Core IM | Internal Medicine Podcast

How do you approach requests for 'futile' care? What do we mean by futility? What kind of recovery do we think is meaningful? How do we evaluate potentially inappropriate care? Where can we go for guidance on this?Show notes, Transcript and References:  https://www.coreimpodcast.com/2023/02/01/futility-at-the-bedside-segment/Time stamps04:45 What do we mean by “futility”?11:20 Definitions20:23 Ethical Analysis39:13 RecommendationsTags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethics

What does the duration of afib tell you about the thromboembolic risk? When do you start anticoagulation for post-op afib? What do the most recent guidelines recommend for perioperative anticoagulation management? How many devices do you know that can be useful in post-discharge cardiac monitoring in new atrial fibrillation? How can we improve our communication regarding afib management?Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Show notes, Transcript and References: https://www.coreimpodcast.com/2023/01/18/diagnosis-of-atr…-matters-segment/Time stamps01:12 Intro03:51 Deep Dive 108:16 Deep Dive 215:25 Deep Dive 321:05 Deep Dive 427:07 Deep Dive 5Tags: IM Core, CoreIM, Devices, cardiac, risk, perioperative, stroke, surgery, anticoagulation

Is it enough to look at LDL-C? What is Apo-B? How do you use TG/HDL ratio to understand your patients cardiovascular risk? Do you need to get a fasting lipid panel? How does it affect the triglycerides and LDL?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/12/15/reimagining-the-…-the-gap-segment/Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E8Time stamps01:24 Intro 03:37 Fasting vs. Nonfasting Lipid Panel05:11 Current guidelines07:43 Pathophysiology Overview09:04 Pathophysiology of Apo-B vs. LDL-C with traffic analogy11:23 Apo-B15:40 TG-to-HDL ratio17:06 TakeawaysTags: IM Core, CoreIM, risk, USPSTF, ACC/AHH, family medicine, cardiology, primary care

What are some ways you address unrealistic hopes with your patients? How can you build a portfolio of hope with your patients? Can you learn to guide your patients hope?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/11/23/hope/Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E7Time stamps01:20 Intro 04:37 What are some definitions of hope?09:57 How can we address unrealistic hope? 21:39 Addressing hope in clinical practice 32:10 ConclusionTags: IM Core, CoreIM, care, communication, goal setting, support, strategies , medical humanities

What tests and history points help with the diagnosis of alcohol-associated hepatitis? What other etiologies should be ruled out? To steroid or not to steroid? What are the medications for alcohol use disorder? Do you make sure your patients have a late night snack? How do you prognosticate? Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/11/09/alcoholic-hepati…5-pearls-segment/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps01:42 Intro 04:37 Pearl 1: Diagnosis 13:20 Pearl 2: Differential & Treatment20:48 Pearl 3: Nutrition & Alcohol Cessation 27:45 Pearl 4: To steroids or to not steroids?!35:34 Pearl 5: Throwback Tags: IM Core, CoreIM, ALT, AST, liver abnormalities, gastroenterology, alcohol use disorder, nutrition, MELD, Lille, Steroids, Alcoholic Hepatitis

How do you educate your patients on aspirin use? For what reasons do you start, continue or stop aspirin? What does trial data tell us? How does aspirin exerts its effect?Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E6ACP CME: http://bit.ly/CIMCMEShow notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/Time stamps03:03 Guideline recommendations 07:00 How does Aspirin work? 09:11 Trial Data13:00 ASCVD Risk Calculator18:07 Starting vs. Stopping Aspirin 22:11 Summary Tags: IM Core, CoreIM, guidelines, atherosclerosis, ASCVD, plaque, bleeding, shared decision-making

How do you educate your patients on aspirin use? For what reasons do you start, continue or stop aspirin? What does trial data tell us? How does aspirin exerts its effect?Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E6ACP CME: http://bit.ly/CIMCMEShow notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/Time stamps03:03 Guideline recommendations 07:00 How does Aspirin work? 09:11 Trial Data13:00 ASCVD Risk Calculator18:07 Starting vs. Stopping Aspirin 22:11 Summary Tags: IM Core, CoreIM, guidelines, atherosclerosis, ASCVD, plaque, bleeding, shared decision-making

