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The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole. No boring lectures here, just high value content and a healthy dose of humor. Fantastic podcast for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine. Topics include heart disease, obesity, diabetes, cardiac imaging, migraines, fibromyalgia, hypertension, cholesterol, osteoporosis, insomnia, testosterone, functional medicine, dementia, and more!
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Now displaying: December, 2016

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole.

thecurbsiders@gmail.com

Dec 19, 2016

Summary:

Advance your career and expertly navigate the job hunt with guidance from Dr. Alia Chisty of Temple University Hospital.  Highlights include Dr. Chisty offering up her personal email address for mentorship and Dr. Watto announcing our first contest. This episode is full of wisdom to enhance your career whether you're gainfully employed or looking for your first job.

Clinical Pearls:

  1. Meet with your mentors at the start of the process. They can:
    1. Help clarify your goals
    2. Activate your network
  2. Look for jobs 9 months in advance.
  3. An ideal job: incorporates your interests, skills, and values.
  4. Leverage your network (friends, mentors, program director) to identify available opportunities
  5. Email your cover letter (typically an email) and CV to the division chair or section chief
    1. Craft your elevator pitch.
    2. Do your homework.
    3. Explain how you will add value.
  6. When interviewing:
  7. Give yourself credit! Highlight experiences in your CV (e.g. conference attendance, lectures given, etc.)
  8. Have someone review and proofread your CV.
  9. If an employer makes a promise, then have it included in your contract. Don’t just take their word!
  10. Have a lawyer review your contract.

Goal: Listeners will learn to craft a systematized approach to finding their perfect job.

Learning objectives:

By the end of this podcast listeners will:

  1. Recognize timeline for applications and finding or switching jobs.
  2. Design an effective CV and cover letter.
  3. Recognize the importance and utility of mentors in the application process

Disclosures:

Dr. Chisty reports no relevant financial disclosures.

Time Stamps

0:20 Intro

03:40 Rapid fire questions

07:10 When to start looking for jobs

09:22 How to narrow your focus

11:33 Too many choices may be worse

13:05 Asking yourself the right questions

14:40 Quick recap of what we’ve learned

15:20 Who to contact, and what to send

19:30 Recruiters

22:25 How to prepare for your interview

26:05 Ramit Sethi on finding your dream job and negotiating your salary

27:36 Where to look for jobs (including social media)

31:10 Discussion of social media

33:18 What to include in your CV

35:25 Our first contest (send us your CV!)

36:30 So you’ve been offered a job (s)

38:38 Take home points

40:15 Outro

Links from the show:

  1. NEJM career center: http://www.nejmcareercenter.org/jobs/internal-medicine/
  2. JAMA career source: http://www.jamacareercenter.com/resources_overview.cfm
  3. Zerzan, J.T. et al.  2009.  Making the most of mentors: a guide for mentees.  Academic Medicine 84: 140-144. https://www.ncbi.nlm.nih.gov/pubmed/19116494
  4. Ramit Sethi on finding your dream job http://www.iwillteachyoutoberich.com/find-your-dream-job/
  5. Ramit Sethi on negotiating your salary http://www.iwillteachyoutoberich.com/blog/salary-negotiation/
  6. Pride and Prejudice by Jane Austen
  7. Harry Potter and the Goblet of Fire by JK Rowling
  8. NEJM Journal Watch http://www.jwatch.org
  9. AHRQ ePSS app  https://itunes.apple.com/us/app/ahrq-epss/id311852560?mt=8

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Dec 5, 2016

Summary:

On this episode we’ll teach you to dominate hypertensive urgency and severe hypertension (HTN) in the clinic, the ER, or on the hospital wards. The Curbsiders offer you this delicious serving of knowledge food so you can manage high blood pressure (BP) without making the same egregious errors that we made during our more formative years.

Of note, The Curbsiders are guestless for this episode. Guestless? Is that a word? Our guest for this episode was supposed to be Dr. Wallace Johnson, a Cardiologist, and expert on HTN from the University of Maryland. He did a fantastic job, but, unfortunately, technical difficulties caused us to lose any useable audio. Our sincerest gratitude and deepest apologies to Dr. Johnson. Nevertheless, we pressed on and used one of our own, the illustrious Dr. Paul Williams, as our expert guest.

