Core IM | Internal Medicine Podcast

We start with a gripping story of seizures and use it as a jumping-off point to unpack practical pearls for in-flight emergencies. Along the way: what’s actually in the emergency medical kit, when planes divert, how ground medical support works, altitude physiology, legal protections, and how to stay calm when medicine suddenly happens at 35,000 feet. By the end, you may still sweat a little…but hopefully less than before.

🔹Sponsor: Oakstone CME

Use the code "CORE325" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

04:40 | Emergency Medical Kit (EMK) Standard Contents

08:50 | Role of Ground-Based Medical Support & Flight Diversion Decision-Making

19:35 | Interpreting Hypoxia at Altitude

22:06 | In-Flight Liability

23:35 | Common Chief Concerns & Useful Additional Medications

24:53 | How to Be Resourceful in an Austere Environment

Tags: CoreIM, Internal Medicine, Medical Education, In-flight Care, Medical Emergencies, Clinical Reasoning, Seizure Management, Hypoxia, Airway Management, Cardiac Emergency, Syncope, Respiratory Distress

Can you distinguish benign eosinophilia from a sign of serious disease, and know exactly when to act at the bedside?

In this high-yield episode, test your clinical reasoning as we tackle:

• When eosinophilia becomes dangerous and why it matters
• How to distinguish if its from atopy vs. systemic disease
• Which medications to stop (and which to watch)
• How travel, diet, and exposure history shape your workup
• When to suspect malignancy before giving steroids

🔹Transcript and Shownotes: 

02:34 | Why Do We Care About Eosinophilia? (Pearl 1)

10:24 | Atopy and Eosinophilia (Pearl 2)

18:57 | Drugs and Eosinophilia (Pearl 3)

27:29 | ID and Eosinophilia (Pearl 4)

33:54 | Pearl 5: Eosinophilia, Steroids, and Neoplasms (Pearl 5)

Tags: CoreIM, Internal Medicine, Medical Education, Eosinophilia, Hypereosinophilia, Allergy Immunology, Hematology, Pulmonology, Parasitic Infections, Atopy

Is coffee helping or harming our patients’ hearts?

In this Beyond Journal Club, we unpack the CRAVE trial and use it as a lens to answer a bigger question:

How should clinicians interpret nutrition research, especially when it feels inconsistent or hard to trust?

Listen for a concise, practical framework you can use the next time a patient asks about coffee, diet, or lifestyle.

🔹Sponsor: Oakstone CME

Use the code "CORE325" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹 Transcript and Show notes

00:00 | Challenges of interpreting nutritional research.

02:22 | Best practices for evaluating studies in nutrition. 

12:35 | Delve into the CRAVE trial as an example of critically appraising nutritional investigations.

26:41 | Applying this to clinical practice for your patients.

Tags: IMCore, Internal Medicine, Medical Education, Epidemiology, Diet and Lifestyle

Why can these infections be tricky? How to diagnose osteomyelitis at the bedside? Do we always need IV vs oral antibiotics? And the best for last: Simple, practical wound care strategies for medical students, residents, and clinicians who want a clear, usable approach.

.🔹Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com

🔹Transcript and Shownotes:

02:15 | Pearl 1: Pathophysiology

08:20 | Pearl 2: Diagnosis

16:35 | Pearl 3: Treatment

20:35 | Pearl 4: Antibiotics

27:39 | Pearl 5: Wound Care

Tags: CoreIM, Internal Medicine, Medical Education, Diabetic Foot Infections, Osteomyelitis, Foot Ulcer, Wound Care

A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?

A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?

A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?

And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?

🔹Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

See here for Neph Madness details 

See here for the POCUS region of NephMaddness

VOTE here to build your bracket!

🔹Transcript and Shownotes:

00:52 | What is NephMadness?

02:19 | Detecting post-renal obstruction in a patient who reported normal urination

11:26 | POCUS for discharge or continue diurese

17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound

23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis line

Along the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.

If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUS

Most clinicians see dementia medications on the med rec, but many of us aren’t sure how much they actually help. In this episode we break down donepezil, memantine, and the new anti-amyloid drugs, and when to stop them.

• Do cholinesterase inhibitors really work?

• What should clinicians know about lecanemab and donanemab before referring patients?

• How much benefit should we expect and for how long?

• When should you deprescribe dementia medications?

🔹Sponsor: Caraway’s cookware set is a favorite for a reason.

For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.

🔹Transcript and Shownotes

02:27 | Deep Dive 1: How do we deliver the news of a diagnosis of dementia?

09:41 | Deep Dive 2: Prescribing medications for cognitive decline

29:30 | Deep Dive 3: Patient-centered management for a patient with cognitive decline

35:46 | Deep Dive 4: Planning for an uncertain future

Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistant

Cognitive decline is tough for all parties. What are the high-yield questions to ask? What should you add to your one-liner? When do you stop using MOCA and try to clearly describe their functional status? Do all patients with cognitive decline need an MRI?

🔹Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com

🔹Transcript & Shownotes:

01:12 | Cognitive Concerns During a Routine Follow-Up

03:41 | Deep Dive 1: How do you pivot when you recognize unexpected memory issues?

15:08 | Deep Dive 2: What tools should we use to characterize and stage cognitive decline?

31:09 | Deep Dive 3: How do we determine the etiology of cognitive decline?

Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistant

From metformin to basal insulin to overlooked older medications, this episode reviews the T2D medication toolkit clinicians use every day. We then dive into new evidence on once-weekly insulin to help you individualize therapy while reducing treatment burden.

🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

🔹Transcript and Shownotes:

00.58 | Insulin Hx & Types

06:00 | Indications for Insulin and the Burden on Patients

08:26 | What is the QWINT-1 Trial?

16:18 | Discussion

Tags: CoreIM, Internal Medicine, Evidence-Based Medicine, Insulin Resistance, Clinical Reasoning, Hospital Medicine, Medical Education, Endocrine, Endocrinology

Is patient confidentiality absolute or conditional? When does protecting privacy put others at risk? Can you follow a former patient in the EHR for learning? Should you post a compelling case online even if it’s “de-identified”? And when does the law force you to betray patient trust? In this episode of At the Bedside, learn how clinicians should act when ethics, law, and trust collide.

🔹 Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com

🔹Transcript and Shownotes:

03:51 | What is the difference between Privacy and Confidentiality?

05:50 | Guidelines and laws

10:06 | Limits/appropriate breaches (competing principles/obligations) 

22:03 | Privacy vs education

35:34 | Conclusion

Baby alligators  - those betrayals of purpose , or, death by a thousand paper cuts !

Check out our latest episode, where Dr. Eileen Barrett walks us through how to tackle baby alligators with:

Regulated curiosity

Strategic empathy

Small, well-chosen moves...

...and change that is big enough to matter, and small enough to win!

🔹 Sponsor: Caraway’s cookware set is a favorite for a reason.

For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.

🔹 Transcript & Shownotes

00:00 | What are “baby alligators” in medicine?

02:24 | Rifaximin & Workflow Fixes

14:17 | Verbal Orders Policy

18:39 | Micro Skills for Change

25:12 | Key Takeaways

#PhysicianBurnout #DoctorLife #HealthcareEfficiency, CoreIM, Internal Medicine, Career Development, Quality Improvement, QI

Gray zones of VTE management! How to approach anticoagulation duration in unprovoked, provoked-irreversible, and provoked-reversible clots?

When dose-reduced DOACs make sense for long-term secondary prevention? What truly constitutes DOAC failure? We also devle into how APLAS a critical do-not-miss diagnosis that changes management entirely.

🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

🔹 Transcript & Shownotes

(2:56) - (13:15) | PEARL 1: Managing clots in the “unprovoked”/provoked-irreversible patient

(13:21) - (18:10) | PEARL 2: Managing provoked, “reversible” clots

(18:14) - (25:14) | PEARL 3: DOAC failure: time to step it up?

(25:20) - (37:25) | PEARL 4: APLAS: the exception to everything

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematology

We hope these stories resonate with anyone who has felt pulled between professional purpose and personal life, and remind you that you’re not alone in wanting both.

🔹 Sponsor: Oakstone CME

Use the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 

🔹 Transcript and Shownotes

(1:09) | How the Horn Award Opened the Door to Growth in Dr. Tyra Fainstad’s Career and Life

(10:28) | How Dr. Carol Ward Created the Horn Award and Honored Mary Horn’s Legacy

(14:16) | Dr. Hilit Mechaber’s Story of Courage, Vision, and Impact Beyond the Award

(17:55) | Why does the Horn Award Matter?

Tags: CoreIM, Internal Medicine, Career Development Award, Mary O'Flaherty Horn Award, Clinical Care, Scholarship, Teaching, Leadership, Wellness and Care, Family Responsibilities

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In this episode, we walk through the BALANCE trial and use it as a lens to revisit how 1) host, 2) organism, and 3) source should guide treatment. When shorter really is enough, and when it isn’t?

🔹 Sponsor: Oakstone CME

Use the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 

🔹 Transcript and Shownotes

Timestamp

(02:58) | Host, Organism, Source: The Core Framework Behind Duration

(09:02) | How Evidence Shifted Practice

(11:27) | The BALANCE Trial: Short-Course vs Standard-Course Therapy

(18:55) | Where does this leave us?

Tags: CoreIM, Internal Medicine, Infectious disease, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education

How quickly can triglycerides rise? At what threshold are patients at risk of pancreatitis or cardiovascular adverse outcomes? What do you have to rule out? How do you counsel on lifestyle changes? Which medications do you start with why and when?

🔹 Transcript and Shownotes

(03:19) | Lipoprotein Lipase and Why Triglycerides Fluctuate Fast

(05:27) | Triglycerides as a Cardiovascular Risk Marker

(09:28) | Acute Management For Pancreatitis induced by Triglycerides

(14:34) | Lifestyle Counseling

(17:31) | Medications That Lower Triglycerides

(25:29) | How to Choose the Right Triglyceride Therapy

(27:56) | Genetic Causes and When to Suspect Familial Disorders

Tags: CoreIM, Internal Medicine, Lipidology, lipid, Cardiology, Metabolic Health, Triglycerides, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education, primary care

Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be at play in septic shock? What are the limitations of the VEXUS score?

🔹 Sponsor: Oakstone CME

Use the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes

(00:00) | Volume overload vs. Venous Congestion

(05:49) | Venous Congestion and AKI, mortality, possible delirium

(10:10) | Measuring Venous Congestion and the Role of VEXUS

(15:05) | Common Mistakes and Best Practices of VEXUS score

(23:13) | Assessing Fluid Tolerance and Risks with Venous Doppler in Acute Care

(25:29) | Fluid vs. Vasopressor Strategy Guided by Venous Assessment 

Tags: CoreIM, Internal Medicine, Critical Care, Nephrology, Cardiology, Fluid Management, POCUS, Ultrasound, Doppler, Hospital Medicine, Clinical Reasoning, Medical Education

SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how do you weigh their side effects and practical use?

🔹 Sponsor:

Use the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript and Show Notes

Timestamps:

(01:43) | Case 1: Managing Uncontrolled Diabetes in a 47-Year-Old Male

(07:15) | Understanding Cost and Insurance Barriers in Diabetes Care

(09:26) | Case 2: Addressing Weight Gain and Financial Stress in a 52-Year-Old Male

(14:16) | Case 3: Managing Coronary Artery Disease and CKD in a 66-Year-Old Male

(19:41) | Case 4: Severe Obesity and Pain Management in a 59-Year-Old Female

(24:19) | Case 5: High A1C and Vascular Comorbidities in a 67-Year-Old Female

(35:34) | Weighing Side Effects and Practical Use of GLP-1 and SGLT2 Inhibitors

Tags: CoreIM, Primary Care, Endocrinology, Diabetes Mellitus, Type 2 Diabetes, Type 1 Diabetes, Metformin, GLP-1, SGLT2, Insulin, CGM, A1C, DKA, Medical Education, Clinical Reasoning, Hospital Medicine

What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?

🔹 Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

 (00:12) | Introduction and Overview of Hepatorenal Treatment

 (03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine

 (12:32) | Finding the Right Dose of Albumin and Knowing When to Stop

 (15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine

 (21:42) | Understanding the High Mortality of HRS-AKI

 (32:30) | Transplant, Dialysis, or Palliation Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver Disease

HRS-AKI vs. other causes of AKI in cirrhosis: What do serum or urine sodium clues, albumin challenges, and shifting diagnostic criteria actually reveal about getting the diagnosis right?

🔹 Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

 (00:57) | Understanding the Pathophysiology of HRS

 (03:42) | How Portal Hypertension Traps the Kidneys

 (10:32) | Sorting the Differential of AKI in Cirrhosis Beyond HRS

 (18:28) | Hyponatremia and Urine Sodium in Advanced Cirrhosis

 (24:04) | Official Diagnosis and Evolving Criteria of HRS

 (29:30) | Albumin: When It Helps and When to Hold Back

 (34:00) | Recap and Future Directions

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Nephrology, renal, hepatology, Portal Hypertension, Liver Disease

Who’s really at risk for fractures, and how should we be treating them? 

Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown?

Find out all the nuances on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

🔹 Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(00:59) | Diagnosing Osteoporosis and Hidden Fracture Risk

(05:38) | Evolution of Bisphosphonate Use in Osteoporosis Treatment

(07:51) | Current Use of Bisphosphonates: Benefits, Risks, and Side Effects

(10:31) | Exploring Non-Bisphosphonate Options for Fracture Prevention

(11:44) | Teriparatide and Alternative Osteoporosis Medications

(14:53) | Inside the Latest Bisphosphonate Clinical Trial

(18:07) | Key Findings from the Zoledronate Fracture Prevention Study

(22:38) | Public Health Impact of Fracture Prevention Strategies

(24:24) | Final Takeaways and Expert Perspectives on Osteoporosis Care

Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone Health

Medications for orthostatic hypotension! When to initiate treatment, how to use them safely, and what to do when new issues arise during treatment. How do those change if someone has autonomic failure? What do you do when your patient has hypertension AND also has orthostatic hypotension?

🔹 Sponsor: Oakstone CME’

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps (+/- 1-2 mins):

(00:28) | Case Recap: Beyond Non-Pharm Strategies

(03:07) | Midodrine: Timing, Testing, & Supine Hypertension

(06:23) | Fludrocortisone: Benefits vs. Risks

(09:01) | Droxidopa: Evidence, Side Effects, Access Issues

(10:11) | Pyridostigmine & NSAIDs: Secondary Options

(12:31) | Balancing Hypertension and Orthostatic Hypotension

(14:29) | Functional Hypotension & Risk Stratification

(18:45) | Symptomatic Patients: What to Stop, What to Continue

(20:19) | Autonomic Disease: Supine & Nocturnal Hypertension

(21:47) | Bed Elevation, Compression, & Non-Pharm Pearls

Tags: Internal Medicine, Geriatrics, Autonomic Dysfunction, Hypertension, Syncope, Falls, Patient Safety, Medical Education, physician assistant, nurse practitioner, hospitalist, primary care, neurology

Learn specific, practical ways to counsel patients on non-pharmacologic interventions. What is our goal with OH treatment? Is it the blood pressure number that matters? How do we avoid missing neurogenic causes of orthostatic hypotension (OH)? 

🔹 Sponsor: Oakstone CME’

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(00:05) | Case Presentation: Urinary Retention → Lightheadedness

(02:37) | Defining Orthostatic Hypotension & Prevalence

(04:10) | Why Diagnosis Is Harder Than It Seems

(06:20) | How (and When) to Measure Orthostatic Vitals

(10:06) | Role of Heart Rate in Narrowing the Differential

(14:41) | Rethinking Treatment Goals: Function > Numbers

(17:52) | Recognizing Orthostatic Intolerance Symptoms

(22:14) | Non-Pharmacologic Strategies in the Hospital

Tags: Primary care, Internal Medicine, Physician Assistant, Nurse Practitioner, Geriatrics, Autonomic Dysfunction, Syncope, Falls, Patient Safety, Medical Education

Next time you’re squinting at a chest tube, feel confident you know exactly what to look for and why. Hear it explained in a way that really sticks!

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(02:50) | Xray vs. POCUS vs. CT for Pneumothorax Diagnosis

(07:29) | Do All PTXs Need Chest Tubes?

(11:55) | Explaining Pneumothorax to Patients

(14:58) | Understanding the Pleural Drainage System

(26:11) | Monitoring Air Leaks with the Water Seal Chamber

(32:27) | Managing Persistent Air Leaks

Tags: CoreIM, Internal Medicine, Pulmonology, Critical Care, Medical Education, 3-Chamber Drainage System, Endobronchial Valves and Pleurodesis

How do you work up neutropenia? When is neutropenia benign? When do neutrophils recover? How can you diagnose neutropenic fever in the first 15 minutes and start antibiotics in the first 60 minutes? Do you always add MRSA coverages? Only Pseudomonas coverage? When do you add fungal coverage?

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(02:24) | Approach to Neutropenia & Duffy Null

(11:38) | Dose and duration-dependent neutropenia vs. immune-mediated neutropenia

(19:46) | When do neutrophils recover?

(29:56) | Classifying Neutropenic Fever Syndromes

(29:53) | Strategies for Managing Low-Risk Neutropenic Fever

(33:02) | Antimicrobial Therapy and Duration in Febrile Neutropenia

Tags: CoreIM, Internal Medicine, Oncology, Hematology, Medical Education, Physician Assistant, Nurse Practitioner, Neutropenic Fever Management, Antibiotics

Have a good laugh and reflect deeply with these three stories that hit the feels in different ways.

If you'd love to hear more stories from Dr. Maria Rosasco, check out some of her other appearances on the podcast: July Stories and Handoffs & Contingency Planning.

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript and Show Notes

Timestamps:

(01:04) | Story 1: Sharing a Personal Story for Patient Care

(03:42) | Story 2: Leading a Family Meeting

(06:52) | Story 3: Early Days of the COVID-19 Pandemic

(10:22) | What Rituals and Values Guide Your Path in Medicine

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Narrative Medicine, Humanities

What went wrong? What were the reasoning or contextual missteps that led us astray?

🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply! Due Aug 1, 2025

🔹 Transcript and Show Notes

Timestamps:

(00:02) | Case Presentation and Initial Diagnosis

(02:47) | Tachycardia and Early Impressions

(04:10) | Clinical Deterioration and New Clues

(07:19) | Problem Representation and Reflection

(21:45) | Lessons on Reasoning and Bias

(26:55) | Final Takeaways and Action Steps

Tags: Clinical Reasoning, Internal Medicine, Diagnostic Accuracy, Hoofbeats, Cognitive Bias, Medical Education, Illness Scripts

• Imaging Pearls | (01:12)
• Deciding on Thoracentesis | (04:00)
• Light’s Criteria and Pseudoexudates | (07:00)
• Pleural Fluid Studies: pH and Cell Differential | (16:56)
• Diagnosing and Treating Parapneumonic Effusions | (23:32)
• Malignant Pleural Effusions: Diagnosis and Management | (30:39)

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript and Show Notes

Tags: Internal Medicine, Medical Education, Pulmonology, CoreIM, Clinical Reasoning, critical care, pulm

Listen for some good laughs and relatable stories!

In this episode, we share raw and real stories from July — from rapid responses to unexpected kindness — and reflect on the emotional weight of starting out in medicine.

🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply! Due Aug 1, 2025

🔹 Transcript and Show Notes

Prior July Stories:

July Stories 2.0 (2023)

July Stories (2019)

Timestamps:

(00:32) | Dr. Ali Trainor's First Day as an Intern

(03:00) | The Patient's Critical Condition and Emotional Response 

(07:12) | Dr. George Tran's First Night Shift 

(10:38) | Dr. Ali Trainor's Second Rotation Experience 

(14:01) | The Importance of Co-Intern

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Narrative Medicine, Humanities

How much do beta blockers help after a heart attack, even when the heart’s pumping well? In this episode, we revisit the origins of beta blockers in post-MI care, examine how evidence evolved, and explore the REDUCE-AMI trial, which questions whether beta blockers are still needed for all.

Listen to this latest episode of Beyond Journal Club, a collaboration between Core IM and NEJM Group, where we put research into context tracing the arc of evidence, dissecting the clinical question, and exploring what the findings could mean for real-world patient care

🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply!

🔹 Transcript and Show Notes

Timestamps:

(00:48) | Background on Beta Blockers and Their Mechanism

(02:41) | Historical Context of Beta Blockers in Heart Disease

(04:56) | Capricorn Trial and Its Impact

(07:17) | Emergence of Doubts About Beta Blockers

(10:09) | Introduction to the REDUCED-AMI Trial

(15:52) | Discussion on Trial Interpretation and Clinical Implications

(16:18) | Comparison with Other Trials and Future Directions

Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Cardiology

🔹 What is invasive fungal disease, and who is most at risk for developing invasive fungal disease? (~ 02:46)

🔹 What are the main classes of fungi? (~11:35)

🔹 What are the pros and cons of B-D Glucan and Galactomannan (~19:16)

🔹 How to increase the yield of blood cultures? How to interpret yeast growth in sputum/BAL and urine cultures? (~ 30:42)

🔹 How is invasive fungal disease treated? (~ 35:14)

📌  Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

📌 Transcript & show notes

Tags: CoreIM, IMCore, Infectious Disease, Hospital Medicine, Hospitalist, ICU, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, mold

🔹What are clinically relevant limitations of an A1c vs. a CGM (1:40)

🔹What do the different parts of the ambulatory glucose profile tell you? (09:59)

🔹What are common pitfalls, medications, lifestyle patterns that are important to ask your patient about when seeing them for a visit to manage blood sugar? (15:19)

🔹 How can you titrate insulin based on when you see the hypoglycemia on the ambulatory glucose profile (20:00)

🔹 When there is too much hyperglycemia, how do you titrate insulin when adding on GLP-1 agonists? (26:30)

📌 Sponsor:  NEJM Fellowship Program, click here to learn more and/or apply!

📌 Transcript & show notes

Tags: CoreIM, IMCore, Endocrinology, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, diabetes management, insulin titration

🔹When is an U/S vs. CT vs. MRI helpful before consulting Interventional Radiology?

🔹What factors go into an IR pre-op evaluation?

🔹 When do drains go in, and when do they come out?

🔹 When a patient has trouble with a drain, what are things you can do before calling IR?

🔹 What does outpatient IR follow up entail, and what does a capping trial of PCN tubes entail?

📌  Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26:  https://www.coreimpodcast.com/MKSAP

Transcript & show notes

Tags: CoreIM, IMCore, Gastroenterology, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, Medical Imaging, Bleeding Assessment, Drain Management, Procedural Sedation

🔹 High-yield reversible causes of constipation? (02:26)

🔹 Which type of fiber is more helpful? And is more hydration really better? And bulk-forming laxatives (9:03)

🔹 Osmotic vs Stimulant Laxatives (15:06)

🔹 Suppositories and enemas? (25:39)

🔹Best practices with opioid induced constipation (34:05)

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📌 Transcript and Show Notes

Tags: CoreIM, IMCore, Gastroenterology, GI Pharmacology, Digestive Health, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, Laxatives, Stool Softeners, Senna, Bisacodyl, Polyethylene Glycol, Bowel Regimen, Magnesium Citrate, Lactulose

How good are we at preventing HIV? How do efficacy and effectiveness differ? We journey from oral pre-exposure prophylaxis (PrEP) to long-acting injectables, and then to the PURPOSE trials, which look at the use of long-acting lenacapavir as PrEP — a potential game-changer in the field of HIV.

Listen to this latest episode of Beyond Journal Club, a collaboration between CoreIM and NEJM Group, where we put research into context, telling the story of how we arrived at the current standard of care, appreciating the clinical question of the trial at hand, and interpreting what the findings may mean for these patients.

🔹 Sponsor:  NEJM Fellowship Program, click here to learn more and/or apply!

🔹 Transcript and Show Notes

Timestamps:

(02:25) | HIV PrEP Daily Truvada and Descovy

(07:48) | On-Demand Prep

(13:25) | Purpose Trials

(20:56) | Discussion of Effectiveness to Efficacy

Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, HIV Prevention, Infectious Disease

What does Lipoprotein(a) tell us that a standard lipid panel doesn’t? Should we be testing everyone for it? Dive into the genetics, clinical implications, and evolving management strategies for Lp(a). Learn how to interpret results, counsel patients, and navigate topics with limited data like aspirin and PCSK9 inhibitors in treatment.

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🔹 Transcript and Show Notes

Timestamps:

(02:17) | Pearl 1: What makes Lp(a) unique? How does it raise ASCVD risk?

(10:32) | Pearl 2: Who should be tested for Lp(a)? When and why?

(16:54) | Pearl 3: Understanding and interpreting Lp(a) levels

(24:04) | Pearl 4: How does an elevated Lp(a) affect management?

(37:05)| Pearl 5: The role of aspirin and PCSK9 inhibitors in Lp(a)

Tags: CoreIM, Internal Medicine, Primary Care, Preventive Cardiology, Atherosclerosis, Lipid Management, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student

A new way to think of clots beyond provoked vs. unprovoked: Learn all about how important it is to think about reversibility! What patient states affect the inherited thrombophilia testing? Learn the nuances and practical approaches!

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🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

Transcript and Show Notes

Timestamps:

(02:07) | Pearl 1: Reframing Provoked vs. Unprovoked to Reversibility

(09:12) | Pearl 2: How can Virchow's Triad help us categorize the etiology of a clot?

(17:01) | Pearl 3: What factors affect anti-thrombin III, Protein C and Protein S deficiency

(28:50) | Pearl 4: Is the Factor V Leiden or Prothrombin Gene Mutation as important as the family history?

(38:41) | Pearl 5: Spaced Repetition of Learning Points

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematology

What is the impact of microplastics on human health? How can we use observational data to support the argument that microplastics may lead to poor health outcomes?

Join us as we tackle these questions and discuss the APAChE study on microplastics and cardiovascular disease on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

🔹 Transcript and Show Notes

🔹 Behind The Scenes YouTube Video

This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

(02:24) | Introduction to Plastic's Key Players

(07:59) | Bradhill/Observational Work

(10:33) | APAChE Study Deep Dive

(18:03) | Discussion

📢 Special Thanks:

🎙️ Audio Editing: Jerome Reyes

📊 Graphics: Dr. Jimin Hwang

CoreIM, Environmental Health, Medical Education, IMCore, Public Health, Clinical Pearls, Physician, Medical Student, Nurse Practitioner, Epidemiology

What is the last sense to go? How can music create connection, ease anxiety, and help process emotions at the end of life? Join Dr. Jafar Al-Mondhiry, Dr. Harry Han, and music therapist Bryanna Tobin as they explore the power of music therapy in hospice care, sharing moving stories and clinical insights.

🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

🔹 Transcript and Show Notes

Timestamps:

(00: 39) | 1st: What is Music Therapy in Hospice?

(07:59) | 2nd: A Powerful Story

(14:19) | 3rd: Challenges in the Field of Music Therapy

Tags:  IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

Incidental fibrosis on CT —what now? What does prone imaging tell you? Is it fibrosis, aspiration, or atelectasis? And once you diagnose ILD, does the “alphabet soup” really matter for treatment? Antifibrotics vs. immunosuppression?

Plus, how do we bridge the gap when social barriers make care unsafe?

🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

Transcript and Show Notes

Timestamps:

(01:26) | Deep Dive 1

(06:38) | Deep Dive 2

(12:37) | Deep Dive 3

(21:13) | Deep Dive 4

(28:06) | Deep Dive 5

Tags: CoreIM, Internal Medicine, Pulmonology, Clinical Pearls, Medical Education, IMCore, Radiology, Hospitalist, Physician Assistant, Nurse Practitioner, Medical Student, interstitial lung disease

SPEP vs. UPEP? What does it tell you and not tell you? What is the role for immunofixation and free light chains in diagnosis? Learn about paraneoplastic antibodies with MGCS and its renal, neurologic, and dermatologic manifestations!

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Behind The Scenes Youtube Interview with Dr. Vincent Rajkumar

Transcript and Show Notes

Timestamps:

(01:26) | Pearl 1: What is a monoclonal gammopathy? What is our expected clinical presentation?

(10:12) | Pearl 2: What is our initial workup? Understanding SPEP, Immunofixation, and Free Light Chains

(24:13) | Pearl 3: Do we need urine testing? When urine testing is necessary and when it is not.

(26:26) | Pearl 4: How should we differentiate monoclonal gammopathies? The continuum of MGUS, SMM, and MM.

(41:35) | Pearl 5: Demystifying Monoclonal gammopathy of clinical significance (MGCS)

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine

How do you differentiate immune checkpoint inhibitor-related adverse events aka IrAEs from other conditions like infection? Join as we go through pneumonitis, colitis, dermatitis and endocrinopathies due to immune checkpoint inhibitor toxicity!

Transcript and Show Notes

ICIs & IrAEs 101 Episode

Behind The Scenes video

Sponsor:

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Timestamps:

(03:14) | Pearl 1

(13:34) | Pearl 2

(24:42) | Pearl 3

(30:34) | Pearl 4

(35:21) | Pearl 5

Tags: CoreIM, Internal Medicine, ClinicalPearls, Skin Toxicity, Medical Education, IMCore, oncology, hospitalist, physician assistant, nurse practitioner, medical student

YouTube Videos

1. Anion Gap Metabolic Acidosis: https://youtu.be/oE0lygmMANM
2. Inhaler Delivery Systems: https://youtu.be/yYPdjClm9Bg
3. Iron Deficiency in Pregnancy https://youtu.be/xTzYSXUbLsc

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

01:27 | Anion Gap Metabolic Acidosis (Dr. Nick Villano)

02:52 | Inhaler Delivery Systems (Dr. Allie Sheridan)

04:44 | IDA in Pregnancy (Dr. Michael Auerbach)

Tags:IMCore, Medical Education, IDA, hospitalist medicine, hospitalist, primary care, nurse practitioner, chalktalks, hematology, asthma, COPD, pregnancy care, Medical Podcast, Clinical Teaching

What’s the evidence been for the use of PPIs in mechanically ventilated patients? What do more recent studies reveal about PPIs and possible harmful side effects of aspiration pneumonia and C. difficile colitis? To find out, tune into the second season of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

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Timestamps:

(02:13) | Define the problem / Clinically important bleeding Outcome/Risk benefit /Risk factors]

(05:58) | Hx and H2 antagonists

(10:42) | SUP-ICU

(15:12) | PEPTIC

(19:30) | REVISE trial

(27:28) | Deprescribing

(29:06) | Outstanding questions

Transcript and Show Notes

Tags: CoreIM, InternalMedicine, CriticalCare, Proton Pump Inhibitors, GIbleeding, ICU, ICU bleeding, Clinical Trials, Evidence Based Medicine, Patient Centered Outcomes, Deprescribing

Why are we missing peripheral arterial disease (PAD)? How is it diagnosed using the Ankle-Brachial Index (ABI)? What treatments improve symptoms and reduce cardiovascular risks? When should revascularization be considered?

Transcript and Show notes

Behind The Scenes YouTube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:23) | PEARL 1: When to suspect PAD? Risk factors?

(07:34) | PEARL 2: How to work up PAD?

(16:26) | PEARL 3: Improving symptoms and quality of life 

(25:38) | PEARL 4: Approach to therapy: Preventing CV mortality 

(33:53) | PEARL 5: Deeper Dive into Antithrombotic Therapy and Anticoagulation 

(39:09) | PEARL 6: Who needs revascularization? 

Tags: CoreIM, PAD, Peripheral Arterial Disease, ABI, claudication, vascular medicine, revascularization, internal medicine, smoking cessation, lipid management, primary care, physician assistant, nurse practitioner, cilostazol. supervised exercise therapy

How is TPN and PPN similar and how is it different? When should each be used? How does bacterial overgrowth lead to complications? Does TPN cause diarrhea?

Transcript and Show notes

Behind the Scenes Youtube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:35) | PEARL 1: Basics of PN: What makes up parenteral nutrition?

(06:54) | PEARL 2: Indications and Contraindications for TPN and PPN: When should I order parenteral nutrition?

(13:40) | PEARL 3: Complications of parenteral nutrition: What are the common adverse effects of parenteral nutrition?

(19:41) | PEARL 4: Parenteral nutrition myths: What should patients know before they start TPN?

(23:56) | PEARL 5: Recap on Tube Feeds: How do we determine the amount of free water to give out patients on tube feeds?

Tags: IMCore, CoreIM, parenteral nutrition, TPN, PPN, clinical nutrition, nutritional support, complications, patient safety, gastrointestinal disorders, critical care, internal medicine, fluid management, ICU, Crit Care, GI, gastroenterology

Limitations to urine drug screening (UDS) in primary care? What are common false positives and false negatives with the urine drug screen test?

Transcript and Show notes

Behind The Scenes YouTube Interviews

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(03:01) | PEARL 1: Basics to Urine Drug Screen (UDS)

(08:03) | PEARL 2: Types of urine drug tests, and what are immunoassays (IA)?

(18:44) | PEARL 3: What are gas chromatography/mass spectrometry (GC/MS)-based tests?

(26:51) | PEARL 4: How do you address unexpected test results on a UDS?

(30:29) | PEARL 5: Throwback to “5 Pearls on Stigma in Opioid Use Disorder” episode

Tags: IMCore, CoreIM, primary care, urine drug screening, opioid use disorder, substance use, harm reduction, addiction medicine, clinical toxicology, patient safety, compassionate care

What if a patient can't afford hospice? Which medications do you deprescribe when on hospice? What happens when patients who are on hospice return to the hospital or ED?

Sponsor: Imagine leveraging A.I to do pre-charting before seeing a patient. Reach out to enterprise@glass.health to integrate Glass A.I into your EMR! For more on Glass or Glass Pro, Use the promo code: CoreIM

Behind the Scenes Youtube Interview

Show notes & Transcript

Hospice 101 Episode 1

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Timestamps:

A hospitalized patient elects to enroll in hospice, now what?

What treatments are typically covered  by hospice?

What medications to continue and discontinue?

Code status in hospice

Approaching the hospice patient coming back to the hospital

Hospice enrollment and re-enrollment is voluntary.

Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

Can the MINT trial change how we treat anemia in acute MI? The largest trial of its kind compared liberal vs. restrictive transfusion strategies in patients with myocardial infarction.

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Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:29) | History of Transfusion Guidelines/Studies

(06:49) | Pathophysiology of Anemia in heart disease

(10:04) | Transfusion in MI Studies

(13:45) | MINT Trial

(22:20) | Takeaways/Discussion

Tags: Tags: CoreIM, IMCore, cardiology, internal medicine, myocardial infarction, anemia, transfusion, physician assistant, nurse practitioner, pharmacist, clinical trials, MINT trial, transfusion strategies, restrictive vs. liberal transfusion, heart attack

Strategies to address moral distress and moral injury — hear from the experts on their work on the topic!

Transcript and Show notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:07) | Strategies for Addressing Moral Distress

(09:25) | Strategies for Address Moral Injury

(20:52) | Conclusion

Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, Medical Humanities, medical ethics

What is moral residue vs. moral injury vs moral distress? How do these concepts impact us as clinicians?

Sponsor: Whether you're looking to open your own practice or buy into a group, Panacea Financial understands the unique needs of physicians and offers tailored financial solutions. 

Transcript and Show notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(04:59) | Definitions

(06:50) | Moral Distress

(09:01) | Moral Residue

(09:01) | Moral Residue

(11:34) | Moral Injury

(13:32) | Causes of Moral Distress and Moral Injury

(18:18) | Consequences

Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, medical humanities, humanism

Listen to 3 cardiorenal cases that highlight that “without flow it really doesn't matter what you're doing with the diuretic!”

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Transcript and Show notes

Cardiorenal Considerations: 5 Pearls Segment

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Timestamps:

(01:53) | Case 1: Diuretic Resistance from Ascites and Intra-abdominal Hypertension

(09:57) | Case 2: Diuretic Resistance from Low Cardiac Output

(26:34) | Case 3: Diuretic Resistance from Inadequate Renal Perfusion Pressure

Tags: IMCore, CoreIM, Diuretics, Cardiorenal, Medical Education, nephrology, cardiology, CCU, ICU, critical care

Signouts! How can we do them better? Hear these memorable stories & ask yourself these FIVE questions when getting your handoff ready for the covering team.

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Use promo code COREIM for 1 month of free access to Glass Pro for unlimited A.I queries !

Show notes & transcripts

Behind the Scenes YouTube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:44) | What makes this patient different from others with similar symptoms or diagnosis?

(07:28) | Does your covering team have the tools to follow up on tasks and information they need for success? 

(16:06) | Is the handoff updated? 

(18:26) | What information about goals of care and prognosis should be communicated to the night team, especially for critically ill patients? 

(22:41) | What are we still uncertain about? 

(25:30) | Closing thoughts 

Tags: IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalist

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Behind the Scenes Youtube Interview

Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(03:04) | What is the philosophy of hospice?

(06:13) | Who qualifies for hospice?

(08:17) | Who makes up the hospice team?

(17:24) | Who pays for hospice?

(21:31) | What are the different levels of care?

(31:57) | What are some limitations of the hospice medicare benefit?

Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

Dive into 4 microskills from the book “Microskills: Small Actions, Big Impact” that offer tangible tools for navigating the professional world with grace and intention.

Book by Dr. Adaira Landry, Dr. Resa E. Lewiss:

MicroSkills: Small Actions, Big Impact

Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Tags: IMCore, CoreIM, primary care, humanities, nurse practitioner, pharmacist, physician assistant

Does colonoscopy prevent colon cancer, and does it save lives? There has never been a randomized controlled trial on screening colonoscopies before NordICC trial, even though it is a guideline based recommendation for everyone over 45! How did this come to be? What do we tell our patients who are on the fence about undergoing screening colonoscopy? To find out, tune into the sixth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group. 

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Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamp:

(00:00) | Introduction

(02:28) |Pathophysiology of Colorectal Cancer & Why Screening Makes Sense

(06:15) | General Cancer Screening – Observational Studies

(09:17) | General Cancer Screening – Randomized Controlled Trials

(14:40) | NordICC Trial

(22:36) | Implications for Patient Care

Tags: IMCore, CoreIM, primary care, gastroenterology, nurse practitioner, pharmacist, physician assistant, sigmoidoscopy, per protocol analysis and intention to treat analysis

Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! 

Use the code CORE50 to get 50% off your first month with Freed

Behind The Scenes YouTube Interviews

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:59) | What causes HFpEF?

(11:22) | Does diastolic dysfunction imply HFpEF?

(19:21) | Is the BNP level helpful in HFpEF?

(25:06) | What scoring systems can be helpful in ruling in HFpEF?

(32:03) | What's the treatment for HFpEF?

Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, heart failure with preserved ejection fraction

Sponsor: At Panacea Financial, you don't need co-signers for personal loans and have reduced payments during training!

Behind the Scenes YouTube Interview

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:56) | How do immune checkpoint inhibitors work?

(07:15) | How do you organize the different immune-related adverse events (irAEs)?

(13:42) | Generally, when do different adverse events can present?

(22:20) | What makes someone more likely to develop an adverse effect?

(26:38) | What role does complementary & alternative medicine play in this patient population?

Tags: Side effects, oncology, cancer, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, pharmacology

Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! 

Use the code CORE50 to get 50% off your first month with Freed

Get CME-MOC credit with ACP!

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:05) | Urinalysis in a patient with AKI from purely cardiorenal syndrome?

(08:47) | What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide?

(18:08) | How can spot urine sodium measurements be used to assess diuretic response?

(27:35) | What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis?

(35:08) | Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD?

Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistance

What are the benefits of early rhythm control versus rate control alone? When is electrical cardioversion used and what information can it tell us? What side effects for amiodarone, dofetilide, and sotalol, propafenone and flecainide? When should catheter ablation be considered in patients with atrial fibrillation?

Behind the Scenes YouTube Interview

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Time stamps:

(02:05) | Pearl 1 - Rhythm control

(11:23) | Pearl 2 - Electrical cardioversion

(17:53) | Pearl 3 - Class III antiarrhythmics and side effects

(26:31) | Pearl 4 - Class Ic antiarrhythmics and side effects

(31:55) | Pearl 5 - Catheter ablation

Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, atrial fibrillation

Should your patients be reaching for albuterol when their asthma flares up? Some of us may have been treating asthma exacerbations incorrectly for many years… What is the right approach? Tune in to the fifth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group, to learn about the latest asthma management trials and guidelines, and how to translate them into better patient care.

Show Notes & Transcript

Timestamps:

(01:47) | Evolving story of asthma management

(03:26) | Pathophysiology of asthma management

(06:01) | Key players & terms

(08:56) | Story of asthma through the decades

(17:55) | MANDALA Trial

Tags: IMCore, CoreIM, primary care, pulmonary, nurse practitioner, pharmacist, physician assistant, inhalers

How do you choose btw PO vs. IV iron? What is the best counseling for oral iron formulations? How do you choose between different IV iron formulations? Should you use the Ganzoni formula?  What is a Fishbane reaction? And how is it different from anaphylaxis?

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Behind the Scenes YouTube Interview

Transcript and Show Notes

Time stamps:

(02:09) | Spaced repetition from the last Gray Matters Episode

(05:29) | Choosing between oral and IV iron

(11:17) | Considerations with oral iron repletion

(24:02) |Considerations with IV iron repletion

(32:36) | Complications and side effects of IV iron

Tags: hematology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant

What do the different iron labs mean?! How to interpret iron labs in the setting of inflammation? How to take a good menstrual history?

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Behind The Scenes YouTube Videos

Transcript and Show Notes

Time stamps:

(03:43) | Iron deficiency labs and interpretation in inflammation

(16:08) | Heavy menstrual bleeding evaluation

(27:04) | When should a premenopausal woman with iron deficiency have endoscopy?

(35:15) | Recap

Tags: hematology, women's health, gastroenterology, heavy menstrual bleeding, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, iron deficiency diagnosis

Uncover many blind spots on tube feeds!

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Behind the Scenes Youtube Interviews: 

• Short-term enteral access
• Durable enteral access
• What is venting aka decompression?

Show Notes & Transcript

Timestamps:

(02:21) | Indications for tube feeds

(09:36) | Routes of enteral access

(19:20) | Components of tube feeds

(27:03) | Tube feeds complications

(34:50) | Counseling patients before discharge and medication interactions

Tags: IMCore, CoreIM, nursing home, primary care, dietician, nutrition support, hospital medicine, interprofessional education, enteral feeds

How do you manage GDMT in a frail older adult? When is a guardian needed and what is the process for obtaining guardianship?

Sponsor: Echonous, the maker of Kosmos, is redefining point-of-care ultrasound at half the price (or less) of comparable carts. Mention Core IM at the Demo to get a free A.I application of choice!

Behind The Scenes YouTube Interview

Show Notes & Transcript

Timestamps:

(04:03) | Deep Dive 1: How do you approach guideline-directed medical therapy of heart failure with reduced ejection fraction in a frail older adult?

(11:55) | Deep Dive 2: When is a guardian needed and what is the process for obtaining guardianship?

(28:30) | Deep Dive 3: How do you re-evaluate GDMT in a frail older adult once an adverse event has occurred?

(33:27) | Reflections

(37:06) | Recap

Tags: IMCore, CoreIM, nursing home, primary care, cardiology, palliative care hospital medicine, interprofessional education, social work, case management

How do you counsel patients eligible for the RSV vaccines? What do the results of the RENOIR and AReSVi trials tell us and how do they compare? How should we interpret vaccine trials in the first place? Tune in to the fourth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group.

Sponsor: Pathway FREE evidence-based clinical decision support app. Guideline summaries, interactive algorithms, landmark trials & more

Show Notes & Transcript

Time Stamps:

(02:30) | Epidemiology of RSV

(03:46) | Development of RSV vaccine

(05:55) | Vaccine trial design

(12:22) | ARESVI and RENOIR Trials

(18:18) | Who should we recommend the RSV vaccine to?

(19:50) | What don’t we know?

Tags: IMCore, CoreIM, primary care, infectious disease, nurse practitioner, pharmacist, physician assistant

When you see a low mag or a low phos, what are you thinking about? And do PPIs effect magnesium absorption? How much sodium and potassium are found in a typical oral phosphorus supplement?

Sponsor: Pathway FREE evidence-based clinical decision support app. Guideline summaries, interactive algorithms, landmark trials & more

Youtube interview on key points on magnesium

Youtube interview on key points on phosphate

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamps:

(01:37) | Pearl 1: Magnesium

(09:39) | Pearl 2: Framework for hypomagnesemia

(16:53) | Pearl 3: Magnesium repletion

(22:39) | Pearl 4: Phosphorous

(28:36) | Pearl 5: Phosphorous repletion

Tags: IMCore, CoreIM, nephrology, hospital medicine, interprofessional education, renal

Sharpen your de-escalation skills!

Sponsor: GlassHealth | Get unlimited A.I queries for 1 month with promo code: COREIM !

Timestamps:

• 02:26 Difficult Patients
• 10:25 Mediation Toolkit
• 17:20 Maxims of Mediation
• 26:46 When the Conversation Still Breaks Down
• 35:11 Conclusion

Tags: IMCore, CoreIM, ethics, humanities, nurse practitioner, pharmacist, physician assistant, burnout

In community-acquired pneumonia, can steroids improve mortality? Past studies of steroids in CAP have been conflicting, with some showing a mortality benefit and others showing no difference. How does the CAPE COD trial change how we think about patients hospitalized with severe CAP? To find out, tune into the third episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group.

Show Notes & Transcript

• 01:50 Pathophysiology of Steroids and Infection
• 03:50 Steroids in PNA Studies
• 08:56 CAPE COD Trial
• 14:13 Discussion of CAPE COD Trial
• 18:36 Takeaways/Discussion

Tags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistant

Syncope history, PPM/ICD prior to MRI or surgery, anticoagulation for pacemaker or ICD procedures and new cardiac devices and how they may look different on EKG or chest x-ray!

Sponsor: Post Investment: Real Estate Syndications 

Show Notes & Transcript

Timestamps:

• 01:13 Pearl 1: Should we approach syncope history differently in our patients with pacemakers and ICDs?
• 06:31 Pearl 2: Considerations for patients with implantable devices before surgery.
• 12:26 Pearl 3: Considerations for patients with implantable devices before MRI.
• 14:45 Pearl 4: Anticoagulation in patients undergoing pacemaker or ICD procedures. 
• 18:17 Timestamp 5: Emerging cardiac device technology and how they might look different on EKG or chest x-ray

Tags: IM Core, CoreIM, cardiology, prodromal symptoms, CRT, biventricular pacing

Is Cr or Cystatin C better to assess eGFR? What are pros & cons of each? Does eGFR tell the full picture of kidney function? What may cause false positive albuminuria?

Sponsor: Panacea Financial Student Loan Consultation

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamp:

00:13 Reviewing CKD Classification: G1-5 stage, A1-3 stage

04:20" What's wrong with how we estimate GFR?

06:50 Why is creatinine flawed as an estimator of GFR?

10:52 Enter new contender...Cystatin C!

16:16 Importance of the A Stage!

20:21 Which patients should you measure proteinuria in?

22:10 Treatments for albuminuria!

24:27 Summary and Closing

Tag: Creatinine, nephrology, renal, CoreIM, IMcore, internal medicine, primary care, nurse practitioner, physician assistant

Check out the original interview on Youtube:

Essentials on Genetic Counselor | Lynch Syndrome

Who should be referred for genetic counseling? How can we set our our patients and genetic counselors up for success? And let's do some genetics myth busting!

Behind the Scenes YouTube Interview

Show Notes & Transcript

Timestamp

• 03:13 Part 1: Who should be referred to genetic counseling?
• 11:23 Part 2: How do we set up genetic counselors for success?
• 22:38 Part 3: Genetic counseling myth busting!

Tags: IMCore, CoreIM, primary care. oncology, surgonc, medonc, cancer, nurse practitioner, physician assistant

See some of the original interviews on Youtube!

What is the evidence behind K+ repletion? What is a framework to think through for hypokalemia? What are the different repletion formulations and what else can you do to mitigate hypokalemia? Stepping back, do we really need to get labs every single day?!

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Behind the Scenes YouTube Interview

Whiteboard Animation video

Timestamp

• 01:45 Pearl 1: Evidence for potassium repletion 
• 09:10 Pearl 2: Framework for hypokalemia
• 17:09 Pearl 3: Repletion goals
• 23:00 Pearl 4: Options for hypokalemia treatment
• 29:13 Pearl 5: Frequency of lab checks and repletion

Tags: IMCore, CoreIM, nephrology, hospital medicine, potassium diet, interprofessional education

What is the difference between semaglutide (ozempic) and tirzepatide (mounjaro) in outcomes and mechanism? How did we find out diabetes medications can help with weight loss?

Sponsors: Post Investment: Real Estate Syndications || Hellofresh  

Show Notes & Transcript

• 02:08 Framework for thinking about obesity
• 03:42 History of obesity treatment
• 06:29 Gila monsters and GLP and GIP mechanisms
• 08:29 Story of how medications for diabetes were found to have a weight loss benefit
• 12:50 SURMOUNT-1 trial

Tags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistant

With progressing CKD & HFrEF, what GDMT medications can you start, continue or stop? What does the data on hydralazine/isosorbide tell us and what does it NOT tell us? What are the pros and cons of starting GDMT inpatient versus outpatient? Do you still keep patients on GDMT once their EF recovers? 

Sponsors: Hellofresh | Pranay's Effective Living Formula Course

Pranay's Free Masterclass (Sept 20 and 27th at 5pm PST)

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamps

• 01:54 Pearl 1 – Recap of GDMT and CKD
• 09:15 Pearl 2 – Hydralazine and Isosorbide Dinitrate 
• 20:59 Pearl 3 – Ivabradine 
• 25:47 Pearl 4 – Inpatient vs Outpatient Initiation of GDMT
• 30:55 Pearl 5 – Ejection Fraction Recovery 

Tags: IMCore, CoreIM, hydralazine, heart failure reduced ejection fraction, HFmrEF, HFimpEF, chronic kidney disease, cardiology

What does medical education research say about improving diagnostic errors? What habits help in getting to diagnostic excellence?

Timestamps

• 01:00 System 1 vs. System 2
• 07:46 Cognitive Biases
• 13:46 Case for Knowledge
• 18:29 Other Practices to Decrease Error
• 28:26 Conclusion

CME: http://bit.ly/CIMCME || Show Notes & Transcript

This episode is made in part of ACP’s Diagnostic Excellence curriculum

Tags: IMCore, CoreIM, clinical reasoning, system 1 vs. system 2, cognitive bias, feedback and reflection

What are side effects of tacrolimus and mycophenolate? And what are common medication interactions? What causes of acute kidney injury are unique to renal transplant recipients When a patient has a fever, what are the viral syndromes we should work up? What are signs and symptoms of rejection?

Behind The Scenes YouTube Interview

Timestamps

• 02:41 Types of Immunosuppression
• 14:31 Medication Reconciliation
• 22:36 AKI in the Transplant Patient
• 31:53 Infections in the Transplant Patient
• 40:00 Transplant rejection, cancer after transplant

CME: http://bit.ly/CIMCME || Show Notes & Transcript

Tags: IMCore, CoreIM, renal, internal medicine podcast, hospitalist, nephrology, immunosuppressive

In patients with heart failure with low ejection fraction and chronic coronary disease without unstable symptoms, does stenting open blocked coronary arteries extend life or reduce hospitalizations? There is some literature to suggest those with low EF may benefit from revascularization with surgery.

How does the REVIVED trial change how we think about these patients? Tune in to the first episode in this new series brought to you by Core IM in collaboration with NEJM Group.

Show notes & Transcript

Access to Rotation Prep Cardiology guide on NEJM Resident 360 is free for August 2023. View the relevant sections on ACS and CHF.

Timestamps

• 00:50 Question REVIVED addressed
• 01:44 Revascularication in HFrEF
• 06:32 Revascularization in stable CAD
• 10:02 REVIVED trial
• 12:20 Summary and takeaways

Tags: IMCore, CoreIM, cardiology, internal medicine podcast, hospitalist, stent, CABG, evidence-based medicine

Laugh and be humbled along some of Dr. Maria Rosasco's most memorable July stories !

Listen to the original July Stories: https://bit.ly/3Y4n8jG

Behind The Scenes videos on YouTube

Subscribe to our new Youtube Channel !

Tags: medical humanities, internal medicine, residency, medical school, interprofessional education, rotation, imposter syndrome, feedback

BONUS on Cosyntropin stimulation tests! What exactly is it? How do you interpret them? What is the difference between adrenal insufficiency and steroid withdrawal syndrome?

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 

Behind The Scenes video on YouTube

Show notes & Transcript

Subscribe to our new Youtube Channel !

Tags: IMCore, CoreIM, endocrine, internal medicine podcast, hospitalist, glucocorticoid withdrawal, fatigue

How do you choose between the different steroids? At what dose and duration do you get concerned about worrisome complications? What types of prophylaxis should be started in patients on steroids and when?In which patients should we wean steroids vs. stop abruptly, and how should we do so? What factors limit steroid weaning?

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 

Subscribe to our new Youtube Channel !

