Episode 235 - August 2025 - Part 1 AFP: American Family Physician

Summary

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AFP Podcast Episode 235 – August 2025, Part 1: Clinical Pearls & Evidence Updates

Podcast: American Family Physician Podcast
Host: University of Arizona College of Medicine-Phoenix Family Medicine Residency
Contributing Editor: Dr. Steven Brown
Release Date: August 19, 2025

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Overview

In this episode, the AFP Podcast team (Steve, Rachel, and Kari) highlights key clinical points from the August 2025 issue of American Family Physician. They break down new guidelines, recent evidence, and best practices on the following topics:

• Heart failure with reduced ejection fraction (HFrEF)
• The Oakland score for lower GI bleeding
• Compression therapy for venous leg ulcers
• Non-opioid pharmacologic management of chronic pain
• Burn resuscitation guidelines
• Active monitoring for low-risk ductal carcinoma in situ (DCIS)

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Main Discussion Points & Insights

1. Heart Failure with Reduced Ejection Fraction (HFrEF) Management

From Drs. Gower, Refot, and Falkrod – Womack Army Medical Center, NC

Key Discussion:

• Foundations of Guideline-Directed Medical Therapy (GDMT):

  • Four pillars:
    1. RAS inhibitors (ARNI/ARBs/ACEi)
    2. Beta blockers
    3. Mineralocorticoid receptor antagonists (MRAs, e.g., spironolactone)
    4. SGLT2 inhibitors
       (02:04) Steve: “Don’t forget our tried and true pillars of Goal-Directed Medical Therapy... those are your ARNIs, ARBs, and ACE inhibitors...”

• Titration:

  • Aim to titrate all four classes within 6–12 weeks of diagnosis (02:43).
  • Sequence isn’t standardized, but starting with beta blocker/SGLT2 inhibitor is proposed to reduce sudden death/rehospitalization.

• Effectiveness:

  • Combining all four classes reduces all-cause mortality by 61% and adds 7.9 years of life for a 50-year-old (03:22).

• Common Side Effects:

  • Hypotension and hyperkalemia are most common; manage accordingly with close monitoring (03:28).

• Role of Diuretics:

  • Primarily for symptom management—not disease progression (03:58).

• Hospitalization:

  • Do not stop beta blockers during exacerbations if the patient is already on them (04:24).

• Iron Deficiency:

  • IV iron may improve functional status but does not reduce cardiovascular death/hospitalizations (04:45).

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2. The Oakland Score for Lower GI Bleeding

Medicine by the Numbers, from Drs. Evan Xiao and Yousef – Kings County, Brooklyn

Key Discussion:

• Purpose:

  • Tool to predict safe discharge and major risks in patients with lower GI bleed.

• Evidence:

  • Lacks robust discriminatory power:
    • Major Bleeding: Sensitivity 97%, specificity 9% for score >8—defined as “not really helpful” (06:17).
    • Safe Discharge: Sensitivity 10%, specificity 97% for score <=8—again, not helpful.

• Conclusion:

  • Must use in conjunction with clinical judgment.
    (07:03) Kari: “...the American College of Gastroenterology recommend using this risk tool in combination with clinical judgment.”

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3. Compression Therapy for Venous Leg Ulcer Recurrence

Cochrane for Clinicians, from Drs. Gregory and Epling – Roanoke, VA

Clinical Question:
Do compression stockings prevent recurrence of lower extremity venous ulcers?

Key Discussion:

• Evidence Review:

  • Based on eight trials, most with bias limitations (07:55).

• Best Practice:

  • Heavy (30–40 mmHg) compression reduces re-ulceration over 6 months, NNT=5 (08:14).
  • Long-term: Medium to heavy compression more effective than light to medium (absolute risk reduction 18.8%, NNT=6).

• Tolerability:

  • Higher dropout with higher compression (NNT to harm=14). Many patients struggle with adherence.

• Bottom Line:

  • Lifelong compression recommended; select heaviest compression tolerated. (09:47) Rachel: “Use lifelong compression, ideally with heavy compression. But if patients don’t tolerate heavy compression, medium compression may be similar in efficacy...”

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4. Non-Opioid Pharmacologic Management of Chronic Non-Cancer Pain

From Dr. Sokol, Grossman, and Burgery – Cambridge Health Alliance, MA

Key Discussion:

• Epidemiology:

  • 1 in 5 U.S. adults affected; leading cause of disability (10:47).

• Principles:

  • Multimodal, individualized, and functional-goal oriented care.

• Medications by Condition:

  • Neuropathic Pain:
    • Duloxetine (60mg): NNT=5 for ≥50% pain reduction.
    • Gabapentin/Pregabalin: Moderate relief; dizziness/somnolence common (11:57).
  • Fibromyalgia:
    • Pregabalin, duloxetine, milnacipran effective, but NNTs relatively high (12:13).
  • Osteoarthritis:
    • Topical NSAIDs (e.g., diclofenac) first line for knee/hand OA (NNT=10).
    • Duloxetine may benefit select patients (NNT=6 in responders).
    • Avoid acetaminophen, glucosamine/chondroitin.
  • Low Back Pain:
    • Oral NSAIDs: Small, low-quality benefit.
    • Gabapentinoids, TCAs, SSRIs/SNRIs: Not beneficial, should be avoided (13:44).
    • Muscle relaxants: Only for short-term, acute use (<3 weeks).

• Generalized Chronic Pain:

  • Duloxetine, milnacipran can help multiple conditions.

• Topicals:

  • Capsaicin cream: NNT=6–8, but 1/3 experience burning.
  • Lidocaine: Lacks high-quality evidence (14:52).

Quote:
(15:01) Rachel: “...chronic pain management is about functional outcomes using evidence-informed, patient-centered and multimodal strategies.”

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5. Burn Resuscitation – New Guidelines

Practice Guideline, American Burn Association – Dr. Nelson, Michigan State

Key Discussion:

• Trustworthiness:

  • American Burn Association guideline gets “5 yes, 2 no, 1 unknown” on G Trust Scorecard.

• Cautions:

  • Limited evidence—view as clinical suggestions, not absolute rules.
    (15:56) Rachel: “As pointed out by the AFP’s assistant medical editor... recommendations should be considered more as suggestions than firm guidance.” (16:08) Steve: “Guidelines are not godlines.”

• Protocol:

  • Use Parkland formula for TBSA estimation.
  • Initial resuscitation: 2 mL/kg x %TBSA burn in first 24 hours.
  • Consider albumin for large burns as adjunct.
  • Goal urine output: 0.5 mL/kg/hr.
  • Consider, but don’t rely on, decision support software.
  • Avoid fresh frozen plasma.
  • High dose vitamin C: Benefit uncertain.
  • No recommendation on continuous renal replacement therapy.

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6. Practice-Changing POEM: Active Monitoring vs. Surgery for Low-Risk DCIS

POEM by Dr. Slauson

Study Design & Results:

• 957 women with low-risk DCIS:
  • Randomized to active monitoring vs. usual care (surgery ± radiation).
  • 2-year follow-up:
    • Invasive cancer rates: 4.2% (active monitoring) vs. 5.9% (surgery/radiation)
    • All-cause mortality: No difference

Conclusion:
Active monitoring is not inferior to surgery in carefully selected women with low-risk DCIS.
(18:18) Steve: “Active monitoring might be a good plan for your patient. And I really like the term active monitoring. I think patients might like it better than watchful waiting.”

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Notable Quotes & Memorable Moments

• On GDMT for HFrEF:
  (03:23) Kari: “Practically speaking, this adds an additional 7.9 years of life for a 50 year old patient.”

• On Oakland Score:
  (06:26) Kari: “That’s like a positive likelihood ratio of 1.07. That’s not really helpful.”

• On Compression Stockings:
  (09:44) Kari: “Those things are hard to get on your legs.”
  (09:22) Steve: “Have you ever tried to wear compression stockings all day, especially in the summer? Ish.”

• On Guideline Limitations:
  (16:08) Steve: “Guidelines are not godlines.”

• On Chronic Pain Management:
  (15:01) Rachel: “Chronic pain management is about functional outcomes using evidence-informed, patient-centered and multimodal strategies.”

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Timestamps for Key Segments

• Heart failure with reduced ejection fraction: 01:32 – 05:14
• Oakland score for lower GI bleed: 05:14 – 07:12
• Compression therapy, venous leg ulcers: 07:12 – 10:12
• Non-opioid management of chronic pain: 10:30 – 15:19
• Resuscitation in burns: 15:19 – 17:14
• Active Monitoring in DCIS: 17:19 – 18:18

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Summary

This episode delivers evidence-based updates in a conversational and approachable way. The hosts review major clinical takeaways for practice, continually emphasizing functional outcomes, shared decision-making, and the importance of personalized, guideline-directed care. They also maintain a lively and collegial tone, sprinkling in humor and memorable quotes that reinforce the teaching points. Whether reviewing a guideline or discussing chronic pain management, the bottom line is clear: evidence and patient goals must always guide family medicine practice.

