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In this episode of The Birth Trauma Mama Podcast, Kayleigh is joined by Dr. Ono Nseyo, an OB-GYN practicing in the Bay Area, for a deeply honest and inspiring conversation about patient-centered, trauma-informed care and what it means to show up as both a clinician and a human.Dr. Nseyo shares her journey from growing up as the daughter of Nigerian immigrants to becoming a physician passionate about addressing health disparities and providing care that honors dignity and autonomy. Together, Kayleigh and Dr. Nseyo explore what happens when healthcare providers reject the pressure of rushed, 10-minute appointments and instead prioritize listening, presence, and human connection.This conversation explores:
Dr. Helen Stankiewicz Karita, Associate Professor at UCSF and a national expert on human papillomavirus (HPV)-related diseases in the anal canal, and National STD Curriculum Podcast Editor Dr. Meena Ramchandani discuss how to screen, diagnose, and treat HPV-related warts in the anal area. View episode transcript and references at www.std.uw.edu.This podcast is dedicated to an STD [sexually transmitted disease] review for health care professionals who are interested in remaining up-to-date on the diagnosis, management, and prevention of STDs. Editor and host Dr. Meena Ramchandani is an Assistant Professor of Medicine at the University of Washington (UW), Program Director of the UW Infectious Diseases Fellowship Program, and Associate Editor of the National STD Curriculum.
State of the Bay addresses confusion over this year's COVID vaccine with UCSF's Dr. Monica Gandhi, investigates America's troubled rehab industry with journalist Shoshana Walter, and celebrates San Francisco's Dance Mission Theater.
Listen to our latest podcast as we break down the science of the use of BPC-157 in sports medicine (aka the Wolverine Peptide)
If your self-worth depends on being liked, playing the “good girl,” or keeping everyone else happy, you're stuck in Emotional Outsourcing™. In this episode, our bestie Bea Albina, a UCSF-trained Family Nurse Practitioner, Master Certified Life Coach, and author of End Emotional Outsourcing™, is back and teaching us how to quit people-pleasing, perfectionism, and codependent habits FOR GOOD. We cover: Why we emotionally outsource in the first place. Bea explains how codependency, people-pleasing, and perfectionism are survival strategies we learned early on, NOT character flaws. How Emotional Outsourcing™ keeps you stuck and miserable. We unpack the hidden ways outsourcing your worth drains your energy and relationships. The nervous system's role in healing. Bea shares SIMPLE somatic and polyvagal tools to help you actually regulate and build resilience. Why people-pleasing sometimes feels safer than saying no. Learn how your brain and body keep you locked in old patterns and how to break free. Practical ways to set boundaries without guilt. Simple scripts and reframes for protecting your energy without shame. How to move from perfectionism to self-trust. Shift from performing for approval to living as your authentic self. Daily practices to reconnect with your worth. Because you are SO worthy. Bea teaches us grounding tools to build confidence, self-compassion, and inner safety. PREORDER BEA'S BOOK HERE! (and then go to her website HERE to get all the special preorder goodies!) Join our Patreon and access exclusive content HERE! Learn more about your ad choices. Visit podcastchoices.com/adchoices
Send us a textDiscover the groundbreaking science of Emotional Brain Training (EBT) — a proven method to rewire your unconscious mind, break destructive habits, and return to your brain's natural state of joy. In this captivating conversation, Joey Pinz sits down with Dr. Laurel Mellin, a UCSF health psychologist and New York Times bestselling author, who has spent over 40 years developing EBT to help people eliminate stress overload, reverse harmful patterns, and achieve lasting emotional resilience.Dr. Mellin explains how most of our decisions are driven by the emotional brain — and why traditional “thinking” approaches fail to break deep-rooted patterns. She walks Joey through a live EBT session, revealing how to clear an “emotional blockade” in just 2 minutes, shift brain states, and activate powerful biochemical rewards that make change feel natural.✅ Top 3 Highlights:
On his very first day at San Francisco General Hospital, Dr. Paul Volberding met his first AIDS patient – a moment that shaped his career and left an indelible mark on the fight against an epidemic. Now, more than 40 years later, Volberding reflects on the creation of Ward 86, the nation's first HIV clinics, and how UCSF's compassionate, community-first approach redefined HIV/AIDS care worldwide. The work of Volberding and UCSF's dedicated clinicians and scientists laid the foundation for advancements that continue to save lives today. [Health and Medicine] [Show ID: 40986]
As part of the 2025 Developmental Disabilities Conference, Dr. Elysa Marco talks about various biological approaches to therapy. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40623]
Eating Disorders: A Contemporary Introduction (Routledge, 2022) presents an accessible introduction to the conceptualization and treatment of eating disorders from a psychoanalytic perspective. Each of the chapters offers a different perspective on these difficult-to-treat conditions and taken together, illustrate the breadth and depth that psychoanalytic thinking can offer both seasoned clinicians as well as those just beginning to explore the field. Different aspects of how psychoanalytic theory and practice can engage with eating disorders are addressed, including mobilizing its nuanced developmental theories to illustrate the difficulties these patients have with putting feelings into words, the loathing that they feel towards their bodies, the disharmonies they experience in the link between body and mind, and even the ways that they engage with online Internet forums. This is an accessible read for clinicians at the start of their career and will also be a useful, novel take on the subject for experienced practitioners. Tom Wooldridge, PsyD, ABPP, CEDS-S is Chair in the Department of Psychology at Golden Gate University as well as a psychoanalyst and board-certified, licensed psychologist. He has published numerous journal articles and book chapters on topics such as eating disorders, masculinity, technology, and psychoanalytic treatment. His first book, Understanding Anorexia Nervosa in Males, was published by Routledge in 2016 and has been praised as “groundbreaking” and a “milestone publication in our field.” His second book, Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak, an edited volume in the Relational Perspectives Book Series, was published by Routledge in 2018, and has also been well reviewed. In addition, Dr. Wooldridge has been interviewed by numerous media publications including Newsweek, Slate, WebMD, and others for his work. He is on the Scientific Advisory Council of the National Eating Disorders Association, Faculty at the Psychoanalytic Institute of Northern California (PINC) and the Northern California Society for Psychoanalytic Psychology (NCSPP), an Assistant Clinical Professor at UCSF's Medical School, and has a private practice in Berkeley, CA. Helena Vissing, PsyD, SEP, PMH-C is a Licensed Psychologist practicing in California. She is associate professor at California Institute of Integral Studies. She can be reached at contact@helenavissing.com. She is the author of Somatic Maternal Healing: Psychodynamic and Somatic Treatment of Trauma in the Perinatal Period. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/psychoanalysis
Scot Bertram sits down with Rep. Tim Walberg (MI-5), a leading conservative voice in Congress and member of the House Energy and Commerce Committee as well as the House Education and the Workforce Committee. They discuss the GOP's expanded probes into antisemitism at UCLA and UCSF medical schools, why it matters, how deep the bias runs in higher education, and what Republicans in Congress are doing to hold these institutions accountable.
