great. We’re going to be talking about the good, the bad, and the ugly of physicians and social media, including perceptions, practice, and marketing, and all the things therein. My opening question here is always, tell us who you are and what you do.

Dr. Gray: Yeah, of course. I’m a family medicine physician in West Texas. I’m specifically in Lubbock, Texas. Not many people know where that is, but we’re up in the panhandle area of Texas. I take care of a large outpatient panel and I’m an assistant clinical professor for the Texas Tech University Health Sciences Center.

I also do some fun stuff on the side. I sit on several different boards. I’m the team physician for a Division I, Big 12 athletics basketball team, which is lots of fun. Then, of course, I’m deeply involved in physician leadership, education, and community health. That’s what brought me to the social media world.

Outside the clinic, I also host a podcast myself called The Med Edit Podcast, and we create digital content focused on evidence-based medicine. I really love preventive care and making healthcare more understandable and more human to people who don’t have a healthcare background.

Dr. McDonald: Awesome. Fun fact, I did a triathlon in Lubbock, Texas, maybe 16 years ago at this point. So, I know exactly where Lubbock is.

Dr. Gray: It’s changed a lot in that time. Maybe you can come back and visit now that we’re bigger.

Dr. McDonald: I will do that. Tell us how you first got involved with social media and realized the power, the good and the bad, that social media could be, that it’s not just a distraction, if you will. How did you first get involved and what was that first “aha” moment for you?

Dr. Gray: I’ve been attending going on my ninth year. I remember coming out of residency and thinking it was a huge risk and very unnatural, and nobody else was doing it. I created a social media page, starting with a Facebook page that was a professional landing page and then creating an Instagram. My goal at that time was to grow my practice and give an inside look at some education, but also who I was. Growing the practice happened very quickly, so my social media use shifted toward helping with some frustrations that I was having in clinic.

I’d spend 20 minutes explaining something that took 30 seconds to misinform online. Over the last nine years, social media has drastically exploded when it comes to healthcare, especially around COVID-19. It was around the COVID-19 pandemic, when I was working in a hospital parking lot, swabbing people, with all the misinformation online, that I started to pivot a little more toward showing both the humanity of medicine and what we are doing, as well as trying to fight back on that information that people are asking for but are not necessarily getting in the most reputable ways.

It was a scary time. It really just came back to wanting to educate, advocate, and connect to patients and other physicians who may be going through the same experiences I was.

Dr. McDonald: Yeah. Did anyone mention social media, public perception, or marketing at all during medical school or residency for you? Because I didn’t get anything, personally.

Dr. Gray: Oh, no, not at all. That wasn’t even a though—in fact, so much so, that I was scared to do it at first because I thought that the company I work for (a large hospital system) was going to immediately be like, “This is a bad idea.”

But funnily enough, several of them started following me, and then, at one point during the pandemic, they said, “Hey, we saw a post you did. Is there a way that you could write that out so we could print it in our distribution mailing stuff?” Because they thought it was a very good connection. I wrote about an experience I had during the COVID-19 pandemic, working with patients and healthcare workers who were really scared about what was going on.

It was shocking that it was better accepted then. But what’s even more interesting now is, nine years later, you’ve got med students, college students, and residents with gigantic social media followings. I’m sure we’ll touch on some of that later—that becomes a very different animal that we probably do need more education on.

Dr. McDonald: Yep, absolutely. We won’t put the cart before the horse, but the reason I think there’s been a void within social media for so long is because initially, people, physicians, and healthcare organizations were afraid to comment or put their voices into the social media space. There was a need, an interest, a desire for this healthcare information, and it got filled with junk.

That’s why I think having physicians, having trusted voices, present in the social media ecosphere is not only important, it’s critical, especially in this day and age. I think part of the reason we’re in the position we are now with so much mis- and disinformation is because for a long time, physicians and trusted messengers were not there. But, again, that’s my own bias.

Dr. Gray: No, I completely agree. In fact, I think that it’s done a disservice, and it’s a little bit our fault as physicians for not taking more risks, getting in front of this, and teaching this in medical school and residency—thinking ahead about how to go with the times, or you’re going to get left behind. I think we got left behind, so now we’re trying to play catch up, but I think that’s a pretty hard thing to do in this day and age.

Dr. McDonald: The horses are out of the barn. The horses out of the barn and across the field and down the mountain at this point.

Dr. Gray: Yes.

Dr. McDonald: So, you already touched on some of these things—the good aspects and the benefits of social media—can you delve in a little bit more deeply? What are the biggest benefits you see in terms of education and myth busting? What are some other pieces that you found most useful for you, both personally and professionally?

Dr. Gray: I think you can put that into two buckets for me: personally and professionally. Professionally, it’s actually nice for me. I do learn from some really amazing, reputable physicians that are putting really great CME on Instagram and/or TikTok, whatever you choose, in nice bite-sized amounts. And they are evidence-based. They’re factual. I follow so many cool dermatologists who are doing things that I don’t experience and see much in clinic, but it has such a large benefit.

Especially being in primary care, unless you’re going to go read specifically what their societies just put out, you are getting some benefit from that specialist information if it’s a true, trustworthy source material. I think is a really cool benefit.

The second is personal networking connections. It’s neat that you can meet other people, learn things. I’ve done a lot of speaking events based on social media use. They’ve invited me to come speak. I’ve interviewed them. It’s been a really neat interaction to expand that networking opportunity.

And then of course, at the same time, it’s just something that we can use to scale our own education beyond what our typical textbooks or our typical board review courses are. Again, there’s always a big caveat to making sure you’re getting the right information and making sure that it is reputable. But at the same time, it’s definitely out there. It’s coming out more and more.

For the patients, that’s a whole other angle too. We are actually scaling our education beyond what we can just do in the class—I was going to say classroom. It’s a classroom too, but an exam room. I guess I’m a teacher. If I wasn’t a doctor, I would want to be a teacher. So, I think that’s what’s happening: I’m getting to teach in a different way. I have my med students that I teach, but I also get to teach my patients. I get to teach them while we’re in the exam room, and then while we’re out of the exam room.

I think the thing that is really important—and there are some people who are very skilled at their delivery method—is countering some of that misinformation. I follow some of the public health experts that are on social media and I love it. They’re credible voices that are able to counter some of that misinformation, and I love reposting some of that stuff. It doesn’t have to be my content either—I can just share it in stories or comment on it, and it’s nice that we can amplify some public health voices that aren’t normally getting amplified.

Then, of course, the humanizing of physicians has been nice. I think that we went from “healthcare heroes” to “money-grubbing big pharma shills.” It’s just a very interesting dynamic to go through in the last 10 years, where you went from one thing to something completely different. We’re rehumanizing medicine, too, and showing emotion and how we care for our patients. We attend their funerals, we live their lives, especially as a family medicine physician.

I even have med students that have come up to me and said, “Hey, I’ve started following you. I’m interested in family medicine.” I just love the idea that family medicine is getting more of a spotlight because we do so many diverse things.

Dr. McDonald: Absolutely. So much of what you just said, I’ve experienced personally and heard from multiple different people. I love that idea, of a teacher, because do you know the Latin root of physician actually is teacher? Somebody fact-checked me on that because we teach patients one at a time, but if we can teach patients en masse—there’s not enough primary care physicians as it is, and if we can amplify our voices to teach thousands or millions of patients at once, how beneficial is that as a society overall? I love that piece.

The other piece I love is humanizing us as physicians. We’re all people, and I think I’ve seen some folks really be very vulnerable on social media when it comes to burnout and the mental health aspects of what it’s really like to be a physician and have bad patient encounters. Humanizing the work we do and who we are brings a lot of credibility, but it also helps people better understand what it really is to be a physician.

Most of our listeners are physicians. I use the analogy: imagine you have 20-minute meetings all day long, back to back to back, and every single 20-minute meeting needs to have action steps, a deliverable, and follow-up direct outcomes. Can you imagine if the business world worked in 20-minute meetings like that? It’s just unfathomable for some folks, I think.

But anyway, we’re clearly on the same page, which is helpful. Let’s shift now. Not everything’s all sunshine and butterflies and rainbows—so what are some of the pitfalls of social media? What are some of the challenges that may exist?

Dr. Gray: I think we’re seeing some of that play out recently, with some of the bigger names on social media. There’s been some drama about transparency, about funding. That’s a bit of pitfall. Also, trying to do too much too fast and losing your voice; the most successful people on social media are pretty authentic.

You really need to make sure what your goals are before you go into this. For me, I had zero desire to be any kind of influencer, grow any kind of following. I’m not even that big compared to some of my colleagues, but at the same time, you sit there and you’re like, “Wow, 21,000 thousand people!” That’s a lot of people that are looking at something you’re saying, so you want to make sure that you’re very careful about what you say without losing your authenticity.

And a lot of people like to mimic what’s trending instead of what’s authentically you. I don’t think that’s always the best approach.

Dr. McDonald: Yeah. You mentioned you work for a big organization. Have you ever been approached by people who are a little bit skeptical or afraid of what you’re doing, or have you been told to remove a post about anyone or anything?

Dr. Gray: Once. In the time I’ve been doing this, only once. I’m actually really thankful that my organization has been very supportive. I’ve never had an issue. I love that the legal department follows me, so shout out to them.

Dr. McDonald: That’s always helpful.

Dr. Gray: Yeah, I did have one time, and this I think is a good learning lesson for anybody who is a physician that’s posting and sharing stories. I do think that people really resonate if you can share a story from a patient encounter. I’ve always tried to be very, very careful: de-identified everything I possibly can, even genders. Some of my stories, if I do share anything, are over a decade old.

You try as hard as you can. I run a lot of it by friends who are physicians as well and ask them if they feel like it’s de-identified enough. Some of these friends are ultra-conservative about it and others are not as much, so it’s kind of nice to get all that background.

But yes, I had one post ever. It was this past year. I had a patient with colon cancer, and I de-identified everything on a CT scan report. There was no date, no name, no facility location. I de-identified everything I possibly could, but with just the description of the tumor, legal did give me a call. They felt like with the specific description of the tumor itself, somebody could trace back because of the image.

If I hadn’t said the words out loud, it may have been fine, but because it was the picture of the image…. So, lesson learned completely. I did not argue. I did not have any problem, and I was very thankful for their advice because I understand that and then can take that going forward. I think the post was up for two minutes. So again, thankful the legal department’s right on that and being my advocate. They were so kind about it.

But what’s so funny is that I took that down and, still feeling the passion to talk about the reason I did this, I immediately went and created a different post that became way more impactful and was way more viral. It was kind of neat that it was still touching on the same colon cancer discussion, but it was even greater audience. So, I’m lucky, but yes, that does happen. I’m actually thankful for having that backup, completely.

Dr. McDonald: Yep, definitely. Medicine is a team sport, and I think that expands beyond the four walls of our clinic or our hospitals also.

Dr. Gray: And wouldn’t that be great if this was something to teach in med school? I would love to go in now and be like, “Okay, if you’re going to post, you think you’ve de- identified enough, but maybe this is how we can do it further.” Even legal said, “It doesn’t cross the line, but I feel like we’re getting close to gray, and we don’t like gray in legal.” And I was like, “I don’t like that either, so let’s make sure we’re all clear.” This is something we could teach, and then you could feel more confident.

Dr. McDonald: I think your example is a really good one, where there are multiple stakeholders, and building relationships and having shared lines of communication and line of sight is really helpful. When I first became a member of my organization, I met with our public affairs team and I said, “Hey, I love using social media. I love educating patients. Here’s what I’m about, and here’s what I want to do. ”

Letting them know ahead of time, and having them understand where I was coming from, really helped to mitigate and prevent a lot of complications or misunderstandings later down the road. They have my cell phone number. They literally text me all the time. If there’s something where they have questions, they will even reach out to me to then create some content for them specifically. I think there’s really a shared collaboration.

A lot of physicians I talk to say, “Well, I work for an organization and what if they fire me?” But I think being proactive, and making them understand you’re coming from a place of wanting to help improve your community health and educate people, you’re going to have a lot more buy-in versus if you’re trying to build relationships after there’s a mistake or a misstep. Nobody’s perfect; it’s going to happen at some point.

Dr. Gray: I think that’s the best advice that you just said. If you’re in an institution (not a private practice by yourself), you need to go reach out to whoever you can and let them know you’re doing it. Maybe don’t fully ask permission, but loop them in and make them feel a team player.

Just as practical advice, I’m not going to go get on here and start talking horribly about the company I work for. You wouldn’t want to have that with your employee either, right? You don’t want your nurse going around like, “I can’t stand Dr. Gray. She’s crazy on the internet.”

At the same time, I think talking about physician burnout or frustration or being exhausted after clinic—so far, they don’t seem to have any issue with that because I think it’s relatable to you and your emotion and being authentic, without taking down the specific system you work for. We all know medicine has problems and we’re trying to fix it by having these conversations.

Dr. McDonald: Yep, that’s a great point. Have you ever had any posts which were misunderstood, weaponized, or criticized? And if so, how did you respond?

Dr. Gray: Oh my gosh, yes. In West Texas, we were having our measles outbreak several months back, and it was wild here. I mean, I’ve diagnosed measles myself for a patient and I was like, “This is so crazy. We never thought we’d have to do this.”

An infant passed away here from measles. It was just a very emotional time. I had a young baby that was the same age that was too young to be vaccinated and was counting on herd immunity. So, there was a lot of emotion. I feel like I’m pretty logical and try not to be too emotional in social media posts, but I was sharing a little bit about the frustrations that we, as physicians, have when we’re seeing something that we feel is a public health problem that’s being misrepresented and creating a lot of fear.

I posted something very short and then, oh boy, that algorithm figured it out and made it run down every anti-vax chain that could possibly exist. I got hundreds of comments, very negative, going after me and saying that big pharma paid for my medical school, that I am a big pharma shill, that I am too young and have been five minutes out of medical school. (It’s been a decade since residency, so that’s a little different.)

But then there was some influencer who has 300,000 followers, and she took my video and made fun of it publicly to her followers, and then it grew that way. It was one of those moments where you’re like, “Why am I doing this? Why am I subjecting myself, on my own free will, to be absolutely torn down by people who they don’t have the education and are not treating the patients. This is all misinformation.” It’s very frustrating, and it makes you want to cry. It happens.

The nice thing is, eventually the algorithm shifts and it goes back to physicians and other people that can back you up. But you have to have thicker skin than I usually am prepared for on social media because this is going to happen inevitably. Especially if you’re growing a following, it will happen.

Dr. McDonald: Thick skin is definitely helpful, but also, it depends on how you reframe it. If you’re going viral and people are responding, whether it’s positive or negative, you’ve clearly hit on something. So, if you’re getting trolled, I’d take it as a badge of honor, meaning you’re doing something right.

You’re doing something that is helping break down misinformation or hitting some kind of a nerve. You’re having those conversations or raising that issue amongst the public. Again, I know it can be emotionally challenging at the time, and I’ve been there myself, but if you reframe it as, “Alright, it’s going viral, people are trolling me, that means I’m doing something right, honestly.”

Dr. Gray: Someone told me that and I agreed and I was like, “That made it so much better.” And then it hit 2 million views, and it had thousands and thousands of comments. In the end, if you really look, most of them are positive by the end of it. You’re like, “Okay, okay, every mean thing that people said actually made this thing go faster.”

Dr. McDonald: I think this is also part of us supporting each other. Those of us who are in the social media space can like, share, amplify, and support the positives. For every troll, if there’s two or three people in support, it can make a difference overall.

We tend to focus on the negative, right? It’s always like, “Oh, I have a million comments and they’re all bad!” But if you look at them, only 20% of them are bad. Most of them are good, but it is what it is. It can be definitely very emotionally challenging when you wake up in the morning, and you see a post has blown up. There are a lot of emotions that run through you.

Dr. Gray: Absolutely.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

Let us know what you thought of this week’s episode on X: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.

Thanks for listening.

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Karen B. Jacobson, MD, MPH, discusses a new study in which COVID-19 vaccination timing during pregnancy was associated with reduced infant infection and hospitalization outcomes. She describes how the findings should be interpreted and what clinicians can do to strengthen vaccine counseling with their patients.

ContributorKaren B. Jacobson, MD, MPHResearch Scientist & Infectious Diseases PhysicianVaccine Study Center Kaiser Permanente Northern California Division of Research

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

On this week’s episode, Dr. Karen Jacobson discusses a new study that investigated whether COVID-19 vaccination timing during pregnancy impacted infant infection outcomes.

My name is Karen Jacobson. I’m an infectious diseases physician with the Permanente Medical Group and a research scientist at the Kaiser Permanente Vaccine Study Center in Oakland, California.

Infants younger than six months are too young to be vaccinated against COVID-19, but they can still experience severe disease. In fact, infants are the age group with the highest rate of hospitalization from COVID-19 aside from the very elderly, with people over 75 years of age.

Previous studies, including those done at our site by Ousseny Zerbo (the senior author on this study) and others, have showed that COVID-19 vaccination during pregnancy protected infants from COVID-19 infection in the first months of life. However, at this stage in the pandemic, many pregnant people have been vaccinated before the pregnancy began. We wondered if those vaccinations received before pregnancy still resulted in any protection for their infants. We also wondered if the protection of during-pregnancy vaccination we had seen previously would still hold up for later variants of COVID-19, including the later Omicron variants.

This was a retrospective cohort study of infants born at Kaiser Permanente Northern California (KPNC), which is an integrated healthcare organization that serves over 4.5 million people. About 40,000 infants are born each year at KPNC facilities. This cohort that we studied were born from July 2021 to June 2023.

We looked at when the birth mothers had received their most recent COVID-19 vaccine before the birth, and we categorized their exposure by when they received their most recent vaccine up to 14 days before delivery. This was categorized as:

During pregnancy;
Three months before pregnancy began;
Three to six months before pregnancy began;
Six to 12 months before pregnancy began;
More than 12 months before pregnancy began; or
Never.

We were interested in two outcomes. The first was any PCR-confirmed COVID-19 infection, or COVID-19 infection determined by diagnostic code. The second was COVID-19 hospitalizations, or hospitalizations within seven days before or 30 days after a COVID-19 infection.

We chart reviewed those hospitalizations to confirm they were truly COVID-19–related. We performed a Cox regression with a calendar timeline, adjusting for maternal and infant characteristics, and calculated the vaccine effectiveness, comparing a vaccine in any of these durations versus the unvaccinated mothers.

First of all, we found that vaccination in any interval before pregnancy, even very recently before pregnancy begins, was not protective in any of the analyses. However, we did find that vaccination during pregnancy, particularly in the third trimester, was protective against infant COVID-19 outcomes and was very protective against hospitalization for COVID-19. Vaccination anytime during pregnancy was 52% protective against hospitalization and 64% protective when given in the third trimester.

As expected based on past studies, we also found that protection was highest in the infant’s first two months of life. We also found that protection was high in the Delta period, became less strong during the early Omicron period, but then in the later Omicron periods (with BA4, BA5, and BQXB variants), the protection of third-trimester vaccination was actually higher than it was back in the Delta period.

That’s reassuring because prior studies that looked at Delta and the early Omicron periods had suggested that effectiveness was declining for the newer variants, but that’s not what we found. We actually found quite strong protection in the later variants. This is important because there was a continued benefit during pregnancy, even in a population with substantial prior immunity in the moms.

I wouldn’t say that our study is making any specific recommendations for the COVID-19 vaccine and how it should be given around pregnancy. We believe that pregnant patients should continue to follow the current American College of Obstetricians and Gynecologists (ACOG) guidelines, which recommend getting an updated COVID-19 vaccine as soon as it is available, regardless of whether the person is not yet pregnant or pregnant in any trimester.

Delaying vaccination risks severe illness for the pregnant person and their baby, and there’s plenty of evidence that vaccination before and during pregnancy is beneficial for the moms and for pregnancy outcomes. In no way do our findings suggest that vaccines should be delayed till third trimester in order to protect the infant. Our study suggests that for mothers whose routine, updated COVID-19 vaccine happens to fall in the third trimester, their babies are likely very protected from COVID-19.

What we can’t yet answer and would be a topic of future research is whether mothers who received an updated vaccine before pregnancy should receive an additional third-trimester booster for the purpose of protecting those infants. That is a topic for future research.

For clinicians who are interacting with pregnant people, they have two patients: the mother and the baby. They’re looking to balance care of both of those patients. I think we and others have shown the vaccines are a great way to protect both the pregnant patient and the infant. We have a lot of evidence of the benefits to both the pregnant person and the infant that can be explained to your patients. I think most parents really do want to protect their infants from any bad outcomes, and being armed with the most information about different protection measures helps parents make those decisions.

I’d like to reiterate that COVID-19 vaccination during pregnancy is an important tool for protecting infants who are too young to be vaccinated. Our findings reinforce that the timing of the vaccination matters and that pregnancy is a key window for prevention. I encourage clinicians and patients to follow current ACOG guidelines regarding COVID-19 vaccination and pregnancy, and I look forward to future studies that might elucidate whether a booster is additionally protective or helpful.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

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Carmen Teague, MD, MC, discusses her experience changing practice models to recover from burnout and reclaim her love for medicine.

ContributorCarmen Teague, MD, MCTeague Internal Medicine & Enrichment
MDVIP

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

This week, Dr. Carmen Teague discusses her experience with burnout as a primary care physician, and the changes she made to recover and reconnect with her patients.

My name is Dr. Carmen Teague. I am a general internist practicing in Charlotte, North Carolina, and I’m the owner of Teague Internal Medicine & Enrichment, which is an MDVIP-affiliated primary care practice here in the Charlotte area. My practice is focused on prevention, enrichment outside of medicine, and restoring the joy of practicing medicine.

I would say that I have had a torturous path as an internist. I actually have an undergraduate degree in psychology and theater, didn’t take the first pre-med class. I then pursued a master’s in counseling, and in that experience, I spent a year working at a state psychiatric hospital for the criminally insane and the indigent insane in the state of Massachusetts. In that very bizarre setting, I fell in love with medicine. I had to go back and take all the prerequisites while I did Alzheimer’s research at Duke University.

I was almost 28 when I went back to med school. I jokingly say I was the grandmother of my class. I chose internal medicine because it was the medicine that I fell in love with, and I moved to the Charlotte area and completed residency here. I joined the largest multi-specialty group that was part of the big healthcare system in this area. That was probably early 2000s.

That was when healthcare reform was on the horizon. There was a lot of talk about healthcare changing, and I’ve never been very good at sitting in the back row, so I raised my hand for some local leadership opportunities. By 2009, I was asked to be the director of internal medicine for the second largest not- for-profit healthcare system in the country. That was a position that I held for just over 14 years.

Now, I did not leave practice. I continued to see patients with 50% of my time spent clinically, but I chose to be a part of leadership to try to work toward making healthcare better. In that role, I oversaw a lot of different things for healthcare management, including the hiring and firing of physicians, management of quality programs, budgets oversight, and driving and managing system initiatives. It was an amazing experience for most of that—until it wasn’t. Unfortunately, the role ended up being the sounding board for a lot of frustrations for many internists as healthcare continued to change, as we tried to do the best things that we could for our patients.

Over time, I watched our system and all of healthcare in general shift from patient-focused medicine to volume- and revenue-focused medicine. That was really difficult. I found myself like a lone wolf crying in these C-suite meetings going, “Wait a minute, whoa, what are we doing?” I became more and more frustrated.

And then COVID hit. Quite frankly, COVID put that trajectory on steroids. I found myself, two years into COVID, pretty burned out and disillusioned with the way healthcare was going. I left leadership, and less than a year after I left that leadership role, my successor walked into my office and informed me that due to budgetary changes, the office where I had practiced almost 24 years was going to be closed.

That was devastating. I was transferred about 13.5 to 14 miles to a suburb. Overnight, I lost the practice that I had built for almost 24 years. I was exhausted. I felt like I couldn’t care well for patients. And because I was a seasoned provider, I was seeing 24 to 28 patients a day. In that six months after the move, I lost 30 pounds, and I would say that I hit rock bottom.

My family came around me. My two daughters, who were at that time pre-med in college, came home for Christmas break. This was December of 2023. They took one look at mom and said, “What is going on here? Who are you? ” For lack of a better analogy, my family staged in an intervention and said, “Mom, you have loved your job your entire career. We don’t even know who you are anymore.” At that point, I hit my knees and said something has to change.

