Core IM | Internal Medicine Podcast

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.com Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.com Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.com Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.com Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.com Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Branch Basics and use the code COREIM for 15% off: https://branchbasics.com * Check out FIGS and use code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Branch Basics and use the code COREIM for 15% off: https://branchbasics.com * Check out FIGS and use code FIGSRX for a great deal: https://wearfigs.com * Check out Tempo Meals for 60% Off: https://tempomeals.com/COREIM * Check out Uncommon Goods for 15% off: https://uncommongoods.com/COREIM * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Branch Basics and use the code COREIM for 15% off: https://branchbasics.com * Check out FIGS and use code FIGSRX for a great deal: https://wearfigs.com * Check out Tempo Meals for 60% Off: https://tempomeals.com/COREIM * Check out Uncommon Goods for 15% off: https://uncommongoods.com/COREIM * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Branch Basics: https://branchbasics.com/COREIM and use the code CoreIM for 15% * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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: (01:42) | Starting Treatment for Newly Diagnosed Type 2 Diabetes (08:40) | Balancing Cost, Coverage, and First-Line Therapy Choices (13:44) | Choosing Therapy for CAD and CKD: The Case for SGLT2 vs. GLP-1 (19:42) | Managing Obesity, Sleep Apnea, and Pain in Diabetes Care (27:57) | Rethinking Sulfonylureas and Shifting Toward Modern Agents (29:07) | Choosing Between GLP-1 and SGLT2 Inhibitors for Comorbidities (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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Branch Basics: https://branchbasics.com/COREIM and use the code CoreIM for 15% * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Uncommon Goods: https://uncommongoods.com/COREIM * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko: https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Uncommon Goods: https://uncommongoods.com/COREIM Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko: https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko: https://ekohealth.com/COREIM * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko: https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 "CORE25" for 25% off: 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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko: https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 "CORE25" for 25% off: 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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use the code FIGSRX for 15% off your first purchase: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org * Get 15% off Branch Basics with code COREIM at https://branchbasics.com/COREIM! #branchbasicspod Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 "CORE25" for 25% off: 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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out FIGS and use the code FIGSRX for 15% off your first purchase: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org * Get 15% off Branch Basics with code COREIM at https://branchbasics.com/COREIM! #branchbasicspod Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 "CORE25" for 25% off: 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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Washington Red Raspberries: https://redrazz.org Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and Show Notes Tags: Internal Medicine, Medical Education, Pulmonology, CoreIM, Clinical Reasoning, critical care, pulm Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Our Sponsors: * Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy