Primary Care Pearls – Details, episodes & analysis

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

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

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

=== Learning Points ===

1. Lifestyle modifications need to be tailored to the patient. This often involves starting with a careful dietary and activity history and helping the patient incorporate small, healthy changes that are congruent with their cultural background
2. There are multiple medications available for weight loss and selecting the right one requires knowledge of a patient's comorbid health conditions, as well as taking into account their personal preference. Side-effects tolerance cost, and or insurance coverage
3. Recognize how to counsel patients on when it may be appropriate to pursue bariatric surgery and what they can expect following the procedure.
4. The most important step in helping patients manage obesity is by starting the conversation and letting patients know that you are there to support them along every step of the way.
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 the third episode of our type II diabetes series, our patient Tabby joins us to speak about her experience with insulin, monitoring blood glucose, and lifestyle modifications. We wrap up the mini-series with some specific advice from both our patient and expert interviewees.

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

=== Outline ===

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

=== References ===

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

=== About Us ===

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

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

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

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

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

=== Outline ===

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

=== References ===

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

=== Recommended Reading ===

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

=== About Us ===

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

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

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

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

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

=== Outline ===

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

=== References ===

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

=== Recommended Reading ===

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

=== About Us ===

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

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

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

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

=== Outline ===

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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

=== References ===

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

=== Recommended Reading ===

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

=== About Us ===

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

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

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

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

=== Outline ===

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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

=== References ===

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

=== Recommended Reading ===

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

=== About Us ===

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

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

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

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

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

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

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

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

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

=== Learning Points ===

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

=== Our Expert(s) ===

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

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


=== References ===

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

=== Recommended Reading ===

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

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

Hosts: Nate Wood, Maisie Orsillo, and Addy Feibel
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Producers: Helen Cai and Addy Feibel
Other Background music: TrackTribe, Jesse Gallagher, Madirfan, The Tides, Corbyn Kites, and pATCHES

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

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

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

Music composed by: Josh Onyango

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

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