#57 A 39M on Inpatient Psychiatry with a Fever: Hoofbeats Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 22 January 2020

⏱️ 55 minutes

🔗️ Recording | iTunes | RSS

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Summary

How do you learn from diagnostic errors? Walk through a case that the host had initially gotten wrong and uncover possible reasons as why from data gathering to hypothesis generation to the interplay between hypothesis generation and evaluation. Learn interesting tidbits on prior work in medical education around how we think, particularly around diagnostic failures. CME Credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im) Time Stamps * 02:39 Case Introduction * 04:46 Yes/No questions with our first two discussants * 18:43 The diagnosis is revealed * 21:14 Why did I miss the diagnosis? * 27:44 Using diagnostic problem solving to break down the case and understand our errors * 30:20 The importance of data gathering * 30:49 Introducing our third clinician * 34:17 Hypothesis generation * 37:11 The interplay between hypothesis generation and evaluation * 38:34 The win-stay, lose-shift heuristic * 41:33 Cognitive forcing strategies * 49:32 Knowledge vs. experience Tags: Dermatology, rash, DRESS, AGEP, varicella Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	Hi everyone this Coriam episode this month will count for
0:04.0	Sammy credit with ACP yay
0:06.9	we will link the exact URL in the show notes so click on the link answer three
0:10.4	questions and get see me credit. And with that, Q the intro.
0:15.6	We had our latest morbidity and mortality conference
0:18.4	a couple of weeks ago, and since then I've been thinking.
0:22.0	We're supposed to learn from our mistakes, that's the assumption these conferences are built on.
0:27.1	But how?
0:28.8	How do we go about doing that, actually?
0:31.9	What do I do to uncover the truth of what went wrong in my thinking, especially when I barely
0:36.6	understand how my own brain works, and when I suspect I can't fully trust it to investigate itself objectively because of the fragility of memory and of my pride.
0:47.0	I think back to my training and I remember blocks on kidney disease, conferences on epidemiology,
0:53.0	getting my cases precepted in clinic,
0:55.0	but when it comes to how we as doctors should be analyzing our diagnostic failures,
1:00.0	I guess the unspoken assumption I worked with was just I'd just figure it out along the way.
1:06.0	But at this point in my career, I'm not so sure anymore.
1:10.0	A couple of years ago I had a case that's stuck with me, a case in which I missed the diagnosis.
1:16.0	Fortunately, no harm came to the patient.
1:18.0	He was treated appropriately, he recovered, and his diagnosis wasn't even delayed,
1:22.0	because another clinician immediately recognized what he had.
1:25.0	But ever since that case has bothered me, because to this day I don't think I truly understand why I miss that diagnosis.
1:33.6	Now that we've been doing hoof beats, I've been thinking,
	...

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