Darren B. Taichman, MD, PhD
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From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University.
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners to generate a differential diagnosis for a patient with fever and thrombocytopenia. How would they approach making a diagnosis?
Generate a list of tick-borne illnesses. How do Rocky Mountain spotted fever, human ehrlichiosis and anaplasmosis, and Lyme disease differ?
What precautions should patients take to avoid exposure to tick-borne illnesses? What evaluation is appropriate if a patient reports finding a tick on his or her body? Is prophylactic antibiotic treatment ever appropriate?
Arrange to review the histology slides of a patient on your service with breast cancer. Ask the pathologist to show slides demonstrating atypia and carcinoma in situ. Discuss how confident (or not) such diagnoses are.
Why and what treatment is pursued for ductal carcinoma in situ? What are the gaps in our knowledge regarding the best approach? Use the accompanying editorial to help frame your discussion. Ask an oncologist to discuss this with your team. Should the results of this study alter the decision to pursue certain treatments?
Ask your learners how they would discuss the potential for uncertainty in the diagnosis of a cancerous lesion. How might your learners help a patient deal with such uncertainty? Are they themselves comfortable dealing with it?
Watch the episode with your learners.
Review the pharmacologic treatment requirements following the placement of bare-metal and drug-eluting coronary stents. Which drugs are needed, and for how long? Ask an invasive cardiologist to discuss how the type of stent is chosen for each patient.
Ask a surgical colleague to discuss how s/he approaches the use of antiplatelet agents in patients who require elective surgery. For how long does s/he prefer such agents be held before surgery?
Log on and answer the multiple-choice question to earn CME for yourself!
Assign members of your team to read the summary and the paper to which it refers before your next team rounds.
Concisely present the key teaching points to each other and then discuss if and how they might alter your practice.
Listen to an audio recording of the essay, read by Michael LaCombe, MD.
Ask your learners if they have ever felt physically threated by a patient. Do they worry they might become a victim of violence at the hands of one of their patients?
How should they handle such a threat? Many professions involve putting oneself at risk. What risks do we take as physicians?
Is whether one buys a gun a medical question? Why or why not? Should our choice be influenced in any way by our roles as physicians?
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Taichman DB. Annals for Educators - 17 May 2016. Ann Intern Med. ;164:ED10. doi: 10.7326/AFED201605170
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Published: Ann Intern Med. 2016;164(10):ED10.
Ethics, Hospital Medicine, Infectious Disease, Tick-Borne Diseases.
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