IMreasoning - Clinical reasoning for Doctors and Students

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: 6:34pm NZST

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:


Direct download: episode_22_DEM_update_-_161116_2.07_PM_amplified.mp3
Category:general -- posted at: 11:02am NZST

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 with a snippet of your case, and we will be in touch.

Remember to comment on this episode either on our Facebook page or on our webpage

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: 3:03pm NZST

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: 11:55am NZST

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.

Direct download: episode_19_-_larry_weed_intro_-_5_09_16_8.51_PM.mp3
Category:general -- posted at: 9:30pm NZST

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


Direct download: episode_18_-_STC_4_-_130716_6.16_PM.mp3
Category:general -- posted at: 6:41pm NZST

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 for links to Bob's new book, and other resources we discuss with Bob.

Visit us at 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: 8:15pm NZST

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.


Direct download: episode_15_-_feedback_2_-_Vic_eval_-_180516_6.11_AM.mp3
Category:general -- posted at: 6:26am NZST

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: 6:55am NZST

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: 3:38pm NZST

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: 3:59pm NZST

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: 2:47pm NZST