BackTable OBGYN

Not all pain is visible and not all solutions are obvious, especially in chronic pelvic pain. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Aakriti Carrubba, an expert in minimally invasive gynecological surgery and pelvic pain from the Mayo Clinic, to talk through the evaluation and treatment of chronic pelvic pain.---SYNPOSISDr. Carrubba shares her journey from Kentucky to Florida, detailing her extensive training and interest in managing pelvic pain. The discussion covers the evaluation of pelvic pain, the significance of a thorough patient history and systematic pelvic exams, and the role of interdisciplinary approaches, including physical therapy and pain management. Dr. Carrubba emphasizes the importance of addressing central sensitization and chronic pain syndromes, explaining that not all pain can be attributed solely to structural abnormalities. The episode also touches on the integration of advanced AI tools in medical practice to enhance patient documentation and overall care.---TIMESTAMPS00:00 - Introduction01:09 - Dr. Carrubba’s Background and Journey03:54 - Fellowship Experience and Pelvic Pain Focus06:44 - Approach to Chronic Pelvic Pain14:04 - Detailed Pelvic Pain Exam Techniques17:14 - Trigger Point Injections and Their Role21:33 - Challenges in Pain Management and Education26:34 - Role of Central Sensitization in Chronic Pelvic Pain29:35 - Approach to Central Sensitization and Screening33:13 - Approaches to Excision Surgery36:04 - Post-Surgery Management and Hormonal Suppression38:19 - Teaching and Training in Pelvic Pain Management41:35 - Pain Rehabilitation Clinic for Central Sensitization44:59 - Teaching Pelvic Pain Anatomy to Trainees48:24 - Advancements in AI for Medical Documentation52:26 - Reflections on Pelvic Pain Training and Education56:00 - Final Thoughts

No money, no mission. Understanding coding is the key to funding care and making your practice sustainable. In this episode of BackTable OBGYN, host, Dr. Mark Hoffman, chats with Dr. Jon Hathaway, associate professor at IU School of Medicine and coding specialist. They discuss the intricacies of medical billing, the impact of coding knowledge on revenue, and the systemic gaps in residency training regarding financial literacy. ---SYNPOSISDr. Hathaway shares his journey from mastering coding to becoming a national expert, providing a crash course on CPT, RVU, and ICD codes, and emphasizing the importance of accurate billing for the sustainability of healthcare practices. The episode offers valuable insights into the challenges and opportunities in medical coding and the broader financial aspects of healthcare.---TIMESTAMPS00:00 - Introduction 02:03 - Dr. Hathaway's Journey into Coding04:11 - Understanding the Financial Side of Healthcare07:10 - The Disconnect in Healthcare Payments11:26 - The Complexity of Medical Billing18:11 - The Role of CPT, RVU, and ICD Codes24:03 - The Process of Approving New Procedures32:38 - Understanding the Value Update Process33:47 - Case Study: Cystoscopy in Hysterectomy Codes35:26 - Survey Participation and Its Impact36:12 - Roles and Responsibilities in ACOG38:12 - Challenges of RVU-Based Compensation42:08 - Specialty-Specific RVU Valuation48:42 - Comparing OB and GYN Reimbursements50:02 - Envisioning an Ideal Healthcare System55:10 - Maximizing Billing Efficiency59:46 - Final Thoughts

The future of gynecologic surgery is less invasive, more precise, and closer than you think. In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman welcomes Dr. Noam Smorgick, Director of Minimally Invasive Gynecologic Surgery at Shamir Hospital in Israel. They discuss Dr. Smorgick’s journey into the field of OBGYN and her innovative approaches to intrauterine adhesion management and hysteroscopic surgery for complex pathologies.---SYNPOSISTopics include the advantages of hysteroscopic management over traditional methods, the importance of maintaining fertility, the nuances of the Israeli healthcare system, and the development of new surgical instruments and procedures. The episode also highlights shared decision-making in patient care and looks ahead to the future direction of gynecologic surgery. Dr. Smorgick shares insights from recent studies and her experiences, making it a valuable listen for practitioners and anyone interested in gynecologic surgery advancements.---TIMESTAMPS00:00 - Introduction02:05 - Dr. Smorgick’s Journey to Medicine05:01 - Insights into Israeli Healthcare System10:20 - Intrauterine Adhesions and Hysteroscopic Management11:28 - Research on Retained Products of Conception15:07 - Comparing Management of Pregnancy Loss22:02 - Future Directions in Hysteroscopic Surgery23:46 - Infertility Treatments in Israel25:50 - Managing Uterine Septums and Adhesions28:03 - Shared Decision Making in Surgery32:03 - Techniques and Tools for Metroplasty33:08 - Adhesion Prevention Strategies35:35 - Postoperative Care and Follow-Up36:59 - Office Hysteroscopy Procedures38:05 - Reusable vs. Disposable Instruments45:51 - Future of Hysteroscopy---RESOURCESNetherlands Publication: Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/28390688/ Dr. Smorgick’s Publications: A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception: https://pubmed.ncbi.nlm.nih.gov/24997472/ Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?: https://pubmed.ncbi.nlm.nih.gov/37782418/

