5 Questions with Dr. Richard Burwick

Summary

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Blood, Sweat and Smears: Episode Summary

Episode: 5 Questions with Dr. Richard Burwick
Host: Dr. Brad Lewis, Machaon Diagnostics
Guest: Dr. Richard Burwick, San Gabriel Valley Perinatal Medical Group
Date: May 5, 2025

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Overview

In this episode of Blood, Sweat and Smears, the focus is on bridging the worlds of hematology and maternal-fetal medicine. Dr. Brad Lewis (host) and guest Dr. Richard Burwick discuss inter-specialist collaboration, challenges unique to pregnancy-related hematologic issues, and their shared goal of optimal patient care. Dr. Burwick shares insights from his high-risk pregnancy practice, discusses research and practice gaps, and offers advice for the medical community and trainees.

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Key Discussion Points & Insights

1. What Should Hematologists Understand About Maternal-Fetal Medicine?

[01:05]

• Dr. Burwick: Hematology consultants aren’t expected to be obstetricians, but when consulted, it’s because there’s a pregnancy complication outside typical obstetric conditions.
• Collaborative Roles:
  • OB/MFM doctors call hematologists for input on non-routine hematologic conditions (e.g., severe hemolysis, thrombocytopenia, TMAs).
  • Hematologists should focus on their diagnostic and management expertise.
  • Collaboration allows merging domain-specific knowledge for best patient care.
• Memorable Quote:

  “When we're calling them, it's something probably out of the ordinary... They know their field and that's what we want, is their hematologic input.” – Dr. Burwick [01:36]

2. What Should Maternal-Fetal Medicine Specialists Understand About Hematology?

[02:57]

• Expectation of Learning:
  • MFMs must be prepared and knowledgeable on hematology issues relevant to pregnancy.
  • The degree of expertise in pregnancy among hematologists varies, especially between academic and community settings.
• Communication is Key:
  • MFM providers should clearly communicate pregnancy details, such as gestational stage and options like delivery, since hematologists may not know obstetric nuances.
• Integrated Decision-Making:

  "Our job is to, to tell the hematologist, give them as much information on the obstetric side, so that way we can each focus on our respective fields." – Dr. Burwick [04:19]

3. Are We 'Rounding the Corner' on Major Issues in Maternal-Fetal Medicine?

[05:03]

• Unfinished Work:
  • Despite progress in some areas (e.g., hematology, nephrology), pregnancy-specific research and therapies lag.
  • Pregnant and lactating women are usually excluded from clinical drug trials, leading to knowledge gaps in treatment and drug safety/dosing.
• Call for More Research:

  “We need a lot of information on just safety for even just existing drugs. And then... treatments for pregnancy-specific conditions... There's still a long way to go.” – Dr. Burwick [05:52]

4. Dr. Burwick’s Draw to Maternal Fetal Medicine

[06:31]

• Personal Inspiration:
  • A formative experience during a third-year clinical rotation inspired a focus on pregnancy and the miracle of childbirth.
  • The challenge of managing high-risk pregnancies and the reward of healthy outcomes for both mother and baby are especially meaningful.
• Memorable Quote:

  “Mom and baby are connected. So maternal treatments can affect baby, treatment for baby might affect mom. And how do we balance those decisions?” – Dr. Burwick [07:06]
  “The reward at the end with the goal of a healthy baby is such a noble effort.” [07:27]

5. The One Change He’d Make in Medicine (The “Magic Wand” Question)

[07:54]

• Insurance as a Barrier:
  • Insurance complexity is a major obstacle: high costs, delayed authorizations, copays, and hurdles accessing drugs, tests, and specialty care.
  • Late referrals or treatment due to insurance slow the process and can compromise care quality.
• Wish for Simpler Healthcare Access:

  “That would be, I guess, the great holy grail that we're all trying to solve – not having to worry about that, just being able to take care of our patients.” – Dr. Burwick [08:51]

Bonus Question: Advice for the Medical Community

[09:16]

• Mentoring the Next Generation:
  • Encourages physicians to teach and mentor students and trainees, especially since many are discouraged from healthcare careers by negative messaging and financial burdens.
  • Highlights the importance of clinical, in-person teaching and fostering passion for medicine.
• Memorable Quote:

  “Find a student, take a couple, mentor, take them under your wing... we need to be a part of training the next generation so we continue to have good healthcare providers in the future.” – Dr. Burwick [10:35]

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Notable Quotes & Memorable Moments

• On Collaboration:

  “They don't have to have all the answers. It's a team effort... we're just looking for their subspecialty expertise.” – Dr. Burwick [02:31]

• On Gaps in Research:

  “We’re still seeing that pregnant women and women who are breastfeeding, lactating, they're excluded from clinical trials...” – Dr. Burwick [05:14]

• On Mentorship:

  “There's actually more learners than educators and there's a lot of students and trainees that are dying for in person ... teaching and the clinical pearls that you can only learn in clinical medicine hands on with patients.” – Dr. Burwick [10:20]

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Key Timestamps for Reference

• [01:05] – Bridging hematology and OB/MFM: expectations and collaboration
• [02:57] – What MFMs should understand about hematology and vice versa
• [05:03] – Are we solving the big issues in maternal-fetal medicine?
• [06:31] – What drew Dr. Burwick to the field
• [07:54] – “Magic wand” question: fixing insurance
• [09:16] – Bonus: The importance of mentoring and teaching the next generation

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Summary by: Blood, Sweat and Smears Podcast Summarizer AI
**For clinicians, trainees, and anyone seeking insight into the intersection of hematology and high-risk obstetrics.

Transcript

[A]

Hello and welcome to Blood, Sweat and Smears, your Macheon Diagnostics podcast with tag team hosts, including Our medical director, Dr. Brad Lewis, senior director Bjorn Stromses. That's me. And other guest hosts. We hope you find these podcasts interesting and informative. Thank you for listening. And away we go. Hi, this is Bjorn, continuing our series 5 questions posing 5 questions to physicians in and around the disease areas we work in. Today we are going to birth a new conversation, no epidural included here. Dr. Richard Berwick, a maternal fetal medicine doctor with San Gabriel Valley Perinatal Medical Group. Thanks for joining us today, Dr. Berwick.

[B]

Thank you. Thank you everyone for having me and for hosting this session today.

[A]

I'm excited to get into this. All right, so question number one. Being in maternal fetal medicine, what is one thing you wish your hematology colleagues understood about your subspecialty?

[B]

That's a great question. I guess in a peripheral world, I wish that they all knew everything about obstetrics, but then I guess maybe we'd be out of a job if they didn't need us. But no, I mean, I think, of course I want all of our subspecialists, I think, should learn as much about pregnancy and women's health as much as possible so that they can be fully engaged as consultants. The truth is, I don't expect them to know all of obstetrics. And I think the one thing they should know is when we're consulting them in particular, because I'm thinking OBGYN or maternal fetal medicine, if we're consulting them, it's because, yeah, we have a concern with a hematologic disorder that doesn't fit with a normal pregnancy disorder. Right. So we know how to treat preeclampsia, HELLP syndrome, postpartum hemorrhage, those typical obstetric conditions. So when we're calling them, it's something probably out of the ordinary, whether it's severe homolysis, thrombocytopenia, tma, concerned about a TMA disorder. So I think the key is when we are calling them, I think they just have to stick to their bread and butter. Hematology, you know, we want to know, what do they think of as hematologists? What's their differential diagnosis? They may be concerned about the pregnancy side. Maybe they don't understand all the full aspects of obstetric conditions, but they know their field and that's what we want, is their hematologic input. And then of course, it's a collaboration at that point that they don't have to have all the Answers. It's a team effort, collaborative. So we want to see what are some lab tests that they would do, what are, what are some of the common diagnoses that they have, what are some of the treatments that they would propose. And then we discuss in terms of where are we at in the pregnancy, what are the safety considerations. So really they should know that we're in it together at the end of the day, and we're just looking for their subspecialty expertise.

