Episode 229 -- May 2025 -- Part 1 AFP: American Family Physician

Summary

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AFP: American Family Physician Podcast

Episode 229 — May 2025 (Part 1)
Release Date: May 16, 2025
Hosts: Residents and faculty of the University of Arizona College of Medicine–Phoenix Family Medicine Residency
Contributing editor: Dr. Steven Brown

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Episode Overview

This episode presents concise, evidence-based highlights from the May 2025 issue of American Family Physician, focusing on essential topics for family medicine clinicians. Discussions include key clinical takeaways about trigeminal neuralgia, early medication abortion, SGLT2 inhibitors for CKD and diabetes, female sexual dysfunction, the health impacts of per- and polyfluoroalkyl substances (PFAS), and the effectiveness of methotrexate for juvenile idiopathic arthritis.

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Main Topics and Key Discussion Points

1. Trigeminal Neuralgia: Rapid Evidence Review

(01:25–04:22)
Contributor: Dr. Ameche

• Definition and Types:

  • Chronic neuropathic facial pain involving the trigeminal nerve
  • Subtypes:
    • Classic (vascular compression-related)
    • Secondary (due to MS or tumor)
    • Idiopathic (no identified cause)
  • Quote:

    “The hallmark is recurrent episodes of unilateral facial pain... severe with an electric shock like shooting, stabbing or sharp quality.” — B (02:23)

• Symptoms:

  • Brief, severe, shock-like, triggered by minimal stimuli (e.g., breeze, shaving, chewing)
  • Often misdiagnosed as dental pain (80% see a dentist first)

• Diagnosis:

  • Clinical; all suspected cases should get brain MRI to rule out secondary causes (SOrC evidence).

• Treatment:

  • First-line: Carbamazepine (SOrA evidence).
  • Quote:

    “A Cochrane review...identified a response rate of 72% in the treatment group compared to 12% in the placebo group; NNT=2.” — D (03:45)

  • Refractory Cases: Consider surgery.
  • Other therapies: Research ongoing in herbal medicine and TENS.

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2. Early Medication Abortion

(04:39–06:00)
Contributor: Dr. Mark Abell

• Clinical Question: Is medication abortion prior to confirmation of intrauterine pregnancy safe/effective?
• Study: RCT of 1,500 women (9 countries), compared early med abortion vs. standard protocol with confirmed IUP.
  • Results:
    • 95% had complete abortion
    • Surgical intervention less in early group (1.8% vs 4.5%)
    • Ongoing pregnancy higher in early group (3% vs 0.1%)
    • Slightly shorter bleeding and greater satisfaction in early group
    • Quote:

      “In short, early medication abortion is as safe and effective as standard of care treatment.” — D (05:52)

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3. Cochrane for Clinicians: SGLT2 Inhibitors for Chronic Kidney Disease & Diabetes

(06:00–08:22) Contributor: Dr. Tracy Johns

• Question: Are SGLT2 inhibitors effective for people with CKD and type 2 diabetes?
• Evidence:
  • 53 RCTs, 65,000+ patients, broad range of kidney disease (not type 1 diabetes, few on dialysis)
  • Benefits:
    • Reduces all-cause mortality (NNT=119/year)
    • Kidney failure risk halved (NNT=35)
    • Reduces CV events, heart failure hospitalizations (NNT=42 for MACE in severe CKD)
    • Lower risk of severe hypoglycemia
  • Risks:
    • Increased genital infections (NNH=38)
    • No increase in DKA vs standard of care
  • Notable quote:

    “SGLT2 inhibitors decrease the rate of cardiac events, progression of kidney disease and the rates of heart failure hospitalizations.” — C (08:12)

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4. Female Sexual Dysfunction (FSD)

(08:49–12:15) Contributors: Drs. Dalrymple, Hogue, and Thacker

• Definition & Prevalence:

  • FSD covers issues of desire/arousal, orgasm, and pain; affects 40–50% of women.
  • Quote:

    “The most important part of diagnosis is that the symptoms cause significant distress, impact quality of life.” — D (09:20)

• Diagnosis:

  • DSM-5, validated questionnaires (FSFI, Distress Scale)
  • Review medications; many can contribute (beta-blockers, SSRIs, etc.)
  • Physical exam focused on dermatologic, anatomic, neurologic, and signs of secondary causes

