Clinical Focus

  • Internal Medicine

Professional Education

  • Fellowship:Palo Alto VA Healthcare SystemCA
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2013)
  • Residency:Stanford University Hospital -Clinical Excellence Research Center (2013) CA
  • Doctor of Medicine, University of California San Francisco (2010)
  • Bachelor of Arts, Harvard University (2004)
  • Medical Education:Univ of California San Francisco (2010) CA

Stanford Advisors


All Publications

  • A National study of burdensome health care costs among non-elderly Americans BMC HEALTH SERVICES RESEARCH Richman, I. B., Brodie, M. 2014; 14
  • European genetic ancestry is associated with a decreased risk of lupus nephritis ARTHRITIS AND RHEUMATISM Richman, I. B., Taylor, K. E., Chung, S. A., Trupin, L., Petri, M., Yelin, E., Graham, R. R., Lee, A., Behrens, T. W., Gregersen, P. K., Seldin, M. F., Criswell, L. A. 2012; 64 (10): 3374-3382


    African Americans, East Asians, and Hispanics with systemic lupus erythematosus (SLE) are more likely to develop renal disease than are SLE patients of European descent. This study was undertaken to investigate whether European genetic ancestry protects against the development of lupus nephritis, with the aim of exploring the genetic and socioeconomic factors that might explain this effect.This was a cross-sectional study of SLE patients from a multiethnic case collection. Participants were genotyped for 126 single-nucleotide polymorphisms (SNPs) informative for ancestry. A subset of participants was also genotyped for 80 SNPs in 14 candidate genes for renal disease in SLE. Logistic regression was used to test the association between European ancestry and renal disease. Analyses were adjusted for continental ancestries, socioeconomic status (SES), and candidate genes.Participants (n = 1,906) had, on average, 62.4% European, 15.8% African, 11.5% East Asian, 6.5% Amerindian, and 3.8% South Asian ancestry. Among the participants, 656 (34%) had renal disease. A 10% increase in the proportion of European ancestry estimated in each participant was associated with a 15% reduction in the odds of having renal disease, after adjustment for disease duration and sex (odds ratio 0.85, 95% confidence interval 0.82-0.87; P = 1.9 × 10(-30) ). Adjustment for other genetic ancestries, measures of SES, or SNPs in the genes most associated with renal disease (IRF5 [rs4728142], BLK [rs2736340], STAT4 [rs3024912], and HLA-DRB1*0301 and DRB1*1501) did not substantively alter this relationship.European ancestry is protective against the development of renal disease in SLE, an effect that is independent of other genetic ancestries, candidate risk alleles, and socioeconomic factors.

    View details for DOI 10.1002/art.34567

    View details for Web of Science ID 000309403000035

    View details for PubMedID 23023776

  • European population substructure correlates with systemic lupus erythematosus endophenotypes in North Americans of European descent GENES AND IMMUNITY Richman, I. B., Chung, S. A., Taylor, K. E., Kosoy, R., Tian, C., Ortmann, W. A., Nititham, J., Lee, A. T., Rutman, S., Petri, M., Manzi, S., Behrens, T. W., Gregersen, P. K., Seldin, M. F., Criswell, L. A. 2010; 11 (6): 515-521


    Previous work has demonstrated that Northern and Southern European ancestries are associated with specific systemic lupus erythematosus (SLE) manifestations. In this study, 1855 SLE cases of European descent were genotyped for 4965 single-nucleotide polymorphisms and principal components analysis of genotype information was used to define population substructure. The first principal component (PC1) distinguished Northern from Southern European ancestry, PC2 differentiated Eastern from Western European ancestry and PC3 delineated Ashkenazi Jewish ancestry. Compared with Northern European ancestry, Southern European ancestry was associated with autoantibody production (odds ratio (OR)=1.40, 95% confidence interval (CI) 1.07-1.83) and renal involvement (OR 1.41, 95% CI 1.06-1.87), and was protective for discoid rash (OR=0.51, 95% CI 0.32-0.82) and photosensitivity (OR=0.74, 95% CI 0.56-0.97). Both serositis (OR=1.46, 95% CI 1.12-1.89) and autoantibody production (OR=1.38, 95% CI 1.06-1.80) were associated with Western compared to Eastern European ancestry. Ashkenazi Jewish ancestry was protective against neurologic manifestations of SLE (OR=0.62, 95% CI 0.40-0.94). Homogeneous clusters of cases defined by multiple PCs demonstrated stronger phenotypic associations. Genetic ancestry may contribute to the development of SLE endophenotypes and should be accounted for in genetic studies of disease characteristics.

