Diversity in medicine addressing the disparities in healthcare
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Diversity in Medicine: Addressing the Disparities in Healthcare. African-American Women’s Medicine. Case I. Ms. Jones is a 31y.o. G2P2 LMP 01/01/2010 States she feels well but “a bit anxious” and overwhelmed at work New onset vague lower back pain

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Diversity in Medicine: Addressing the Disparities in Healthcare

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Diversity in medicine addressing the disparities in healthcare

Diversity in Medicine:Addressing the Disparities in Healthcare

African-American Women’s Medicine

Case i

Case I

  • Ms. Jones is a 31y.o. G2P2 LMP 01/01/2010

  • States she feels well but “a bit anxious” and overwhelmed at work

  • New onset vague lower back pain

  • Decreased appetite, decreased interest in sex

  • Frequent insomnia, fatigue

  • Last felt well one year ago after the birth of her son.

Physical exam case i

Physical Exam Case I

  • Ht. 60in Wt. 101lbs Bp 100/70 R 18 T 98.7

    Physical examination: unremarkable

    All labs within normal limits including TSH and autoimmune profile

Past history case i

Past HistoryCase I

  • Past Obstetrical History: two sons ages 1 and 2 uncomplicated vaginal deliveries

  • Past Surgical History: none

  • Past Family History: Mother “nervous breakdown” after her divorce at age 32

  • Brother: Bi-polar type 2

  • Past social History: Works as executive bank home loan officer at Wells Fargo

Case i discussion

Case IDiscussion:

  • Awareness: What do you see? What do you hear? What are your thoughts as a clinician?

  • Any stereotypes?

  • What’s your plan?

  • Let’s discuss this case in detail

Case ii

Case II

  • Ms. Williams is a 35y.o. G0P0 LMP 3mo ago presents with complaints of intermittent vaginal discharge and itching.

  • Recently has unexplained weight loss, increased thirst, increased urinary frequency.

  • Denies pelvic pain, N/V/F/C

  • Trying to conceive for the past 2 years

Case ii physical examination

Case IIPhysical Examination

  • Ht. 62 inches Weight 180lbs BMI>30

  • Bp 142/98 Temperature 98.6

  • Heart: mild murmur

  • Lungs: clear to auscultation

  • Abdomen: no masses palpated/ obese

  • Ext: mild edema pedal

  • Pelvic Exam: consistent with discharge likely yeast

Case ii past history

Case IIPast History

  • Past Medical history: has not been to the doctor in 5 years

  • Past Family History: Sister age 13 with type II DM, Mother with type II DM, HTN

Case ii labs

Case IILabs

  • HgA1c: 9

  • FBS: 120

  • 2hour OGTT: 205

  • Genital Cx: Consistent with Candida Albicans


Case ii discussion

Case IIDiscussion

  • What are your thoughts?

  • What is your diagnosis? Is there more than one?

  • Let’s discuss this in detail

Case iii

Case III

Tanisha is a 21 y.o. G2P0 LMP 01/10/2010 presents to the ER with a 3 day complaint of pelvic pain progressively worsening in the past 24 hours.

  • The pain is associated with nausea no vomiting, moderate vaginal bleeding and foul smelling discharge.

  • Further history includes new boyfriend for the past two weeks, no use of condoms

Case iii physical exam and past medical history

Case IIIPhysical Exam and Past medical History

  • Ht. 67in weight 128lbs Bp 110/70 R 18 T. 100.4 Pulse 110

  • Past Surgical History: D & C x two

  • Past Ob History: elective ab x 2

  • Meds: orthotricyclen-lo

  • Abdomen: extremely tender

  • Pelvic Exam: foul smelling discharge, cervical motion tenderness, chandelier sign

Case iii discussion

Case IIIDiscussion

  • What is your diagnosis?

  • What are you thinking?

  • Let’s discuss the social issues

Case iv

Case IV

  • Mrs. Smith is a 60 y.o. G5 P5 LMP 9 years ago who presents with c/o vaginal dryness and painful sexual intercourse. Recent onset of recurrent headaches rated 8/10.

  • Denies N/V/F/C

  • Exercises intermittently works as head publicist for the William Morris Agency manages a “superstar”

Case iv physical examination

Case IVPhysical Examination

  • Ht. 68inches Weight 140lbs BP 160/110

  • R 18 Temperature 98.6

  • Past Medical hx: Menopause 9years ago

  • Past Surgical Hx: neg

  • Past Family Hx: Mother died breast CA age 51, Sister with HTN, Brother ESRD with transplant last year @ age 40

  • All: NKDA

  • Past Social Hx: No ETOH,Drugs, eats fast food everyday, loves IN N Out Burgers

Case iv discussion

Case IVDiscussion

  • What are you concerned about as a clinician? What are you thinking and why?

  • Let’s discuss this case in detail.



What have we learned from these cases..

Has this presentation changed your perspective ? How will you approach the AA patient now with common medical complaints.

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