Use this link for CME-MOC credit with ACP

Show notes & Transcript

• 02:59 Types of Corticosteroids
• 14:31 Side Effects of Steroids
• 21:15: Prophylaxis 
• 27:32 Steroid Weaning 
• 33:38 Steroid Weaning Limitations 

Tags: IMCore, CoreIM, endocrine, adrenal insufficiency, internal medicine podcast, hospitalist, hydrocortisone, fludrocortisone, methylprednisolone, prednisone, dexamethasone, steroid withdrawal syndrome

In cirrhosis, what actually contributes to the bleeding vs. clotting risk? Does the INR capture it? What is in FFP? Do you have to give FFP prior to a paracentesis and a thoracentesis? How much of FFP stays in the intravascular space? Does indwelling pleural catheters increase risk of malnutrition or infection?

Show notes & Transcript

• 02:36 Deep Dive 1: Bleeding risk of paracentesis and thoracocentesis
• 05:35 Deep Dive 2: FFP effect on bleeding risk
• 15:43 Deep Dive 3: Risks of FFP
• 19:45 Deep Dive 4: Indwelling pleural catheters
• 30:31 Recap

Tags: IMCore, CoreIM, hepatology, internal medicine podcast, hospitalist, heme/onc, pulmonary

How long can fatigue last for after radiation? Are all patient post radiation immunocompromised?  What are the potential acute and long-term side effects after lung, breast, prostate and brain radiation?

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 

Use this link for CME-MOC credit with ACP

Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

• 02:37 Systemic Radiation Side Effects
• 14:29 Lung Radiation Side Effects
• 18:22 Breast Radiation Side Effects
• 21:45 Prostate Radiation Side Effects
• 24:54 Brain Radiation Side Effects

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, rad onc, EBRT, brachytherapy

What are the different types of radiation? What should we and shouldn’t we put in our one-liners? What makes palliative radiation different from curative radiation? And when to refer to for palliative radiation?

Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

• 02:04 What is radiation?
• 03:17 How does radiation therapy work?
• 04:50 How is today’s radiation different from the past?
• 05:40 What role does radiation play in cancer treatment?
• 07:48 What are the different types of radiation?
• 15:34 How do you write a rad onc one-liner as an internist?
• 19:59 What is palliative radiation and how/when should we use it?

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, EBRT, brachytherapy

What did you have to "unlearn" in your learning journey? How do you organize your time? Organize how you keep up with medical evidence? What is your calendar management system? How can you use your leadership skills to improve the well-being of your team members?

Show notes & Transcript

• 01:12 Learning Journey
• 05:58 Lifelong Learning
• 11:14 Time Management
• 16:38 Role Modeling
• 19:59 Re-Calibrating Failure

Tags: IMCore, CoreIM, failure, fixed mindset, growth mindset, imposter syndrome, leadership, learning styles, role modeling, success, time management

What does the HbA1c really measure? What are its limitations? How does fructosamine and glycated albumin work? What will falsely elevate or decrease it? What are the benefits of continuous glucose monitoring? What are the limitations of a glucose-centric view and should we be more insulinocentric?

Show notes, Transcript and References

Time stamps

• 00:35 Random Glucose, Fasting Glucose, Glucose Tolerance Test
• 03:03 Hemoglobin A1c
• 08:26 Fructosamine and Glycated Albumin
• 10:50 Continuous Glucose Monitoring
• 15:44 The Overlooked Issue of Insulin Resistance
• 19:11 Summary

Tags: IM Core, CoreIM, insulin resistance, diabetes, microvascular and macrovascular complication

When do you have a device interrogated? Do you know what kind of device your patient has? Do you know how to manage patients with a device who develop bacteremia? How do you discuss end of life care in patients with devices such as a pacemaker or ICD?

• Visit www.medmastery.com/coreim for 15% off Medmastery Pro subscription. Discount code: “COREIM15”
• Use this link for CME-MOC credit with ACP
• Show notes, Transcript and References

Time stamps

• 02:51 What are the different types of pacemakers and defibrillators? Who is it indicated for? How can where the leads clue you what the implantable device may do?
• 21:28 How to determine which type of device your patient has?
• 25:10 What can a device interrogation tell you and doesn't tell you?
• 32:13 Do all patients with bacteremia need their implantable cardiac devices taken out? 
• 38:44 End-of-life considerations with pacemakers vs. ICDs 

Tags: IM Core, CoreIM, sinus node dysfunction, AV dissociation, palliative care, CRT, biventricular pacing

How does transplant compare to dialysis? Who is a good candidate for a kidney transplant? How long do patients have to wait for a deceased donor kidney transplant? What can increase or decrease the waiting time for your patient? Who is a good living donor candidate? What are the risks of living donors?

• Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 
• Use this link for CME-MOC credit with ACP
• Show notes, Transcript and References

Time stamps

• 03:49 Episode start
• 07:13 Dialysis vs. kidney transplant morbidity and mortality
• 11:44 Eligibility for kidney transplant and when to refer
• 21:34 Pre-transplant evaluation process
• 25:38 How long are wait times on the transplant list?
• 36:21 What benefits of living donation? What are risks to the kidney donor?

Tags: IM Core, CoreIM, renal, dialysis, nephrology, nephrologist, renal, CKD, chronic kidney disease, living donor kidney

What is your approach to trach complications? What do all the words in the one liner of a trach patient mean? What are best practices for airway clearance? When is a patient ready for a speaking valve? What is the process for decannulation?

Behind the Scenes YouTube Interview

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im 

Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E10

Show notes, Transcript and References: 

https://www.coreimpodcast.com/2023/03/08/trac/

Time stamps

2:56 Trach Components

12:47 Trach Complication Management

27:48 Airway Clearance

34:53 Speaking Valve

38:54 Decannulation

Tags: IM Core, CoreIM, pulmonary, critical care, ICU, nursing care, respiratory therapy, pharmacy

Why are safety net hospitals barely surviving? What makes a hospital a safety net hospital? How essential are safety net hospitals in caring for low income Americans? How do we pay for that care?

Show notes, Transcript and References:

https://www.coreimpodcast.com/2023/03/02/safety-net-hospitals/

Timestamps:

0:00 Hahnemann University Hospital

4:36 What is a Safety Net Hospital?

11:11 The Origins and Paradox of the Safety Net Hospital

Links to other episodes:

A Complex Patchwork of Supplemental Payments:

https://www.healthaffairs.org/do/10.1377/hp20221223.651856/full/

The Future of Safety Net Hospitals & Payment Policies:

https://www.healthaffairs.org/do/10.1377/hp20221223.105519/full/

Tags: IM Core, CoreIM, health policy, health disparities, insurance, medicare and medicaid

How does your problem representation change as we get more history in this episode? How can we use Oxaam's razor & Hickman's dictum as powerful diagnostic tools IF used properly?

Show notes, Transcript and References:  https://www.coreimpodcast.com/2023/02/15/25438/

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 

Time stamps

• 01:51 Intro
• 07:57 Case 
• 13:09 Differential
• 16:15 Diagnosis
• 22:20 Problem Representation 

Tags: IM Core, CoreIM, diagnostic tools, Occam's razor, Hickam's dictum, data collection, mental model, clinical reasoning, rheumatology

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 stamps

• 04:45 What do we mean by “futility”?
• 11:20 Definitions
• 20:23 Ethical Analysis
• 39:13 Recommendations

Tags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethics

Check out original interviews on our Youtube channel!

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?

Behind The Scenes videos

Get CME-MOC credit with ACP

Show notes, Transcript and References

Time stamps

• 01:12 Intro
• 03:51 Deep Dive 1
• 08:16 Deep Dive 2
• 15:25 Deep Dive 3
• 21:05 Deep Dive 4
• 27:07 Deep Dive 5

Tags: 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-E8

Time stamps

• 01:24 Intro 
• 03:37 Fasting vs. Nonfasting Lipid Panel
• 05:11 Current guidelines
• 07:43 Pathophysiology Overview
• 09:04 Pathophysiology of Apo-B vs. LDL-C with traffic analogy
• 11:23 Apo-B
• 15:40 TG-to-HDL ratio
• 17:06 Takeaways

Tags: 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-E7

Time stamps

• 01:20 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 Conclusion

Tags: 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 stamps

• 01:42 Intro 
• 04:37 Pearl 1: Diagnosis 
• 13:20 Pearl 2: Differential & Treatment
• 20:48 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-E6

ACP CME: http://bit.ly/CIMCME

Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/

Time stamps

• 03:03 Guideline recommendations 
• 07:00 How does Aspirin work? 
• 09:11 Trial Data
• 13:00 ASCVD Risk Calculator
• 18:07 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?

Whiteboard animation video on YouTube

Show notes, Transcript and References

Get CME-MOC credit with ACP

Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”

Timestamps:

• 01:37 Pearl 1
• 03:54 Pearl 2
• 13:53 Pearl 3
• 18:07 Pearl 4
• 29:30 Pearl 5

Tags: 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-E5

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/

Time stamps

• 01:30 Deep Dive #1
• 17:27 Deep Dive #2

Tags: 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?

