Podcasts about how doctors think

In months with five weeks, host Paul Wirkus, MD, FAAP and guest Angelo Giardino, MD, FAAP hold a book club. This month they are discussing How Doctors Think by Jerome Groopman, MD.No credit available for this episode. See vcurb.com for additional episodes. 

We discuss "Because We Care: A Philosophical Investigation into the Spirit of Medical Education" by Camillo Coccia and Mario Veen. You can download it here: https://doi.org/10.1080/10401334.2022.2056744  This is the 8th installment of the series on philosophy in medical education of Mario Veen and Anna Cianciolo, which appears in Teaching and Learning in Medicine: An International Journal -- it will also appear as a book chapter in our upcoming book Helping a Field See Itself: Envisioning a Philosophy of Medical Education (Springer, forthcoming 2022). Camillo is a medical doctor from South Africa. Currently he works as a senior house officer at Letterkenny University Hospital department of Hematology. He has a special interests in existentialist philosophy, German idealism and phenomenology. Camillo also published a book chapter with Sven Schaepkens, called "In Pursuit of Time: An Inquiry into kairos and reflection in medical practice and health professions education" Camillo is featured on Episode 18 - How Doctors Think of the interdisciplinary philosophy podcast Life From Plato's Cave. Our co-host today our dr. Adina Kalet.  Adina is a General Internist and the Stephen and Shelagh Roell Endowed Chair of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education  at the Medical College of Wisconsin. She has spent her career building the evidence base for ensuring  health professions education produces excellent health professionals committed to and capable of caring for the health of the public with character.   Mario Veen (@MarioVeen) is Assistant Professor Educational Research at the Erasmus Medical Center Rotterdam in The Netherlands. Mario is action editor for the Philosophy in Medical Education series of the journal Teaching & Learning in Medicine and co-editor of the first two books about philosophy and medical education: Applied Philosophy for Health Professions Education: A Journey Towards Mutual Understanding (Springer, 2022) and Helping a Field See Itself: Envisioning a Philosophy of Medical Education (Taylor & Francis, forthcoming 2022). He hosts the podcasts Let Me Ask You Something, and Life From Plato's Cave. If you have any questions about this episode, let me know! https://twitter.com/MarioVeen and https://marioveen.com/  Mario

Today Asif asks Ali about his involvement with Canada Reads, which returns on March 28, 2022 (4:43). After a brief digression about the band Genesis, Ali discusses the genesis of Canada Reads. He talks about how it was developed by the CBC and how the guests and books are selected. He then discusses notable guests and books and how he became involved with the show.  Then Asif discusses his favourite medical books (39:24): ‘The House of God' by Samuel Shem, ‘An Anthropologist on Mars: Seven Paradoxical Tales' by Oliver Sachs, ‘How Doctors Think' by Jerome Groopman, and ‘When Breath Becomes Air' by Paul Kalanithi.  The opinions expressed are those of the hosts, and do not reflect those of any other organizations. This podcast and website represents the opinions of the hosts. The content here should not be taken as medical advice. The content here is for entertainment and informational purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions.    Music courtesy of Wataboi and 8er41 from Pixabay   Contact us at doctorvcomedian@gmail.com   Follow us on Social media: Twitter: @doctorvcomedian Instagram:  doctorvcomedian   Show Notes: Canada Reads 2022: https://www.cbc.ca/books/canadareads/meet-the-canada-reads-2022-contenders-1.6326413 Jerome Groopman: http://jeromegroopman.com/ When Breath Becomes Air: https://www.penguinrandomhouse.com/books/258507/when-breath-becomes-air-by-paul-kalanithi/ Five years later: Lucy Kalanithi on loss, grief and love: https://scopeblog.stanford.edu/2020/04/20/five-years-later-lucy-kalanithi-on-loss-grief-and-love/

