Mayo Clinic Talks

When the Physician Becomes the Patient

Guests: Philip T. Hagen, M.D. and Melanie D. Swift, M.D. (@swifzdh) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

Do you self-manage your health? Do you avoid regular routine screenings? Drs. Hagen and Swift from the Mayo Clinic Physician Health Center layout the evidence supporting the need for organizational support that directly addresses the barriers of time, safe space, and confidentiality. If you have a practitioner as a patient, how can you partner with colleagues in Occupational Medicine to confidentially, accurately, and efficiently evaluate what impact the conditions or medications may have on your patient’s ability to practice?

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Mayo Clinic Physician Health Center https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/overview 
• A survey of physicians’ perceptions of their health care needs Steffen MW, Hagen PT, Benkhadra k, Molella RG, Newcomb RD, Murad MH. Occupational Medicine, Volume 65, Issue 1, January 2015, Pages 49–53, https://doi.org/10.1093/occmed/kqu145 

Air Travel Safety: When to Advise Your Patient Not to Fly

Guest: Clayton T. Cowl, M.D., M.S. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

What conditions should trigger you to do a preflight assessment for your patients? What special precautions should be taken for patients with heart failure, who’ve recently had surgery, or are pregnant? Dr. Cowl dives into the physiological challenges a mildly hypoxic and high-altitude environment can have on your patients as they age and manage chronic illnesses. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Aerospace Medical Association – Medical Considerations for Airline Travel https://bit.ly/2qLAKVg
• American College of Chest Physicians – Guidelines and Resources https://bit.ly/2qJGSxi 

Perception of Risk in Adolescent Substance Use Disorder

Guest: Tyler S. Oesterle, M.D., M.P.H. (@OesterleMD)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

What are the current trends in substance abuse in the adolescent population? Is nicotine still the primary gateway? What questions should you be asking patients and their families? Dr. Tyler Oesterle covers what leads to experimentation, how it is changing in today’s landscape, and how adolescent addiction and treatment differs from adults, and some medications that can be helpful.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

New Drug Development and Approval

Guest: Denise M. Dupras, M.D., Ph.D.

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

How do new drugs make it to market? How do generics come to market and what are the differences in the approval process? Dr. Denise Dupras details the process from discovery to mass market release, safety, the electronic health record, rising costs, and a few affordability tips for your patients.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Hernias: When to Watch; When to Refer

Guest: David R. Farley, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

What should you be looking for in your physical exam? How do you differentiate a femoral hernia from a swollen lymph node? Dr. David Farley breaks down common hernias, the importance of the history and the exam, when imaging studies like a CT scan may be needed, the impact of smoking, weight gain, and life style on incision healing, and when someone should be referred for surgery. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Everything You Need to Know About Cervical Cancer Screening in 20 Minutes

Guest: Lois J. Mc Guire, APRN, C.N.P., M.S. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

When do you begin cervical cancer screening in your patients? Is it really ok to go 5 years in between pap smears? Which algorithm should you use to determine next steps? Lois Mc Guire details the ins and outs of cervical cancer screening including pathology reports, follow up testing recommendations, intervals for routine screening, and some expert tips for performing pap smears. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive: 

• ASCCP Guidelines: http://www.asccp.org/guidelines 
• US Preventative Services Task Force: https://bit.ly/31h88zR 
• The American College of Obstetrics and Gynecologists: https://bit.ly/2IVhc7g 

Medication Use and Deprescribing for the Elderly

Guests: Emily J. Holm, Pharm.D., BCACP, R.Ph. and Audrey J. Umbreit, Pharm.D., R.Ph. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

With over half of adults potentially taking an inappropriate medication some of the side effects can be very insidious. What can you do to mitigate these effects for your patients and how can you safely reduce the chance of a prescription cascade? Drs. Holm and Umbreit share tips on how you can help your patients take their medications correctly. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive: 

• Beers Criteria https://dcri.org/beers-criteria-medication-list/ 
• STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People Age and Ageing, Volume 44, Issue 2, March 2015, Pages 213–218, https://doi.org/10.1093/ageing/afu145 

Increasing Immunization Rates – Would You Like Fries with That?

Guest: Robert M. Jacobson, M.D. (@RobertJMD)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

What are the true contraindications for the flu vaccine? How early is too early for your patients to get vaccinated? Dr. Robert Jacobson discusses the ins and outs of vaccines, how to respond to common reasons patients don’t want to get vaccinated, and how to increase your practice’s vaccination rates.

Tips @14:54: It’s more of a stop sign than “do you want fries with that?”

TLDR: Listen at 19:21 for Dr. Jacobson’s must-know tips!

