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What Do You Need?

September 2021
12min

Adrian and Kris think about what they need in the clinic as well as in their professional lives. Take a listen to hear what’s in their pockets, their phones, and. . . bloodstreams.

Parvo B19 in the Family

September 2021
21min

How do you diagnose and manage Parvo B19 in little kids and their pregnant moms? Matt Zeitler and Neda get into all the relevant details in this super practical conversation.

Paper Chase #1: Beta Blockers & Mortality in Heart Failure Patients on Dialysis

September 2021
8min

Metoprolol is associated with a reduction in mortality in patients with HFpEF and new dialysis initiation

Fibroids

September 2021
27min

Uterine fibroids are a common condition that we can diagnose and even treat in primary care. Listen in as Neda interviews ObGyn Dr. Sara Mazzoni about the ins and outs of fibroids.

Paper Chase #2: Weight Loss Maintenance with Exercise, Liraglutide, or Both

September 2021
7min

A strategy combining exercise and liraglutide improved healthy weight loss maintenance.

Seasonal Allergies

September 2021
34min

Andy Barnett does an in depth review of how to treat seasonal allergies including how to add /adjust meds for patients who are experiencing severe allergic symptoms despite their current medication regimen.

The Big Picture: Being A County Health Officer in a Pandemic

September 2021
26min

The covid pandemic has been challenging for all front-line clinicians. Can you imagine if you were in charge of the public health of an entire county? In this very special conversation, Neda sits down with Dr. Nilesh Kalyanaraman, Anne Arundel County Health Officer in Maryland, to learn about his public health goals and personal challenges in the pandemic, and what we can learn from them.

Paper Chase #3: Meds for Preschool Kids with ADHD

September 2021
7min

Both were effective, however, stimulants had better efficacy but also overall more adverse events.

Dental Care for Children

September 2021
29min

Many of the children we see in practice will have never seen a dentist, or may not have access to one. In order for us to feel more comfortable with children’s dental health, Paul interviews Dr. Karlyyn Sievers about how to perform a pediatric dental exam and what advice we should give.

Paper Chase #4: Blood Pressure Reduction to Prevent CV Disease

September 2021
8min

A 5 mmHg reduction in systolic blood pressure reduced the risk of major cardiovascular events by 10% irrespective of previous cardiovascular disease. This was true even at normal baseline blood pressures.

Ischemic Colitis

September 2021
21min

Ischemic colitis is a “can’t miss” diagnosis, but something we don’t always think about in the primary care setting. Neda and Dr. Jason Shen discuss all things ischemic colitis in this interesting conversation.

Paper Chase #5: Peppermint Oil for IBS Symptoms

September 2021
9min

The data isn’t great, but the potential benefits likely outweigh the risks in a trial of peppermint essential oils for IBS symptoms

Mailbag: Breastfeeding with HIV

September 2021
11min

PA Perspectives

September 2021
13min

Did you know up to 70% of women have uterine fibroids?  Adrian and Kris review the segment on uterine fibroids to recap everything you need to know about this common cause of abnormal uterine bleeding.

PA's Around the World

August 2021
12min

PAs are going global. Adrian and Kris delve into a December 2020 article in JAAPA that outlines the breadth of PAs across the globe describing where PAs practice and train

Yet More Less is More

August 2021
16min

Paul and Neda are back at it, continuing their ongoing series on the JAMA Less is More series for reducing unnecessary interventions in primary care. 

Paper Chase #1: Trial of Psilocybin versus Escitalopram for Depression

August 2021
9min

There was no significant change in depression scores between psilocybin and escitalopram

What's That Lab: CO2

August 2021
13min

Have you ever seen an abnormal CO2 on routine labs and not known what to do? Us too! Paul Simmons walks us through the different disease states that can affect CO2 in this segment of “What’s That Lab?”

Caring for the Adult with Trisomy 21

August 2021
19min

Many of us are comfortable with caring for children with Trisomy 21, but what about adults? Neda sits down with Dr. Micaela Bowers to discuss the care of adults with Trisomy 21.

Paper Chase #2: Delayed Antibiotics for Respiratory Tract Infections

August 2021
8min

Immediate, delayed and no antibiotic prescribing led to similar symptom course, complication rate, and patient satisfaction.

Deadly Drug Combinations

August 2021
19min

We prescribe medications all the time in primary care. Sometimes, we prescribe something that can cause a lethal drug-drug interaction. Dr. Joe Martinez walks Neda through 4 common scenarios of well-intentioned drug-drug combos gone awry.