[A]

Great. And what is one thing you wish your subspecialty understood about hematology?

[B]

I do think we should vice versa. Like I mentioned, the hematologists trying to know as much about obstetrics and women's health, I think, particularly maternal fetal medicine. Our job is to know sort of the medical side of pregnancy complications. And it's our job to learn as much about hematology and hematologic disorders as possible. You know, that's important that we become prepared when we call for the consultation. So we know what to ask for as well. Because the more we know, we can get specific. Say for me, okay, if I'm, you know, I have expertise in teammate disorders, I may already be suspecting, say, atypical hus, or maybe I'm suspecting ttp. I can come to them and say, hey, this is what I'm suspecting. But not everybody will come at it that way. So I think the hematologist, again, it's a little bit collaboration that there's varying degrees of expertise. There's some particularly in academic centers, there may be a hematologist that has really great pregnancy knowledge, like they're the OB person in the hematology department. But that may not be true in the community. So I work with a lot of community hospitals and there may not be a dedicated hematologist who focuses in on pregnancy. So we have to understand that the OBs and MFMs, we may have varying degrees of hematology understanding and vice versa. The hematologist may not have a lot of expertise in pregnancy. So I think it's our job to communicate. I tell obno, MFM providers communicate the situation. You know, where are we at? Are we early in pregnancy where treatment decisions maybe are more aggressive because we have more options, or are we late where actually we do have the option of delivery because the hematologist isn't going to know exactly. Actually, is that an option? Can we just deliver the patient? Is that going to help? And that's where we come in. We know we have that body of knowledge of, oh, we're actually pretty close where, you know, maybe that would, you know, weighing for our decision making. Do we have unique fetal considerations as well? So our job is to, to tell the hematologist, give them as much information on the obstetric side, so that way we can each focus on our respective fields.

[A]

Right now in maternal fetal medicine, do you feel like you're rounding the corner on the big issues and why or why not?

[B]

Oh, that. I wish actually, you know, I wish we were turning the corner. I suppose if we cured everything again, maybe I wouldn't have as much to do. But unfortunately a lot of work to be done. And I mean, I think there is increasing attention to maternal health, women's health, and there's definitely some new barriers that constantly arise to provide in, you know, that care. But it's just treatments are slow. So there's a lot of breakthroughs, I think, in hematology, world nephrology right now, clinical trials, new drugs getting approved all the time. We don't see that in pregnancy. And we're still seeing that pregnant women and women who are breastfeeding, lactating, they're excluded from clinical trials. So we actually don't have the safety data. We don't even know if the drug dosing is the same in pregnancy or maybe you have to, you know, different pharmacokinetics in pregnancy. So we need a lot of information on just safety for even just existing drugs. And then of course, treatments for pregnancy, specific conditions like preterm birth, preeclampsia. We don't have anything that's really effective at prevention. So unfortunately, our big diseases are big conditions. There's still a long way to go. I'm hopeful, optimistic, but I would love to see more input, more commitment to women's health research. Pregnancy research would be incredible if we could do that.

[A]

What was the draw for you to maternal fetal medicine?

[B]

Definitely, of course I'm biased. I love maternal fetal medicine. And I guess if I went back to like just being a medical student, I didn't know initially I was going to go into obgyn, but probably my third year clinical rotation, I was drawn to, I think, pregnancy, labor and delivery. And it's just such amazing, I think even just seeing a witness in those deliveries for the first time. And even still, even to this day, it's such an amazing process and bringing life into the world and wanting to be part of that. And so I always focus on pregnancy. And then I wanted to be part of the managing the high risk because I wanted to make sure we got to that point of a healthy delivery because every expectant parent is, is one in healthy newborn baby. That's all that's important is I just want a healthy baby. And in the high risk world, it's hard. There's a lot of maternal complications, fetal complications, but I like that challenge, that balance, you know, they're connected. Mom and baby are connected. So maternal treatments can affect baby, Treatment for baby might affect mom. And how do we balance those decisions? It was always just fascinating to me. And the reward at the end with the goal of a healthy baby is such a noble effort. So I really enjoy it and I think that's what drew me in. And hopefully more people get into the field. It's a great, important field.

