Background: While understanding the cognitive contributions to diagnosis has become important, few studies have aimed to understand physician diagnostic reasoning in real-time. Using a case-based approach, we sought to: (a) characterize differences in diagnostic reasoning among hospitalists; and (b) identify factors associated with diagnostic accuracy. Methods: A total of 10 hospital medicine attending physicians from [...]

Background: Diagnostic error in medicine is increasingly recognized as “the next frontier for patient safety”. Current research has explored the etiologies of diagnostic errors in two unique dimensions: as systems-based or cognitive-based causes. One study, however, suggests that roughly half of all errors stem from both domains. Using a focused ethnographic approach, we sought to [...]

Background: Point of care ultrasound (POCUS) has become an integral part of the physical examination and a valuable diagnostic tool. POCUS is unique among medical technologies in that it requires physical co-location of the provider and patient. Previous studies have shown the value of shared decision-making between patients and providers requiring a mutual understanding of [...]

Background: Lung ultrasound (LUS) is emerging as a useful diagnostic tool for several lung pathologies. Some studies have found its accuracy in diagnosing pulmonary edema surpasses that of chest x-ray (CXR) but the available evidence is conflicting. CXR currently receives a Class I recommendation by the AHA in the evaluation of decompensated heart failure. Given [...]

Background: Lung ultrasound (LUS) is emerging as a useful diagnostic tool for several lung pathologies including pulmonary edema. The number of sonographic B-lines on LUS has been used as a test to detect pulmonary congestion in patients with chronic heart failure. However, its ability to detect elevated left-sided filling pressures relative to accepted noninvasive measure [...]

Case Presentation: A 57 year old man with a history of heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD) and hypertension presented with two weeks of exertional dyspnea and lower extremity edema, followed by 4-days of progressive tongue swelling. One-month prior, he was initiated on an ACE inhibitor (ACEi) and experienced tongue [...]

Case Presentation: A 22 year old man with no past medical history presented to our emergency department with three weeks of nausea, vomiting and abdominal pain. He also reported subjective fevers, hematochezia, hematemesis, oral ulcers, gum bleeding, dark colored urine and 30 pound weight loss over the past month. The patient was not forthcoming with [...]