• Treatment:

  • Desire/Arousal Disorders:
    • First-line: CBT, couples/mindfulness therapy
    • Meds: flibanserin, bremelanotide (limited efficacy & expensive)
    • Consider bupropion for SSRI-induced dysfunction
    • Topical testosterone for certain postmenopausal patients (monitor closely)
  • Orgasmic Disorders:
    • CBT, sex therapy, directed masturbation, OTC vibrators
  • Genitopelvic Pain Disorders:
    • Pelvic floor PT, self-dilation for vaginismus, topical estrogens or non-hormonal agents for dryness
  • Referral:
    • All patients: consider mental health referral; procedural or failed therapy: refer to gyn/urogynecology

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5. Curbside Consultation: PFAS Exposure and Testicular Cancer

(12:31–16:47) Contributors: Drs. Cervantes and Gurbo

• Case: 46-year-old firefighter with testicular mass, occupational PFAS exposure (firefighting foams)

• PFAS Background:

  • Group of “forever chemicals,” resistant to oil/water; used in non-stick cookware, fabrics, firefighting
  • Prevalent in >50% of US tap water
  • Environmental/health concern due to their persistence and bioaccumulation

• Health Effects:

  • Associated (observationally) with decreased vaccine response, dyslipidemia, fetal growth issues, kidney/liver/thyroid/testicular/breast cancers, ulcerative colitis
  • Quote:

    “There is an association between PFAS and decreased antibody response after vaccination, elevated risk for dyslipidemia… and heightened risk for kidney cancers in adults.” — C (14:48)

• Clinical Guidance:

  • No specific screening or treatment recommended; PFAS blood tests only show exposure, not disease risk or causation
  • Home exposure mitigation possible (filtering, water testing)
  • Occupational risk acknowledged; compensation/VA referral possible; some states have “presumptive” laws for job-related cancers

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6. Medicine by the Numbers: Methotrexate for Juvenile Idiopathic Arthritis

(17:25–20:14) Contributors: Drs. Sonoda and Dougherty

• Condition: JIA = most common childhood rheumatic disease, onset <16 yrs

• Recommendation:

  • Methotrexate = preferred over leflunomide/hydroxychloroquine for active JIA (2021 ACR guidance)

• Evidence:

  • 2024 Cochrane review: 5 RCTs, 575 kids/teens globally
  • Results:
    • Low-certainty evidence: may improve treatment response vs placebo
    • Little or no difference vs other DMARDs or injected steroids in inactive disease or AEs
    • Quote:

      “Low certainty evidence also showed that...methotrexate plus intra-articular glucocorticoids may have little to no effect on sustained clinically inactive disease at 12 months.” — D (19:19)

• Caveats:

  • Most trials used low doses, short duration, small sample sizes
  • Authors rate evidence as “yellow” (unclear benefit); recommend more robust studies
  • Quote:

    “Further research with optimal dosing of methotrexate and longer follow up is needed to properly assess the use of methotrexate in JIA treatment.” — D (20:14)

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Memorable Quotes and Moments

• “Over 80% of patients initially seek a dental evaluation because [trigeminal neuralgia] can mimic dental pain.” — B (02:57)
• “In short, early medication abortion is as safe and effective as standard of care treatment.” — D (05:52)
• “PFAS are highly concerning to environmental regulators because of their prevalence in water…they are extremely long lasting, receiving the nickname forever chemicals.” — D (14:13)
• “Low certainty evidence...weekly oral methotrexate may have little or no effect on treatment response, function…with low certainty of evidence.” — C (19:41)

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Useful Timestamps

• Trigeminal Neuralgia Deep Dive: 01:25–04:22
• Early Medication Abortion Evidence: 04:39–06:00
• SGLT2 Inhibitors for CKD/Diabetes: 06:00–08:22
• Female Sexual Dysfunction: 08:49–12:15
• PFAS & Testicular Cancer Curbside: 12:31–16:47
• Methotrexate for JIA: 17:25–20:14

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Original Language and Tone:
The discussion is collegial, thorough, and practical, offering family docs rapid evidence reviews, nuanced clinical context, and thoughtful comments on patient care and counseling. There is a strong focus on actionable pearls, realistic limitations, and patient-centered considerations.