By pure dumb luck, I had a friend that I had known from undergrad, medical school, and residency, who practiced with an MDVIP-affiliated practice in the Atlanta, Georgia area. He happened to call, and he said, “Carmen, I have a better way to practice.” I was connected with MDVIP, and I left the big healthcare system in May 2024 and started my own practice in August 2024. I have not looked back. It’s been the best decision I have ever made in my career.

With all of the constraints on the quality measures, and the different things that have to be clicked off with a visit with a patient, doctors are averaging seven to eight minutes of face-to-face time, and that really is devastating. Patients are asked coming in the door, “What are the three things you want to address today? Anything else, you’ll have to postpone to another visit.” It’s frustrating for physicians because they can’t care for the whole person, and it’s really frustrating for patients because they feel like they came in with a list and the doctor doesn’t have time to manage it.

That’s just the doctor-patient relationship. You then have interference from insurance. You have these lovely processes called prior authorizations, which basically means that even though you as a physician know it’s the right test or the right medication for the patient, you have external forces having you go through multiple questions and approval processes to get the tests, medications, or procedures that you know are correct for a patient. It is exhausting for physicians, and it’s incredibly frustrating for patients.

I would liken my experience to a frog and a pot of boiling water. I don’t think I realized how much I was being boiled until I took a minute to step away. Every night I laid in bed and I questioned if I had done the right thing for patients. I was always worried I missed something because I was seeing so many patients. I felt like I was spread so thin. It was just more than I felt like I could manage appropriately.

And I had been an incredibly busy, successful physician within that healthcare organization. I kept up with quality standards. I had excellent marks on all of the ticks that I was supposed to do, whether that be quality, medication adherence, etc., but I felt like I was still failing patients.

I opened this practice and I actually had the opportunity to hire my own staff who share the same passion to care for patients in a different way. Every single morning, my staff and I stand in front of the list of patients on our schedule. We pray over the patients that need it. We discuss how can we best serve each patient. We round and have a plan for every single patient coming in the door.

It’s a time management thing as well. I see six to eight patients a day in this practice instead of 28 patients a day that I was seeing on some days in my old world. I get to schedule patients for an annual physical for 90 minutes, and that means I have the time to review all relevant testing, set goals, and build a thoughtful plan. I get to ask a patient, “What is important to you? What are your goals and what do you want to achieve with your health? How can we partner together to do that?” When I was seeing patients in seven minutes, there was no opportunity to do that.

I would say this particular model is incredibly rewarding for physicians and patients. The MDVIP membership model allows us to offer a battery of evidence-based diagnostic tests and screenings, most of which are not fully covered by insurance anyway, but it helps us spot trends early and focus on prevention. Instead of saying, “Oh, this is abnormal, you need to take this medicine,” we can get ahead of things and say, “Wow, we’re trending in the wrong direction here. How can we make lifestyle changes so that we can prevent you from needing a medicine or prevent you from needing an intervention in the future?” That is incredibly satisfying for patients as well as for physicians.

Recognize that you’re not broken, that this system is just strained, and that you may be dealing with burnout—I like the term moral injury better. I think burnout is just exhaustion with the task demands, but moral injury is what I think physicians feel when being asked to do things or see patients in ways that conflict with what you believe is right morally.

That term came out of military terms, where soldiers go into combat and are asked to do things that conflicts with what their moral standard would be. I think physicians have been put in that same angst by not feeling like you can address all of the problems a patient has, or not being able to get the tests that you know are right just because you’re constrained by third-party insurance, etc.

I would tell physicians to understand they’re not alone. In my leadership role, I was that sounding board. I heard the frustrations of hundreds and hundreds, if not thousands, of physicians who felt that way. I would tell physicians to step back and take an inventory. Look at how your current role aligns with your values, your clinical judgment, and your life outside of medicine, and give yourself permission to see that change is not a bad thing. If you cannot practice the way that you feel called to practice in the system that you’re in, explore other options.

Concierge medicine—I would say that what we practice is more “membership wellness.” There’s a slight difference. Membership wellness is paying a membership fee for the focus on prevention. But I would say it provides a choice. It is not for everyone, but it is right for some people, especially folks who are highly motivated around prevention or have really complicated medical history and need a quarterback helping to manage their multiple medical problems or multiple specialists they’re seeing.

I’m fully grounded in Western medicine, that’s what I was trained in. But having this flexibility and less structure helps me to encourage, research, and help patients look for nontraditional ways of treating different ailments or symptoms. I get to focus on prevention early and pick up trends rather than waiting for a crisis. That is so satisfying because often, in the traditional model, it was just throwing a pill at something or putting a Band-Aid on a problem that probably could have been addressed years before if you’d had the time to change lifestyle or make better choices with a patient.

Physicians and patients alike have choice, and I would encourage physicians who are listening to this to realize if you feel like you are a gerbil on a wheel and you are in a volume-based system, that there is a different way to practice medicine and you can certainly explore that. Again, this model’s not for everyone, but there are other models.

I would encourage patients, that if they feel that they are not getting the care that they need or not getting the time that they need with a physician, that they explore other models. This practice has been open a little over 18 months, and there’s a waiting list to join this practice, which is shocking and humbling to me, but it tells me that patients are hungry for a different experience when going to the doctor.

It has truly restored the joy in being a physician. I wake up every morning so excited to come to the office, and I’m so honored to care for the patients that walk through our door. It truly has transformed the way that I can be a doctor and deliver care. I think it’s been a transformative experience for patients as well. It’s very different. In my complex patients, we have prevented hospitalizations, averted crises, and kept folks out of the hospital, which is incredible because that saves the system lots of money from healthcare costs, and it also is just better care for the patients.

The name of my practice is Teague Internal Medicine & Enrichment, and the acronym is TIME, because that’s the one thing I wanted back with my patients.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

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Scott L. Weiss, MD, MSCE, discusses the rising incidence of pediatric sepsis and offers a tool that healthcare facilities can use to improve patient outcomes.

Read the full Q&A here.

ContributorScott L. Weiss, MD, MSCEPediatric Intensivist
Division Chief of Critical Care Medicine
Vice Chair of Research Department of Pediatrics
Nemours Children’s Hospital

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Previously, Dr. MedLaw walked through how physicians should disclose a colleague’s error. Now, she discusses the steps physicians should take to disclose to patients, employers, and insurance carriers when they have personally made an error.

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George Karandinos, MD, PhD, discusses his recent study on pediatric mental health outcomes after parental firearm injury. He shares why it is important for clinicians to stay in communication with each other and proactively address mental health.

Read the full Q&A here.

ContributorGeorge Karandinos, MD, PhD
Research Investigator
MGH Gun Violence Prevention Center
Mongan Institute
Massachusetts General Hospital

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Reina Haque, PhD, MPH, discusses her recent investigation into the link between antihypertensive treatment and extended survival in patients with metastatic breast cancer. Given the findings, she calls for increased collaboration between oncology, cardiology, and primary care specialties to optimize health outcomes.

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

This week, Dr. Reina Haque discusses how effective hypertension management may improve survival outcomes in women with advanced and metastatic breast cancer.

I’m Reina Haque. I’m a senior research scientist in the Department of Research and Evaluation at Kaiser Permanente Southern California. And I’m also a professor of health system sciences at the Kaiser Permanente School of Medicine. The focus of my research is on cancer epidemiology, survivorship, and pharmacoepidemiology. I thank you for taking interest in this study today.

We looked at whether treating high blood pressure more effectively could improve survival for women with advanced or metastatic breast cancer. Our study followed over 1,300 adult women treated for metastatic breast cancer in Southern California, who were diagnosed from 2008 to 2020. Then, we followed them through 2021 for a maximum of 13 years of follow-up.

We were able to track these study subjects over time using the comprehensive electronic medical records of Kaiser Permanente. I think a really strong advantage of the study is that we had a diverse cohort. The women came from different backgrounds, and nearly half were women of color. Almost half already had high blood pressure when they were diagnosed with cancer.

We used a study design called an observational cohort study. We used health and pharmacy records to compare women who took only one type of blood pressure medication with those who took more than one type. Then, we identified subjects who had a lower risk of death, and whether w omen’s blood pressure stayed within a healthy range. We also took into account other factors such as age, cancer treatments, other health conditions, and how often the women saw their doctors.

We found that managing high blood pressure may help women with advanced breast cancer live longer. We also found that women who took more than one type of blood pressure medication were much less likely to die than those taking just one type. We determined that using more than one medication type to treat high blood pressure was linked to a 38% lower risk of dying. This protective effect was even stronger among Hispanic patients, and this lower risk was also suggested in Black women as well.

Many women with advanced breast cancer also have other health issues such as high blood pressure, which is very common, and these issues may not always get enough attention. Our study shows that treating chronic conditions like high blood pressure may help women live longer, especially women of color who often have worse cancer outcomes.

These findings really do matter. Women who took more than one type of blood pressure medication had a 38% lower risk of dying than those who took only one type, and this protective effect was strongest among Latinas and Black patients. This is important because high blood pressure increases the risk of stroke, heart attacks, and other health problems.

This benefit was even stronger for women who took their medications regularly. In this group, the risk of death was reduced by more than half.

In terms of the clinical implications, our findings show that treating other health problems like high blood pressure is an important part of caring for women with advanced breast cancer. Our research highlights the need for doctors in cancer, heart, primary care, and other areas to work together. Doctors should make sure to treat high blood pressure as a part of cancer care and not just focus on the cancer itself.

There seems to be a significant knowledge gap about outcomes in patients with metastatic breast cancer, so I feel that our study addresses this gap. I am planning more research on this topic, specifically how treating comorbidities would be important among women with cancer. Amongst women with advanced cancer, given advances in treatment, they’re living longer, but they also have additional chronic health problems that need to be addressed. I hope that in the future we can study how managing diabetes or high cholesterol can better survival in such women.

Our project really highlights the need for doctors in oncology, cardiology, and primary care areas to work together to manage these patients. Ultimately, I think that will have the best outcome in improving survival.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

ContributorReina Haque, PhD, MPHSenior Cancer Epidemiologist
Department of Research & Evaluation
Kaiser Permanente

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Dr. MedLaw returns to discuss the important steps physicians should take when they find that another doctor charged with their patient’s care has made an error—and what legal consequences might follow if they fail to report it.

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Dimitri A. Christakis, MD, MPH, discusses the clinical implications of a recent study showing that adults with intellectual and developmental disabilities have higher rates of anxiety and depression, pharmacologic utilization, and cost barriers compared to the general population.

ContributorDimitri A. Christakis, MD, MPH

Professor of Pediatrics
Director, Child Health Institute
University of Washington

Pediatrician
Seattle Children’s Hospital

Chief Health Officer
Special Olympics

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Shyam Sundaresh, MD, a primary care physician and obesity medicine specialist, discusses his approach to managing obesity in older adults, including diagnostic tools, medication safety, and more.

ContributorShyam Sundaresh, MD
Assistant Professor of Medicine
Icahn School of Medicine at Mount Sinai

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Heather M. Snyder, PhD, discusses key findings from the US Pointer study, a large US-based clinical trial in which structured support, rather than self-guided lifestyle change, significantly benefited participants.

She shares how clinicians can integrate the findings into routine care to help patients improve cardiometabolic health and reduce dementia risk.

ContributorHeather M. Snyder, PhDSenior Vice President
Medical & Scientific Relations
Alzheimer’s Association

Disclosures: Heather M. Snyder, PhD, has no relevant financial relationships or conflicts of interest to disclose. Dr. Snyder is a full-time employee of the Alzheimer’s Association; her spouse is an employee at Abbott Labs in an unrelated field.

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Dr. MedLaw returns with advice for doctors to maintain anonymity and professionalism online to avoid potential legal and employment repercussions.

She covers two main topics: the potential for personal social media posts to result in job termination and the discoverability of such posts in medical malpractice cases.

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Editorial board member Alex McDonald, MD, returns for a discussion about science communication with Jess Steier, DRPH, PMP, of the Unbiased Science podcast.

In part 2 of their conversation, they discuss how simple, clear messaging can be the most effective tool when addressing vaccine hesitancy with patients.

Listen to part 1 here.

ContributorsAlex McDonald, MD
Family & Sports Medicine Physician
Southern California Permanente Medical Group

Jess Steier, DRPH, PMPCEO
Unbiased Science

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Editorial board member Alex McDonald, MD, returns for a discussion about science communication with Jess Steier, DRPH, PMP, of the Unbiased Science podcast.

In part 1 of their conversation, they explore how a “connection, not correction” approach can help deescalate exam room encounters and foster a safe space for patients to ask difficult questions.

ContributorsAlex McDonald, MD
Family & Sports Medicine Physician
Southern California Permanente Medical Group

Jess Steier, DRPH, PMPCEO
Unbiased Science

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Aatif M. Husain, MD, provides social context for a recent analysis showing that inaccurate TikTok videos about epilepsy garnered significantly more engagement than physician-led videos. He also shares how clinicians can combat misinformation, both online and in the exam room.

Read the full Q&A here.

ContributorAatif M. Husain, MDProfessor of Neurology
Duke University School of Medicine

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Dr. MedLaw returns to discuss non-compete agreements. She walks through how courts evaluate non-competes in the context of medical practice, and what doctors should consider before signing them.

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Editorial board member Alex McDonald, MD, returns for a conversation about leadership with family medicine physician Marie-Elizabeth Ramas, MD.

In part 2, they highlight the difference between mentorship and sponsorship, the power of showing up in uncomfortable spaces, and how self-advocacy can strengthen both individual careers and the broader health system.

Listen to part 1 here.

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Editorial board member Alex McDonald, MD, returns for a conversation about leadership with family medicine physician Marie-Elizabeth Ramas, MD.

In part 1, they discuss the importance of understanding the rules of the system, using influence with integrity, and accepting losses as part of a strategy for success.

Listen to part 2 here.

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Alexis Kuerbis, PhD, MSW, discusses her research on alcohol use prevention among older adults, identifying promising interventions and emphasizing the importance of tailored care.

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Rachel Rosovsky, MD, MPH, reviews findings from the STORM-PE study, which showed the benefits of adding computer-assisted vacuum thrombectomy to anticoagulation prior to progression in patients with pulmonary embolism.

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Ekta Kapoor, MBBS, discusses a Mayo Clinic study that identified significant gaps in care among women with menopause symptoms. She puts the findings into present-day context and shares what clinicians can do to continue closing the gap.

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Melissa Reider-Demer, DNP, discusses how a redesigned discharge workflow improved inpatient throughput during periods of capacity strain at UCLA Health, and why this initiative is transferable to hospitals of any size.

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Karl Nadolsky, DO, and W. Timothy Garvey, MD, unpack several key points in the AACE’s latest obesity management guidance, including diagnosis, staging, and medication selection.

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What should you do when a colleague’s judgment, behavior, or health puts patients at risk? Dr. MedLaw examines mandatory reporting laws, liability traps, and how clinicians can act decisively without escalating conflict.

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Research indicates that 53% of adults in the US aren’t aware of the cancer risks associated with alcohol consumption. Sanjay S. Shete, PhD, discusses the findings and how physicians can help.Let us know what you thought of this week’s episode on X: @physicianswklyWant to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.Thanks for listening.Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.

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The American Law Institute’s updated malpractice standard marks a major shift away from the old locality rule, redefining how physicians’ decisions are judged in court. This new approach centers on evidence-based practice and the reasonability of care under real-world clinical circumstances.Dr. Medlaw unpacks how the new national standard reshapes malpractice claims.Let us know what you thought of this episode on X: @physicianswklyWant to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.Thanks for listening.Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.

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In part 2 of their conversation, Alex McDonald, MD, and Rachel Franklin, MD, share how they communicate effectively with patients about preventive care, disease management, and misinformation.Let us know what you thought of this week’s episode on X: @physicianswklyWant to share your medical expertise, research, or unique experience in medicine on the podcast? Email us at editorial@physweekly.com.Thanks for listening.Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.

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Physician’s Weekly editorial board member Alex McDonald, MD, chats with Rachel Franklin, MD, about the importance of accounting for social determinants of health when treating patients, emphasizing wellness beyond the absence of disease.

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In the second part of their conversation, Alex McDonald, MD, and Amanda d’Almeida, MD, MPH, share practical strategies for physicians to address misinformation at the point of care.

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Dr. MedLaw explains how physicians facing malpractice suits can use legal motions and strategy to actively shape their defense.

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Editorial board member Alex McDonald, MD, returns to speak with Amanda d’Almeida, MD, MPH, about the process of leveraging social media to share evidence-based medical information.

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Katrina Kimport, PhD, shares her research on how post-Dobbs abortion restrictions have affected obstetric care. Read the full study here.

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Jeffrey Lazar, MD, discusses how the simple practice of sitting down during exams can improve the healthcare experience for both patients and clinicians.Read the full interview here.

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Alex McDonald, MD, speaks with Robert H. Hopkins, Jr., MD, of the National Foundation for Infectious Diseases, about how physicians can navigate discussions about vaccines amid shifting regulations.

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Dr. MedLaw returns to share how physicians can apologize to patients without accidentally creating evidence of malpractice.

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In this episode, Sara Tolaney, MD, of Dana-Farber Cancer Institute, discusses sequencing strategies after progression in HER2-positive metastatic breast cancer. She reviews current second-line standards, considerations for patients with brain metastases, and emerging therapies in the post–T-DXd setting.

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Ada Stewart, MD, FAAFP, discusses the strengths and limitations of various cervical screening methods, emphasizing the importance of appropriate patient selection when considering HPV self-collection.

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Physician’s Weekly board member Alex McDonald, MD, and Stephanie Sutherland, PhD, continue their discussion about science communication, emphasizing the importance of empowering patients through health literacy.

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Physician's Weekly board member Alex McDonald, MD, returns to talk with medical writer Stephanie Sutherland, PhD, about the critical need for effective science communication with patients.

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What is “eggshell skull?” Dr. MedLaw returns to explain the legal standard and how it impacts physician liability and damages in malpractice cases.

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M. Bradley Drummond, MD, discusses how new inhaler technologies can detect early warning signs of COPD exacerbations.

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Alex McDonald, MD, is joined by Elizabeth McNeil of the California Medical Association, and together they unpack H. R. 1’s sweeping healthcare cuts, coverage losses, and payment shifts—highlighting what they mean for physicians and patients nationwide.

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In this episode, Hope Rugo, MD, of City of Hope, shares insights from the SERENA-6 trial, which evaluated ctDNA-guided treatment changes for patients with HR-positive/HER2-negative metastatic breast cancer.

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When a patient demands non-standard treatment, clinicians must decide carefully whether to deny or provide it. Dr. MedLaw returns to advise how doctors can protect themselves legally, no matter what choice they make.

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In part 2 of her discussion about how innovations in medical training can reduce burnout and turnover, Dr. Patty Knecht expands on the roles of technology and personalized learning.

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Patty Knecht, PhD, RN, shares what she has learned about effective medical training, emphasizing how increased clinician preparedness can prevent burnout and decrease turnover.

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In this episode, Dr. William Gradishar reviews key data on PARP inhibitors in breast cancer, including early insights from the OPERETTA and CompLEEment trials. He explores emerging combination strategies with immunotherapy and DNA-damaging agents, the potential to reduce chemotherapy use, and new tools to better identify candidates for targeted treatment.

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Cardiac electrophysiologist Seth Goldbarg, MD, shares how AI can improve outcomes for patients with persistent and longstanding atrial fibrillation by identifying critical areas for ablation.

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First-Line Therapy—Has the Standard of Care Shifted for Good?

In this episode, Dr. Sara Tolaney, of Dana-Farber Cancer Institute, discusses how DESTINY-Breast09 is redefining first-line treatment in HER2-positive metastatic breast cancer. She explores whether T-DXd plus pertuzumab should replace the long-standing THP regimen, the future role of induction-maintenance strategies, and open questions on optimal therapy duration.

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In part 2 of their conversation, Drs. Alex McDonald and Robert Assibey continue talking about career transitions, offering advice on how clinicians can find mentors and build themselves a support system.

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In part 2, Dr. Auriemma discusses how combining pharmacotherapy with lifestyle modification leads to significantly greater and longer-lasting weight loss and health improvements in patients with obesity, prompting experts to call for a shift away from outdated, one-size-fits-all approaches.

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Physician’s Weekly board member Alex McDonald, MD, sits down with family medicine physician Robert Assibey, MD, to talk about career transitions in medicine, sharing their experiences so far and their advice for other clinicians.

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Dr. MedLaw discusses the implications of a recent change in Medicare policy, sharing how clinicians can navigate legal complexities while maintaining the quality of patient care.

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Eduardo Hernandez, MD (Texas Heart Institute Center for Cardiovascular Care), discusses the urgent need to rethink cardiovascular risk screening and subsequent management in working-age populations.

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As the conversation around obesity continues to evolve, Dr. Anthony Auriemma explores why it's essential to treat it as a serious medical condition—grounded in science, guided by clinical integrity, and focused on long-term patient safety and trust.

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Child and adolescent psychiatrist Mona Potter, MD, discusses the benefits of moving beyond traditional mental health models to support children with anxiety and obsessive-compulsive disorder.

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Welcome to this podcast where we dive into the intersection of cutting-edge science and practical healthcare, exploring the questions that shape patient outcomes and redefine how we approach complex diseases. Today we're talking about a topic that's critical for nephrologists and all healthcare professionals working with kidney disease, APOL1-mediated kidney disease, or AMKD.

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Physician's Weekly board member Alex McDonald, MD, and psychiatrist Barry K. Herman, MD, continue their conversation about ADHD, offering resources that primary care physicians can use to become more comfortable with diagnosing and managing the condition in routine practice.

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PW board member Alex McDonald, MD, returns to host a conversation with Barry K. Herman, MD, about the increasing prevalence of ADHD in the US population and how primary care physicians can meet growing diagnostic needs amid the shortage of child psychiatrists.

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Dr. MedLaw returns this week to share the legal do's and don'ts of filling out electronic medical records.

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Megan Georges, MS; Elizabeth Pino, PhD; and David Wiley of the Boston Medical Center continue their conversation on rehabilitation access disparities for patients with violent injuries, sharing steps that individual clinicians can take to help close gaps. Their findings were recently published in JAMA Network Open.

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Megan Georges, MS; Elizabeth Pino, PhD; and David Wiley of the Boston Medical Center describe how survivors of community violence face disproportionately high rates of rehab denials compared with patients injured in motor vehicle crashes. Their findings were recently published in JAMA Network Open.

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Tom Zaubler, MD, continues sharing his insights on AI's applications in the field of behavioral healthcare, emphasizing the technology's ability to identify which patients are at high risk for suicide.

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Tom Zaubler, MD, discusses how AI can help behavioral health practitioners track their patients' well-being longitudinally and devote more time to developing trusting clinical relationships.

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What exactly does "document everything" entail, and how can clinicians set themselves up for success during malpractice investigations? In her latest podcast episode, Dr. MedLaw dives into medicolegally savvy documentation practices.

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Welcome to this podcast where we dive into the intersection of cutting-edge science and practical healthcare, exploring the questions that shape patient outcomes and redefine how we approach complex diseases. Today we're continuing our conversation with Dr. Adriana Hung, this time with an emphasis on genetic testing in APOL1-mediated kidney disease (AMKD).

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Richard "RJ" Kedziora (Estenda Solutions) comments on the current landscape of digital health solutions, including persistent challenges in reimbursement and patient engagement, as well as where the future of healthcare AI may be headed.

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Stacey E. Alexeeff, PhD, and Jamal Rana, MD, PhD, highlight key points from their research into the impact of wildfires on cardiovascular events. They also share strategies to ensure patients with cardiovascular disease are prepared to protect their health in times of increased air pollution.

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In view of Match Day, Corinne L. Bria, MD, director of the Residency Training Program at Nemours Children's Hospital, offers insight into how the resident selection process has changed in recent years.

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Samuel Mikhail, MD, pediatric resident at Nemours Children's Hospital, reflects on his Match Day experience, shares how the process can be improved, and offers advice for current and future applicants.

