#198 Microskills for Change That are Big Enough to Matter, Small Enough to Win

Baby alligators  - those betrayals of purpose , or, death by a thousand paper cuts !Check out our latest episode, where Dr. Eileen Barrett walks us through how to tackle baby alligators with:Regulated curiosityStrategic empathySmall, well-chosen moves......and change that is big enough to matter, and small enough to win!🔹 Sponsor: Caraway’s cookware set is a favorite for a reason.For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.🔹 Transcript & Shownotes00:00 | What are “baby alligators” in medicine?02:24 | Rifaximin & Workflow Fixes14:17 | Verbal Orders Policy18:39 | Micro Skills for Change25:12 | Key Takeaways#PhysicianBurnout #DoctorLife #HealthcareEfficiency, CoreIM, Internal Medicine, Career Development, Quality Improvement, QIFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Gray zones of VTE management! How to approach anticoagulation duration in unprovoked, provoked-irreversible, and provoked-reversible clots?When dose-reduced DOACs make sense for long-term secondary prevention? What truly constitutes DOAC failure? We also devle into how APLAS a critical do-not-miss diagnosis that changes management entirely.🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/🔹 Transcript & Shownotes(2:56) - (13:15) | PEARL 1: Managing clots in the “unprovoked”/provoked-irreversible patient(13:21) - (18:10) | PEARL 2: Managing provoked, “reversible” clots(18:14) - (25:14) | PEARL 3: DOAC failure: time to step it up?(25:20) - (37:25) | PEARL 4: APLAS: the exception to everythingTags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

We hope these stories resonate with anyone who has felt pulled between professional purpose and personal life, and remind you that you’re not alone in wanting both.🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and Shownotes(1:09) | How the Horn Award Opened the Door to Growth in Dr. Tyra Fainstad’s Career and Life(10:28) | How Dr. Carol Ward Created the Horn Award and Honored Mary Horn’s Legacy(14:16) | Dr. Hilit Mechaber’s Story of Courage, Vision, and Impact Beyond the Award(17:55) | Why does the Horn Award Matter?Tags: CoreIM, Internal Medicine, Career Development Award, Mary O'Flaherty Horn Award, Clinical Care, Scholarship, Teaching, Leadership, Wellness and Care, Family ResponsibilitiesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In this episode, we walk through the BALANCE trial and use it as a lens to revisit how 1) host, 2) organism, and 3) source should guide treatment. When shorter really is enough, and when it isn’t?🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and ShownotesTimestamp(02:58) | Host, Organism, Source: The Core Framework Behind Duration(09:02) | How Evidence Shifted Practice(11:27) | The BALANCE Trial: Short-Course vs Standard-Course Therapy(18:55) | Where does this leave us?Tags: CoreIM, Internal Medicine, Infectious disease, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How quickly can triglycerides rise? At what threshold are patients at risk of pancreatitis or cardiovascular adverse outcomes? What do you have to rule out? How do you counsel on lifestyle changes? Which medications do you start with why and when?🔹 Transcript and Shownotes(03:19) | Lipoprotein Lipase and Why Triglycerides Fluctuate Fast(05:27) | Triglycerides as a Cardiovascular Risk Marker(09:28) | Acute Management For Pancreatitis induced by Triglycerides(14:34) | Lifestyle Counseling(17:31) | Medications That Lower Triglycerides(25:29) | How to Choose the Right Triglyceride Therapy(27:56) | Genetic Causes and When to Suspect Familial DisordersTags: CoreIM, Internal Medicine, Lipidology, lipid, Cardiology, Metabolic Health, Triglycerides, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education, primary careFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be at play in septic shock? What are the limitations of the VEXUS score?🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹Transcript and Shownotes(00:00) | Volume overload vs. Venous Congestion(05:49) | Venous Congestion and AKI, mortality, possible delirium(10:10) | Measuring Venous Congestion and the Role of VEXUS(15:05) | Common Mistakes and Best Practices of VEXUS score(23:13) | Assessing Fluid Tolerance and Risks with Venous Doppler in Acute Care(25:29) | Fluid vs. Vasopressor Strategy Guided by Venous Assessment Tags: CoreIM, Internal Medicine, Critical Care, Nephrology, Cardiology, Fluid Management, POCUS, Ultrasound, Doppler, Hospital Medicine, Clinical Reasoning, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how do you weigh their side effects and practical use?🔹 Sponsor:Use the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript and Show NotesTimestamps:(01:43) | Case 1: Managing Uncontrolled Diabetes in a 47-Year-Old Male(07:15) | Understanding Cost and Insurance Barriers in Diabetes Care(09:26) | Case 2: Addressing Weight Gain and Financial Stress in a 52-Year-Old Male(14:16) | Case 3: Managing Coronary Artery Disease and CKD in a 66-Year-Old Male(19:41) | Case 4: Severe Obesity and Pain Management in a 59-Year-Old Female(24:19) | Case 5: High A1C and Vascular Comorbidities in a 67-Year-Old Female (35:34) | Weighing Side Effects and Practical Use of GLP-1 and SGLT2 InhibitorsTags: CoreIM, Primary Care, Endocrinology, Diabetes Mellitus, Type 2 Diabetes, Type 1 Diabetes, Metformin, GLP-1, SGLT2, Insulin, CGM, A1C, DKA, Medical Education, Clinical Reasoning, Hospital MedicineFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?🔹 Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps: (00:12) | Introduction and Overview of Hepatorenal Treatment (03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine (12:32) | Finding the Right Dose of Albumin and Knowing When to Stop (15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine (21:42) | Understanding the High Mortality of HRS-AKI (32:30) | Transplant, Dialysis, or Palliation CareTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver DiseaseFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

HRS-AKI vs. other causes of AKI in cirrhosis: What do serum or urine sodium clues, albumin challenges, and shifting diagnostic criteria actually reveal about getting the diagnosis right?🔹 Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps: (00:57) | Understanding the Pathophysiology of HRS (03:42) | How Portal Hypertension Traps the Kidneys (10:32) | Sorting the Differential of AKI in Cirrhosis Beyond HRS (18:28) | Hyponatremia and Urine Sodium in Advanced Cirrhosis (24:04) | Official Diagnosis and Evolving Criteria of HRS (29:30) | Albumin: When It Helps and When to Hold Back (34:00) | Recap and Future DirectionsTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Nephrology, renal, hepatology, Portal Hypertension, Liver DiseaseFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Who’s really at risk for fractures, and how should we be treating them? Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown?Find out all the nuances on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.🔹 Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps:(00:59) | Diagnosing Osteoporosis and Hidden Fracture Risk(05:38) | Evolution of Bisphosphonate Use in Osteoporosis Treatment(07:51) | Current Use of Bisphosphonates: Benefits, Risks, and Side Effects(10:31) | Exploring Non-Bisphosphonate Options for Fracture Prevention(11:44) | Teriparatide and Alternative Osteoporosis Medications(14:53) | Inside the Latest Bisphosphonate Clinical Trial(18:07) | Key Findings from the Zoledronate Fracture Prevention Study(22:38) | Public Health Impact of Fracture Prevention Strategies(24:24) | Final Takeaways and Expert Perspectives on Osteoporosis CareTags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone HealthFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy