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 curiosity

Strategic empathy

Small, well-chosen moves...

...and change that is big enough to matter, and small enough to win!

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🔹 Transcript & Shownotes

00:00 | What are “baby alligators” in medicine?

02:24 | Rifaximin & Workflow Fixes

14:17 | Verbal Orders Policy

18:39 | Micro Skills for Change

25:12 | Key Takeaways

#PhysicianBurnout #DoctorLife #HealthcareEfficiency, CoreIM, Internal Medicine, Career Development, Quality Improvement, QI

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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.

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🔹 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 everything

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematology

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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.

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🔹 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 Responsibilities

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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?

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🔹 Transcript and Shownotes

Timestamp

(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 Education

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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 Disorders

Tags: CoreIM, Internal Medicine, Lipidology, lipid, Cardiology, Metabolic Health, Triglycerides, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education, primary care

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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?

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🔹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 Education

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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?

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🔹 Transcript and Show Notes

Timestamps:

(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 Inhibitors

Tags: 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 Medicine

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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?

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🔹 Transcript & Show Notes

Timestamps:

 (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 Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver Disease

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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?

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🔹 Transcript & Show Notes

Timestamps:

 (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 Directions

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Nephrology, renal, hepatology, Portal Hypertension, Liver Disease

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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.

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🔹 Transcript & Show Notes

Timestamps:

(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 Care

Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone Health

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Medications for orthostatic hypotension! When to initiate treatment, how to use them safely, and what to do when new issues arise during treatment. How do those change if someone has autonomic failure? What do you do when your patient has hypertension AND also has orthostatic hypotension?

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🔹 Transcript & Show Notes

Timestamps (+/- 1-2 mins):

(00:28) | Case Recap: Beyond Non-Pharm Strategies

(03:07) | Midodrine: Timing, Testing, & Supine Hypertension

(06:23) | Fludrocortisone: Benefits vs. Risks

(09:01) | Droxidopa: Evidence, Side Effects, Access Issues

(10:11) | Pyridostigmine & NSAIDs: Secondary Options

(12:31) | Balancing Hypertension and Orthostatic Hypotension

(14:29) | Functional Hypotension & Risk Stratification

(18:45) | Symptomatic Patients: What to Stop, What to Continue

(20:19) | Autonomic Disease: Supine & Nocturnal Hypertension

(21:47) | Bed Elevation, Compression, & Non-Pharm Pearls

Tags: Internal Medicine, Geriatrics, Autonomic Dysfunction, Hypertension, Syncope, Falls, Patient Safety, Medical Education, physician assistant, nurse practitioner, hospitalist, primary care, neurology

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