Eating Disorders: A Contemporary Introduction (Routledge, 2022) presents an accessible introduction to the conceptualization and treatment of eating disorders from a psychoanalytic perspective. Each of the chapters offers a different perspective on these difficult-to-treat conditions and taken together, illustrate the breadth and depth that psychoanalytic thinking can offer both seasoned clinicians as well as those just beginning to explore the field. Different aspects of how psychoanalytic theory and practice can engage with eating disorders are addressed, including mobilizing its nuanced developmental theories to illustrate the difficulties these patients have with putting feelings into words, the loathing that they feel towards their bodies, the disharmonies they experience in the link between body and mind, and even the ways that they engage with online Internet forums. This is an accessible read for clinicians at the start of their career and will also be a useful, novel take on the subject for experienced practitioners. Tom Wooldridge, PsyD, ABPP, CEDS-S is Chair in the Department of Psychology at Golden Gate University as well as a psychoanalyst and board-certified, licensed psychologist. He has published numerous journal articles and book chapters on topics such as eating disorders, masculinity, technology, and psychoanalytic treatment. His first book, Understanding Anorexia Nervosa in Males, was published by Routledge in 2016 and has been praised as “groundbreaking” and a “milestone publication in our field.” His second book, Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak, an edited volume in the Relational Perspectives Book Series, was published by Routledge in 2018, and has also been well reviewed. In addition, Dr. Wooldridge has been interviewed by numerous media publications including Newsweek, Slate, WebMD, and others for his work. He is on the Scientific Advisory Council of the National Eating Disorders Association, Faculty at the Psychoanalytic Institute of Northern California (PINC) and the Northern California Society for Psychoanalytic Psychology (NCSPP), an Assistant Clinical Professor at UCSF's Medical School, and has a private practice in Berkeley, CA. Helena Vissing, PsyD, SEP, PMH-C is a Licensed Psychologist practicing in California. She is associate professor at California Institute of Integral Studies. She can be reached at contact@helenavissing.com. She is the author of Somatic Maternal Healing: Psychodynamic and Somatic Treatment of Trauma in the Perinatal Period. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network
Eating Disorders: A Contemporary Introduction (Routledge, 2022) presents an accessible introduction to the conceptualization and treatment of eating disorders from a psychoanalytic perspective. Each of the chapters offers a different perspective on these difficult-to-treat conditions and taken together, illustrate the breadth and depth that psychoanalytic thinking can offer both seasoned clinicians as well as those just beginning to explore the field. Different aspects of how psychoanalytic theory and practice can engage with eating disorders are addressed, including mobilizing its nuanced developmental theories to illustrate the difficulties these patients have with putting feelings into words, the loathing that they feel towards their bodies, the disharmonies they experience in the link between body and mind, and even the ways that they engage with online Internet forums. This is an accessible read for clinicians at the start of their career and will also be a useful, novel take on the subject for experienced practitioners. Tom Wooldridge, PsyD, ABPP, CEDS-S is Chair in the Department of Psychology at Golden Gate University as well as a psychoanalyst and board-certified, licensed psychologist. He has published numerous journal articles and book chapters on topics such as eating disorders, masculinity, technology, and psychoanalytic treatment. His first book, Understanding Anorexia Nervosa in Males, was published by Routledge in 2016 and has been praised as “groundbreaking” and a “milestone publication in our field.” His second book, Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak, an edited volume in the Relational Perspectives Book Series, was published by Routledge in 2018, and has also been well reviewed. In addition, Dr. Wooldridge has been interviewed by numerous media publications including Newsweek, Slate, WebMD, and others for his work. He is on the Scientific Advisory Council of the National Eating Disorders Association, Faculty at the Psychoanalytic Institute of Northern California (PINC) and the Northern California Society for Psychoanalytic Psychology (NCSPP), an Assistant Clinical Professor at UCSF's Medical School, and has a private practice in Berkeley, CA. Helena Vissing, PsyD, SEP, PMH-C is a Licensed Psychologist practicing in California. She is associate professor at California Institute of Integral Studies. She can be reached at contact@helenavissing.com. She is the author of Somatic Maternal Healing: Psychodynamic and Somatic Treatment of Trauma in the Perinatal Period. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/food
Eating Disorders: A Contemporary Introduction (Routledge, 2022) presents an accessible introduction to the conceptualization and treatment of eating disorders from a psychoanalytic perspective. Each of the chapters offers a different perspective on these difficult-to-treat conditions and taken together, illustrate the breadth and depth that psychoanalytic thinking can offer both seasoned clinicians as well as those just beginning to explore the field. Different aspects of how psychoanalytic theory and practice can engage with eating disorders are addressed, including mobilizing its nuanced developmental theories to illustrate the difficulties these patients have with putting feelings into words, the loathing that they feel towards their bodies, the disharmonies they experience in the link between body and mind, and even the ways that they engage with online Internet forums. This is an accessible read for clinicians at the start of their career and will also be a useful, novel take on the subject for experienced practitioners. Tom Wooldridge, PsyD, ABPP, CEDS-S is Chair in the Department of Psychology at Golden Gate University as well as a psychoanalyst and board-certified, licensed psychologist. He has published numerous journal articles and book chapters on topics such as eating disorders, masculinity, technology, and psychoanalytic treatment. His first book, Understanding Anorexia Nervosa in Males, was published by Routledge in 2016 and has been praised as “groundbreaking” and a “milestone publication in our field.” His second book, Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak, an edited volume in the Relational Perspectives Book Series, was published by Routledge in 2018, and has also been well reviewed. In addition, Dr. Wooldridge has been interviewed by numerous media publications including Newsweek, Slate, WebMD, and others for his work. He is on the Scientific Advisory Council of the National Eating Disorders Association, Faculty at the Psychoanalytic Institute of Northern California (PINC) and the Northern California Society for Psychoanalytic Psychology (NCSPP), an Assistant Clinical Professor at UCSF's Medical School, and has a private practice in Berkeley, CA. Helena Vissing, PsyD, SEP, PMH-C is a Licensed Psychologist practicing in California. She is associate professor at California Institute of Integral Studies. She can be reached at contact@helenavissing.com. She is the author of Somatic Maternal Healing: Psychodynamic and Somatic Treatment of Trauma in the Perinatal Period. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/psychology
Join Lillian Samuel, CEO of Big Brothers Big Sisters of the Bay Area, at Commonwealth Club World Affairs for an inspiring talk: “When Kids Have Mentors, Cities Get Stronger.” Backed by powerful national economic data, Lillian will discuss how mentoring doesn't just change one life—it uplifts entire communities. Youth with mentors are more likely to graduate high school, attend college, and earn significantly more as adults. Mentorship narrows income gaps and boosts local economies. Through inspirational local case studies, she'll share how even a single match between a Big and Little can ripple out to benefit families and neighborhoods. This is more than a program—it's a proven strategy for creating stronger, more connected cities. Don't miss this opportunity to learn how one relationship can transform a life and a community. About the Speaker Lillian Samuel is the CEO of Big Brothers Big Sisters of the Bay Area, serving all nine counties. Under her leadership, the organization earned national recognition with back-to-back Quality and Growth Awards in 2022, 2023 and 2024. With more than 15 years of experience in nonprofit leadership, she has held leadership roles in institutions at UCSF, Girl Scouts of Northern California, and Bay Area health centers. Lillian holds degrees from the University of Pennsylvania and the University of San Francisco and has served on multiple boards. A Psychology Member-led Forum program. Forums at the Club are organized and run by volunteer programmers who are members of The Commonwealth Club, and they cover a diverse range of topics. Learn more about our Forums. OrganizerPatrick O'Reilly Learn more about your ad choices. Visit megaphone.fm/adchoices
AI is transforming discharge documentation. Dr. Ben Rosner of UCSF breaks down how large language models (LLMs) perform compared to physicians—and what that means for safety, education, and clinical workflows. Learn what “LLM as jury” could mean for quality control and how AI might de-skill future doctors if we're not careful.