Transcript

[Podcast Announcer]

The AFP Podcast is brought to you by the American Academy of Family Physicians and by Mayo Clinic. Mayo Clinic proudly supports this AFP podcast. Mayo Clinic Family Medicine puts patients first by pursuing innovations that change lives and the future of care. Learn more about joining our [e-mail] FamilyMedicine.

[Steve Brown]

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

[Rachel Dunn]

I'm Rachel.

[Kari Staus]

And I'm Kari.

[Steve Brown]

We are residents and faculty, mostly residents, from the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we're going to talk about heart failure, lower GI bleeding, venous leg ulcers, non opioid pharmacologic management of chronic pain, resuscitation in burns, and ductal carcinoma in situ.

[Rachel Dunn]

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. We're on a mission delivering the best from American family.

[Steve Brown]

Okay, let's start with heart failure with reduced ejection fraction, or HFrEF medical management from Drs. Gower, Refot and Falkrod from Womack Army Medical center in North Carolina.

[Kari Staus]

I like to call this section the E Effectiveness of New Therapies. Don't laugh at me.

[Steve Brown]

That's terrible.

[Kari Staus]

I thought it was pretty clever.

[Rachel Dunn]

I love it. So we've all seen and treated heart failure inpatient and outpatient, but I always get a little nervous that I'm not up to date. So here's the perfect refresh.

[Steve Brown]

Yes, so don't forget our tried and true pillars of Goal Directed medical therapy, or gdmt, are still the same. Your first group is your RAS inhibitors. RAS is the renin angiotensin aldosterone system, and Those are your ARNIE's, your ARBS, and your ACE inhibitors. Number two of your GMT is your beta blockers. Three is your mineralocorticoid receptor antagonist, or we're going to call them MRAs, which includes spironolactone, and then four is your SGLT2 inhibitors.

[Kari Staus]

Okay, so say someone is newly diagnosed with HFrEF, meaning their ejection fraction is less than 40%. What should be my next move?

[Rachel Dunn]

Ideally, we titrate all pillars of gdmt by 6 weeks, although 12 is acceptable. But there's not really a generalized consensus on the order in which to start. One proposal is to start with a beta blocker and SGLT2 inhibitor to reduce the risk of sudden death and heart failure readmissions without any significant effect on blood pressure.

[Steve Brown]

And then you add your RAS inhibitor a week or two after that and your mineralocorticoid receptor antagonist maybe a week or two later.

[Kari Staus]

And I think it's important to mention why we care so much about gdmt. The combination of all four classes for management of HFREF compared with placebo reduces the all cause mortality by 61%.

[Steve Brown]

Dang.

[Kari Staus]

Practically speaking, this adds an additional 7.9 years of life for a 50 year old patient.

[Steve Brown]

Kari, what are the most common side effects of these medications?

[Kari Staus]

Hypotension and hyperkalemia are the biggest concern. However, hypotension, if not symptomatic or not lower than a systolic pressure of less than 90 millimeters of mercury is not an indication to stop medical management in regard to hyperkalemia.

[Rachel Dunn]

Usually it's due to the MRAs and should be an indication to stop this medication, especially if potassium is greater than 6. But often the SGLT2 inhibitor will help mitigate this.

[Steve Brown]

Yeah, so the other thing that we should talk about is diuretics. Diuretics do not have a significant effect on mortality, but they can be used for symptom management.

[Rachel Dunn]

Loop diuretics are first line agents for pulmonary congestion, improved exercise capacity improvement and they reduce heart failure readmissions.

[Kari Staus]

Okay, so this brings me to my question about heart failure exacerbations. Should we be holding beta blockers for exacerbations?

[Rachel Dunn]

No, we shouldn't be. If a patient is already on a beta blocker, please continue it during hospitalization. If they are not though, you can wait until after appropriate diuresis to start.

[Steve Brown]

The article also discusses comorbid iron deficiency anemia. We sometimes get pretty excited about anemia in ischemic cardiomyopathies.

