What goes into decision making? What are the invisible tugs that may keep patients from acting in line with their values? Why isn't it part of the formal capacity assessment? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/07/22/capacity-2-0-and-voluntarism/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: 2:57 Defining voluntarism 5:36 Four elements that influence voluntarism 10:26 How do you incorporate voluntarism into the capacity assessment? 16:11 Discussions with uncooperative patients 19:14 Protecting unrepresented patients 21:30 Clinician perspective 25:06 Moral distress Tags: medical humanities, ethics, psychiatry, IM Core, CoreIMFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Unpack a famous historical legend's medical dilemma on a special "Historical CPC" episode! Show notes, transcript and references: https://www.coreimpodcast.com/2020/07/08/22729/ Time Stamps: 02:55 HPI 07:33 Past Medical History 04:25 Physician Exam findings 24:22 Historical Figure Revealed 26:30 Reflections on top 3 diagnosis Tags: cognitive and neuropsychiatric disturbances, rabies, mercury poisoning, cholera, delirium, COREIM, IMCORE, clinical reasoning caseFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Packed with so many clinically relevant points taking care of a patient with decompensated heart failure on general medicine floors! Time Stamps: 03:17 What are the key initial clinical variables in evaluating heart failure admissions? 10:09 What are key lab findings for patients with heart failure exacerbation? 17:14 Which guideline-directed medical therapy, and in what circumstances? 22:12 What are diuretics dosing strategies and monitoring tips to help guide initial volume removal? 28:43 What role do thiazides and ultrafiltration play in diuresis, why does diuretic-induced metabolic alkalosis happen and what should you do about it? 38:09 Expert Recap Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/24/5-pearls-on-inpatient-heart-failure/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im   Tag: Cardiology, BNP, cardiorenal syndrome, beta-blockers, CoreIM, IMCoreFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

SNF vs. NH? SAR vs. SNF? What are the differences in resources, nursing and clinician oversight and who pays for what?! Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/10/snf-sar-nh-alf-and-more-discharge-options-interprofessional-education-series/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps: 04:07 SAR vs SNF 13:35 Long term Nursing Home Care 18:30 Assisted Living Facility 24:40 Acute rehab 26:11 LTACH 27:49 Home Tags: Subacute rehab, skilled nursing facility, long-term acute care hospital, CoreIM, Core_IM, hospital medicine, family medicine, emergency medicine, physician assistant, nurse practitioner, interprofessional educationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let's dive deeper into the dogma of salt restriction in heart failure! Show notes, transcript and references: https://www.coreimpodcast.com/2020/05/20/salt-restriction-in-heart-failure-mind-the-gap-segment/ Get CME-MOC credit with ACP! Time Stamp 01:37 Sodium restriction guidelines 07:13 Current data in outpatient data 11:32 Do inpatient studies show signal? 13:44 Physiology behind sodium balance 16:27 Take away and clinical applicability Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you navigate new challenges with goals of care with your patients in clinics? Show Notes, Transcript, References: https://www.coreimpodcast.com/2020/05/06/outpatient-advanced-care-planning-during-covid-19/ Time Stamps 01:32 COVID Crisis as an Outpatient and Advance Care Planning (ACP) 08:06 The virtual visit 12:44 Vital Talk Mnemonic:  “CALMER” 22:03 Challenges to Outpatient COVID Care 26:03 Parting Thoughts Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Episode Outline Disconnection/connection: Patients Disconnection/connection: Family/friends Disconnection: Security, Certainty Connection: Other clinicians Sharing fears, supporting each other) Shared ethos in healthcare (one workforce, no division of specialty or hierarchy) Conclusion: Post-traumatic growth / Peri-Traumatic Growth Thank you to everyone we interviewed, particularly to the voices you heard: Dr. Kimberly Manning (@gradydoctor) Dr. John Hwang (Hoofbeats segment) Dr. Steve Liu (Mind the Gap segment) Dr Katherine Arthur Dr. Maria Garcia-Jimenez Dr. Kelsey Luoma Hosts: Dr. Margot Hedlin (@MargotHedlin) - Introduction and Ending Dr. Tamar Schiff Dr. Michael Shen (also audio editing) Dr. Jafar Al-Mondhiry (@mondhiry)   tags: COVID19, COVID-19, CoreIM, coronavirus, narrative medicineFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is your approach to goals of care conversations, particularly