Core IM | Internal Medicine Podcast

#183 Diagnose the Clinician: Hoofbeats Segment

22 snips
Jul 21, 2025
Dr. McQuaid, a hospice physician and director of the clinical reasoning curriculum at the University of Pittsburgh, dives into complex diagnostic challenges in clinical practice. He unpacks a clinical case involving severe symptoms and critical lab findings, emphasizing the urgency of recognizing sepsis. The discussion also highlights cognitive biases and the importance of structured problem analysis. With insights into diagnosing lymphoma and tumor lysis syndrome, Dr. McQuaid shares lessons that blend clinical reasoning with personal reflection to enhance diagnostic accuracy in high-pressure situations.
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ANECDOTE

Unexpected Tumor Lysis Syndrome Case

  • Cindy Fain treated a patient initially thought to have metastatic hepatocellular carcinoma who actually had high-grade B-cell lymphoma.
  • The diagnosis of tumor lysis syndrome came late, resulting in rapid deterioration despite treatment.
INSIGHT

Knowledge Organization Over Knowledge

  • Diagnostic errors often reflect gaps in knowledge organization rather than lack of knowledge.
  • Efficient retrieval and activation of the right illness scripts are crucial for accurate diagnosis.
INSIGHT

Context Shapes Diagnostic Thinking

  • Context and clinical setting deeply influence illness script activation.
  • Being on an oncology floor naturally triggers consideration of tumor lysis syndrome more than other wards.
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