Paper Chase #3: Dapagliflozin in Patients with Chronic Kidney Disease

August 2021
5min

In patients with CKD, risk for worsening GFR, ESRD, or death from renal or cardiovascular causes was significantly lower with dapagliflozin

POTS

August 2021
23min

POTS is a syndrome we come across in primary care that can be difficult to diagnose and even harder to treat. For a rundown on POTS, along with some tips and tricks for our patients, listen in on this conversation between Neda and primary care PA, Ashley Greer.

Teens and Sleep

August 2021
16min

Lisa and UCSF Pediatrician Sabrina Fernandez discuss the importance of sleep, risks of poor sleep, and how to counsel families.

Paper Case #4: Severe Adverse Events Associated with Oral Steroid Bursts in Kids

August 2021
6min

Short steroid bursts were associated with increased risk of pneumonia, sepsis and GIB within the first 30 days.

Advanced Care Planning

August 2021
23min

Just in case you’re not a rockstar at discussing Advanced Care Planning with your patients, regular guest and geriatrician Dr. Jenny Litrivis is back to school Neda (and all of us) on how to do this important work better.

Do You Know Your POOPs?

August 2021
28min

We knew that Paul Simmons would jump on a topic that mentions “poop.” No, not that kind of poop! In this conversation, Paul and Dr. Vu Tran discuss a different type of POOP - conditions that cause pain out of proportion to exam.

Paper Chase #5: Preventing Readmission in Comorbid SUD

August 2021
8min

Patient navigation reduced inpatient readmissions and ED visits in patients with comorbid substance use disorder

MAILBAG: Hepatitis C Monitoring After Cure

August 2021
9min

PA perspectives

August 2021
18min

Kris and Adrian review the segment on POTS and walk you through the signs and symptoms, work-up, diagnosis, and management of this potentially elusive condition.

New Groundbreaking AAP Guidelines for Managing Fever in Young Infants 8-60 Days

July 2021
30min

We have been trying to figure out which febrile young infants have serious bacterial infections for almost four decades now. We now have a new evidence-based approach that allows us to do less invasive testing with a more precise way to find those sick needles in the haystack. Drs. Mizuho Morrison & Sol Behar review this “hot off the press” publication by the AAP, which to date is the greatest collaborative effort from all of the thought leaders in pediatrics and incorporates the best research into one comprehensive guideline on how to manage fever in the well appearing young infant. This latest guideline will give license to clinicians to push the envelope to be more liberal managing very young infants who present with fever. The guidelines may help avoid some invasive procedures (I’m looking at you, LP!), and even manage some of these lower risk patients from the comfort of their homes and with oral antibiotics (or none at all!), rather than shotgunning all of their care on the inpatient ward with broad spectrum antibiotics.

Ambiguity and Well-Being: Knowing is only half the battle

July 2021
15min

Adrian and Kris summarize and share their take on the February 2020 Medical Educator article, “Tolerance of ambiguity and psychological well-being in medical training: A systematic review” by Jason Hancock and Karen Mattick which finds an association between provider tolerance for ambiguity and their psychological well-being. When tolerance for ambiguity is lower, psychological well-being was lower too. How comfortable are you in being uncomfortable?

Opioid Alternatives

July 2021
24min

How robust is your toolkit when it comes to pain management? Especially when it comes to opioid alternatives? It’s about to become a whole lot fuller, thanks to this conversation with Jay and Neda.

Paper Chase #1: DOACs vs Warfarin in Valvular A-Fib

July 2021
5min

DOACs had improvement in risk of stroke or embolization and less bleeding compared with warfarin in patients with valvular atrial fibrillation, excluding mechanical valves or mitral stenosis.

TIDBSI: Lower Extremity Edema

July 2021
21min

When someone complains of lower extremity swelling, how confident are you in diagnosing the etiology? Listen in as Paul Simmons and Justin McCarthy discuss a thoughtful approach to this common concern in this TIDBSI conversation.

Paper Chase #2: Semaglutide vs Placebo in Weight Loss Maintenance

July 2021
6min

After a run-in period of subcutaneous semaglutide, patients who continued semaglutide experienced continued weight loss in contrast to placebo where weight was regained.

Celiac Disease

July 2021
31min

Gluten “intolerance” is all the rage, but how can we evaluate our patients’ concerns while differentiating from celiac disease? Paul Simmons dives into diagnosis and treatment of celiac disease with Dr. Alan Ehrlich, Editor of DynaMed and someone who knows quite a bit about this condition, both personally and professionally.

Medical Home: Health Maintenance Success In Between Visits

July 2021
21min

Continuing our series on the Medical Home, Neda and Dr. Holly Tse discuss how to deploy good health maintenance habits between patient visits.

Paper Chase #3: Breastfeeding and Child IQ at Age 5

July 2021
6min

There is an association between breastfeeding and higher IQ scores, but the confounders are complex.

