The Clinical Problem Solvers

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Dr. Palmer presents a clinical unknown case to Dr. Stanley

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Dr. Marion Stanley

Dr. Marion Stanley is a hospitalist and an internal medicine residency associate program director at Northwestern Memorial Hospital. She completed medical school at University of Chicago, Pritzker School of Medicine and graduated from University of California, San Francisco for residency. She spends her clinical time on the general medicine teaching services as well as the general medicine and oncology hospitalist units. She enjoys spending time with her husband and two daughters, ages 4 and 1.

 

Dr. Geralyn Palmer

Dr. Geralyn Palmer is a first year internal medicine resident at the University of Wisconsin. She completed her undergraduate and medical education in her home state of South Dakota. After residency, Geralyn hopes to pursue a career in medical education, and is currently considering a broad specialty differential. In her free time she enjoys long walks outside (preferably with dogs), experimenting in the kitchen, and The Great British Bake Off.  

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Dr. Julia Armendariz presents a clinical unknown to Dr. Laura Huppert.

Dr Laura Huppert 

Laura Huppert, MD, is a third year Hematology/Oncology Fellow at the University of California, San Francisco (UCSF).  Her clinical interest is in solid tumor malignancy, including the treatment of breast cancer and melanoma.  She is also interested in medical education, and recently published a handbook for internal medicine entitled “Huppert’s Notes”, published by McGraw Hill.  Dr. Huppert earned her M.D. from Harvard Medical School. She completed her Internal Medicine Residency and Chief Residency at UCSF.

Dr. Julia Armendariz

Julia Armendariz, MD is a general medicine hospitalist. Her interests lie in medical education, trainee wellness, and effective communication. She is a faculty member of the Stanford Internal Medicine Residency Wellness Committee and the Stanford GME Women in Medicine group. Dr. Armendariz earned her M.D. from Oregon Health and Science University in Portland, OR and completed her Internal Medicine Residency at Stanford.

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Jack, Dan, and Emma teach us an approach to intrarenal AKI and anemia. 

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Learning Objectives
By the end of this episode, listeners will be able to: 

• Describe the clinical features that can help clinicians determine which organ system is causing lower extremity edema 
• Produce a prioritized differential diagnosis for an acute kidney injury 
• List the clinical features that suggest the presence of hemolysis 
• Summarize the clinical significance of spherocytes on a peripheral blood smear 
• List the urinalysis and urine microscopy findings that suggest the presence of a glomerulonephritis 

Episode Transcript

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Shanthi presents a clinical unknown to Sam, Michael, and Jack.  

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Michael Vu

Michael Vu is a second year Internal Medicine resident at Methodist Dallas. He completed his undergraduate education at the University of Texas at Dallas and his medical training at the University of North Texas Health Science Center – Texas College of Osteopathic Medicine. His current career interests include clinical reasoning, medical education, and cardiology. In his free time, he enjoys working out, cooking, and spending time with his wife.

Samantha Etienne

Sam is a PGY3 and chief resident at Methodist Dallas Medical Center in Dallas, TX. She attended the University of Texas Medical Branch at Galveston and is an aspiring hematologist/oncologist. Outside of medicine, she enjoys spending quality time with friends and family and has a real passion for food. She is considered by many a connoisseur of tacos.

Shanthi Kappagoda

Shanthi Kappagoda was born in United Kingdom and grew up in the UK and Canada. She graduated from UC Davis School of Medicine and completed her internal medicine residency at Brigham and Women’s Hospital in Boston. She completed her Infectious Disease fellowship at the Stanford School of Medicine and after fellowship remained at Stanford as a clinical faculty member. She works primarily on the ICU-ID consult service. In her free time, she enjoys spending time with her two children, growing vegetables and hiking around California State parks.

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In this episode, we invite the powerful sister duo Oni Blackstock, MD, MHS and Uché Blackstock, MD to share their experiences on leaving public health and academia to become social entrepreneurs, creating their own organizations in health equity.

