IMreasoning - Clinical reasoning for Doctors and S

IMreasoning - Clinical reasoning for Doctors and S

Australia

Welcome to IM Reasoning with your hosts Dr. Art Nahill and Dr. Nic Szecket, two general internists with a passion for teaching clinical reasoning. Join us for case discussions, conversations and interviews that explore issues important to clinicians and students, with a special focus on clinical reasoning, the once-mysterious process behind the remarkable abilities of the master clinician.

Episodes

20: Medicine in Denial - Part 2  

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?

19: Medicine in Denial? - an introduction to Dr. Larry Weed  

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

Episode 18: STC 4 with Becky Lane  

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

 

Episode 17: Teaching Clinical Reasoning - Bob Trowbridge  

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.

16: Feedback 2 - just an end-of-run evaluation  

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

 

15: Feedback  

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!

14: Cognitive Autopsy of a groin lump  

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?

13: Stump the Chumps - take 3  

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!

12: Compassion in Healthcare  

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!

11: Stump the Chumps - take 2  

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.

10: The Second Victim  

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.

9: The Human Diagnosis Project  

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!

8: DEM conference - Day 3  

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.

7: DEM conference - Day 2  

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.

6: Diagnostic Error in Medicine conference 2015 - Day 1  

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.

5: Stump the Chumps  

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.

4: Wise Words from Gurpreet Dhaliwal  

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.

3: Differential Diagnosis and Problem Representation  

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.

2: Biases  

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.

1: Setting the Stage - How Doctors Think  

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

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