[A]

So question five here is if you could wave a magic wand and just fix one of the things in medicine right now, what would that be?

[B]

Oh, man. And then this is all of medicine.

[A]

Sure, yeah. All of medicine or your subspecialty, however you want to take that.

[B]

Well, the one thing I would fix is insurance. Right. I mean, I guess that's big picture, which I think a lot of physicians and patients would agree it's problematic. I mean, the cost of insurance plans, even cost prohibitive to patients, so the plans are so expensive, and then they're still getting nickel and dime with co pays and deductibles, cost of drugs, and then they can't get into their doctors. So you talk about like managed care plans where it's just delayed. So I'm seeing patients. So for example, I'm a consultant, so their patients are referred to me from their primary OB and they're just coming later than they should. And it's almost always because of delays in authorization. So I can't treat them as effectively because they're presenting late. And then even you get into the cost of different drugs and treatments and laboratory tests, and that's needed. And there's just so many hurdles. We can't provide the care that we need. So that would be, I guess, the great holy grail that we're all trying to solve would be not having to worry about that, just being able to take care of our patients. That would be the magic wand that I think many of us would love.

[A]

That would be a pretty good thing to take care of and at a challenge for many, many providers, for sure. So that is five questions, which leads us to our bonus question, which is what is something you'd recommend? And it can be anything.

[B]

That's a great question. I guess. I think that could be Anything in the whole world. But you know, I guess if I stick into medicine, I'm just coming from a conference and you know, it really is important. I'm going to say what I recommend to people in care providers is we need to educate and mentor the next generation. Think it's so important to me because right now it's difficult and actually students are hearing the negative. Don't go into medicine, not going to healthcare, careful what you wish for. It's, they're hearing the cost, their cost of education is too high and it's not worth it. On the other end, they're thinking kind of financially, all these burdens, talking about insurance. But I don't think that's what we want to be doing is discouraging everybody going into the medical field. These are, you know, students, some cases residents who have already dedicated and chosen this career path. We want to encourage them and hopefully continue to find ways to improve the system. But we should be focused on making sure that they're good providers, particularly in the community. Because yes, I've been in academic practices, but now the past couple of years I've been in community settings. There's a lot of learners out there. There's actually more learners than educators and there's a lot of students and trainees that are dying for in person also there's a lot of them are getting like virtual education and they're dying for face to face in person teaching and the clinical pearls that you can only learn in clinical medicine hands on with patients. So I think find someone to mentor or teach and it doesn't have to be in medicine and it could be life mentorship, you know, But I think for us in medicine, find a student, take a couple, mentor, take them under your wing kind of we need to be a part of training the next generation so we continue to have good healthcare providers in the future.

[A]

Fantastic. I really appreciate your time, Dr. Berwick, and thank you for participating.

[B]

Thank you very much. It's wonderful chatting anytime.

[A]

That's it for us here at Blood, Sweat and Smears, a podcast produced by Matrion Diagnostics, your reference lab and CRO specializing in thrombosis, hemostasis and rare disease. Thank you for listening and if you have a question or comment or there's a topic you'd like Dr. LA to speak to, please send us an email to blood sweatandsmeersacheondiagnostics.com that's M A C H A O N diagnostics.com youm can follow Macheon at Twitter at matriondx Be sure to subscribe to Stay in the Know Share this podcast with clinicians you think might appreciate it, and we hope you'll join us next time here at Blood, Sweat and Smears.