during COVID-19? How do you navigate some of the new challenges with COVID19? Show notes, transcript and references: https://www.coreimpodcast.com/2020/04/22/goc-on-inpatient-service-during-covid-19/ Time stamps: 05:54 Laying the groundwork 08:56 Asking permission, eliciting values and making a recommendation 15:55 When a patient is dying 16:42 Sharing the prognosis first 20:28 Functional status post-CPR 21:52 Headline statement 23:40 Virtual and PPE Communication Challenges 25:28 Separate process from outcome Tag: coronavirus, COVID, CoreIM, Sars-cov-2, medicine floors, wards, advanced care planningFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you organize your day? How do you minimize exposure of yourself and your colleagues? What are the new things to keep in mind with discharging patients? Show notes, transcripts and references: CME Credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps 02:37 Entrance and Exit strategy 04:25 Prioritizing patient acuity 08:14 PPE uses 11:11 Respiratory concerns in COVID-19 patients 16:35 Patient examination 18:49 Family updates 20:56 Oxygen requirements 23:12 Medications 24:08 Discharging patients 31:00 What we mean by isolation tag: coronavirus, COVID, CoreIM, sars-cov-2, medicine wardsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Practical tips on starting estrogen or testosterone on patients who are transgender and approach to primary care with cancer screening. CME Credit with ACP; https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Show notes, transcripts, and references: https://www.coreimpodcast.com/2020/04/01/5-pearls-on-transgender-health-hormone-therapy-and-preventive-screening/ Time Stamps: 02:54 Hormone therapy contraindications 07:09 Time course for hormone changes 10:21 Hormone risks 19:09 Hormone treatment options 25:22 Preventative Care Screening Tags: CoreIM, gender affirming careFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Practical tips on Gender Affirming Care! Show notes, transcript and references Time Stamps: 02:43 The Gender Unicorn and how it helps us better understand gender identity,  expression, and sex assigned at birth 11:15 Gender dysphoria 14:16 The organ or anatomical inventory 16:46 The inevitability of mistakes 18:39 Ways to ensure gender-affirming care in clinic  Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What goes into a capacity assessments? Is it just reciting risks, benefits and alternatives? Explore this and more on this At the Bedside Episode! Show notes, Transcript and References: https://www.coreimpodcast.com/?p=22310 Time Stamps: 2:04 Introduction to decision making 4:12 Choice 8:24 Understanding 11:22 Appreciation 13:58 Reasoning 21:55 Common myths and misconceptions 25:11 When and how to call a psychiatry consult for capacity assessment 27:47 Conclusion Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humantiesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the new guidelines for influenza treatment? What are the diagnostic ratios of flu symptoms and tests? Time Stamps 03:10 The art of diagnosing the flu 05:17 Bayesian statistics and the diagnostic odds ratio 07:09 The ins and outs of diagnostic testing for the flu 08:44 Changes in influenza guidelines - testing and treatment 11:17 The not-so-rosy origin story of neuraminidase inhibitors (NAIs) 13:47 Neuraminidase inhibitors (NAIs), mortality benefit and limitations of studies 15:49Take aways Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is the difference between a case manager and social worker? What are the limitations that social workers and case managers face? How do you create a safe space for the interdisciplinary team? Show Notes and References Get CME-MOC credit with ACP! Time Stamps: 03:54 What are the various roles within a multidisciplinary teams? 10:42 Understanding limitations of social workers and case managers 15:55 The “behind the scenes” paperwork 18:42 Insurance and medications 22:17 Insurance and disposition options 25:08 The importance of creating a safe space for better communication Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the symptoms? What distinguishes coronavirus from other influenza-like illness? When coronavirus is suspected, what should you do? Show notes and references CME credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im ACP Interactive Learning Module Time Stamps 01:30 Novel parts of coronavirus 03:00 What symptoms do patients present with for the novel coronavirus? 04:22 What distinguishes coronavirus from other influenza-like illness? 05:31 When coronavirus is suspected, what should you do? 07:13 What does testing for coronavirus entail? 09:06 What kind of isolation is required? 10:13 Do patients need to be isolated in biocontainment units? 