IMreasoning - Clinical reasoning for Doctors and Students (general)

This is one of favourite episodes of all time.  "All time" being since August 2015...  Have we really produced enough episodes to justify a "rebroadcast"? possibly not, but we're doing it anyway.

We're working on a couple of episodes that we'll have out in the new year, but we didn't want to let so much time pass without seeing you all again. Enjoy!

Direct download: episode_47_rebroadcast_compassion_Tony_Fernando_-_141218_3.53_PM.mp3
Category:general -- posted at: 2:44am EST

Join us for another installation of STC international, this time with a case from Adam Clements from Wisconsin.

Direct download: episode_46_STC_international_Wisconsin_-_251118_8.30_AM.mp3
Category:general -- posted at: 2:40pm EST

This is by listener request! Art and Nic analyse what went wrong in the case of man who presented with sudden onset back pain. 

Direct download: episode_45_Cognitive_Autopsy_of_sudden_back_pain_-_111018_1.44_PM.mp3
Category:general -- posted at: 9:16pm EST

An "In-between-isode".  Art and Nic discuss lessons from the conferences in Switzerland, Association of Medical Educators of Europe (AMEE) and the European Diagnostic Error in Medicine Conference (EuroDEM).  We also discuss Argentinian Parrilla's...

Direct download: episode_44_Swiss_Ruminations_-_150918_7.52_AM.mp3
Category:general -- posted at: 4:05pm EST

Back with another instalment of STC live, this time from Perth, Australia.  The Australian Medical Student Association put on a fantastic conference with truly inspiring speakers.  We had so much fun sharing the stage with Michelle Johnston, ED doctor and author, who brought the humour and the grace to our session. Play along as the case evolves and see if you can do better than us!

Direct download: episode_43_STC_AMSA_Perth_with_Michelle_Johnston_-_10818_1.10_PM.mp3
Category:general -- posted at: 9:23pm EST

We chat once again with Gurpreet Dhaliwal, this time about what it takes to become a master diagnostician.  We discuss the main strategies; seeing many cases, deliberate training, getting feedback, closing the loop, and others.

Direct download: episode_42_becoming_an_expert_diagnostician_-_Goop_-_30718_8.16_AM.mp3
Category:general -- posted at: 8:24pm EST

We discuss the importance of the words that we choose to use in our medical documentation.  Words matter! They can generate stigma, and they can bias the decisions we subsequently make as practitioners.

Direct download: episode_41_Words_post_amp.mp3
Category:general -- posted at: 4:45am EST

It was a pleasure to finally get back to case-solving! Enjoy another interesting case of STC with our friend and colleague Rahul Gandhi, who is galavanting around the world getting super smart, so he can fix everything.

Direct download: episode_40_STC_International_Rahul_post_amp.mp3
Category:general -- posted at: 5:55pm EST

It was a pleasure to finally get back to case-solving! Enjoy another interesting case of STC with our friend and colleague Rahul Gandhi, who is galavanting around the world getting super smart, so he can fix everything.

Direct download: episode_40_STC_International_Rahul_post_amp.mp3
Category:general -- posted at: 5:55pm EST

Some of you may have heard of the double tragedy involving Jack Adcock, a six year old who died from sepsis and Dr. Bawa-Garba, a pediatric trainee in the UK convicted of manslaughter in relation to his death and prevented from ever working again. Justice or a clear case of scapegoating?

Listen as we discuss this troubling case and its far-reaching implications for transparency, honest reflection, and patient safety.

Direct download: episode_39_Bawa_Garba_-_140318_1.25_PM.mp3
Category:general -- posted at: 11:59pm EST

We're back after a long summer break.  Enjoy this episode on uncertainty in medicine.  We talk to Arabella Simpkin, an English paediatrician, working in Boston, who spends a lot of time thinking and writing about uncertainty and our need to embrace it, or at the very least, tolerate it graciously.

Direct download: episode_Arabella_Simpkin_pre_amp.mp3
Category:general -- posted at: 10:09pm EST

If you missed us live on Facebook last week, here's you chance to catch up.  Enjoy our STC session.  The case is from Australia, sent to us by Elise Perger (Allan) and Alison Miller... and we invited Chang as a guest host, back by popular demand.