The one thing certain about the COVID vaccine right now is that everything about it is changing.The Food and Drug Administration recently approved the next round of COVID-19 vaccines for the fall season, but it's significantly changed just WHO can get it.That move comes amidst a broader effort by the Health and Human Services Secretary Robert F. Kennedy, Jr. to change policy and guidance around many vaccines. At this point — we're guessing you have lots of questions about vaccination in general, but especially around COVID shots.That's why we asked our NPR listeners to submit their questions about the FDA's new COVID vaccine guidance.UCSF infectious disease doctor Dr. Peter Chin-Hong answers your questions. For sponsor-free episodes of Consider This, sign up for Consider This+ via Apple Podcasts or at plus.npr.org. Email us at considerthis@npr.org.This episode was produced by Brianna Scott. It was edited by Courtney Dorning.Our executive producer is Sami Yenigun.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy
Welcome to another episode of the Sustainable Clinical Medicine Podcast! This week, Dr. Sarah Smith sits down with Dr. Diane Sliwka, Chief Physician Experience Officer at UCSF, to explore what it really takes to create a sustainable and fulfilling career in medicine. Dr. Sliwka shares her personal journey through hospital medicine, the challenges of burnout, and how systemic change and leadership can make a real difference for clinicians. Together, they discuss practical strategies for improving work-life balance, the power of advocacy, and the importance of open communication in healthcare organizations. Whether you're a physician, healthcare leader, or anyone interested in the future of clinical practice, this episode is packed with insights and inspiration to help you thrive in your career and support a healthier medical community. Here are 3 key takeaways from this episode: Systemic Change Is Essential for Combating Burnout: Dr. Sliwka's experience highlights that physician burnout is often rooted in systemic issues—such as long hours, inflexible schedules, and excessive documentation. Addressing these challenges requires organizational change, not just individual resilience. Leadership and Advocacy Make a Difference: Taking on leadership roles and advocating for change within the system can lead to meaningful improvements. Dr. Sliwka's journey shows that when clinicians step into leadership and use data to drive decisions, they can influence policies that support well-being, such as improved scheduling, documentation support, and wellness initiatives. Continuous Improvement and Open Communication Are Key: Sustainable clinical practice depends on ongoing feedback, open communication between frontline staff and leadership, and a willingness to adapt. Initiatives like anonymous surveys, regular check-ins, and a culture that values listening to clinicians' needs are crucial for creating a healthier, more supportive work environment. Meet Dr. Diane Sliwka: Diane Sliwka, MD is a Hospitalist and Clinical Professor of Medicine in the Division of Hospital Medicine at the University of California San Francisco Medical Center. In her role as Chief Physician Experience Officer at UCSF Health, she has led provider experience efforts organizationally since 2014. Diane co-designed and facilitated UCSF's well-being centered leadership development program for physicians. She also leads UCSF Health's Center for Enhancement of Communication in Healthcare which provides relationship centered communication skills training for providers. She hosts “The Expansive Life Project” on Instagram, providing personal well-being resources and tips focused on mid-career working professionals. You can find Dr. Sliwka on: Instagram: https://www.instagram.com/theexpansivelifeproject/ Linked In: linkedin.com/in/diane-sliwka-md-59122413b UCSF Web Bio: https://hospitalmedicine.ucsf.edu/people/diane-sliwka -------------- Would you like to view a transcript of this episode? Click Here **** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine. Learn more at https://www.chartingcoach.ca **** Enjoying this podcast? Please share it with someone who would benefit. Also, don't forget to hit “follow” so you get all the new episodes as soon as they are released. **** Come hang out with me on Facebook or Instagram. Follow me @chartingcoach to get more practical tools to help you create sustainable clinical medicine in your life. **** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.
HIFU (high-intensity focused ultrasound) is one of the most talked-about focal therapies in prostate cancer—but who is it really right for? In this conversation, Dr. Matthew Cooperberg (UCSF)—a leading voice in urology, epidemiology, and integrative prostate cancer care—breaks down patient selection vs. energy modality, how modern imaging (MRI, fusion, RSI) drives precision, what genomics (e.g., Decipher) can and can't tell us, and how salvage options compare after focal therapy vs. radiation. We also tackle lifestyle factors, trial design, and why midlife PSA screening (ideally
In this episode, I speak with Chandra about her path into trauma-informed work with young children and their caregivers. Raised in San Francisco by parents who worked in child welfare, Chandra was exposed early to stories of trauma and healing. Before age 7, several of her friends lost their parents to cancer, which inspired her to become a doctor. In high school, during an internship on a pediatric oncology ward she noticed that while physical health was prioritized, children's emotional needs were often overlooked. This realization led her to study psychology. After college, Chandra worked at a residential program with children aged 6–12. She found the children often opened up about trauma during informal moments—car rides, bedtime, or watching TV—highlighting the need to involve caregivers in the healing process. In 1998, Chandra interned with Dr. Alicia Lieberman at UCSF's Child Trauma Research Program, where she trained in Child-Parent Psychotherapy (CPP), an evidence-based treatment for young children under age 6 who have experienced trauma. She later developed the CPP fidelity framework and co-authored the second edition of the manual. Chandra noted a key challenge: although many parents recognize their child's trauma, few clinicians are trained to work effectively with young children. Many therapists also avoid discussing trauma directly with young children, which can leave them alone with their experiences. CPP begins with the therapist meeting alone with the caregiver to supportively explore the child's symptoms, experiences of trauma, the caregiver's own history, including how past experiences may shape the parent's responses. Then the therapist and caregiver gently acknowledge past traumatic experiences to the child—“speaking the unspeakable”—and help the child process their experiences using developmentally attuned pacing and modalities, including play and art. As children process their experiences they sometimes shift topics or activities or seek physical comfort when they begin to move outside their window of tolerance. Therapists help parents understand this process, attune to their child's needs, and support their child. CPP has a strong evidence base, including five randomized controlled trials. It has shown positive outcomes for preschoolers exposed to violence and infants and toddlers who experienced maltreatment. Notably, a recent study found CPP is associated with lower epigenetic age acceleration in trauma-exposed children aged 2–6—suggesting a measurable impact at the biological level. Chandra Ghosh Ippen, Ph.D. is a child trauma psychologist specializing in working with families with children under age 6. She is co-developer of Child-Parent Psychotherapy, the associate director of the Child Trauma Research Program at the University of California, San Francisco, and a member of the Board of Directors of Zero to Three. She has spent over 30 years conducting clinical work, research, and training in the area of childhood trauma and diversity-informed practice. She is also an award-winning children's book author and has written 5 children's books as well as the free Trinka and Sam disaster series, which has been translated and distributed to over 400,000 families around the world.
When we talk about resilience, too often the conversation stops at “mental grit” or “pushing through.” But the truth is this: resilience isn't about grinding harder. It's about recovery. But in the 21st century, marked by global pandemics, mass caregiving crises, economic instability and high inflation, and unprecedented trauma, this outdated definition no longer serves us. Holistic Resilience reframes resilience as not just surviving adversity but rebuilding from the inside out—biologically, emotionally, financially, socially, and spiritually. It integrates nervous system recovery with identity reinvention, creating a blueprint for sustainable thriving after disruption. It's about rewiring the nervous system after disruption. And for those who have been through trauma, who spend months or years in a state of hypervigilance, this recovery is both urgent and lifesaving. In this episode of the Holistic Wealth podcast, our topic is "What is Holistic Resilience? The New Resilience Frameworks for the 21st Century". Resources Used in This Episode:Holistic Wealth (Expanded and Updated): 36 Life Lessons to Help You Recover from Disruption, Find Your Life Purpose, and Achieve Financial FreedomWhy We Need a New Framework for ResilienceThe numbers speak for themselves:70% of adults worldwide will experience at least one traumatic event in their lifetime. That's 5.6 billion people alive today (WHO, 2023).Roughly 1 in 13 people globally will develop PTSD at some point.Long-term caregiving reduces life expectancy by an average of 9 years due to stress-induced telomere shortening (UCSF study).Trauma survivors are 2-3x more likely to develop chronic illness, depression, or financial instability.A landmark ACEs (Adverse Childhood Experiences) study found that people with 4 or more ACEs are 12x more likely to attempt suicide and 3x more likely to develop heart disease.