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Salvatore Viscomi, MD (Carna Health), highlights the increasing prevalence of chronic kidney disease and calls on the healthcare system to increase screening and prevention efforts.

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President Jimmy Carter’s public battle with melanoma and his successful treatment with immunotherapy helped shape public perception and awareness of these groundbreaking treatments. Alicia Zhou, PhD, CEO, Cancer Research Institute, explores how his advocacy influenced research funding, policy changes, and clinical trial engagement. She discusses the rapid advancements in immunotherapy since Carter’s diagnosis in 2015, the remaining challenges in accessibility and efficacy, and the future directions that could revolutionize cancer care.

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Wrapping up their healthcare predictions, PW editorial board member Dr. Alex McDonald and guest Victor Zhou (Klarity Health) discuss new drugs for weight loss and pain management that clinicians can expect to see this year.

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PW editorial board member Dr. Alex McDonald and guest Victor Zhou (Klarity Health) continue discussing their anticipated 2025 healthcare innovations, zeroing in on gene-editing technologies and precision medicine

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PW editorial board member Dr. Alex McDonald has a conversation with Victor Zhou (Klarity Health) about what changes may be coming to healthcare in 2025.

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In part 2, Amanda Hess, an Advisory Board Member of the Association for Blood Donor Professionals, returns to discuss barriers that prevent people from donating blood and share strategies to address common misconceptions.

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Amanda Hess, an Advisory Board Member of the Association for Blood Donor Professionals, offers a resource that clinicians can share with patients to help increase blood donation participation.

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In her first episode of 2025, Dr. MedLaw takes a look back at all her podcast episodes from last year and pulls out the most important takeaways for physicians.

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In the second part of her conversation about burnout, Louise Underdahl, PhD, discusses the pandemic's impact on physician mental health, as well as how collaboration between clinicians and administrators may be the most effective path forward.

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Louise Underdahl, PhD, elaborates on the findings from her recent systematic review on physician burnout, including an overview of various solutions.

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Dr. MedLaw returns to advise how physicians can handle negative online reviews without accidentally giving away patients' health information and potentially facing legal trouble.

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In the second part of their conversation about deductibles resetting at the start of the year, Blake Walker (Inbox Health) and Jeff Hillam (Red House Medical Billing) discuss common reasons why patients raise issues with medical bills and how clinicians can be prepared.

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In the first part of their conversation, Blake Walker (Inbox Health) and Jeff Hillam (Red House Medical Billing) share some practices physicians can adopt to facilitate seamless billing and payment as deductibles reset in the new year.

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On this episode, PW Physician Editor Linda Girgis, MD, offers comment on the recent shooting of UnitedHealthcare’s CEO.

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On this episode, Andrea Austin, MD (Southwest Healthcare Medical Education Consortium; Heartline: Conversations With Healthcare Changemakers) discusses how emotional trauma can impact physicians. She also describes some practices clinicians can adopt to process the trauma they experience at work.

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In the second part of their interview, PW editorialboard member and regular contributor Alex McDonald, MD, FAAFP (Southern California Kaiser Permanente, and President-Elect of the California Academy of Family Physicians), and family medicine physician Frank Domino, MD (University of Massachusetts Chan Medical School) share some steps clinicians can take to ensure that they—and their patients—have access to accurate medical information.

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On this episode, PW editorialboard member and regular contributor Alex McDonald, MD, FAAFP (Southern California Kaiser Permanente, and President-Elect of the California Academy of Family Physicians), interviews family medicine physician Frank Domino, MD (University of Massachusetts Chan Medical School) about medical communication and the potential dangers of misinformation.

Stay tuned for next week’s episode to listen to part 2.

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On this episode, PW regular contributor Dr. MedLaw returns to share key points that physicians should include in their clinics’ social media policies to protect patient privacy and prevent liability.

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Today we are joined Dr. Reggie Ferreira of Tulane University. He discusses the importance of physician pre planning before a potential natural disaster, noting the need to collaborate with the community before the event.

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Andrea Austin, MD (Heartline: Conversations With Healthcare Changemakers podcast), and Bradley Block, MD (Physician's Guide to Doctoring podcast), have a conversation about the benefits and potential pitfalls of using humor in medicine. They describe common situations where physicians may consider using humor and offer advice on how to crack jokes that will land well.

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On this episode, PW editorial board member and regular contributor Alex McDonald, MD, FAAFP (Southern California Kaiser Permanente, and President-Elect of the California Academy of Family Physicians), sits down with Ilan Shapiro, MD (Pediatrician and Medical Director, AltaMed), to discuss the importance of civic engagement and how ensuring patients are registered to vote can positively impact health.

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For breast cancer awareness month, Steven Chen, MD, MBA, highlights the value of whole-person health in managing breast cancer-related lymphedema, emphasizing differences from traditional care, cost barriers, patient education, early detection, long-term side effects, and the importance of specialist collaboration.

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On this episode, Ewurama Sackey, MD, and Jason James, MD, advocate for clinicians in the fields of behavioral health and obstetrics and gynecology to screen patients more often for postpartum depression (PPD). They emphasize PPD’s distinction from the “baby blues” and strategies to reduce disparities for women of color.

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For National Primary Care Week, PW editorialboard member and regular contributor Alex McDonald, MD, FAAFP (Southern California Kaiser Permanente, and President-Elect of the California Academy of Family Physicians), has a conversation with family medicine physician Marc Price, DO (Family Medicine of Malta). They discuss the PCP’s role as a trusted doctor providing comprehensive care to local communities, emphasizing how greater investment in their specialty could help improve the U.S. healthcare system.

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PW regular contributor Dr. MedLaw reviews a recent controversy in which Disney claimed arbitration after a woman died of anaphylaxis while visiting their parks. With this in mind, Dr. MedLaw shares how arbitration agreements are held to different ethical standards in medicine and how physicians can ensure they are fair to patients and hold up in court.

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On this episode, Dr. Bradley Block (Physician's Guide to Doctoring podcast) shares how physicians can use subtle nonverbal cues to convey interest and authority to their patients, which can help build trust and improve the efficiency of visits. He also discusses how physicians can address “the question behind the question,” or the deeper issues patients may struggle to articulate.

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This week, we are joined by Andrea Austin, MD (Southwest Healthcare Medical Education Consortium; Heartline: Conversations With Healthcare Changemakers). Dr. Austin discusses the concept of resilience, sharing practical, small changes physicians can make to improve their mental health and well-being, especially in moments of stress.

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Dr. Rajat Thawani continues his conversation on non-small cell lung cancer. Today he reviews various strategies to help diagnosis NSCLC, including the importance of testing patients who are smokers and non-smokers. He also explains why multidisciplinary teams can help this patient population.

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Today we are joined by Dr. Rajat Thawani. He discusses why biomarker testing is crucial in guiding treatment decisions for patients with ROS1 mutations in NSCLC. He also highlights how specialized biomarker testing teams enhance the identification and management of patients with ROS1-positive NSCLC by providing knowledge about resistance mechanisms and helping select appropriate therapies.

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Today we are joined by Dr. MedLaw. She discusses the complexities of the "standard of care" in medical malpractice cases. Dr. MedLaw explains that while the standard is meant to reflect what is recognized as acceptable and appropriate medical practice, it must also consider the specific circumstances, location, and the evolving nature of medical knowledge, allowing for some flexibility and acknowledging the role of medical judgment.

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Today we are joined by Abhinav Singh, MD, MPH. He discusses the impact of diet and lifestyle on sleep quality, including how raw foods, and foods rich in fiber, vitamins, and antioxidants, can help lower inflammation and improve sleep. Additionally, Dr. Singh explains why it is important for providers to determine whether patients have trouble falling asleep or staying asleep, as these issues may have different causes and require different solutions.

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Today we are joined by gastroenterologist Dr. Gil Melmed. He discusses the high prevalence of pain in patients with IBD, especially among those hospitalized with acute pain. He also highlights the risks associated with opioid use and advocates for a proactive pain management approach while describing a proactive pain bundle implemented at Cedar-Sinai, which includes acetaminophen, gabapentin, and NSAIDs, aiming to minimize opioid use.

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Today we are joined by Dr. Christopher Worsham from Harvard Medical School. He explains why healthcare professionals should utilize publicly available data to better understand how popular culture influences patient behaviors.

Reference:

Worsham CM, et al. Online search interest in gynecologists after the release of the film Barbie. JAMA Netw Open. 2024;7(7):e2424658. Published 2024 Jul 1. doi:10.1001/jamanetworkopen.2024.24658

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Today we are joined by Dr. Anthony Auriemma. He discusses the popularity and efficacy of GLP one therapy but notes that while these new medications have shown promising results, there is a lot of misinformation about them. He also expresses hope for future treatments, including new medications and potential price reductions.

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PeerPOV: The Pulse on Medicine is a weekly podcast series that features expert commentary on the latest healthcare news, landmark research, and more.

On this episode, PW editorialboard member and regular contributor Alex McDonald, MD, FAAFP (Southern California Kaiser Permanente, and President-Elect of the California Academy of Family Physicians), continues his conversation with pediatrician Shannon Udovic-Constant, MD (The Permanente Medical Group, San Francisco, California). They discuss considerations related to privacy and record-keeping when treating colleagues or their children.

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PeerPOV: The Pulse on Medicine is a weekly podcast series that features expert commentary on the latest healthcare news, landmark research, and more.

On this episode, PW editorialboard member and regular contributor Alex McDonald, MD, FAAFP (Southern California Kaiser Permanente, and President-Elect of the California Academy of Family Physicians), interviews pediatrician Shannon Udovic-Constant, MD, (The Permanente Medical Group, San Francisco, California) about the ethical considerations of treating physician colleagues or their children. Stay tuned for next week’s episode to listen to part 2.

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PeerPOV: The Pulse on Medicine is a weekly podcast series that features expert points of view on the latest healthcare news, landmark research, and more.

On this episode, Jeffrey Gladd, MD, chief medical officer at Fullscript, shares his personal journey with whole-person health and how it has impacted his practice.

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John Bertrand (CEO, Digital Diagnostics) speaks with us about LumineticsCore, an AI diagnostic system that autonomously diagnoses patients for diabetic retinopathy, including macular edema, to detect disease before it leads to blindness. Also, regular contributor Dr. MedLaw discusses the role of private equity in your practice.

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Changes Are Coming Soon!

Stay tuned for an exciting new format, dropping July 10!

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PW editorial board member and regular host Alex McDonald, MD, speaks with stress expert Jay Winner, MD, about stress reduction techniques for you and your patients. Too much stress can ruin our days and shorten our lives. It ages us, harms relationships, and impairs job performance. Excessive stress can exacerbate almost any medical condition, including obesity, heart disease, chronic pain, depression, and headaches. And in our busy lives, reducing stress can seem like just one more time-consuming and overwhelming task. Dr. Winner shares that some of the best stress reduction techniques take only seconds!

Dr Winner is author of the book “Relaxation on the Run” and hosts a number of stress relief videos on his Stress Remedy website.

Take a deep breath and enjoy listening!

Changes Are Coming Soon!
Stay tuned for an exciting new format!

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Regular contributor Dr. MedLaw explores what to do when you get a negative online review. We also speak with Drs. John Sayer (University of Newcastle, UK) and Roman-Ulrich Müller (University Clinic Cologne, Germany), live from the 61st European Renal Association annual meeting to discuss the 11% of the world’s population that has genetic kidney disease. We talk about how one-third of renal failure is attributable to faulty genes, as well as the ethical considerations of sequencing all babies at birth.

Enjoy listening!

More reading:

BabySeq project https://www.genomes2people.org/research/babyseq/

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PW Editorial Board member Alex McDonald, MD (Southern California Kaiser Permanente Medical Group), speaks with Joanna Bisgrove, MD (Rush Universitiy), who has broken remarkable boundaries as a hard-of-hearing physician. As a physician with a disability, Dr. Bisgrove is determined to advocate for a country where there are no barriers for persons with disabilities anywhere.

In this conversation, Dr. Bisgrove shares insights on ableism and antiableism. Also discussed is the pioneering work of Dr. Phil Zazove, whose groundbreaking efforts in family medicine particularly advanced healthcare access and outcomes for the deaf and hard-of-hearing community. Dr. Zazove's work has not only influenced public health policies but also inspired healthcare professionals nationwide, including Dr. Bisgrove, to think differently about patient communication and inclusivity. This discussion aims to provide the framework for understanding able-ism and anti-ableism, fundamental concepts all physicians should know!

Enjoy listening!

Docs with disabilities initiative https://www.docswithdisabilities.org/

Medical Students with Disability and Chronic Illness https://msdci.org/

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We speak with Gregg Stone, MD, who presented findings at ACC 2024 from RELIEVE-HF, a randomized trial designed to evaluate the safety and effectiveness of treating patients with heart failure with an interatrial shunt. The results are clear, so keep listening to hear his interpretation of the results. We next talk to, Javed Butler, MD, who presented results from the EMPACT-MI randomized trial, which examined treating patients with empagliflozin following a heart attack. The results add to our understanding of SGLT2 inhibitors and how they can impact major outcomes in a broad population of adults with heart failure, chronic kidney disease, or type 2 diabetes.

We also hear from regular contributor Dr. Medlaw (radiologist and medical malpractice attorney), who turns her attention to the harsh reality that the divorce rate when at least one spouse is a physician is >20% higher than in non-physician marriages. Is a pre-nuptial agreement a good idea? Dr. Medlaw explains all the aspects to consider.

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Dike Drummond, MD (TheHappyMD@PW author) brings a wealth of knowledge and experience in preventing physician burnout through innovative strategies and leadership principles to a lively discussion. Dr. Drummond explores the concept of "leadership power tools," one of the seven healthy habits for doctors to maintain wellbeing and stave off burnout. These tools are not just about managing teams but also about managing oneself in the high-stakes environment of healthcare.

We also look at "servant leadership," a style that emphasizes the growth, well-being, and empowerment of employees. Dr. Drummond shares insights into how this approach can create an inclusive environment where everyone can thrive authentically. As part of that, we discuss the importance of leading by asking questions and the simple yet powerful act of saying "thank you," both to individuals and teams. Additionally, our conversation touches on innovative healthcare models like direct primary care and concierge medical practice, which are reshaping patient care and physician job satisfaction.

Join us as Dr. Drummond shares his valuable insights and practical advice on building a fulfilling career in medicine without sacrificing personal health and happiness.

Enjoy listening!

Additional reading:

Play to Win: https://www.thehappymd.com/blog/the-7-habits-of-physician-wellbeing

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PW editorial board member and regular contributor Alex McDonald, MD, speaks with Kim Yu, MD, FAAFP (PRIME National Strategy Consultant, American Board of Family Medicine; Director of Health Care Strategy, KCS Inc.), about new mandates concerning value-based care and what they might mean to you.

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Regular contributor Dr. MedLaw discusses the question many physicians are asking themselves: what are the rules regarding AI use in medicine and physician liability? Also, Saby George, MD, FACP (Roswell Park Cancer Institute), discusses results of the Checkmate 67T trial, which he recently presented at the 2024 ASCO Genitourinary Cancers symposium. The study compared subcutaneous nivolumab with intravenous nivolumab in patients with advanced kidney cancer. Dr. George reviews the impact the trial results will have on all cancer types with nivolumab in their treatment arsenal.

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PW Editorial Board member and columnist Alex McDonald, MD (family and sprots medicine, Kaiser Permanente), speaks with Erika Roshanravan, MD (family physician and medical director, CommuniCare+OLE), about trauma-informed care and the need to shift the focus in patient conversations from “What’s wrong with you?” to “What happened to you?” A trauma-informed approach to care acknowledges that healthcare organizations and care teams need a complete picture of a patient’s life situation—past and present—to provide effective healthcare services with a healing orientation. Adopting trauma-informed practices can potentially improve patient engagement, treatment adherence, and health outcomes, as well as healthcare provider and staff wellness. It can also help reduce avoidable care and excess costs for both the healthcare and social service sectors.

Enjoy listening!

More information:

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58.

The Sanctuary Model: https://www.thesanctuaryinstitute.org/about-us/the-sanctuary-model/

Dr. Glaucomflecken’s

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“Healthcare is at a very delicate moment,” says Jeanne Haggerty, a lobbyist for Williams & Jensen in Washington DC. With 25 years of governmental affairs experience in Washington, she should know. Haggerty’s successful career on the Hill has included working on the Senate Finance Committee, and later, the House Energy and Commerce Committee. During this time, she built strong relationships and knowledge in a wide variety of policy areas, but her specialty is healthcare policy. Haggerty takes the time to explain the upcoming health policy issues to watch in Congress in 2024 and conjectures on what might happen to healthcare policy depending on who wins the upcoming presidential election. This discussion is bipartisan and has no political leaning. There is, however, a strong call to action for physicians interested in policy to contact the AMA or other specialist society to ensure that the voice of clinicians is heard, no matter what the topic is you are passionate about.

