Primary Care Pearls – Details, episodes & analysis

In this episode our producer, Helen Cai, leads a far reaching conversation with Alissa (guest speaker on Breastfeeding episode) about the joys and challenges of raising children while pursuing rigorous medical training.

=== About Us ===

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

Hosts: Helen Cai

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Steve Adams, The Mini Vandals, Density & Time

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In this bonus episode, one of our producers, Helen Cai, dives deeper into the challenges and opportunities of training medical providers to be more competent and confident in guiding new parents through breastfeeding. Our expert is Dr. Deanna Nardella, MD, MHS, a Yale Pediatrician. 

=== About Us ===

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

Hosts: Helen Cai

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Schwartzy

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In this episode, Dr. Barenboim and Dr. Holt discuss the important role that medications and mutual support groups play in helping James maintain sobriety from alcohol.

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

=== Outline ===

Chapter 1: Managing Alcohol Withdrawal in the Outpatient Setting

Chapter 2: Medications for AUD

Chapter 3: Recovery Group/Social Support

=== Learning Points ===

1. Although our training has historically focused on the inpatient setting, managing alcohol withdrawal in the outpatient setting is also possible. A sample regimen for this may be 10mg diazepam every 6 hours on the first day, then every 8 hours on the second day, every 12 hours on the third day, and then once on day 4.
2. Medications approved by the FDA in the treatment of alcohol use disorder include: naltrexone, acamprosate, and disulfiram. Disulfiram is considered a first-line medication. 
3. Successful treatment of AUD often requires trying lots of combinations of interventions, which can include medications and non-pharmacologic interventions such as mutual support groups or therapy. The diversity of support groups is growing, making them more accessible to patients; but patients may need to trial many different groups before finding one that “works” for them.

=== Our Expert(s) ===

Dr. Stephen Holt attended Columbia University’s College of Physicians & Surgeons and subsequently completed his residency training and Chief Residency at Yale's Primary Care Internal Medicine Residency Program before joining the program as an Assistant Professor. He currently serves as the Associate Program Director for Ambulatory Education in the Primary Care Program. His areas of interest include addiction medicine, medical education, and the art and science of physical diagnosis. 

=== References ===

1. Tiglao SM, Meisenheimer ES, Oh RC. Alcohol Withdrawal Syndrome: Outpatient Management. Am Fam Physician. 2021 Sep 1;104(3):253-262. PMID: 34523874.
2. McPheeters M, O'Connor EA, Riley S, Kennedy SM, Voisin C, Kuznacic K, Coffey CP, Edlund MD, Bobashev G, Jonas DE. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023 Nov 7;330(17):1653-1665. doi: 10.1001/jama.2023.19761. Erratum in: JAMA. 2024 Oct 2. doi: 10.1001/jama.2024.11331. PMID: 37934220; PMCID: PMC10630900.
3. Garbutt JC, Kranzler HR, O'Malley SS, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA 2005; 293:1617.
4. Skinner MD, Lahmek P, Pham H, Aubin HJ. Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PLoS One 2014; 9:e87366.

=== About Us ===

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

Hosts: Dylan Balter

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Asher Fulero, Dan Bodan, Penguin Music, Nathan Moore, Chris Haugen

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In this episode, Dr. Barenboim and Dr. Holt explore a couple's journey through a changing relationship to alcohol and when it became an alcohol use disorder.

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

=== Outline ===

Chapter 1: Early Development of a Relationship with Alcohol

Chapter 2: Diagnosing AUD

Chapter 3: Approaching the Conversation

Chapter 4: Motivational Interviewing

=== Learning Points ===

1. Someone’s relationship with alcohol is shaped by many factors. Learning more about these elements--such as upbringing, social circles, and if alcohol is used to cope with stressors--will provide a comprehensive biopsychosocial understanding about the role that alcohol plays in a patient’s life. 
2. Be familiar with and use screening tools for excessive alcohol use. These might include the AUDIT-C or the NIAAA Single Alcohol Screening Question. 
3. Motivational interviewing not only allows us to understand more about someone’s relationship with alcohol, but provides the guiding framework to explore what they are willing to take on in terms of change and intervention. A key aspect of motivational interviewing in this context is eliciting the patient’s perspectives on what is beneficial and detrimental about their alcohol use, and pointing out the discrepancies in alcohol’s impact on their life.

=== Our Expert(s) ===

Dr. Stephen Holt attended Columbia University’s College of Physicians & Surgeons and subsequently completed his residency training and Chief Residency at Yale's Primary Care Internal Medicine Residency Program before joining the program as an Assistant Professor. He currently serves as the Associate Program Director for Ambulatory Education in the Primary Care Program. His areas of interest include addiction medicine, medical education, and the art and science of physical diagnosis. 

=== References ===

1. What is a standard drink? https://www.niaaa.nih.gov/alcohols-effects-health/what-standard-drink
2. Highlights for the 2022 National Survey on Drug Use and Health: https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-main-highlights.pdf 
3. Facts About U.S. Deaths from Excessive Alcohol Use: https://www.cdc.gov/alcohol/facts-stats/index.html 
4. AUDIT-C: https://www.mirecc.va.gov/cih-visn2/Documents/Provider_Education_Handouts/AUDIT-C_Version_3.pdf
5. AUDIT: https://auditscreen.org/ 

=== About Us ===

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

Hosts: Dylan Balter

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Puddle of Infinity, Adam MacDougall, Density & Time, Jesse Gallagher, Asher Fulero, Astron, Lauren Duski, 

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

Please complete this brief 3 minute survey to provide us Feedback on Season 1 so we can continue to improve the podcast for all our listeners!

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

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

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

=== Learning Points ===

1. Lifestyle modifications need to be tailored to the patient. This often involves starting with a careful dietary and activity history and helping the patient incorporate small, healthy changes that are congruent with their cultural background
2. There are multiple medications available for weight loss and selecting the right one requires knowledge of a patient's comorbid health conditions, as well as taking into account their personal preference. Side-effects tolerance cost, and or insurance coverage
3. Recognize how to counsel patients on when it may be appropriate to pursue bariatric surgery and what they can expect following the procedure.
4. The most important step in helping patients manage obesity is by starting the conversation and letting patients know that you are there to support them along every step of the way.
5. 
   

=== Our Expert(s) ===

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

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

=== References ===

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

=== About Us ===

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

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

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

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

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

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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

=== References ===

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

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

=== About Us ===

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

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

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

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

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

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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

=== References ===

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

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

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

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

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

=== About Us ===

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

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

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

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

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

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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

=== References ===

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

=== Recommended Reading ===

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

*For more reading recommendations, check out our transcript!

=== About Us ===

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

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

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

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

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

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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

=== Recommended Reading ===

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

=== About Us ===

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

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

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