10:42 What is treatment for the novel coronavirus? 12:30 Potential for vaccines 15:23 What is R0? 17:12 Animal reservoirs with 2019-nCoV, SARS, and MERS 19:18 What should we tell patients for prevention? Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you learn from diagnostic errors? Walk through a case that the host had initially gotten wrong and uncover possible reasons as why from data gathering to hypothesis generation to the interplay between hypothesis generation and evaluation. Learn interesting tidbits on prior work in medical education around how we think, particularly around diagnostic failures. CME Credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps 02:39 Case Introduction 04:46 Yes/No questions with our first two discussants 18:43 The diagnosis is revealed 21:14 Why did I miss the diagnosis? 27:44 Using diagnostic problem solving to break down the case and understand our errors 30:20 The importance of data gathering 30:49 Introducing our third clinician 34:17 Hypothesis generation 37:11 The interplay between hypothesis generation and evaluation 38:34 The win-stay, lose-shift heuristic 41:33 Cognitive forcing strategies 49:32 Knowledge vs. experience Tags: Dermatology, rash, DRESS, AGEP, varicella Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Why is prognostication hard? How do we improve at communicating prognosis? How should we approach uncertainty? Explore this and more on this At the Bedside episode! Prognosis Calculators, Transcript and References Time Stamps 02:48 What is prognosis? 04:00 Why offer prognostication? 08:32 Why is prognostication hard? 16:41 How do we improve at communicating prognosis? 21:56 How should we approach uncertainty? 31:06 Take Aways Tag: life expectancy, CoreIMFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dive deeper into hx of the influenza virus, how vaccines are made and vaccine effectiveness ! Time Stamps   02:59 The history of the influenza virus 08:18 What does the influenza vaccine target? 13:20 Chickens, and bugs, and mammalian cells, oh my! How the vaccine is made. 14:00 What to do about egg allergies. 15:53 Vaccine effectiveness and herd immunity. 17:43 Waning immunity and other debates Show Notes, Transcript and References Get CME-MOC credit with ACP!Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Explore gaps in your knowledge about the home health world, particularly on home health aides! Get CME-MOC credit with ACP ! Full transcript, show notes, references Time Stamps: 02:33 What support do our patients have at home and how does those people play a role in their care? 06:00 Are there various types of home care workers? 07:25 What role do home attendants play in caring for a patient? 08:31 What tasks do home health aides do? 10:11 What are the types of "skilled carez'? 13:17 What can Medicare cover for older adults in terms of home health aides? 15:17 How does Medicare define homebound? 16:03 How does having Medicaid impact access to home care? 19:10 What if a patient isn’t eligible for Medicare or Medicaid? 19:43 What is the cost to use a private agency for home health services? 24:02 What are some challenges that home health aides face? 25:42 What are “plans of care”? 30:01 Who makes up the home care workforce? 31:52 When patients get discharged from the hospital, do they go home to the same home care assistance?Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

  Get CME Credit with ACP! Full Transcript with references and show notes Time Stamps 4:30 What is the daily risk of thrombosis if HIT Is left untreated? 5:40 What happens during platelet activation? 07:11 How long does it take for patients to develop for IgG antibodies to Heparin to form? 09:52 Is HIT common? 10:28 Who is at higher risk for HIT? 11:48 Why does low molecular weight heparin have a lower risk for HIT than unfractionated heparin? 15:30 Approach to thrombocytopenia 17:44 How do medications cause thrombocytopenia? 18:38 With medications, what is the time course between medication initiation and thrombocytopenia? 22:20 What is the sensitivity and specificity of anti-PF4 antibody? 23:58 How does the serotonin-release assay (SRA) work? 29:10 What type of anticoagulant do you choose for treating HIT? 31:58 Why is it important to not use warfarin in patients with platelet counts <150,000? 33:32 What is the treatment duration for a patient has confirmed HIT? 36:29 Dr. Cuker’s story and the "Scarlet H" 39:07 Dr. Linkin’s Recap 42:25 Dr. Linkin’s story 44:37 Pearl 5: Throwback to coronary calcium scores    Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