Vulvar Dermatoses, Part 1

July 2021
25min

Vulvar dermatoses is a relatively common complaint that can affect women of all ages. There are a wide variety of symptoms and severity and finding the correct diagnosis requires a thorough history and physical examination. A biopsy may be necessary to confirm the diagnosis and exclude malignancy. Due to the sensitive nature of the problem. Many patients delay seeking medical care. Mizuho chats with Brittney DeClerk and Jenny Beck Esmay on the differential diagnosis we should stop to consider before treating this disease process. 

Vulvar Dermatoses, Part 2

July 2021
14min

Vulvar dermatoses is a relatively common complaint that can affect women of all ages. There are a wide variety of symptoms and severity and finding the correct diagnosis requires a thorough history and physical examination. A biopsy may be necessary to confirm the diagnosis and exclude malignancy. Due to the sensitive nature of the problem. Many patients delay seeking medical care. Mizuho chats with Brittney DeClerk and Jenny Beck Esmay on the differential diagnosis we should stop to consider before treating this disease process.

Paper Chase #4: Stroke Risk Scores Across All Kidney Function

July 2021
10min

Modified CHADS2 score performed well and consistently across all kidney function strata.

Sun Care and Sunscreen

July 2021
19min

Advising our patients on prevention of skin cancer through sun protection is an important part of preventive care. But what sunscreens are best? How can we help patients succeed? Drs. Neda Frayha and Aleah Thompson try not to burn out on sun care in this sunny conversation.

Paper Chase #5: E-Visit Use and Outcomes

July 2021
7min

In-person follow-up visits were minimal and the majority of patients received a prescription.

Mailbag: Pneumonia Vaccines

July 2021
8min

PA perspectives

July 2021
14min

Kris and Adrian review the segment “TIDBSI - Lower Extremity Edema” and give their take on the development, diagnosis, and treatment of a common outpatient clinical complaint.

AAPA Five Year Strategic Plan

June 2021
14min

Strategic plans are the backbone of any profession or organization and help outline the path to success.  Adrian and Kris discuss the new five-year AAPA strategic plan and give their insights into the direction of the profession over the next few years.

CKD Diet Tips

June 2021
15min

Our listeners have lots of questions about chronic kidney disease. In the introduction to this month’s PC RAP episode, Aisha and Neda dig into the best CKD diet advice we can give our patients.

Paper Chase #1: CNS-Active Polypharmacy in Adults with Dementia

June 2021
7min

14% of older adults with dementia filled prescriptions consistent with CNS-active polypharmacy

Medical Home: Health Maintenance Success During the Visit, Part 1

June 2021
20min

What is a medical home and how can it help us succeed in keeping patients current on their screenings and chronic disease management? Dr. Holly Tse gives Neda super practical tips on how we can rock our health maintenance core measures in this two-part series.

Medical Home: How PCPs Can Rock Our Quality Metrics, Part 2

June 2021
15min

What is a medical home and how can it help us succeed in keeping patients current on their screenings and chronic disease management? Dr. Holly Tse gives Neda super practical tips on how we can rock our health maintenance core measures in this two-part series.

Paper Chase #2: Empagliflozin in Heart Failure with Reduced EF

June 2021
5min

Empagliflozin improved LVEF and led to significantly greater functional capacity and quality of life scores over placebo

Top 10 Things We Should Stop Doing

June 2021
29min

Do you like our “Things I do, but should I?” series? Keeping with this spirit, Paul Simmons and Dr. Mark Graber hone in on the top 10 things we should all STOP doing in clinical practice based on the most recent evidence.

Paper Chase #3: Ablation vs Antiarrhythmics for Initial Treatment of A-Fib

June 2021
6min

Among patients receiving initial treatment for symptomatic paroxysmal afib, there were lower rates of recurrence of afib with ablation compared to antiarrhythmic drug therapy. The rate of recurrence was very low in both groups.

Patellofemoral Pain Syndrome

June 2021
25min

Knee pain is a common urgent care complaint. Matt Baird sits down to discuss patellofemoral pain including its presentation,  treatment, and patient education. 

Abnormal Pap Smears

June 2021
20min

Do you freeze up when you receive an abnormal pap result? If you’re not always sure of what to do next, listen in as Dr. Elizabeth Lavery, Ob/Gyn, walks us through the 2019 guidelines for management of abnormal pap smears. 

Paper Chase #4: Albumin Infusions in Cirrhosis

June 2021
6min

Treating to an albumin >3.5 did not improve renal dysfunction, infection or mortality.

Need a FAVER? Responding to Inappropriate Patient Requests

June 2021
23min

Have you ever been in a situation when a patient requests something that’s inappropriate or tries to dictate their care? Do you know the best way to respond? Drs. Michael Baca-Atlas and Matt Zeitler discuss the evidence-based way to respond to these situations.