[Kari Staus]

Yeah, and I get it. The reasoning makes sense. We want to make sure there's adequate oxygen delivery when the pump is malfunctioning. Newer evidence doesn't really show a significant reduction in cardiovascular death and heart failure hospitalizations with the addition of IV iron, but it does show an improvement in functional status and quality of life.

[Rachel Dunn]

And just for completeness, other medical and device based therapies exist. But I would probably talk to your friendly cardiologist before starting most of these. Fair.

[Steve Brown]

Next, Medicine by the numbers, the Oakland score for predicting safe discharge and major risks after lower gastrointestinal bleeding. This is from Drs. Evan Xiao and Yousef from Kings county in Brooklyn. All right, Kari and Rachel, you're seeing a 67 year old patient in the emergency department who has a lower GI bleed and you're wondering, can I send this patient home? Do I need to admit them? Do they need emergent intervention? Well, maybe you can use the Oakland score for making this decision. What do you think, Rachel?

[Rachel Dunn]

Well, let's take a look at this meta analysis and systematic review and see. The systematic review looked at four cohorts.

[Kari Staus]

Three cohorts were retrospective, one was prospective. Possible patient outcomes were safe discharge, major bleeding, need for blood transfusion, or a need for hemostasis.

[Steve Brown]

You can find the Oakland score on MD Calc. Points are given for various demographic labs and vital signs.

[Rachel Dunn]

Let's look at the outcome of major bleeding. A score over 8 has a 97% sensitivity and a 9% specificity to predict major bleeding.

[Kari Staus]

That's like a positive likelihood ratio of 1.07. That's not really helpful.

[Steve Brown]

Nope. For the outcome of safe discharge, an Ohkland score less than or equal to 8 has a sensitivity of 10% and a specificity of 97%.

[Kari Staus]

Okay. Still a negative likelihood ratio of 0.9. Not helpful.

[Steve Brown]

Nope. It's not any better for predicting blood transfusion or need for hemostasis.

[Rachel Dunn]

Thennt.com has assigned a color of yellow, meaning unclear, benefit, to the Oakland score for lower GI bleed risk prediction.

[Kari Staus]

These authors and the American College of Gastroenterology recommend using this risk tool in combination with clinical judgment.

[Steve Brown]

Next, Cochrane for clinicians. Compression therapy for preventing the recurrence of venous leg ulcers. From Drs. Gregory and Epling from Roanoke, Virginia.

[Rachel Dunn]

Our clinical question is do compression stockings prevent the recurrence of lower extremity venous ulcers? But first, why do golfers wear two pairs of socks?

[Steve Brown]

Why?

[Rachel Dunn]

In case they get a hole in one.

[Kari Staus]

That's a good reason.

[Steve Brown]

Compression stockings are a mainstay of venous stasis leg ulcer therapy and are also recommended after healing to prevent recurrence.

[Kari Staus]

So let's hear about this Cochrane review.

[Rachel Dunn]

They looked at eight trials with nearly 2,000 patients with recently healed ulcers. Although of note, most studies had limitations in allocation, concealment, intervention, blinding, outcome assessment, blinding or other biases such as reporting bias or industry funding.

[Kari Staus]

So what's the best treatment?

[Steve Brown]

So the world can't agree on a compression standard. So we have the EU class, the US and the uk. So we're going to mix those all up in here. EU class 3, which corresponds to US heavy, which is 30 to 40 millimeters of mercury compression that may reduce re ulceration compared with no compression over 6 months with an NNT of only 5.

[Rachel Dunn]

Light compression was no different from medium compression in preventing leg re ulceration at 12 months. Other studies with more long term follow up showed that medium to heavy compression was more effective than light to medium compression at preventing re ulceration over 18 months to 10 years, with an absolute risk reduction of 18.8% and a number needed to treat of six.

[Kari Staus]

Okay, so what I'm hearing is heavy compression is preferred, but what's the Achilles heel?

[Steve Brown]

Yes, well so higher compression levels had higher dropout rates.

[Rachel Dunn]

Yes, the number needed to harm from dropout was 14. So definitely try to balance efficacy with tolerability.

[Steve Brown]

Have you ever tried to wear compression stockings all day, especially in the summer? Ish compression stockings can reduce the recurrence of venous leg ulcers, although this is based on limited evidence. Higher grade compression is more effective, but patients are more likely to not wear their stockings at high compression.

