Mayo Clinic Talks

Microaggressions in Medicine

Guests: Catherine W. Njathi-Ori, M.D., Erin K. O'Brien, M.D. (@ErinOBrienMD), Nafisseh S. Warner, M.D. (@nafisseh_warner) 

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

What are microaggressions? How do you recognize them? How do you address them? Efficient teams and effective health care require diverse and inclusive environments. Drs. Njathi-Ori, O’Brien, and Warner present on microaggressions in medicine, the evidence in gender gap research, and give you tools to address microaggressions when they happen in your environment.

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

Recent Updates in the Management of Hyperlipidemia

Guest: Stephen L. Kopecky, M.D. 

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

What are the updated guidelines for managing hyperlipidemia and how do the risk modifiers change how patients should be treated? What do you do when a patient starts a statin and there is no change in cholesterol levels? What do you do when increasing the dose or switching to a stronger drug continues to have little to no impact? Dr. Kopecky discusses the updated guidelines, challenges with statin therapy, and additional tactics to consider in treating hyperlipidemia. 

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

Deeper Dive:

• 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines http://www.onlinejacc.org/content/early/2018/11/02/j.jacc.2018.11.003 
• Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/NEJMoa1812792 

Addressing Misinformation and Vaccine Hesitancy in a Post-Fact Society

Guest: Gregory A. Poland, M.D. (@drgregpoland)

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

The World Health Organization has listed vaccine hesitancy as a Top 10 Global Health Threat. How do you discuss vaccine myths with vaccine hesitant patients? What are the true risks associated with vaccines? How do you navigate conversation with a patient who refuses a flu vaccine because they had one in the past and still got the flu? Dr. Gregory Poland discusses vaccine hesitancy, immunization in pregnancy, late-season flu vaccines, antigenic burden and the evidence behind single session multiple vaccine administration, and the ethics of health care provider immunizations.

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

Deeper Dive:

• Poland GA, Jacobson RM. The age-old struggle against the antivaccinationists. N Engl J Med. 2011 Jan 13;364(2):97-9. doi: 10.1056/NEJMp1010594. https://www.nejm.org/doi/10.1056/NEJMp1010594 
• Poland GA. Influenza vaccine failure: failure to protect or failure to understand? Expert Rev Vaccines. 2018 Jun;17(6):495-502. https://doi.org/10.1080/14760584.2018.1484284 
• Poland CM, Poland GA. Vaccine education spectrum disorder: the importance of incorporating psychological and cognitive models into vaccine education. Vaccine. 2011 Aug 26;29(37):6145-8. https://doi.org/10.1016/j.vaccine.2011.07.131 

Getting the Most Out of Colon Cancer Screening

Guest: John B. Kisiel, M.D. (@DrJohnKisiel) 

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

Who is a good candidate for multitarget stool DNA testing and what do you do when it’s positive but the colonoscopy is discordant? Do you have a surveillance plan for your patients with ulcerative colitis and irritable bowel disease? What are the current screening recommendations for the general public versus patients with a family history? Dr. John Kisiel discusses these recommendations and the evidence behind them. He shares tips on managing patients on anticoagulant therapy going for polypectomy and when to stop screening in the elderly. 

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

What You Need to Know About E-Cigarettes, Vaping, and IQOS

Guest: J. Taylor Hays, M.D. (@jtaylorhays)

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

What’s the difference between e-cigarettes, vaping, and the newly FDA authorized “heat-not-burn” or IQOS devices? Do they really help our patients stop smoking and what data is available on the safety of these products? Listen now to hear Dr. Taylor Hays discuss these points and more.

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

Deeper Dive:

• The FDA Authorization of IQOS: https://bit.ly/2XV2cLw 
• A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy: https://www.nejm.org/doi/full/10.1056/NEJMoa1808779 

Preventive Therapies for Breast Cancer

Guest: Sandhya Pruthi, M.D. (@DrSandhyaPruthi)

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

How can we help women at high risk of breast cancer manage their risk? How do you rank these risks and approach their management? Dr. Pruthi discusses what you can do and tools that you can use to help calculate risk and what to do with the information you have.

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

Deeper Dive:

• Breast cancer risk assessment tools:
  • Gail model https://bcrisktool.cancer.gov/
  • IBIS tool http://www.ems-trials.org/riskevaluator/ 

Meeting the Needs of Our Female Veterans

Guest: Ashley Laganiere, CVSO 

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

Female veterans can face significant barriers to receiving proper care. As the number of female service members increases, what can we do to help address these barriers and facilitate access to the care they need? What resources exist and how do we identify this population if they do not readily self-identify as veterans? 