As part of the 2025 Developmental Disabilities Conference, Emily Hill talks about how sibling support can be a catalyst for family empowerment. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40622]
As part of the 2025 Developmental Disabilities Conference, Emily Hill talks about how sibling support can be a catalyst for family empowerment. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40622]
As part of the 2025 Developmental Disabilities Conference, Emily Hill talks about how sibling support can be a catalyst for family empowerment. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40622]
As part of the 2025 Developmental Disabilities Conference, Judy Mark, Vivian Do, Miguel Lugo, all from Disability Voices United, talk about supported decision-making in healthcare. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40611]
As part of the 2025 Developmental Disabilities Conference, Judy Mark, Vivian Do, Miguel Lugo, all from Disability Voices United, talk about supported decision-making in healthcare. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40611]
As part of the 2025 Developmental Disabilities Conference, Judy Mark, Vivian Do, Miguel Lugo, all from Disability Voices United, talk about supported decision-making in healthcare. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40611]
Urologic oncologist Dr. Peter Carroll presents the latest research on active surveillance as a preferred approach for managing low-risk prostate cancer and selected cases of intermediate-risk disease. Drawing from two decades of UCSF data, he explains how long-term outcomes support the safety and effectiveness of delaying treatment for carefully monitored patients. Carroll emphasizes that surveillance decisions should be guided by MRI imaging, PSA density, cancer volume, histologic subtype, and genomic testing. He notes that while many men experience gradual changes over time, only a small percentage require immediate treatment. Carroll also discusses innovations such as AI-assisted pathology and risk profiling to reduce unnecessary procedures. His data-driven approach offers patients a personalized path that preserves quality of life without compromising outcomes. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40801]
Urologic oncologist Dr. Peter Carroll presents the latest research on active surveillance as a preferred approach for managing low-risk prostate cancer and selected cases of intermediate-risk disease. Drawing from two decades of UCSF data, he explains how long-term outcomes support the safety and effectiveness of delaying treatment for carefully monitored patients. Carroll emphasizes that surveillance decisions should be guided by MRI imaging, PSA density, cancer volume, histologic subtype, and genomic testing. He notes that while many men experience gradual changes over time, only a small percentage require immediate treatment. Carroll also discusses innovations such as AI-assisted pathology and risk profiling to reduce unnecessary procedures. His data-driven approach offers patients a personalized path that preserves quality of life without compromising outcomes. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40801]
Urologic oncologist Dr. Peter Carroll presents the latest research on active surveillance as a preferred approach for managing low-risk prostate cancer and selected cases of intermediate-risk disease. Drawing from two decades of UCSF data, he explains how long-term outcomes support the safety and effectiveness of delaying treatment for carefully monitored patients. Carroll emphasizes that surveillance decisions should be guided by MRI imaging, PSA density, cancer volume, histologic subtype, and genomic testing. He notes that while many men experience gradual changes over time, only a small percentage require immediate treatment. Carroll also discusses innovations such as AI-assisted pathology and risk profiling to reduce unnecessary procedures. His data-driven approach offers patients a personalized path that preserves quality of life without compromising outcomes. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40801]
Urologic oncologist Dr. Peter Carroll presents the latest research on active surveillance as a preferred approach for managing low-risk prostate cancer and selected cases of intermediate-risk disease. Drawing from two decades of UCSF data, he explains how long-term outcomes support the safety and effectiveness of delaying treatment for carefully monitored patients. Carroll emphasizes that surveillance decisions should be guided by MRI imaging, PSA density, cancer volume, histologic subtype, and genomic testing. He notes that while many men experience gradual changes over time, only a small percentage require immediate treatment. Carroll also discusses innovations such as AI-assisted pathology and risk profiling to reduce unnecessary procedures. His data-driven approach offers patients a personalized path that preserves quality of life without compromising outcomes. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40801]
Joining us is Congressman Tim Walberg, who represents Michigan's Fifth Congressional District and serves on both the House Energy and Commerce Committee and the House Education and the Workforce Committee. Today, he's weighing in on the GOP's expanding investigations into antisemitism at UCLA and UCSF medical schools. With growing concerns about bias and hostility on college campuses, Rep. Walberg will explain why these probes are necessary, how Congress is addressing antisemitism in higher education, and what steps need to be taken to ensure accountability and protect Jewish students.
Dr. Helen Stankiewicz Karita, Associate Professor at UCSF and a national expert on human papillomavirus (HPV)-related diseases in the anal canal, and National STD Curriculum Podcast Editor Dr. Meena Ramchandani discuss screening tools for anal dysplasia and anal cancer. View episode transcript and reference at www.std.uw.edu.This podcast is dedicated to an STD [sexually transmitted disease] review for health care professionals who are interested in remaining up-to-date on the diagnosis, management, and prevention of STDs. Editor and host Dr. Meena Ramchandani is an Assistant Professor of Medicine at the University of Washington (UW), Program Director of the UW Infectious Diseases Fellowship Program, and Associate Editor of the National STD Curriculum.
About the Guest(s): Dr. Parag Gandhi (host): Oculofacial plastic surgeon at Maryland Eye & Face and University of Maryland Hospitals in Baltimore. He is the Chair of the Global Outreach Committee of ASOPRS, has extensive experience leading medical missions, developing global ophthalmology programs, and two surgical mission trips to Ukraine with Face 2 Face. Dr. Raymond Cho: Clinical Professor and Director of Oculoplastic & Orbital Surgery at Ohio State University Wexner Medical Center. A retired U.S. Army Colonel and veteran of Operation Iraqi Freedom, Dr. Cho has participated in multiple missions to Ukraine with the Canadian Face the Future Foundation. Dr. Jorge Corona: Oculofacial plastic surgeon in private practice in Dallas, Texas, and a Clinical Associate Professor at Texas Tech University. He has extensive global medical mission experience, including four trips to Ukraine with LEAP Global Missions. Dr. Dave Russell: Oculofacial plastic surgeon at Kaiser Northern California, who has participated in two humanitarian missions to Ukraine with LEAP, contributing to complex trauma care and surgical training. Dr. Stuart Seiff: Emeritus Professor of Ophthalmology at UCSF and CEO of Pacific Center for Oculofacial & Aesthetic Plastic Surgery. He co-directed the Symposium on Wartime Ophthalmic Trauma in 2022, and has completed four surgical missions to Ukraine with LEAP Global. Episode Summary: In this compelling episode on time-urgent humanitarian efforts in Ukraine, Dr. Parag Gandhi hosts an esteemed panel of oculofacial plastic surgeons who discuss their inspiring work in Ukraine amidst ongoing conflict. The episode provides an in-depth look into the role of these surgical missions in both medical education and patient care of civilians and wounded soldiers, highlighting the transformative impact on both the Ukrainian medical community and the participating surgeons in training and practice. Throughout the discussion, the guests share their motivations and experiences, emphasizing the importance of global outreach in oculoplastic surgery, addressing wartime trauma, and the complexities of secondary trauma reconstructions seen in Ukraine. This episode underscores the essential need for humanitarian medical aid in conflict zones, and the power of medical collaboration across borders to foster resilience and adaptability in the face of adversity. Heroyam slava! Resources: Razom for Ukraine, the Co-Pilot Project: Umbrella NGO and surgical education program that unites American, Canadian, and Ukrainian surgeons, and all of the initiatives we discuss on this episode. Face 2 Face, Face the Future, and LEAP Global Missions: Key organizations supporting medical missions and training initiatives in Ukraine. ASOPRS Foundation: Backing efforts to foster educational initiatives for Ukrainian ophthalmologists to learn key aspects of oculofacial plastic surgery to meet current wartime needs. Friends of Chervonohrad: NGO involved in supporting many health initiatives, including surgical trips to Ukraine through fundraising efforts and pre-travel security assessments for teams. Christian Medical Association of Ukraine: Partnering in efforts to redefine medical practices and values. Links to learn more about the humanitarian missions and donate to support surgical education: Razom for Ukraine, the Co-Pilot Project: https://www.razomforukraine.org/projects/cpp/ ASOPRS Foundation: https://www.asoprsfoundation.org/donate