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

What I Wish I Knew When I Started in Medicine

Guest: John M. Wilkinson, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Dr. John Wilkinson and Dr. Darryl Chutka share the key takeaways from their decades of practice. Listen in to their pearls and share yours with us on Twitter with hashtag #MayoClinicTalks. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Prosthetic Joint Infections: Risks, Retention, and Removal

Guest: Elie F. Berbari, M.D. (@DOCElie)

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Infection remains an uncommon but major complication of prosthetic joint replacement procedures. What increases your patient’s chance of getting an infected joint? What can you do to decrease the chance of infection? Do patients need antibiotics when having dental work? Dr. Elie Berbari discusses these questions and more in what Dr. Darryl Chutka calls “one of the best Grand Rounds” he’s heard. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive: 

• Appropriate Use Criteria For the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures https://bit.ly/2QAn6LN 
• The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints https://doi.org/10.1016/j.adaj.2014.11.012 

Thyroid Extracts, Subclinical Hypothyroidism, and Thyroid Function Testing

Guest: M. Regina Castro, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

What do you do when a patient presents with subclinical hypothyroidism? When do you treat and how do you treat? Dr. Regina Castro presents the discussion around treating subclinical hypothyroidism, thyroid extract, and how to differentiate common symptoms from non-thyroid causes. Dr. Castro covers nodules, fine needle aspirates, the Sensitive TSH test, Total T4, Free T4, and TPO antibodies, and the role of lab testing in diagnosis. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Sexuality in the Elderly Female

Guest: Carol L. Kuhle, D.O., M.P.H. (@clkejd) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

A decline in sexual activity and an increase in sexual dysfunction commonly occurs in the elderly, but do you ask you patients about it? What questions should you be asking them? What are the reasons a decrease in function or desire occur? Dr. Carol Kuhle steps through the common causes, questions, and treatments encountered through her work and research at the Mayo Clinic Center for Women's Health (https://www.mayoclinic.org/departments-centers/womens-health/center-for-womens-health/overview or on Twitter @WHMayoClinic). 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• A Study of Sexuality and Health Among Older Adults in the United States August 23, 2007 N Engl J Med 2007; 357:762-774 DOI: 10.1056/NEJMoa067423

At the Cutting Edge of Medicine: Ultrasound-Guided Minimally-Invasive Outpatient Surgery

Guest: Jonathan T. Finnoff, D.O. (@FinnoffJonathan) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 5: Greater efficacy, lower cost, and quicker recovery, ultrasound-guided procedures are sure to change the landscape of medicine. What can be treated with these procedures? What’s the evidence behind them? Are they really safe? Dr. Jonathan Finnoff discusses ultrasound-guided procedures in application to carpal tunnel syndrome, trigger finger, de Quervain's tenosynovitis, adductor tendinopathy, and chronic exertional compartment syndrome. Listen now to hear more about this cutting-edge game changer and what it means for your patients. Hear more from Mayo Clinic Sport Medicine on Twitter @MayoClinicSport. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Dermatologic Conditions for the Primary Care Provider

Guest: Mark Denis P. Davis, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Does skin not exposed to the sun have an increased chance of skin cancer when patients have had multiple sunburns? Are existing moles or new moles more likely to become a melanoma? Dr. Mark Denis Davis discusses skin cancer, sun exposure, and sunscreen. Dr. Davis also dives into rosacea, eczema, psoriasis, urticaria, onychomycosis, and warts. Who is at risk? What increases the risk? How do you treat it? 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Sports-Related Foot and Ankle Injuries

Guest: Edward R. Laskowski, M.D. (@DrEdSportsMed) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 4: What are some of the common foot and ankle injuries seen in athletes? When is the wait and see approach not advised? When should patients be referred for surgery? Dr. Laskowski dives into detail on presentation and mechanism of injury, risk of recurrence, the role of bracing and proper balance and proprioceptive exercises. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

How to Effectively Manage Obesity

Guest: Maria L. Collazo-Clavell, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

What is the true key to weight loss? What about maintaining that loss? How do you manage these conversations with your patients? What framing of those conversations leads to more effective outcomes? Dr. Maria Collazo-Clavell discusses approaches for effectively discussing health concerns and obesity with our patients. How to identify their goals and build upon them utilizing motivational interviewing and partnering effectively with other health care providers. Dr. Collazo-Clavell also covers medications and referral for bariatric procedures.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Maintenance of Lost Weight and Long-Term Management of Obesity Kevin D. Hall Ph.D. and Scott Kahan M.D., M.P.H. Medical Clinics of North America, 2018-01-01, Volume 102, Issue 1, Pages 183-197 DOI: 10.1016/j.mcna.2017.08.012

Recognition of Overuse Injuries and Prevention of Long-Term Consequences in Young Athletes

