Hospital and Internal Medicine Podcast

Good Intentions, Worse Outcomes: How Incentives Backfire

Well-intentioned policies and performance metrics that created perverse incentives and currently worsen patient outcomes.

Science vs. Hospital Habit: Why We Ignore the Data on Salt, Fluids, and Metformin

More trials show low-salt diets and restrictive fluid strategies do not improve heart-failure outcomes, while another shows continuing metformin in many hospitalized pati

Elevated Lactate vs Lactic Acidosis: Words That Change Care And Outcomes

This episode clarifies the difference between an elevated lactate level (hyperlactatemia) and true lactic acidosis, which requires evidence of metabolic acidosis (low pH

When Stool Turns to Stone: Manually Disimpact Again or Buy Coca Cola? Fecalomas, Risks, and Treatments

Fecalomas—rock‑hard impacted stool that cause obstruction, stercoral colitis, perforation, and even death—most often in immobile elderly patients or those on opioids. Sta

Does Mouthwash Cause Oral Cancer? Does Mouthwash Eliminate The Benefits of Exercise?

This episode examines the concerns about mouthwash and oral cancer. While ethanol can form the carcinogen acetaldehyde, how worried should we be? Strong antiseptic rinse

Recent Hyponatremia Correction Rate Data Is Becoming Harder to Ignore

Multiple studies in multiple journals are going against the norms and previous guidelines. The times they are a changing.

In the COBRRA Trial Apixaban Kicked The Asssssth of Rivaroxaban

For acute treatment of Venous Thromboembolism the debate of which direct oral anticoagulant to use appears to now be settled.  

Heart Failure with Preserved Ejection Fraction (Diastolic CHF) and SGLT-2 Inhibitor Therapy

The double-blind, randomized phase III EMPEROR-Preserved trial showed a benefit of the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin in patients with hea

Should You Postpone Interventions for INFECTED Necrotizing Pancreatitis?

An important recently published randomized control trial provides guidance on this controversy.

Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2

Unique Infectious Considerations in Cirrhosis - part 1

Diabetic Gastric Emptying Abnormalities (and sometimes normal) - Part 1

Almost nobody feels comfortable managing DELAYED gastric emptying (gastroparesis) and very few medical providers even think about RAPID gastric emptying in their diabetic

Gastric Emptying Abnormalities - Part 2

Can we trust a nuclear study to nail the diagnosis? Are motor abnormalities really the cause of symptoms? What is a POP procedure? 

Morphine for later stage COPD patients not on hospice

Does regular, low-dose, oral sustained-release morphine improve disease-specific health status or cause respiratory adverse effects in patients with moderate to very seve

The JAMA controversy and loss of conversation in medicine

My take on what went down at the Journal of the American Medical Association. I disagree with the comment there isn't "structural racism in health care", but was the back

Cows Milk - Healthy or Not?

Psilocybin Mushrooms - will they become an accepted medicine?

Understand Basic Epigenetic Changes in Medicine and Everyday Life

This lecture provides a basic understanding of how epigenetic changes influence infections/sepsis, vaccinations, cancer, future generations, your muscles, and (of course)

Hyponatremia etiology by history and physical

Hyponatremia remains a challenging topic for many because they are trying to memorize algorithms and numbers. You can usually nail the etiology by history & physical and

Cytokine Storm - part 1

If you use the term 'cytokine storm' and don't really know what you mean by it, you are far from unique. Let me help to try and clarify it for you just a bit.