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

Deeper Dive: 

• National Association of County Veterans Service Officers: https://www.nacvso.org/
• Minnesota Association of County Veterans Service Officers: https://www.macvso.org/index.html
• VA Women’s Health Research Network: https://www.hsrd.research.va.gov/for_researchers/womens_health/ 
• Military Health and Health Care https://www.rand.org/topics/military-health-and-health-care.html 

Lyme Disease: When to Test, When to Treat

Guest: Bobbi S. Pritt, M.D. (@ParasiteGal) 

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

How do you detect Lyme’s disease without the rash? What are the implications for our patients if we miss it? If you practice in an endemic area what are the guidelines for treatment when your patient has been bitten by a tick? Dr. Bobbi Pritt discusses Lyme disease detection, prophylaxis, and some of the long-term consequences of Lyme disease. Listen now to learn the ABCs of tick bite prevention. 

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

Deeper Dive:

• CDC Guidelines for Tick Bite Prophylaxis: https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html
• Dr. Pritt's “Creepy, Dreadful, Wonderful Parasites” blog https://parasitewonders.blogspot.com/ 

Perception of Care and Quality of Care: Finding the Sweet Spot in Patient Experience Data

Guest: Kenneth G. Poole, Jr., M.D., M.B.A. 

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

Does perception of care equal quality of care? Healthcare is increasingly consumer-centric and patient experience data can inform us about how we compare within our own institution and across healthcare. But the data can also be influenced by the nature of your practice and implicit bias present in our patients. What are some of the unintended implications of patient experience data? How can we responsibly interpret and utilize it? What scores should we be striving for? What is the sweet spot?

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

Deeper Dive:

• Dr. Poole’s article in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMp1813418 
• A brief webcomic by Whit Taylor and Chris Kindred on the Tuskegee Experiment: https://thenib.com/tuskegee-experiment?utm_campaign=web-share-links&utm_medium=social&utm_source=link 

Management of HIV and the Barriers to a Cure

Guest: Stacey A. Rizza, M.D. (@DrStaceyRizza) 

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

How close are we to having an immunization for HIV? What’s on the horizon? When should your patients be referred to an HIV center or clinic for care? How do you connect a patient that wants local care when a center isn’t close by? Dr. Rizza discusses the management of HIV, pharmacotherapy, and goals of treatment in the second episode of this two-part HIV mini-series.

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

Screening for HIV: Who Are You Missing?

Guest: Stacey A. Rizza, M.D. (@DrStaceyRizza) 

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

Can you predict who has HIV and who doesn’t? Do you order universal HIV screening? What screening tests should be ordered and what happens when the results are positive or equivocal? When is a false negative possible? What is the effective window for post-exposure prophylaxis? Dr. Stacey Rizza discusses HIV and progression to AIDS, medical exposures, and screening in the first episode of this two-part HIV mini-series.

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

Deeper Dive:

• Universal screening: https://doi.org/10.1016/j.mayocp.2012.06.021 

The Rising Cost of Prescription Drugs

Guest: S. Vincent Rajkumar, M.D. (@VincentRK) 

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

Why are prescription drug costs so high in the United States? What role does the rebate system potentially play in drug availability? What is value-based pricing? Vincent Rajkumar, M.D. discuss research in this area and provides resources for health care providers to have discussions with patients about drug affordability. 

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

Deeper Dive:

• https://doi.org/10.1016/j.mayocp.2012.07.007 
• https://doi.org/10.1016/j.mayocp.2015.01.014 

The Five-Finger Approach to Restoring Patient Function

Guest: Jeffrey S. Brault, D.O. (@JeffBrault) 

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

When should patients be referred to a physiatrist versus a physical therapist? What services can you expect when referring your patient to physical medicine and rehabilitation? Can they help your patients avoid surgery? What resources do they utilize to decrease pain and increase function? Listen as Dr. Jeff Brault discusses his five-finger approach to treatment of chronic and degenerative disease. 

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

Time’s Up Healthcare: Accelerating a Safe, Equitable, Dignified Workplace

Guest: Sharonne N. Hayes, M.D. (@SharonneHayes) 

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

The healthcare system is not immune to bias, harassment, and discrimination. How do we create a climate of mutual respect? How do we empower bystanders to step up? How do we create systems and procedures to ensure consistent messaging and action when these things occur? Listen in as Dr. Sharonne Hayes discusses the Time’s Up Healthcare movement and what you can do to get involved. 

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

Deeper Dive:

• https://www.timesuphealthcare.org 

Dementia: Things You Shouldn’t Forget

Guest: Richard J. Caselli, M.D. 

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

When does forgetfulness become a red flag for dementia? What’s normal aging and what’s underlying disease process? When is a mental status exam not enough and what should you do next? Dr. Richard Caselli discusses dementia diagnosis, risk factors, treatment, and research. 

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

Finding Balance and Harmony in the Face of Illness: Integrative Medicine

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

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

How does integrative medicine differ from alternative and complementary medicine? Are the practices evidence-based? How and when can these techniques be applied in your current practice? Listen as Dr. Christina Chen discusses the practice of integrative medicine and its impact on her patients. 