President Trump's Fox News comments on wanting to “stop the killing” in Ukraine, aiming for a trilateral meeting with Putin and Zelensky, potentially in Moscow. The White House reports 465 arrests in D.C. since the federal crime crackdown began, with robberies down 46%, carjackings down 83%, and violent crime down 22%, though concerns linger about D.C.'s corrupt system releasing arrestees. DNI Tulsi Gabbard strips security clearances from 37 intelligence officials, including James Clapper, for politicizing intel. Boston Mayor Michelle Wu defiantly refuses to comply with federal immigration laws, risking prosecution. California's AB495, fast-tracked to Governor Newsom, alarms Pastor Jack Hibbs for enabling “medical kidnapping” of children. A UCSF speaker, Dante King, labels whiteness a “biologically transmitted proclivity” for psychopathy, exposing DEI's deep roots. The IVF debate heats up as Orchid's founder, Noor Siddiqui, equates embryo screening to parental love, prompting a chilling response to NYT's Ross Douthat's emotional plea about losing the human connection in procreation. AM Update, Aaron McIntire, Trump Ukraine peace talks, Zelensky-Putin meeting, D.C. crime crackdown, Tulsi Gabbard, James Clapper, Boston Mayor Michelle Wu, immigration defiance, California AB495, Jack Hibbs, medical kidnapping, Dante King, DEI wokeness, IVF moral debate, Noor Siddiqui, Ross Douthat
Our guest today is Dr. Gena Castro Rodriguez, a licensed marriage and family therapist, educator, and nationally recognized thought leader with over three decades of experience in mental health, trauma-informed care, and community wellness. Based in San Francisco, Dr. Castro Rodriguez has spent her career expanding access to culturally responsive services and building resilience in underserved communities.Her leadership spans roles such as Executive Director of the National Alliance for Trauma Recovery Centers at UCSF, Chief of Victim Services for the SF District Attorney's Office, and Co-Founder of the Youth Justice Institute. Today, she continues her mission as an Associate Professor at the University of San Francisco, where she helps shape the next generation of counselors and advances the work of the Center for Community Counseling and Wellness.Dr. Castro Rodriguez shares insights on the trauma facing our immigrant communities, trauma recovery, restorative justice, and the intersection of mental health and social justice—offering a powerful vision for healing that centers on equity, dignity, and community voice.#Drgenacastrorodriguez#Genacastrorodriguez.com#TraumaInformedCare#MentalHealthEquity#RestorativeJustice#CommunityHealing#CulturallyResponsive#Mentalhealthfirstaid
Leading dermatologist and NPF Medical Board Member, Dr. Tina Bhutani, and Gail Reiser who lives with plaque psoriasis discuss what “on treatment remission” means for those who have the disease and health care providers. Join moderator and resident physician Olivia Kam as she discusses the definition of on treatment remission for plaque psoriasis, and how this definition impacts the management of the disease and when to change treatments with leading dermatologist Dr. Tina Bhutani from Synergy Dermatology in San Francisco, and Gail Reiser who has been living with plaque psoriasis for over 42 years experiencing a variety of treatment options. The intent of this episode is to increase knowledge of the latest consensus statement defining what “on treatment remission” means in the context of managing plaque psoriasis and how such information can be used to guide patient/provider discussion and setting treatment goals. This episode is sponsored by AbbVie. Timestamps: (0:23) Intro to Psoriasis Uncovered and guest welcome dermatologist Dr. Tina Bhutani and Gail, who has been living with plaque psoriasis for over 42 years. (1:56) Definition of “on treatment remission” and development of this unified consensus statement that included almost 100 stakeholders. (3:28) How the definition of “on treatment remission” impacts management of psoriasis. (5:09) A patient's perspective about “on treatment remission” and what it means for future care. (8:57) Assessing when a change in treatment may be appropriate. (11:19) What information a dermatologist can provide to assess if treatment is effective. (14:20) Prioritizing what to discuss with a dermatologist or health care provider. (17:21) Call to action for dermatologists from the “On Treatment Remission” consensus statement. (20:37) Advice for discussing treatment goals as a patient and health care provider. Key Takeaways: · A new consensus statement helps define and standardize what “On Treatment Remission” is and what it means for patient care. · Given current treatment options it is possible to reach skin clearance and on treatment remission. · Having standardized goals makes it easier for health care providers and patients who have psoriatic disease to work together to reach on treatment remission. Guest Bios: Tina Bhutani, M.D., MAS, is a board-certified dermatologist who is the CEO and owner of Synergy Dermatology in San Francisco. Dr. Bhutani is also an Associate Clinical Professor of Dermatology at UCSF where she previously co-directed the Psoriasis and Skin Treatment Center and directed the Clinical Trials Unit for over 8 years. Dr. Bhutani understands the importance of treating the whole patient and is committed to a patient-centered approach to dermatology. She is a recognized leader in dermatology, giving talks at many national and international meetings. Dr. Bhutani is a member of the National Psoriasis Foundation Medical Board who recently published a consensus statement called “Defining On Treatment Remission in Plaque Psoriasis” in JAMA Dermatology. Gail Reiser was initially diagnosed with plaque psoriasis at age 12. She remembers the misdiagnoses and difficult treatments of the past such as coal tar and occlusion. Over 42 years of living with plaque psoriasis, Gail has experienced a variety of treatment options including topicals and light therapy, feeling “it is exhausting to treat psoriasis”. As she got older and her plaque psoriasis progressed, she eventually decided to try biologics and hasn't looked back since making that change. She feels her psoriasis is in remission but fears losing that in the future. Resources: “Redefining Remission. A new definition for patients, providers, and payers.” Advance Online, National Psoriasis Foundation. S. Schlosser. July 14, 2025. To hear other perspectives about living with psoriasis through the resource Gail mentioned: MyPsoriasisTeam. Treatment and Management of Psoriasis
Listen to our latest podcast as Brian Feeley sits down with our superstar physical therapist, Danny Keller, as they discuss why physical therapy works in treating injuries that seems on first glance to need surgery.
As part of the 2025 Developmental Disabilities Conference, Dr. Raul Gutierrez, Associate Professor of Pediatrics at San Francisco General Hospital, talks about supporting immigrant children. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40619]
As part of the 2025 Developmental Disabilities Conference, Dr. Raul Gutierrez, Associate Professor of Pediatrics at San Francisco General Hospital, talks about supporting immigrant children. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40619]
As part of the 2025 Developmental Disabilities Conference, Dr. Raul Gutierrez, Associate Professor of Pediatrics at San Francisco General Hospital, talks about supporting immigrant children. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40619]
With school sports starting up and people gearing up for fall sporting endeavors, it's important to understand the role of injury prevention, load management, and overuse; not just for professional athletes but for athletes of all ages and skill levels. Listen to our latest podcast as we break this topic down.
As part of the 2025 Developmental Disabilities Conference, Allen Friedland, Terri Hancharick and Jack Jadach talk about a collaborative approach to enhancing health in fitness centers. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 40613]
Dr. Anthony DiGiorgio, a neurosurgeon at UCSF with a strong interest in healthcare policy, joins the show to unpack the complex and often misunderstood world of Medicaid. In a wide-ranging and nuanced discussion, he explores who qualifies for coverage, why most Medicaid spending goes to groups people don't typically expect, and whether the system should be expanded or fundamentally reformed. Dr. DiGiorgio outlines his support for a robust safety net, emphasizing targeted subsidies over a government-run program, and offers his take on the proposed “Big Beautiful Bill” currently in Congress. Along the way, the conversation touches on broader healthcare issues including the 340B drug discount program, the Affordable Care Act, and the role of the free market in ensuring access to care. Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on YouTube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA
Get ready for an empowering discussion about women's health, regenerative aesthetics, and building confidence from the inside out!In this episode, hosts Metaxia Dalikas and Francine Kagarakis are joined by the incredible Dr. Chantal Lunderville, a physician trained at UCLA and UCSF and Lipgloss & Aftershave Medical + Wellness Editor, who's redefining aging with a bold, holistic approach to esthetics and wellness. Hear from Dr. C, founder of her own esthetic practice and host of the podcast “Spilling the Medical Tea”, as she shares insights on the connection between skin, hormones, and overall health.Plus, we'll explore how spas are evolving into vital bridges between physicians and clients, and discuss the importance of combining traditional and holistic approaches to achieve true beauty and wellness.Don't miss this conversation packed with invaluable advice and expertise!