Is a positive ANA always significant? What does the titer mean? Is the pattern of the ANA helpful? What patient histories should you not get an ANA for and which aspects of the history would raise suspicion for autoimmunity? How can you use the physical exam to assess likelihood of autoimmune disease? What is the ddx for a positive ANA?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/05/ana-antinuclear-…5-pearls-segment/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imSponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”Timestamps:01:37 Pearl 103:54 Pearl 213:53 Pearl 318:07 Pearl 429:30 Pearl 5Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, Rheumatology

Is a positive ANA always significant? What does the titer mean? Is the pattern of the ANA helpful? What patient histories should you not get an ANA for and which aspects of the history would raise suspicion for autoimmunity? How can you use the physical exam to assess likelihood of autoimmune disease? What is the ddx for a positive ANA?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/05/ana-antinuclear-…5-pearls-segment/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imSponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”Timestamps:01:37 Pearl 103:54 Pearl 213:53 Pearl 318:07 Pearl 429:30 Pearl 5Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, Rheumatology

How do you decide which lung nodules should be worked up inpatient or outpatient? How common are incidental lung nodules? What considerations are there for patients that could potentially get lost to follow up? What risk adopted approach can be implement in our practice? Do you know what fast forward rounds are?Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E5Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/Time stamps01:30 Deep Dive #117:27 Deep Dive #2Tags: IM Core, CoreIM, outpatient, inpatient, PCP, management, communication, discharge summary, incidentaloma

Can you identify where along the clinical reasoning pathway the learner is struggling? What coaching exercises can be helpful? What feedback do you fall back on when working with learners? What are common challenges?Digital Education Conference 2022 in Oct 7 2022: https://cmecatalog.hms.harvard.edu/digital-educationShow notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Hear personal stories about racial trauma or stereotype threat. How can we respond and how do we differentiate an up stander from a bystander? What barriers exist when we try to respond?Show notes, Transcript and References:   https://www.coreimpodcast.com/2022/08/24/upstander/ Time stamps00:59 Intro05:51Overview of Microaggressions09:11 Prevalence12:43 How to respond22:03 Barriers to appropriate response27:00 ConclusionTags: IM Core, CoreIM, bystander, race, microaggressions, hidden curriculum, DEI

What are the 3 types of solutes you can use in hyponatremia? What are each of their drawbacks? How do loop diuretics work help in hyponatremia? What can you use to tell you on day 1 that fluid restriction alone will not work?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/08/03/hyponatremia-man…5-pearls-segment/Sponsor: https://go.amboss.com/CoreIM-E4Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:01:20 Intro04:46 Pearl 113:13 Pearl 224:03 Pearl 332:49 Pearl 437:05 Pearl 5

Digital Education Conference 2022 in Oct 7 & 8 2022: https://cmecatalog.hms.harvard.edu/digital-educationWhat does each diagnostic test tell you? How do you interpret urine osmolality, urine sodium, or urine urea? What studies can be used to better assess response to treatment? How can uric acid be utilized as a diagnostic tool? What is the interplay between ADH and UOsm?Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/10/5-pearls-on-hyponatremia-episode-1/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imTags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrology

Other than infection, what do you think about as other causes of fever? How can you distinguish sepsis from drug fever from antibiotics? What medications are most likely to cause neurotoxicity? What are some risk factors? How do you think about goals of care with patients? Show notes & Transcript:  https://bit.ly/3Rs57I9Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptionsDiscount code: "coreim" Time stamps02:50 Deep Dive #113:12 Deep Dive #226:39 Deep Dive RecapTags: IM Core, CoreIM, antibiotics, CMO, DNR/DNI, sepsis, reflection, grey matters

What are the 3 different types of inhaler devices and what should you educate patients about each? When do you stop the inhaled steroid in COPD? And when do you think of increasing the dose? What is important to communicate at the time of diagnosis, and during goals of care discussions? Show notes, Transcript and References:https://www.coreimpodcast.com/2022/06/22/5-pearls-on-copd-management/Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E3Timestamps:Pearl 1: 3:20Pearl 2: 8:20Pearl 3: 15:47Pearl 4: 26:55Pearl 5: 34:10Tags: IMCore, CoreIM, Pulmonary, medication management, spirometry

“Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Show notes, Transcript and References: https://www.coreimpodcast.com/2022/06/15/spirituality/Time stamps00:01 What is spirituality?7:12 Why does spirituality matter?12:09 How do we screen for it?18:50 Chaplains27:49 Conclusion Tags: IM Core, CoreIM, ethics, medical humanities

What are the indications for a simple transfusion? And what the indications for an exchange transfusion? What is your approach to pain management in patients with sickle cell? What are the treatment options for sickle cell and which ones actually decrease sickle crisis and improve mortality? What are some of the major sickle cell complications to watch out for and how can we prevent some of them?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/06/01/5-pearls-on-sickle-cell-anemia/Sponsor: https://go.amboss.com/CoreIM-E2Timestamps:1:33 Pearl 14:48 Pearl 218:43 Pearl 329:45 Pearl 435:22 Pearl 5Tags: IM Core, CoreIM, hematology oncology, health inequity, vaso-occlusive crisis

How do you counsel patients on beta blockers? Is one beta-blocker better than the other? What is preferred: ACEi, ARBs or ARNIs? What are the pros and cons of each? How does spironolactone compare to eplerenone? When do you stop mineralocorticoid receptor antagonist? What are risks with SGLT2 inhibitors? How do you initiate GDMT? Which meds do you start first and in what order?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/05/11/5-pearls-on-guideline-directed-medical-therapy/Sponsor: https://go.amboss.com/GDMTGet CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:03:13 Pearl 112:14 Pearl 220:36 Pearl 326:42 Pearl 432:16 Pearl 5Tags: IM Core, CoreIM, heart failure with reduced ejection fraction, GDMT, treatment, cardiology

How much of D5W vs. isotonic saline contributes to intravascular volume? How do you distinguish between oncotic pressure and tonicity? What balanced solutions do you reach for? What is the data behind using colloids like albumin as an intravascular expander? How much do pRBCs stay in the plasma? Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/04/27/fluids-colloids-5-pearls-segment/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:02:14 Intro04:26 Pearl 111:08 Pearl 220:43 Pearl 331:06 Pearl 435:06 Pearl 5Tags: IM Core, CoreIM, fluids, hypertonic, volume, crystalloid, tonicity, blood, nephrology, hospital medicine

What do you include in your initial basic work-up for suspected pulmonary hypertension? Do you know how to calculate the PASP on the ECHO? What physiological insults that can cause high pulmonary pressures? How can we interpret the E/e' ratio? Show notes, Transcript and References: https://www.coreimpodcast.com/2022/04/06/pulmonary-hypertension/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imTime stamps:02:18 Intro05:27 Pearl 1 12:17 Pearl 216:13 Pearl 324:04 Pearl 430:08 Pearl 5Tags: IM Core, CoreIM, PASP, Echo, hypoxia, PA pressure, vascular resistance

How can we use food as medicine? How can we best counsel our patients on their diets? Which pre-set diets can we recommend for or against? How can we make the changes sustainable? Show notes, Transcript and References: https://www.coreimpodcast.com/2022/03/23/obesity-and-nutr…-2021-sgim-recap/Time stamps:03:10 Trends in weight and dieting06:01 Counseling patients on diet09:35 Food group recommendations14:53 Pre-set diets20:47 Making sustainable changesTags: Core IM, IM Core, diet, salt intake, fiber, weight

What are some tricks to help you perform a virtual physical exam? What role do these visits play in our overall care for the patient? What tools do we have at our disposal for a more thorough evaluation?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/03/09/telemedicine-and…-2021-sgim-recap/Tags: IM Core, CoreIM, tele visit, gizmos, history taking, virtual, physical exam, assessment, functional status, tips

How long should you anticoagulant for a PE? When can you safely stop anticoagulation for thrombogenic patients who need an urgent biopsy? Should an IVC filter be placed to prefer further embolization of a DVT? What percentage of patients with cancer associated blood clots will have progression while on anticoagulation?Show Notes, Transcript, and References: https://www.coreimpodcast.com/2022/02/23/24433/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps:02:40 Deep Dive #1 Anticoagulation08:50 Deep Dive #2 DOACs14:08 Deep Dive #3 IVC Filter17:49 Deep Dive #4 Biopsy25:00 RecapTags: Core IM, IM Core, Anticoagulation, Bleeding, DOACs, IVC, reflections, clots