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Summary

This episode delivers essential, up-to-date clinical pearls relevant for primary care, blending evidence reviews with pragmatic advice on tricky, evolving, or controversial topics. The discussions favor clarity and practicality for busy clinicians, address common diagnostic pitfalls, and underscore areas for ongoing research or vigilance in patient care.

Transcript

[A]

The AFP Podcast is brought to you by the American Academy of Family Physicians and by the American Family Physician Journal. You enjoy listening to the AFP Podcast team discuss the journal. You can also read it in print or online. Plus, subscribers can earn over 130 CME credits per year. Subscription details can be found at afp.org c AFP Subscribe.

[B]

Welcome to the American Family Physician podcast for part one of the May 2025 issue. I'm Jake.

[C]

I'm Marian.

[B]

I'm Nadia and we are residents and faculty, mostly residents, of the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we'll talk about trigeminal neuralgia, early medication, abortion, sodium glucose, CO transporter 2 inhibitors, female sexual dysfunction per and polyfluoroalkyl substances and methotrexate for juvenile idiopathic arthritis.

[C]

The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians, the editor of American Family Physician or Banner Health do not use this podcast for medical advice. Instead, see your own family doctor for medical care.

[B]

We'Re on a mission delivering the best from American Female Physician On a mission delivering the best Strong American Family physician First up, we have a main topic, Trigeminal Neuralgia Rapid Evidence Review and it comes to us from Dr. Ameche from Spartanburg Regional Family Medicine Residency Program in Charleston, South Carolina.

[D]

So what is trigeminal neuralgia?

[C]

Trigeminal neuralgia is a chronic neuropathic pain condition that affects the trigeminal nerve. It's considered uncommon.

[D]

It can be classified into three types.

[C]

Classic tn, which is often caused by neurovascular compression of a nerve root secondary.

[B]

Tn, which is linked to conditions like multiple sclerosis or a tumor and idiopathic.

[D]

Tn, where no identifiable cause is found despite investigation.

[C]

So what are some of the typical symptoms people experience?

[B]

Well, the hallmark is recurrent episodes of unilateral facial pain. It's often described as severe with an electric shock like shooting, stabbing or sharp quality.

[D]

These episodes are brief, lasting from a fraction of a second up to two minutes, but they usually occur frequently. These flare ups can also be triggered by stimuli like talking, shaving, chewing or even a breeze.

[C]

Some patients might have small trigger zones where minimal stimulation causes pain, which can be a key clue for the diagnosis.

[B]

Interestingly, over 80% of patients initially seek a dental evaluation because it can mimic dental pain.

[D]

It is important to note that trigeminal neuralgia is a clinical diagnosis.

[C]

However, brain MRI is recommended for all suspected cases to rule out other causes like multiple sclerosis or or a tumor. This is rated a sort C level of evidence.

[B]

All right, let's talk about how trigeminal neuralgia is managed.

[D]

The goal is to reduce pain intensity and frequency. The initial drug of choice is carbamazepine. This is rated a soar A level of evidence.

[B]

A Cochrane review identified two small older randomized controlled trials with 98 patients comparing carbamazepine with placebo.

[D]

The review showed the response rate was 72% in the treatment group compared to 12% in the placebo group, with a number needed to treat of two.

[C]

What about patients with refractory symptoms?

[B]

Well, in cases where symptoms are refractory to medication, surgery is an effective option.

[D]

Well, what about other therapies?

[C]

There are larger studies underway evaluating herbal medicine in the management of idiopathic tnt.

[D]

Some studies have shown that transcutaneous electro nerve stimulation units can be effective in decreasing pain intensity during TN flare ups.

[B]

All right, perfect. So carbamazepine surgery, if that's ineffective, and maybe herbal medicine and maybe transcutaneous electrical nerve stimulation. All right, let's keep moving. We have a poem and it's about early medication abortion comes to us from Dr. Mark Abell.

[C]

Our clinical question today is medication abortion prior to confirmation of intrauterine pregnancy safe and effective?

[D]

The study reviewed was a randomized controlled trial with 1500 women across nine countries who were seeking medication abortion for a suspected but unconfirmed early pregnancy. The women were then randomized to receive early medication abortion or medication abortion after confirmation of intrauterine pregnancy, the latter being standard of care.