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Regular contributor Dike Drummond, MD, (family physician, CEO of TheHappyMD.com, PW columnist) talks about the difference between your job and your medical practice, recognizing the fact that they are almost never attuned. More importantly, he provides critical tools to mend the bridge and regain your grip on the work that you love. What are the changes that need to happen and how do you go about that? Dr. Drummond talks us through this complex and sensitive process.

~~~~~~~~~~~~
3 Work Life Balance Shortcuts for Physicians
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Dr. Drummond has coached and trained more than 40,000 doctors for more than 175 organization and association clients since 2010. His Burnout Prevention MATRIX White Paper shares 235 different ways to stop physician burnout.

Enjoy Listening!

Additional reading:

Book recommended in the podcast: The First 90 Days by Michael Watkins

Gottman Institute 5:1 Ratio for a trusting relationship: https://www.gottman.com/blog/the-magic-relationship-ratio-according-science/

Harvard Business Review article Managing your boss: https://hbr.org/2005/01/managing-your-boss

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Sara Gorman, PhD, MPH, discusses the work she does as executive director of Those Nerdy Girls, along with a group who provide evidence-based answers to common medical questions in order to battle medical mistrust and misinformation. Dr. Gorman is also the founder of Critica, non-profit organization of scientists and social scientists who counteract science denial.

Also, regular contributor, board-certified radiologist, and medical malpractice lawyer Dr. MedLaw speaks about when and how you might be responsible for another doctor’s actions.

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Physician’s Weekly editorial Board member Alex McDonald, MD, CAQSM, FAAFP (Kaiser Permanente), speaks with Scott Nass, MD, MPA, FAAFP, AAHIVS (Aledade), about LGBTQ+ healthcare. Since 2019, Dr. Nass has served as Chief Medical Officer for the transgender community-founded and -led Transgender Health and Wellness Center in Palm Springs, Riverside, and San Diego, CA. Additionally, he is past president of GLMA: Health Professionals Advancing LGBTQ Equality, a national organization committed to ensuring health equity for all sexual and gender minority individuals. His areas of expertise and practice focus include primary care, HIV, LGBTQ health, and addiction medicine.

Please note that the cadence of the PW Podcast has moved to every other week.

Enjoy listening!

Additional reading:

The Gender Unicorn

The National LGBTQIA+ Health Education Center

Health Professionals Advancing LGBQT+ Equality

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The medical field is constantly evolving, with innovative advancements revolutionizing the way we diagnose, treat, and prevent diseases. As we move into 2024, there are numerous promising developments that hold the potential to significantly impact healthcare and improve the lives of individuals worldwide. PW Podcast host, Rachel Giles, MD, and PW editorial board member Alex McDonald, MD, offer their perspectives on anticipated medical breakthroughs they feel could shape the future of healthcare in 2024.

Please note that the PW Podcast is moving to an every-other-week cadence. Our next episode will be on January 17.

Enjoy listening!

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PW Podcast host Rachel Giles, MD, and PW editorial board member Alex McDonald, MD, offer their perspectives on what they feel are the top 10 medical innovations of 2023. Some are already in practice, whereas others are recent breakthroughs not quite ready for “prime time.” All in all, it was a great year for medical science. Think we missed a top medical innovation of 2023? Let us know!

We’ll be back the first week of January 2024 with a look at anticipated medical breakthroughs in 2024! Until then, we wish you all safe and healthy holidays!

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In a lively discussion, E. David Crawford, MD (University of Colorado), explains the controversy around prostate-specific antigen (PSA) test screening. The National Cancer Institute describes the PSA controversy as follows: “Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives.”

Also, regular contributor Dr. MedLaw addresses how to handle when you find yourself at odds with an insurance company over the decision to settle a malpractice lawsuit. While many doctors may express a desire to go to trial in the face of a malpractice lawsuit, seeking vindication and clearing their name, the reality is that the majority of these cases settle out of court. On the other hand, a doctor who is eager to put the matter behind them may feel pressured into settling. So, how does a doctor navigate the situation when they find themselves at odds with their insurance company over the decision to settle?

Enjoy listening!

PS: Stay tuned for next week! PW editorial board member Alex McDonald, MD, joins host Rachel Giles, MD, in their annual discussion of the top medical news stories of the year!

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Physician’s Weekly’s editorial Board member Alex McDonald, MD, FAAFP, speaks with Jill Grimes, MD (best known as @tiktokcollegedoc), about hercommitment to empowering individuals with accurate medical information and practical advice that has made her a respected figure in the field of healthcare communication and education. Dr. Grimes is a highly regarded physician, author, and educator with a passion for promoting health literacy and preventive care, with a special focus on targeting teens and young adults. She is known for her expertise in primary care, women's health, and adolescent medicine. Dr. Grimes is an accomplished author, having written extensively on health-related topics in books, articles, and blogs.

Enjoy listening!

Additional Reading:

https://jillgrimesmd.com/

Threaldhealth focusing on teens and early adults: https://www.threadhealth.com/

Shots heard round the world (a comprehensive guide to preparing for, defending against, and cleaning up after an anti-vax attack online)

There is a reference to an earlier Physician’s Weekly podcast from January 2023, in which we interview Dana Corriel, MD, a board certified internist, entrepreneur & digital strategist. She is the founder of an online platform that works to centralize the efforts of verified health experts in social media (Social Media for Docs, @SoMeDocs, https://twitter.com/SoMeDocs).

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This week, we take the time to delve into the important topic of physician burnout with our single guest, Dike Drummond, MD, family physicians and CEO of TheHappyMD.com. In this first episode of a series of in-depth conversations, Dr. Drummond speaks with us about how and when to quit your practice. More importantly, he talks about the vast majority of cases in which that is not necessary. What are the changes that need to happen and how do you go about that? Dr. Drummond talks us through this complex and sensitive process.

If you feel it’s time to move on, check out Dr. Drummond’s step-by-step formula to find, interview, negotiate, and onboard yourself and your family into a new and much better practice. Dr. Drummond has coached and trained more than 40,000 physicians for more than 175 organization and association clients since 2010. His Burnout Prevention MATRIX White Paper shares 235 different ways to stop physician burnout.

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The Know Your Lemons Foundation was founded in 2014 by Corrine Ellsworth-Beaumont, MA, PhD, a designer who lost her grandmothers and a close friend to breast cancer. She created the #knowyourlemons campaign as an initiative to help improve early detection of breast cancer through symptoms and screening education in a fun, accessible, and inclusive way. We interviewed Dr. Ellsworth-Beaumont at the World Cancer Leaders’ Summit. Using 12 lemons instead of breasts helps the campaign achieve a global reach, overcoming cultural taboos around breasts. Learn how an image can save lives from breast cancer, as was featured in a Ted Talk.

We also speak with regular contributor Dr. MedLaw, a licensed radiologist and medical malpractice attorney, about where the line can be drawn between medical and ordinary professional negligence. Doctors are usually concerned about liability for medical malpractice, but what about liability as operators of their office? A busy medical office, with staff, patients, and visitors coming and going, can be a real liability arena. As a business and premises owner, what do you need to think about?

Enjoy listening!

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Digital health expert Patty Riskind (CEO, Orbita) digs into three main barriers physicians may perceive in incorporating chatbots into their practice. Virtual assistants, such as chatbots, have changed the way businesses operate, and how people navigate their day-to-day tasks. From making travel plans to scheduling car services, digital tools are improving consumer access while conserving staff resources, but the medical world has been falling behind.

Also, Marc Bonaca, MD, MPH (University of Colorado), discusses the first 10 prescription drugs that will be subject to Medicare price negotiations under the Inflation Reduction Act. A critical step in the Biden administration’s attempt to drive down the high cost of prescription drugs for older people. While Medicare wields enormous power over the costs of other aspects of medical care, dictating how much doctors and hospitals can be paid for medical services, it has been barred from negotiating drug costs. That will change next year, when Medicare for the first time will be able to directly haggle with drug-makers over prices for the costliest medications. The negotiated prices will go into effect in 2026.

Enjoy listening!

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Caryssa Lim, MPH, a third-year medical student at Kaiser Permanente Bernard J. Tyson School of Medicine, talks with PW editorial board member Alex McDonald, MD, about whether medical school can/should be looked at as a time of despair and paralysis or the best opportunity of a lifetime to affect change. They also discuss what it was like being a medical student during the pandemic, how medical education is changing, and the three things Lim would like to see changed in medical school.

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Heather Raymond shares her remarkable story of breast cancer survival, following a diagnosis while working at Kaiser Permanente in 2021, with PW editorial board member Alex McDonald, MD. They discuss the importance of screening and how to talk with patients, because awareness in October isn’t enough.

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Cambrian Liu, PhD (University of Chicago), explains regenerative medicine and what it can mean for patients. He tells us about how his lab focusses on cells that can travel from another organ into the colon when tissue there is damaged by inflammatory bowel disease. Also, regular contributor Dr. MedLaw walks us through the ins and outs of what to do when you get a subpoena, depending on the circumstances. As a physician bound to shield patient privacy, you must be particularly alert for confidentiality issues in subpoena situations. She also talks about the safeguards in place for HIPAA compliance and how and when a doctor can object to a subpoena.

Enjoy listening!

Resource:

Liu CY, Girish N, Gomez ML, Kalski M, Bernard JK, Simons BD, Polk DB. Wound-healing plasticity enables clonal expansion of founder progenitor cells in colitis. Dev Cell. 2023 Aug 25:S1534-5807(23)00407-0. doi: 10.1016/j.devcel.2023.08.011. Epub ahead of print. PMID: 37652012.

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In the fourth episode of a series on physician burnout, TheHappyMD@PW columnist Dike Drummond, MD (family physician and CEO of TheHappyMD.com), talks about revenue models for medical practices and whether being an employee is always the right choice. He offers several innovative possibilities for ensuring you are practicing in the best possible environment.

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Reilly Bealer, MD (University of North Carolina), speaks with PW Editorial Board member Alex McDonald, MD, offering insights to help answer this question, noting that maternal mortality rates more than tripled among Native American and Alaska Native moms while continuing to be highest among Black mothers, according to a study recently published in JAMA. Dr. Bealer, who was a Government Relations and Advocacy Fellow at the AMA in 2020-2021—where she fought for access to Medicaid up to 12 months post-partum—adds that, unfortunately, worsening healthcare for Black and BIPOC mothers—a trend typically relegated to southern states—is expanding. According to the study, New York and New Jersey saw an increase in Black and Latina deaths, while more Asian mothers died in Wyoming and Montana. Dr Bealer gives some great insights into the problems at hand.

Additional reading

Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States. Fleszar LG, Bryant AS, Johnson CO, Blacker BF, Aravkin A, Baumann M, Dwyer-Lindgren L, Kelly YO, Maass K, Zheng P, Roth GA. JAMA. 2023 Jul 3;330(1):52-61.

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Viktoria Bogner-Flatz, MD (Ludwig Maximilian University, Germany), discusses observations from use of a mobile CT scanner equipped with AT to detect head injuries at the 2022 Munich Oktoberfest. Using lessons from 2022, the mobile scanner is back right now for the 2023 event. Also, regular contributor Dr. MedLaw explores the concept of pre-contracting with patients to limit legal issues, on the heels of the OceanGate Titan submersible disaster which saw the media giving attention to long disclaimers that specifically listed death as a risk.

Enjoy Listening!

Additional reading

Flatz W, Hinzmann D, Kampmann P, Poehlmann L, Reidler P, Schlichtiger J, Kanz KG, Ricke J, Bazarian J, Bogner-Flatz V. Mobile Computed Tomography at Munich Oktoberfest. N Engl J Med. 2023 Sep 14;389(11):1051-1052.

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Adam Landman, MD (Mass General Brigham), answers the question of whether voice assistants like Siri or Alexa can help bystanders perform CPR when needed. His recently published study found that the directions provided by these AI voice assistants are inconsistent and lack relevance, often directing people to inappropriate information. But he has some solutions. Also, Ann McKee, MD (Boston University), discusses her study of 152 brains from contact sport players who died before reaching age 30, which found chronic traumatic encephalopathy (CTE) among more than 40%. The findings confirm that CTE can occur even in young people, but more work is needed to determine how CTE relates to clinical symptoms.

Enjoy listening!

Additional reading

Murk W, Goralnick E, Brownstein JS, Landman AB. Quality of Layperson CPR Instructions From Artificial Intelligence Voice Assistants. JAMA Netw Open. 2023 Aug 1;6(8):e2331205. doi: 10.1001/jamanetworkopen.2023.31205.

McKee AC, et al. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol. 2023 Aug 28:e232907. doi: 10.1001/jamaneurol.2023.2907.

https://www.nih.gov/news-events/nih-research-matters/how-football-raises-risk-chronic-traumatic-encephalopathy

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Regular PW Podcast contributor, “Dr. MedLaw” discusses doctor-lawyer communications, in light of several recent prominent news stories about lawyers revealing client communications coming out of the investigations into attempts to interfere with the 2020 election. With most physicians taking it as a given that what they tell an attorney is shielded from discovery, she answers the question of whether doctors should be worried that the attorneys representing them could be forced to reveal their communications.

Also, Haillie Meek, DVM, MPH (New York State Epidemic Intelligence, CDC), explains her recently presented report on how the ongoing Canadian wildfires have impacted ER visits in New York for asthma exacerbations. At the time of this recording on September 10, more than 1,000 fires were still active in Canada, including about 650 deemed to be out of control.

Enjoy Listening!

Additional reading:

The CDC report on wildfire impact on ER asthma visits: https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a6.htm?s_cid=mm7234a6_w#contribAff

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We talk with PW columnist and TheHappyMD.com CEO Dike Drummond, MD, about the three energy accounts—physical, emotional, and spiritual—we all have. The different types of energy serve different purposes because we are more than just physical beings, especially when functioning as a physician caring for patients. Dr. Drummond explains how any of these falling into a negative balance gives rise to a different symptom of physician burnout, how each is filled in a different way, and how to take the time to care for yourself and prevent sliding into burnout.

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This week, we have two top-tier guests explaining some pretty remarkable breakthroughs published this summer in their respective fields of MS and dermatology, respectively.

Sergio Baranzini, PhD (UCSF), discusses recently published research on a genetic breakthrough in understanding MS progression. Dr. Baranzini’s research involves large analyses of samples from patients with MS to characterize the activity of genes during 1) different stages of the disease (eg, remission vs. relapse), 2) differential response to treatment (eg, good responders vs. poor responders), and 3) disease progression (eg, benign vs. severe).

Also, Peter Marinkovich, MD (Stanford) explains a genetic breakthrough in the treatment of the severe skin condition recessive dystrophic epidermolysis bullosa. We learn about this condition and how Dr. Marinkovich’s team has developed an effective gene therapy that has shown very promising results in their recently published clinical trial.

Enjoy Listening!

Additional reading

International Multiple Sclerosis Genetics Consortium; MultipleMS Consortium. Locus for severity implicates CNS resilience in progression of multiple sclerosis. Nature. 2023 Jul;619(7969):323-331

Gurevich I, Agarwal P, Zhang P, Dolorito JA, Oliver S, Liu H, Reitze N, Sarma N, Bagci IS, Sridhar K, Kakarla V, Yenamandra VK, O'Malley M, Prisco M, Tufa SF, Keene DR, South AP, Krishnan SM, Marinkovich MP. In vivo topical gene therapy for recessive dystrophic epidermolysis bullosa: a phase 1 and 2 trial. Nat Med. 2022 Apr;28(4):780-788.

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Samir Mitragotri, PhD (The Mitragotri lab, Harvard) discusses a novel breakthrough his lab recently published in which an engineered particle referred to as a “backpack” can robustly adhere to macrophage surfaces and regulate cellular phenotypes in vivo. Understanding how these approaches work is not only interesting, it is a refreshing and innovative approach to drug delivery we will be seeing more of soon.

Also, Pancreatic Cancer Action (PCA) founder and pancreatic cancer survivor Ali Stunt reviews life-changing interventions taking place to diagnose pancreatic cancer earlier and improve survival. PCA has succeeded in campaigning for many life-changing interventions in terms of direct referrals for CT scans for general practitioners, direct referrals for pharmacists, and breaking down barriers so that the general public can better understand symptoms and risk factors.

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Additional reading

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://gco.iarc.fr/today/data/factsheets/cancers/13-Pancreas-fact-sheet.pdf

https://www.mitragotrilab.seas.harvard.edu/

Kapate N, Dunne M, Kumbhojkar N, Prakash S, Wang LL, Graveline A, Park KS, Chandran Suja V, Goyal J, Clegg JR, Mitragotri S. A backpack-based myeloid cell therapy for multiple sclerosis. Proc Natl Acad Sci U S A. 2023 Apr 25;120(17):e2221535120.

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Almost one-half of adolescents have experienced a mental health disorder, and while medications have the potential to be very effective for some, others might not respond or even experience adverse reactions as a result of their genetics. When it comes to treating children and teens in crisis, every second counts—and drug-gene testing can help doctors ensure they prescribe the right therapies from the start. Genetic tests for variants impacting drug metabolization have advanced tremendously and insights uncovered in youth can yield lifelong benefits by identifying which treatments will be effective for each patient. Joel Diamond, MD (University of Pittsburgh, 2bPrecise), unpacks how drug-gene testing can optimize behavioral health treatment pathways for young patients for their entire lives.

Also, Jennifer Brown, MD, PhD, covers what every doctor should know about recognizing chronic lymphocytic leukemia (CLL), including recent treatment developments. She discusses the meeting of the International Workshop on CLL iwCLL that she is organizing this year in Boston; iwCLL is an international, non-profit association committed to creating progress in the management and outcome of patients with CLl world-wide.

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In the second episode of a series of in-depth conversations, Dike Drummond, MD (family physician, CEO of TheHappyMD.com), discusses the fundamental conflict underlying most physicians’ burnout and how to move forward. Dr. Drummond has coached and trained more than 40,000 doctors for over 175 organization and association clients since 2010. His Burnout Prevention MATRIX White Paper shares 235 different ways to stop physician burnout. This is a topic worthy of extensive discussion. Take the time to take care of yourself and listen to what our guest can teach you about recognizing and dealing with imminent burnout.

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Nicolas Girard, MD (Curie-Montsouris Thorax Institute, Institut Curie, France), discusses lung cancer research he presented at ASCO 2023, including an advance in the understanding of this difficult-to-treat disease. Also Gregory Lip, MD (University of Liverpool, UK), reviews the most important updates to the CHEST clinical guidelines on antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19.

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Additional Reading

Tatjana Potpara et al, Antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19: An American College of Chest Physicians Expert Panel Report, Chest (2023). DOI: 10.1016/j.chest.2023.06.032

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Vignesh Arasu, MD, PhD (Kaiser Permanente Northern California Division of Research), explains his research at the intersection of medical imaging, breast cancer, and artificial intelligence. With the recently released documentary “Below the Belt” brining endometriosis into the limelight of late, we also take a deep dive into its etiology with David Redwine, MD, a retired obstetrician-gynecologist who spent his career investigating the origin of endometriosis.

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Additional reading

Arasu VA, Habel LA, Achacoso NS, Buist DSM, Cord JB, Esserman LJ, Hylton NM, Glymour MM, Kornak J, Kushi LH, Lewis DA, Liu VX, Lydon CM, Miglioretti DL, Navarro DA, Pu A, Shen L, Sieh W, Yoon HC, Lee C. Comparison of Mammography AI Algorithms with a Clinical Risk Model for 5-year Breast Cancer Risk Prediction: An Observational Study. Radiology. 2023 Jun;307(5):e222733. doi: 10.1148/radiol.222733. PMID: 37278627; PMCID: PMC10315521.

https://www.belowthebelt.film/

Redwine DB. Was Sampson wrong? Fertil Steril. 2002 Oct;78(4):686-93. doi: 10.1016/s0015-0282(02)03329-0. PMID: 12372441.

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Amie Zarling, PhD (Associate Professor of Clinical Psychology at Iowa State University), reviews some interesting research on developing and evaluating effective programs for hard-to-reach, under-resourced, and/or under-served populations, which primarily focus on improving family health. Also, regular contributor Dr. MedLaw discusses how, when, and why physicians should disclose their own errors. Did you know that hiding an error will underpin the independent intentional tort of fraudulent concealment and that because it is an intentional choice, it will not be covered by malpractice insurance? How about that the Statute of Limitations for fraudulent concealment is also usually three times longer than that for malpractice?

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Further reading

https://faculty.sites.iastate.edu/azarling/

Hudson J, Zarling A, Ungar R, Albright L, Tkatch R, Russell D, Schaeffer J, Wicker ER. Older Adults' Experiences in a Web-Based Intervention for Loneliness. Gerontol Geriatr Med. 2023 Mar 22;9:23337214231163004. doi: 10.1177/23337214231163004. PMID: 36968123; PMCID: PMC10037731.

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Welcome to Episode 101, which seems a great place to go back to basics! Regular PW podcast contributor and PW Editorial Board member Alex McDonald, MD, speaks with Francis Chu, MD, a family physician who currently serves as the program director for Kaiser Permanente San Jose (KPSJ) Family Medicine Residency, director of Graduate Medical Education at KPSJ, assistant dean of the KP Silicon Valley Regional Campus, and volunteer instructor of Family Medicine at Boston University. Drs. McDonald and Chu have a great conversation about graduate medical education and how best to use it to your advantage.

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This week’s episode of the PW Podcast is celebratory, in honor of our 100th episode. This has been a fantastic adventure, and we have been honored to interview more than 150 health practitioners to date, exposed to so much fantastic clinical science and expertise! We need to thank all our guests, as well as our regular contributors, Dr. Medlaw and Dr. Alex McDonald. This is an opportunity to also thank our sound guys at The Audio and the great staff at Physician’s Weekly. But we would especially like to thank you, the listeners!

To celebrate this milestone, Dr. Alex McDonald (Physician’s Weekly Editorial Board Member and family/sports medicine physician at Southern California Permanente Medical Group) and PW Podcast host Rachel Giles, MD, generated a list of their “Heroes of Medicine,” which they discuss in this episode; this list reflects their personal choices and just scrapes the surface. We would love to hear your suggestions of who was missed!

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Heroes of Medicine:

Hippocrates promoted the idea that gods did not cast illnesses
Edward Jenner: 1796, first vaccine à small pox
Watson and Crick (and Rosalind Franklin): 1953 - DNA
Louis Pasteur: 1864, microorganisms in the air and water
Alexander Fleming: 1928, antibiotics
Ignaz Semmelweiss: 1846, handwashing, and no one believed him!
Harold Varmus: open access publishing (Public Library of Science, PLoS)
James Lind: first clinical trial, he was a ship's surgeon in the Royal Navy. While at sea in May 1747, Lind provided some crew members with two oranges and one lemon, proving scurvy could be prevented by citrus
Jennifer Doudna: 2006, CRISPR gene editing
Mary Claire King: 1989, not for discovery of breast cancer gene but for her humanitarian work performing pro bono sequencing of children “lost” in the dictatorship of Argentina and placing them back with their families
Peter Ratcliffe, Bill Kaelin, Greg Semenza: 2019, Nobel prize - hypoxia signaling
Elizabeth Blackwell: 1849, became the first woman in America to receive an MD. She was soon joined by her younger sister, and together, the Blackwells founded the New York Infirmary for Indigent Women and Children, the first hospital staffed entirely by women.
Paul Farmer: with colleagues, pioneered novel, community-based treatment strategies that demonstrate the delivery of high-quality healthcare in resource-poor settings. He wrote extensively on health, human rights, and the consequences of social inequality.

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Doctor burnout is a significant and pervasive issue that can have detrimental effects on well-being, job satisfaction, and ultimately, patient care. Dike Drummond, MD, family doctor and CEO of TheHappyMD.com, discusses this important topic. Dr. Drummond is the author of the Burnout Prevention MATRIX, which shares 235 ways to stop burnout, and has coached and trained over 40,000 doctors.

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Patrice Forget, MD, PhD (University of Aberdeen) discusses developments in safe pain management and the best evidence-based use of opioids in the current landscape. Dr. Forget is a recognized international expert on pain management and recently published an overview on this topic in Lancet. Also, Dr. MedLaw shares her clinical and legal perspective on dealing with another doctor’s errors. Dr. MedLaw explores the issue of whether doctors who notice these errors become legally liable if they do not intervene in the event of a worsening medical situation.

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Additional reading:

Forget P, Hauser W. Europe has much to do to improve the quality of and access to safe pain management. Lancet. 2023;401(10389):P1651. doi:10.1016/S0140-6736(23)00669-4

Forget P. Prescribing and deprescribing opioids. Pain. 2022;163(1):1-2. doi:10.1097/j.pain.0000000000002299