How long should you anticoagulant for a PE? When can you safely stop anticoagulation for thrombogenic patients who need an urgent biopsy? Should an IVC filter be placed to prefer further embolization of a DVT? What percentage of patients with cancer associated blood clots will have progression while on anticoagulation?Show Notes, Transcript, and References: https://www.coreimpodcast.com/2022/02/23/24433/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps:02:40 Deep Dive #1 Anticoagulation08:50 Deep Dive #2 DOACs14:08 Deep Dive #3 IVC Filter17:49 Deep Dive #4 Biopsy25:00 RecapTags: Core IM, IM Core, Anticoagulation, Bleeding, DOACs, IVC, reflections, clots

How can you implement effective note taking for virtual learning? Do you use interleaving during rounds? What is the 5/10/30 rule and how does it apply to mentorship? Does implicit bias affect gender performance scores in clinical rotations? How common are biased patient behaviours? How can you foster a safer learning environment for trainees? How can you promote antiracism?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/02/09/medical-educatio…ng-core-im-recap/Time stamps02:10 Make it Stick Virtually 08:35 Mentoring in the Modern Era: More than the Traditional Dyad13:29 Clinical Update in Medical Education 20:58 Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity Tags: IM Core, CoreIM, virtual learning, note taking, feedback, mentorship, microaggressions, gender bias, sterotype threat

What's your comfort level with managing hyponatremia and how does it change in unfamiliar environment? How can you vary your practice to build up adaptive exerptise? Show notes, Transcript & References:  https://www.coreimpodcast.com/2022/01/26/hoofbeats-consult-case/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps01:36 Case10:42 Case analysis 22:45 An unfamiliar domain25:50 Lab review40:04 ConclusionsTags: IM Core, CoreIM, hyponatremia, preeclampsia, reasoning, adaptive expertise, situational awareness

Have you ever thought about where the 1g/dL hemoglobin appropriate bump after 1 unit of pRBC transfusion? How does the patient's intravascular volume affect this? What rise in hemoglobin should you expect? What factors can impact this?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/01/05/1-to-1-prbc-bump…-the-gap-segment/Time stamps01:22 Unpacking the question 01:55 The math 04:32 Functional hemoglobin08:50 Donor and Patient 11:18 Scenarios12:58 Summary14:34 Clarification Tags: IM Core, CoreIM, hemoglobin, intravascular volume, irradiation, donation

Let's apply to cases! We use the 7 questions framework to 3 practical casesShow notes, Transcript and References: https://www.coreimpodcast.com/2021/12/22/treatment-over-objection-part-2/Time stamps2:19 Case 1: Review of Framework7:59 Case 29:04 Consent vs. Assent 11:11 Role of Consult Services13:16 Role of Surrogates15:29 Conclusion Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humanities

Get a very useful framework to help you weigh the risks and benefits of treatment over objection!Show notes, Transcript and References: https://www.coreimpodcast.com/2021/12/08/treatment-over-objection/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps03:02 Ethical and emotional challenges10:08 Case 118:55 Study of the 7 Questions22:46 Conclusion  Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humanties

What degree of hyperkalemia makes you worried enough to send your patient to the ED? Are ECG changes sensitive in detecting hyperkalemia? Do you know how to advise your patient on dietary changes? What medications can you effectively use in the outpatient setting?Show notes, Transcript and References: https://www.coreimpodcast.com/2021/11/17/hyperkalemia-mind-the-gap-segment/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps01:01 Introductions07:58 Nutrition17:13 Medications20:48 Outpatient medications26:16 RecapTags: IM Core, CoreIM, outpatient, blood work, diet, electrolytes, ECG, nephrology, chronic kidney disease, nutrition

What are pearls and pitfalls when assessing an older patient for the first time?Time Stamps:02:25 Initial Office Visit08:08 Mobility Assessment 13:25 Cognitive Evaluation 19:27 Medications 26:29 Throwback PearlShow notes, Transcript and References: https://www.coreimpodcast.com/2021/10/31/5-pearls-on-geriatric-care/Tags: Core IM, IM Core, delirium, goals of care, dementia, mini cog, MOCA, deprescribing