[Kari Staus]

Those things are hard to get on your legs.

[Steve Brown]

Yeah, they really are.

[Rachel Dunn]

So bottom line, use lifelong compression, ideally with heavy compression. But if patients don't tolerate heavy compression, medium compression may be similar in efficacy compared to light. So some compression is definitely preferred to none. But be sure to assess arterial supply as needed by palpating pulses or getting vascular studies.

[Steve Brown]

More after this.

[Podcast Announcer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the Permanente Medical Group Incorporated. Seeking flexible schedules and competitive benefits, join our multidisciplinary practice at the Permanente Medical Group. We offer moving allowance, Northern California home buying assistance and real work Life balance.

[Steve Brown]

Explore opportunities@northern california.permanente.org now non opioid pharmacologic Management of Chronic Non cancer pain from Dr. Sokol Grossman and Burgery from the Cambridge Health alliance in Massachusetts.

[Rachel Dunn]

Chronic pain affects about 1 in 5 U.S. adults. It's not just a symptom, it's the leading cause of disability and is linked to reduced life expectancy.

[Kari Staus]

Unlike acute pain, chronic pain sticks around for at least three months, often after tissue healing. It's biopsychosocial in nature. Biologic, psychological and social factors can all.

[Steve Brown]

Contribute to this pain, which is why treatment must be individualized and multimodal. No single solution works for everyone.

[Kari Staus]

Mm, true.

[Rachel Dunn]

When treating chronic pain, we start by clearly assessing the pain type and source, then focus on the patient's functional goals.

[Kari Staus]

In terms of medical management, the goal is to use the lowest effective dose, monitor the side effects closely, and discontinue anything ineffective. Obviously, shared decision making is key Here.

[Rachel Dunn]

Okay, that makes sense. Let's talk about specifics. Neuropathic pain first. Evidence supports duloxetine, pregabalin and gabapentin. Duloxetine at 60 milligrams per day shows a number needed to treat of five for at least a 50% pain reduction.

[Steve Brown]

Gabapentin and pregabalin offer moderate pain relief. Gabapentin at 1200 milligrams per day gives an NNT of 5 to 7, but dizziness and somnolence are common. Pregabalin has similar efficacy but greater dropout at higher doses.

[Kari Staus]

For fibromyalgia, pregabalin reduces pain by 30 to 50%, but this has a number needed to treat between 7 and 14. Duloxetine and milnacipran also help, though evidence is lower quality.

[Rachel Dunn]

Now to talk about osteoarthritis. Topical NSAIDs, especially diclofenac, are first line for knee and hand OA. They've got lower systemic risk, similar efficacy to oral NSAIDs and an NNT of 10.

[Steve Brown]

Oral NSAIDs still play some role, particularly for hip osteoarthritis, but come with a slightly higher gi, renal and cardiovascular risk. Topical is preferred unless deeper joints are involved.

[Rachel Dunn]

Consider the use of duloxetine for OA as well. Although studies demonstrate a clinically insignificant mean improvement in pain scores and physical functioning for knee and hip OA, some patients treated with duloxine had at least a 50% improvement in pain, and for that group the NNT was 6 compared with placebo.

[Kari Staus]

One of our residents just did their presentation on duloxine for arthritis and I'm definitely going to consider that more often now.

[Steve Brown]

Yeah, that's great. Importantly, many drugs like acetaminophen, glucosamine and chondroitin lack evidence and should be avoided for osteoarthritis.

[Kari Staus]

Okay, so for low back pain, options are more Limited. Oral NSAIDs offer small improvements, but evidence is low quality. There's actually no evidence of long term benefit from any medication.

[Rachel Dunn]

Wow. Avoid gabapentinoids for back pain. They don't work and carry significant risks. Likewise, tricyclics, SSRIs and SNRIs unfortunately offer minimal benefit and higher harm in low back pain.

[Steve Brown]

Muscle relaxants may help in the short term, like under three weeks, but they should not be used for chronic use. Risks outweigh benefits beyond that point.

[Rachel Dunn]

Okay. For generalized chronic pain, there's high quality evidence that shows duloxetine, 60 milligrams per day and melnasopran at 100 milligrams per day slightly improved pain in multiple chronic pain conditions including fibromyalgia, neuropathic pain and musculoskeletal pain.