[B]

So the women in the standard of care group received ultrasound at seven days and if necessary, 14 days prior to receiving the medication. Most of the women in the study had had prior pregnancies, but 23% were pregnant for the first time and the average BMI was 24. The average age was 29.

[C]

95% of women who participated had a complete abortion. Surgical intervention for incomplete abortion was more common in the standard of care group at 4.5% versus 1.8 in the early group. Women had one less day of bleeding and higher satisfaction. However, ongoing pregnancy was more common in the early abortion group at 3% versus 0.1%.

[D]

In short, early medication abortion is as safe and effective as standard of care treatment.

[B]

Moving right along, we have a Cochrane for clinicians and this one looks at sodium glucose cotransporter 2 inhibitors. It comes to us from pharmacist Dr. Tracy Johns from Tampa, Florida.

[D]

So what's the clinical question?

[C]

Are Sodium glucose CO transporter 2 SGLT2 inhibitors effective in reducing complications for people with chronic kidney disease, CKD and type 2 diabetes.

[B]

This Cochrane review included 53 randomized controlled trials with over 65,000 total participants.

[D]

These studies were conducted between 2012 and 2022 with a median follow up of 45 weeks.

[C]

It is important to note that most of the studies did not include patients with type 1 diabetes or patients on dialysis. The evidence shows they reduce the risk of mortality in patients with any stage CKD and type 2 diabetes. The number needed to treat to prevent one death in one year is 119.

[B]

They also were found to significantly reduce the risk of kidney failure and kidney composite outcomes with a number needed to treat of 35 to prevent one case of kidney failure.

[D]

They were also found to decrease the doubling of serum creatinine and albuminuria progression when compared with placebo.

[C]

Well, what about cardiovascular benefits and and potential side effects?

[B]

So the studies evaluated cardiovascular benefits based on the rates of cardiovascular death, non fatal myocardial infarction, non fatal stroke or hospitalization for heart failure.

[D]

There are decreased rates in hospitalization due to heart failure in all CKD subgroups.

[C]

In patients with more severe disease like CKD stages 3 through 5, SGLT2 inhibitors reduce the risk of 4.5 major adverse cardiovascular events over a one year period with a number needed to treat of 42.

[D]

Wait, but what about the side effects?

[C]

Regarding side effects they can increase the risk of genital infections with a number needed to harm of 38.

[B]

There was no effect on rates of diabetic ketoacidosis though compared to standard of care.

[D]

SGLT2s also caused fewer cases of severe hypoglycemia when compared to standard of care.

[C]

So overall, SGLT2 inhibitors decrease the rate of cardiac events, progression of kidney disease and the rates of heart failure hospitalizations.

[D]

And then we'll be right back.

[A]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the AAFP's upcoming Family Centered Pregnancy Care course happening August 25th through the 28th in Denver, Colorado. Arrive early for Advanced Life Support obstetrics courses for providers and instructors. Register [e-mail] fcpc2025.

[B]

We have another main topic, female sexual dysfunction and it comes to us from Drs. Dalrymple, Hogue and Thacker from Virginia.

[C]

To start off when we use the word women today we are talking about cisgender women or other people assigned female sex at birth. Female sexual dysfunction, or FSD is an umbrella of sexual disorders that can be categorized into sexual desire and arousal disorders, orgasmic disorders and genital pelvic pain disorders. These disorders affect a staggering 40 to 50% of women through all ages.

[D]

The diagnosis is based off of DSM 5 criteria, but the most important part of diagnosis is that the symptoms cause significant distress impact quality of life.

[B]

You should screen for FSD by using open ended questions. If there's a concern, use a validated questionnaire like the Female Sexual Function Index and the Female Sexual Distress Scale for further assessment.

[C]

After you've taken a thorough history, it's important to review their medication list as many medications can contribute to fsd. These medications include antiepileptics, antihistamines, beta blockers, statins, thiazides, spironolactone, hormonal medications like aromatase inhibitors, opioids and psychotropics.

[D]

While doing a pelvic exam, make sure to evaluate for dermatologic, anatomic and neurologic changes.

[B]

In most cases, FSD can be diagnosed without any lab workup unless you're suspicious of a secondary cause like hypothyroidism. Interestingly, there's no correlation between hormone levels like testosterone and estrogen and and the degree of sexual dysfunction.