Dr. Hope Rugo and Dr. Kamaria Lee discuss the prevalence of financial toxicity in cancer care in the United States and globally, focusing on breast cancer, and highlight key interventions to mitigate financial hardship. TRANSCRIPT Dr. Hope Rugo: Hello, and welcome to By the Book, a podcast series from ASCO that features engaging conversations between editors and authors of the ASCO Educational Book. I'm your host, Dr. Hope Rugo. I'm the director of the Women's Cancer Program and division chief of breast medical oncology at the City of Hope Cancer Center, and I'm also the editor-in-chief of the Educational Book. Rising healthcare costs are causing financial distress for patients and their families across the globe. Patients with cancer report financial toxicity as a major impediment to their quality of life, and its association with worse outcomes is well documented. Today, we'll be discussing how patients with breast cancer are uniquely at risk for financial toxicity. Joining me for this discussion is Dr. Kamaria Lee, a fourth-year radiation oncology resident and health equity researcher at MD Anderson Cancer Center and a co-author of the recently published article titled, "Financial Toxicity in Breast Cancer: Why Does It Matter, Who Is at Risk, and How Do We Intervene?" Our full disclosures are available in the transcript of this episode. Dr. Lee, it's great to have you on this podcast. Dr. Kamaria Lee: Hey, Dr. Rugo. Thank you so much for having me. I'm excited to be here today. I also would like to recognize my co-authors, Dr. Alexandru Eniu, Dr. Christopher Booth, Molly MacDonald, and Dr. Fumiko Chino, who worked on this book chapter with me and did a fantastic presentation on the topic at ASCO this past year. Dr. Hope Rugo: Thanks very much. We'll now just jump into the questions. We know that rising medical costs contribute to a growing financial burden on patients, which has [GC1] [JG2] been documented to contribute to lower quality-of-life, compromised clinical care, and worse health outcomes. How are patients with breast cancer uniquely at risk for financial toxicity? How does the problem vary within the breast cancer population in terms of age, racial and ethnic groups, and those who have metastatic disease? Dr. Kamaria Lee: Breast cancer patients are uniquely at risk of financial toxicity for several reasons. Three key reasons are that breast cancer often requires multimodal treatment. So this means patients are receiving surgery, many receive systemic therapies, including hormonal therapies, as well as radiation. And so this requires care coordination and multiple visits that can increase costs. Secondly, another key reason that patients with breast cancer are uniquely at risk for financial toxicity is that there's often a long survivorship period that includes long-term care for toxicities and continued follow-ups, and patients might also be involved in activities regarding advocacy, but also physical therapy and mental health appointments during their prolonged survivorship, which can also add costs. And a third key reason that patients with breast cancer are uniquely at risk for financial toxicity is that the patient population is primarily women. And we know that women are more likely to have increased caregiver responsibilities while also potentially working and managing their treatments, and so this is another contributor. Within the breast cancer population, those who are younger and those who are from marginalized racial/ethnic groups and those with metastatic disease have been shown to be at an increased risk. Those who are younger may be more likely to need childcare during treatment if they have kids, or they're more likely to be employed and not yet retired, which can be disrupted while receiving treatment. And those who are racial/ethnic minorities may have increased financial toxicity due to reasons that exist even after controlling for socioeconomic factors. And some of these reasons have been shown to be increased risk of job or income loss or transportation barriers during treatment. And lastly, for those with metastatic breast cancer, there can be ongoing financial distress due to the long-term care that is needed for treatment, and this can include parking, transportation, and medications while managing their metastatic disease. Dr. Hope Rugo: I think it is really important to understand these issues as you just outlined. There has been a lot of focus on financial toxicity research in recent years, and that has led to novel approaches in screening for financial hardship. Can you tell us about the new screening tools and interventions and how you can easily apply that to clinical practice, keeping in mind that people aren't at MD Anderson with a bunch of support and information on this but are in clinical practice and seeing many, many patients a day with lots of different cancers? Dr. Kamaria Lee: You're exactly right that there is incredible nuance needed in understanding how to best screen for financial hardship in different types of practices. There are multiple financial toxicity tools. The most commonly used tool is the Comprehensive Score for Financial Toxicity, also known as the COST tool. In its full form, it's an 11-item survey. There's also a summary question as well. And these questions look at objective and subjective financial burden, and it uses a five-point Likert scale. For example, one question on the full form is, "I know that I have enough money in savings, retirement, or assets to cover the cost of my treatment," and then patients are able to respond "not at all" to "very much" with a threshold score for financial toxicity risk. Of course, as you noted, one critique of having an 11-item survey is that there's limited time in patient encounters with their providers. And so recently, Thom et al validated an abbreviated two-question version of the COST tool. This validation was done in an urban comprehensive cancer center, and it was found to have a high predictive value to the full measure. We note which two questions are specifically pulled from the full measure within the book chapter. And this is one way that it can be easier for clinicians who are in a busier setting to still screen for financial toxicity with fewer questions. I also do recommend that clinicians who know their clinic's workflow the best, work with their team of nurses, financial navigators, and others to best integrate the tool into their workflow. For some, this may mean sending the two-item survey as a portal message so that patients can answer it before consults. Other times, it could mean having it on the tablet that can be done in the clinic waiting room. And so there are different ways that screening can be done, even in a busy setting, and acknowledging that different practices have different amounts of resources and time. Dr. Hope Rugo: And where would people access that easily? I recognize that that information is in your chapter, or your article that's on PubMed that will be linked to this podcast, but it is nice to just know where people could easily access that online. Dr. Kamaria Lee: Yes, and so you should be able to Google ‘the COST measure', and then there is a website that also has the forms as well. So it's also beyond the book chapter, Googling ‘the COST measure', and then online they would be able to find access to the form. Dr. Hope Rugo: And how often would you do that screening? Dr. Kamaria Lee: So, I think it's definitely important that we are as proactive as possible. And so initially, I recommend that the screening happens at the time of diagnosis, and so if it's done through the portal, it can be sent before the initial consult, or again, however, is best in the workflow. So at the time of diagnosis and then at regular intervals, so throughout the treatment process, but then also into the follow-up period as well to best understand if there's still a financial burden even after the treatments have been completed. Dr. Hope Rugo: I wonder if in the metastatic setting, you could do it at the change of treatment, you know, a month after somebody's changed treatment, because people may not be as aware of the financial constraints when they first get prescribed a drug. It's more when you hear back from how much it's going to cost. And leading into that, I think it's, what do you do with this? So, you know, this cost conversation is really important. You're going to be talking to the patient about the cost considerations when you, for example, see that there are financial issues, you're prescribing treatments. How do we implement impactful structured cost conversations with our breast cancer patients, help identify financial issues, and intervene? How do we intervene? I mean, as physicians often we aren't really all that aware, or providers, of how to address the cost. Dr. Kamaria Lee: Yes, I agree fully that another key time when to screen for financial toxicity is at that transition between treatments to best understand where they're at based off of what they've received previously for care, and then to anticipate needs when changing regimens, such as like you said in the metastatic setting. As we're collecting this information, you're right, we screen, we get this information, and what do we do? I do agree that there is a lack of knowledge among us clinicians of how do we manage this information. What is insurance? How do we manage insurance and help patients with insurance concerns? How do we help them navigate out-of-pocket costs or even the indirect costs of transportation? Those are a lot of things that are not covered in-depth in traditional medical training. And so it can be overwhelming for a lot of clinicians, not only due to time limitations in clinic, but also just having those conversations within their visit. And so what I would say, a key thing to note, is that this is another area for multidisciplinary care. So just as we're treating patients in a multidisciplinary way within oncology as we work with our medical oncology, surgical colleagues across the board, it's knowing that this is another area for multidisciplinary care. So the team members include all of the different oncologists, but it also includes team members such as financial counselors and navigators and social workers and even understanding nonprofit partners who we have who have money that can be set aside to help reduce costs for certain different aspects of treatment. Another thing I will note is that most patients with breast cancer often say they do want to have these conversations still with their clinicians. So they do still see a clinician as someone that can weigh in on the costs of their treatment or can weigh in on this other aspect of their care, even if it's not the actual medication or the radiation. And so patients do desire to hear from their clinicians about this topic, and so I think another way to make it feel less overwhelming for clinicians like ourselves is to know that even small conversations are helpful and then being knowledgeable about within your institution or, like I said, outside of it with nonprofits, being aware of who can I refer this patient to for continued follow-up and for more detailed information and resources. Dr. Hope Rugo: Are those the successful interventions? It's really referring to financial navigators? How do people identify? You know, in an academic center, we often will sort of punt this to social workers or our nurse navigators. What about in the community? What's a successful intervention example of mitigating financial toxicity? Dr. Kamaria Lee: I agree completely that the context at which people are practicing is important to note. So as you alluded to, in some bigger systems, we do have financial navigators and this has been seen to be successful in