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The 14th-century bubonic plague killed up to half the population in Europe, the Middle East, and North Africa. It has been hypothesized that such a deadly disease may have provided a selected event for genetic variants that protect against infection. People with protective versions of certain genes would be more likely to survive and pass on those variants to future generations. Yet pinpointing such variants has been a challenge. An NIH-funded team of researchers, led by Drs. Hendrik Poinar (McMaster University) and Luis Barreiro (University of Chicago) sampled DNA from the remains of more than 500 people who died before, during, and after the Black Death, which raged in 1348 to 1349. Dr. Barreiro, explains his research, which found genetic variant enriched by the Black Death contribute to Crohn’s and other autoimmune disorders.

There have been some big breakthroughs in the treatment of liver cancer the last 2 years, raising the question of whether non-trial populations of patients do as well as those reported in the major clinical trials. We speak with Cha Len Lee, MD (University of Toronto), about therapy with atezolizumab and bevacizumab improving recurrence-free survival in patients with hepatocellular carcinoma (HCC) following surgical resection or ablation, according to results from the phase 3 IMbrave050 clinical trial (NCT04102098). As this combination therapy is finding its way into practice, Dr. Lee performed a study to assess the efficacy, safety, and value of esophagogastroduodenoscopy with regard to this combination therapy in the real world.

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Additional reading:

Klunk J, et al. Evolution of immune genes is associated with the Black Death. Nature. 2022 Nov;611(7935):312-319.

Kudo M, et al. Efficacy, safety and patient reported outcomes (PROs) from the phase III IMbrave050 trial of adjuvant atezolizumab (atezo) + bevacizumab (bev) vs active surveillance in patients with hepatocellular carcinoma (HCC) at high risk of disease recurrence following resection or ablation. ASCO, June 2-6, 2023, Chicago, USA. Abstract: 4002

Hack SP, et al. Future Oncol. 2020 May;16(15):975-989.

Finn RS, et al. N Engl J Med 2020; 382:1894-1905.

Lee C

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Gary Milechman, MD, FACC (UCSF Cardiovascular Care and Prevention Center), explains how curiosity guides his differential diagnostics approach, which he shares in teaching the nearly lost art of diagnostics. Also, Adrian Desai Boström, PhD (Karolinksa Institute, Sweden), discuses the implications of his study findings, indicating that male adolescents living in areas where bipolar disorder is diagnosed more frequently are also associated with significantly fewer suicide deaths than in patients living in areas where bipolar disorder is less prevalent.

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Additional reading:

Andersson P, Jokinen J, Jarbin H, Lundberg J, Desai Boström AE. Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden. JAMA Psychiatry. 2023 May 24:e231390. doi: 10.1001/jamapsychiatry.2023.1390. Epub ahead of print. PMID: 37223908; PMCID: PMC10209824.

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Karsonya Wise Whitehead, PhD (Executive Director, Karson Institute for Race, Peace, and Social Justice, Communication and African & African American Studies, Loyola University Maryland and President, National Women's Studies Association), discusses the ongoing impacts of the George Floyd murder case, sharing the facts that 79% of Black parents say police violence affects their mental health and that 38% of Black people say the feel anxious when the see an officer. Also, Tracy Velázquez, MS, MPA (Senior Manager, Safety & Justice, The Pew Charitable Trusts), reviews a nationally representative survey that found only 13% of US adults know of the 988 Suicide and Crisis Lifeline and its purpose, 9 months after its launch.

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Additional reading:

https://www.nytimes.com/interactive/2023/05/25/well/mind/black-mental-health-police-violence.html

https://www.pewtrusts.org/en/research-and-analysis/articles/2023/05/23/most-us-adults-remain-unaware-of-988-suicide-and-crisis-lifeline

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Steven Younger, MD (Sutter Health California Pacific Medical Center), talks with us about tough conversations with patients after poor outcomes, as well as the “Great Resignation” and the consequent stress on physicians due to shortages.

Also, Nader Sanai, MD (Chief Scientific Officer/Director Neurosurgical Oncologist, Ivy Brain Tumor Center), discusses the challenges facing brain cancer research and treatmentand efforts to find a cure. Those with a brain cancer diagnosis quickly run out of options. Survival rates haven't risen in decades, and a new FDA-approved therapy hasn't been introduced in as long. Brain cancer has long been underfunded, compared with other cancers and relative to the number of new cases, deaths, and years of life lost. To answer this unmet need, Dr. Sanai has pioneered a phase 0 clinical trial approach for research and drug development. We hear about how tides are changing for the better with this experimental approach.

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Carla Perissinotto, MD, MHS (Professor of Geriatric Medicine, UCSF) frames her recently published data on social isolation and loneliness as medical issues in the context of the Surgeon General’s report stating that “loneliness in older adults is a health priority.” We then turn to a situation many doctors would not have necessarily have thought was related to them. The charges were recently dropped against Alec Baldwin in the case of the cinematographer who was killed on his movie set when a real bullet was fired instead of a blank, but charges are still pending against the armorer who loaded the gun that was given to him. Many doctors are confused about this; does it suggest that if someone assisting a doctor misinforms them about a patient or hands them a wrong medicine that liability stops with that assistant? Our regular contributor, Dr. MedLaw (board-certified radiologist and malpractice attorney) answers these and other related questions.

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Further reading

Holt-Lunstad J, Perissinotto C. Social Isolation and Loneliness as Medical Issues. N Engl J Med. 2023 Jan 19;388(3):193-195.

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Dena Battle (President, KCCure), a former congressional aide who spent nearly two decades working on tax and healthcare policy—with expertise in health care reimbursement, tax treatment of benefit plans, the orphan-drug tax credit, and corporate research and development policy—discusses medical misinformation on the Internet and the mitigation of doctor-patient discord. Also, Bernard Zalc, MD, reviews a new model that may help correlate demyelination with the evolution of cognitive and motor abilities in patients with multiple sclerosis (MS). This new tool, which allows in vivo monitoring, has the potential to advance our knowledge of the link between visual disorders—one of the most common symptoms of multiple sclerosis—and associated demyelination lesions. Keep listening to learn more!

Additional reading:

Henriet E, Martin EM, Jubin P, Langui D, Mannioui A, Stankoff B, Lubetzki C, Khakhalin A, Zalc B. Monitoring recovery after CNS demyelination, a novel tool to de-risk pro-remyelinating strategies. Brain. 2023 Mar 30:awad051.

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John Showalter, MD (CPO, Linus Health) discusses the types of cognitive care that patients want from their physicians and what physicians need to know about cognitive health as is carves out a bigger place in primary care. According to a recent survey of patient expectations, more than 80% of elderly patients are concerned about developing dementia, but their doctors are not screening for early indicators or discussing treatment and prevention. Dr. Showalter discusses this survey data and why proactive cognitive care must become the standard immediately. Also, Lydia Makaroff, PhD (CEO, Fight Bladder Cancer in the UK, and current President, World Bladder Cancer Patient Coalition), and Alex Filicevas (Executive Director, World Bladder Cancer Patient Coalition) explore obstacles to quality care in bladder cancer, as well as topline and brand new data from their global survey among patients and caregivers. Wondering why you might see a lot of bubble blowing this month? May is Bladder Cancer Awareness Month, and to draw attention to this, the world bladder cancer community, patients and physicians alike, will be blowing bubbles.

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Regular contributor Dr. MedLaw explains the legal doctrine “assumption of the risk,” helping answer the question “If a patient is explained the risks of medical care and agrees to the treatment, aren’t they agreeing to those risks?” Also, Cynthia Kelly, RD, CD (CEO of the Gluten Intolerance Group), discusses new understandings in gluten sensitivity and intolerance, including Celiac disease. She reviews the pathophysiology and addresses how to help patients overcome obstacles to reducing gluten intake.

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Steven Woolf, MD, MPH (Virginia Commonwealth University School of Medicine), discusses the ominous implications of the largest increase in US all-cause pediatric mortality rates in at least 50 years (up 20% in 2019-2021). A nation that begins losing its most cherished population—its children—faces a crisis like no other. Also, Sergio Giralt, MD, reviews results from the MarMMa-3 trial, which investigated the safety and efficacy of idecabtagene vicleucel for relapsed or refractory multiple myeloma. The findings were recently published in the New England Journal of Medicine. How will this change the treatment landscape for patients with multiple myeloma?

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Additional reading:

Woolf SH, Wolf ER, Rivara FP. The New Crisis of Increasing All-Cause Mortality in US Children and Adolescents. JAMA. 2023 Mar 28;329(12):975-976.

Rodriguez-Otero P, Ailawadhi S, Arnulf B, Patel K, Cavo M, Nooka AK, Manier S, Callander N, Costa LJ, Vij R, Bahlis NJ, Moreau P, Solomon SR, Delforge M, Berdeja J, Truppel-Hartmann A, Yang Z, Favre-Kontula L, Wu F, Piasecki J, Cook M, Giralt S. Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2023 Mar 16;388(11):1002-1014.

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Priya Sarin Gupta, MD, MPH (Mass General), discusses how mobile health services for medically underserved populations work, as well as the potential impacts of the recently FDA-approved OTC Narcan for opioid overdose treatment. Also, World Ovarian Cancer Coalition CEO Clara MacKay talks about the newest advances in ovarian cancer, how the organization supports patients with ovarian cancer worldwide, barriers being addressed, and the upcoming World Ovarian Cancer Day, which brings awareness every year on May 8.

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Sarfaraz Niazi, PhD (University of Illinois at Chicago), discusses the impacts of the Inflation Reduction Act—President Biden’s historic new prescription drug law under which drug companies will pay rebates to Medicare when their prescription drug prices increase faster than the rate of inflation for certain drugs—on the use of generics and biosimilars. Also, Sami Khella, MD (University of Pennsylvania), talks about the phase 3 NEURO-TTRansform Study, which produced promising results for eplontersen in treating hereditary transthyretin-mediated amyloid polyneuropathy.

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Robert Glicksman (George Washington University Law School) speaks about how provisions affecting climate change, which he recently published in the New England Journal of Medicine, will have substantial health effects on the American public. We also talk to Art Papier, MD, who is dedicated to applying machine learning and AI to improve accuracy in dermatology diagnoses among non-dermatologists to diagnose skin conditions (34% improvement), save time, and enhance patient-physician communication.

Further reading:

Glicksman RL. Protecting the Public Health with the Inflation Reduction Act - Provisions Affecting Climate Change and Its Health Effects. N Engl J Med. 2023 Jan 5;388(1):84-88.
https://www.aad.org/member/practice/managing/vendors/visualdx, for a free, 30-day trial: https://www.visualdx.com/pricing/.

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Fitting with the theme of Spring, Dr. Yaniv Elkouby (Hebrew University, Israel) discusses his recently published research on how eggs develop in the fetal period of developing females. This involves a chromosomal bouquet formed by microtubule fibers, which is necessary for proper oocyte development. When perturbations in these structures occur, infertility or miscarriage results.
Also, Chris DiBlasio, MD, explains how prostate-specific membrane antigen PET imaging will significantly improve the detection and treatment of prostate cancer.

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Board-certified radiologist, medical malpractice lawyer, and regular contributor Dr. MedLaw talks about how doctors should approach the situation when patients want to take charge of their treatment plan entirely, without considering all the evidence-based options. Also, Jaime Herrera Caceres, MD (Penn State Health), briefly discusses a novel stent methodology for male incontinence, recently in the news, as well as his important work galvanizing the local LatinX medical community to give public lectures in Spanish on preventative medicine and cultural stigmas to raise health literacy and awareness.

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Joseph Vassalotti, MD (Clinical Professor of Nephrology at Icahn School of Medicine at Mount Sinai and CMO at the National Kidney Foundation), talks about how doctors should properly test for renal function using a race-independent equation, about albuminuria, and about the effects of COVID-19 on patient’s kidneys. Also, Jeremy Reiter, MD, PhD (Professor at UCSF), discusses the underpinnings of kidney diseases, both sporadic and inherited, as well as the Tabula Sapiens project in which his lab contributed in-depth transcriptome data from various sites along the nephron.

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We talked on the street outside ASCO GU 2023 with kidney cancer survivors and advocates Bryan Lewis and Howard McClurd of KidneyCan about how they helped raise $235 million in 6 years for kidney cancer research. KidneyCan runs the Kidney Cancer Advocacy Days, for which they encourage all stakeholders to join meetings in Washington, DC on March 13 and virtual meetings conducted via Zoom on March 14. Also, Michael Alchoueiry, MD (Brigham and Woman’s Hospital), talks about his work on the unique pathophysiology of chromophobe renal cell carcinoma, the unmet need in patients for targeted therapies, and about his group’s recent publication looking at ferroptosis as the potential Achilles heel for this type of tumor.

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Toni Choueiri, MD (Dana-Farber Cancer Institute, Harvard), discusses the latest research in kidney cancer presented at the 2023 ASCO Genitourinary Cancers Symposium. Also, regular contributor Dr. MedLaw explains all you need to consider and do, as well as not do, in the delicate situation of having to report a colleague.

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PW Editorial Board Member Alex McDonald, MD, talks with Hussain Lalani, MD, MPH ( Brigham and Women’s Hospital, Harvard Medical School), who’s research focuses on understanding the challenges and inequities patients face in accessing affordable prescription drugs and evaluating the impact of health policies and interventions. He also serves on the National Steering Committee of Doctors for America’s Drug Affordability Action Team. They talk about what all doctors in the US should know about pharmaceutical pricing, and the implications that process can have. Also, Matthias Stelljes, MD (University of Muenster, Germany), discusses the outcomes and implications of the ASAP trial, which assessed the management of relapsed or refractory acute myeloid leukemia using intensive chemotherapy in advance of allogeneic hematopoietic cell transplantation.

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Kai Rejeski, MD, (University Hospital, LMU Munich, Germany) discusses CAR-T cell therapy in mantle cell lymphoma and beyond, including the new tool he and colleagues have developed that can predict toxicity, infections, and clinical outcomes. Also, regular contributor Dr. MedLaw explains what kind of liability exists when a doctor recommends another doctor to a hospital or practice. It turns out that failure to honestly describe a candidate for a job can carry significant liability.

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In this episode, we have two interviews: one general, but incredibly entertaining, about health equity and one on a clinical study in chronic lymphocytic leukemia (CLL). This last interview is with Ryan Jacobs, MD (Dept. Hematology, Atrium Health Levine Cancer Institute), who discusses hisnew real-world study using more than 2 years of EMRs that shows that patients with CLL treated with first-line Bruton’s tyrosine kinase inhibitor (BTKi) acalabrutinib were 89% more likely to initiate a next-line treatment when compared with patients treated with another BTKi first-line ibrutinib. But first, Physician’s Weekly Editorial Board member and frequent contributor Alex McDonald, MD, speaks with La Tanya Hines, MD, a board-certified obstetrician and gynecologist practicing in Los Angeles about health equity—what it is and where it goes wrong.

Enjoy listening!

Additional reading:

https://www.diversityinmedicine.uci.edu/dr-la-tanya-hines/

Jacobs R. et al, Real-World Comparison of Time to Next Treatment for Patients with CLL Initiated on First-Line Treatment with Ibrutinib Versus Acalabrutinib. Presented at the American Society of Hematology (ASH 2022) on Monday, December 12, 2022, Abstract 797.

Lu X, et al. Real-World Adherence to First-Line Ibrutinib and Acalabrutinib Single-Agent Among Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Clinical Lymphoma Myeloma and Leukemia, Volume 22, Supplement 2, 2022: S280-S281, abstract CLL-492

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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Both interviews in this episode are with presenters at the 2023 ASCO Gastrointestinal Cancers symposium. Dr. Myriam Chalabi (Netherlands Cancer Institute) discusses the TARZAN trial, which found that, in patients with rectal cancer, neoadjuvant radiotherapy followed by atezolizumab and bevacizumab resulted in an encouraging complete response rate. The findings of this phase 1 study demonstrate that total mesorectal excision may be prevented in a significant proportion of patients, increasing the chance for organ preservation and reducing the risk for long-term morbidity related to surgery. It is a small but very exciting study!

But first, Dr. Laura Dawson(Princess Margaret Cancer Centre, Toronto, Canada) reviews her phase 3 study of single-dose radiotherapy to manage pain from hepatocellular carcinoma and liver metastases.The results of this trial delivered encouragingly good results, beyond even the palliative endpoint.

Enjoy listening!

Additional reading:

Dawson LA, et al. Canadian Cancer Trials Group HE.1: A phase III study of palliative radiotherapy for symptomatic hepatocellular carcinoma and liver metastases. LBA492, Rapid Abstract Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract, ASCO-GI 2023, San Francisco, CA, USA, 19-21 January.
Soliman H, Ringash J, Jiang H, Singh K, Kim J, Dinniwell R, Brade A, Wong R, Brierley J, Cummings B, Zimmermann C, Dawson LA. Phase II trial of palliative radiotherapy for hepatocellular carcinoma and liver metastases. J Clin Oncol. 2013 Nov 1;31(31):3980-6.
Verschoor YL, et al. Radiotherapy, atezolizumab, and bevacizumab in rectal cancers with the aim of organ preservation: The TARZAN study. Poster Session C: Cancers of the Colon, Rectum, and Anus, Abstract 158, 2023 ASCO GI Cancers Symposium, San Francisco, CA, USA, 19-21 January.
Chalabi M. Defying all odds in MMR-deficient rectal cancers. Cancer Cell. 2022 Sep 12;40(9):914-916.

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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Peter de Keizer (Associate Professor, University Medical Center Utrecht, Netherlands) and founder and managing director of Cleara Biotech B.V. discusses his drive to understand how cells that stop dividing and enter a “holding pattern,” known to cell biologists as senescence, drive disease and aging. We talk about how the peptides he has developed, called FOXO4 peptides, will enter clinical trials next year in patients with liver metastases. They work by selectively killing senescent cells, which in turn might unlock localized tissue regeneration programs. This is really cool stuff, and I bet most of you have never heard of this sort of approach!

Also, our recurring guest, a board-certified radiologist and medical malpractice lawyer who goes by the pseudonym Dr. MedLaw, answers all our questions about liability associated with referrals, something we all do and probably haven’t considered to the depth she covers.

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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Brian Carr, MD, discusses results of the Standing Up to Knee Pain: The Physical, Social, and Mental Impact of Knee OA survey, which polled 500 US adults who have been treated for chronic knee pain and/or osteoarthritis (OA) of the knee. It found that although 100% of patients have tried some form of treatment to address their pain, a staggering 97% still report that their daily lives are negatively impacted by their condition. The majority (75%) had trouble climbing stairs and exercising, and more than one-half reported that knee pain impaired their overall health and fitness.

Also, Physician’s Weekly’s editorial Board member Alex McDonald, MD, speaks with Dana Corriel, MD, a board-certified internist, entrepreneur & digital strategist. She is the founder of an online platform that works to centralize the efforts of verified health experts (@SoMeDocs). They have a great conversation about the potential of entrepreneurship among doctors!

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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As 2023 is upon us, we are probably being realistic to expect continued inflation, a choppy economy, COVID-19 disruptions in healthcare, and on-going supply chain disruptions continuing into the year. Some leaders in healthcare systems are even predicting an “exceptionally turbulent 2023.”1 While inflation appears to be stabilizing, the higher cost of consumer goods is making it difficult for some people to pay for medical services, therapies, and devices. As a result, healthcare consumers might put off buying prescriptions or medical devices that can help them treat or monitor a condition.

On the flip side, but much harder to predict, there will be a number of significant medical advances, many of which will be incremental improvements, and a few of which will be major breakthroughs. PW Podcast host Rachel Giles, MD, and PW editorial board member Alex McDonald, MD, discuss the trends to watch this year, from wearables and patient engagement to next-generation therapies and vaccines.

Happy New Year!

References:

https://www2.deloitte.com/us/en/blog/health-care-blog/2022/2023-outlook-for-health-care-could-margins-staffing-stall-progress-to-future-of-health.html
Gene therapy pipeline 1Q2022-2Q 2025, CVS Health, February 2, 2022; Approved cellular and gene therapy products, FDA, September 19, 2022; The state of the industry, Alliance for Regenerative Medicine, January 26, 2021
van Dyck CH, et al. Lecanemab in Early Alzheimer's Disease. N Engl J Med. 2022 Nov 29. doi: 10.1056/NEJMoa2212948. Epub ahead of print. https://www.nature.com/articles/d41586-022-03081-0

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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Co-hosts Dr. Alex McDonald and Dr. Rachel Giles give their perspectives, in no particular order of importance, on our choices for the top 14 medical innovations for 2022. Some are already in practice, while others are recent breakthroughs not quite ready for “prime time.” All-in-all it was a great year for medical science; let us know what you think the biggest medical innovations were in 2022!

We wish you a safe and healthy holiday season! We’ll be back the first week of January 2023 with an episode dedicated to looking at anticipated medical breakthroughs in 2023!

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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In this episode we have two interviews about two different—but both very important—topics. In the second interview, Dr. Celestin Hategeka, from the Department of Global Health and Population, Harvard TH Chan School of Public Health, discusses his recently published systematic review in PLoS Medicine that identified several unmet needs in noncommunicable disease prevention, as well as control interventions, in low- and middle-income countries.

But first, our regular contributor, Dr. MedLaw—a board-certified radiologist and medical malpractice attorney—discusses the important topic of employment contracts. As always, Dr. MedLaw serves us a fascinating twist with her insights!

Enjoy listening!

Additional reading:

Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med. 2022 Jul 25;19(7):e1004055.

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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In this episode, we have two interviews, about two completely different topics, although they are both about taking charge of the problem at hand. First, PW Editorial Board Member Dr. Alex McDonald speaks with Dr. Jay W. Lee, CMO at Share Our Selves, a federally qualified health center in Orange County, CA. Respected and known as a relational, facilitative leader who motivates and empowers his team to think big and deliver on the organizational mission, his key strengths include practice transformation, health equity, strategic planning, health policy and management, and digital health/social media. He feels that family medicine must rise up and become the leaders of our communities. It’s a lively and fun interview!

Next, we speak with Dr. Reina Haque, senior cancer epidemiologist in the Kaiser Permanente Southern California Department of Research & Evaluation. Dr. Haque discusses her recently published study, in JAMA Network Open, which found that moderate to high levels of physical activity—equal to about 15 minutes a day—reduced mortality by 60% in breast cancer survivors.

Enjoy listening!

Additional reading:

Chen LH, Irwin MR, Olmstead R, Haque R. Association of Physical Activity With Risk of Mortality Among Breast Cancer Survivors. JAMA Netw Open. 2022;5(11):e2242660. doi:10.1001/jamanetworkopen.2022.42660

https://www.familydocs.org/fmrising/

Let us know what you thought of this week’s episode on Twitter: @physicianswkly

Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com!

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With most Americans recently celebrating Thanksgiving by joining friends and family over a large, turkey-heavy celebratory meal, we take an inDEPTH look at how our bodies deal with excess nitrogen.

Animals mostly excrete excess nitrogen as ammonia, urea, or uric acid, which is produced during protein metabolism. Ammonia is the direct waste produced as a byproduct of protein metabolism by all animals. But because of its toxicity, many animals convert ammonia into a less toxic form. The major excretory product in humans is urea, which is excreted in urine by the kidneys.

Fun fact: birds and reptiles have evolved the ability to convert toxic ammonia into uric acid, which packs four nitrogens into each molecule, compared with two nitrogens in each human urea molecule. Not only is that a much more efficient means of excreting nitrogen, uric acid is a white crystal precipitate, which is why guano is white and makes such an excellent fertilizer.

Humans have many diseases caused by excess nitrogen. Later in this episode, we will talk with Dr. Julien Baruteau, from the Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, in London, UK, about how his lab goes about modeling urea cycle disorders using patient cells. But first, we speak with Dr. Michael Pillinger (NYU Grossman School of Medicine, NY), about how gout flares result from an innate immune response against monosodium urate crystal deposits, and about his recent results from the PIVOTAL study, presented at the ACR Convergence 2022 meeting.

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We are entering holiday season, and as a recent study published in the journal Atherosclerosis recently showed, celebrating the winter holidays is associated with up to 20% higher levels of total and LDL cholesterol, as well as up to a 15% higher risk for hypercholesterolemia in the general population. Although the holiday season is not a great time for a diagnosis of hypercholesterolemia, it is a great time to start talking about some of the revolutionary new methods to treat hyperlipidemia.

To take up that challenge, we take an in-depth look at two new studies just reported at the American Heart Association (AHA) Scientific Sessions 2022, held in Chicago, Nov 5-7. Statins are first-line agents for reducing LDL cholesterol (LDL-C) and the risk of major cardiovascular events. In addition, biotechnological advancements in medication therapy have led to the development of inclisiran, a recently approved twice-yearly injectable agent to help patients with heterozygous familial hypercholesterolemia and clinical cardiovascular disease on a maximally tolerated statin to reach LDL-C targets. Inclisiran has demonstrated robust LDL-C reduction in clinical trials in combination with a favorable safety profile; however, the effect on cardiovascular clinical outcomes still remains under evaluation. First, Professor Kausik “Kosh” Ray (Imperial College London, UK, and President European Atherosclerosis Society) talks about the ORION-3 trial. Then, Professor Jeff Anderson (Intermountain Heart Institute, Utah) discusses the VICTORION-INCEPTION Trial.