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

Blind biopsies leave questions unanswered. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes back Dr. Linda Bradley, an expert in obstetrics, gynecology, and hysteroscopy from the Cleveland Clinic, to discuss the benefits and advancements of direct visualized endometrial sampling over traditional blind biopsy techniques. ---This podcast is supported by:Medtronichttps://www.medtronic.com/en-us/healthcare-professionals/specialties/gynecology/product-portfolio.html---SYNPOSISDr. Bradley emphasizes the importance of hysteroscopy for accurate diagnosis and treatment of various gynecological issues, including abnormal uterine bleeding. They explore the limitations of blind biopsies and the advantages of hysteroscopy in detecting focal lesions, avoiding unnecessary hysterectomies, and ensuring patient safety. The discussion also touches on the economic and procedural challenges in adopting hysteroscopy more widely in clinical practice.---TIMESTAMPS00:00 - Introduction 03:30 - The Evolution of Hysteroscopy at Cleveland Clinic04:49 - Challenges and Innovations in Hysteroscopy06:30 - Clinical Insights: Direct Visualized Endometrial Sampling12:03 - Case Studies and Practical Applications15:46 - The Importance of Visual Examination in Gynecology20:03 - Advocating for Hysteroscopy in Medical Practice31:07 - Patient History and Trauma Considerations31:34 - Cancer Detection and Missed Diagnoses32:14 - Challenges with Unscheduled Bleeding32:56 - Case Study: Blood Transfusions and Hysterectomy33:38 - Importance of Hysteroscopy34:43 - Hysteroscopy Techniques and Best Practices37:41 - Ultrasound and SIS (Saline Infusion Sonohysterography) for Imaging38:45 - Post-Operative Care and Follow-Up47:41 - Environmental and Economic Considerations in Healthcare52:51 - Final Thoughts and Patient Advocacy

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women. --- SYNPOSIS Dr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health. --- TIMESTAMPS 00:00 - Introduction03:41 - Challenges in Menopause Medicine07:21 - Misconceptions and Risks of HRT15:35 - Understanding Bioidentical Hormones18:48 - WHI Studies and Their Impact23:21 - Practical Guide to Prescribing HRT33:47 - Understanding Estrogen Levels and Risks36:04 - Debating Gels vs. Patches37:51 - Concerns with Compounded Products and Pellets38:50 - Patient Education and Meeting Them Where They Are42:12 - Progesterone Benefits and Sensitivities46:38 - Testosterone Therapy for Women51:36 - The Importance of Lab Tests55:39 - DHEA and Vaginal Health57:14 - Advocacy for Accurate Hormone Therapy Information01:00:05 - Conclusion and Final Thoughts --- RESOURCES The Peter Attia Drive episode with Dr. Rachel Rubin:https://peterattiamd.com/rachelrubin/ FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women:https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4mDr. Rachel Rubin’s Hormone Therapy for Early Adopters Course:https://rachelrubinmd.thinkific.com/courses/MHTCME