Diagnose and treat lupus in primary care with tips from rheumatologist, Beth Jonas MD, FACR (UNC). We discuss the history and exam findings in lupus, initial lab workup, the dreaded ANA, who needs expanded lab testing, lifestyle factors in lupus, vaccinations, the basics of treatment...and Jethro Tull?!  Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced: Kate Grant MBChB DipGUMed; Matthew Watto MD, FACP Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guest: Beth Jonas MD, FACR Time Stamps 00:00 Intro, disclaimer, guest bio 03:03 Guest one-liner; Book recommendation*: How Doctors Think (book) by Jerome Groupman; Career advice 10:50 A case of hematuria and rash, Ms Luna Wolferton 12:00 Differential diagnosis for a patient with symptoms suggestive of lupus 13:50 Clues for lupus on history and exam 15:42 Classification criteria versus making a clinical diagnosis of lupus (Dorner 2019) 18:17 ANA, what is it good for? 21:33 Basic lab workup (CBC, urinalysis and TSH) 25:10 Labs to send once lupus is suspected 28:15 Does Ms Wolferton have lupus?  29:10 Spiel for explaining lupus to a patient 31:20 ANA titers 33:02 Are there classic phenotypes of lupus? 34:40 Lifestyle factors 38:20 Bone density and chronic steroids 39:42 Vaccinations; Antimicrobial prophylaxis 41:55 Hydroxychloroquine; Treatment goals in lupus 44:38 Steroids and add on therapies e.g. methotrexate, Belimumab 47:55 The importance of hydroxychloroquine 49:15 Drug-induced lupus (e.g. hydralazine, isoniazid, minocycline, procainamide) 51:17 Take Home Points; Plug: Thurston Arthritis Center at UNC Chapel Hill 53:40 Outro Goals Listeners will recognize and diagnose various presentations of lupus (SLE) in primary care, counsel patients with a new diagnosis of lupus, learn the general approach to treatment, and provide preventive care.  Learning objectives After listening to this episode listeners will... Recognize its myriad manifestations and diagnose lupus.  Perform an initial workup for suspected lupus Interpret positive ANA titers and order appropriate follow up testing Counsel patients with a new diagnosis of lupus Educate patients on nonpharmacologic therapy for lupus Discuss the basics of lupus treatment and monitoring/prevention including vaccinations, control of vascular risk factors, antimicrobial prophylaxis and promotion of bone health Provide excellent primary care and preventive medicine to co-manage lupus Counsel patients with a new diagnosis of lupus  *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr. Jonas reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Jonas B, Williams PN, Watto MF. “#171 Lupus in Primary Care with Beth Jonas MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 8, 2019.

We learn about the University of Rochester School of Medicine and their admissions process with the Associate Dean for Admissions. We also answer listener questions. To get more information about this episode and others visit https://case.edu/medicine/allaccess  Resources: The University of Rochester School of Medicine Dr. Nobay's Interests & Recommendations: Books:   How Doctors Think, Dr. Jerome Groopman The God of Small Things, Arundhati Roy Unaccustomed Earth, Jhumpa Lahiri The Tennis Partner, Dr. Abraham Verghese Podcasts & Blogs: The Daily by the New York Times FemInEM: Females Working in Emergency Medicine Contact:  mdadmish@urmc.rochester.edu