House of God author, Samuel Shem and Prof Katharine Watson share thought-provoking takes on Gallows Humor. Laugh and listen to this captivating take on the different shades of humor in the day-to-day of medicine. Time Stamps 02:33 Episode preview and Guest Introductions 04:20 Definition of Gallows Humor 07:25 Gallows Humor by Comedians vs Patients vs Physicians The Good 08:15 Benefits/Functions of Humor in General 11:10  Connection 13:07 Coping/Catharsis 16:22 Resistance Against Oppression 19:03 Humor as our Authenticity/Humanity The Bad, The Ugly 21:01 Unintended Audiences (e.g., patients, families) 25:30 “Corporeal” Joking 28:00 Toxic Role Modeling 31:10 Desensitization/Losing Empathy Tips, Takeaways & Conclusion33:48 Challenging Inappropriate Jokes 35:45 Excessive Gallows Humor:  Signal of Distress? 37:17 Using Gallows Humor: Questions to Ask Yourself 38:40 Keeping the Faith! 41:11 Excerpt from Man’s 4th Best Hospital by Samuel Shem Transcript and References Tag: medical humanities, medical ethics, CoreIM, IMCoreFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

1st outpatient clinical reasoning case on Core IM Hoofbeats! Get CME-MOC Credit (live at 9AM EST on 10/16) Time Stamps 01:18 Case introduction 11:40 The Casablanca strategy 23:17 The diagnosis revealed 25:30 Logical fallacy: Denying the antecedent 33:22 Components of illness scripts 41:37 Conclusion Show notes, transcripts and references! Do you have a good case or an expert you would like to suggest for an episode? Send it our way at [email protected] Tag: normocytic anemia, splenomegaly, CoreIM, endocarditis, clinic caseFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Go deeper into the world of blood cultures! Time stamps 04:10 Review of Choosing Wisely Guidelines 05:55 What are estimated incidences of positive blood cultures? 06:17 Which clinical signs or patient history is more likely to have positive blood cultures? 09:48 What is the estimated incidence of false positive blood cultures? 11:01 What infections more likely to have bacteremia? 13:50 How do positive blood cultures impact patient outcomes and the use of resources? Show notes, transcript, and references   Tags: Infectious disease, CoreIM, pyelonephritis, cellulitis, community acquired pneumonia        Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Practical tips on smoking cessation! Get CME Credit with ACP! Full Transcript with References and Show Notes Time Stamps 04:50 What questions are important to ask after a patient who contemplative about quitting tobacco? 07:00 Is quitting abruptly on a quit date or gradual cessation to a quit date better? 08:10 How can technology help support patients who are trying to quit? 08:49 How should we prepare patients who quit smoking and are worried about weight gain? 11:06 How can we try to convince patients to use medication as assistance to quit smoking? 11:50 What is the most effective nicotine replacement approach? 13:54 What are the potential side effects of the nicotine patch? 15:00 What should we prescribe for patients who smoke <5 cigarettes a day? 16:28 How can we determine how severe a patient’s nicotine dependence is? 18:26 When is the ideal frequency of nicotine gum or lozenge? 21:45 How does varenicline work? 25:05 Can you start varenicline in patients who have had psychiatric history? 27:15 What major side effect is seen in patients taking bupropion? 29:15 How do e-cigarettes work? 31:18 How should we approach adding e-cigarettes into a patient’s plan for quitting? 31:42 How should we discuss e-cigarette use with our patients? 33:47 Recap 39:54 Screening for Barrett’s Esophagus  Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Do we have to sign the AMA form? Do insurances deny payment for patients who leave AMA? What is your approach to AMA discharges? Core IM At the Bedside speaks to ethics researcher, Dr. David Alfandre, author of Things We Do For No Reason: Against Medical Advice Discharges Show Notes, Full Transcript and References Time Stamps 3:03 Demographics of AMA discharges 5:59 Clinician/System related factors of AMA discharges 10:30 Strategies for mitigating AMA Discharges 15:59 Do we have to make patients sign the AMA form? 18:27 Do insurances deny payment for patients who leave AMA? 23:09 Take Away Points Tags: shared-decision making, harm reductionFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

We hope these stories can make us more introspective and open minded on how these concepts can affect each one of us differently. Let's continue the discussion on the Women in Medicine Twitter chat on 8/25 at 9pm EST ! Full Transcript and Show Notes Time Stamps 2:07 Introduction to one woman’s journey 3:00  Stereotype Threat 6:15 Not all Anger is Created Equal 10:17 Asking and Writing Your Own Job Description 13:08 Imposter Syndrome 15:50 Breaking Points to Self Care 18:50 Work Life Integration 21:40 Support Networks Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