The guidelines are in and the myths are out. In this episode of the BackTable Podcast, Dr. Suzette Sutherland hosts Dr. Melissa Kaufman and Dr. Giulia Ippolito to discuss the new 2025 AUA/SUFU guidelines on genitourinary syndrome of menopause (GSM). ---SYNPOSISThe doctors delve into what GSM is, its symptoms, and the new evidence-based clinical guidelines for screening, diagnosing, and treating this condition. The episode emphasizes shared decision-making, safe use of local low-dose vaginal estrogen, and addresses concerns related to hormone therapy and cancer risks. Additionally, the doctors cover non-hormonal interventions, the role of vaginal moisturizers and lubricants, and the use of vaginal lasers. The importance of follow-up and ongoing patient education is also highlighted. The conversation aims to equip clinicians with the knowledge to better manage GSM and improve patient outcomes.---TIMESTAMPS00:00 - Introduction 01:35 - Overview of the 2025 AUA/SUFU Guidelines02:27 - Guideline Development Process05:48 - Categories of Guidelines07:03 - Understanding GSM: Symptoms and Diagnosis10:28 - Patient Education and Shared Decision Making15:22 - Hormonal Interventions and Safety Concerns17:17 - Local Vaginal Estrogen: Recommendations and Usage23:12 - Compounded Estrogens and Alternative Therapies25:48 - Understanding Estrogen Dosage Forms26:11 - Introduction to DHEA and Its Benefits27:15 - Exploring Ospemifene as an Alternative28:05 - Guidelines for Treating GSM Symptoms30:11 - The Role of Vaginal Estrogen in UTI Prevention33:01 - Non-Hormonal Interventions for GSM35:39 - Laser Treatments for GSM39:59 - Addressing Cancer Risks with Vaginal Estrogen44:48 - Endometrial Surveillance and Follow-Up49:14 - Advocating for Vaginal Estrogen Use51:13 - Conclusion and Final Thoughts

Where you perform a procedure could cost your patient thousands or save them just as much. In this Backtable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park sit down with Dr. Barbara Levy to discuss the economic challenges and implications of performing medical procedures in various settings such as hospitals, ambulatory surgery centers (ASCs), and office environments.  They explore how hospitals have leveraged billing structures for financial gain, often driving up patient costs, and highlight how procedures like hysteroscopies and endometrial ablations can be performed more efficiently and cost-effectively in office settings. The conversation also touches on how insurance companies and healthcare policy shape both patient expenses and physician practice. Dr. Levy emphasizes the importance of understanding the broader healthcare system to effectively advocate for positive changes in patient care and outcomes. TIMESTAMPS 00:00 - Introduction 00:48 - Hospital Lobbying and Facility Fees 02:43 - Impact on Patients and Physicians 04:06 - Insurance Companies and Healthcare Economics 08:34 - Office vs. ASC vs. Hospital Procedures 12:59 - Cryoablation and Patient Experience 14:53 - Conclusion and Final Thoughts CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

OBGYN Briefs - Understanding Medical Facility Fees in Practice The way you code and calculate costs might be affecting your practice more than you realize. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD. They discuss the complexities of practice expenses and coding in medical specialties, emphasizing the differences between direct and indirect expenses which vary by geography and specialty.  The conversation covers the challenges in surveying costs, the importance of accurate representation in surveys, and the strategic implications of coding. They also touch on the complications arising from procedure revaluation and the impact of site-of-service on reimbursements. TIMESTAMPS 00:00 - Introduction  00:48 - Understanding Practice Expenses 02:28 - Survey Challenges and Fraud Concerns 03:19 - Valuation of Medical Procedures 07:39 - Impact of Code Changes on Payments 11:01 - The Complexity of Medical Coding 15:18 - Site of Service and Facility Fees CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

OBGYN Briefs - Understanding the RUC's Role in Healthcare Costs Every procedure has a price, but how is it set? In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD, to discuss her work with the key organizations influencing medical billing and reimbursement. They explore Dr. Levy's extensive involvement with ACOG, AMA's CPT Editorial Panel, and the RBRVS Update Committee (RUC), offering an overview of the complex systems governing coding and reimbursement in medicine. From how new procedures receive codes to the financial impact on physicians, this brief offers valuable insights for OBGYN practitioners navigating the world of medical billing and coding. TIMESTAMPS 00:00 - Introduction  00:48 - Personal Anecdotes and Career Beginnings 02:01 - Understanding Medical Reimbursement 03:17 - Roles and Responsibilities in Medical Committees 05:34 - The Coding Process Explained 09:16 - The Role of the RUC and CPT Editorial Panel 15:16 - RVUs and Practice Expenses 17:48 - Final Thoughts CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today. --- SYNPOSIS Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence. --- TIMESTAMPS 00:00 - Introduction02:50 - Focus on Menopause and Hormone Replacement Therapy04:20 - The Women's Health Initiative (WHI) Study05:39 - Understanding Risks and Misconceptions12:43 - Reevaluation of the Women’s Health Initiative Study18:31 - Impact of Media and Physician Education19:58 - Current State of Hormone Therapy22:17 - Broader Implications and Future Directions27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments29:49 - The Impact of Hormone Therapy on Women's Health32:11 - Risks of Not Using Hormones35:44 - Hormones and Brain Health: Debunking Myths40:41 - The Timing Hypothesis and Long-Term Hormone Use46:32 - Advocacy and Education for Menopause Awareness48:04 - Conclusion and Upcoming Resources --- RESOURCES PBS: The M Factor: Shredding the Silence on Menopause:https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/ The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/ Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

Vaginal estrogen is not the enemy. Outdated data is. In this crossover episode of the BackTable Urology and OBGYN podcasts, Dr. Suzette Sutherland and Dr. Yahir Santiago-Lastra delve into the persistent challenges and ongoing advocacy efforts surrounding the FDA's black box warning on vaginal estrogen. --- SYNPOSIS They explore the historical context and far-reaching influence of the 1990s Women’s Health Initiative (WHI) study, asserting that its misinterpretation continues to shape misconceptions and hinder effective menopause care. The discussion highlights recent data refuting the risks associated with vaginal estrogen therapies and underscores the urgent need for updated, evidence-based guidelines to support women throughout menopause. Dr. Santiago-Lastra also draws attention to gender-based inequities in hormone treatment, the robust evidence contradicting the current black box warning, and the multi-faceted advocacy required to bring about change. This episode is part of a broader series focused on various aspects of menopause. --- TIMESTAMPS 00:00 - Introduction02:01 - Menopause Series Overview03:55 - History of the Black Box Warning on Estrogen07:26 - Understanding the Black Box Warning12:11 - The Citizen's Petition and FDA Process18:11 - Gender Inequity in Medical Treatment22:45 - Factors Resulting in Gender Inequity29:02 - Genital Urinary Syndrome of Menopause (GSM)29:32 - Benefits of Vaginal Estrogen33:33 - Legislative Advocacy and Medicare34:43 - Professional and Patient Advocacy36:35 - Challenges and Progress in Label Change43:35 - Historical Context and Gender Equity45:07 - Recap and Future Directions

Step inside the evolving world of fetal therapy where precision, teamwork, and full-spectrum care matter most. In this episode of the BackTable OBGYN Podcast, Dr. Anthony Shanks, Vice Chair of Education in the OB department at Indiana University School of Medicine, interviews Dr. Hiba Mustafa, a distinguished maternal-fetal medicine specialist and fetal interventionalist at Riley Children's Hospital. They discuss Dr. Mustafa's expertise in fetal diagnosis and therapy, her training journey through various fellowships, and her role in directing multiple fetal medicine programs. --- SYNPOSIS Dr. Mustafa elaborates on the intricacies of fetal interventions, including procedures for complications in monochorionic twins, spina bifida repair, and new emerging therapies. They also touch on research methodologies like the Delphi consensus technique and summarize key findings from recent studies on conditions such as hemolytic disease, gastroschisis, lower urinary tract obstructions, and preterm birth in twin pregnancies. Dr. Mustafa shares insights on how to stay sharp in the field, the importance of teamwork in surgical procedures, and advice for those aspiring to enter the field of fetal therapy. --- TIMESTAMPS 00:00 - Introduction02:45 - The Role of a Fetal Interventionalist04:00 - Dr. Mustafa’s Training Journey07:42 - Fetal Surgery Fellowships16:43 - Conditions Treated by Fetal Interventionalists21:17 - Monitoring and Referrals for Monochorionic Twins30:04 - Understanding Percutaneous Procedures31:10 - Navigating the Equator in Fetal Surgery32:31 - Laser Surgery Techniques and Outcomes33:18 - The Importance of Placenta Delivery33:47 - In Utero Spina Bifida Repair36:19 - Minimally Invasive Techniques for Spina Bifida38:28 - Maintaining Skills in Fetal Interventions42:11 - Delphi Consensus Technique in Medical Research46:19 - Key Takeaways from Recent Research51:55 - Future of Fetal Therapy and Personal Insights

Real innovation? It’s not just the tools and techniques you use, it’s how you think. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Kevin Stepp, a MIGS surgeon and urogynecologist in Charlotte, North Carolina, and an OBGYN professor at Wake Forest University School of Medicine. Dr. Stepp shares his journey into the field, including his serendipitous start in single-port laparoscopy and the many surgical innovations that he has pioneered. --- SYNPOSIS The conversation highlights the importance of anatomical knowledge, thinking beyond conventional surgical approaches, and the significance of teamwork and efficiency in the operating room. A central focus is placed on the development and application of single-port techniques, highlighting the associated learning curves and the evolving role of robotic surgery. The discussion also explores how surgical team dynamics, effective communication, and ongoing innovation collectively contribute to better patient outcomes and advancement in the medical field. --- TIMESTAMPS 00:00 - Introduction03:50 - Pioneering Single Port Laparoscopy10:10 - Challenges and Advantages of Single Port Surgery13:52 - Cosmetic Considerations and Incision Techniques27:27 - Innovative Approaches and Future Directions30:40 - Understanding 3D Anatomy in GYN Surgery32:10 - Sustaining Innovation in Urogynecology33:53 - Efficiency in Surgical Procedures39:20 - Advancement of Surgical Educational Materials 42:47 - Single Port and Robotic Procedures50:50 - Building a Team through Positive Surgical Culture01:02:13 - Continuous Improvement and Humility in Surgery