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

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 stamps

• 04:51Overview of Microaggressions
• 08:11 Prevalence
• 11:43 How to respond
• 21:03 Barriers to appropriate response
• 26:00 Conclusion

Tags: 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-E4

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im 

Time stamps:

• 01:20 Intro
• 04:46 Pearl 1
• 13:13 Pearl 2
• 24:03 Pearl 3
• 32:49 Pearl 4
• 37:05 Pearl 5

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?

Show notes and Transcript: 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

Amboss Article on Hyponatremia

Tags: 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/3P8wqG6

Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions

Discount code: "coreim"

Time stamps

• 02:50 Deep Dive #1
• 13:12 Deep Dive #2
• 26:39 Deep Dive Recap

Tags: 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-E3

Timestamps:

• Pearl 1: 3:20
• Pearl 2: 8:20
• Pearl 3: 15:47
• Pearl 4: 26:55
• Pearl 5: 34:10

Tags: IMCore, CoreIM, Pulmonary, medication management, spirometry

How do you ask about spiritual health? How is spirituality different from religion?

Show notes, Transcript and References:

https://www.coreimpodcast.com/2022/06/15/spirituality/

Time stamps

• 00:01 What is spirituality?
• 7:12 Why does spirituality matter?
• 12:09 How do we screen for it?
• 18:50 Chaplains
• 27:49 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-E2

Timestamps:

• 1:33 Pearl 1
• 4:48 Pearl 2
• 18:43 Pearl 3
• 29:45 Pearl 4
• 35:22 Pearl 5

Tags: 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/GDMT

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im 

Time stamps:

• 03:13 Pearl 1
• 12:14 Pearl 2
• 20:36 Pearl 3
• 26:42 Pearl 4
• 32:16 Pearl 5

Tags: 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 Intro
• 04:26 Pearl 1
• 11:08 Pearl 2
• 20:43 Pearl 3
• 31:06 Pearl 4
• 35:06 Pearl 5

Tags: 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?

Whiteboard animation video on YouTube

Show notes, Transcript and References

Get CME-MOC credit with ACP

Time stamps:

• 02:18 | Intro
• 05:27 | Pearl 1 
• 12:17 | Pearl 2
• 16:13 | Pearl 3
• 24:04 | Pearl 4
• 30:08 | Pearl 5

Tags: 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 dieting
• 06:01 Counseling patients on diet
• 09:35 Food group recommendations
• 14:53 Pre-set diets
• 20:47 Making sustainable changes

Tags: 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 Anticoagulation
• 08:50 Deep Dive #2 DOACs
• 14:08 Deep Dive #3 IVC Filter
• 17:49 Deep Dive #4 Biopsy
• 25:00 Recap

Tags: 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 stamps

• 02:10 Make it Stick Virtually
• 08:35 Mentoring in the Modern Era: More than the Traditional Dyad
• 13:29 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 stamps

• 01:36 Case
• 10:42 Case analysis 
• 22:45 An unfamiliar domain
• 25:50 Lab review
• 40:04 Conclusions

Tags: 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 stamps

• 01:22 Unpacking the question 
• 01:55 The math 
• 04:32 Functional hemoglobin
• 08:50 Donor and Patient 
• 11:18 Scenarios
• 12:58 Summary
• 14:34 Clarification 

Tags: IM Core, CoreIM, hemoglobin, intravascular volume, irradiation, donation

Let’s apply to cases! We use the 7 questions framework to 3 practical cases

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/12/22/treatment-over-objection-part-2/

Time stamps

• 2:19 Case 1: Review of Framework
• 7:59 Case 2
• 9:04 Consent vs. Assent 
• 11:11 Role of Consult Services
• 13:16 Role of Surrogates
• 15:29 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 stamps

• 03:02 Ethical and emotional challenges
• 10:08 Case 1
• 18:55 Study of the 7 Questions
• 22:46 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 stamps

• 01:01 Introductions
• 07:58 Nutrition
• 17:13 Medications
• 20:48 Outpatient medications
• 26:16 Recap

Tags: 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 Visit
• 08:08 Mobility Assessment 
• 13:25 Cognitive Evaluation 
• 19:27 Medications 
• 26:29 Throwback Pearl

Show 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 therapies
• 14:49 Sodium Glucose Cotransporter-2 Inhibitors
• 16:27 Sulfonylurea & Thiazolidinediones
• 18:00 Basal Insulin inpatient

Show 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 Agenda

14:46 Exploring patient goals

18:54 Reducing drug use

24:09 Reducing harm in opioid use

29:06 Recap

Tags: 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 Introduction
• 04:01 Information Gathering
• 20:41 Informed Consent
• 29:47 Giving Recommendations
• 36:47 Mistakes
• 48:22 Wrap Up

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/12/code-status

Tags: 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?

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

What leads patients to search for alternative treatments than those offered in Western Medicine? How can we provide patients with safer complimentary interventions? How do we prioritize what is important in our patients health?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/10/15/approach-to-patients-with-cam-beliefs/

Time stamps:

• 01:49 Intro
• 04:54 What is CAM
• 06:29 Prevalence of CAM
• 08:01 Holistic approach to patient care
• 11:09 Patient empowerment
• 14:38 Integrating CAM
• 18:34 Risks and Benefits
• 19:50 Caution patients
• 22:29 Indirect Risk
• 23:45 Big Picture
• 26:04 Therapeutic Alliance
• 27:27 Conclusion

Tags: IM Core, CoreIM, supplements, homeopathic, naturopathic, Ayurvedic medicine, mind-body interventions, massage, acupuncture, and chiropractic manipulation, qi gong and Reiki

How can we feel more comfortable in treating these patients? What treatment options do we now have in our toolbox to fight COVID-19? How has the landscape changed in what we can offer patients?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/09/30/covid-management/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps

• 04:16 Supportive Care
• 07:48 Step-up approach to oxygenation
• 13:44 Data Points
• 15:30 Clots
• 19:13 Steroid use

Tags: IM Core, CoreIM, oxygenation, proning, anticoagulation

How do we respond to challenging times? Are you a driver of change? How can we forge ahead during times of adversity? What lessons can we learn from the stories of our peers and colleagues?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/09/16/transitions-episode/

Time Stamps:

• 02:48 Minneapolis 2020 with Dr. Uloko
• 06:44 Early HIV/AIDS with Dr. Kalet
• 12:07 Hurricane Sandy with Dr. Hwang
• 17:20 Aftermath of the Syrian Civil War
• 20:23 Transitions with Dr. Arora

Tags: Core IM, IM Core, change, inspiration, narrative medicine

What are common mistakes with protein on the UA? What questions should you ask while obtaining a history that could clue you into nephrotic syndrome? Are kidney biopsies risky business? Is there an associated clot risk in patients with nephrotic syndrome?

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Show note, Transcript and References: https://www.coreimpodcast.com/2020/09/02/5-pearls-on-nephrotic-syndrome/

Amboss Article on Nephrotic Syndrome: https://www.amboss.com/us/knowledge/Nephrotic_syndrome?utm_source=affiliate&utm_medium=link&utm_campaign=coreim-01

Time Stamps:

• 03:22 Evaluating Proteinuria
• 09:37 Nephrotic Syndrome specifics
• 22:31 Who to biopsy
• 31:39 Diuretics
• 37:16 Thrombosis Risk

Tags - CoreIM, IM Core, edema, proteinuria, kidneys, thrombosis, urinalysis, diuresis 

How tough is it to forge your career in clinical research? What struggles do physicians face in finding protected time? Are there setbacks and frequent rejections? How can you follow your passion and find success?

Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/19/research-careers…rs-in-gim-series/

Time Stamps:

1:28 Origins

6:57 Mentorship

14:30 Reality, Roadbumps, and Failures

18:17 The path of many fellowships

Tags - CoreIM, IM Core, clinical investigator, general internal medicine

Are fall prevention programs helping our patients? Should patients receive outpatient PT based on clinical diagnosis? How has the landscape changed because of insurance reimbursement?

Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/05/physical-therapi…education-series/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imTime Stamps:

• 01:47 Functional Assessment
• 07:47 Documentation
• 14:35 Outpatient PT
• 18:14 Durable Medical Equipment
• 22:55 Reimbursement

Tags: Core IM, IM Core, physical therapy, durable medical equipment, IPE, multidisciplinary team, interdisciplinary

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, CoreIM

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 case

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, IMCore

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 education

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

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

Episode Outline

1. Disconnection/connection: Patients
2. Disconnection/connection: Family/friends
3. Disconnection: Security, Certainty
4. Connection: Other clinicians

• Sharing fears, supporting each other)
• Shared ethos in healthcare (one workforce, no division of specialty or hierarchy)

1. 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 medicine

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 planning

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 wards

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 care

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

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 humanties

• What are the new guidelines for influenza treatment? What are the diagnostic ratios of flu symptoms and tests? Time Stamps03:10 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

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

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 ModuleTime 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?

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

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, CoreIM

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!

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?

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

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, IMCore

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 hello@coreimpodcast.com

Tag: normocytic anemia, splenomegaly, CoreIM, endocarditis, clinic case

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

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

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 reduction

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