Episode Learning Objectives

After listening to this episode learners will be able to…

1. Recognize some common factors that influence Black women’s decisions to leave traditional health careers

2. Define counterspaces and understand their value 

3. Apply tools to combat burnout that could be applied to traditional or alternative health careers 

 

Credits

• Written and produced by: Michelle Ogunwole, MD, Naomi F. Fields, LaShyra Nolen, Chioma Onuoha, Rohan Khazanchi, MPH, Dereck Paul, MD MS, Utibe R. Essien, MD, MPH, Jazzmin Williams, and Jennifer Tsai MD, M.Ed

• Hosts: Michelle Ogunwole, MD, Naomi Fields, and LaShyra Nolen

• Infographic: Creative Edge Design

• Audio edits: David Hu

• Guests: Oni Blackstock, MD, MHS and Uché Blackstock, MD

 

Time Stamps

00:00 Introduction

03:49 Defining “CounterSpaces”

5:22 Why Drs. Uché and Oni Blackstock created their counterspaces

17:54 Value gained outside of academia, public health

24:08 Finding balance in racial equity opportunities

34:17 On challenging the self-sacrificing mentality in medicine

42:26 On “doing the work” within academia

49:01 The meaning of sisterhood

52:20 Closing Remarks 

Episode Takeaways:

1. Definition of CounterSpaces: CounterSpaces are academic and social safe spaces that allow underrepresented faculty to promote their own learning, wherein their experiences are validated and viewed as critical knowledge; they have space to vent frustrations by sharing stories of isolation, microaggressions or overt discrimination; and they can challenge the deficit notion of people of color and establish and maintain a positive collegial racial climate for themselves.

2. Root causes of the exodus Black women physicians from academia and public health: In many academic and public health institutions, Black women feel undervalued, untitled, underfunded, and undersupported. Their contributions to diversity, equity, and inclusion efforts are expected, but not compensated or rewarded. They are disproportionately passed over for promotions and opportunities despite quality work. These factors directly contribute to the growing trend of Black women physicians leaving these fields to pursue nontraditional health careers.

3. You are gifted!: “Sometimes you’re in these environments [academic, public health] for so long where you’re undervalued and underappreciated, you’re not supported the way that you should be, that you actually start thinking that– or start forgetting that you’re actually someone with gifts to share.” — Dr. Uché Blackstock

4. Self-sacrifice is not the highest virtue: Medicine is its own subculture where people are expected to make sacrifices of their time, personal and family life, and finances in order to demonstrate that they are good physicians. It is okay to say that you don’t want that for yourself, and work to actively counter this cultural norm in order to live a fulfilling personal and professional life.  

5. There are opportunities to advance racial equity inside and outside of academia: For those who feel driven to pursue racial and health equity work within academia and/or public health: (1) understand what you value from working at an academic institution and recognize that there may be options to do that work outside of academia (e.g. research), and (2) build a support structure that enables you to stay true to your values as you work to create change from within.

 

For those having a hard time deciding if they should stay in academia or other traditional research or public health roles, Dr. Oni Blackstock offers important advice about listening to and trusting oneself:

“… just listening to your intuition, that’s like our main form of knowing. We have all these other forms of knowledge in books and what we’re taught in school, but really many times, the answer lies within us. So, again, just making sure that we’re in tune and listening to what we feel like our needs are. And if they’re telling us to leave, that we are true to those voices and we leave. And if they’re saying there’s work for us to do here, we want to stay and we have the support to be able to do that, then do that.” — Dr.  Oni Blackstock

Pearls 

“The work of liberation is the work of freeing the soul to be exactly who we were meant to be.” — GirlTrek

 

The role of an abundance mindset in achieving work/life balance 

Many of us operate from a scarcity mindset; we feel that opportunities are limited and therefore take all opportunities that come our way without regard for our genuine interest in the opportunity or our true time availability. Especially for people early in their careers, there is an unspoken pressure to accept all opportunities that could possibly advance one’s career. It is impossible to achieve work/life balance when operating from this mindset, and as a consequence, it leads to burnout. 