Or, you can still watch the Facebook video at the link below.

https://www.facebook.com/IMreasoning/videos/1974175999573953/

Let us know if you liked the Facebook live event.  We can do it again!

Direct download: episode_37_STC_International_Live_event_-_151217_2.53_PM.mp3
Category:general -- posted at: 3:23pm EST

Enjoy our live Stump the Chumps at Main Medical Centre.  We were honoured to be invited by Bob Trowbridge and it was a pleasure to visit Portland, Maine.

Direct download: episode_36_STC_at_MMC_-_151117_7.00_AM.mp3
Category:general -- posted at: 1:22pm EST

Part two of our exploration of the connections between art, artistic thinking, creativity, with clinical reasoning and diagnosis.

We speak to Alexa Miller, a medical educator who uses arts-based learning and visual thinking skills to train students and seasoned professionals alike to better observe, describe, communicate, and to tolerate uncertainty.

We also speak with Jay Baruch, a writer, medical educator, and emergency doctor who is also the director the clinical arts and humanities at Brown Medical School.

Direct download: episode_35_-_turning_the_wheel_part_2_Alexa_edits_amplified.mp3
Category:general -- posted at: 8:37pm EST

Another enjoyable Diagnostic Error in Medicine conference, this time in Art's home town of Boston (actually, Newton...).  In this episode we discuss our thoughts inspired by one of the sessions, run by Doug Salvador and Harry Hoar from Baystate Medical Centre. They addressed how to get one's own hospital administration to engage in Diagnostic Error.  Remember to check the website IMreasoning.com for the attachment so you can follow along while you listen.


This is part one of a two-part series exploring the deep connections between creative thinking and clinical reasoning.  We discuss Art's and Glenn's work as poets and physicians, and how each endeavour enriches the other.


Enjoy an episode of STC.  This time WE weren't in the hot seat!  Humbling to see an excellent trainee in action.

Direct download: episode_32_STC_with_Chang_-_110917_2.35_PM.mp3
Category:general -- posted at: 12:03am EST

We finally got the chance to collaborate with Genevieve on her case for STC.  And we were keen to get this out just before GPTEC. Enjoy!

Direct download: episode_31_STC_international_with_Genevieve_Yates_-_90817_final.mp3
Category:general -- posted at: 7:25pm EST

We were privileged to speak to one of our patients, recently treated by our service, about her experience while her doctors struggled with diagnostic uncertainty.  The usual suspects were at play; uncommon diagnoses, uncommon presentations, cognitive biases, systems issues, etc.

Check out the new look to our website! www.imreasoning.com 


This time, we did not have a pause button! and we could not edit out all the times we sounded a little thick.  So enjoy the raw experience.  We did!

Direct download: episode_29_STC_at_AusDEM_-_220617_5.48_PM.mp3
Category:general -- posted at: 2:24am EST

Coined by the New York Times as the "leading debunker of preconceived notions in the medical world", Don Redelmeier is an award winning researcher, teacher, and clinician.  Enjoy our conversation with Dr. Redelmeier where we discuss pitfalls in clinical reasoning...as well as New Zealand idioms...

Tell us what you think on:

www.imreasoning.com

www.facebook.com/imreasoning

Twitter, @IMreasoning

or email us at imreasoning@gmail.com

 

Direct download: episode_28_-_Don_Redelmeier.mp3
Category:general -- posted at: 5:26am EST

Finally, our first STC International.  An interesting case from Broome, Western Australia.  Thanks Casey Parker.


While waiting for another of our home-grown cases we decided to do a STC using a published case from the Clinical Problem-Solving series of the New England Journal of Medicine.

Let us know what you think of this format!

www.imreasoning.com

www.facebook.com/imreasoning

or now you can make noise at us on Twitter.  Our handle is @IMreasoning

 

Direct download: episode_26_STC_from_NEJM_-_160317_11.45_AM.mp3
Category:general -- posted at: 6:56pm EST

Do all diagnostic errors occur because we're rushing, and prematurely jumping to conclusions? Can we course-correct by simply slowing down and by being mindful of our own inherent biases?

Geoff Norman and his colleagues review the literature to try to answer these and other questions about where errors in clinical reasoning come from.

