The Curbsiders Internal Medicine Podcast

Latest Episodes:

#131 A Case of Cough and Dyspnea Dec 17, 2018

Show notes

Hone your diagnostic skills with this mystery case of cough and dyspnea http://hdx.org/pdp (click link to follow along). The Curbsiders deconstruct the case and discuss their diagnostic schemas for these common problems with the help of returning guest, Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx.

Use this link http://hdx.org/pdp to follow along with the case on the Human Dx app or website and check out more Global Morning Report cases.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

00:00 Announcement, disclaimer, intro, guest bio
03:13 When and how to practice clinical reasoning
05:53 Creating diagnostic schemas and Clinical Problem Solvers Podcast
09:40 A bit on Human Dx and the show format
12:00 Case of a 40 yo male with a cough
23:22 Some insights from Reza on “signal versus noise”
37:10 Case conclusion/answer, cognitive autopsy and Reza’s take home points
45:36 Outro

#130 Work-Life Fit: Women In Medicine Dec 13, 2018

Show notes

Create a successful partnership and career withs tips from Wonder Woman, Sue Hingle MD of ACP.
Work-Life Balance: is it a myth, or attainable if we could just find the right fit? In this episode, we chat with Dr. Susan Hingle about identifying our work-life priorities and re-evaluating these priorities throughout our lives. We strategize about achieving personal and professional goals (pro tip: stop worrying about what others think!). Dr. Hingle is Professor in the Department of Internal Medicine and Vice Chair of Education and Faculty Development and Associate Internal Medicine Residency Program Director at Southern Illinois University. She is also the Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP). She has served at the ACP in a variety of ways, including as a member of the ACP Women’s Task Force. Her clinical expertise is in women’s health, health promotion, and disease prevention. Enjoy the episode!
ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.
Credits

Written and produced by: Nora Taranto MS4, Shreya Trivedi MD, Leah Witt MD, Sarah P. Roberts MPH.

CME Questions by: Shreya Trivedi MD

Editors: Matthew Watto MD and Chris Chiu MD

Hosts: Shreya Trivedi MD, Paul Williams MD, Leah Witt MD

Guest: Susan Hingle MD

Time Stamps

00:00 Disclaimer, intro and guest bio
02:52 Guest one liner, WIM Moment of awakening, advice for her younger self
07:45 Picks of the week
10:30 Physician with family and caregiver responsibility; How to plan for personal and professional goals
18:20 What to look for in a partner, how to work with them to achieve work life fit, and non-traditional roles
28:35 Advice on family planning
31:40 Residency programs and life events
32:55 Should you go part-time?
39:43 Work life balance? Or work life fit? And some examples/tips for success
49:54 Take home points
50:45 Outro

#129 Depression and Suicide: Occupational Hazards of Practicing Medicine Dec 10, 2018

Show notes

Dr Elisabeth Poorman MD joins us to discuss the natural history of physician depression in residency and beyond. We share some of our own personal stories, and discuss how we can support one another and reach out for help, how to take care of our mental health in an emotionally demanding career, how to deal with licensing questions and worry about stigma, and what systemic changes may be coming (read: we think need to be coming) down the line. The problem of depression and suicide is a particularly real one in medicine, a profession that is, by its very nature traumatic and emotionally draining (both in terms of work demands and also the sick and dying patients we treat).
N.b. This is a sensitive topic. If this is triggering for anyone listening, the national suicide hotline number 1-800-273-8255. Moreover, if anyone needs or wants guidance on available resources, Dr. Elisabeth Poorman has made herself available either via email, private msg on FB or twitter (@DrPoorman), or any of us on twitter. We are happy to talk and see that you get support you need.
Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.
Credits

Written and produced by: Nora Taranto MS4, Shreya Trivedi MD
Hosts: Stuart Brigham MD, Shreya Trivedi MD, Matthew Watto MD
Edited by: Matthew Watto MD
Guest: Elisabeth Poorman, MD

#128 Aspirin Overhyped and Overused Dec 03, 2018

Show notes

Aspirin’ to figure out if ASA can help prevent a heart attack? Interpreting all the new trials doesn’t have to cause chest pain! Join Dr. Ambarish Pandey from UT Southwestern as he helps The Curbsiders ASCEND the mountains of the latest studies to ARRIVE at some well-informed conclusions on the role of aspirin in primary prevention for cardiac events. The team also discusses secondary prevention, aspirin and dual (or triple) antiplatelet therapy, and whether it’s okay to stop giving aspirin to older adults without known CAD (Spoiler alert: it’s okay). ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Credits

Written and produced by: Justin Berk MD, Matthew Watto MD

CME questions by: Justin Berk MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD and Chris Chiu MD

Guest: Dr. Ambarish Pandey MD

Time Stamps

00:00 Disclaimer, intro and guest bio
04:15 Guest one liner, book recommendation, career and research advice
11:07 Case of aspirin for primary prevention, aspirin’s public persona, and nocebo effects of statins
21:40 ARRIVE and ASCEND trials
28:14 Aspree trial
32:38 Coronary artery calcium; aspirin use for secondary prevention
37:42 Dual antiplatelet therapy and the DAPT score
41:25 Should we continue aspirin when a patient also needs a DOAC?
46:14 Should we continue DAPT in a patient who needs a DOAC (or warfarin)?
49:40 Deprescribing aspirin for primary prevention in older adults?
50:51 Closing remarks
52:33 Outro

Hotcakes: Exercise, Aspirin, Fish Oil and Hypertension Nov 29, 2018

Show notes

Tony Breu MD joins us for some hotcakes, and “cold cakes” including: how aspirin and zodiac sign affect the treatment of acute MI, a recent study on how exercise is probably still good for you, the recently announced REDUCE-IT trial, and the evidence (or lack thereof) for the treatment of hypertensive urgency. Welcome to another edition of Hotcakes and Hot Takes, where we discuss the most interesting articles and news that we have been reading. Special guest is the prolific Dr. Tony Breu (@tony_breu) who is an Assistant Professor of Medicine at Harvard Medical School and a Hospitalist and Director of Internal Medicine Resident Education at the VA Boston Healthcare System. He is known for his series on "Things We Do For No Reason” as well as his thought-provoking “Tweetorials” online. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST on day of release).

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD

CME Questions: Christopher Chiu MD

Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD

Guest Presenter and Content Planning: Anthony Breu MD

Editor: Christopher Chiu MD

Cover-Art: Christopher Chiu MD

Time stamps

00:00 Disclaimer, intro, guest bio
05:53 Discussion on Tweetorials
08:00 Cold Cake: ISIS-2 and the treatment of acute MI with aspirin
14:04 ISIS-2 and zodiac subgroup analysis
16:19 What is the relationship between cardiorespiratory fitness on mortality?
24:40 Discussion of the REDUCE-IT study
33:00 Cold Cake: VA Cooperative study and the evidence for treating essential hypertension
36:42 TWDFNR and the treatment of hypertensive urgency
46:36 Wrap-up and outro

#127 STIs: Syphilis, Gonorrhea and Chlamydia Nov 26, 2018

Show notes

Master the diagnosis and management of common STIs (sexually transmitted infections) with tips from expert, Dana Dunne MD, Associate Professor of Medicine in Infectious Diseases at Yale. Topics include: the stages and many presentations of syphilis, syphilis treatment and counseling, the natural history, diagnosis, and screening guidelines for gonorrhea and chlamydia, treatment options in the age of growing resistance, and a discussion of partner notification and treatment.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Bryan Brown MD

Hosts: Bryan Brown MD, Paul Williams MD, Matthew Watto MD

Guest: Dana Dunne MD

Special thanks to Kate Grant MBChB, Dip GUMed for her contribution of knowledge and artwork.

Time Stamps

00:00 Announcement, disclaimer, intro and guest bio
04:29 Guest onliner, book recommendation, advice for learners/teacher, and picks of the week
11:00 A case of syphilis, clinical manifestations and discussion of the stages
26:05 Testing for syphilis
39:05 Mandatory reporting and partner tracing
42:40 Counseling patients with syphilis
44:44 A case of gonorrhea and chlamydia, clinical manifestations, screening guidelines
52:30 How to counsel patients to obtain samples from urethra, rectum, vagina, oropharynx; Mycoplasma genitalium
59:40 CDC treatment guidelines, Super gonorrhea, test of cure, and treatment of partners
72:35 Take home points
74:30 Outro

