Artificial Intelligence: Best Practices in Primary Care to Achieve the Quintuple Aim (Toub, 5/28/25)

 A recording of this presentation is available HERE.

Pathologizing Queer Patients (Harlow, 5/14/2025)

 A recording of this presentation is available HERE.

Care of Patients with Developmental Disabilities (French, 5/7/25)

 A recording of this presentation is available HERE.

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Many, many thanks to Dr. Anne French, SRFMR Class of '99, who gave a pearl-filled presentation today about caring for patients with autism. Dr. French's many years of caring for patients with Intellectual and Developmental Disabilities (IDD) at Sonoma Developmental Center and now at Santa Rosa Community Health are literally priceless. We are so lucky to have her wisdom!

Please do watch her presentation. 

For those of you who prefer the Cliff's notes and pearls:

• always presume confidence when speaking with an autistic patient (even if non-verbal), speak as if they understand (they often do!)
• autism is often accompanied by other psych comorbidities, including anxiety disorders: GAD, OCD, and disordered sleep -- to name a few-- which impede function at school and work
• other psychiatric comorbidities also exist, including bipolar disorder and ADHD. These may be challenging to tease out
• look for anxiety
• consider GABA, fish oil, probiotics (for parents who don't want to use meds)
• r/o ADHD w/Vanderbilt
• okay to do trial of meds like Strattera without psychiatrist consult
• when you see self-injurious behavior (SIB), think physical discomfort (e.g. allergies, headaches)-- naltrexone can be a miraculous treatment for some with SIB (doesn't always work, but blocks the reward pathway for SIB)
• Dr. French highly recommends the use of Gene Sight, which is covered by both Medicare and Medi-Cal. It is intended to help prescribers understand how individuals process psych meds differently
• can help avoid medications that will have problematic effects
• gives MTHFR status (folate), which can be supplemented. Of note,  patients with autism tend to have decreased folate
• Physicians can only refer autism evaluation to the Northbay Regional Center before age 3, but parents can self refer after that. Give parents the phone number and email address of NBRC if they need to self-refer.
• Dr. MacLeamy is a clinical psychologist in Petaluma. He and associates have the PHP contract to diagnose autism in SoCo
• Applied behavioral analysis (ABA) Therapy, parents can self-refer, certified behavioralists can help treat at home/school (e.g. getting autistic kids to take shower, brush teeth, manage school day)>> many people with autism need extra support to reach their milestones
• Always look for physical causes of agitation (e.g. allergies, dental pain, constipation)
• Social stories is a simple way to teach people with autism, about social situations and expected behaviors (e.g. this is what happens when you go to the doctor, airport, pap smear, etc)
• Use EMLA cream for lab draws
• Medications that help with dysregulation include propranolol, clonidine, guanfacine, May be helpful.
• Disordered sleep should be treated. Extra challenging in children (limited options). Consider melatonin, 5HTP, Consider Buspar (age >6).
• Parents can get defensive and feel othered by the healthcare system. Building relationship and trust with them is key!
• Polypharmacy is a HUGE problem, particularly notable is multiple antipsychotics in boys/men with autism during and after puberty.
• Deprescribe antipsychotics when possible>> start with highest risk meds, if 2 of something, take one away
• Oversedation may occur with age
• Falls and/or ataxia can also be an issue with polypharmacy as patients with IDD age

Gene Sight report