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.
Listen to an audio recording of the On Being a Doctor essay , read by the author of the editorial , Dr. Michael LaCombe.
Ask your learners if they have ever heard fellow physicians make disparaging remarks about patients with mental illness. Think about whether you have ever made such remarks yourself. Why does it matter if we're just “joking” or “blowing off steam”?
In what ways do we “label” patients who have mental illness? How do these labels affect the care of patients?
Is our profession prejudiced against patients with mental illness? Do your learners think patients pick up on our prejudices?
The author of the On Being a Doctor essay and the editorialist each comment that a professional culture that labels mental illness as a weakness, and even “dirty,” impedes us from seeking support when we need it for ourselves. How?
Do your learners and your colleagues know where to turn for help if they need it themselves?
Ask patients on rounds about their depression or other mental illnesses. Consider carefully how you will do so. How will your questions, responses, and manner be viewed by your learners?
Suggest that these 2 pieces be discussed at your next faculty meeting.
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners what variables assure them that a patient presenting with chest pain may be safely sent home.
Does your hospital have a “chest pain pathway”? How closely is it followed? Review the results of this randomized trial. Why do your learners think some patients were admitted even when deemed appropriate for discharge by the HEART score? How does such nonadherence to the protocol affect the results?
Review the results of the systematic review. How comfortable would your learners be discharging a patient presenting with chest pain, a normal high-sensitivity troponin T measurement, and an ECG without ischemic changes?
Do all such patients with a high-sensitivity troponin T measurement above the level of detection require admission? What are the problems with such an approach? Use the accompanying editorial to help frame your discussion.
Is the exclusion of an ACS your only concern in such patients? Is that all that is considered in the emergency room? What other entities need to be considered (e.g., stable or unstable angina)? What are the next steps to consider in these patients once an ACS has been safely excluded?
Ask your learners whether they feel qualified to treat a patient's substance use disorder. Which ones? Use the recent In the Clinic: Substance Use Disorders to help review key management issues.
Where do your learners turn for help? Is it available? How do they arrange for a patient's acute safety and longitudinal care? What resources are available locally to patients at your center?
Invite an expert in substance use disorders to discuss what your learners' roles should be in the identification and longitudinal management of these problems. How should the specialist and primary care physician share management?
The position paper calls for increased access to methadone, buprenorphine, and naltrexone to treat opioid use disorder. Do your learners agree that access should be increased? Should your learners be prescribing these agents, or must they be managed by specialists?
How might proposed changes to current health care laws and the definitions of “preexisting illnesses” affect your patients?
Take a break, and watch the short video with your learners.
Ask them whether they have patients who are considered “cured” of a malignancy. Is there anything your learners do differently in these patients?
Ask what malignancies are particularly concerning after successful treatment for Hodgkin lymphoma.
What cardiac abnormalities might result from mantle radiation?
Use the provided multiple-choice question to teach, and be sure to enter your answer online to earn CME credit for yourself.
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Taichman DB. Annals for Educators - 16 May 2017. Ann Intern Med. ;166:ED10. doi: 10.7326/AFED201705160
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Published: Ann Intern Med. 2017;166(10):ED10.
Cardiac Diagnosis and Imaging, Cardiology, Emergency Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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