 

However, with an abundance mindset, one recognizes that opportunities are not finite and that saying no to one opportunity frees up our ability to say yes to a better opportunity that comes along later down the line. Dr. Uché Blackstock shared an example of how she experienced a tension between a scarcity mindset and an abundance mindset when deciding whether to continue part-time clinical work or to devote full-time effort to the organization she founded. When she embodied an abundance mindset and let go of her clinical career, she was free to say yes to even more fulfilling opportunities that came her way.

 

Relatedly, Dr. Oni Blackstock discussed the importance of pausing before committing to opportunities. White supremacy culture creates an artificial sense of urgency so we often respond reflexively. By taking a moment to pause and reflect, one can take on opportunities that align with one’s values and that one has adequate time for without sacrificing personal responsibilities. Taking a moment to pause ensures that we react from our authentic self and not from institutional culture.  

 

Cultivate tools to sustain a career in traditional and alternative health careers 

Cultural norms rooted in white supremacy and capitalism create an environment that extracts goods, time, and energy from people without providing a source from which to renew those resources. Dr. Oni Blackstock advises listeners to be “cognizant of the day to day ways in which these systems work against us,” and to actively fight against this culture with things that replenish ourselves. Tools that Dr. Oni Blackstock uses include: daily meditation, creating a gratitude list of 3 things each morning, and yoga and exercise several times a week. Additionally, she spoke about the importance of mentorship and a strong support network so you have people to turn to for advice and encouragement.

 

Finding effective strategies to replenish oneself is important for anyone advancing racial equity work in their careers as social entrepreneurs, academicians, public health officials. 

Dr. Oni Blackstock shared a treasured quote around this idea: “ Learn to drink as you pour, so the spiritual heart cannot run dry and you always have love to give”-Ma Jaya 

 

Self-reflection is a vital component of professional development

It is easy to become consumed by various career opportunities that are presented to us. In order to maintain one’s ability to effectively transform the existing culture of medicine into an anti-racist one, it is important to find time to reflect on one’s journey and direction. Below are some questions that CPSolvers ARM host Dr. Michelle Ogunwole synthesized after this conversation with Drs. Oni and Uché Blackstock. 

 

• What are the things (situations, contexts, people) that are making you question your gifts? 

• What are the wake up calls that we need in our life? How can they help you in your next step? 

• Who are you taking advice from? 

• What is keeping you from being your authentic self? 

 

References

1. National Academies of Sciences, Engineering, and Medicine 2020. Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine: Opening Doors. Washington, DC: The National Academies Press. https://doi.org/10.17226/25585. 

2. National Academies of Sciences, Engineering, and Medicine 2021. Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press.   https://doi.org/10.17226/26061. 

3. Blackstock, U. Why Black doctors like me are leaving faculty positions in academic medical centers. (2020, January 08). Retrieved from https://www.statnews.com/2020/01/16/black-doctors-leaving-faculty-positions-academic-medical-centers/ 

4. Forrester A. Why I Stay – The Other Side of Underrepresentation in Academia. N Engl J Med. 2020;383(4):e24. https://www.nejm.org/doi/full/10.1056/NEJMpv2022100 

5. Doll KM, Thomas CR Jr. Structural Solutions for the Rarest of the Rare – Underrepresented-Minority Faculty in Medical Subspecialties. N Engl J Med. 2020;383(3):283-285. https://www.nejm.org/doi/full/10.1056/NEJMms2003544 

6. Blackstock, O, Blackstock, U. Opinion: Black Americans should face lower age cutoffs to qualify for vaccine. https://www.washingtonpost.com/opinions/black-americans-should-face-lower-age-cutoffs-to-qualify-for-a-vaccine/2021/02/19/3029d5de-72ec-11eb-b8a9-b9467510f0fe_story.html 

7. https://www.girltrek.org/ 

8. https://www.healthjustice.co/ 

9. https://advancinghealthequity.com/about/ 

 

Disclosures 

The hosts and guests report no relevant financial disclosures.