Paper Chase #5: USPSTF on Low Dose CT for Lung Cancer Screening

June 2021
6min

USPSTF recommends annual lung cancer screening with low-dose CT in adults aged 50-80 who have 20 pack-year smoking history and currently smoke or quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years.

Mailbag: Thoracic Outlet Syndrome

June 2021
12min

When a listener asked us to devote a conversation to thoracic outlet syndrome, Neda knew she had to tackle it - she’s had several patients with this disorder herself. Here, Neda and Aisha dive into the nuances of how to approach and treat both neurogenic and vascular TOS.

PA perspectives

June 2021
30min

Kris and Adrian review the segment “Abnormal Paps” and take a closer look at what PAs need to know before and after ordering cervical cancer screening. 

Post COVID Return to Play in Pediatric Patients

May 2021
17min

Reports of long term health issues after COVID infection have raised concerns about when it is safe to return to participate in sports after COVID infection. Cardiology, sports medicine, and pediatric societies have provided guidance to guide health care professionals in advising their patients in regard to return to play issues. In this Hippo segment, sports medicine expert Dr. Tracy Zaslow and pediatric emergency medicine physician Dr. Janet Semple-Hess review all there is to know about Post-COVID Return to Play.

Improving Vaccine Adherence in Adults

May 2021
10min

Vaccinations have been at the forefront of public health medicine and are arguably the single greatest advancement in medical history.  Listen to Adrian and Kris discuss strategies to improve vaccine adherence in adult patients as the medical community is fighting back against COVID-19.  Then listen to the personal reasons frontline PAs decided to get the COVID-19 vaccine and how you can use these in your patient counseling. 

Paper Chase #1: Consequences of Inappropriate L-Spine MRI

May 2021
6min

MRI use for acute LBP was associated with increased amount of surgery, cost, opioid prescriptions and higher pain scores

Alcohol Withdrawal Syndrome as an Outpatient

May 2021
18min

In the era of covid, we need to be more mindful than ever of how to help our patients with alcohol withdrawal syndrome detox safely in the outpatient setting. Our Addiction Medicine expert and Family Medicine physician extraordinaire, Dr. Michael Baca-Atlas, joins Neda for an enlightening conversation on an important and under-discussed topic.

Paper Chase #2: Individual vs Group Behavioral Therapy for Weight Loss in Rural

May 2021
6min

Among obese patients in rural primary clinics, in-clinic group visits resulted in greater weight loss at 2 years, though differences were small

COVID and Cancer Screening

May 2021
20min

It’s been over a year since the start of the pandemic, and we are still catching up on preventive visits and cancer screenings. Neda discusses this public health concern and the impact of it with Dr. Shana Ntiri.

HIV and Pregnancy

May 2021
26min

Almost 2 million adolescents and adults in the US are living with HIV. Many of these are women of childbearing age. How do we manage our pregnant patients who are HIV positive, especially if we have limited access to specialists? Hippo’s own Drs. Matt Zeitler and Michael Baca-Atlas discuss HIV and pregnancy with HIV fellow Dr. Lakecia Pitts.

Paper Chase #3: Metabolic Surgery vs Medical Therapy in Type 2 Diabetes

May 2021
5min

Bariatric surgery led to significantly more diabetic remission at ten years compared to medical weight loss

PECARN Pie: Infant Fever Pt 1

May 2021
29min

The young febrile infant is at risk for serious infections. Older risk stratification strategies have involved extensive, invasive work-ups. New research from the PECARN group has allowed for a simpler evaluation of the full term, well appearing febrile young infant using only blood and urine testing. Sol sits down with fellow EM physician, and founding chair of the PECARN network, Dr. Nate Kuppermann to discuss the latest trends in evaluating this high risk population.

PECARN Pie: Infant Fever Pt 2

May 2021
20min

The young febrile infant is at risk for serious infections. Older risk stratification strategies have involved extensive, invasive work-ups. New research from the PECARN group has allowed for a simpler evaluation of the full term, well appearing febrile young infant using only blood and urine testing. Sol sits down with fellow EM physician, and founding chair of the PECARN network, Dr. Nate Kuppermann to discuss the latest trends in evaluating this high risk population.

Paper Chase #4: Epidemiologic Trends in Firearm Injuries in the US

May 2021
7min

Suicide appears to be the most common cause of firearm injury death in the US, and most people who die from suicide never reach the hospital. Assaults and unintentional injuries account for most nonfatal injuries.

New Drugs of Abuse

May 2021
28min

Huffing, dripping, dabbing, vaping. Do you know what these terms mean? If not (or even if you do), tune in as Paul Simmons discusses new (and old) drugs of abuse with Dr. Kelly Sinclair.