providing applications and assisting with applications for things such as pharmaceutical assistance, insurance applications, discount opportunities. Another successful intervention are financial toxicity tumor boards, which I acknowledge might not be able to exist everywhere. But where this is possible, multidisciplinary tumor boards that include both doctors and nurses and social workers and any other members of the care team have been able to effectively decrease patients' personal spending on care costs and decrease co-pays through having a dedicated time to discuss concerns as they arise or even proactively. Otherwise, I think in the community, there are other interventions in regards to understanding different aspects of government programs that might be available for patients that are not, you know, limited to an institution, but that are more nationally available, and then again, also having the nonprofit, you know, partnerships to see other resources that patients can have access to. And then I would also say that the indirect costs are a significant burden for many patients. So by that, I mean even parking costs, transportation, childcare. And so even though those aren't interventions necessarily with someone who is a financial navigator, I would recommend that even if it's a community practice, they discuss ways that they can help offset those indirect costs with patients with parking or if there are ways to help offset transportation costs or at least educate patients on other centers that may be closer to them or they can still receive wonderful care, and then also making sure that patients are able to even have appointments scheduled in ways that are easier for them financially. So even if someone's receiving care out in the community where there's not a financial navigator, as clinicians or our scheduling teams, sometimes there are options to make sure if a patient wants, visits are more so on one day than throughout the week or many hours apart that can really cause loss of income due to missed work. And so there are also kind of more nuanced interventions that can happen even without a financial navigation system in place. Dr. Hope Rugo: I think that those are really good points and it is interesting when you think about financial toxicity. I mean, we worry a lot when patients can't take the drugs because they can't afford them, but there are obviously many other non-treatment, direct treatment-related issues that come up like the parking, childcare, tolls, you know, having a working car, all those kinds of things, and the unexpected things like school is out or something like that that really play a big role where they don't have alternatives. And I think that if we think about just drug costs, I think those are a big issue in the global setting. And your article did address financial toxicity in the global setting. International financial toxicity rates range from 25% of patients with breast cancer in high-income countries to nearly 80% in low- and middle-income countries or LMICs. You had cited a recent meta-analysis of the global burnout from cancer, and that article found that over half of patients faced catastrophic health expenditures. And of course, I travel internationally and have a lot of colleagues who are working in oncology in many countries, and it is really often kind of shocking from our perspective to see what people can get coverage for and how much they have to pay out-of-pocket and how much that changes, that causes a lot of disparity in access to healthcare options, even those that improve survival. Can you comment on the global impact of this problem? Dr. Kamaria Lee: I am glad that you brought this up for discussion as well. Financial toxicity is something that is a significant global issue. As you mentioned, as high as 80% of patients with breast cancer in low- and middle-income countries have had significant financial toxicity. And it's particularly notable that even when looking at breast cancer compared to other malignancies around the world, the burden appears to be worse. This has been seen even in countries with free universal healthcare. One example is Sri Lanka, where they saw high financial toxicity for their patients with breast cancer, even with this free universal healthcare. But there were also those travel costs and just additional out-of-hospital tests that were not covered. Also, literature in low- and middle-income countries shows that patients might also be borrowing money from their social networks, so from their family and their friends, to help cover their treatment costs, and in some cases, people are making daily food compromises to help offset the cost of their care. So there is a really large burden of financial toxicity generally for cancer globally, but also specifically in breast cancer, it warrants specific discussion. In the meta-analysis that you mentioned, they identified key risk factors of financial toxicity globally that included people who had a larger family size, a lower income, a lack of insurance, longer disease duration, so again, the accumulation of visits and costs and co-pay over time, and those who had multiple treatments. And so in the global setting, there is this significant burden, but then I will also note that there is a lack of literature in low-income countries on financial toxicity. So where we suspect that there is a higher burden and where we need to better understand how it's distributed and what interventions can be applied, especially culturally specific interventions for each country and community, there's less research on this topic. So there is definitely an increased need for research in financial toxicity, particularly in the global setting. Dr. Hope Rugo: Yes, and I think that goes on to how we hope that financial toxicity researchers will have approaches to large-scale multi-institutional interventions to improve financial toxicity. I think this is an enormous challenge, but one of the SWOG organizations has done some great work in this area, and a randomized trial addressing cancer-related financial hardship through the delivery of a proactive financial navigation intervention is one area that SWOG has focused on, which I think is really interesting. Of course, that's going to be US-based, which is how we might find our best paths starting. Do you think that's a good path forward, maybe that being able to provide something like that across institutions that are independent of being a cancer only academic center, or more general academic center, or a community practice? You know, is finding ways to help patients with breast cancer and their families understand and better manage financial aspects of cancer care on a national basis the next approach? Dr. Kamaria Lee: Yes, I agree that that is a good approach, and I think the proactive component is also key. We know that patients that are coming to us with any cancer, but including breast cancer, some of them have already experienced a financial burden or have recently had a job loss before even coming to us and having the added distress of our direct costs and our indirect costs. So I think being proactive when they come to us in regards to the additional burden that their cancer treatments may cause is key to try to get ahead of things as much as we can, knowing that even before they've seen us, there might be many financial concerns that they've been navigating. I think at the national level, that allows us to try to understand things at what might be a higher level of evidence and make sure that we're able to address this for a diverse cohort of patients. I know that sometimes the enrollment can be challenging at the national level when looking at financial toxicity, as then we're involving many different types of financial navigation partners and programs, and so that can maybe make it more complex to understand the best approaches, but I think that it can be done and can really bring our understanding of important financial toxicity interventions to the next level. And then the benefit to families with the proactive component is just allowing them to feel more informed, which can help decrease anticipation, anxiety related to anticipation, and allow them to help plan things moving forward for themselves and for the whole family. Dr. Hope Rugo: Those are really good points and I wonder, I was just thinking as you were talking, that having some kind of a process where you could attach to the electronic health record, you could click on the financial toxicity survey questions that somebody filled out, and then there would be a drop-down menu for interventions or connecting you to people within your clinic or even more broadly that would be potential approaches to manage that toxicity issue so that it doesn't impact care, you know, that people aren't going to decide not to take their medication or not to come in or not to get their labs because of the cost or the transportation or the home care issues that often are a big problem, even parking, as you pointed out, at the cancer center. And actually, we had a philanthropic donor when I was at UCSF who donated a large sum of money for patient assistance, and it was interesting to then have these sequential meetings with all the stakeholders to try and decide how you would use that money. You need a big program, you need to have a way of assessing the things you can intervene with, which is really tough. In that general vein, you know, what are the governmental, institutional, and provider-level actions that are required to help clinicians do our best to do no financial harm, given the fact that we're prescribing really expensive drugs that require a lot of visits when caring for our patients with breast cancer in the curative and in the metastatic setting? Dr. Kamaria Lee: At the governmental level, there are patient assistant programs that do exist, and I think that those can continue and can become more robust. But I also think one element of those is oftentimes the programs that we have at the government level or even institutional levels might have a lot of paperwork or be harder for people with lower literacy levels to complete. And so I think the government can really try to make sure that the paperwork that is given, within reason, with all the information they need, but that the paperwork can be minimized and that there can be clear instructions, as well as increased health insurance options and, you know, medical debt forgiveness as more broad just overall interventions that are needed. I think additionally, institutions that have clinical trials can help ensure that enrollment can be at geographically diverse locations. Some trials do reimburse for travel costs, of course, but sometimes then patients need the reimbursement sooner than it comes. And so I think there's also those considerations of more so upfront funds for patients involved in clinical trials if they're going to have to travel far to be enrolled in that type of care or trying to, again, make clinical trials more available at diverse locations. I would also say that it's important that those who design clinical trials use what is known as the “Common Sense Oncology” approach of making sure that they're designed in minimizing the use of outcomes that might have a smaller clinical benefit but may have a high financial toxicity. And that also goes to what providers can do, of understanding what's most important to a particular patient in front of them, what outcomes and what benefit, or you know, how many additional months of progression-free survival or things like that might be important to a particular patient and then also educating them and discussing what the associated financial burden is just so that they have the full picture as they make an informed