20 Qs with Core IM Team vs. Expert Discussant ! Full Transcript and Show notes Get CME-MOC Credit for listening to this episode (live at 09:00 am EST on 8/7) Time Stamps 00:20 The game of medical Twenty Questions 04:37 Case introduction 05:50 The CoreIM team attempts to solve the case 15:36 The discussant’s diagnostic schema for abnormal bleeding 23:37 Primary versus secondary hemostasis 30:33 The pathology report ! 37:38 Criteria for the final diagnosis 38:46 Dissecting a diagnostic coup 49:42 Conclusion Do you have a good case or an expert you would like to suggest for an episode? Send it our way at [email protected] Tags: Coagulopathy, Bleeding Disorder, Diagnostic Schema, Von Willebrand's Disease, Clinical ReasoningFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Night and Day… join us for part II of our exploration into why we prescribe medications in the morning vs. at night, featuring statins! 03:28 How do statins and cholesterol synthesis work again, anyway? 04:00 Power in numbers - what do the meta-analyses say about timing of statins? 04:40 The long and short of it - how half-life may dictate when to take your statin. 07:35 Effect magnitude - does medication timing actually really impact patient outcomes? 10:30 Practical matters - so what should we tell patients? 11:05 Review of teaching points Show notes, transcripts and referencesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Coronary calcium scores and Coronary CTAs! ACP members can claim CME-MOC Credit ! Quiz yourself on the 5 pearls we will be covering below: 3:10 What are the big picture differences of functional stress tests and anatomical cardiac tests? 7:48 What is the role of coronary artery calcium scores in managing coronary artery disease (CAD)? 16:20 How do coronary CTAs compare to stress tests? 24:28 When should we avoid CTA? 29:33 How do we communicate coronary CTA results with patients? 36:02 Recap Full transcript, infographics and show notes ! Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In ‘At The Bedside’, our newest podcast segment, we tackle important topics that *aren’t* easily indexable in guidelines and UpToDate article –  topics that are better discussed…well…at the bedside. Our first episode examines the all-too-common trope of the ‘difficult’ patient. 01:13      Introduction 05:27      Question 1: What makes a patient difficult for you? 13:22      Question 2: What is a “good outcome” when working with difficult patients? 23:05      Question 3: What have you learned from your difficult patients? 31:56      Conclusion Show notes, Transcript, Further ReadingFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Transitions can be hard. Laugh, commiserate and be inspired by these July stories in medicine! Very big thank you to everyone who told their stories ! Let's help each other feel a little less alone in the struggle, be more understanding and compassionate or laugh at ourselves. Please share this episode with colleagues.  Do you have a July story? Email us at [email protected]. Lets continue conversation over social media. Which stories moved you? Which July stories can you relate to? Tweet us, find us on instagram at coreimpodcast or Facebook. Good luck this coming July !Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect clinical reasoning and dive deeper into an interesting case! 02:04     Initial Presentation 03:03     The Core IM team tackles the case 09:30     Social History 16:05     Physical Exam 22:47     An exercise in Bayesian inference 36:35     Pre-mortem 43:37     Revealing the diagnosis 48:57     How do we define diagnostic success? Full transcript with references and show notes Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dive deeper into why we prescribe medications in the morning vs. at night ! Why do we dose warfarin at night? (2:45) Back to the basics - what are the pharmacodynamics of warfarin and how does vitamin K intake matter? (4:28) Practical matters - so what should we tell patients (6:14) Dippers and non-dippers - what happens to blood pressure (BP) at night? (9:32) The surprising link between dipping and cardiovascular outcomes (11:15) Timing is everything… or is it? The evidence behind taking BP meds at night (11:58) Review of teaching points (15:58) What is your prescribing practice with blood pressure medications? Leave a comment, tweet us or share with us on instagram or facebook on how you dose BP meds? Transcript with references and show notesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on stress tests! Quiz yourself on the 5 pearls we will be covering: What are the indications for a stress