Enjoy listening!

Additional reading
Vedel-Krogh S, Kobylecki CJ, Nordestgaard BG, Langsted A. The Christmas holidays are immediately followed by a period of hypercholesterolemia. Atherosclerosis. 2019 Feb;281:121-127.

Ray K, et al. Efficacy and Safety of Twice-Yearly Subcutaneous Inclisiran in Patients With High Cardiovascular Risk and Elevated Low-Density Lipoprotein Cholesterol up to 4 Years-The ORION-3 Trial. Presented at the American Heart Association Scientific Sessions, Nov 5-7th, 2022.

Anderson J, et al. A Randomized Study to Compare LDL-C-Lowering Effects of Inclisiran With Usual Care vs Usual Care Alone in Patients With Recent Hospitalization for an Acute Coronary Syndrome: Rationale and Design of the VICTORION-INCEPTION Trial. Presented at the American Heart Association Scientific Sessions, Nov 5-7th, 2022, Abstract 10851.

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Urological surgeon Phillip Cornford, BSc(hons), MB, BS, FRCS(Urol), MD, FEBU, (University of Liverpool) discusses unmet needs in early prostate cancer detection and exciting new techniques for advanced disease. Also, biotech industry expert Annaleen Daemen speaks about various innovative approaches to treatment-resistant prostate cancer, including the prospect of genome-driven diagnostics leading clinical care decisions.

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This week, we take a deep dive into the benefits and problems facing primary care physicians, through the lenses of a family physician and an academic team. Kevin Grumbach, MD, explains to PW Editorial Board Member Alex McDonald, MD, why change is needed now in primary care or the “critical sector to the health of our people is about to implode.” Also, Steven Atlas, MD, discusses his JAMA study results, which turned up some important deficiencies in systems for managing abnormal cancer screening test results that can ultimately improve prevention in primary care.

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Dr. Husein Moloo discusses the impact of medicine’s carbon footprint on climate change and how to lower it. Also, Dr. MedLaw details management service organizations: what to look out for and when they can help your practice.

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This episode, we have two really interesting and very different interviews. Physician’s Weekly speaks with our regular contributor, a registered physician and medical malpractice attorney, who goes by the alias Dr. MedLaw. We explore when and how it is appropriate for physicians to apologize… or not.

But first, Princeton University Professor Rebecca Burdine, PhD, speaks about the value of modelling rare diseases. Dr. Burdine uses small zebrafish for her studies, and you would be amazed at how well these small fish can model diseases, and even be used in diagnostics. Dr. Burdine is also a caregiver to her daughter, who has the rare disease Angelman Syndrome, which Dr. Burdine just happens to study. She provides excellent insights into the value of studying rare diseases.

Enjoy listening!

Additional reading

Willgoss T, Cassater D, Connor S, Krishnan ML, Miller MT, Dias-Barbosa C, Phillips D, McCormack J, Bird LM, Burdine RD, Claridge S, Bichell TJ. Measuring What Matters to Individuals with Angelman Syndrome and Their Families: Development of a Patient-Centered Disease Concept Model. Child Psychiatry Hum Dev. 2021 Aug;52(4):654-668.

Cheng KC, Burdine RD, Dickinson ME, Ekker SC, Lin AY, Lloyd KCK, Lutz CM, MacRae CA, Morrison JH, O'Connor DH, Postlethwait JH, Rogers CD, Sanchez S, Simpson JH, Talbot WS, Wallace DC, Weimer JM, Bellen HJ. Promoting validation and cross-phylogenetic integration in model organism research. Dis Model Mech. 2022 Sep 1;15(9):dmm049600.

Bird LM, Ochoa-Lubinoff C, Tan WH, Heimer G, Melmed RD, Rakhit A, Visootsak J, During MJ, Holcroft C, Burdine RD, Kolevzon A, Thibert RL. The STARS Phase 2 Study: A Randomized Controlled Trial of Gaboxadol in Angelman Syndrome. Neurology. 2021 Feb 16;96(7):e1024-e1035.

Patterson VL, Burdine RD. Swimming toward solutions: Using fish and frogs as models for understanding RASopathies. Birth Defects Res. 2020 Jun;112(10):749-765.

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For this episode, we have two fascinating interviews in honor of National Breast Cancer Awareness Month, when we raise awareness for the prevention, early detection, treatment, and survivorship of breast cancer. To that end, we speak with Dr. Tania Španić, President of Europa Donna, The European Breast Cancer Patient Organization, who is a survivor herself. She is also Chair of the European Society of Medical Oncology’s Patient Advocacy Working Group.

We also talk to Dr. Ines-Maria Vaz-Duarte-Luis from the Cancer Institute Gustave Roussy in Paris, about her recent articles on the dynamics of patient-reported outcomes after adjuvant breast cancer chemotherapy.

We hope these 2 interviews provide the lens of the patient perspective and physician-researcher on various QOL aspects that patients affected by breast cancer must face.

Enjoy Listening!

Additional reading

Paluch-Shimon S, et al. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5). Ann Oncol. 2022 Aug 4:S0923-7534(22)01858-0.

Di Meglio A, et al. Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy. J Clin Oncol. 2022 Sep 20;40(27):3190-3204.

Vaz-Luis I, et al. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol. 2022 Aug 10:S0923-7534(22)03792-9.

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Management Service Organizations (MSOs) can help you delegate the business side of medicine so you can focus on patient care. Dr. MedLaw explains, including, how MSOs factor into the corporate practice of medicine and more.

Also, did you know cilia play an important role in early beginnings of cancer in neural crest cells? Lukas Sommer, PhD, discusses his teams' research in developmental and cell biology.

Enjoy listening!

https://www.anatomy.uzh.ch/en/research/sommer.html

Zingg D, Debbache J, Peña-Hernández R, Antunes AT, Schaefer SM, Cheng PF, Zimmerli D, Haeusel J, Calçada RR, Tuncer E, Zhang Y, Bossart R, Wong KK, Basler K, Dummer R, Santoro R, Levesque MP, Sommer L. EZH2-Mediated Primary Cilium Deconstruction Drives Metastatic Melanoma Formation. Cancer Cell. 2018 Jul 9;34(1):69-84.e14.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

In this episode, we have two fascinating interviews. Physician’s Weekly’s Editorial Board Member Alex McDonald, MD, interviews Kavita Arora, MD, Division Director of General Obstetrics and Gynecology, University of North Carolina School of Medicine (https://www.med.unc.edu/obgyn/directory/kavita-aurora-md-mbe-ms/) about how to flip the narrative that providing abortion service is healthcare. In this interview Dr. Arora is “Not sure that I would agree that the measures are well-intended; I think they are misogynistic and controlling of women. They invade patient-clinician privacy and the sacred relationship that happens in my exam room.”

But first, Physician’s Weekly’s senior editor Martta Kelly speaks with Dr. Osama Amro, Director of Swedish Polycystic Kidney Disease Center in Seattle, WA, about their multidisciplinary patient-centered approach to pain management strategies in the management of autosomal dominant polycystic disease (ADPKD). ADPKD is one of the most common genetic diseases in humans, affecting 1 in 400 individuals, and is the fourth most common cause of renal failure worldwide. If one parent has ADPKD, the children have a 50% chance of inheriting the gene (though up to 10% of patients don’t have a family history and have de novo mutations). Pain management is central to progressive ADPKD, as the cysts grow, the weight of the kidneys can affect other systems. Dr. Amro provides practical tips on both pharmacological and non-pharmacological approaches.

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The evolution of biomarkers informing therapy decisions began in 2004, when the FDA approved a medicine to treat EGFR mutated non-small cell lung cancer (NSCLC). Since then, researchers have identified more than 20 distinct mutations in driver genes that are specific to lung cancer, nine of which are treatable through FDA-approved therapy drugs: epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS1, BRAF V600E, NTRK, MET, RET, and histological expression of programmed death ligand 1 (PD-L1).

Confirming a patient's biomarker status can open the door to precision medicine.

The molecular characterization of lung cancer has considerably changed the classification and treatment of these tumors, becoming an essential component of pathologic diagnosis and oncologic therapy decisions. The success of targeted anticancer therapies and new immunotherapy approaches has created a new paradigm of personalized therapy and has also led to accelerated development of new drugs for lung cancer treatment. Additional research is needed to identify and help treat the approximately one-third of lung cancer patients for whom biomarkers have yet to be identified.

This podcast focuses on clinically relevant cancer biomarkers as targets for therapy, as well as potential new targets for drug development. We spoke in our first episode with Dr. David M. Waterhouse, who just moved to the Dana Farber Cancer Institute at Harvard Medical School, and until last month was the former Director of Clinical Research at Oncology-Hematology Care, in Cincinnati. We also talk about how these biomarkers are used in academic versus community hospitals. In this second episode, we talk with Dr. Sinchita Roy Chowdhuri, a molecular pathologist from University of Texas MD Anderson Cancer Center, about what you didn’t know about actionable biomarkers for NSCLC.

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To acknowledge the Philadelphia Chromosome translocation t(9;22) in chronic myeloid leukemia (CML), every September 22 (9/22) is World CML Day. Today’s podcast episode looks at this topic through different lenses. First, two members of the Lancet Haematology’s committee on adverse events—Jan Geissler, co-founder of the CML Advocates Network, and Gita Thanarajasingam, MD, the committee chair and a hematologist at the Mayo Clinic—discuss how side effects are reported and analyzed and how the committee intends to change that. Geissler also talks about how his experience as a patient with CML led him to become and expert advocate.

Additional reading:

Geissler J, Huber S. Improving outcomes through patient-generated evidence-the next step in patient advocacy. Lancet Haematol. 2022 Jun;9(6):e399-e400.

Thanarajasingam G, et al. Reaching beyond maximum grade: progress and future directions for modernising the assessment and reporting of adverse events in haematological malignancies. Lancet Haematol. 2022 May;9(5):e374-e384

Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017 Jul 11;318(2):197-198.

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September 15 is World Lymphoma Awareness Day, with the theme We Can’t Wait. To honor the leaps and bounds that research into this rare cancer has made, today’s podcast views the current state of lymphoma through different lenses. First, Dr. Constantine Tam, Head of Lymphoma Service at Alfred Hospital and Professor of Hematology at Monash University in Melbourne, Australia talks about the SEQUOIA trial on the efficacy of BTK inhibitor zanubrutinib versus bendamustine and rituximab in untreated chronic lymphocytic leukemia and small lymphocytic lymphoma, recently published in Lancet Oncology.

Also, Lorna Warwick, CEO of the Lymphoma Coalition, based in Canada as a federation of more than 80 lymphoma patient organizations worldwide that runs the World Lymphoma Awareness Day project, discusses the more than 80 subtypes of non-Hodgkin’s lymphoma. She has some great insights into the unmet needs of patients with lymphoma and how to budge the needle on care.

Enjoy listening!

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Today’s episode features two interviews, taking different lenses on news in hearing loss. We first talk with Frank Lin, MD, PhD, at the Johns Hopkins School of Medicine about the various obstacles to hearing health, including new advice on the just FDA-approved OTC hearing aids. He has been part of the FDA rule from the start and tells us a little about how this came to be, as well as some of the benefits. We then speak with Susan D. Emmett, MD, MPH, from the University of Arkansas. She recently led a randomized controlled trial in 15 communities in rural Alaska, looking at whether telemedicine specialty referral can improve time to follow-up for school hearing screening compared with standard primary care referral. Enjoy listening!

Additional reading

Lin FR, Reed NS. Over-the-counter hearing aids: How we got here and necessary next steps. J Am Geriatr Soc. 2022 Jul;70(7):1954-1956.

Emmett SD, et al. Mobile health school screening and telemedicine referral to improve access to specialty care in rural Alaska: a cluster- randomised controlled trial. Lancet Glob Health. 2022 Jul;10(7):e1023-e1033

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Today’s episode features two interviews. First, we talk about a very timely topic—monkeypox—with public health specialist Dr. Louise Sigfrid from Oxford University. An ongoing outbreak of monkeypox, a viral disease, was confirmed in May 2022. The initial cluster of cases was found in the United Kingdom, where the first case was detected on May 6, 2022 in an individual with travel links to Nigeria. The President Biden administration this month declared the outbreak of monkeypox a public health emergency. Who is at risk? What are the clinical guideline recommendations? Dr. Sigfrid has been involved in the public health response since the beginning of the current outbreak and recently published a paper examining the clinical guidelines for prevention and treatment of monkeypox.

Our second interview is with regular contributor and registered radiologist and medical malpractice attorney, Dr. MedLaw. She tells us all about what “loss of chance” means in a medical malpractice claim. Under the loss of chance doctrine, a doctor can be held liable for causing the patient's loss of a chance to be cured if the doctor negligently fails to diagnose a curable disease and the patient is harmed by the disease.

Enjoy listening!

Additional reading

Webb E, et al. Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review. BMJ Glob Health. 2022 Aug;7(8):e009838. doi: 10.1136/bmjgh-2022-009838. PMID: 35973747.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Today’s episode features two interviews, with an inDEPTH look at prevention. First, we discuss primary prevention of HIV-AIDS from a community global approach, with Rachel Baggaley, MBBS, MSc, the team lead for testing, prevention, and populations in the Global HIV, Hepatitis and STI Programs at the WHO, who has recently published papers in the Lancet HIV and BMJ. Our second interview is with Alan Pollack, MD, PhD, Chair and Professor of Radiation Oncology at the University of Miami’s Sylvester Comprehensive Cancer Center. He talks us through his recently published trial in the Lancet about a new intervention for secondary prevention of prostate cancer after prostatectomy.

Enjoy listening!

Additional reading

Schmidt H, et al. Lancet HIV. 2022;9(5):e363-e366.

Kennedy C, et al. BMJ Open. 2022;12(2):e054121.

Pollack A, et al. Lancet. 2022 May 14;399(10338):1886-1901.

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Confirming a patient's biomarker status can open the door to precision medicine.

This podcast focuses on clinically relevant cancer biomarkers as targets for therapy, as well as potential new targets for drug development. We speak in our first episode with Dr. David M. Waterhouse, who just moved to the Dana Farber Cancer Institute at Harvard Medical School, and until last month was the former Director of Clinical Research at Oncology-Hematology Care, in Cincinnati. We also talk about how these biomarkers are used in academic versus community hospitals. In our second episode, we will talk with Dr. Sinchita Roy Chowdhuri, a molecular pathologist from University of Texas MD Anderson Cancer Center in Houston, about what you didn’t know about actionable biomarkers for NSCLC.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Today’s episode features two interviews, with an inDEPTH look at twins. In 1984, Hrubec and Robinette published what was arguably the first review of the role of twins in medical research. The authors acknowledged a growing distinction between two categories of twin studies: those aimed at assessing genetic contributions to disease and those aimed at assessing environmental contributions while controlling for genetic variation. “Classical twin models” compare phenotypic similarity within monozygotic or identical twin pairs to that within dizygotic or fraternal pairs to establish the proportion of variance in a given trait due to genetic variation within a population and the proportion due to environmental variation. ‘Twin differences’ or ‘discordant twin models', which focus on comparisons within monozygotic pairs control for maternal factors during pregnancy, gestational age, location and season of birth, postnatal familial factors, age, ethnicity, gender, and genetics, they are very useful in teasing out environmental factors. Later in this episode, we interview Dr. Karri Silventoinen (Dept Public Health, University Helsinki, Finland), an expert in twin studies, about his recent publication in Science Reports that identifies the significant effect of education on smoking prevention and cessation through discordant twin study involving more than 100,000 twin pairs.

But first I catch up with a doctor who was recently in world news for successfully separating craniopagus conjoined twins with fused brains, pediatric neurosurgeon Professor Owase Jeelani, from the Great Ormond Street Hospital for Children in London, the UK. Dr. Jeelani tells us how the surgery was “a really close call”, and how the team overcame an unexpected obstacle. In 2019, Dr. Jeelani co-founded Gemini Untwined, a global charity dedicated to supporting the research and treatment of craniopagus twins.

Enjoy listening!

Additional reading

Hrubec Z, Robinette CD. The study of human twins in medical research. N Engl J Med. 1984 Feb 16;310(7):435-41.

McCallum S, BBC News 1 August 2022, Conjoined twins separated with the help of virtual reality. https://www.bbc.com/news/technology-62378452

Silventoinen K, et al. Smoking remains associated with education after controlling for social background and genetic factors in a study of 18 twin cohorts. Sci Rep. 2022 Jul 31;12(1):13148.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

The phrase "prevention is better than a cure" is often attributed to the Dutch philosopher Erasmus around 1500 AD. But in the US, most people are more familiar with Benjamin Franklin telling Philadelphians in 1736 that“An ounce of prevention is worth a pound of cure.” One hundred years later, Thomas A. Edison said “The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease". For the last 50 years, preventative medicine has been gaining tremendous ground, and we are steadily learning more using clinical research.

Today’s episode features two interviews with an inDEPTH look at prevention. Professor John Mathers from Newcastle University, UK, discusses just-published data from the groundbreaking CAPP2 study that puts an interesting twist on how aspirin could prevent colorectal cancer. Also, Dr. Nanette Wenger, clinical cardiologist and professor emerita at Emory University School of Medicine has “buckets of research” to share on cardiovascular disease prevention in women, beyond the more than 1,300 scientific papers she’s had published.

Enjoy listening!

Additional reading

Burn J, et al. Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomized, placebo-controlled trial. Lancet. 2020 Jun 13;395(10240):1855-1863.

Mathers JC, et al. Cancer Prevention with Resistant Starch in Lynch Syndrome Patients in the CAPP2-Randomized Placebo-Controlled Trial: Planned 10-Year Follow-up. Cancer Prev Res (Phila). 2022 Jul 25:OF1-OF12.

Wenger NK, et al. Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association. Circulation. 2022 Jun 7;145(23):e1059-e1071

Oliveira GMM, Wenger NK. Special Considerations in the Prevention of Cardiovascular Disease in Women. Arq Bras Cardiol. 2022 Feb;118(2):374-377.

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. We have a fantastic interview for you; we speak with Dr. Raman Muthusamy from David Geffen School of Medicine at UCLA, about a surgery- and medicine-free approach to treat gastroesophageal reflux disorder (GERD), called transoral incisionless fundoplication (TIF), which can have durable results.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Earlier this week I was listening to National Public Radio’s This American Life podcast, which featured blind comedian Darryl Lenox, who talked about how his trust in strangers dramatically shifted after he lost his sight. It got me thinking about how being visually impaired is truly an obstacle to care in some circumstances and brought me to the idea of this inDEPTH episode.

Today’s episode features two interviews. We start off by exploring the association of vision loss on health care utilization, functional implications of vision loss, ethical and communication issues in patient-centered care delivery, patient engagement, and adherence. In our second interview, we go for a more optimistic ending, in which Physician’s Weekly’s Chris Cole interviews Dr. Andrea Lora Kossler, a plastic and reconstructive surgeon at the Byers Eye Institute Stanford University School of Medicine, in California, about her study published this month Aug 2022, about teprotumumab in retaining functional vision.

But first I interview Professor Alan R. Morse from the Department of Ophthalmology, Columbia University.

Enjoy listening!

Additional reading

Morse AR, Seiple W, Talwar N, Lee PP, Stein JD. Association of Vision Loss With Hospital Use and Costs Among Older Adults. JAMA Ophthalmol. 2019 Jun 1;137(6):634-640.

GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021 Feb;9(2):e144-e160.

Ugradar S, Kang J, Kossler AL, Zimmerman E, Braun J, Harrison AR, Bose S, Cockerham K, Douglas RS. Teprotumumab for the treatment of chronic thyroid eye disease. Eye (Lond). 2022 Aug;36(8):1553-1559

Lu TJ, Amarikwa L, Sears CM, Kossler AL. Advances in the Treatment of Thyroid Eye Disease Associated Extraocular Muscle Myopathy and Optic Neuropathy. Curr Neurol Neurosci Rep. 2022 Jun;22(6):313-325.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Today’s episode features 2 interviews. In our second interview, Physician’s Weekly interviews our regular contributor, Dr. MedLaw, a certified radiologist and medicine malpractice lawyer. She talks about the “Captain-of-the-Ship Doctrine”, which is a principle that holds a surgeon liable for the actions of assistants who are under the surgeon's control but who are employees of the hospital, not the surgeon. The surgeon as "the captain of the ship," is directly responsible for an alleged error or act of alleged negligence because they control and direct the actions of those in assistance. But she gives some fascinating examples to explain this principle.

But first, Physician’s Weekly’s Julia Ernst interviews Dr. Danielle Andrade (Professor of Neurology, University of Toronto, Canada). Vaccination is a common seizure trigger in individuals with Dravet syndrome, which is a severe form of epilepsy characterized by frequent, prolonged seizures often triggered by hyperthermia, and often coupled with developmental delay, speech impairment, ataxia, hypotonia, sleep disturbances, and other health problems. Information surrounding COVID-19 vaccine side effects in patients with Dravet Syndrome would aid caregivers and providers in deciding on and managing COVID-19 vaccination. To that end, Dr. Andrade lead a recently published survey through the Dravet Syndrome Foundation's Family Network to find out whether patients or caregivers with Dravet Syndrome had significant problems if they had received a COVID-19 vaccination. Stay tuned to find out…

Enjoy listening!

Additional reading

Hood V, Berg AT, Knupp KG, Koh S, Laux L, Meskis MA, Zulfiqar-Ali Q, Perry MS, Scheffer IE, Sullivan J, Wirrell E, Andrade DM. COVID-19 vaccine in patients with Dravet syndrome: Observations and real-world experiences. Epilepsia. 2022 Jul;63(7):1778-1786. doi: 10.1111/epi.17250. Epub 2022 Apr 20. PMID: 35383912; PMCID: PMC9111612.

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Welcome to this week’s episode of the Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. Today we have two great interviews, one with the senior author on a recent trial using a unique medical approach published in Nature Medicine, and the other with our regular expert, who goes by the pseudonym Dr. MedLaw.

But first, we talk with Professor Stephen Russell, from the University of Iowa Institute for Vision Research, Iowa City, IA, about how his team has been using oligonucleotide injections into the eyes of vision-impaired patients with Leber’s congenital amaurosis, to force the transcription machinery to skip the exon bearing a mutation in a gene called CEP290. The trial has some surprising results, which were recently published in Nature Medicine.

Enjoy listening!

Further reading

Russell SR, Drack AV, Cideciyan AV, Jacobson SG, Leroy BP, Van Cauwenbergh C, Ho AC, Dumitrescu AV, Han IC, Martin M, Pfeifer WL, Sohn EH, Walshire J, Garafalo AV, Krishnan AK, Powers CA, Sumaroka A, Roman AJ, Vanhonsebrouck E, Jones E, Nerinckx F, De Zaeytijd J, Collin RWJ, Hoyng C, Adamson P, Cheetham ME, Schwartz MR, den Hollander W, Asmus F, Platenburg G, Rodman D, Girach A. Intravitreal antisense oligonucleotide sepofarsen in Leber congenital amaurosis type 10: a phase 1b/2 trial. Nat Med. 2022 May;28(5):1014-1021. doi: 10.1038/s41591-022-01755-w. Epub 2022 Apr 4. PMID: 35379979; PMCID: PMC9117145.

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Later in this episode, we have an interview given by Physician’s Weekly’s Executive Editor Christopher Cole, with Cerebrovascular Neurosurgeon Dr. Peter Rasmussen (Cleveland Clinic, OH). Dr. Rasmussen is committed to digital health solutions, and as such, he is the Chief Clinical Officer of The Clinic, which is the only digital health company that combines the world-renowned clinical expertise of Cleveland Clinic with innovative connectivity technologies. They talk about the role of virtual second opinions and the cost savings associated with them. Unnecessary testing and procedures are expensive. One study found that more than 622,000 patients in the state of Washington alone underwent an unnecessary test or procedure in a one-year period, costing ~$282 million.

But first, we talk with Professor Fatima Cody Stanford, who is an obesity medicine physician-scientist at Massachusetts General Hospital/ Harvard Medical School, who recently published in both Nature Medicine and Lancet Digital Health about how telehealth can both support and exacerbate health disparities.

Enjoy listening!

Further reading

Sharma A, Winkelman RD, Schlenk RP, Rasmussen PA, Angelov L, Benzil DL. The Utility of Remote Video Technology in Continuing Neurosurgical Care in the COVID-19 Era: Reflections from the Past Year. World Neurosurg. 2021

Dec;156:43-52. doi: 10.1016/j.wneu.2021.08.145. Epub 2021 Sep 9. PMID: 34509681; PMCID: PMC8428034.

Yee V, Bajaj SS, Stanford FC. Paradox of telemedicine: building or neglecting trust and equity. Lancet Digit Health. 2022 Jul;4(7):e480-e481. doi: 10.1016/S2589-7500(22)00100-5. PMID: 35750399; PMCID: PMC9214484.

Yee V, Bajaj SS, Stanford FC. Building a pandemic supply chain - equity over equality. Nat Med. 2022 Apr;28(4):609-610. doi: 10.1038/s41591-022-01748-9. PMID: 35288699.

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Welcome to this episode -our 50th episode!- of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. Today’s episode takes an inDEPTH look at osteoarthritis, a condition that affects more than 32 million adults in the United States. “Wear and Tear arthritis” has been in the news lately, because despite being the most frequent reason for activity limitation in adults, a new study has found that walking can ward off knee pain for people with osteoarthritis. Education, exercise, and weight loss are cornerstones of management, complemented by NSAIDs (for patients who are candidates), corticosteroid injections, and several adjunctive medications. For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.

Later in this episode, Physician’s Weekly’s Martta Kelly interviews Dr. Ewa Roos (University of Southern Denmark, Odense, Denmark). She recently published a paper looking at exercise therapy and how it was effective in improving muscle strength at 3- and 12-month follow-up compared to partial meniscectomy. She said these results made her, “re-think the way I think as a clinician”.

But first, I interview Dr. Philip Conaghan (Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK) to define meaningful within-patient change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). His team analyzed data from 3 phase 3 clinical trials (ClinicalTrials.gov: NCT02697773, NCT02709486, NCT02528188) of tanezumab, a novel treatment intended for the relief of signs and symptoms of moderate-to-severe osteoarthritis, administered subcutaneously every 8 weeks. Patients with moderate-to-severe OA of the hip or knee completed the WOMAC and patient global assessment of OA (PGA-OA) at regular time points.

Enjoy listening!

Further reading:

Berg B, Roos EM, Kise NJ, Engebretsen L, Holm I, Risberg MA. Muscle Strength and Osteoarthritis Progression After Surgery or Exercise for Degenerative Meniscal Tears: Secondary Analyses of a Randomized Trial. Arthritis Care Res (Hoboken). 2022 Jan;74(1):70-78. doi: 10.1002/acr.24736. PMID: 34151533.

Conaghan PG, Dworkin RH, Schnitzer TJ, Berenbaum F, Bushmakin AG, Cappelleri JC, Viktrup L, Abraham L. WOMAC Meaningful Within-patient Change: Results From 3 Studies of Tanezumab in Patients With Moderate-to-severe Osteoarthritis of the Hip or Knee. J Rheumatol. 2022 Jun;49(6):615-621. doi: 10.3899/jrheum.210543. Epub 2022 Mar 1. PMID: 35232805.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers in collaboration with Physicians Weekly.

