In this episode, Dr. Liang interviews Dr. Quinn (Adolescent Health Provider) and Alexis (Teenager) on her personal experience with navigating social media, mental health struggles, and reproductive health with her healthcare providers.

=== Outline ===

Chapter 1: Definitions

Chapter 2: Establishing a relationship with the patient

Chapter 3: Mental health

Chapter 4: Social media

Chapter 5: Sexual and reproductive health

Chapter 6: Conclusion

=== Learning Points ===

1. First impressions are important. How you set up and frame the relationship with a teen patient will set the tone for the teen’s trust, and how much they choose to confide in you in the coming years.
2. Instead of being prescriptive or setting limits, such as with social media, we can equip teens with the skills to reflect on their interactions. What does it mean to be kind in an online world? Is it leading to meaningful and constructive interactions? Or is it quickly becoming a detriment to someone’s identity and how they see themselves?
3. No matter the topic, using normalizing language can go a long way in empowering adolescents to share. When discussing topics included in the social history, using simple language can go a long way in avoiding misunderstandings. Remember, it might be the first time that teens are hearing these words being used.

=== Our Expert(s) ===

Sheila M. Quinn, DO, is an attending physician in the Craig-Dalsimer Division of Adolescent Medicine and the Transition to Adult Care Program at Children's Hospital of Philadelphia. Her areas of expertise include adolescent and young adult health, reproductive health, and health care transitions.

=== Toolkits and Resources ===

• n/a

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Addy Feibel

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Editing: Helen Cai, Josh Onyango

Theme music: Josh Onyango

Other background music: Nat Keefe, TrackTribe, Geographer, Asher Fulero, Loopop, Freedom Trail Studio, Chris Haugen, Aaron Kenny, Ammil, penguinmusic,

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In the final episode of the ESRD series, Dr. Montano and Bernstein discuss the implications and mechanisms behind dialysis and our patients share their experiences with both dialysis and kidney transplantation.

=== Outline ===

Chapter 1: Approaching dialysis

Chapter 2: Hemodialysis vs peritoneal dialysis

Chapter 3: Practicalities of living on dialysis

Chapter 4: Kidney transplantation

=== Learning Points ===

1. Hemodialysis and peritoneal dialysis are the two primary options for long-term renal replacement therapy. The two modalities are very different, and the patient’s lifestyle and individual needs should be considered when choosing a form of dialysis.
2. The decision to start dialysis is complex and should involve shared decision-making between the patient and their healthcare team with open communication.
3. Dialysis significantly impacts patients’ lives by requiring them to change their daily routines and dietary restrictions. Beyond this, it can significantly impact their emotional and social well-being.
4. Kidney transplantation offers a potential for improved quality of life and further longevity, as compared to dialysis options.

=== Our Expert(s) ===

Dr. Paul Bernstein graduated from Union College in 1982, where he earned a BA in Biology. He then attended the Albert Einstein College of Medicine, where he was elected to AOA. In 1988, he joined the Yale Traditional Internal Medicine Residency, serving as Chief Resident from 1991-1992. From 1992-1995, he was a Yale nephrology fellow, and after that, he joined the faculty at the University of Rochester. From 1997-2000, he was an APD for the University of Rochester Primary Care Residency, and from 2000-2012, he was Program Director for the Internal Medicine Residency at Rochester General Hospital.

=== Further Reading ===

1. NIH National Institute of Diabetes and Digestive and Kidney Diseases: Facts about Peritoneal Dialysis
   https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis
2. Wong B, Ravani P, Oliver MJ, Holroyd-Leduc J, Venturato L, Garg AX, Quinn RR. Comparison of Patient Survival Between Hemodialysis and Peritoneal Dialysis Among Patients Eligible for Both Modalities. Am J Kidney Dis. 2018 Mar;71(3):344-351. doi: 10.1053/j.ajkd.2017.08.028. Epub 2017 Nov 22. PMID: 29174322.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Host: Josh Onyango

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Aaron Kenny, The Tides, TrackTribe, Dan Bodan, Astron, Asher Fulero, VYEN, The Soundlings

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In this first episode of the ESRD series, Dr. Montano and Bernstein discuss how to diagnose kidney failure while Drs. Hart and Aklilu wrestle with the fraught history of using race in the measurement of kidney function.

=== Outline ===

Chapter 1: A gradual progression

Chapter 2: A history of EGFR through the lens of race

Chapter 3: Involving the nephrologist

Chapter 4: Medication adjustments and monitoring

=== Learning Points ===

1. The symptoms underlying a progression from CKD to ESRD are often vague. A definitive diagnosis requires measuring kidney function.
2. The history of measuring kidney function includes the use of creatinine as a biomarker and the development of equations to calculate EGFR. Many of these equations have historically explicitly involved race, which has come under scrutiny and controversy.
3. Once a patient’s creatinine is consistently higher than 1.6, consider referral to a nephrologist for assistance with ongoing monitoring and considerations for transplantation.
4. A diagnosis of ESRD may require medication adjustments and careful monitoring for complications such as anemia, electrolyte changes, bone mineral disease, and swings in blood pressure.

=== Our Expert(s) ===

Dr. Paul Bernstein graduated from Union College in 1982, where he earned a BA in Biology. He then attended the Albert Einstein College of Medicine, where he was elected to AOA. In 1988, he joined the Yale Traditional Internal Medicine Residency, serving as Chief Resident from 1991-1992. From 1992-1995, he was a Yale nephrology fellow, and after that, he joined the faculty at the University of Rochester. From 1997-2000, he was an APD for the University of Rochester Primary Care Residency, and from 2000-2012, he was Program Director for the Internal Medicine Residency at Rochester General Hospital.

=== Further Reading ===

1. NIH National Institutes of Diabetes and Digestive and Kidney Diseases: Fast Facts on Kidney Disease https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
2. Diao JA et al. National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations. J Am Soc Nephrol. 2023 Feb 1;34(2):309-321. doi: 10.1681/ASN.2022070818. Epub 2022 Nov 11. PMID: 36368777; PMCID: PMC10103103.
3. St Peter WL et al; Written on behalf of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Am J Health Syst Pharm. 2024 Nov 18:zxae317. doi: 10.1093/ajhp/zxae317. Epub ahead of print. PMID: 39552516.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Host: Josh Onyango

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: I Think I Can Help You, John Patitucci, Chris Haugen, DivKid, Asher Fulero, Jesse Gallagher, Saidbysed

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls