Episode 28 - Holding the Bag: Discharge, Follow-Up, and Lost Ownership in Medicine

Episode 29 - The Mystique of Translocation: An Overused Mechanism in Infectious Diseases?

When a patient develops an infection without an obvious source, someone will eventually suggest a familiar explanation: translocation. In this episode of The Host Response, we explore the biology behind bacterial translocation, why the concept is often invoked in Infectious Diseases, and how a plausible mechanism can sometimes become a substitute for finding the real source. Using cases of E. coli bacteremia, abscesses, and other "mystery" infections, we examine the cognitive appeal of translocation, the risks of premature diagnostic closure, and why uncertainty is often more productive than a convenient explanation. Key themes: * Bacterial translocation and gut permeability * Unexplained gram-negative bacteremia * Diagnostic reasoning and cognitive bias * Source identification in Infectious Diseases * Avoiding premature closure Sometimes the most important question isn't "Could this be translocation?"...it's "What else haven't we found yet?"

Episode 28 - Holding the Bag: Discharge, Follow-Up, and Lost Ownership in Medicine

Discharge from hospital is often treated as a conclusion, but in practice, it frequently marks the start of a less clearly defined phase of care. In this episode of The Host Response, we explore the concept of “holding the bag” in infectious diseases and internal medicine: what happens when responsibility for follow-up is not clearly assigned after discharge. We discuss common real-world scenarios from consult and inpatient practice, including management of resolving infections requiring ongoing antibiotics, intra-abdominal abscesses with drains still in place, pending biopsy or microbiology results, repeat imaging requests, and medications started in hospital without a clear stop date (including anticoagulation, glucocorticoids, and antimicrobial courses). When ownership of these elements is ambiguous, follow-up work often shifts to outpatient consultants, primary care physicians, or patients themselves, regardless of who made the original plan. This episode focuses on practical challenges in transitions of care: discharge documentation, assignment of responsibility for results and procedures, and how unclear follow-up plans contribute to fragmentation in clinical care. A discussion relevant to Infectious Diseases, hospital medicine, and anyone involved in post-discharge follow-up or consult-based care.

Episode 27 - Bundles 4.0

In this fourth instalment of Bundles, Dr. Paul Bunce is joined again by Dr. Brooke Fraser to cover a mix of Infectious Diseases insights, useful resources, and ideas from beyond medicine that shape how we think and practice. In this episode: 🧠 Teaching tools * The Gorgas Course - Case of the Week [https://www.uab.edu/medicine/gorgas/cases-blog] - A practical, case-based tropical medicine resource from the Gorgas Course * A visual, diagnostic reasoning approach with IDImages.org [https://www.idimages.org] 📚 From the literature * Updated 2026 Surviving Sepsis Guidelines [https://journals.lww.com/ccmjournal/fulltext/2026/04000/surviving_sepsis_campaign__international.5.aspx] and the case for prolonged beta-lactam infusion * A recent JAMA Network Open study [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2844132] applying the AMBITION trial strategy for cryptococcal meningitis in a US setting 🌍 Beyond the PubMeds * 99% Invisible: “Towers of Silence” [https://99percentinvisible.org/episode/579-towers-of-silence/] - ecology, culture, and unintended consequences * The Death of Expertise [https://global.oup.com/academic/product/the-death-of-expertise-9780197763834?cc=ca&lang=en&], by Tom Nichols - why mistrust of experts is rising, and where that argument falls short 🛟 Safe space * Brooke’s segment challenges the idea of ‘infection seasons’, highlighting that ticks are active whenever temperatures are above ~4°C, and that Legionella doesn’t reliably follow the calendar we think it does. * Severe Pseudomonas aeruginosa sepsis with necrotizing enterocolitis (historically termed “Shanghai fever [https://pmc.ncbi.nlm.nih.gov/articles/PMC3995289/]”). What it is, who gets it, and why it matters. You can find more episodes and teaching resources at www.FirstCallID.ca   If you found this episode useful, consider sharing it with a colleague or trainee, and subscribing on your preferred platform.

Episode 26 - Liars Who Lie: Why Infectious Diseases depends on verifying the story

In this episode of The Host Response, Dr. Paul Bunce explores a deceptively simple problem in infectious diseases: the clinical story you’re given isn’t always the story you need. From “CSF was clear” to “ALL of the hardware is out,” small assumptions, missing details, and imprecise language can quietly shape major management decisions. In a field where treatment depends heavily on context, verifying the fundamentals matters. Through real examples and practical reflections, this episode focuses on how to approach clinical information with a more critical eye: checking key details, asking more precise questions, and recognizing when something doesn’t quite fit. This is not about mistrust. It’s about clinical responsibility. Whether you’re an infectious diseases physician, trainee, or any clinician involved in complex care, this episode offers practical strategies to improve diagnostic clarity and decision-making. More episodes and teaching resources are available at firstcallid.ca

Episode 25 - Don’t Mistake Silence for Ignorance: Clinical Reasoning and Timing in Infectious Diseases

When should you say everything you’re thinking...and when should you hold back? In this episode of The Host Response, Dr. Paul Bunce explores a subtle but important aspect of clinical reasoning in infectious diseases: timing. Consultants often carry multiple working diagnoses, contingencies, and “next steps” in mind, but not all of these need to be voiced immediately. Knowing what to share, when to share it, and what to hold in reserve is a skill that develops over time. Topics explored include: * Why not every thought needs to be documented or discussed upfront * The concept of the “tomorrow thought” in evolving clinical cases * How stepwise decision-making can reduce confusion and improve clarity * The risks of being perceived as having “missed something” * Real-world examples of pacing investigations and treatment This episode is a reflection on how experienced clinicians balance transparency, uncertainty, and timing…and why silence is not the same as inaction. 🎓 More infectious diseases teaching resources: FirstCallID.ca