“Hoofbeats: A 65M with Fatigue” From Core IM Podcast – How To Efficiently Make The Diagnosis In Primary Care

This is a link to Hoofbeats: A 65M with Fatigue [How To Efficiently Make A Diagnosis In The Primary Care Office] Oct 16, 2019 from CoreIM by By: Dr. Cindy Fang, Dr. Isaac Holmes, Dr. Kenneth B. Hymes and Dr. John Hwang. Graphic: Dr. Amy Ou.
Audio: Harit Shah. Peer Review: Dr. Andrew Parsons, Dr. Talal Hilal

TIME STAMPS               SHOWNOTES            TRANSCRIPT            REFERENCES 

This is an awesome podcast. It is actually a great podcast about how to work up a very common primary care office problem: How do you efficiently work up a potentially serious problem of fatigue in a 65 year old in your office. 

The patient doesn’t look sick at initial presentation but the complaint sounds serious. How do you proceed.

The discussants outline a clear awesome approach that leads to the diagnosis.

The discussants covered everything — wow. 

Here are excerpts:

Time Stamps

  • 01:18 Case introduction
  • 11:40 The Casablanca strategy
  • 23:17 The diagnosis revealed
  • 25:30 Logical fallacy: Denying the antecedent 
  • 33:22 Components of illness scripts
  • 41:37 Conclusion

Show Notes

  • The casablanca strategy is a form of diagnostic workup that is temporizing, where common suspects are rounded up in a panel of tests. It is commonly used to “buy time” but should not be considered as the only mode of workup. 
  • One can think of illness scripts as an organization of knowledge on disease entities. A rounded illness script should include:
    • Enabling conditions
    • the fault
    • the consequences +/- management and prognosis.
  • Framing the case with the appropriate enabling conditions help retrieve appropriate illness scripts and arrive at the correct diagnosis.

The graphic below shows all the primary care physician found on history and physical during the initial office visit:


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