Today we have 2 very interesting and timely interviews to share with you.

Later in this podcast, Physician’s Weekly’s Senior Editor Julia Ernst interviews Dr. Karla O’Dell, from the University of Southern California, about tracheostomy procedures, in particular how you can do open bedside tracheostomies at a low cost without extra risks in safety outcomes. This is of course particularly relevant for this COVID-19 pandemic, and she also reflects on what she thinks those long-term implications will be.

But first, we speak with Professor Frank Staal, from the Dept of Immunology at the Leiden University Medical Center, the Netherlands, who was in the news this week because he co-led a team who treated the first baby with severe congenital immune deficiency (SCID) with gene therapy in the Netherlands, and the first time gene therapy has been used to treat this particular form of SCID worldwide. Have you ever heard of the 1976 movie “The Boy in the Plastic Bubble”? That was based on the story of David Vetter, who was born with SCID and lived in a plastic sterile bubble because he had essentially no immune system. New gene therapy techniques are offering alternatives to bone marrow transplants. The treatment in the news this week was effective and the baby is well with a competent immune system.

Enjoy listening!

Further reading

Tang L, West J, Lee E, Kharidia K, Hasday S, Chambers T, Kokot N, Swanson M, O'Dell K. Open Bedside Tracheostomy: Safe and Cost Saving but Underutilized Nationally. Otolaryngol Head Neck Surg. 2022 Apr 5:1945998221091905. doi: 10.1177/01945998221091905. Epub ahead of print. PMID: 35380905.

Zheng M, Arora N, Chambers T, O'Dell K, Johns MM. Comparison of Treatment for Recurrent Respiratory Papillomatosis at a Public County Versus Private Academic Hospital. J Voice. 2022 Feb 20:S0892-1997(22)00018-2. doi: 10.1016/j.jvoice.2022.01.019. Epub ahead of print. PMID: 35197218.

Klaver-Flores S, Zittersteijn HA, Canté-Barrett K, Lankester A, Hoeben RC, Gonçalves MAFV, Pike-Overzet K, Staal FJT. Genomic Engineering in Human Hematopoietic Stem Cells: Hype or Hope? Front Genome Ed. 2021 Jan 22;2:615619. doi: 10.3389/fgeed.2020.615619. PMID: 34713237; PMCID: PMC8525357.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. Today’s theme is preventative medicine, with interviews about research in colorectal cancer screening and in dietary intervention in T2D patients to achieve remission. In case you haven’t been exposed to it much, preventive medicine is a medical specialty that focuses on the health of individuals and communities. The goal of preventive medicine is to promote health and well-being and prevent disease, disability, and death. Preventive medicine specialists must have a broad range of medical skills as well as expertise in behavioral, economic, environmental, and social sciences. A doctor of preventive medicine can help create healthier communities, save lives, and transform healthcare systems.

Later in this podcast, we speak with Dr. Richard Rosenfeld, about a recently published Expert Consensus Statement he authored with the aim to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. In that publication, expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Prof. Rosenfeld is Chairman, and Program Director of Otolaryngology at SUNY Downstate University in New York.

But first, we speak to Prof. Michael Kanter, from Kaiser Permanente’s School of Medicine in California. He has had oversight of the quality of care provided by 22,000 physicians to 12.2 million patients within the healthcare system nationally and was responsible for the development of the organization’s national quality strategy. He works to significantly improve key clinical quality metrics, including cancer screenings, blood pressure control, and tobacco cessation. As you probably already know, Colonoscopy has played a pivotal role in the declining US incidence of colorectal cancer in persons older than 50 years observed over the past 2 decades. Physician’s Weekly senior editor Martta Kelly speaks with Prof. Kanter about his ‘moonshot vision’ of reducing mortality from colorectal cancer by 50% in 10 years, by improving quality metrics in colorectal cancer screening programs.

Enjoy listening!

Further reading

Kanter MH, et al. Beyond Screening: An Interim Report and Analysis of a Multimodal Initiative to Decrease Colon Cancer Mortality. Joint Commission Journal on Quality and Patient Safety, 2022, in press. https://www.jointcommissionjournal.com/article/S1553-7250(22)00086-1/fulltext

Rosenfeld RM, et al. Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine. Am J Lifestyle Med. 2022 May 18;16(3):342-362.

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Later in this podcast, we have a riveting conversation with our returning guest who goes by the pseudonym Dr. MedLaw. She is a certified radiologist as well as a lawyer, and she provides 5 essential tips you need to know to avoid getting patient complaints. She provides examples of common mistakes that you will definitely recognize, or if you are like me, may have made yourself. Always a fantastic segment.

But first, we interview a family physician and the president of Physicians Group of Southeastern Ohio, Dr. Patrick Goggin, about bringing back house calls. When Dr. Patrick Goggin’s grandfather started a primary care practice in Cambridge, Ohio in 1930, the “house call” was a common practice. Recently Dr. Patrick Goggin and his brother Mark, who are both partners of Medical Associates of Cambridge, saw a need to bring back the “house call” and adapt the practice to better serve their senior population. At the time, Medical Associates of Cambridge had just entered a partnership with Agilon health to transform into a new strategy of value-based care that treats the “whole patient, not the disease.” Now, when many of their patients are unable to get in for their regular and annual wellness exams, doctors and nurses make house calls to those who are chronically ill and homebound.

Enjoy listening!

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Welcome to this episode of Physician’s Weekly podcast. I am your host Dr Rachel Giles, from Medicom Medical Publishers in collaboration with Physician’s Weekly. This week, we have 2 really interesting interviews about very different topics.

I will start with the second interview. The 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, was held 3 -7 June 2022 in Chicago, IL. One of the most covered topics talked in the hallways and you may have read in newspapers, was about precision treatment in aggressive breast cancer. It all started 24 years ago, when a drug called Herceptin changed how doctors treat breast cancer. Its approval in 1998 made it possible to target the aggressive breast tumors tied to a gene called HER2. Other drugs quickly followed Herceptin and, over the years since, have substantially improved survival for people with the disease.

A quarter of a century later, another shift in treatment could be on the horizon. At the American Society of Clinical Oncology meeting, researchers presented results proving that, for the first time, a targeted medicine, called trastuzumab deruxtecan (or T-Dxd for short) can help metastatic breast cancer patients whose tumors express only low levels of HER2. Because many more patients may soon be eligible for treatment with T-Dxd, we focused on a safety follow-up analysis of the randomized phase 3 DESTINY-Breast03 study reinforced the risk-benefit profile of trastuzumab deruxtecan compared with trastuzumab emtansine in patients with HER2-positive unresectable or metastatic breast cancer. We speak with Prof. Guiseppe Curigliano (University of Milan, Italy) to learn the latest results.

But first, we speak with Sonya M. Sloan, MD, better known as #OrthoDoc, has established herself as a force to be reckoned with in the male-dominated field of Orthopedic Surgery. Licensed to practice medicine in several states, she travels the country as a locum tenens physician. There’s a shortage of doctors in America, and all types of facilities need locum tenens providers to relieve physician burnout, maintain patient satisfaction, and stay fully staffed during busy times, or while searching for a permanent doctor. Furthermore, locum tenens helps more people see a provider and receive care, offsetting the physician shortage in underserved areas—especially rural communities, urban areas with health professional shortages, VA hospitals, and Indian Health Service facilities. A 2021 survey indicated that 72% of healthcare facility managers are seeking locum tenens physicians. This is up from 47% in 2016 and up from 39% in 2012. Physician’s Weekly senior editor Martta Kelly interviews Dr. Sloan.

Dr. Sloan is the author of a book titled The Rules of Medicine: A Medical Professionals Guide to Success

Extra reading:

Modi S, Jacot W, Yamashita T, Sohn J, Vidal M, Tokunaga E, Tsurutani J, Ueno NT, Prat A, Chae YS, Lee KS, Niikura N, Park YH, Xu B, Wang X, Gil-Gil M, Li W, Pierga JY, Im SA, Moore HCF, Rugo HS, Yerushalmi R, Zagouri F, Gombos A, Kim SB, Liu Q, Luo T, Saura C, Schmid P, Sun T, Gambhire D, Yung L, Wang Y, Singh J, Vitazka P, Meinhardt G, Harbeck N, Cameron DA. Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer. N Engl J Med. 2022 Jun 5. doi: 10.1056/NEJMoa2203690. Epub ahead of print. PMID: 35665782.

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Welcome to this episode of the Physician’s Weekly Podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. On 24 February 2022, Russia invaded Ukraine, and by March 14th the WHO declared that Ukraine health facilities were ‘stretched to breaking point’. The United Nations have declared a humanitarian crisis of enormous proportions. Beyond hanging gold and blue flags of support, many physicians here in the US have jumped into the fray, eager to help with their professional services.

Today we have an IN-DEPTH style episode, interviewing 2 Ukrainian-American doctors who have gone to Ukraine and delivered their expertise in addition to much needed supplies.

Physician’s Weekly’s Chris Cole interviews Dr. Oleg Turkot first. He is an Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital, in Maryland. Dr. Turkot entered Ukraine on 28th February with 2 dozen ultrasound Butterfly portable ultrasound probes donated by the Butterfly Network, which can be connected to most mobile phones and being so portable, can be used at frontline hospitals. Using ultrasound to locate shrapnel, he compared most Ukrainian hospitals to a Trauma Bay in US hospitals, and he describes teaching doctors there on the ground how to utilize basic needle guidance techniques in chicken breasts.

I next speak to an old friend and colleague, Prof Gennady Bratslavsky, the Chair of the Urology Department, specializing in Urologic Oncology at Upstate SUNY in Syracuse, NY. Prof Bratslavsky’s wife Katya sold nearly $300K of her art to fund the purchase of 2 ambulances and the transport of tons of medicine by a military plane. He tells, how after a 20-hour trip in an ambulance packed with supplies from Poland, showing up at the Ukrainian border with his American passport, made the border patrol think he was crazy.

Both of our guests in this week’s episode have amazing stories. Enjoy Listening!

More information, and the websites mentioned by our guests:

https://m.facebook.com/butterflynetinc/photos/a.352492691501365/4895646557185933/?type=3&locale=hi_IN&_rdr

http://www.katyabratslavsky.com/

https://kybeleworldwide.org/https://worldofconnections.org/https://t2t.org/a-ukraine-donation/

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Welcome to this episode of Physician’s Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers in collaboration with Physician’s Weekly. And yes, this week I am grateful to have my voice at all, after 3 days of viral laryngitis.

This week, women’s health has been all over the news, and that will be the topic of this week’s InDEPTH episode. May 8th through 14 was also the National Women’s Health Week, during which the U.S. Department of Health and Human Services’ Office on Women’s Health is encouraging women and girls to reflect on their individual health needs and take steps to improve their overall health. The lenses of this InDEPTH dive are access to care and practice setting.

Women’s health remains a major problem in the US. In this episode we first take a look at maternal mortality in the US; the rate in the United States is roughly 20 maternal deaths per 100,000 births (about 700 deaths among the approximately 4 million people who give birth each year). Those statistics are not going down, but up for the last 15 years. American women today are 50% percent more likely to die because of pregnancy-related health issues than their mothers were. We interview Dr. Charles Jaynes, Vice President, Clinical Operations, Ob Hospitalist Group to understand the many factors that cause pregnancy and childbirth to remain unusually risky in the U.S. Based on recent CDC data, the leading causes of pregnancy-related deaths are cardiovascular conditions, infection, and hemorrhage.

With hypertension and heart disease being major contributors to maternal morbidity, our second interview takes a deeper dive into the factors that can facilitate timely detection of cardiovascular disease, particularly in women. Physician’s Weekly senior editor Martta Kelly interviews Dr. Carlos Iribarren, of the Kaiser Permanente Division of research in Oakland CA about his recent study, from the MINERVA cohort study of over 5000 women.

They talk about how over the past decade, total and premature CVD deaths among women in the United States increased by 20,000 between 2009 and 2019. In addition to mortality, morbidity related to CVD has also increased, particularly among younger women. In the Atherosclerosis Risk in Communities Study between 1995 and 2014, the proportion of hospitalizations for acute myocardial infarction in young adults aged 35 to 54 years increased for women in contrast with a decline for men. To curb the growing burden of CVD morbidity and mortality among women, innovative approaches to improve risk prediction and prevention of CVD are needed. Breast arterial calcification (BAC), a form of medial artery calcification that can be detected on routine mammography, has been proposed as a sex-specific marker for CVD risk among women. However, in contrast to coronary artery calcium, the biologic basis and clinical utility of BAC remains unclear given nearly two-thirds of United States women over the age of 40 undergo routine screening mammography every 1 to 2 years, the potential value of BAC for CVD risk estimation could impact millions of women without incurring extra cost or radiation exposure. The interview with Dr. Iribarren talks about their recently published data

One note about Dr. Jaynes interview: he refers to ACOG a few times, which is an abbreviation for The American College of Obstetricians and Gynecologists, and also to the monthly journal published by that professional society as the “Green Journal”.

Enjoy listening!

More reading:

https://www.womenshealth.gov/nwhw/about

Iribarren C, Chandra M, Lee C, Sanchez G, Sam DL, Azamian FF, Cho HM, Ding H, Wong ND, Molloi S. Breast Arterial Calcification: a Novel Cardiovascular Risk Enhancer Among Postmenopausal Women. Circ Cardiovasc Imaging. 2022 Mar;15(3):e013526.

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Welcome to this episode of Physician’s Weekly podcast. Today we are going to talk about tools that help primary physician’s stay in control.

I am this podcast’s host, Dr. Rachel Giles, from Medicom Medical Publishers in collaboration with Physician’s Weekly. Physician’s Weekly is trying out a new editorial initiative, inDEPTH; DEPTH is an acronym for Diverse, Evidence-based Perspectives in Today’s Healthcare. Instead of a traditional point/counterpoint format in which two opposing sides of a given issue present their case, inDEPTH views the same issues through different lenses, allowing for diverse, reasonable, evidence-based conclusions to coexist. These sourced viewpoints both create visibility into how different colleagues interpret and address key issues, as well as serve to expand clinicians’ frame of reference—all to achieve better patient care and enhance physicians’ day-to-day practice of medicine.

For decades, doctors have been able to monitor a patient’s healthcare progress through electronic medical records. Ironically, there was no way to measure the physicians who were caring for them or what happens to patients outside the exam room.

Today’s episode features 2 interviews from family practitioners who use a new technology in their practices to tackle this problem, called Physician Insights, which was created by Agilon Health and adopted by more than 14 primary care practices across the USA. The Physician’s Insight tool uses artificial intelligence and other technology tools to measure how efficiently and effectively a physician is meeting quality patient care standards.

Here to tell us more about how they use the Physician Insights tool and how it helps their practices are Dr. Kristin Oaks, family physician at Central Ohio Primary Care in Columbus, OH, and Dr. Lou Civitarese, family physician at Preferred Primary Care Physicians in Pittsburgh, PA.

Enjoy listening!

For more information on Physician Insights Tool see: www.agilonhealth.com

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. This episode has 2 inDEPTH interviews with top-line specialists who just published studies we think are interesting to our physician colleagues.

Both interviews were conducted by Physician’s Weekly’s own Senior Editor Martta Kelly. Later in this episode, she interviews Dr. Lihi Eder, from the Women’s College Research Institute and University of Toronto, in Canada about biomarkers of cardiovascular disease in patients with psoriatic disease, which her research group just published in Arthritis & Rheumatology. The researchers wondered if 2 biomarkers may reflect atherosclerosis burden independent of traditional cardiovascular risk factors in over 1000 patients with psoriatic disease with a mean follow-up of over 7 years. The first clinical CV event was the study’s primary endpoint. Keep listening to find out the results.

But first, Physician’s Weekly speaks with Dr. Heather Schickedanz. Dr. Schickedanz is a geriatrician affiliated with multiple hospitals, including UCLA Medical Center, in Los Angeles. When researchers first discovered a link in the late 1990s between childhood adversity and chronic health problems later in life, the real revelation was how common those experiences were across all socioeconomic groups.

Adverse childhood experiences (ACEs) are universal, yet highlights some disparities among socioeconomic groups. People with low-income and educational attainment, people of color, and people who identified as gay, lesbian or bisexual had a significantly higher chance of having experienced adversity in childhood.

It is estimated that three out of five adults across the U.S. had at least one adverse experience in their childhood, such as divorce, a parent's death, physical or emotional abuse, or a family member's incarceration or substance abuse problem. A quarter of adults have at least three such experiences in childhood, which – according to other research — increases their risk for most common chronic diseases, from heart disease and cancer to depression and substance abuse. Here we talk to Dr. Schickendanz about her recently published research on the association between Adverse Childhood Experiences and Dementia in American Older Adults.

Enjoy listening!

Colaco K, Lee KA, Akhtari S, Winer R, Welsh P, Sattar N, McInnes IB, Chandran V, Harvey P, Cook RJ, Gladman DD, Piguet V, Eder L. Association of Cardiac Biomarkers with Cardiovascular Outcomes in Patients with Psoriatic Arthritis and Psoriasis: A Longitudinal Cohort Study. Arthritis Rheumatol. 2022 Mar 8. doi: 10.1002/art.42079. Epub ahead of print. PMID: 35261189.

Schickedanz HB, Jennings LA, Schickedanz A. The Association Between Adverse Childhood Experiences and Positive Dementia Screen in American Older Adults. J Gen Intern Med. 2021 Nov 15. doi: 10.1007/s11606-021-07192-8. Epub ahead of print. PMID: 34782990.

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In this episode, we focus on the clinical value of gene expression profiling tests to analyze a number of different genes in breast cancer cells to predict the risk of cancer recurrence, and to provide insight into the biological natural history of the individual tumor. The results of gene expression profiling tests can help determine who may benefit from adjuvant treatment after surgery.

Notably, this year is the 20th anniversary of the 2 seminal papers which showed that gene expression could predict clinical outcomes for breast cancer patients. That 70-gene signature, which later became Mammaprint, was published first in Nature, and then followed up a few months later with survival data in a publication in the New England Journal of Medicine.

Today we speak with the first author of the most recent New England Journal of Medicine paper, from 2016, demonstrating the clinical value of MammaPrint as a decision aid for early breast cancer, Dr. Fatima Cardoso (Director Breast Unit Champalimaud Clinical Center Lisbon, Portugal). This result from the MINDACT study was followed up in a 2021 Lancet Oncology publication, which provided level 1 evidence of the validity of that 70-gene signature. We also interview Dr. William Audeh (Chief Medical Officer at Agendia BV, CA) to discuss the implications of the MINDACT trial and the added value of the genomic profiling tools MammaPrint and Blueprint. Dr. Audeh also touches upon the FLEX study, which provides whole transcriptome data linked with a clinical database annotated with over 800 clinical characteristics, over 90 sites in USA and > 9K patients enrolled with the ambition to enroll 30K. We also touch upon new data from the I-SPY trial, which indicates that within the high-risk region, there is also information to be gained by stratifying patients into High Risk 1 and 2 categories. Enjoy listening!

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March is National Kidney Month, which brings awareness to kidney health, which in turn is a global public health burden. For this last episode of Physician’s Weekly podcast this March of 2022, we wanted to highlight a recent publication about the use of diuretics in patients with chronic kidney disease, or CKD, with a prevalence of 11% in the USA . Diuretics are useful in the management of most patients with CKD because they reduce ECF volume; lower blood pressure; potentiate the effects of ACE inhibitors, ARBs, and other antihypertensive agents; and reduce the risk of cardiovascular disease in CKD.

Physician’s Weekly’s Senior Editor Martta Kelly interviews Dr. Alan S Go, of the Kaiser Permanente of Northern California, whose team looked at the effect of diuretics on renal outcomes among nearly 48K adults with chronic kidney disease. Loop and thiazide class diuretics are an important part of guideline-directed medical therapy for patients with CKD with hypertension, edema, metabolic acidosis and/or hyperkalemia. Yet diuretics can be also be associated with acute elevations in serum creatinine and electrolyte derangements. Whether diuretics result in direct kidney injury versus benign hemoconcentration of serum creatinine remains controversial, which was the rationale behind this large study.

But first, March is also famous for MATCH DAY from the National Resident Matching Program (NRMP). Match Day is when domestic and international medical school students and graduates learn in which U.S. residency programs they will train. Naturally this is extremely important to the careers of all residents and it is coupled with high stress and anxiety, as well as questions about how best to prepare. Some recent participants set up a Resident-led platform, called Inside The Match, with information, help reviewing your applications, and a podcast series to provide everything you wanted to know about the residency match process but were too afraid to ask.

Physician’s Weekly interviews psychiatry resident and co-founder Simone Bernstein, previously recognized as a social entrepreneur in Forbes’ 30 under 30 list. She is truly a mover and shaker!

Enjoy listening!

Additional reading:

https://www.insidethematch.com/
Fitzpatrick JK, Yang J, Ambrosy AP, Cabrera C, Stefansson BV, Greasley PJ, Patel J, Tan TC, Go AS. Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study. BMJ Open. 2022 Jan 31;12(1):e048755.

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. This week’s episode has 2 in-depth interviews that we are pretty certain you will enjoy.

Later in this episode, Physician’s Weekly speaks with Professor Richard Sullivan, Professor of Cancer and Global Health at King’s College London, and Director of the Institute of Cancer Policy (ICP) and co-Director of the Conflict and Health Research Group. Prof. Sullivan's studies the impact of conflict on health. Professor Sullivan qualified in medicine and trained in surgery (urology), gaining his PhD from University College London. He was also clinical director of Cancer Research UK between 1999 and 2008. Prof. Sullivan talks about the Russian invasion of Ukraine and how healthcare there will be drastically affected.

But first, Physician’s Weekly’s correspondent talks with our regular contributor, Dr MedLaw. Dr MedLaw is a board certified radiologist as well as a medical malpractice attorney, and today she turns her focus on expert witnesses, how are they selected, what are the expectations, and she gives some juicy bad examples of expert witnesses as well.

Enjoy listening!

That’s all the time for this episode of the Physician’s Weekly podcast. Stay healthy and stay safe!

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Later in this episode, Physician’s Weekly speaks with Dr. Stephen Thomas, Director of the University of Maryland Center for Health Equity and from the Health Advocates in Reach and Research (HAIR) program about Building Trust, Styling Hair, Saving Lives. University of Maryland researchers and HAIR health advocates are part of a large and growing network of scientists, academics, barbers and other community advocates working to improve the health of vulnerable communities through the unique environments of Black barbershops and salons. Dr Thomas is an amazing storyteller and was so fascinating, that we gave him twice the amount of time we usually plan for our guests. I can almost guarantee this will be the best story you have heard today.

But first, Physician’s Weekly’s Senior Editor Martta Kelly interviews Dr Randall M Clark. Dr. Clark is professor of anesthesiology at the University of Colorado School of Medicine in Aurora, Colorado and a pediatric cardiac anesthesiologist at Children’s Hospital Colorado. He is also the current president of the American Society of Anesthesiologists (ASA), the nation’s largest organization of physician anesthesiologists. He talk about how a new (February 22, 2022) joint statement issued by the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation (APSF) points to data that all elective surgical procedures should be delayed at least 7 weeks after COVID-19 infection in unvaccinated patients. What is the appropriate length of time between recovery from COVID-19 and surgery/procedure with respect to minimizing postoperative complications?

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

Although opioids relieve burn injury-related pain, they have serious adverse side effects. Prior studies have investigated alternative approaches to pain reduction in burn injury patients that focus on distraction, such as music, hypnosis, toys, and virtual reality.

In this episode, Physician’s Weekly’s Senior Editor Martta Kelly interviews Dr. Thomas Delate, a research scientist at Kaiser Permanente, about his study on the value of telementoring services in educating prescribers about chronic pain management, including opioid prescriptions , recently published in Clinical Journal of Pain.

Also in this episode, we speak with Dr., an Associate Professor of geriatric medicine at the University of Florida, about developments in dementia care in our ever-increasing aging population.

But first, we speak with our regular expert contributor with the pseudonym Dr. Medlaw how physicians should approach expert witnesses as a defendant in a malpractice lawsuit.

That’s it for this week’s podcast. Thanks for listening. Stay safe and stay healthy.

Gersch WD, Delate T, Bergquist KM, Smith K. Clinical Effectiveness of an Outpatient Multidisciplinary Chronic Pain Management Telementoring Service. Clin J Pain. 2021 Jul 12. doi: 10.1097/AJP.0000000000000967. Epub ahead of print. PMID: 34265787.

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. There was a lot of interesting medical news this last week. Later in this episode, we interview Dr. Samer Al Hadidi, from Little Rock, Arkansas, who the lead author of a study about the lack of enrollment of African-American patients into trials in general, and here in particular, trials that were used to register the use of CAR-T cell therapies for the treatment of various hematological malignancies. He presents some interesting solutions that can be applicable to all trials.

Also in this episode of Physician’s Weekly Podcast, we speak to our regular contributor, who goes by the pseudonym, Dr. MedLaw all about what “Causality” means in the courtroom. When is a doctor the cause of a medical problem, and what can be done about it?

But first, Physician’s Weekly speaks with Dr. Eric Jonasch, from the University of Texas MD Anderson Hospital in Houston, about the results of the his recently published New England Journal of Medicine article reporting the registrational data for a small molecule belzutifan in patients with the rare tumor syndrome von Hippel-Lindau disease, abbreviated as VHL. I have had the distinct honor of knowing hundreds of VHL patients over the last 20 years, and this study has truly become a landmark breakthrough for patients dealing with tumors in their kidneys, pancreas, adrenal glands, brain or spinal cord, eyes, endolymph sacs, epididymis, or broad ligament. It was FDA approved in August 2021, and the patient and medical VHL community is so relieved to have a systemic treatment finally.

