Primary Care Perspectives

Delivering serious news is unfortunately a part of pediatrics. While some believe that we are inherently either good or bad at this skill, we know that is not true and that you can learn how to do this well. In this episode, Julie W. Stern, MD, the Director of Outreach Services with the Division of Oncology at Children's Hospital of Philadelphia, shares best practices and lessons learned from years of having difficult conversations. 

Tzield or Teplizumab, is a CD3-directed monoclonal antibody to delay the onset of Stage 3 Type 1 Diabetes in adults and pediatric patients aged 8 years and older. This is an important new treatment option because when diabetes is recognized in the early stages (Stage 2), there is an approved treatment that has been shown to delay the need for insulin by about 2-3 years. In this episode, Neha S. Patel, DO, who is an Associate Professor of Pediatrics and an attending physician in the Division of Pediatric Endocrinology and Diabetes at Children's Hospital of Philadelphia, teaches us what we need to know about Tzield and how patients can access it. 

Jessi Gold, MD, MS, shares some of the lessons from her book, How Do You Feel: One doctor's search for humanity in medicine, including managing emotions, addressing burnout, and exploring self-identity. This episode feels like self-care! Learn the difference between secondary trauma, burnout, PTSD, and why healthcare workers are particularly at risk for experiencing trauma. Dr. Gold not only explores the current state of healthcare worker mental health but gives actionable ideas to help the helpers!

Paul Tran, MD, a pediatric gastroenterologist and medical educator, empowers and encourages medical learners through his comedic online medical education, using the handle @alimentaryschool. Listen as we discuss how he got started, the anatomy of a post, and how to respond to online criticism. In addition, we hear about his viral posts and why he's always carrying a notebook. 

Two experts from the CHOP Bariatric Program, Joy Collins, MD, and Elizabeth Parks Prout, MD, MSCE, update us on the state of pediatric obesity, the current medication and surgical management options, and the outcomes of these interventions. The Adolescent Bariatric Program at CHOP is a unique collaboration between our Health and Well-being Clinic, surgeons at CHOP and HUP, clinical psychologists, a clinical dietician, a social worker, and a physical activity specialist. In this episode, Drs. Collins and Prout discuss the psychosocial impacts of bariatric surgery and their team-based, holistic approach to treating patients. 

An estimated 11.4% of US children are diagnosed with ADHD. In this episode, Thomas Power, PhD, ABPP, Director of the Center for Management of ADHD at CHOP, discusses a new Clinical Pathway for the Evaluation and Treatment of ADHD and how primary care providers can utilize and promote psychosocial interventions for ADHD. We discuss behavioral parent training, peer interventions, school supports, emotion regulation, and more, in this fascinating episode!

In light of the recent measles outbreaks, Scott Krugman, MD, MS, FAAP, created a series of social media posts about vaccine-preventable infections. In this episode, he shares pearls from those posts so that we can learn more about these illnesses, which many practicing pediatric providers have never seen outside textbooks thanks to the success of vaccines. He also talks about how his social media posts were received online and why they were so popular.

In this episode, we discuss the definition and work-up of short stature as well as treatment of growth hormone deficiency. Marissa Kilberg, MD, MSEd, an attending physician in the Division of Endocrinology and Diabetes teaches us about who might qualify for growth hormone deficiency treatment, possible side effects, the logistics of treatment, and when treatment is not indicated. Dr. Kilberg offers primary care providers strategies about the work-up that can be done in primary care as well as management pearls for patients on growth hormone therapy. 

In this episode, Juhee Lee, MD, an attending physician in the Division of Allergy and Immunology at CHOP, discusses some of the nuanced ways anaphylaxis can present and reviews the diagnostic criteria for anaphylaxis. We use a few cases to apply the diagnostic criteria to real-world challenges and discuss how to manage patients with anaphylaxis in the outpatient setting. Dr. Lee teaches us about what's new in anaphylaxis treatment, including intranasal epinephrine, and when patients need to carry epinephrine auto-injectors. Lastly, we review the CHOP Clinical Pathway for the Evaluation/Treatment of Children with Anaphylaxis, which is a great resource. 

Sine 2023, both the FDA and AAP have supported the use of goat milk-based infant formula, but awareness of this option still lags and many think of it as a niche product. Ari Brown, MD, a board-certified practicing pediatrician in Austin, Texas, the author of the best-selling Baby 411 book series, and Kabrita’s Chief Medical Advisor, teaches us more about why families would choose a goat milk-based formula and the safety data behind its use in the US. Dr. Brown also gives us a great review of all of components of formula and what we should be looking for in the ingredients. In this episode, we also discuss the risks of homemade infant formula, raw milk, and unregulated formula, and Dr. Brown shares her experience in working in both the formula industry and in her pediatric clinic.