Clinical Pearls:

  1. Hypertensive crisis is divided into hypertensive emergency and hypertensive urgency.
    • “Emergency” needs IV therapy NOW
    • “Urgency” needs increased oral therapy over next 24-72 hours
  2. History, physical exam, and familiarity with the patient are key for triage (e.g. verify BP readings, assess compliance, etc.)
  3. Severe HTN and hypertensive urgency can often be treated in the outpatient setting
  4. IV agents are not indicated outside of true hypertensive emergency (i.e. objective end organ damage)
  5. We recommend increasing dose or frequency of existing BP meds as 1st line (better long-term solution)
  6. Intermittent dosing of oral labetalol, clonidine, and captopril can be considered as 2nd line (short-term solution)
  7. Rule out uncontrolled pain, volume overload, alcohol withdrawal, illicit drug, and missed medications as cause of severe HTN
  8. Evidence from observational studies suggests that headaches are NOT caused by HTN
  9. Untreated severe HTN was historically fatal in months to years prior to development of antihypertensives

Goal: Listeners will become proficient in the appraisal of severe hypertension/ hypertensive urgency and employ safe and practical management strategies.

Learning objectives:

By the end of this podcast listeners will:

  1. Confidently triage patients with severe hypertension and provide appropriate disposition in a variety of settings
  2. Employ a safe and common sense approach to the treatment of severe hypertension in the clinic, the ER, or on the wards
  3. Be familiar with pharmacologic management of severe hypertension in a variety of settings
  4. Recognize the common causes of severe blood pressure elevation in the inpatient setting
  5. Counsel patients on the relationship of severe hypertension and headache
  6. Recall the natural history of untreated severe hypertension

Disclosures:

The Curbsiders report no relevant financial disclosures, but hope to become successful enough to display an absurd list of disclosures in the future.

Time Stamps

0:00 Hook

0:26 Intro

1:38 Rapid fire questions

03:45 Triage of patient with severe HTN

05:05 Case example HTN in office

07:05 Does HTN cause a headache?

08:30 Workup of severe HTN in the office

10:20 Stuart discusses HTN and headaches

11:30 In office treatment of blood pressure

14:28 Recap

15:50 Stuart discuss HTN emergency at normal BP

17:00 Acute treatment of HTN in ER

18:10 Approach to the inpatient with HTN

20:50 Choice of agent for inpatient HTN

23:23 Italian study of HTN crisis in the ER

24:20 Outcomes in asymptomatic patients with severe HTN

26:15 Sleep apnea and HTN

27:10 Natural history of untreated severe HTN

29:10 Take home points

30:50 Outro

Links from the show:

  1. Blood Meridian by Cormack McCarthy
  2. Horton Hears a Who by Dr. Seuss
  3. ASCVD risk calculator http://tools.acc.org/ASCVD-Risk-Estimator/
  4. Epocrates. Download it here
  5. Dr. Johnson’s excellent review article on hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/23102030
  6. Another great review with tables on oral drug therapy and dosing for hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/18710665
  7. Fascinating article from 1928 on The Syndrome of Malignant Hypertension* http://archinte.jamanetwork.com/article.aspx?articleid=535650
  8. Observational study from Italy characterizing symptoms and outcomes in hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/8591878
  9. JNC 7 recommendations for hypertensive crisis: See page 54 of this PDF for details http://www.nhlbi.nih.gov/files/docs/guidelines/express.pdf
  10. Most recent review we could find on hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/25575271
  11. Migraine and subsequent risk of stroke in the Physicians' Health Study. https://www.ncbi.nlm.nih.gov/pubmed/7848119
  12. Blood pressure as a risk factor for headache and migraine: a prospective population-based study. https://www.ncbi.nlm.nih.gov/pubmed/25155744
  13. Blood pressure and risk of headache: a prospective study of 22,685 adults in Norway. https://www.ncbi.nlm.nih.gov/pubmed/11909904
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