The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking

And get your own Cognitive Bias Codex poster here: Cognitive Bias Codex

Please write us with comments and feedback on Facebook at https://www.facebook.com/IMreasoning

or on our webpage at www.IMreasoning.com

and send us your STC cases to imreasoning@gmail.com

 

Direct download: episode_25_revisiting_dual_process_thinking_-_210217_8.22_AM.mp3
Category:general -- posted at: 2:44pm EST

Doctors should always strive to present themselves as unbreakable to their patients...  All doctors are smart...  All patients have a definitive diagnosis...

Believe it or not, versions of these ideas, and many others, are pervasive in our medical education institutions, and to varying degrees are believed and practiced by doctors everywhere.

In this episode, we debunk and discuss our favourite myths. Enjoy!

Don't forget to write us with feedback on our Facebook page at https://www.facebook.com/IMreasoning

or on our webpage at www.imreasoning.com

and write to us with your STC cases to imreasoning@gmail.com

 

Direct download: episode_24_myths_2_-_110117_9.37_PM.mp3
Category:general -- posted at: 3:52am EST

Transillumination of the sinuses? shifting dullness? the puddle sign?

In this episode we poke fun and debunk our favourite "useless" physical exam manoeuvres that we continue to teach our medical students.  We couldn't cover all of them in one go, so stay tuned for more...

Try the app DxLogic on the iPhone to have a quick reference to the utility of many studied history features and physical exam manoeuvres.

Also, check out JAMA's series of articles entitled "The Rational Clinical Exam".

Direct download: episode_23_myths_-_101216_6.12_PM.mp3
Category:general -- posted at: 12:34am EST

Enjoy a short episode where we bring you our highlights of the DEM2016 conference in Hollywood, Los Angeles.

This is a very well-organised, relevant, and creative conference, and it just gets better every year.  Consider attending the next DEM conference.  Either in Boston in one year, or come to visit our neck of woods for the first Australasian DEM in Melbourne in May! You can get more information on the SIDM website:

http://www.improvediagnosis.org

 

Direct download: episode_22_DEM_update_-_161116_2.07_PM_amplified.mp3
Category:general -- posted at: 5:02pm EST

Enjoy another instalment of Stump the Chumps.  Friend and colleague Anthony Jordan presents a case of angio-edema...and other symptoms.

Be the next one to present a STC case!  If you're willing to record your voice, write to imreasoning@gmail.com with a snippet of your case, and we will be in touch.

Remember to comment on this episode either on our Facebook page www.facebook.com/IMreasoning or on our webpage www.imreasoning.com

Also, if you have a chance you could rate us on iTunes to help spread the good word...

Direct download: episode_21_STC_5_anthony_jordan_-_251016_4.51_PM.mp3
Category:general -- posted at: 10:03pm EST

As promised, today's episode brings you an interview with Dr. Larry Weed.  We hear from the man himself about his vision for a healthcare revolution.

We would love to hear from you about this episode.  Do you think we are doing things right? Or do you think the way we go about diagnosis is fundamentally wrong?

Direct download: episode_20_-_larry_weed_part_2_interview_-_240916_11.43_AM.mp3
Category:general -- posted at: 7:55pm EST

This is part 1 of 2 where we explore the work of Dr. Lawrence Weed.  If you haven't already, before you listen to this episode, have a look at his 1971 Grand Rounds lecture to an audience at Emory University.

https://www.youtube.com/watch?v=qMsPXSMTpFI

Direct download: episode_19_-_larry_weed_intro_-_5_09_16_8.51_PM.mp3
Category:general -- posted at: 5:30am EST

Enjoy another instalment of Stump the Chumps.  Our good friend and colleague Becky Lane challenged us with a very interesting presentation of a young man.

Don't forget to leave feedback on our Facebook page www.facebook.com/imreasoning

 

Direct download: episode_18_-_STC_4_-_130716_6.16_PM.mp3
Category:general -- posted at: 2:41am EST

In this episode we get tips on how to teach clinical reasoning from Bob Trowbridge, an expert clinical educator at Maine Medical Centre.

Go to our website www.imreasoning.com for links to Bob's new book, and other resources we discuss with Bob.

Visit us at https://www.facebook.com/IMreasoning to comment on the episode and to give us your thoughts on this topic.