Scabies

May 2021
25min

Think of seeing a patient with scabies. Are you itchy yet? If you can tolerate the itching, listen in on this conversation between Neda and Dr. Avir Mitra on the unique challenges of a centuries old disease. 

Paper Chase #5: Physical Activity and BMI Association with CV Risk

May 2021
7min

Physical activity improves CV risk, but does not compensated for the negative effects of obesity

Mailbag: A Little More Smorgasbord

May 2021
9min

PA Perspectives

May 2021
18min

Covid has disrupted cancer screening across the country, especially for some of those most at risk for cancer. Kris and Adrian will discuss the segment as well as add their own take on getting cancer screening back on track and how to approach the topic with patients...and with patience.

COVID Vaccine Safety in Pregnancy

April 2021
10min

In this Hippo Education bonus, Dr. Rob Orman digs into the data just published regarding mRNA vaccine safety in pregnant patients, and what it means for our patients. He also reviews data just published looking at the effect of COVID on maternal and neonatal morbidity and mortality among pregnant women.

Long Covid / Post Acute Sequelae of SARS Co-V 2 (PASC)

April 2021
27min

Covid isn’t going anywhere. And neither is Long Covid, or as it’s now called, Post-Acute Sequelae of SARS-CoV-2, or PASC. We sit down with pulmonologist, critical care physician, and emerging PASC expert Dr. Andi Levine from the University of Maryland School of Medicine to learn all about this challenging syndrome and how front-line clinicians can best approach its workup and treatment.

The Story Behind COVID Vaccines and Brain Blood Clots

April 2021
27min

The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed an underlying mechanism, CDC and NHS recommendations, and a primer on cerebral venous thrombosis -- the primary clot site associated with VITT.

Better Nutritional Counseling

April 2021
17min

Do you feel like your nutritional counseling skills need a little “modification”?  If so, you are in luck!  Adrian and Kris discuss strategies on improving your patient communication and nutritional counseling to help your patients adhere to a healthy lifestyle. 

Paper Chase #1: High LDL and Risk of MI in Older Adults

April 2021
7min

People aged 70-100 with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and lowest estimated number needed to treat in 5-years to prevent one event

Less is More, Some More

April 2021
15min

Less is more! We were thrilled to learn about the JAMA Internal Medicine series highlighting which primary care services we can scale back on or do away with completely. In this month’s Primary Care RAP introduction, Neda and Paul continue breaking down some of these recommendations and how they’ll put them into practice. 

Lactational Mastitis

April 2021
16min

Clogged ducts, warm compresses, and dicloxacillin, oh my! Join Neda as she dives into lactational mastitis with women’s health expert, Dr. Elizabeth Lavery.

Paper Chase #2: PT Referral for Acute Back Pain and Sciatica

April 2021
6min

Early referral from primary care to physical therapy improved disability more than usual care alone.

Trauma Informed Care: Part 1

April 2021
25min

Many of our patients have lived through trauma, and the Covid-19 pandemic is a form of collective trauma in itself. How can we, as primary care clinicians, provide sensitive, trauma-informed care to our patients? Neda sits down with national experts Drs. Sadie Ellisseou and Megan Gerber to discuss this important topic. 

Trauma Informed Care: Part 2

April 2021
19min

Many of our patients have lived through trauma, and the Covid-19 pandemic is a form of collective trauma in itself. How can we, as primary care clinicians, provide sensitive, trauma-informed care to our patients? Neda sits down with national experts Drs. Sadie Ellisseou and Megan Gerber to discuss this important topic. 

Paper Chase #3: Fluoroquinolones and Risk of Aortic Aneurysm or Dissection

April 2021
6min

Fluoroquinolones were not associated with increased aortic aneurysm or aortic dissection risk compared to penicillins or cephalosporins

Snip Chat: Circumcisions

April 2021
26min

Our Peds RAP colleague Dr. Lisa Patel and her colleague (and circumcision expert) Dr. Amy Lawson review some tips and tricks for circumcision.

Hospitalist Corner: Patient Handoffs

April 2021
27min

Have you ever been a part of a really bad handoff? How about a really good handoff? You know the difference between them, but what is the evidence-based way to perform them effectively? Listen in as Neda discusses handoffs with hospitalist Dr. Subha Airan-Javia.

Paper Chase #4: Benefits of CPAP on Glycemic Control in DM2 and OSA

April 2021
5min

Glycemic control was statistically reduced, but effects were modest

Proceed with Confidence: Local Anesthesia

April 2021
22min

Injecting local anesthetic burns, right? What if there was a way to minimize the pain associated with injection of local anesthetic? Drs. Brian Rayala and Matthew Zeitler at UNC Chapel Hill look at the evidence regarding this, and provide some insight into reduction of pain with this common procedure.

Cannabis Hyperemesis Syndrome

April 2021
16min

Cannabis Hyperemesis syndrome and other complications from acute cannabis intoxication are becoming a more common presentation in the UC/ED due to the increased use of cannabis products. Keeping this diagnosis on your clinical radar can expedite the workup and appropriate treatment of these patients. 

Paper Chase #5: Depressive Symptoms and CV Disease

April 2021
5min

Baseline depressive symptoms were associated with CVD incidence

Mailbag: Rational Approach to Proteinuria

April 2021
16min

PA Perspectives

April 2021
15min

How often do you prescribe antibiotics to patients in clinical practice?  Do you do comprehensive medication reconciliations before you do?  If not, you should listen to Adrian and Kris discuss the segment on common drug-drug interactions that can lead to potentially serious complications.

COVID-19 and School Reopening Update

March 2021
21min

In this Hippo Education bonus, Lisa Patel, MD, sits down with Jeanne Noble, MD, Associate Professor of Emergency Medicine and Director of COVID Response at UCSF Parnassus, to discuss the clinical data and updated CDC guidelines regarding school reopening during COVID, from in-school transmission rates, vaccines, and mental health issues. Lisa also interviews Itoco Garcia, Ed.D, Superintendent of Sausalito Marin City School District, on how his schools safely reopened during the pandemic.

Race Based Medicine

March 2021
21min

Have you ever wondered why there’s a Black and Non Black eGFR for our patients or why is race even a factor in pulmonary function tests? Dr. Jay-Sheree Allen and Dr. Neda Frayha discuss the use of race in clinical decision making tools. Think calculators, algorithms, where you insert your patient’s demographic data - including race - and the outcome disparities depending on what data you put in.

A Huge PA Advocacy Win

March 2021
6min

The PA profession had a huge win at the beginning of this year when one of the AAPAs top legislative priorities was signed into law. PAs can now bill and be paid directly by Medicare, something that was previously afforded to other health professions, but not PAs. Adrian and Kris summarize AAPAs news briefing and discuss what this means for PAs. Does it change how you bill?

Health Literacy

March 2021
15min

When our own Dr. Aisha Lofters realized she should have used the word “poop” instead of “stool” when discussing colon cancer screening with her patient, it was a major light bulb moment for her. Join her and Neda as they explore what health literacy means, how low health literacy can affect patient care, and how we can promote happy and healthy outcomes in our lower health literacy patients.

Paper Chase #1: High Blood Pressure and Long-Term CV Events in Young Adults

March 2021
6min

Higher BPs were associated with more CV risk but data on the included studies is limited

Unexpected Killers in Primary Care

March 2021
31min

How are your anxiety levels? Because we’re about to ratchet them up to an 11. In this segment, EM/IM physician Dr. Joe Martinez teaches Paul about 4 patients with deadly diagnoses who presented with seemingly benign findings. Let’s heighten our awareness of do-not-miss pathology that can masquerade as run-of-the-mill disease processes.

Gabapentinoids

March 2021
17min

It seems like gabapentin is prescribed for everything from hot flashes to dementia. Are we prescribing it appropriately? In this segment, Dr. Molly Heublein takes a deep dive into the use (and misuse) of gabapentinoids.

Paper Chase #2: Effect of CBD and THC on Driving

March 2021
8min

Unsafe driving behaviors were higher in the THC and equal THC/CBD groups 40-100 minutes after vaporization. There was no significant difference between CBD only and placebo

Hospitalist Lightning Round: Heme/GI

March 2021
20min

Hospitalist Corner Lightning Round is back! This time Dr. Maj Cina drops knowledge on a few common inpatient scenarios, focusing on apixaban and colonoscopy prep.

Recurrent Pregnancy Loss

March 2021
23min

Recurrent pregnancy loss can be difficult for our patients to live with. Reproductive endocrinologist Dr. Lauren Roth joins us for a conversation on the causes, evaluation, and management of recurrent pregnancy loss

Paper Chase #3: Effect of Omega-3 in Elderly Patients After MI

March 2021
6min

There was no difference between omega-fatty acid supplements and placebo on CV outcomes in eldelrly pts with recent MI

Virtues and Sins of Medicine: Part 1

March 2021
21min

Dr Richard Alan John Asher was an eminent British hematologist and endocrinologist who died in April 1969. During his career, he wrote an essay titled, “Seven Sins of Medicine.” Drs. Paul Simmons and Keith Dickerson ruminate on this essay and how it still applies to the practice of medicine today.

Virtues and Sins of Medicine: Part 2

March 2021
14min

Dr Richard Alan John Asher was an eminent British hematologist and endocrinologist who died in April 1969. During his career, he wrote an essay titled, “Seven Sins of Medicine.” Drs. Paul Simmons and Keith Dickerson ruminate on this essay and how it still applies to the practice of medicine today.

Paper Chase #4: Once-Weekly Insulin for DM2

March 2021
6min

Once-weekly treatment with insulin icodec had glucose-lowering efficacy and safety profile similar to those of once daily insulin glargine U100 in patients with type 2 diabetes

The Game Bag

March 2021
20min

There is a lot of variability in terms of practice patterns when it comes to providing medical care for an out of hospital event. Keys to preparation include having a good understanding of the particular event logistics and anticipating potential injuries and medical complications.

Paper Chase #5: LP and Spinal Hematoma

March 2021
7min

There was not an increased risk of spinal hematoma complications in pts with coagulopathy

Mailbag: Smorgasbord

March 2021
9min

PA Perspectives

March 2021
23min

Remember when you learned the phrase “If you hear hoofbeats, think horses” to explain that usually the things we see are usual? What happens when those unusual things sneak in though? In this segment, Kris and Adrian review the Unexpected Killers segment and highlight their PA perspectives on thinking about these important “Do Not Miss” diagnoses! Like the diagnoses themselves, a do-not-miss segment.

COVID-19 and Intimate Partner Violence

February 2021
18min

In this Hippo Education bonus, Dr. Lisa Patel and Dr. Maya Ragavan discuss intimate partner violence (IPV) in the context of COVID-19. While data has focused on prevalence, they dive into how the pandemic has changed survivors’ experiences, access to resources, approach to safety planning, privacy concerns, and survivor resilience. They also discuss alternative means of counseling families for IPV in the setting of increased telehealth, where survivors may not be in a private place to disclose an abusive relationship.

Race and Medical Education

February 2021
28min

In this installment of Hippo Education’s Race and Medicine series, Jay and Neda dive into some of the unique challenges facing Black medical students and residents. They also discuss solutions in both undergraduate and medical education with two experts in the field: Dr. Millard Collins, Chair of the Department of Family & Community Medicine at Meharry Medical College and Dr. Renee Crichlow, former Director of Advocacy and Policy in the Department of Family Medicine and Community Health at the University of Minnesota School of Medicine. She is currently the Chief Medical Officer of Codman Square Community Health Center and incoming Vice Chair of Health Equity at Boston University Department of Family Medicine.

More helpful POEMs for 2021

February 2021
9min

Kris and Adrian continue their review of patient-oriented evidence to help you provide great care by doing less from the article called, “ Top POEMs of 2019 Consistent with the Principles of the Choosing Wisely Campaign from an online article from the American Academy of Family Practice, October 30, 2020.

All About Amitriptyline

February 2021
16min

What is the deal with amitriptyline? Is it a panacea? Or a pariah? PC RAP’s own Dr. Jay-Sheree Allen and Dr. Neda Frayha break it all down for us in this medication deep dive.

Paper Chase #1: Antibiotics vs Appendectomy for Appendicitis

February 2021
7min

Antibiotics were not inferior to appendectomy at 90 days. 30% of the antibiotic group ended up having an appendectomy by 90 days.

Proceed With Confidence: Onychocryptosis

February 2021
22min

How’s your toenail-removing game? If it needs a little practice, listen to this segment about onychocryptosis to help you proceed with confidence in the why and how of removing a toenail.

Paper Chase #2: Memory Training for Children

February 2021
5min

Computer games did not improve children's working memory at six months.

Keeping Up with the Literature with Dr. Alan Ehrlich

February 2021
25min

On average, 5,000 new medical articles are published every day. In this segment, Dr. Alan Ehrlich, Executive Editor of DynaMed, and Paul Simmons discuss some practical tips in staying current with the literature and applying it to our everyday practice.

Light Chains, SPEPs, and MGUS

February 2021
23min

Kappa? Lambda? SPEPs? MGUS? WTH? Hematologist Dr. Victoria Giffi walks us through a clear, helpful primer on this alphabet soup of immunoglobulins.

Paper Chase #3: Palliative Care and Chronic Illness

February 2021
6min

Use of palliative care was associated with less acute healthcare use and modestly lower symptom burden, but there was no significant difference in quality of life.

Primary Care of Gay, Bisexual and Other Men Who Have Sex With Men: Part 1

February 2021
19min

There are significant health disparities for men who have sex with men. In this enlightening segment, Drs. Matt Zeitler and Hayden Shafer discuss these disparities and how we can address them in our primary care practice.

Primary Care of Gay, Bisexual and Other Men Who Have Sex With Men: Part 2

February 2021
8min

There are significant health disparities for men who have sex with men. In this enlightening segment, Drs. Matt Zeitler and Hayden Shafer discuss these disparities and how we can address them in our primary care practice.

Paper Chase #4: Patient-Reported Errors in EHR Notes

February 2021
6min

Patients reported errors in medical documentation almost a quarter of the time, and half of those errors were deemed serious.