Enjoy listening!

More reading:

Jonasch E, Donskov F, Iliopoulos O, Rathmell WK, Narayan VK, Maughan BL, Oudard S, Else T, Maranchie JK, Welsh SJ, Thamake S, Park EK, Perini RF, Linehan WM, Srinivasan R; MK-6482-004 Investigators. Belzutifan for Renal Cell Carcinoma in von Hippel-Lindau Disease. N Engl J Med. 2021 Nov 25;385(22):2036-2046. doi: 10.1056/NEJMoa2103425. PMID: 34818478.

Al Hadidi S, Dongarwar D, Salihu HM, Kamble RT, Lulla P, Hill LC, Carrum G, Ramos CA, Heslop HE, Usmani SZ. Health disparities experienced by Black and Hispanic Americans with multiple myeloma in the United States: a population-based study. Leuk Lymphoma. 2021 Dec;62(13):3256-3263. doi: 10.1080/10428194.2021.1953013. Epub 2021 Jul 18. PMID: 34278937.

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

There was a lot of interesting medical news this last week. For example, there was the first transplant of a genetically modified pig heart into a human (the recipient was David Bennet Sr), and at the time of this recording he is still doing well. However, Mr Bennet’s criminal past stirred up ethical questions about who deserves access to the scarce supply of human organs in the US.

There was also a paper published in the journal Science which garnered attention, after over 50 years of research, since the very first paper in 1972, which finally answered the question about whether infection with Epstien-Barr virus, or EBV, which causes mononucleosis, places people at a much higher risk of multiple sclerosis.

The answer is yes, it puts people at a 34-fold higher risk, and to put that into perspective, smoking only puts people at <30-fold higher risk of lung cancer. Later in this episode, we interview the lead study author, Professor Alberto Ascherio, at Harvard University, and he describes how they had to screen 10 million young adults to prove that infection with EBV ALWAYS precedes MS.

Also in this episode of Physician’s Weekly Podcast, we speak to our regular contributor, who goes by the pseudonym, Dr MedLaw about what “standard of care” means in the courtroom, and how clinical guidelines can be used.

But first, Physician’s Weekly speaks with Dr. Manali Kamdar, from the University of Colorado, about the results of the TRANSFORM study, which demonstrated that CAR T cells are an effective and safe therapy for the second line in diffuse large B-cell lymphoma. She presented the interim results as a Late-breaking abstract at the American Society of Hematology Annual Meeting a few weeks ago. She does a great job introducing herself.

Enjoy listening!

More reading:

Bjornevik K, Cortese M, Healy BC, Kuhle J, Mina MJ, Leng Y, Elledge SJ, Niebuhr DW, Scher AI, Munger KL, Ascherio A. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022 Jan 21;375(6578):296-301.

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Patients want to learn about medical errors that affect their health. Most physicians support error disclosure and believe they have an ethics obligation to disclose harmful errors to their patients or families, even if this disclosure comes at a personal or professional cost. However, in practice, physicians typically do not disclose harmful errors to patients. In a survey of U.S. physicians published in 2007, 320 (95%) of the 338 responding physicians indicated that they felt obligated to tell patients about such a mistake; however, only 41% of respondents reported that they had in practice disclosed minor harmful errors to their patients, while only 5% reported that they had disclosed major errors. Clearly, a discrepancy exists between physicians' desire to disclose and their practice of disclosing errors. In this episode of Physician’s Weekly, we speak to our regular contributor, who goes by the pseudonym, Dr MedLaw about which legal malpractice aspects should be considered when errors may have occurred, and when it is and is not appropriate to apologize.

Also in this episode, we speak with Dr Shauna Newton, from Massachusetts General Hospital, about how in young adults between 20 and 39 years of age with high cholesterol levels, guidelines are simply not being met in a large multicenter study, and that there are some undefined elements for how to treat patients in this age group. She recently presented her results at the American Heart Association’s Scientific Sessions.

But first, Physician’s Weekly speaks with Dr Björn Meyer, in Germany, who is an expert in the in the development and evaluation of computer-based psychological treatments for various psychiatric and physical conditions, including randomized controlled trials of internet interventions. To date 4 of his team’s programs have shown clear clinical benefit in randomized controlled trials and are reimbursed by insurance in Germany. We talk about how this approach can really make a difference to closing gaps in access to care in traditionally underserved communities. He does a great job introducing himself.

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Roman Shinder, MD from the Department of Ophthalmology at SUNY Downstate Medical Center in New York, on initial data at the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery, held in New Orleans from November 11 to 12, 2021 looking at efficacy of teprotumumab as monotherapy for the treatment of dysthyroid optic neuropathy [1].

Yuming Guo, MD PhD, Professor of Global Environmental health at Monash University, in Australia, about the link with global wildfires to human health, which was published in the New England Journal of Medicine and the Lancet Planet Health [2,3].

Alexander Blood, MD, from Brigham and Women’s Hospital, Massachusetts, the first author of the current study, about his presentation at the late-breaking session at the American Heart Association Scientific Sessions held Nov 13-15, 2021 [4], on an ongoing remote digital care program to manage hypertension and hypercholesterolemia

Further reading:

Artymowicz A, Shinder R. Teprotumumab as monotherapy for dysthyroid optic neuropathy. Poster presented at: American Society of Ophthalmic Plastic & Reconstructive Surgery 2021 Annual Meeting; November 12-15, 2021; New Orleans, LA.
Xu R, Yu P, Abramson MJ, Johnston FH, Samet JM, Bell ML, Haines A, Ebi KL, Li S, Guo Y. Wildfires, Global Climate Change, and Human Health. N Engl J Med. 2020 Nov 26;383(22):2173-2181.
Chen G, Guo Y, et al. Mortality risk attributable to wildfire-related PM2·5 pollution: a global time series study in 749 locations. Lancet Planet Health. 2021 Sep;5(9):e579-e587
Blood AJ, et al. Digital Care Transformation: Report from the First 10,000 Patients Enrolled in a Remote Algorithm-based Cardiovascular Risk Management Program to Improve Lipid and Hypertension Control. LBS02, AHA Scientific Sessions 2021, 13–15 November.

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Did you know? According to a report published by the WHO, adherence rates in developed countries average only about 50%, and there is little data about adherence in countries where access to care is more limited or consistent. Adherence is a key factor associated with the effectiveness of all pharmacological therapies but is particularly critical for medications prescribed for chronic conditions. Of all medication-related hospitalizations that occur in the United States, between one-third and two-thirds are the result of poor medication adherence. Inadequate adherence also is a major player in adverse events to medications.

Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. We have 3 fantastic in-depth interviews for you this week, touching on improved hospital workflow for stroke patients, a presentation on management of gout in dialysis patients, and medication experience.

In this 31st episode of the Physician’s Weekly Podcast, we speak with Dr Danny Sands, about addressing barriers such as understanding their condition, cultural issues, and denial can help patients avoid adverse effects from poor medication adherence. Dr Sands is a primary care physician at Beth Israel Deaconess Medical Center, and is a founder and co-chair of the board of the Society for Participatory Medicine. In 2009 he was recognized by HealthLeaders Magazine as one of “20 People Who Make Healthcare Better.”

Also in this episode, we speak with Dr Anthony Bleyer, Professor of nephrology at the Wake Forest School of Medicine, North Carolina, about his presentation of the results of a cohort study into the prevalence, risk factors and outcomes of gout in dialysis patients at the Kidney Week of the American Society of Nephrology, which was held virtually 4-7 November, 2021 [1].

But first, Physician’s Weekly speaks with Ferdinand Hui, about workflow optimization and mobile technology. Dr. Hui hails from Johns Hopkins – but is currently working in Hawaii- and we talk about the deluge of communication apps in hospitals and what makes something valuable, versus noise. He recently published a paper in Journal of Neurointerventional Surgery [2] on the impact of mobile apps on treatment times for patients with stroke where time is of the essence. His team showed that that utilization of RapidAI mobile application can significantly reduce treatment times in stroke care by accelerating the process of mobilizing stroke clinicians and interventionalists.

Enjoy listening!

Further reading:

Bleyer AJ, et al. Risk Factors and Outcomes of Gout in Dialysis Patients: A Cohort Study of the United States Renal Data System (USRDS). PO0792, American Society of Nephrology: Kidney Week 2021, 04-07 November.
Murray NM, Unberath M, Hager GD, Hui FK. Artificial intelligence to diagnose ischemic stroke and identify large vessel occlusions: a systematic review. J Neurointerv Surg. 2020 Feb;12(2):156-164.

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In this 30th episode of the Physician’s Weekly Podcast, we speak with Dr Raman Muthsamy from UCLA, about a surgery-free and medicine-free approach to treat gastroesophageal reflux disorder (GERD), called transoral incisionless fundoplication (TIF) which can have durable results.

Also in this episode, we speak with our regular contributor who goes by the pseudonym Dr MedLaw, about what a “jury of peers” might mean for a doctor testifying. As she points out, it will be unlikely that there will be anyone with medical knowledge on that jury, so what then?

But first, Physician’s Weekly speaks with Dr Rupert Bartsch from Vienna, Austria about their recently presented research in treating brain metastases in HER2-positive breast cancer with antibody-drug conjugate trastuzumab deruxtecan. This is our last segment on breast cancer in recognition of October being Breast Cancer Awareness Month.

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Breast cancer is the most common cancer among women, apart from skin cancers. According to the National Breast Cancer Foundation, Inc., about 1 in 8 American women will experience this cancer in their lives. Breast cancer is an incredibly difficult disease to fight or to watch a loved one go through. Raising awareness of the scope and seriousness of this disease is one of the most important and impactful functions of breast cancer events and promotional items. Fundraising events, such as walks and fun runs, have become a common way to raise awareness about this issue and financially support the people and families who have been affected by this disease. Individuals as well as nonprofit organizations like the Susan G. Komen Breast Cancer Foundation and Breastcancer.org have taken it upon themselves to earn money for breast cancer research. One of the slogans often used is, Breast Cancer Awareness Is Not Just a Month.

Later in this podcast, Physician’s Weekly’s Senior Editor Martta Kelly interviews Dr John Barbieri , Dermatologist at Brigham and Women's Hospital in Boston about cardiovascular risk factors in patients with psoriasis and psoriatic arthritis. We know that patients with psoriasis and psoriatic arthritis have an increased risk of cardiovascular mortality, but are less likely to have traditional cardiovascular risk factors identified and managed. This is a major evidence to practice gap. To improve the prevention of cardiovascular disease in patients with psoriatic disease, Dr Barbiera lays out some pragmatic approaches for physicians.

Also in this podcast, we’re back again this week with Physician’s Weekly regular contributor, known by the pseudonym Dr. MedLaw, a board-certified radiologist and medical malpractice attorney. Today she takes a deep dive in the doctor-patient privilege, what that means, when and how it can be used, and why it is important. Did you know that patient privilege came about as a public health intervention to prevent the spread of venereal disease?

But firstly, in honor of Breast Cancer Awareness Month, today we will kick off our podcast with an interview with Dr. Marco Timmers, the CEO of up-and-coming pharmaceutical company Byondis, who presented their initial data from the phase 3 TULIP trial in breast cancer patients during the Presidental Symposium at the European Society of Medical Oncology, just a few weeks ago. Their new antibody-conjugate drug, called trastuzumab duocarmazine was compared to the physician’s choice for the 3rd line setting in 436 metastatic HER2-positive breast cancer. The results showed impressive efficacy in the initial topline results.

Enjoy listening.

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Welcome to this episode of Physician’s Weekly Podcast, in collaboration with Physician’s Weekly. We have 3 fantastic in-depth interviews for you this week.

The European Society of Medical Oncology ended a few days ago and later in this episode, I had the opportunity to speak with Dr. Javier Cortes, in Barcelona, Spain about his Presidential Symposium late-breaking presentation held at that meeting, in which he revealed the data from the much-anticipated phase 3 DESTINY-Breast03 trial for patients with advanced breast cancer. The results of the antibody-drug conjugate trastuzumab deruxtecan compared head-to-head with the current standard, called TDM1, were practice-changing, with spectacular efficacy (I am not sure I have ever seen a P-value with 22 zeros) and excellent safety outcomes.

Also in this episode, our correspondent Dylan Prentner speaks with pediatrician Umbereen Nehal, who was Chief Medical Officer and Vice President of Medical Affairs for Community Healthcare Network in New York city. In addition, Dr. Nehal led a nationwide campaign as chair of the Task Force of American Muslims for Affordable Health Care that was conducted in conjunction with the White House, where she leveraged community resources to educate and enroll American Muslims in new health coverage options. In recognition of this work, Nehal was honored by an invitation from President Barack Obama to the White House. Dr. Nehal talks with us about how to find the balance of hope and humanism in what she says is a system of perverse incentives.

But first, Physician’s Weekly speaks with dermatologist Dr Sophie Weatherhead from Newcastle, UK about their recently published research in phototherapy and psoriasis .

Further reading:

Watson N, Wilson N, Shmarov F, Zuliani P, Reynolds NJ, Weatherhead SC. The use of psoriasis biomarkers, including trajectory of clinical response, to predict clearance and remission duration to UVB phototherapy. J Eur Acad Dermatol Venereol. 2021 Jul 13. doi: 10.1111/jdv.17519. Epub ahead of print. PMID: 34255884.

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This podcast is sponsored by Anelto, a leading technology platform that enables innovative healthcare solutions to keep seniors connected to healthcare providers from anywhere. Visit www.anelto.com.

Welcome to this episode of Physician’s Weekly Podcast. My name is Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. We have 3 great in-depth interviews for you this week covering a new trial with promising results to relieve common lower back pain, remote patient monitoring of senior citizens, and a trial showing that having COVID patients position themselves in the prone position, so-called “awake prone positioning”, has improved outcomes in patients with severe COVID-19.

Todd Alamin, MD, spinal surgeon at Stanford University: About 140,000 back pain patients are treated with lumbar fusion in the US every year, and we discuss their clinical trial data suggesting that perioperative outcomes are far better using a perispinous tension band after decompression, as opposed to lumbar fusion after decompression, with at least identical, if not better, long term results

Later in this episode, Physician’s Weekly speaks with Jie Li, PhD, RRT, RRT-ACCS, RRT-NPS from Rush University in Chicago and Professor Stephan Ehrmann, MD, PhD, from the Intensive Care Unit at the University Hospital in Tours, France about their recent study published in the Lancet Respiratory Medicine looking at awake prone positioning in patients with severe COVID-19. In this prospectively designed, multicenter, international, randomized, open-label meta-trial, with a large sample size (1121 patients), these 2 researchers found that awake prone positioning reduced the incidence of treatment failure within 28 days of enrolment (the primary composite outcome of intubation or death) in patients with acute severe hypoxemic respiratory failure due to COVID-19 supported with high-flow nasal cannula.

Also in this episode, our correspondent Dylan Prentner speaks with Mark Denissen , the President and Chief Executive Officer of Anelto aboutremote patient monitoring (RPM) of seniors by real-time symptom tracking. Anelto RemoteCare tracks patient engagement, identifies common requests, questions, and commands; and even tracks user responses and adherence to protocols with alerts and reminders.

Technologies such as Remote Patient Monitoring are helping transform senior patient care, ensuring patient safety and well-being while continuing to live independently. Most RPM solutions are not developed specifically with the senior population in mind, especially those with chronic conditions. For seniors, RPM needs to be a complete solution that is easy to use with 24/7 access to care management providers. Visit www.anelto.com.Ehrmann S, Li J, et al; Awake Prone Positioning Meta-Trial Group. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med. 2021 Aug 20:S2213-2600(21)00356-8.

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An interview with lead investigator on full results from EMPEROR-Preserved Trial, which affirm that empagliflozin lowers the risk of CVD for heart failure in patients with HFpEF.

Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly. This week I am recording this episode in the Italian alps, while attending the European Association of Urology Guidelines Panel meeting for Renal cell carcinoma, but we have 2 great in-depth interviews for you this week.

Later in this episode, Physician’s Weekly’s Editorial Director Chris Cole interviews Dr. J. Stacey Klutts, a medical microbiologist at Rush University, about his op-ed in the Tampa Bay Times comparing the Delta variant of SARS-CoV-2 to Gorilla Glue, which went viral. And yes, the pun was intended. Dr Klutts also tells us about exactly how the vaccine was developed and how the Delta variant is detected in patients. Did you know there are currently 13 subtypes of the Delta variant?

But first, we speak with the presenter at the European Society of Cardiology Annual Congress HOTLINE plenary talk, prof. Stefan Anker at the Charité Hospital in Berlin, Germany, about the full results of the EMPEROR-Preserved trial, which affirm that empagliflozin lowers the risk of cardiovascular death/hospitalization for heart failure in patients with heart failure and preserved ejection fraction (HFpEF), leading one expert to say this is “a big day for patients living with HFpEF, a big day for heart failure clinicians.”

The primary endpoint—a composite of CV death and hospitalization for heart failure—was reduced by a relative 21% in patients treated with the sodium-glucose cotransporter 2 (SGLT2) inhibitor emagliflozin.

Published simultaneously online in the New England Journal of Medicine, these results represent the first trial to show unequivocal benefit of any drug on major heart failure outcomes in patients with heart failure and a preserved ejection fraction.

Anker SD, et al; EMPEROR-Preserved Trial Investigators. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021 Aug 27.

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

At the start of the COVID-19 pandemic, stay-at-home orders and other restrictions drastically affected how people lived and worked, resulting in social isolation and economic instability. Not surprisingly, presented at the American Chemical Society which was held Aug. 22-26,, researchers show that some people turned to a variety of drugs for relief. Using wastewater analysis, the team lead by Dr Bikram Subedi identified a spike in consumption of easily abused prescription opioids and anti-anxiety sedatives, while some illicit drug use plummeted, between March and June 2020. Their results showed that consumption of hydrocodone — one of the most abused prescription opioids — spiked by 72% from March to June 2020. The researchers suggest the change was because people had easier access to doctors as they switched to telemedicine appointments. Conversely, the use of illicit stimulants dropped by 16% for methamphetamine and 40% for cocaine. The researchers suggest that travel restrictions limited interstate and international trafficking of these drugs.

These data strongly suggest that there is an unmet need in multidisciplinary telementoring services to reduce opioid use in the outpatient setting. In this episode, Physician’s Weekly’s Senior Editor Martta Kelly interviews Dr. Thomas Delate, a research scientist at Kaiser Permanente, about his study on the value of telementoring services in educating prescribers about chronic pain management, including opioid prescriptions , recently published in Clinical Journal of Pain. I think you will be surprised by the efficacy of this approach.

Also in this episode, we speak with our regular expert contributor with the pseudonym Dr. Medlaw on how physicians how to “knock it out of the park” while giving a deposition in a malpractice case and the key elements in preparing to testify.

But first, we speak with Dr. Bruce Brod, a Professor of Dermatology at University of Pennsylvania, and spokesperson for the America Association of Dermatology, about developments in the treatment and understanding of one of the most common diseases in humans, eczema or atopic dermatitis, which affects up to 30% of children.

That’s all the time we have for this week’s podcast. Thanks for listening, I hope you learned something about telementoring for chronic pain relief, about the pathophysiology of atopic dermatitis, and about the best way to go about testifying in a court of law. Stay safe and stay healthy.

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Welcome to this episode of Physician’s Weekly Podcast. My name is Dr Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician’s Weekly.

According to the American Burn Association, burn injuries affect approximately 250,000 children in the United States each year. The pain associated with burn injuries extends beyond the injury itself; there is also significant pain from dressing changes, which can be exacerbated by the anxiety of anticipating this additional pain.

In this episode, Physician’s Weekly’s Senior Editor Martta Kelly interviews Dr. Henry Xiang about his research on the use of smartphone-based virtual reality games during dressing changes in pediatric patients with burn injuries, recently published in JAMA Network Open.

Also in this episode, we speak with Dr. Benjamin Bensadon, an Associate Professor of geriatric medicine at the University of Florida, about developments in dementia care in our ever-increasing aging population.

But first, we speak with our regular expert contributor with the pseudonym Dr. Medlaw how physician’s can avoid coming across like a jerk while giving a deposition in a court of law.

Xiang H, Shen J, Wheeler KK, Patterson J, Lever K, Armstrong M, Shi J, Thakkar RK, Groner JI, Noffsinger D, Giles SA, Fabia RB. Efficacy of Smartphone Active and Passive Virtual Reality Distraction vs Standard Care on Burn Pain Among Pediatric Patients: A Randomized Clinical Trial. JAMA Netw Open. 2021 Jun 1;4(6):e2112082. doi: 10.1001/jamanetworkopen.2021.12082. PMID: 34152420; PMCID: PMC8218073.

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This week on Physician's Weekly...

About a third of multiple sclerosis patients find that oral fampridine improves their walking speed by about 25%. However, it is unknown whether fampridine can also improve upper limb function. In a randomized trial run by neurologist Dr. Maria Gaughan at University College Dublin, Ireland addresses this question.

There are many reasons a defense lawyer asks for a case to be dismissed by the Court. But what are the conditions under which a malpractice suit can be dismissed? Dr. MedLaw, as always, provides a clear and practical answer to that question.

Dr. Linda Girgis, dedicated board-certified family physician in private practice and Editor in Chief of Physician’s Weekly discusses the landscape of primary care practice today with COVID.

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In an interview with Physician’s Weekly, Annie Sparrow, MD, Special Advisor to the Director-General, World Health Organization, implores the International Olympic Committee (IOC) to heed lessons of the past and warning signs for the future

This week, the world’s greatest athletes will gather together in Tokyo for the Olympics – and, unfortunately, so will COVID variants. Physician’s Weekly, a trusted source of medical news, voices the growing concern from the medical community of a post-Olympic spike in COVID cases in an interview with Annie Sparrow, MD, Assistant Professor, Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York.

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Do you remember that the Zika virus outbreak was a real concern at the Brazil Olympic Games of 2016? To find out if Japan has been able to learn from that experience, Physician’s Weekly speaks with Dr. Annie Sparrow, assistant professor of population, and health science, and policy at Mount Sinai Hospital in New York, about the potential risks for the Paralympics, held just one month later.

Also in this episode, our correspondent Kai Marshall speaks with our regular expert contributor with the pseudonym Dr. Medlaw about how a doctor should prepare for a deposition in a malpractice case: in a court of law, what should you wear? How should you act? What should you never, ever do?

First, we speak to Dr. Guy Jones, an Radiation Oncologist in Reno where he serves as the Medical Director for Oncology Nevada. SERMO, in case you don’t know of it, is a social media platform for physicians. Recently, Dr. Jones and colleagues polled over 70,000 physicians to generate the COVID-19 Real Time Barometer, gathering data about how physicians can counter vaccination resistance. For example, more than 72% of physicians surveyed said that patients continue to voice concerns over vaccine side effects. Still others have reported ongoing misinformation discouraging people from getting vaccines.

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This Week's interviews:

Alex McDonald, MD, Sports Medicine and Family Physician, Southern California Permanente Medical Group
Emmanuel Bartholomé, MD, Dept Head of Neurology, Brussels Free University, and Presenter at AAN 2021.
Dr. Medlaw, MD, JD, medical malpractice attorney, board certified radiologist, Physician's Weekly regular contributor.

Have you ever asked yourself how many kidneys does a single individual have during the course of their life? Hint: it is not two.

Host of Physician’s Weekly Podcast, Dr. Rachel Giles, will answer that riddle in the episode (listen to find out!)

In this episode of the Physician’s Weekly Podcast, we speak with our regular contributor with the pseudonym Dr. Medlaw about the patient’s responsibility in a malpractice lawsuit .

Also, Prof. Emmanuel Bartholomé on new data presented at the American Academy of Neurology 2021 about the phenomenon of smoldering lesions in multiple sclerosis.

But first we talk with Dr. Alex McDonald about the concept of Lifestyle Medicine: what it is and why we need it.

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This week's thought leaders include:

Sara Hurvitz, MD, UCLA Jonsson Comprehensive Cancer Center
Brady Scott, PhD, Respiratory Care at Rush University
Sallie McAdoo, Director of the Kidney Cancer Association
Dr. Medlaw, MD, JD, medical malpractice attorney, board certified radiologist

In a landmark case, a US jury has found a former police officer Derek Chauvin guilty of murder over the death of African-American George Floyd. From the medical point of view, one interesting and controversial aspect of this trial was of use of a video as evidence to prove the cause of death.

In this episode of the Physician’s Weekly Podcast, we spoke with our regular expert contributor with the pseudonym Dr. Medlaw about how videos can provide medical evidence for the murder of George Floyd.

Also in this episode, we interview Dr. Brady Scott, Associate Professor in the Division of Respiratory Care at Rush University about Lessons learned in critical care / respiratory care during the COVID-19 pandemic.

Medical Oncologist Sara Hurvitz, MD, at the UCLA Jonsson Comprehensive Cancer Center discusses a new clinical trial she is involved with taking a novel approach to treat breast cancer patients.

But first we talk with the medical director of the Kidney Cancer Association, Sallie McAdoo, about the need for kidney cancer awareness in honor of World Kidney Cancer Day on June 17th, 2021.

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