Imagine being admitted to a psychiatric hospital and accused of being a pathological liar because no matter how carefully you follow the high-carb diet prescribed by your physicians, you continue to lose weight. In the introduction to his book, How Doctors Think, Dr. Jerome Groopman shares the story of a woman who was misdiagnosed with anorexia nervosa. The patient was ready to give up when one last doctor discovered villous atrophy and determined that it was celiac disease—not an eating disorder—that was causing her malnourishment. Today the Gluten Free RN explores the reasons why celiac disease and gluten sensitivity are often mistaken for anorexia nervosa. She shares the limited research in the field, as well as the symptoms related to malnourishment that may be caused by gluten, including several mental health disorders. Listen in as Nadine covers the use of PWAG (people who avoid gluten) as a derogatory term and shares her frustration with labels like ‘orthorexia nervosa’ which imply that gluten-sensitive patients are obsessed with healthy food: ‘I avoid gluten like the plague because it is, in fact, the plague for those of us who have celiac disease.’     What’s Discussed:  The use of PWAG as a derogatory term ‘People who avoid gluten’ Half of people in US Implies food crazed/obsessed  The new term orthorexia nervosa Refers to obsessive behavior in pursuit of healthy diet Not clinical term/official diagnosis  The concept of food as medicine  Anecdotal evidence of celiac disease misdiagnosed as anorexia Introduction of Dr. Jerome Groopman’s book, How Doctors Think Woman admitted to psychiatric hospital (thought to be pathological liar) Continued to lose weight despite prescribed high-carb diet Biopsy revealed Marsh 4 damage Gluten-free diet resolved symptoms  Why celiac disease and gluten sensitivity are misdiagnosed as eating disorders Inability to absorb nutrients results in severe weight loss, malnutrition Become picky eaters because food causes suffering Practice food avoidance  The prevalence of celiac disease 3% of the US population Millions undiagnosed  How gluten affects a celiac patient Gluten protein as neurotoxin Damages intestines Impairs immune system Causes inflammation Heart attack Stroke Joint, muscle pain Any -itis  Nadine’s recommended variation of a Paleo diet Local, organic, whole foods 100% grass-fed beef (no antibiotics/hormones) Nutrient dense  The study of celiac disease and eating disorders Very few research studies in last 11 years Handful of case studies in literature  The issues associated with malnourishment Little body fat Cachectic Hormonal disruption Thyroid issues  The anger and contempt Nadine has experienced as the Gluten Free RN Gluten, dairy associated with comfort food People resistant to give up  The mental health issues associated with malnourishment Significant cognitive impairment Hypoxia Brain atrophy (shrinking)  The effect of gluten on epithelial tissue Leaky skin, lungs, blood vessels, blood-brain barrier Causes increased/decreased blood pressure, POTS  The consequences of gluten getting through the blood-brain barrier Causes hypoxia Brain needs oxygen to work appropriately Brain fog (irritability, anger) Early onset dementia  The shocking statistics around psychotropic medication in the US Up to 50% of population on anti-depressants, mood-altering drugs Gluten-free diet could help ‘get brain back’  Nadine’s advice for parents of children who miss multiple days of school Could be undiagnosed celiac disease No downside to clinical trial of gluten-, dairy-free diet Consider Whole30 Diet (eliminate sugar, grains, legumes)  The process of a gluten detox Gluten has narcotic-like effect on brain May feel worse before you feel better One day to two months  The benefits of maintaining a gluten-free diet Anxiety goes away Mood improves Able to sleep Pain resolves Heal intestines, epithelial tissue Reduce inflammation Heal immune system Brain receives necessary oxygen  The foods Nadine recommends as part of a super-good, high fat diet Avocados Olive oil Coconut oil Coconut milk Hemp milk  Why Nadine chooses not to eat if there is any risk of gluten contamination in her food  The places where gluten hides Single bread crumb Dusting of flour Oil French fries cooked in Personal care products Resources: How Doctors Think by Jerome Groopman, MD Dr. Groopman’s NPR Interview “The Interaction Between Eating Disorders and Celiac Disease: An Exploration of 10 Cases” in the European Journal of Gastroenterology & Hepatology “Orthorexia and Anorexia Nervosa: Two Distinct Phenomena? A Cross-Cultural Comparison of Orthorexic Behaviours in BMC Psychiatry “Predictors of Orthorexic Behaviours in Patients with Eating Disorders: A Preliminary Study” in BMC Psychiatry “Eating Disorders and Celiac Disease: A Case Report” in The International Journal of Eating Disorders Connect with Nadine:  Instagram Facebook Contact via Email ‘Your Skin on Gluten’ on YouTube Melodies of the Danube Gluten-Free Cruise with Nadine Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism

In this episode of ‘Gluten Free RN,’ Nadine discusses common signs and symptoms of gluten intolerance in children as well as the importance of identifying celiac disease early to allow for the growth and development of body and brain. Nadine employs anecdotes about her own clients at the Gluten Free RN office to illustrate the myriad of ways that gluten can affect the health and development of undiagnosed kids. This episode explains the GI problems, developmental delays, autoimmune disorders and neurological issues that children with gluten intolerance face as long as they remain undiagnosed. Click and listen to recognize the warning signs! What’s Discussed:  The common dismissal of celiac symptoms in children The profound impact of gluten intolerance on fetal development and maternal health It typically takes 9-15 years for a person to be diagnosed correctly Signs and symptoms of celiac disease and gluten intolerance in children Failure to thrive Low birthweight Short stature, stunted growth and delayed development Lactose intolerance Abdominal pain and vomiting Focus and retention issues (ADD, ADHD, ODD) Autism Psychiatric issues Delayed puberty Listen for the full list Katie’s story After suffering from chronic constipation, her colon was removed – but her health did not improve until she learned about celiac disease and changed her diet Because her growth was stunted as a result of malnourishment, Katie only grew to 5’3” despite having a size 10 foot Why vitamins, minerals and supplements don’t help children with celiac disease or gluten intolerance Why undiagnosed celiac disease patients suffer from focus issues and psychiatric disorders Inflammation of the brain causes hypoxia Low oxygen flow results in ‘brain fog’ Sam’s story At 17, she was overweight and suffering from abdominal pain She was still wetting the bed and had yet to get her period After receiving a celiac diagnosis and adopting a gluten-free diet, Sam lost 100 pounds and has gone on to have two healthy children The importance of testing the entire family for celiac disease once one member has received a diagnosis The high percentage of celiac patients who are asymptomatic Roughly 50% of people diagnosed with celiac disease would say they have no symptoms The increased chances of developing autoimmune disorders when children with celiac disease go undiagnosed The enormous genetic overlap between celiac disease and Type 1 diabetes Why parents should be tested for celiac disease prior to a pregnancy Undiagnosed expectant mothers are at an increased risk of miscarriage, complications and delivering babies with low birthweight and neural defects How to navigate birthday parties, camps, school events, etc. Proper planning and communication make it easy Resources Mentioned:  How Doctors Think by Jerone Groopman  University of Chicago Medicine Celiac Disease Center Website  EnteroLab Celiac Testing Resources  Connect with Nadine:  Instagram Facebook Contact via Email Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism

Summary: Does the thought of responding to an in-flight emergency ruin your air travel? Then tune in because on this episode, Angelica Zen, MD, Chief Resident of Internal Medicine at UCLA, recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane.   Clinical Pearls: Stay Calm!  If you freak out, so will everyone else. Think outside the box and be prepared to improvise from available resources. (e.g. ask another passenger for a glucometer) Standard medical kit contains - manual BP cuff, stethoscope (cheap), gloves, oropharyngeal airways, CPR masks, bag-valve masks, IV set, 500 ml saline, needles, syringes, analgesic tabs, antihistamine (tabs or injection), aspirin, atropine, inhaler (bronchodilator), Dextrose 50%, Epi (1:1000 and 1:10000), IV lidocaine, nitroglycerin tabs, supplemental oxygen. Don’t forget to utilize the ground medical team! Legal repercussions very unlikely unless there is “gross neglect” or “intentional harm”. DON’T treat patients if YOU’VE BEEN DRINKING! Common emergencies in order of decreasing frequency - syncope and presyncope, dyspnea, acute coronary syndrome, altered mental status, psychiatric emergencies, stroke, cardiac arrest Goal: Listeners will understand their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane. Learning objectives: By the end of this podcast listeners will: Be familiar with the contents of the standard medical kit Think outside the box to identify, improvise and utilize available resources for patient care Recognize the medical legal consequences of providing emergency medical care on a plane Confidently evaluate and manage common in-flight emergencies using the available resources Disclosures: Dr. Zen reports no relevant financial disclosures. Time Stamps 00:26 Intro 02:06 Start of Interview 03:02 Rapid Fire Questions 07:08 Dr. Zen tells her story 17:27 Monitoring your patient in-flight 18:05 Contents of the standard in-flight medical kit 20:10 What Dr. Zen would have done differently 21:05 How to use available resources in-flight 22:20 Medical legal implications 26:07 How to respond to common in-flight emergencies and how to respond 27:35 Syncope and presyncope 29:52 Hypoxia altitude simulation test (HAST) 31:15 Altered mental status 31:52 Anaphylaxis 33:19 Stroke and acute coronary syndrome 34:51 Dr. Zen’s take home points 36:40 Outro Links from the show: Baby delivered in-flight by Angelica Zen, MD http://newsroom.ucla.edu/stories/ Pharmacy article detailing supplies in standard medical kit on plane http://www.ashp.org/menu/News/PharmacyNews/NewsArticle Great review article on In-Flight Emergencies. Nable JV, Tupe CL, Gehle BD, Brady WJ.  In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45. doi: 10.1056/NEJMra1409213. Article on the hypoxia (or high) altitude simulation test (HAST) https://www.ncbi.nlm.nih.gov/pubmed/18398121 Interesting article: Passenger safely defibrillated 21 times during International Flight. Harve H1, Hämäläinen O, Kurola J, Silfvast T. AED use in a passenger during a long-haul flight: repeated defibrillation with a successful outcome. Aviat Space Environ Med. 2009 Apr;80(4):405-8. How Doctors Think by Jerome Groupman: Amazon.com link NEJM Physicians First Watch http://www.jwatch.org/medical-news

In the article posted today, Pamela Hartzband, M.D., and Jerome Groopman, M.D. (the later the author of the popular book How Doctors Think), rant about all sorts of things… some of which have nothing to do with Lean... http://leanblog.org/audio116 --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/lean-blog-audio/support