Group Prenatal Care

February 2021
18min

Can you picture attending a routine prenatal visit in a visit with other pregnant women? What does the literature say about this? Neda discusses group prenatal care with Ob/Gyn Dr. Sara Mazzoni.

Tips for Getting Paid!

February 2021
29min

When you are deciding to bill a level 99213 vs 99214, how comfortable are you with your documentation? How about billing for procedures? Paul dives deep into coding with Dr. Kim Yu in this segment, including the 2021 Medicare coding changes.

Paper Chase #5: Smoking Cessation in New Cancer Diagnoses

February 2021
6min

Among smokers recently diagnosed with cancer, sustained counseling and provision of free cessation medication resulted in higher six month quit rates.

Mailbag: Intuitive Eating

February 2021
14min

PA Perspectives

February 2021
13min

Kris and Adrian review, reflect and share their takes on this month’s 2 part segment about the unique components of care for men who have sex with men.

Are you a POEt and don’t know it?

January 2021
13min

We made it to 2021!!!! 2020 is behind us, but you can look forward to a great discussion with Adrian and Kris around using quality patient-oriented evidence that matters (POEMs) to change common practice patterns in primary care.

Paper Chase #1 - CV and Renal Outcomes with Empagliflozin in Heart Failure

January 2021
7min

Among patients with heart failure, SGLT inhibitors improved rate of hospitalizations and decline in renal function regardless of diabetes status

Less is More

January 2021
16min

Less is more! We were thrilled to learn about the JAMA Internal Medicine series highlighting which primary care services we can scale back on or do away with completely. In this month’s Primary Care RAP introduction, Neda and Paul begin breaking down some of these recommendations and how they’ll put them into practice. Happy new year!

The Big Picture: Facing Death with Dr. BJ Miller

January 2021
25min

Why are we so afraid of death? What is the vicarious death bed test, and what role does love play? How can we help our patients face death on their own terms, and how can we all live our best lives beforehand? We ask these questions and more of Dr. BJ Miller, a palliative care specialist with Mettle Health and co-author of A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death. 

Paper Chase #2 - Early Rhythm-Control Therapy in Patients with A-Fib

January 2021
7min

Early rhythm control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions

PFTs for the PCP: Part 1

January 2021
19min

PFTs? Easy as ABC! Pulmonologist Dr. Nirav Shah is back, this time walking Neda and Paul through pulmonary function tests in a super clear, straightforward way.

PFTs for the PCP: Part 2

January 2021
16min

PFTs? Easy as ABC! Pulmonologist Dr. Nirav Shah is back, this time walking Neda and Paul through pulmonary function tests in a super clear, straightforward way.

Paper Chase #3 - Time Restricted Eating on Weight Loss

January 2021
5min

Time-restricted eating on its own is not more effective in weight loss than eating throughout the day.

What's That Lab: Bilirubin

January 2021
13min

It’s time for another installment of our fan-favorite “What’s That Lab?” series! This time, our own Paul Simmons answers a listener question about bilirubin. 

Tattoo Complications

January 2021
19min

Tattoos have become more and more common over the past decade. Besides regret, there are other cutaneous complications that clinicians should be aware of. Having a broad differential beyond simple bacterial infections can assist in making decisions on appropriate treatment and prompt referral to specialists when indicated.

Paper Chase #4 - Physician EKG Interpretation Accuracy

January 2021
5min

Physicians at all training levels had deficiencies in EKG interpretation, even after education interventions.

PCOS

January 2021
27min

Endocrinologist Dr. Rana Malek is back on Primary Care RAP, this time teaching Neda and Paul about the in’s and out’s of polycystic ovarian syndrome in her usual, chock-full-of-clinical-pearls way. 

Navajo Health and COVID-19

January 2021
22min

The COVID-19 pandemic has struck minority populations and populations of color most severely. One population hit particularly hard, but to little public notice, has been the Native American population in North America. Our own Paul Simmons and Dr. Matt Nelson, a family physician providing full-spectrum care to the Navajo population in Page, Arizona, discuss not only what Dr. Nelson has seen through the COVID-19 pandemic, but his perspective on the unique challenges and benefits of working with the Navajo population.

Paper Chase #5 - Fecal Microbiota Transplantation

January 2021
6min

Among patients with recurrent CDI treatment with FMT, cure rates were high with minimal adverse effects.

Mailbag: Long Covid Syndrome

January 2021
30min

Just when we all get accustomed to treating COVID-19, along comes Long Covid Syndrome to keep us on our toes. Some patients take months to recover and experience debilitating fatigue, dyspnea, and joint pains that have a huge impact on their quality of life. Neda and Paul answer a few listener questions about Long Covid Syndrome and what we know about it so far.