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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. 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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  1. Diversity in Medicine:Addressing the Disparities in Healthcare African-American Women’s Medicine

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Case IILabs • HgA1c: 9 • FBS: 120 • 2hour OGTT: 205 • Genital Cx: Consistent with Candida Albicans • EKG:NSR

  10. Case IIDiscussion • What are your thoughts? • What is your diagnosis? Is there more than one? • Let’s discuss this in detail

  11. 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

  12. 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

  13. Case IIIDiscussion • What is your diagnosis? • What are you thinking? • Let’s discuss the social issues

  14. 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”

  15. 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

  16. Case IVDiscussion • What are you concerned about as a clinician? What are you thinking and why? • Let’s discuss this case in detail.

  17. Conclusion 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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