Medicine

IMreasoning - Clinical reasoning for Doctors and Students

Drs. Art Nahill & Nic Szecket

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

37: STC International Live on Facebook
01:05:22
2017-12-15 08:11:16 UTC 01:05:22
37: STC International Live on Facebook

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!

36: Live STC at MMC
46:46
2017-12-15 08:11:16 UTC 46:46
36: Live STC at MMC

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.

35: Turning the Wheel 2
01:03:41
2017-12-15 08:11:16 UTC 01:03:41
35: Turning the Wheel 2

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.

34: Tackling the drivers that lead to diagnostic error
35:21
2017-12-15 08:11:16 UTC 35:21
34: Tackling the drivers that lead to diagnostic error

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.

33: Turning the Wheel
36:21
2017-12-15 08:11:16 UTC 36:21
33: Turning the Wheel

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.

32: STC with Chang
57:59
2017-12-15 08:11:16 UTC 57:59
32: STC with Chang

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

31: STC International with Genevieve Yates
01:00:04
2017-12-15 08:11:16 UTC 01:00:04
31: STC International with Genevieve Yates

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!

30: Diagnostic Uncertainty
48:11
2017-12-15 08:11:16 UTC 48:11
30: Diagnostic Uncertainty

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 

29: STC live! at the Australian DEM
49:40
2017-12-15 08:11:16 UTC 49:40
29: STC live! at the Australian DEM

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!

28: Donald Redelmeier
48:51
2017-12-15 08:11:16 UTC 48:51
28: Donald Redelmeier

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

 

27: STC International with Casey Parker
49:24
2017-12-15 08:11:16 UTC 49:24
27: STC International with Casey Parker

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

26: STC from the Clinical Problem-Solving series in NEJM
40:20
2017-12-15 08:11:16 UTC 40:20
26: STC from the Clinical Problem-Solving series in NEJM

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

 

25: Revisiting Dual Process Thinking
34:47
2017-12-15 08:11:16 UTC 34:47
25: Revisiting Dual Process Thinking

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

 

24: Myths part 2
40:56
2017-12-15 08:11:16 UTC 40:56
24: Myths part 2

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

 

23: Myths of the Physical Exam part 1
51:57
2017-12-15 08:11:16 UTC 51:57
23: Myths of the Physical Exam part 1

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".

22: Diagnostic Error in Medicine 2016 - Los Angeles
18:44
2017-12-15 08:11:16 UTC 18:44
22: Diagnostic Error in Medicine 2016 - Los Angeles

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

 

21: STC - 5 with Anthony Jordan
44:38
2017-12-15 08:11:16 UTC 44:38
21: STC - 5 with Anthony Jordan

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...

20: Medicine in Denial - Part 2
48:01
2017-12-15 08:11:16 UTC 48:01
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
26:14
2017-12-15 08:11:16 UTC 26:14
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

18: STC 4 with Becky Lane
52:30
2017-12-15 08:11:16 UTC 52:30
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

 

17: Teaching Clinical Reasoning - Bob Trowbridge
33:57
2017-12-15 08:11:16 UTC 33:57
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
17:40
2017-12-15 08:11:16 UTC 17:40
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
58:53
2017-12-15 08:11:16 UTC 58:53
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
52:53
2017-12-15 08:11:16 UTC 52:53
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
56:35
2017-12-15 08:11:16 UTC 56:35
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
01:05:43
2017-12-15 08:11:16 UTC 01:05:43
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
25:10
2017-12-15 08:11:16 UTC 25:10
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
39:38
2017-12-15 08:11:16 UTC 39:38
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
46:57
2017-12-15 08:11:16 UTC 46:57
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
35:08
2017-12-15 08:11:17 UTC 35:08
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
32:41
2017-12-15 08:11:17 UTC 32:41
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
29:51
2017-12-15 08:11:17 UTC 29:51
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
42:49
2017-12-15 08:11:17 UTC 42:49
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
41:30
2017-12-15 08:11:17 UTC 41:30
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
30:21
2017-12-15 08:11:17 UTC 30:21
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
37:25
2017-12-15 08:11:17 UTC 37:25
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
25:59
2017-12-15 08:11:17 UTC 25:59
1: Setting the Stage - How Doctors Think

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

0: Art and Nic
06:00
2017-12-15 08:11:17 UTC 06:00
0: Art and Nic

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.

37: STC International Live on Facebook
01:05:22
2017-12-16 15:30:32 UTC 01:05:22
37: STC International Live on Facebook

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!

36: Live STC at MMC
46:46
2017-12-16 15:30:32 UTC 46:46
36: Live STC at MMC

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.

35: Turning the Wheel 2
01:03:41
2017-12-16 15:30:32 UTC 01:03:41
35: Turning the Wheel 2

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.

34: Tackling the drivers that lead to diagnostic error
35:21
2017-12-16 15:30:32 UTC 35:21
34: Tackling the drivers that lead to diagnostic error

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.

33: Turning the Wheel
36:21
2017-12-16 15:30:32 UTC 36:21
33: Turning the Wheel

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.

32: STC with Chang
57:59
2017-12-16 15:30:32 UTC 57:59
32: STC with Chang

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

31: STC International with Genevieve Yates
01:00:04
2017-12-16 15:30:32 UTC 01:00:04
31: STC International with Genevieve Yates

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!

30: Diagnostic Uncertainty
48:11
2017-12-16 15:30:32 UTC 48:11
30: Diagnostic Uncertainty

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 

29: STC live! at the Australian DEM
49:40
2017-12-16 15:30:32 UTC 49:40
29: STC live! at the Australian DEM

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!

28: Donald Redelmeier
48:51
2017-12-16 15:30:32 UTC 48:51
28: Donald Redelmeier

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

 

27: STC International with Casey Parker
49:24
2017-12-16 15:30:32 UTC 49:24
27: STC International with Casey Parker

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

26: STC from the Clinical Problem-Solving series in NEJM
40:20
2017-12-16 15:30:32 UTC 40:20
26: STC from the Clinical Problem-Solving series in NEJM

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

 

25: Revisiting Dual Process Thinking
34:47
2017-12-16 15:30:32 UTC 34:47
25: Revisiting Dual Process Thinking

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

 

24: Myths part 2
40:56
2017-12-16 15:30:32 UTC 40:56
24: Myths part 2

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

 

23: Myths of the Physical Exam part 1
51:57
2017-12-16 15:30:32 UTC 51:57
23: Myths of the Physical Exam part 1

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".

22: Diagnostic Error in Medicine 2016 - Los Angeles
18:44
2017-12-16 15:30:32 UTC 18:44
22: Diagnostic Error in Medicine 2016 - Los Angeles

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

 

21: STC - 5 with Anthony Jordan
44:38
2017-12-16 15:30:32 UTC 44:38
21: STC - 5 with Anthony Jordan

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...

20: Medicine in Denial - Part 2
48:01
2017-12-16 15:30:32 UTC 48:01
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
26:14
2017-12-16 15:30:32 UTC 26:14
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

18: STC 4 with Becky Lane
52:30
2017-12-16 15:30:32 UTC 52:30
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

 

17: Teaching Clinical Reasoning - Bob Trowbridge
33:57
2017-12-16 15:30:32 UTC 33:57
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
17:40
2017-12-16 15:30:32 UTC 17:40
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
58:53
2017-12-16 15:30:32 UTC 58:53
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
52:53
2017-12-16 15:30:32 UTC 52:53
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
56:35
2017-12-16 15:30:32 UTC 56:35
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
01:05:43
2017-12-16 15:30:32 UTC 01:05:43
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
25:10
2017-12-16 15:30:32 UTC 25:10
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
39:38
2017-12-16 15:30:32 UTC 39:38
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
46:57
2017-12-16 15:30:32 UTC 46:57
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
35:08
2017-12-16 15:30:32 UTC 35:08
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
32:41
2017-12-16 15:30:32 UTC 32:41
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
29:51
2017-12-16 15:30:32 UTC 29:51
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
42:49
2017-12-16 15:30:32 UTC 42:49
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
41:30
2017-12-16 15:30:32 UTC 41:30
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
30:21
2017-12-16 15:30:32 UTC 30:21
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
37:25
2017-12-16 15:30:32 UTC 37:25
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
25:59
2017-12-16 15:30:32 UTC 25:59
1: Setting the Stage - How Doctors Think

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

0: Art and Nic
06:00
2017-12-16 15:30:32 UTC 06:00
0: Art and Nic

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.