test? (2:18) How to choose  stress protocol in a stress test? (8:29) How to choose diagnostic modality in a stress test? (14:46) How do we interpret results from stress tests, and how should this be communicated to patients? (24:08) Pearl Recap (31:13) Risk of contrast induced nephropathy between arterial and venous contrast load (36:02) For full transcript, infographic and show notes: https://www.coreimpodcast.com/2019/04/24/stress-testing/   Tags: Internal Medicine, Internist, Primary Care Physician, Hospitalists, Emergency Medicine, Nurse Practitioner, Physician Assistant, Family Physician, CardiologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect 3 interesting cases and improve your clinical reasoning skills! Time Stamps: New features in this episode [0:30] Case one: 66M w RUQ pain [1:09] Case two: 41M w Afib in RVR [9:26] Case three: 50M w Syncope [14:33] Reveal [19:57] Retrieving illness scripts [22:29] Typical versus Atypical presentation of diseases [26:12] For full transcript and show notes: https://www.coreimpodcast.com/?p=21028 Tag: medical education, clinical cases, expert clinicians, internal medicine podcastFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Check out part 1: Acute Coronary Syndrome and TIMI Risk Score Lets go deeper into 1) How the chest pain history correlates with pathophysiology? [2:40] 2) How has high-sensitivity troponin changed the way we think about unstable angina? [7:34] For transcript, infographic and show notes: https://www.coreimpodcast.com/2019/03/27/unstable-angina/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on inpatient pain management! Quiz yourself on the 5 pearls we will be covering: How effective are non-opioids? ( 3:17) Are NSAIDs contraindicated in patients with kidney, liver or heart disease? If not, how can we use them safely? (10:51) What are the best practices for patients who require opioid analgesia? (19:00) When prescribing opioids at discharge what can we do to minimize harm? (25:02) Throwback to mechanism of acetaminophen and NSAIDs (27:14) How do we believe tylenol works and how does that compare to NSAIDS? (28:27) For full transcript of the audio and show notes: https://www.coreimpodcast.com/2019/03/13/5-pearls-on-pain-management/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let's go deeper into the world of ACS and the origin of the TIMI score and major adverse cardiac events "MACE" outcomes! The basics – what is acute coronary syndrome? (4:08) Clinical context matters – angina pectoris, atypical chest pain, and troponins (5:22) You can’t just “cath” everyone – risk stratification to identify patients with high mortality risk (9:42) TIMI isn’t perfect – the issues with the score and MACE outcomes (14:00) Review of teaching points (17:58) For full transcript and show notes: https://www.coreimpodcast.com/2019/02/27/acute-coronary-syndrome-acs-and-the-timi-score/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and improve your clinical reasoning skills! Time Stamps: New features in this episode [00:25] Data point 1: Early hypothesis generation? [03:20] Data point 2: Pertinent negatives? [11:18] Data point 3: Representativeness heuristic over-represented in medical education? [13:28] Data point 4: Economical hypothesis generation by expert clinicians [19:20] Data point 5: Diagnosing diagnostic error [22:10] Data point 6: Moving toward a final diagnosis [27:11] Case resolution [29:50] For full transcript and show notes: https://www.coreimpodcast.com/2019/02/13/hoofbeats-47m-with-chest-pain/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Barrett's Esophagus and more! Quiz yourself on the 5 pearls we will be covering: What is Barrett’s esophagus and why should we care? (4:12) Who do we screen for Barrett’s, and why? (8:41) How do we screen for Barrett’s and counsel? (13:50) How do we treat and monitor Barrett’s esophagus? (18:21) Take Aways (21:45) Throwback to trending troponins (23:05) For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2019/01/30/5-pearls-on-barretts-esophagus/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and improve your clinical reasoning skills! Time stamps: Player three has entered the game! [0:15] Case presentation, part 1 [1:20] First impressions [3:24] Rethinking another provider’s diagnosis [4:36] Interpreting the test of treatment [8:48] Keeping your instincts on a leash? [10:58] Case presentation, part 2 [12:33] Diagnostic schemas [14:30] Our discussant’s differential and the final diagnosis [17:46] Shira’s cognitive autopsy [23:02] For full transcript and show notes: https://www.coreimpodcast.com/2019/01/16/hoofbeats-34m-with-fever-headache-and-myalgias/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on troponins and