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 which patients with venous thromboembolism (VTE) require hospitalization. Which patients may be safely treated at home?
How do your learners arrange for outpatient management of a patient with newly diagnosed VTE? What needs to be in place? What teaching is required? How is this accomplished, and who checks on whether everything is safely arranged? How should follow-up be arranged?
Review the histories of several patients recently admitted with pulmonary embolism. Could any have been treated completely as an outpatient? What are the potential barriers to outpatient management at your institution, even among patients for whom it would be medically appropriate?
Invite someone from your institution's emergency department to discuss the intervention used in this study with your team. Is there an algorithm for deciding on outpatient management in your emergency department?
Ask your learners what may be concluded from this study with regard to diabetic care provided by physicians, NPs, and PAs. What are the limitations?
Why did the authors limit their analysis to patients who had a primary care provider (PCP) consistently for 2 years? The authors explain in the paper's discussion.
What is an intermediate outcome? Why might diabetes be a good disease in which to study intermediate outcomes?
The editorialist comments that it is time to stop referring to NPs and PAs as “mid-level” providers. Why? Is this term used at your institution? Why might it be appropriate or inappropriate? Do NPs and PAs prefer that this term be used?
What roles do NPs and PAs serve at your institution? Do they serve as patients' PCPs? How does the care they provide differ from and/or complement that of other members of the health care team? Are there limitations? How is it coordinated with the care provided by physicians?
What might be the advantages and disadvantages of care provided by physicians, NPs, and PAs?
Are there tensions between these groups of PCPs? If so, why?
Ask your learners whether they ask their patients about marijuana use. Why or why not? Might it be important?
What do we know about the potential benefits and harms of marijuana? Use the findings of recent systematic reviews (here and here) to help inform your discussion.
What do patients believe are the benefits and harms? Use data from this same survey to prompt discussion. Why is it important to know what patients view as the harms and benefits?
Teach at the bedside! Ask patients on your service about marijuana use. Why do they use it? In what forms? Do they believe it is beneficial? Do they worry about potential harm?
Ask your learners if they know what high-deductible insurance plans are. How might such plans reduce health care costs? Who benefits? What might be the harms?
How does this study attempt to mimic an interventional study? What did this study find? What may be concluded from the data?
What are the limitations to interpreting the findings of administrative data such as those used in this study? Use the accompanying editorial to help frame your discussion.
Teach at the bedside! Ask patients on your service if copays affect whether and when they seek care.
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they have ever been inspired by the commitment of mentors and colleagues who go “above and beyond the call of duty.”
Is there a limit to our responsibilities as physicians to ensure the best possible care to our patients, regardless of the circumstances?
Do your learners allow themselves to feel proud of how hard they work in the service of their patients? Should they? Are they “just” doing their jobs?
Pulmonary Embolism Severity Index
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Taichman DB. Annals for Educators - 18 December 2018. Ann Intern Med. 2018;169:ED12. doi: 10.7326/AFED201812180
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Published: Ann Intern Med. 2018;169(12):ED12.
Cardiology, Coronary Risk Factors, Diabetes, Emergency Medicine, Endocrine and Metabolism.
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