What if surgery isn’t the only answer to pelvic pain? In this episode of the BackTable podcast, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Frank Tu, Vice Chair for Quality at Endeavor Health and Director of the Division of Gynecological Pain and Minimally Invasive Surgery. The episode explores the complexity of chronic pelvic pain, emphasizing its multifactorial origins and individualized treatment approaches.---SYNPOSISDr. Tu shares insights into the persistence and treatment of chronic pelvic pain, the role of trauma, and the evolving understanding of endometriosis and other gynecological conditions. The discussion covers patient treatment modalities, the potential of artificial intelligence in medical diagnostics, and the significant role of non-surgical interventions like physical therapy. Dr. Tu's reflections on interdisciplinary collaborations, preventative approaches, and the future directions of gynecologic pain management provide a comprehensive overview of this complex field.---TIMESTAMPS00:00 - Introduction05:21 - Mentorship and Influences07:01 - Research and Innovations in Pelvic Pain09:21 - Preventative Approaches to Chronic Pain14:15 - Exploring Pain Mechanisms and Treatments26:32 - The Role of Sensory Reintroduction30:20 - The Importance of Mental Health30:49 - Challenges in Treating Chronic Pelvic Pain31:24 - The Role of Surgery and Mental Health in Pain Management34:00 - Barriers to Effective Pelvic Floor Physical Therapy35:40 - The Complexity of Treating Dysmenorrhea44:11 - Exploring Personalized Medicine and AI in Pain Management51:22 - The Future of Pain Management and AI54:25 - The Role of Big Data and AI in Medical Research59:25 - Final Thoughts

Equity is not just a box to check; it is the framework for lasting change. In this week's BackTable podcast, guest host Dr. Veronica Lerner speaks with Dr. Ebony Carter, a high-risk obstetrician and Division Director for Maternal-Fetal Medicine at the University of North Carolina at Chapel Hill. Dr. Carter shares insights into her career journey, which was influenced by her mother's activism in health equity, her work on reproductive health disparities, and community engagement projects. ---SYNPOSISThe conversation underscores the importance of patient participation and agency in clinical decision-making. Dr. Carter and Dr. Lerner also discuss the development of an equity rubric for peer-reviewed journals, highlighting the need for inclusive and intentional research practices. They explore practical applications of the rubric, including the proper acknowledgment of contributors to foundational concepts. The episode further delves into Dr. Carter’s mentorship initiatives at the Green Journal and her guiding philosophy of pursuing impactful, community-driven work rooted in passion and purpose.---TIMESTAMPS00:00 - Introduction02:06 - Dr. Carter's Journey and Inspiration05:19 - Community Engagement and Health Equity06:19 - Patient Advocacy and Shared Decision Making08:54 - Collaborative Research and Community Partnerships16:58 - Addressing Bias in Medical Practice22:12 - Equity in Academic Publishing28:26 - Diversifying the Peer Review Pool30:33 - Creating and Implementing the Equity Rubric31:17 - The Impact and Application of the Equity Rubric33:31 - Personal Reflections on Equity and Research35:25 - Citing Foundational Work38:48 - Mentorship and Training Future Leaders47:05 - Career Transitions and Future Goals52:36 - Final Thoughts and Advice for Aspiring Professionals---RESOURCESFull Equity Rubric:https://journals.lww.com/greenjournal/Documents/OnG_Equity_Rubric_1.pdf ​Equity Rubric Introduction Video:https://youtu.be/Jh5_L-pYkuE?si=JREjSSCr98jqjVVB Equity Rubric Introduction Video Slide Deck:https://journals.lww.com/greenjournal/Documents/Green%20Journal%20Equity%20Rubric%20YouTube_final_2022_01_16%20(Slides).pdf