Should we use oral diabetes agents in our hospitalized patients? Do you hold metformin for fear of lactic acidosis? Do you typically order an insulin sliding scale? When can you comfortably restart PTA meds?Time Stamps:02:25 Can we give metformin in the hospital?10:50 Incretin-based therapies14:49 Sodium Glucose Cotransporter-2 Inhibitors16:27 Sulfonylurea & Thiazolidinediones18:00 Basal Insulin inpatientShow notes, Transcript and References: https://www.coreimpodcast.com/2021/10/13/oral-diabetes-medications-in-hospitalization-mind-the-gap-segment/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Tags: Core IM, IM Core, glucose, insulin, hospitalized patients, oral medications, sliding scale, DPP-4, GLP-1

What are practical phrases can you incorporate to help patients who use drugs? What changes can you make to ensure person-first language? What safe drug practices can you advise? What is MOUD?Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/29/5-pearls-on-stig…oid-use-disorder/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps:04:24 Starting the Conversation 10:43 The Shared Agenda14:46 Exploring patient goals18:54 Reducing drug use24:09 Reducing harm in opioid use29:06 RecapTags: Core IM, IM Core, MOUD, buprenorphine, patient centeredness, motivational interviewing, safe practices

A very practical episode around nuanced code status conversations with many examples!Time Stamps:00:08 Introduction04:01 Information Gathering20:41 Informed Consent29:47 Giving Recommendations36:47 Mistakes48:22 Wrap Up Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/12/code-statusTags: Core IM, IM Core, DNR/DNI, CPR, intubation, goals of care, shared decision making, documentation, conversations, recommendations

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 education

What are the indications for a stress test?  How to choose stress protocol in a stress test?  How to choose diagnostic imaging in a stress test?  How do we interpret results from stress tests, and how should this be communicated to patients? 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, Cardiology, angina, ischemia

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   Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humanties

20 Qs game with Core IM Team vs. Expert Discussant ! Full Transcript and Show notes Get CME-MOC Credit for listening to this episode 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

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 hello@coreimpodcast.com. Tags: Narrative Medicine, CoreIM, IMcore, imposter syndrome

How can we help colleagues that we think are struggling with substance use disorder? What options are available for physicians? Are these different state to state? What deterrents do physicians face when seeking help? Time Stamps: 00:21 Introduction 02:59 Scope/Definitions 08:05 Systems for Physician Impairment 13:50 Barriers to Care 24:48 Helping an Impaired Physician 28:44 Systems Level Change Show notes, Transcript and References: https://www.coreimpodcast.com/2021/06/09/physician-clinician-impairment/ Tags: Core IM, IM Core, impairment, substance use disorder, mental health, stigma, treatment, cost

Debunk common myths of penicillin allergies! What's the best way to ask about allergies? How can you challenge patients to determine if they have a true allergy? Organic chemistry buffs, what mediates cross-reactivity? What medications can you safely give your patients? Show note, Transcript and References: https://www.coreimpodcast.com/2021/06/02/5-pearls-on-penicillin-allergy/ Time Stamps: 02:49 Penicillin Myths 07:20 Penicillin Allergy 11:21 Allergic Reactions 19:01 Managing allergic reactions 26:53 Alternative medications 33:28 Recap Tags: CORE IM, IM Core, history taking, rash, skin testing, hypersensitivity, medications, over labeling, antibiotics, management

What are good habits in QI? What are the areas of expertise needed to have a successful career in QI? How can you get involved in quality improvement? What projects can you get involved with, and how do you work outside of your own interests? How can you partner with your healthcare system to make changes? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/05/08/quality-improvement-careers-series/ Time Stamps: 01:36 Getting started 05:01 Formal training 08:27 What are areas of expertise to get good at? 16:27 Typical Day 19:27 Challenges 23:56 Metrics Tags: CORE IM, IM Core, fellowships, jobs, leadership, metrics, training, patient safety