more! Quiz yourself on the 5 pearls we will be covering: What aspects of the history are concerning in a patient with a positive troponin? (4:00) What is the difference between the TIMI, GRACE, and HEART scores, and how should we use them in the evaluation of a patient with an elevated serum troponin? (8:42) How does the change in troponin over time help with diagnosis, and what should we consider in a patient with uptrending troponins but an unremarkable ECG? (14:48) What can a “negative but detectable” troponin tell you about any patient, not just those with suspected ACS? (21:31) Pearls Recap (25:26) Throwback – what are the first-line medications for alcohol use disorder? (28:36) For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2019/01/04/5-pearls-on-troponins/ Tags: chest pain, cardiology, myocardial infarction, acute coronary syndromeFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let's dive deeper into the world of acetaminophen and fever and how it may work and patient outcomes Time Stamps: What data is there to support the use of acetaminophen as a fever reducer? (2:08) Does acetaminophen improve patient outcomes? (4:30) How does acetaminophen compare to other medications like NSAIDs? (9:56) What is the mechanism of acetaminophen action? (10:50) Review of teaching points (16:02) For full show notes and transcript of audio: https://www.coreimpodcast.com/2018/12/19/mind-the-gap-on-acetaminophen-fevers-pathophysiology-and-patient-outcomes/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here: Time stamps: Case [1:19] Diagnostic weight [8:42] Hypothesis driven reasoning [12:26] Anomalous clinical data [19:30] Final diagnosis [22:20] Take away points [31:21] Human Dx  Case link: https://www.humandx.org/o/co7yrer3dim2y59t5c0sbd370?s=FEED For show notes: https://www.coreimpodcast.com/2018/12/05/hoofbeats-43m-with-diarrhea/Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Women in medicine inspire us with what they would tell their younger selves. Some of the speakers with Shreya Trivedi MD @ShreyaTrivediMD at the Women in Medicine GirlMedLive Conference: Qaali Hussein MD @QaaliHussein1 Clinical Pearl @ClinicalPearl Marguerite Duane MD @mduanemd Kate Prior MBBS @doctorwibble C. Nicole Swiner MD @docswiner Carmen Landrau MD @DrLandrau Jessica Willett MD @jkwillettmd Ilene Brenner MD @irb123 Joannie Yeh MD @BetaMomma Karen Davidson, Esq [email protected] Suzanne Feigofsky MD @DrSuzyFeigofsky GirlMedLive: https://www.girlmedmedia.com/ Episode page: https://www.coreimpodcast.com/2018/11/21/what-would-you-tell-your-younger-self/ Tags: career development, professional development, lifelong learning, burnout, imposter syndrome, mentorship, worklife balanceFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Alcohol Use Disorder (AUD) treatment and more! Quiz yourself on the 5 pearls we will be covering: Throwback: At what levels of drinking does unhealthy alcohol use start, and how do you screen for unhealthy alcohol use? (1:47) What does the brief intervention and counseling part of SBIRT entail? (4:43) What are the first line medications for AUD and contraindications to them? (11:11) What are the  second-line medications for AUD and their limitations? (18:14) What new therapies are being studied for for alcohol use disorder? (22:09) Pearls Recap (25:06) For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2018/11/07/5-pearls-on-treatment-of-alcohol-use-disorder/ tag: naltrexone, acamprosate, gabapentin, topiramate, SBIRT, neuromodulation, nalmafene, psychaedelics, audit-cFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect a working diagnosis through a process of validation! Time Stamps: Your collective differential [0:40] The test results (that you asked for) are in... [2:13] The hospital course, and the diagnosis (or is it?) [7:10] Validating a diagnosis: Base rate, adequacy, and coherence [8:30] Revisiting the differential [14:44] What to do when there is no final diagnosis? [17:39] For full show notes: https://www.coreimpodcast.com/2018/10/24/hoofbeats-85f-with-acute-ams-part-2/ Tags: Clinical reasoning, Diagnostic UncertaintyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Submit your diagnosis or differential for this episode's case at HumanDx.org (free registration required): http://hdx.org/2VP ! Part 2 (releasing 10/24) will have the final diagnosis! Time stamps: A new challenge and the rules of the game (1:13) Introduction to Human Dx (3:06) The case: An 85 year-old woman with paranoid delusions (5:28) What exactly is problem representation? (15:15) Building the differential (19:53) For full show notes: https://www.coreimpodcast.com/2018/10/10/hoofbeats-85f-with-acute-ams/  Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy