Core IM | Internal Medicine Podcast

Clear steps to spot hidden diabetic foot infections and when a probe-to-bone test matters. Practical imaging and biopsy tips to avoid overcalling osteomyelitis. When surgery is needed versus antibiotics and why oral therapy can be as effective as IV. Simple, usable wound care and offloading strategies for everyday clinical practice.

Dr. Jeffrey Cott, nephrologist and intensivist who teaches practical POCUS for kidney care. He walks through real cases: using renal, lung, and venous ultrasound to spot obstruction, guide diuresis despite rising creatinine, distinguish COPD from volume overload in dialysis patients, and assess new AV fistula usability at the bedside.

Clear guidance on how and when to use common dementia drugs like cholinesterase inhibitors and memantine. A look at the new anti-amyloid antibodies, who qualifies, and the imaging and monitoring they require. Practical tips on when to stop medications, simplify regimens, and set up home supports and advance care planning.

They walk through how to recognize when memory concerns should take visit primacy. Practical phrasing and involving family are discussed for sensitive cognitive screening. Listeners hear which brief tests and staging tools to use and when to stop screening and document function. The conversation covers reversible contributors, initial labs, and when brain imaging or advanced biomarkers are indicated.

Lakshmira Vindra, endocrinologist and NEJM editorial fellow, outlines diabetes physiology and trial evidence with clarity. She walks through insulin types and when to start therapy. The conversation explains the QWINT-1 trial comparing once-weekly insulin to daily glargine. They discuss hypoglycemia differences, practical patient phenotypes, and oral alternatives to minimize injections.

Gregory Brisson, an internist and ethics educator who researches EHR patient-tracking. Joel Geiderman, an emergency physician and medical ethics leader with duty-to-warn experience. They debate privacy versus confidentiality, legal limits like duty to warn and mandatory reporting, whether students should follow patients in the EHR, and rules for sharing clinical cases online.

Dr. Eileen Barrett, an internist and healthcare leader, shares her innovative approach to improving clinician workflows. She introduces the concept of 'baby alligators,' the small frustrations that hinder productivity. Eileen suggests using regulated curiosity and strategic empathy to tackle these issues effectively. She recounts her successful efforts in changing the rifaximin ordering process, emphasizing the power of small, well-chosen actions that can lead to substantial change. Her tips on navigating collaboration and advocating for improvements are both practical and inspiring.

Dive into the gray areas of VTE management! Discover how to determine anticoagulation duration for different types of clots. Learn about the significance of dose-reduced DOACs and what constitutes true DOAC failure. The discussion highlights antiphospholipid syndrome as a critical diagnosis that can shift treatment strategies. Explore detailed case examples involving cancer-related clots and travel-induced DVTs, emphasizing personalized risk assessments and practical takeaways in anticoagulation care.

Dr. Tyra Feinstadt, a primary care internal medicine physician, shares her transformative journey through the challenges of early parenting and professional identity. She describes how the Horn Award catalyzed her career growth and introduced her to coaching. Dr. Hilit Mechaber, a general internist and dean, reflects on her own Horn Award application experience, highlighting the validation it brought and how it influenced her approach to leadership and career flexibility. Together, they explore the duality of pursuing professional purpose while managing personal life.

Dr. Manali Nigam, an editorial fellow at the New England Journal of Medicine and neurologist at Mass General Brigham, dives into the complexities of antibiotic duration for bacteremia. They dissect the BALANCE trial, revealing how host, organism, and infection source affect treatment courses. Discover why seven days may often suffice, while situations like S. aureus or osteomyelitis demand longer therapy. With a focus on evidence-based practice, Nigam emphasizes the importance of tailored treatment plans despite the push for shorter defaults.