 

Citation

Blackstock O, Blackstock U, Ogunwole M, Fields NF, Nolen L, Onuoha C, Williams J, Tsai J, Essien UR, Paul D, Khazanchi R. “Episode 10: CounterSpaces in Medicine: Finding Safe Spaces and Redefining Value.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. July 15, 2021.

 

Transcript

 

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Dr. Frederick Weber discusses an approach to chronic diarrhea with the TCQ squad

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Dr. Frederick Weber

Dr. Frederick Weber is a Clinical Professor of Medicine at the University of Alabama Birmingham in the Division of Gastroenterology and Hepatology.  He is the former Medical Director of the Division.

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We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz

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Gabriela Pucci

Gabriela has graduated from Medical School at Unicamp and recently finished her neurology residency at Unesp, both in Brazil. She is interested in Medical Education and Clinical Reasoning and has obviously fallen in love with CPSolvers and VMRs since day 1. In her free time, she likes to practice pilates, play with her dogs, binge-watch Netflix comedy series, read biography books, go out with her friends (pre-COVID), drink wine, and cook (still learning).

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Rabih and Reza discuss learning during the process of clinical reasoning on VMR. 

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https://clinicalproblemsolving.com/wp-content/uploads/2021/06/WDX11-6.24.21-RTP.mp3Simone and Lindsey present a case to Dr. Kirsten Austad, followed by a discussion about women in leadership and “the double bind”  Want to test your learning? Take our episode quiz here Dr. Kristen Austad 

Kirsten Austad MD, MPH is an Assistant Professor of Family Medicine at Boston University School of Medicine and a hospitalist at Boston Medical Center. She earned her undergraduate degree in English Literature and Medical Microbiology and Immunology from the University of Wisconsin-Madison and her medical degree from Harvard Medical School in the New Pathway Program. She completed her residency in Family Medicine at Boston Medical Center, the largest safety-net hospital in New England. Following residency, she completed a research fellowship at Brigham and Women’s Hospital in Global Women’s Health and earned a Masters in Public Health from the Harvard T.H. Chan School of Public Health. During this time she worked clinically as a nocturnist at Brigham and Women’s Hospital / Dana Farber Cancer Institute. After fellowship she returned to Boston Medical Center where she is a hospitalist and the Medical Director of the HealthNet Inpatient Family Medicine service, one of the largest family medicine hospitalist services in the country.

   

Her research focuses on global implementation science aimed at improving the delivery of women’s health care in low-resource settings, including respectful maternity care and family planning. In addition to global health research, she also has extensive experience in program development, having spent 6 years as the Director of Women’s Health for Maya Health Alliance, a non-profit providing care to indigenous Maya patients in the highlights of Guatemala, where she trained and supervised a team of over 20 nurses and doctors to provide community-based patient-centered women’s health care.

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Bronson presents a clinical unknown to Mohit, Kai, and Lindsey.

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Mohit Harsh

Mohit is a current Chief Resident in the Department of Internal Medicine at WashU. He is from Huntington, West Virginia and attended Marshall University School of Medicine in his hometown. He loves clinical reasoning and has a special interest in Hospital Medicine. Outside of work, he enjoys cooking new recipes, hiking, walks in the park, and has recently developed a green thumb with over 30 house plants and a garden.

Kai Jones

Kai Jones is from Tulsa, Oklahoma and studied Biology and Anthropology at Washington University in St. Louis. She attended Washington University for medical school and is now a second-year resident in Internal Medicine at Barnes-Jewish Hospital. She is interested in Endocrinology, and  community based participatory research. Her hobbies include golf, and cooking.

Bronson Knuzler

Bronson Kunzler was born and raised in Salt Lake City, Utah, he studied finance at Utah State University and is currently an MS3 at Penn State University College of Medicine. He is interested in Internal Medicine with hopes to become a Cardiologist. In his free time he enjoys cheering for the Utah Jazz, barbeque, and visiting museums.

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