The Curbsiders Internal Medicine Podcast

Get schooled on driver’s safety for older adults by expert, Alice Pomidor MD, Professor of Geriatrics at Florida State University. Whether or not older adults can continue to drive is a huge problem faced by for primary care clinicians, and will remain one until driverless cars become ubiquitous. Topics covered include: how to take a driving history, red flags, physical exam, cognitive exam, and vision assessment for driver’s safety, resources, when to refer, alternate means of transportation, and the legal repercussions of reporting...or not reporting. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written and produced by: Matthew Watto MD and Elizabeth Garbitelli MD Candidate 2022 Editor: Matthew Watto MD Cover Image by: Kate Grant MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Alice Pomidor MD  Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:10 Guest onliner, book recommendations, and career advice 10:43 Clinical case, and the 5 Rs of clinicians responsibility 19:15 Taking a history from older adult drivers 26:28 The clinical exam for driver’s safety (cognition, vision, and MSK tests) 37:24 How can we avoid patient anger towards clinician and family members? 41:10 When and where to refer for driving evaluation 47:00 Alternative transportation 52:00 What to do if someone refuses or forgets to stop driving 59:45 Reporting requirements and legal ramifications 69:15 Take home points 72:00 Outro  Tags: driving, elderly, geriatrics, dementia, treatment, prevention, cognition, seniors, drivers, safety, crash, motor, vehicle, car, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

27 Aug 20181h 13min

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges. Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory medicine. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Credits: Written and produced by: Justin Berk MD, MPH, MBA Editor: Matthew Watto, MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP Guest: Lenny Feldman MD, FACP Time Stamps 00:00 Announcements 00:38 Disclaimer, intro, and guest bio 03:53 Guest one liner, some recommendations, and advice 08:35 Defining high value care and things we do for no reason (TWDFNR) 12:40 Why do clinicians order useless testing? 14:58 Urine electrolytes for acute kidney injury 20:30 Renal ultrasound for acute kidney injury 25:54 Stop ordering folate for anemia workup 31:47 How many units should I transfuse? 34:40 Prealbumin and albumin for malnourishment. 43:24 Iodine, shellfish and contrast allergy 50:28 Patient leaving against medical advice 56:45 Switching from IV to oral antibiotics 63:27 Dr Feldman’s plugs 65:36 Outro

20 Aug 20181h 7min

Point-of-care Ultrasound AKA POCUS ain’t no hocus. Dr. Renee Dversdal (@ReneeDversdal) Director of the Oregon Health & Science University Point of Care Ultrasound and General Medicine Ultrasound Fellowship Director, joins The Curbsiders to discuss her craft. Topics include: Defining POCUS, the value POCUS adds to the physical exam, training pathways and the appropriateness of billing. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date). Follow this link to read the ACP’s statement in support of POCUS in Internal Medicine. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Christopher Chiu MD and Renee Dversdal MD Produced and CME questions by: Christopher Chiu MD Edited by: Matthew “Mike” Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Christopher Chiu MD Guest Expert: Renee Dversdal MD Tags: point-of-care, acp, impocus, ultrasound, bedside, POCUS, CLUE, exam, training, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

13 Aug 20181h

“Women in medicine, be bold.” Medical World, powerful women are here to stay. Dr. Vineet (Vinny) Arora, Professor of Medicine at University of Chicago, an exemplary Woman in Medicine and Leadership, shares snippets of her own story, valuable career advice to folks at all levels of training, and fascinating data about the gender disparities that exist in training, promotion, and pay.  We hope you’ll learn from this episode, whether you have faced or anticipate facing these struggles as a Woman in Medicine or as a member of another marginalized group, or whether you’re an ally and want to learn more about the issue. Women are entering medical school now more than ever, and are learning to provide the best possible care to patients (didn’t you see that patients of female physicians have significantly lower mortality rates than patients of male physicians? (Tsugawa et al., 2016)).  The modern medical woman wants to teach, mentor, and lead--and be fairly evaluated, and promoted. That’s where We In Medicine (both women and men) have some work to do.  Because gender disparities (and other disparities hinging on identity) do exist. N.b. This episode is our inaugural in what we hope will be a Women in Medicine series for the Curbsiders.  We have many more topics with which we’d like to engage, from career trajectory to imposter syndrome to sexual harassment to balancing career and personal lives (as inequity is not only at work (Khullar. Being a Doctor is Hard. It’s Harder for Women. NYT 2017)), to conversations about race, gender, and LGBTQ identity in medicine.  We’re passionate, at The Curbsiders, about all these topics, and we want to dive deep into how to make Medicine a more welcoming and ceiling-less place for all.  We can’t wait to bring this series to you, not to mention to bring some more fabulous female experts on air. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written and produced by: Leah Witt MD, Shreya P. Trivedi MD, Nora Taranto AB, Sarah Phoebe Roberts MPH, Molly Heublein MD, Beth Garbitelli, Hannah R Abrams, Images by: Beth Garbitelli and Hannah Abrams Editor: Matthew Watto MD Hosts: Leah Witt MD, Shreya P. Trivedi MD, Matthew Watto MD Guest: Vineet Arora MD

