49 episodes listed below
Diagnostic reasoning done out loud, wrong turns included.
Art Nahill and Nic Szecket, two doctors based in New Zealand, work through clinical cases aloud, weighing lab values, building a differential and naming the biases that pull it off course. Interviews sit alongside the case work, one of them on medical assistance in dying, and the hosts signed off in 'Our final episode'.
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IMreasoning is a show about how doctors think, carried by two physicians based in New Zealand, Art Nahill and Nic Szecket. They reason through cases aloud, and the draw is hearing a diagnosis get built instead of being handed a tidy answer. The signature format is Stump the Chumps. An outside case arrives, from Queensland in one episode and from Human Dx in another, and the findings come out piece by piece while the hosts put together a differential and then cut it back. The numbers matter here. One presenter reads out a full biochemistry panel, sodium through LDH, before the urine specific gravity is flagged as the key. Another case puts a febrile, tachycardic patient two weeks out from chemotherapy in front of them, and the talk turns to whether she is truly neutropenic and how little mildly raised liver enzymes actually reveal. The hosts are open about their own misses. In 'Our final episode', one of them recounts a patient whose red and white cells in the urine were written off as part of being sick, until he came back five days after discharge with worse kidney function and turned out to have a vasculitis. A registrar's cognitive autopsy at Grand Rounds put the miss down to anchoring on blood loss as the reason for a low hemoglobin, and confirmation bias is named in the same breath. Elsewhere the warning is not to stop at a UTI just because the urine looks positive, since the poor UTI gets blamed for so much. The humor is gentle and self-mocking. One host comes back from a kayaking trip warning that his reasoning may be rusty, having Coxiella burnetii on the differential gets claimed as a win, and the pair ask for North American cases in place of what they call curly Australian ones. Life beyond the microphone shows through. One episode opens with Szecket introduced as the new Clinical Director of General Medicine at Auckland Hospital, a post he says he took because no one else was going to. Another begins with a COVID update explaining New Zealand's level 2.5 for listeners elsewhere, down to QR-code check-ins and masks on public transport. The interview side carries real weight. Stefanie Green, who trained as a family doctor and is a MAID provider and assessor as well as head of CAMAP, talks through the parts of Canadian assisted-dying law set aside for review, including mature minors and advance requests from someone with early dementia, against the backdrop of New Zealand's own end-of-life referendum. That conversation closes on the point that what seems trivial to one person may be unbearable to another. For a first listen, '68: STC with Ramey Bajwa' is a clear example of the case format and '67: MAID with Stefanie Green' of the interviews. The run is over: the final episode thanks listeners and helpers, urges everyone to carry clinical reasoning to whoever will listen, and signs off with 'We will not see you next time.'
Made for: Suits a medical student or practising clinician who learns best by hearing a differential built and narrowed step by step, and who wants cognitive bias discussed through actual cases instead of in the abstract.
What sets it apart: Instead of lecturing, it walks through the diagnostic process itself: in Stump the Chumps the two doctors meet an outside case as its findings are read out, and they are candid about their own misses, naming anchoring and confirmation bias when a diagnosis slips.
Welcome to IM Reasoning with your hosts Dr. Art Nahill and Dr. Nic Szecket, two general internists with a passion for teaching clinical reasoning. Join us for case discussions, conversations and interviews that explore issues important to clinicians and students, with a special focus on clinical reasoning, the once-mysterious process behind the remarkable abilities of the master clinician.
A possible UTI walks in; Art Nahill and Nic Szecket ask what else you might be missing.
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Short reviews from the PlayNext desk, based on the episodes we processed.
A thoughtful farewell on anchoring, confirmation bias, and clinical clues that were too easy to miss.
The farewell episode begins with housekeeping and a listener's objection to an earlier comment about HIV risk, giving the hosts room to clarify that the point was historical rather than a recommendation tied to where a patient had emigrated from.
A Queensland case turns lab values, uncertainty, and diagnostic detours into a candid lesson in clinical reasoning.
A Queensland case gives this Stump the Chumps episode a sturdy frame: a patient with Crohn's disease, anaemia, a reported left shift, CRP of 68, abnormal liver enzymes, sinus tachycardia, and a chest X-ray without acute changes.
A sober MAID discussion on capacity, mental health, advance requests, and the limits of knowing suffering from outside.
Medical assistance in dying is treated here as a careful conversation about capacity, mental health, advance requests, and the hard truth that suffering cannot be fully known from the outside.
A lively case discussion about resisting diagnostic closure when a familiar explanation seems to fit too neatly.
Fever, delirium, and an unnamed over-the-counter medication frame a tidy clinical reasoning case about how fast a plausible diagnosis can harden into certainty.
Local medicine, told through physicians' lives.
Clinical oncology evidence, translated into treatment decisions.
Nick Sheckett and Art Nahill open with a correction about the old HIV 'three H's' teaching — Haitians, hemophiliacs, and homosexuals — and Art says he recommends HIV testing on 'absolutely everybody.' They then announce that after five years and about 70 episodes, IMreasoning is ending because recording, idea generation, and the Auckland-to-Middlemore split have made the show harder to sustain.
IMreasoning hosts Nick Sheckett and Art Nahill analyze Alec Rezai’s Baylor College of Medicine case of a 70-year-old woman with two days of watery diarrhea and fever after immigrating from Haiti six months earlier.
IMreasoning’s "STC with Ramey Bajwa" follows a 33-year-old woman from Queensland who arrives with postural dizziness, right-sided neck pain, and a left temporal headache she describes as the "worst headache" she has ever had.
Nick Sheckett and Art Nahill speak with Stephanie Green, a Canadian family physician who works as a MAID assessor and provider in Victoria, British Columbia, and co-founded CAMAP.
Nick Shekut and Art Nahill open with a reverse Stump the Chumps case from HumanDX and then work through an 83-year-old woman with acute confusion, fever, dysuria, hematuria, and a history of taking unnamed over-the-counter pills.
Art Nahill lays out an outside-in framework for headache, moving from scalp and meninges toward the brain, eyes, and sinuses.
Daniel Kilov, a memory athlete and PhD student, says he once struggled to remember school materials before learning mnemonic techniques.
Nick Sheckett and Art Nahill assess a painful, two-month rash on a 62-year-old man's left posterior leg.
Hosts discuss COVID-19 updates in Spain and New Zealand before a clinical reasoning case challenge.
A special episode where hosts and a guest diagnostician attempt to diagnose a case presented by a registrar, focusing on clinical reasoning.
Hosts interview Dr.
Hosts Art Nahill and Nic Szecket introduce a rebroadcast of an interview with Tony Fernando on compassion in healthcare, discussing the holiday season and their podcast's focus on clinical reasoning.
Hosts Art Nahill and Nic Szecket introduce a Facebook Live event called 'Stump the Chumps International' and discuss listener participation.