Direct download: episode_17_-_Bob_trowbridge.mp3
Category:general -- posted at: 4:15am EST

We decided to call this episode an "in-between-isode", borrowing the term from the Tim Ferris show.  Its a short follow up continuing with our theme of feedback.  How do we provide an evaluation for a strong performer?  Does it help them to hear how great they are? Will it be a useful session? Will it help them improve even further?

Leave us your thoughts on our new Facebook page.

https://www.facebook.com/IMreasoning

 

Direct download: episode_15_-_feedback_2_-_Vic_eval_-_180516_6.11_AM.mp3
Category:general -- posted at: 2:26pm EST

In this episode we begin our foray into the topic of feedback.  You will hear us "worry out loud",  together with our guest Dr. Chris Watling from the University of Western Ontario, about the difficulties in giving effective feedback to our trainees.

Several themes arise from our conversation.  Feedback needs to be specific, credible, and not soul-destroying (although ironically, we each shared some of our most traumatic feedback experiences as the most memorable, and influential, course-correcting moments).  How we give and receive feedback is not only dependent on the individuals involved, but also importantly on the culture of the discipline; medical training culture is different from musical training, different from athletic training.

Also, keep an "ear" out for our new segment, the BOM (Bias of the Month). Enjoy!

Direct download: episode_15_-_feedback_1_-_90516_6.08_AM.mp3
Category:general -- posted at: 2:55pm EST

We're trying something new this week.  We go through a case of a diagnostic error with a fine tooth comb to try to find the cognitive pitfalls. We would love to hear your feedback about this episode.  Should we do this again?

Direct download: episode_14_-_Cognitive_autopsy_of_a_groin_lump_-_210316_3.07_PM.mp3
Category:general -- posted at: 10:38pm EST

Finally, our much awaited third try with Stump the Chumps.  This time one of our registrars Dr. Brian Grainger challenges us with a case of a young patient.  This is a longer episode, which I guess reflects the fact that sometimes, when the diagnosis is not obvious, you just have to take your time.  Enjoy!

Direct download: episode_13_-_STC_3_-_160216_3.32_PM.mp3
Category:general -- posted at: 9:59pm EST

What is compassion fatigue? Can you learn how to be more compassionate with your patients? We talk to Dr. Tony Fernando, psychiatrist, sleep specialist, educator and researcher, about compassion in healthcare, happiness, mindfulness, enlightenment, buddhist monks, and a bunch of other stuff. Enjoy!

Direct download: episode_12_compassion_fatigue_Tony_Fernando_-_171215_5.17_PM.mp3
Category:general -- posted at: 8:47pm EST

We bring you our second attempt at "stump the chumps".  Our friend and colleague Oliver Menzies brought an interesting case.  We think this case was not quite as enigmatic as our first one (episode 5) but we hope it illustrates sound clinical reasoning as we work our way through the clinical information.  Enjoy.

Direct download: episode_11_stump_the_chumps_take_2_-_91115_9.21_PM.mp3
Category:general -- posted at: 10:30pm EST

When we talk about medical errors, we need to remember that there are two victims; the patient who suffers harm as a result of the error, and the clinician who makes the error.  As long as the practice of medicine remains a human endeavour, medical errors are inevitable.  As a medical community we need to accept that errors will occur.  We need to talk about them openly and honestly, share our own stories, and support our colleagues when they share their stories with us. As members of society, we should better understand the fallibility of medical practitioners, and we need to understand the limits of their craft.

We had the opportunity to interview Brian Goldman, an ED doctor from Toronto, Canada, who is also a journalist, host of the CBC radio show "White Coat, Black Art", author of two books unveiling the secrets of medical culture, and a "TED-talker" with his presentation entitled "Doctors make mistakes - can we talk about that".

We also interviewed our friend and colleague, Dr. David Spriggs, a Brit who has lived in NZ for many years, an excellent general internist and geriatrician, who regularly teaches our trainees on the reality of making mistakes.

Direct download: episode_10_making_mistakes_-_21115_10.06_pm.mp3
Category:general -- posted at: 7:47pm EST

The future is coming.  In this episode we talk to Shantanu Nundy of the Human Diagnosis Project (HumanDx).  As Shantanu describes it, HumanDx is a worldwide effort to map any health problem to its possible diagnoses.  We have come across various projects that aim to create that elusive, high-fidelity, real-life, artificial intelligence of diagnosis.  HumanDx is building that AI by connecting the knowledge, experience, and real-life cases from all of us.  This is OUR project.  We think that HumanDx is the real thing.  Enjoy!