[C]

Let's talk about treatment for patients with sexual desire and arousal disorder. The first line treatment is cognitive behavioral therapy, couples therapy and mindfulness based therapy.

[B]

You can also consider medications like flibanserin or brimalanitide, although these medications don't work as well and can be expensive.

[D]

If your patient has depression that is well controlled with an SSRI or snris, but they have decreased arousal or desire strongly consider adding bupropion 150 milligrams twice a day.

[C]

Additionally, topical testosterone can be used for postmenopausal women, but long term safety and effectiveness data is limited. If you start your patient on this, you should monitor for androgen excess and do not give systemic or pellet forms of testosterone if your patients are struggling.

[D]

With an orgasmic disorder. For first line treatment is cognitive behavioral therapy, sex therapy and directed masturbation. Physicians should recommend patients purchase an over the counter vibrator device.

[B]

Next, let's discuss genitopelvic pain disorders which may be secondary to pelvic floor dysfunction or menopause. First line treatment for any genitopelvic pain disorder is pelvic floor physical therapy.

[C]

If you have a patient with vaginismus, self dilation and psychotherapy should be offered.

[D]

For vaginal dryness due to genitourinary symptoms of menopause, vaginal moisturizers lubricants and topical estrogens are a first line treatment. Systemic estrogens with or without progesterone should not be considered unless you are treating vasomotor symptoms as well.

[B]

If your patient wants to avoid hormonal treatment, ospimiphene is considered a second line treatment in fsd.

[C]

A referral to a mental health professional who is experienced in FSD should be considered for all patients. If you are considering a procedural or surgical intervention or therapies are not working as expected, a referral to an obgyn or urogynecologist is appropriate.

[B]

Next up we have a curbside consultation and it comes to us from doctors Cervantes and Gurbo from West Virginia University in Morgantown. Go Mountaineers. We're going to start with a case as all our curbside consultations do.

[D]

So we have a 46 year old man who presents to the clinic for evaluation of a painless testicular mass. On exam There is a 3 centimeter non tender firm mass on the right testicle. While discussing your concerns regarding malignancy and the need for further diagnostics, the patient asks whether his occupation as a firefighter could somehow be related.

[C]

He is currently employed as a civilian firefighter during his previous military service. As a firefighter he reports extensive use of aqueous film forming foams that contain PER and polyfluoroalkyl substances or pfas when extinguishing airport and military installation fires.

[B]

So the consult question here is how can you best answer his question about the relevance of PFAS or PFAS in causing his condition?

[D]

PFAS are a class of chemicals, including thousands of different kinds that are widely used in industry and commonly found in the environment. Perfluorooctanoic acid and perfluorooctanesulfonic acid are the more common ones in industrial use.

[B]

Holy cow. Nicely done with those.

[C]

PFAS have a unique property to resist oil and water and thus are used in several consumer products such as nonstick cookware and wrinkle and water resistant fabrics. They are also excellent firefighting tools when addressing petroleum based fires.

[D]

PFAs are highly concerning to environmental regulators because of their prevalence in water due to their water solubility. They are also extremely long lasting, receiving the nickname forever chemicals. Within the United States alone, PFAS have been detected in nearly 50% of all TAP water and they are widely used outside of the United States, making them a significant cause for global concern.

[B]

That's super helpful background for something I was not at all familiar with let's talk about what we know about the health effects.

[C]

Based on observational data and information from both the CDC and Agency for Toxic Substances and Disease Registry. There is an association between PFAS and decreased antibody response after vaccination or infection, elevated risk for dyslipidemia, decreased infant and fetal growth, and heightened risk for kidney cancers in adults.

[D]

Evidence also suggests associations between PFAS and increased risk of liver and thyroid dysfunction, breast and testicular cancers, and an elevated risk of ulcerative colitis in adults.

[B]

Okay, so knowing all this, how should we approach PFAS in our practice?

[C]

Well, although exposures to PFAS has been identified as concerning, no specific medical management is currently recommended due to multiple factors. Exposures are chronic and occur over years. There is no evidence of acute toxicity occurring through ingesting contaminated food or water, and many of the health conditions linked to PFAS are common and it would be difficult to distinguish when they're caused by pfas.

[D]

There are blood tests for pfas. However, a blood test that detects PFAS is a marker only for current or past exposure to the compound, and positive detection cannot be used to predict future disease. Positive testing for PFAS does not indicate current adverse health effects, explain current symptoms, or change treatment for current disease.

[C]

Although no recommended treatments currently are available for treating detectable blood levels of pfas, patients can still consider mitigation efforts in their homes. There are commercial water testing kits and and patients can contact their local health department to learn more about steps for testing. If there are detectable levels, people can consider whole home water filtration systems that filter out pfas. I wonder how expensive that is.

[B]

Probably not cheap.

[D]

Exposure comes in a variety of ways, so it's nearly impossible to avoid it altogether.

[C]

Fortunately, use of PFAS is declining due to planned phaseouts and increased regulations.

[B]

All right, so now looping back to our firefighter patient, we what should we tell him?

[D]

We start by acknowledging that he is likely at a higher risk for testicular cancer given his occupational use of aqueous film forming foams containing pfas, but also acknowledge that civilian firefighting carries a heightened risk of testicular cancer.

[C]

For causality and compensation purposes, you can refer him to the U.S. department of Veterans affairs to obtain service records that may verify his exposure.

[D]

Many states also have presumptive laws regarding occupations such as firefighting that carry an elevated risk of cancer.

[B]

We're going to wrap this episode up with a medicine by the numbers. Methotrexate for juvenile idiopathic arthritis and it comes to us from Drs. Sonoda and Dougherty from Saint Louis University in Missouri.

[D]

Juvenile idiopathic arthritis, or JIA, is arthritis of unknown etiology with onset before 16 years of age and symptoms lasting six weeks or longer, and it is the most common childhood rheumatologic disease.

[C]

The 2021American College of Rheumatology Clinical Practice Guidelines recommends methotrexate as a preferred agent for JIA versus other conventional synthetic DMARDs such as Leflunamide and hydroxychloroquine. Because of its well established evidence and safety profile.

[B]

This medicine by the numbers dug into the Data from a 2024 Cochrane review evaluating weekly oral methotrexate for patients with active JIA in an outpatient setting.

[D]

The review included five randomized controlled trials with 575 children or young adults with a mean age of 4 to 10 years from 16 different countries.

[C]

Comparators across the five studies included placebo, no treatment, methotrexate plus a co intervention like NSAIDs or intra articular glucocorticoids compared with the CO intervention alone and alternative DMARDs like Leflunamide.

[D]

Response was measured using the validated American College of Rheumatology pediatric 70, 50 or 30 improvement criteria.

[C]

They found that with low certainty evidence, oral methotrexate when compared to placebo may improve treatment response for up to six months, but there was little or no difference in participant global assessment or well being or pain. There was also low certainty evidence demonstrating little or no difference in serious adverse events or withdrawal due to adverse events between placebo and oral methotrexate.

[D]

Low certainty evidence also showed that when compared with intra articular glucocorticoids alone, weakly oral methotrexate plus intra articular glucocorticoids may have little to no effect on sustained clinically inactive disease at 12 months or withdrawal from treatment due to adverse events.

[C]

And finally, there was low certainty evidence that showing that when compared with leflonomide, weekly oral methotrexate may have little or no effect on treatment response function, participant global assessment of well being serious adverse events or withdrawals due to adverse events at four months.

[B]

Hmm. So a big caveat pointed out by the authors here is that most trials assessed suboptimal dosing of methotrexate for for only a few months without dose escalation and with low numbers of participants and events reducing reproducibility and the precision of these studies.

[D]

So the Medicine by the Numbers team gives this a color rating of yellow, which means on Claire benefits given the suboptimal dosing of methotrexate and low certainty of evidence. Further research with optimal dosing of methotrexate and longer follow up if is needed to properly assess the use of methotrexate in JIA treatment, please email [e-mail] or tweet FPpodcast.

[C]

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[B]

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[C]

Our podcast team is Christopher Alvarez, Jake Anderson, Steve Brown, Sarah Coles, Marion Dawson.

[D]

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[C]

Our sound and technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabbs, Ryan Evans, and Justin Jenkins. This podcast is brought to you by the residents of Faculty of the University of Arizona College College of Medicine, Phoenix Family Medicine Residency. We'll talk to you soon for the.

[B]

Next edition of the American Family Physician Podcast.