    View details for DOI 10.1038/gene.2009.80

    View details for Web of Science ID 000281563400009

    View details for PubMedID 19847193

  • Assessment of Ultrasound for Use in Detecting Lipoatrophy in HIV-Infected Patients Taking Combination Antiretroviral Therapy AIDS PATIENT CARE AND STDS Viskovic, K., Richman, I., Klasnic, K., Hernandez, A., Krolo, I., Rutherford, G. W., Romih, V., Begovac, J. 2009; 23 (2): 79-84


    The aim of this study was evaluation of ultrasound (US) as a tool for the assessment of lipoatrophy in a population of HIV-infected patients. We enrolled a convenience sample of 151 HIV-infected Caucasian participants (males, 79%) who were treated for at least 1 year with combination antiretroviral therapy (CART) in Zagreb, Croatia. US measurements of subcutaneous fat thickness were done over the malar, brachial, and crural region. We determined sensitivity and specificity of US as a diagnostic tool for lipoatrophy using receiver-operating curves and concordant patient and clinician assessment as our reference for the presence of lipoatrophy. HIV was acquired through heterosexual contact in 50% of participants and by sex between men in 42%. The mean current CD4 cell count was 503.1 cells=mm3 (standard deviation [SD] = 250.8). Seventy-seven (51%) participants were treated with stavudine and 91 (64%) with a protease inhibitor for at least 6 months. Nineteen (13%)participants had lipoatrophy in at least one anatomic site. Sensitivity of US ranged from 67%-71%, specificity from 65%-71%, positive and negative predictive values ranged from 11%-20% and 96-97%, respectively. US diagnosed lipoatrophy was more frequently found in patients with a history of stavudine treatment and in females. Patients with lipoatrophy had a longer duration of CART than those without lipoatrophy. US is a useful tool in ruling out the presence of clinical lipoatrophy in patients on CART. Using this objective measure of subcutaneous fat may be useful in helping clinicians make decisions about changing therapy.

    View details for DOI 10.1089/apc.2008.0118

    View details for Web of Science ID 000263586500003

    View details for PubMedID 19133752

  • National study of the relation of primary care shortages to emergency department utilization ACADEMIC EMERGENCY MEDICINE Richman, I. B., Clark, S., Sullivan, A. F., Camargo, C. A. 2007; 14 (3): 279-282


    Emergency department (ED) visit volumes are increasing nationwide.To determine whether states with primary care shortages have higher rates of ED use.Populations residing in primary care shortage areas were abstracted from the Health Resources and Services Administration Geospatial Database. Annual ED visit volumes were available from the 2001 National ED Inventory. Population data and potential confounders were abstracted from federal data sets. All analyses were conducted at the state level.Primary care shortage densities varied greatly across states, ranging from 3 (New Jersey) to 28 (Mississippi) medically underserved individuals per 100 people. States also varied in their annual ED visit densities, ranging from 23 visits (Hawaii) to 65 visits (Washington, DC) per 100 people. Of the 17 states in the top tertile for primary care shortage, 7 also were in the top tertile for ED visits. Primary care shortage density was positively associated with ED visit density. An increase of 10 medically underserved individuals per 100 people was associated with an annual increase of 4.2 ED visits per 100 people (p = 0.04). The association remained after controlling for six factors, with an increase of 10 medically underserved individuals per 100 people associated with an annual increase of 3.3 ED visits per 100 people (p = 0.04). Nevertheless, five states had high ED visit densities despite comparatively low primary care shortage densities (Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), whereas five others had low ED visit densities despite high primary care shortage densities (Arizona, Idaho, Montana, New Mexico, and South Dakota).A positive association between primary care shortage densities and ED visit densities was found. Although most states adhere to this pattern, some states do not. Further investigation of this dissociation may yield additional explanations for rising ED visit volumes.

    View details for DOI 10.1197/j.aem.2006.10.093

    View details for Web of Science ID 000244635400017

    View details for PubMedID 17242383

  • A profile of US emergency departments in 2001 ANNALS OF EMERGENCY MEDICINE Sullivan, A. F., Richman, I. B., Ahn, C. J., Auerbach, B. S., Pallin, D. J., Schafermeyer, R. W., Clark, S., Camargo, C. A. 2006; 48 (6): 694-701


    Emergency departments (EDs) provide round-the-clock emergency care but also serve as a health care "safety net." We seek to determine the number, distribution, and characteristics of US EDs, with a long-term goal of improving access to emergency care.We created an inventory of nonfederal nonspecialty US hospitals using 2001 data from 2 independent sources. Hospitals that did not report ED visit data, or with large changes in visit volume by 2003, were contacted to obtain or verify visit volume (n=437; 9% of all hospitals). EDs were divided into 2 groups: those with at least 1 patient per hour, 24 hours per day, 7 days per week (> or = 8,760 visits/year) and those with fewer visits.Of 4,917 hospitals, 4,862 (99%) reported an ED. These EDs collectively received 101.6 million visits. One in 3 EDs (n=1,535) received less than 8,760 visits per year; the national median was 15,711 visits per year. Excluding the low-volume EDs, the remaining 3,327 reported 95.2 million annual visits. The typical higher-volume ED received approximately 28,000 visits per year; 28% (n=922) were in a nonurban setting. Among all EDs, per-capita visits varied by state, with the highest ED visit rates in Washington, DC; West Virginia; and Mississippi.Significant variation exists in the distribution and use of US EDs. One third of EDs have an annual visit volume less than 8,760 and, together, they account for 6% of all visits. The United States should consider classifying EDs, as it does trauma centers, to clarify the type of care available in this heterogeneous clinical setting and the distribution of different types of EDs.

    View details for DOI 10.1016/j.annemergmed.2006.08.020

    View details for Web of Science ID 000242310700008

    View details for PubMedID 17067721

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