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

Be Sure to Pack Humility, Teachability, and Adaptability: Making a Difference in Global Health Disparities

Guest: Stephen P. Merry, M.D. 

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

Primary care providers can make a difference in the health disparities experienced internationally. Impact can range from directly providing care to educating staff and building enduring local capacity. Listen for some points to consider when planning a global health trip or medical mission. How do you get started? What skills do you need as a health care provider? How do you pick a location? Where can you find more reliable in-depth information on global health? 

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

Understanding Stress Traps in the Human Brain

Guest: Anjali Bhagra, M.D. (@anjalibhagramd) 

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

How does our brain react to stress and setback? How can we harness what neuroscience tells us about these responses to combat the stresses in our lives we cannot currently change? Dr. Anjali Bhagra steps through the three F’s- focus, fatigue, and fear, to dig a little deeper into how we’re geared to respond and what we can do to intentionally navigate our responses. 

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

Turning the Tables: Getting to Know the Host

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

Host:  Thomas C. Shives, M.D. (@DrTomShives) 

The tables turn as Thomas Shives, M.D., long-time host of Mayo Clinic Radio, interviews Darryl Chutka, M.D., about his career highlights and how he became involved in the Mayo Clinic Talks Podcast.

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

What you Need to Know About Medical Cannabis

Guest: Thomas P. Pittelkow, D.O., M.P.H. 

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

Does medical marijuana have proven benefits? Who can prescribe it? What are the potential harms in using it? Dr. Thomas Pittelkow, a Mayo Clinic anesthesiologist specializing in pain management for cancer patients and advanced interventions in end of life care, discusses the differences between recreational and medical marijuana. Listen in for more on hopes and limitations in cannabis research, best practices for patient conversations, state vs. federal regulations, and the importance of communication with dispensaries. 

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

Deeper Dive: 

• Detailed information about Medical Cannabis, visit https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855. 
• State-to-state regulations, visit http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. 

Communicating with Humility: Lessons Learned

Guest: Katherine W. Arendt, M.D. (@arendt_katie)

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

We practice effective communication with our patients but how effectively do we communicate with our co-workers? At home after a long day? Dr. Katie Arendt discusses how to utilize humility and emotional intelligence to communicate effectively and build awareness of confirmation bias and ladders of inference.

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

Breast Cancer: Screening versus Diagnostic Imaging and the Appropriate Utilization of Genetic Testing

Guest: Sandhya Pruthi, M.D. (@DrSandhyaPruthi)

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

Dr. Sandhya Pruthi, a breast disease specialist in Mayo Clinic’s Breast Diagnostic Clinic, discusses why we don’t use ultrasound as a primary screening test for breast cancer. Listen in for the pros and cons of different types of imaging studies and which are used for screening versus diagnostic testing. Also discussed is the role genetic testing should play in breast cancer screening, who should have testing done, and what tests are available, including when a care plan should include a genetic counselor.

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

Prostate-Specific Antigen (PSA) Testing: A Urologist's Perspective

Guest: Mitchell R. Humphreys, M.D. (@MayoMitch)

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

Prostate cancer is a very common malignancy in men, second only to skin cancer. Despite the fact that it’s one of the more treatable malignancies, it remains the 2nd leading cause of cancer death in men. When diagnosed early, it has an excellent prognosis. The 5-year survival rate approaches 100% in those with local or regional disease. Although screening for prostate cancer is available, the use of screening tests has been controversial and recommendations regarding its use, confusing. Listen in to get a urologist’s perspective.

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

Treating Musculoskeletal Pain: The Role of Platelet-Rich Plasma Injections and Stem Cell Therapy

Guest: Jacob L. Sellon, M.D. (@jlsellon)

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

Dr. Jacob Sellon discusses advances in treatment of musculoskeletal pain and osteoarthritis, covering common questions about platelet-rich plasma and stem cell injections. Do they work? What’s the efficacy demonstrated in literature so far? What are the benefits and risks we need to discuss with our patients? What is FDA compliant versus FDA approved treatment and how does this influence insurance coverage and care management? Where does regenerative medicine research need to go?

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

Provider and Patient Bias: What Do We Do About Culture's Thumbprint in Medicine?

Guest: Sharonne N. Hayes, M.D. (@SharonneHayes) 

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

Dr. Sharonne Hayes discusses the impact of unconscious bias in medicine and how providers can take steps to acknowledge, address, and mitigate these cultural imprints on our automatic thought processes. She then turns the tables discussing patient bias and how health systems and providers can protect and support staff who have been harassed, along with processes that can be put in place to systematically address existing practices that fosters bias. 

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

Deeper Dive: 

• Project implicit can be found at: https://implicit.harvard.edu/implicit/takeatest.html