6 Aug 201859min

Short on time but hungry for knowledge? Curbsiders’ Journal Club gives you the speedy article analysis you crave. We provide brief summaries of recent research and news items in the field of internal medicine, so you can save time and stay on top of the literature. On this episode, we were joined by Kashlak Memorial’s very own Chair of Medicine, Dr. Robert Centor AKA @medrants on Twitter or “Uncle Bob” to the Curbsider Crew. This month’s topics include: estimating atherosclerotic cardiovascular disease risk, whether CT pulmonary angiography (CTPA) effectively rules out pulmonary embolism, discharging low risk patients with pulmonary embolism from the ED, metformin and risk of acidosis in patients with CKD, treating opioid use disorder after a nonfatal overdose, Canagliflozin and renal protection in type 2 diabetes, screening for diabetes among patients below age 40, and the association between nose-picking and staphylococcus. ACP members can claim free CME-MOC at  acponline.com/curbsiders (goes live 0900 EST on podcast release date). Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.   Credits: Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Editor: Matthew Watto MD Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Guest: Robert Centor MD

30 Jul 201855min

Lyme disease and tick-borne illness deconstructed by Infectious Diseases expert, Paul E. Sax MD, of episode 78 fame. Oh, Summer Nights. The time for romance between Danny Zuko and good girl Sandy, the time to sit in the backyard around the bonfire, the time for sunset hikes in the woods and mountains…..and don’t forget, it’s also the time for those pesky woodland ticks who’ll go for a ride on you and maybe suck your blood (gross!). Dr. Sax takes us through the essentials of tick-borne illness, with a focus on Lyme Disease: diagnosing it, treating it, identifying possible co-infections, and managing Post-Lyme residual symptoms.   Our (And Dr. Sax’s) Disclaimer about this episode, and the shownotes: Tick-borne illness is a very serious problem in public health in the US, but management is quite a controversial issue. We’ve done our best with this episode to stay as evidence-based as possible. Moreover, given the limited time we have on air, we have tried to focus on what we think is most clinically relevant. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Shreya P. Trivedi MD, Nora Taranto AB Produced by: Shreya P. Trivedi MD, Nora Taranto AB Editor: Matthew Watto MD Images by:  Hannah R. Abrams Hosts: Shreya P. Trivedi MD, Matthew Watto MD, Paul Williams MD Guest: Paul E. Sax MD

23 Jul 201858min

Renal tubular acidosis aka RTA deconstructed by @Kidney_Boy, Joel Topf MD, Chief of Nephrology at Kashlak Memorial Hospital. We review the three buckets of non gap metabolic acidosis, normal renal physiology & acid base handling, points of failure in RTA, complications and treatment of RTA. Check out Dr Topf’s awesome slides on renal tubular acidosis at http://thecurbsiders.com/podcast . Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Matthew Watto MD and Joel Topf MD Produced by: Matthew Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Joel Topf MD Time Stamps 00:00 Announcements 01:02 Disclaimer 01:40 Intro and guest bio 04:00 Joel’s one liner 06:05 Joel’s “favorite failure” 11:45 Paul shares a failure 13:20 Tweetorials 16:39 Clinical case of non gap metabolic acidosis 18:06 Three buckets of NAGMA and GI losses 21:02 Chloride intoxication and normal saline 25:14 Renal tubular acidosis and normal role of kidney in acid base 35:03 Proximal (type 2) RTA 40:33 Cases of proximal RTA 43:38 Distal (type 1) RTA 53:15 Bicarbonate dosing and titration 55:28 Type 4 RTA (hypoaldosteronism) 62:09 Urinary anion gap and ammonium 67:26 Replacing GI losses of bicarbonate 70:25 Joel reviews quick cases of RTA and NAGMA 74:49 Outro  Tags: renal, tubular, acidosis, non, gap, rta, nagma, metabolic, kidney, diarrhea, sodium, normal, saline, ringer's, lactate, tubule, bicarbonate, physiology, acid, base, ammonia, ammonium, nephrolithiasis, assist

16 Jul 20181h 15min

Expert diagnostician, Dr. Gurpreet Dhaliwal, again joins The Curbsiders to dive deeper into the topic of clinical expertise.  Topics include, and are mainly focused on, Dr. Dhaliwal’s “training regimen:” feedback, simulation, quizzing, learning from consultants, and how to read the medical literature as a clinician.  While we found this episode to be incredibly useful (and entertaining to record), don’t let our bias sway your opinion! In fact, just listen to the episode and listen for practical advise on how to improve your own clinical acumen.   Dr Brigham’s comment:  Be forewarned, much of what we talk about is seemingly common sense, but, upon listening to the episode many times, I realize that we have, over time, overly complicated the fundamentals of expertise.  I’m just as guilty as the next physician. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by:  Stuart Brigham MD Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD Guest: Gurpreet Dhaliwal MD Images by: Beth Garbitelli Edited by:  Matthew Watto MD

9 Jul 201858min