decision. Dr. Hope Rugo: As much as we know. I mean, I think that that's one of the big challenges is that as we prescribe these expensive drugs and often require multiple visits, even, you know, really outside of the clinical trial setting, trying to balance the benefit versus the financial toxicity can be a huge challenge. And that's a big area, I think, that we still need help with, you know. As we have more drugs approved in the early-stage setting and treatments that could be expensive, oral medications, for example, in our Medicare population where the share of cost may be substantial upfront, you know, with an upfront cost, how do we balance the benefits versus the risk? And I think you make an important point that discussing this individually with patients after we found out what the cost is. I think warning patients about the potential for large out-of-pocket cost and asking them to contact us when they know is one way around this. You know, patients feeling like they're sort of out there with a prescription, a recommendation from their doctor, they're scared of their cancer, and they have this huge share of cost that we didn't know about. That's one challenge, and I don't know if there's any suggestions you have about how one should approach that communication with the patient. Dr. Kamaria Lee: Yes, I think part of it is truly looking at each patient as an individual and asking how much they want to know, right? So we all know that patients, some who want more information, some want less, and so I think one way to approach that is asking them about how much information do they want to know, what is most helpful to them. And then also, knowing that if you're in a well-resourced setting that does have the social workers and financial navigators, also making sure it's integrated in the multidisciplinary setting and so that they know who they can go to for what, but also know that as a clinician, you're always happy for them to bring up their concerns and that if it's something that you're not aware of, that you will connect them to the correct multidisciplinary team members who can accurately provide that additional information. Dr. Hope Rugo: Do you have any other additional comments that you'd like to mention that we haven't covered? I think the idea of a financial toxicity screen with two questions that could be implemented at change of therapy or just periodically throughout the course of treatment would be a really great thing, but I think we do need as much information on potential interventions as possible because that's really what challenges people. It's like finding out information that you can't handle. Your article provides a lot of strategies there, which I think are great and can be discussed on a practice and institutional level and applied. Dr. Kamaria Lee: Yeah, I would just like to thank you for the opportunity to discuss such an important topic within oncology and specifically for our patients with breast cancer. I agree that it can feel overwhelming, both for clinicians and patients, to navigate this topic that many of us are not as familiar with, but I would just say that the area of financial toxicity is continuing to evolve as we gather more information on most successful interventions and that our patients can often inform us on, you know, what interventions are most needed as we see them. And so you can have your thinking about it as you see individual patients of, "This person mentioned this could be more useful to them." And so I think also learning from our patients in this space that can seem overwhelming and that maybe we weren't all trained on in medical school to best understand how to approach it and how to give our patients the best care, not just medically, but also financially. Dr. Hope Rugo: Thank you, Dr. Lee, for sharing your insights with us today. Our listeners will find a link, as I mentioned earlier, to the Ed Book article we discussed today in the transcript of this episode. I think it's very useful, a useful resource, and not just for providers, but for clinic staff overall. I think this can be of great value and help open the discussion as well. Dr. Kamaria Lee: Thank you so much, Dr. Rugo. Dr. Hope Rugo: And thanks to our listeners for joining us today. Please join us again next month on By the Book for more insightful views on topics you'll be hearing at Education Sessions from ASCO meetings and our deep dives into new approaches that are shaping modern oncology. Thank you. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Hope Rugo @hope.rugo Dr. Kamaria Lee @ lee_kamaria Follow ASCO on social media: @ASCO on X (formerly Twitter) ASCO on Bluesky ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Hope Rugo: Honoraria: Mylan/Viatris, Chugai Pharma Consulting/Advisory Role: Napo Pharmaceuticals, Sanofi, Bristol Myer Research Funding (Inst.): OBI Pharma, Pfizer, Novartis, Lilly, Merck, Daiichi Sankyo, AstraZeneca, Gilead Sciences, Hoffman La-Roche AG/Genentech, In., Stemline Therapeutics, Ambryx Dr. Kamaria Lee: No relationships to disclose
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Gulcin Benbir, professor of neurology and sleep researcher from Turkey, and Dr. Lourdes Del Rosso, sleep physician and professor at UCSF who served on the task force for updated AASM RLS guidelines, to discuss groundbreaking research on periodic limb movements in sleep (PLMS) that persist after successful sleep apnea treatment. Following the recent updates to RLS guidelines, this conversation addresses the often-overlooked condition of periodic limb movement disorder (PLMD). The guests reveal surprising findings that challenge traditional teaching: while sleep medicine practitioners have long been taught that PLMD improves with PAP therapy, their research shows that 30% of patients continue to experience significant periodic limb movements even after successful OSA treatment. The discussion explores critical clinical questions: Are PLMs innocent bystanders or pathological processes requiring treatment? When do PLMs become PLMD? How should we evaluate residual hypersomnolence in well-treated OSA patients—should we screen for persistent PLMs before prescribing wake-promoting agents? The experts also delve into the complex relationship between RLS and PLMs, examining whether they represent interconnected sensory and motor phenomena or distinct processes. Practical treatment strategies are covered extensively, including the role of iron supplementation, appropriate diagnostic testing, IV iron protocols, and evidence-based pharmacological interventions. The conversation also addresses how the shift toward home sleep testing may impact our ability to detect and treat this important cause of continued sleep disruption. Whether you're treating OSA patients with persistent daytime sleepiness or managing complex sleep disorders, this episode provides essential insights into recognizing and treating PLMD as a potential contributor to ongoing symptoms. Join us for this clinically relevant discussion that may change how you approach residual hypersomnolence in your practice.
In 2012, a UCSF researcher teamed up with city and nonprofit officials to launch a novel experiment meant to answer one question: Can singing in a choir provide real health benefits for older adults? Today, a thriving network of neighborhood choirs continues to discover the answer. Reporter Sheryl Kaskowitz has more in this story from 2024.
Healthcare is a team effort, but we don't always see the full team. Behind every physician visit, every hospital discharge, and every community clinic, there's a vast, often invisible network of professionals keeping the system running. In this episode, we sit down with Dr. Sunita Mutha, Director of the Healthforce Center and Professor of Medicine at UCSF, to talk about these hidden threads holding our healthcare system together. She shines a light on the vital roles played by medical assistants, patient navigators, community health workers, and clinic leaders—roles that are essential, yet too often overlooked. Dr. Mutha walks us through the Healthforce Center's mission to strengthen this workforce, from building lasting leadership programs that ripple across organizations, to fostering statewide collaborations, to producing data-driven insights that inform policy at every level. We also dive deep into the realities of burnout—why it's not just about overwork, but about the erosion of meaning in the work itself. Dr. Mutha reframes burnout as a structural failure, not a personal shortcoming, and shares practical ways to design systems that support the people who make care possible. This is an honest, inspiring look at the human infrastructure of healthcare—what it takes to sustain it, and why investing in people is the key to a more equitable and resilient system. Do you have thoughts on this episode or ideas for future guests? We'd love to hear from you. Email us at hello@rosenmaninstitute.org.
What is shoulder impingement and how do you treat it? Listen to Dr Brian Feeley break it all down.
When you learn to anchor into your own worth, the world no longer gets to decide how you feel about yourself. Beatriz Victoria Albina brings powerful insight and clarity to the conversation on nervous system regulation, emotional outsourcing, and the lifelong practice of coming home to yourself. With equal parts warmth and wisdom, she shares how healing begins when we stop chasing external validation and start reconnecting to the safety, belonging, and worth that already live within us. This conversation is a gentle call to shift from survival mode to self-anchored living—where authenticity and inner peace can finally take root. Key Takeaways: Emotional outsourcing happens when you rely on others to define your safety, worth, or sense of belonging. Nervous system dysregulation can show up as anxiety, over-functioning, or emotional numbness—and it's more common than you think. Healing doesn't mean eliminating big emotions; it means learning how to feel them without abandoning yourself. Anchoring into your truth requires self-awareness, self-regulation, and a commitment to coming back to center—again and again. Regulation is a daily practice, not a quick fix—and community, nature, and breath are powerful allies in that process. About Beatriz Victoria Albina: Beatriz (Béa) Victoria Albina, NP, MPH, SEP (she/her) is a UCSF-trained Family Nurse Practitioner, Somatic Experiencing Practitioner, Master Certified Somatic Life Coach, author of the forthcoming "End Emotional Outsourcing: a Guide to Overcoming Codependent, Perfectionist and People Pleasing Habits" (expected Sept 30, Hachette Balance) and Breathwork Meditation Guide with a passion for helping humans socialized as women to reconnect with their bodies, regulate their nervous systems and rewire their minds, so they can break free from codependency, perfectionism and people pleasing and reclaim their joy. She is the host of the Feminist Wellness Podcast, holds a Masters degree in Public Health from Boston University School of Public Health and a BA in Latin American Studies from Oberlin College. Born in Mar del Plata, Argentina, Béa grew up in the great state of Rhode Island. She has been working in health & wellness for over 20 years and lives with her wife, Billey Albina. Connect with Dr. Michelle and Bayleigh at: https://smallchangesbigshifts.com hello@smallchangesbigshifts.com https://www.linkedin.com/company/smallchangesbigshifts https://www.facebook.com/SmallChangesBigShifts https://www.instagram.com/smallchangesbigshiftsco Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below! Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app. Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.
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