[Kari Staus]

There's also high quality evidence that low concentration topical capsaicin cream provides small benefits in chronic neuropathic and musculoskeletal pain. This has an NNT your number needed to treat of 6 to 8 for a 50% reduction in pain compared with placebo. However, 1/3 of patients report local adverse events, most commonly being intense burning sensation after application.

[Steve Brown]

How else do you know?

[Kari Staus]

Touche. Topical lidocaine lacks high quality evidence supporting its effectiveness for chronic pain.

[Rachel Dunn]

To wrap up chronic pain management is about functional outcomes using evidence, informed, patient centered and multimodal strategies. Check out the tables in the article for a breakdown of each medication, its indications, possible adverse effects and the level of evidence supporting its use.

[Steve Brown]

Now we have a practice guideline, Resuscitation of patients with Burns guidelines from the American Burn Association. This is from Dr. Nelson from Michigan State with a comment for our very own editor, Dr. Arnold.

[Kari Staus]

With any guideline in American Family Physician, we first look at the G Trust Scorecard to see if this is a guideline we can trust. This American Burn association guideline gets five yes scores, two no scores and one unknown score.

[Steve Brown]

They focus on patient oriented outcomes, make clear and actionable recommendations and use a systematic review.

[Rachel Dunn]

As pointed out by the AFP's assistant medical editor, Dr. Arnold, there is a paucity of good evidence to guide these decisions. So these recommendations should be considered more as suggestions than firm guidance.

[Steve Brown]

Guidelines are not godlines.

[Kari Staus]

If I could make a tagline for.

[Rachel Dunn]

You, Dr. Brown, we just had a presentation about that.

[Steve Brown]

Yes we did.

[Kari Staus]

Nevertheless, here are some suggestions.

[Rachel Dunn]

Use the Parkland formula to estimate percentage total body surface area in the burn.

[Steve Brown]

Then resuscitate with 2 ML per kg of fluids during the first 24 hours multiplied by the percent body surface area of of the burn. Consider albumin infusion in the first 24 hours as an adjunct treatment in patients with larger burns.

[Kari Staus]

Monitor resuscitation efforts and titrate by measuring urine output. 0.5mlk per hour is the goal.

[Rachel Dunn]

Consider computerized decision support software. But this should not replace clinical judgment.

[Steve Brown]

They recommend against using fresh frozen plasma.

[Kari Staus]

The benefit of high dose vitamin C is uncertain.

[Rachel Dunn]

They make no recommendation on the use of continuous renal replacement therapy due to limited evidence.

[Kari Staus]

So basically you can use this guideline as a framework for your own clinical assessment and decision making and measure that urine output.

[Rachel Dunn]

Baby got it.

[Steve Brown]

Okay, we have a poem. Poems are patient oriented evidence that matters and this poem is entitled Active Monitoring is not inferior to surgery with or without radiation and in women with low risk Ductal Carcinoma in situ or DCIS. This is from Dr. Slauson.

[Kari Staus]

This was a study that evaluated 957 women who were newly diagnosed with low grade DCIS. They were split into two arms, usual care with surgery with or without radiation and the second arm being active monitoring.

[Rachel Dunn]

Patients were followed for two years and if they had physical exam findings concerning for disease progression they underwent biopsy and surgery if there was identified invasive cancer.

[Steve Brown]

Using an intention to treat analysis. The cumulative rate of invasive cancer was similar in both arms, 4.2% in the active monitoring group compared to 5.9% in the usual care group and all cause.

[Kari Staus]

Mortality did not differ between groups.

[Steve Brown]

So active monitoring might be a good plan for your patient. And I really like the term active monitoring. I think patients might like it better than watchful waiting. Send us your thoughts by emailing [e-mail].

[Kari Staus]

Follow on Instagram fpjournal. Please subscribe and rate us wherever you get your podcasts.

[Steve Brown]

Escuchanos en Espanol A Revista Medica a.

[Kari Staus]

Fap Our podcast team is Jake Anderson, Puneet Bharot, Steve Brown, Justin Chettiak, Sarah Coles, Austin Cotter, Rachel Dunn, Emily Eisenberg, Alaina Kelly, Chisholm Okuwagu, and Kari Staus. Our sound and technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabs, Ryan Evans, and Justin Jenkins.

[Steve Brown]

This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency Programs. We'll talk to you soon for the next edition of the American Family Physician Podcast.