Curious how cross-specialty teamwork is reshaping endometriosis care? In this episode of BackTable OBGYN, host Dr. Mark Hoffman speaks with Dr. Peter Movilla, Associate Medical Director at Newton Wellesley Hospital, and Dr. Anuradha Shenoy-Bhangle, Assistant Professor of Radiology at Harvard Medical School, about their collaborative efforts in advancing endometriosis care. --- SYNPOSIS The discussion covers the development and benefits of monthly multidisciplinary conferences that include gynecologists, radiologists, colorectal, urologic, and thoracic surgeons. The conferences aim to improve preoperative planning, intraoperative accuracy, and postoperative care through detailed imaging techniques, primarily MRI. They also highlight the importance of educating fellows and colleagues, the role of ultrasound screening, and future directions like AI and PET imaging. The episode emphasizes the challenges and rewards of treating endometriosis and fostering better patient outcomes through teamwork and innovation. --- TIMESTAMPS 00:00 - Introduction 01:55 - The Journey to Specialization 07:02 - Building a Multidisciplinary Team 15:07 - The Value of Postoperative Reviews 22:49 - Patient Counseling and Personalized Care 29:36 - Challenges in Endometriosis Treatment 31:00 - Educating Beyond the Clinic 33:05 - Innovations in Imaging 46:22 - Future Directions in Endometriosis Research 53:15 - Conference Highlights and Final Thoughts --- RESOURCES Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease‑focused panel: https://drive.google.com/file/d/1VRBpw5V3AH-rWGEG43K1CMCx2flCXl2M/view?usp=sharing

When should you consider surgical management of chronic pelvic pain conditions? In this episode of the BackTable OBGYN podcast, Dr. Mark Dassel, a MIGS surgeon at Intermountain Health in Salt Lake City, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss medical and surgical management strategies for chronic pelvic pain, particularly endometriosis. --- SYNPOSIS Dr. Dassel emphasizes the importance of stopping the hormonal triggers associated with pain and explores various medical treatments, including hormonal therapies and the role of contraceptives. He also highlights his approach to surgical interventions such as endometriosis excision, endometrioma removal, and hysterectomy, and the importance of holistic treatment plans involving pelvic floor physical therapy and central pain modulators. The episode also covers the complexities of diagnosing and treating pelvic pain, the role of early intervention, and the value of multidisciplinary care. --- TIMESTAMPS 00:00 - Introduction 07:55 - Differentiating Causes of Chronic Pelvic Pain 10:13 - Multidisciplinary Care and Costs 14:26 - Acute vs Chronic Pain 17:00 - Centralized Pain 18:46 - When to Offer Surgery 23:42 - Fertility and Endometriosis 33:25 - Hormonal Suppression Post-Surgery 37:24 - Pelvic Floor Botox and Physical Therapy 44:42 - Hysterectomy for Pelvic Pain 51:53 - Nerve Ablation and Pain Management 57:10 - Final Thoughts

Endometrial ablation has become a cornerstone procedure in the treatment of abnormal uterine bleeding, but is it the right solution for every patient that meets the indication? In this episode of the BackTable OBGYN Podcast, Dr. Ted Anderson from Vanderbilt University joins host Dr. Mark Hoffman to discuss the evolution of endometrial ablation and its contemporary utilization, including patient selection, technical considerations, and alternative treatments for abnormal uterine bleeding. --- SYNPOSIS Dr. Anderson begins by detailing the history of abnormal uterine bleeding alongside the evolution of the endometrial ablation techniques that have been used to treat it. Shifting focus to current day practice, he then shares his approach to endometrial ablation, covering patient selection and the technical aspects of his approach. Throughout the conversation, Dr. Anderson emphasizes the importance of how we define success in endometrial ablation, explaining that eumenorrhea (normal bleeding that no longer interferes with life events) is the goal, as opposed to the more traditional view that amenorrhea is the target outcome. The episode closes with a discussion on the role of alternative treatments, such as the Mirena IUD and hysterectomy for abnormal uterine bleeding. --- TIMESTAMPS 00:00 - Introduction 09:29 - History of Abnormal Uterine Bleeding and Endometrial Ablation 23:31 - Evolution of Endometrial Ablation Devices/Techniques 31:11 - Selecting the Right Patient for Ablation Success 34:38 - Post-Tubal Sterilization Ablation Syndrome 38:27 - The Role of IUDs in Managing AUB 44:07 - Reevaluating Endometrial Ablation Success Metrics 49:55 - Innovative Ablation Techniques: Cryoablation and Steam 51:48 - Adenomyosis and Fertility-Sparing Treatments 57:28 - Final Thoughts