How does cost, potency, and bleeding risk affect which antiplatelet you choose P2Y12 inhibitors? How long after starting, do you feel comfortable stopping DAPT on a patient? How do you manage DAPT in patients who need anticoagulation? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/04/07/5-pearls-on-dual…platelet-therapy/ Join Our Team Time stamps 02:35 Indications 08:52 Medications 17:37 Duration 28:23 De-escalation 30:55 Anticoagulation Tags: IM Core, CoreIM, anticoagulation, DAPT, acute coronary syndrome, stents, thrombosis, bleeding risk, cardiology, hospitalist, primary care

Hear perspectives that don't get as much spotlight! What is it like to be a surrogate? How can we be better listeners for our patients and for their surrogates? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/03/17/supporting-surrogates/ Time Stamps: 01:09 Background Information 03:54 Surrogate Challenges 16:04 Clinician Challenges 36:10 Conclusion Tags: CORE IM, IM Core, decisions, prognosis, goals of care, clinicians, patients, family medicine, palliative care, end-of-life

How can we better serve the public's health? What does the landscape of public health look like? What opportunities are available to better hone your skills? What are common challenges professionals face? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/24/public-health-ca…rs-in-gim-series/ Time Stamps: 01:00 Introduction 05:07 Defining Public Health 11:17 Pursuing a Public Health Career 20:12 Politicization of Health Tags: CORE IM, IM Core, fellowships, advocacy, healthcare, jobs, leadership, population health

What does each diagnostic test tell you? How do you interpret urine osmolality, urine sodium, or urine urea? What studies can be used to better assess response to treatment? How can uric acid be utilized as a diagnostic tool? What is the interplay between ADH and UOsm? Time Stamps: 04:50 General Diagnostic Approach 12:26 Serum Osmolality 19:34 Urine Osmolality 32:09 Urine Sodium 45:23 Uric Acid Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/10/5-pearls-on-hyponatremia-episode-1/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Tags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrology

How can I best answer my families medical questions? How can I give my loved ones the best care without providing it directly for them? What boundaries should I have in place? Show notes, Transcript and References:   https://www.coreimpodcast.com/2021/01/13/treating-friends-family/ Time Stamps: 02:45 The tension, the push and pull 05:45 Prevalence 06:32 Stances of societies/professional organizations 08:18 Concerns 10:35 How to respond 17:52 Favors for physician/trainee colleagues, self-doctoring 22:26 Formal vs informal, documentation 23:55 Long-term care Tags: patient care, advocate, advice, healthcare, Core IM, IM Core, medical ethics, medical humanities

How do you form an educational mission statement? What role do coaches and mentors play? Do you need formal training for a MedEd career? What are the challenges with careers in medical education? Digital Education conference (virtual) on Jan 22, 2021: cmeregistration.hms.harvard.edu/digitaleducation Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/27/medical-educatio…s-careers-series/ Time Stamps: 00:00 Introductions 05:44 General Tips 18:00 Challenges in Med Ed 24:54 Conclusion Tags: CoreIM, IM Core, mission statement, clinician educator, mentors, coaching, training, feedback

Can you identify where along the clinical reasoning pathway the learner is struggling? What coaching exercises can be helpful? What feedback do you fall back on when working with learners? What are common challenges? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: 00:00 Introduction 03:33 Mental Health & Wellbeing 06:43 Case 1 11:48 Exercise 1 12:53 Exercise 2 14:35 Case 2 19:15 Exercise 3 21:22 Exercise 4 23:24 Case 3 27:29 Exercise 5 28:07 Exercise 6 29:24 Conclusion Tags: CoreIM, IM Core, problem representation, coaching exercises, data gathering, hypothesis generation, clinical reasoning, faculty development

What is the difference between mnemonics and schemata? What does the mnemonic NAACP bring to mind? How do repeat interviews bring you closer to or further away from the diagnosis? Show notes, transcript and references: https://www.coreimpodcast.com/2020/11/25/a-29m-with-cough…oofbeats-segment/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: 00:43 Case presentation Part 1 04:55 Case presentation Part 2 06:50 Expert discussant 28:52 Framing bias 33:38 Concluding thoughts Tags:  IM Core, CoreIM, schemata, mnemonics, eosinophilia, framing bias