Core IM | Internal Medicine Podcast

If your patient asks you about a left atrial appendage closure device, what should you tell them?  

 In the latest episode of the Beyond Journal Club podcast from CORE IM and NEJM Group, the hosts will help you: 

• Understand the trade-offs: stroke prevention, bleeding, procedural risks, and medications afterward. 
• Build clinical judgment: weigh which approach may better serve the individual patient, beyond the trial’s headline. 
• Learn from thoughtful counseling: hear how you might discuss the evidence, acknowledge uncertainty, and explore what matters to your patients.

🔹Sponsor: ACP MKSAP Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP7​

🔹Transcript and Show Notes  

01:09 | What the Watchman is, and why it should work?

05:58 | The checkered history: PROTECT-AF and PREVAIL

09:06 | The plot continues: PRAGUE-17, OPTION, OCEAN, and CLOSURE-AF

12:35 | CHAMPION-AF: the biggest test yet

15:03 | Reading the fine print

19:23 | A local solution to a systemic problem

22:45 | How patients hear about it

25:44 | So what do we tell our patients?

29:52 | Takeaways

Tags: IMCore, Internal Medicine, Medical Education, WATCHMAN device, Atrial Fibrillation, Cardiology, DOAC Anticoagulation, Primary Care, Hospital Medicine

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“Should you stop screening for colorectal cancer (CRC) at 75?” 

This episode explores how to individualize screening decisions based on life expectancy, prior colonoscopy findings, and procedural risks. Learn how to navigate these nuanced conversations, avoid age-based assumptions, and use strategies like mailed FIT kits and offering screening choices to help more patients get screened.

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here!

🔹Transcript and Show Notes

01:18 | Screening >75 yo?

10:06 | Takeaways on Colorectal Cancer Screening After 75 

10:37 | Systems thinking: How do we get to an 80% screening rate

Tags: Core IM, Internal Medicine, Colorectal Cancer Screening, Gastroenterology, Cancer Screening 

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“What’s the best way to screen?” This episode breaks down the pros, limitations, and follow-up needs of FIT, Cologuard, CT colonography, and colonoscopy to help you choose the right CRC screening option for your patients. Also learn practical colonoscopy surveillance intervals based on polyp size, number, and pathology.

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here!

🔹Transcript and Show Notes

01:24 | Screening Options Besides Colonoscopy

11:22 | How FIT, FIT-DNA, and CT colonography differ and when each makes sense.

12:52 | Colonoscopy and Frequency

19:29 | How adenoma number, size, and histology guide surveillance intervals. 

Tags: Core IM, Internal Medicine, Colorectal Cancer Screening, Gastroenterology, Cancer Screening 

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“The triglycerides are high. Now what?” This episode breaks down a practical approach to elevated TGs, from knowing when to check ApoB or non-HDL-C to choosing lifestyle changes, lipid-lowering medications, and when to suspect an underlying genetic disorder. 

🔹Transcript and Show Notes

02:17 | Check a non-HDL-C or ApoB if TGs are ≥150 mg/dL 

07:18 | Address waist circumference and lifestyle before meds for high TGs

10:52 | Dr. Watson’s 3-day carbohydrate responsiveness trial 

17:07 | Order a fasting or nonfasting lipid panel?

19:00 | When do you reach for TG-lowering medications? 

25:26 | Familial chylomicronemia syndrome (FCS)

Tags: CoreIM, Medical Education, Hypertriglyceridemia, ACC AHA lipid guidelines, lipid guidelines 2026, cardiovascular risk 

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“Too young for colon cancer.” This episode unpacks the red flags of early-onset colorectal cancer (CRC), from blood in the stool and iron deficiency anemia to persistent abdominal pain and changes in bowel habits, and offers practical pearls for closing the clinical loop. Also learn why a “negative” family history may need a yearly refresh.

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here!

🔹Transcript and Show Notes

01:45 | Colorectal cancer rising in younger adults 

06:42 | Why screening starts at age 45

08:15 | What may be driving early-onset colorectal cancer 

13:37| Key takeaways: symptoms, follow-up, and family history 

Tags: Colorectal Cancer Screening, Internal Medicine, Gastroenterology, Cancer Screening, Oncology

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“It didn’t work.” This episode breaks down practical treatment options (dosing options for naltrexone, acamprosate, topiramate, gabapentin) and counseling pearls to help you meet patients where they are and support their recovery. Also discover blind spots in detox and rehab centers.

🔹Transcript and Show Notes

🔹 Explore ACP’s Substance Use Disorder Education Hub for videos and an AI-powered patient simulation to practice alcohol-use conversations: https://www.coreimpodcast.com/SUDhub

Alcohol Use and Chronic Health Conditions Mini Video Series

01:55 | #1: Naltrexone

12:06 | #2 Acamprosate

16:15 | #3: Topiramate

21:12 | #4: Other meds

29:31 | #5: Detox and rehab blind spots 

Tags: CoreIM, Medical Education, Addiction Medicine, Alcohol Withdrawal, Addiction Treatment, GLP-1, pharmacology

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Have you ever lost a patient and found yourself thinking about them long after the shift ended? This episode explores the grief clinicians can carry after a patient dies, including the losses that aren’t always obvious. We also discuss ways to work through that grief, recognize when it becomes complicated, and lean on your team for support.  

🔹Transcript and Shownotes

04:12 | What is Clinician Grief?

10:02 | Types of Losses

10:22 | Loss of a close relationship with a particular patient

12:56 | Loss due to a professional's identification with the pain of family members

13:56 | Loss of one's unmet goals and expectations and one's professional self-image and role

18:47 | Loss related to one's personal system of beliefs and assumptions about life

21:30 | Past unresolved losses or anticipated future losses

23:29 | The death of the self

25:44 | Coping

Tags: CoreIM, Medical Education, Clinician Wellbeing, Burnout, Secondary Traumatic Stress, Complicated Grief, Coping With Grief, Medical humanities, medical ethics

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How to choose between RUQ ultrasound, CT, HIDA, MRCP, EUS, and ERCP based on the clinical picture? When should you move from diagnostic imaging to therapeutic ERCP, and what should you know about sphincterotomy, stents, and stone removal? Plus, how to interpret bile duct dilation without jumping straight to obstruction?

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹Transcript and Shownotes

02:11 | Pearl 1: Gallbladder Problems Spectrum

07:33 | Pearl 2: Choose Imaging Strategically: Start with RUQUS, Escalate as Needed

14:34 | Pearl 3: Biliary Tree Diagnostics

19:19 | Pearl 4: Invasives that are Diagnostic and Therapeutic

27:06 | Pearl 5: Stenting in ERCP

Tags: CoreIM, Internal Medicine, Medical Education, Gallstones, Cholecystitis, Biliary Disease, ERCP, Biliary Imaging

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Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.

🔹Transcript and Shownotes

6:46 | Pearl 1: Key Principles

15:13 | Pearl 2: Fluids in hyponatremia

26: 03 | Pearl 3: Solutes in hyponatremia management

35:49 | Pearl 4: Lasix in hyponatremia management

40:05 | Pearl 5: Etiologies

Tags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine Osmolality

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Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes

03:00 | Diagnosing Hypertension 

04:10 | When to Start Combination Therapy Instead of Monotherapy 

07:00 | Choosing First-Line Therapy Using the ACT Framework 

13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors 

16:02 | Choosing the Right ARB: Candesartan vs Losartan 

18:39 | Comparing Potency & Duration Across First-Line Antihypertensives 

20:54 | Amlodipine Edema: Why It Happens and How to Fix It 

23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects 

29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications 

Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IM

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