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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 13:50 Barriers to care 28:44 Physician Health System Show notes, Transcript and References: https://www.coreimpodcast.com/2021/06/09/physician-clinician-impairment/ Tags: Core IM, IM Core, impairment, substance use disorder, mental health, stigma, treatment, cost

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

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

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

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

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

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

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

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

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

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

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-im Time 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