#126 Kashlak Morning Report with Human Dx Nov 19, 2018

Show notes

Practice solving diagnostic puzzles with The Curbsiders and Internist / Diagnostician, Reza Manesh MD, Assistant Program Director for Clinical Reasoning of the Osler Medical Training Program at Johns Hopkins! Solve along with us at these links: Case 1 http://hdx.org/I2B and Case 2 http://hdx.org/uM2. Topics include: clinical reasoning terminology, how to use cases to practice diagnostic reasoning, how to build a diagnostic schema, and how to conduct your own cognitive autopsy.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Hannah Abrams

Hosts: Hannah Abrams, Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Doctors Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing cases

Time Stamps

00:00 Disclaimer, intro and guest bio
04:02 Guest one liner, book recommendation, favorite failure, advice for learners
11:27 Human Dx Project and Global Morning Report
15:35 Diagnostic terminology
21:25 Case #1, Reza solves
33:40 Diagnostic autopsy and teaching points for case #1
38:00 Case #2, The Curbsiders solve
57:30 Diagnostic autopsy and teaching points for case #2
61:33 Take home points and a plug
64:30 Outro

#125 Hidden Curriculum Nov 15, 2018

Show notes

Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Credits

Written and produced by: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD

CME questions by: Justin Berk MD

Editors: Chris Chiu MD & Matthew Watto MD

Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD

Guest: Sanjay Desai MD

Time Stamps

00:00 Disclaimer, Intro and guest bio
04:00 Guest one liner, book recommendations, career advice
10:50 Intro to the hidden curriculum and ACP’s three recommendations
22:00 Case #1: A patient with schizophrenia
32:10 Case #2: The iPatient
38:07 Case #3: Attending forgets to wash their hands
41:10 Case #4: A dying patient’s primary care doctor saves the day
46:26 Case #5: A case of violating duty hours
60:10 Take home points
62:00 Outro

#124 The Shoulder - Simplify Your Approach Nov 12, 2018

Show notes

Shoulder pain made simple. Develop your confidence and skills with tips from sports medicine specialist Dr. Carlin Senter MD. We discuss her simplified approach to the basic shoulder exam, including when and how to do special tests, high yield exam maneuvers, when to refer shoulder pain patients to orthopedic surgery, and who can be managed conservatively.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Molly Heublein MD and Nora Taranto MS4

Editor: Matthew Watto MD

Hosts: Molly Heublein, MD, Paul Williams MD, Matthew Watto MD

Guest: Carlin Senter, MD

Time Stamps

00:00 Disclaimer, intro, and guest bio
03:15 Guest one liner, book recommendation, career advice, and some picks of the week
13:20 Clinical case of shoulder pain; helpful historical features
18:54 Differentiating referred pain from c-spine pathology from shoulder pathology
21:00 A framework for shoulder pain, HIP-ROT, and using ROM to generate a differential
27:40 Frozen shoulder aka adhesive capsulitis
31:57 Glenohumeral joint arthritis
33:52 Rotator cuff disease
40:53 Specific testing for rotator cuff tears
51:45 Impingement syndrome versus bursitis
56:25 Counseling patient with shoulder pain or injury
59:03 Steroid injections, topical therapy, and AC joint arthritis
65:18 When to refer to surgery and some take home points

#123 Sleep Apnea Pearls and Pitfalls Nov 05, 2018

Show notes

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Cyrus Askin MD

CME questions by: Cyrus Askin MD

Editor: Chris Chiu MD & Matthew Watto MD

Hosts: Cyrus Askin MD & Matthew Watto MD

Guest: Barbara Phillips, MD

Cover-Art & Infographic - Beth Garbitelli, MS1

Time Stamps

00:00 Disclaimer, intro, guest bio
03:00 Guest one liner, book recommendation, advice for trainees
08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea
12:38 Barriers to diagnosis and treatment of OSA
15:23 Discussion of T90, hypoxemia and sleep fragmentation
17:05 How to read a sleep study report
21:55 Home sleep apnea testing
24:15 What are the consequences of sleep apnea
28:30 What is the efficacy of cpap for lowering blood pressure and mortality
31:45 Counseling a patient who is new to cpap
33:45 Choice of mask
40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices
44:17 Modafinil and z-drugs
47:15 Driver’s license issues in sleep apnea
48:35 Future of sleep medicine and take home points