Direct download: episode_9_The_Human_Diagnosis_Project_-_81015_3.33_pm.mp3
Category:general -- posted at: 5:35pm EST

The Diagnostic Error in Medicine Conference 2015 has finally come!  We have been looking forward to attending this conference for a while now.  This comes on the heels of the freshly published Institute of Medicine Report on diagnostic error, an initiative which was prompted by SIDM, with Mark Graber at the helm.  These three episodes, 6, 7, and 8 are our end-of-day reflections on the presentations we have heard.

Don't forget to post your comments on our website imreasoning.com, in particular about your thoughts on the IOM's definition of a diagnostic error.

Direct download: episode_8_DEM_conference_day_3_-_300915_12.30_am.mp3
Category:general -- posted at: 12:36am EST

The Diagnostic Error in Medicine Conference 2015 has finally come!  We have been looking forward to attending this conference for a while now.  This comes on the heels of the freshly published Institute of Medicine Report on diagnostic error, an initiative which was prompted by SIDM, with Mark Graber at the helm.  These three episodes, 6, 7, and 8 are our end-of-day reflections on the presentations we have heard.

Don't forget to post your comments on our website imreasoning.com, in particular about your thoughts on the IOM's definition of a diagnostic error.

Direct download: episode_7_DEM_conference_day_2_-_300915_12.25_am.mp3
Category:general -- posted at: 12:31am EST

The Diagnostic Error in Medicine Conference 2015 has finally come!  We have been looking forward to attending this conference for a while now.  This comes on the heels of the freshly published Institute of Medicine Report on diagnostic error, an initiative which was prompted by SIDM, with Mark Graber at the helm.  These three episodes, 6, 7, and 8 are our end-of-day reflections on the presentations we have heard.

Don't forget to post your comments on our website imreasoning.com, in particular about your thoughts on the IOM's definition of a diagnostic error.

Direct download: episode_6_conference_day_1_-_300915_12.08_am.mp3
Category:general -- posted at: 12:23am EST

As promised, we bring you our first attempt at "stump the chumps".  This is where we are presented with a challenging diagnostic case and we think out loud as we reason our way through it.  You can play along as you hear the case unfold.

Direct download: Episode_5_STC_Jen_Taylor.mp3
Category:general -- posted at: 10:18pm EST

Dr. Gurpreet Dhaliwal is professor of clinical medicine at UCSF and has written many articles in the realm of clinical reasoning.  Although you have already heard snippets of our conversation on prior episodes, we thought we would share the entire interview with all of you.  Gurpreet has an enlightening way of explaining how we think, and how we move from good clinicians to expert clinicians, through extended problem-solving and feedback.

Direct download: episode_4_Gurpreet_Dhaliwal_-_90815_8.00_am.mp3
Category:general -- posted at: 4:16pm EST

The differential diagnosis is at the heart of analytic thinking for the diagnostician.  Dr. Mark Graber agrees.  As the founder of the Society to Improve Diagnosis in Medicine, he should know.  It can overcome many of the biases we are prone to when we limit ourselves only to diagnosis by pattern recognition.  We discuss some simple approaches to generating a differential diagnosis and developing a problem representation.

Direct download: Episode_3_-_Type_2_thinking_and_differential_dx_amplified.mp3
Category:general -- posted at: 10:56pm EST

We continue laying the foundations of type 1 and type 2 thinking with a discussion about biases.  Once again we hear from Prof. Gurpreet Dhaliwal and some of his thoughts on the utility of studying metacognition.

Direct download: Episode_2_-_biases_-_amplified_pm.mp3
Category:general -- posted at: 10:38pm EST

Our first episode lays down the foundations around type 1 and type 2 thinking.

Direct download: Episode_1setting_the_stage_How_Drs_Think_final.mp3
Category:general -- posted at: 12:30am EST

IMreasoning is a podcast about clinical reasoning, diagnosis, diagnostic error, and other relevant topics for the working doctor, for students and trainess, and anyone else with an interest in meta-cognition and education.

Direct download: episode_0_final_-_250715_6.40_am.mp3
Category:general -- posted at: 2:46pm EST

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