Guest: David B. Soma, M.D. (@DrDaveSoma)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 3: How are overuse injuries different in youth and what trends are occurring in these patients? What conversations should you have with parents of child athletes? What sports put our patients at highest risk? Dr. David Soma discusses the what role should imaging play in this population, the significance of the history and physical, the age-related prevalence of certain conditions and their underlying etiology, and the long-term complications our patients may face if these are not recognized and addressed. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

A Nephrologist’s Take on Renal Function Testing

Guest: Suzanne M. Norby, M.D. (@SuzanneNorby) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

When should we be concerned about an elevated creatinine level? What role should the creatinine level, GFR, BUN, and cystatin C play in determining renal function? Dr. Suzanne Norby discusses the common findings in renal function testing, the various factors that can influence the test results, and when to consider imaging. 

Deeper Dive:

• https://news.mayocliniclabs.com/2016/05/05/ask-the-expert-cystatin-c-and-creatinine-complementary-markers-of-gfr/ 

Things to Look For in a Sports Physical

Guest: Daniel P. Montero, M.D. (@DanMonteroMD) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 2: Who can do these types of exams? What questions are important to cover in the history? What’s the ideal lead time prior to participation that patients should be screened? Dr. Montero discusses the ins and outs of pre-participation sports physicals and the common findings from his practice.

To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. 

Deeper Dive: 

• American Academy of Pediatrics – Pre-Participation Evaluation: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/PPE.aspx 

Preventative Screening for Elderly Patients: When to Stop and What to Stop

Guest: Ying Ying (Christina) Chen, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Preventative health care becomes more complicated as patients age. Do screening tests continue to improve the quality and duration of our elderly patient’s lives? Dr. Christina Chen discusses her process for determining the appropriateness of preventative health screening for patients over 65 and steps through what a generalist should know about the comprehensive geriatric assessment to help maximize independence for our patients. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive:

• US Preventative Health Task Force https://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care  

Sports-Related Concussions: When in Doubt, Sit Them Out

Guest: Cara C. Prideaux, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 1: According to the CDC, sports concussions have reach epidemic levels. Dr. Cara Prideaux discusses risks for concussions, evaluation signs and symptoms, and when referral and imaging is recommended. What should be happening on the sidelines when one of your patients has an event? What are the recommendations for recovery and returning your patients to school and sports? Dr. Prideaux details the dangers of returning too early and what to do when patients are making a delayed transition back to normality. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• American Medical Society for Sports Medicine Position Statement on Concussion in Sport Harmon KG, Clugston JR, Dec K, et al American Medical Society for Sports Medicine position statement on concussion in sport British Journal of Sports Medicine 2019;53:213-225. http://dx.doi.org/10.1136/bjsports-2018-100338 

Airline Emergencies: A Pilot-Physician’s Perspective Part 2

Guest: Robert Haddon, M.D., M.S. & Maryjane (MJ) F. Harris, D.O. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Who decides when the plane needs to land due to a medical emergency and what’s involved in those decisions? What’s the protocol for CPR on board and what tools are available to help with resuscitation? What happens when a passenger dies on a flight? Drs. Haddon and Harris step through the intricacies of responding to in-flight emergencies and the ethics involved. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Airline Emergencies: A Pilot-Physician’s Perspective Part 1

Guests: Robert Haddon, M.D., M.S. & Maryjane (MJ) F. Harris, D.O. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Are you required to respond? If you do, what are your responsibilities? What are your liability risks and protections? Dr. Harris steps through some recommendations for responding to in-flight emergencies. Dr. Haddon runs through what you should ask as part of the physical exam while in-flight and why these questions are important. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Predominant Management Strategies for Irritable Bowel Syndrome

Guest: Stephanie L. Hansel, M.D., M.S. (@SLHanselMD)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

What causes Irritable Bowel Syndrome (IBS)? What diets are recommended? What is gut-brain access and what does it have to do with IBS? Dr. Hansel covers treatment recommendations for IBS-diarrhea predominant, IBS-constipation predominant, and IBS-mixed type, including the role of bile acid malabsorption.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Bile Acid Malabsorption Testing: https://news.mayocliniclabs.com/2018/03/09/michael-camilleri-m-d-leslie-donato-ph-d-discuss-testing-bile-acid-malabsorption-clinical-practice/ 

Thrombotic Disease and Its Treatment

Guest: Matthew A. Bartlett, M.B., B.Ch., B.A.O. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Who can be treated outpatient and who really needs to be evaluated in the ED? When does the risk of treatment outweigh the benefits? What tools can you use to help make these decisions? Dr. Matthew Bartlett discusses when to treat, options for treatment – including direct oral anticoagulants, follow up care, and preventative measures for patients with thrombotic disease. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.