The Host Response: A FirstcallID Podcast

FirstcallID
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The Host Response is a clinically focused, practical podcast exploring Infectious Diseases and critical topics in medical practice. Designed for learners at all stages—from students to seasoned clinicians—it offers concise, high-yield insights and pearls that extend beyond infectious diseases, touching all fields of medicine. Whether you're practicing on the front lines or simply passionate about medical science, The Host Response delivers essential knowledge in a clear and approachable way.

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

    5d ago

    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 permeabilityUnexplained gram-negative bacteremiaDiagnostic reasoning and cognitive biasSource identification in Infectious DiseasesAvoiding premature closureSometimes the most important question isn't "Could this be translocation?"...it's "What else haven't we found yet?"

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

    May 17

    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.

    6 min
  3. Episode 27 - Bundles 4.0

    May 3

    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 - A practical, case-based tropical medicine resource from the Gorgas CourseA visual, diagnostic reasoning approach with IDImages.org📚 From the literature Updated 2026 Surviving Sepsis Guidelines and the case for prolonged beta-lactam infusionA recent JAMA Network Open study applying the AMBITION trial strategy for cryptococcal meningitis in a US setting🌍 Beyond the PubMeds 99% Invisible: “Towers of Silence” - ecology, culture, and unintended consequencesThe Death of Expertise, 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”). 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.

    34 min
  4. Episode 26 - Liars Who Lie: Why Infectious Diseases depends on verifying the story

    Apr 19

    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

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

    Apr 5

    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 casesHow stepwise decision-making can reduce confusion and improve clarityThe risks of being perceived as having “missed something”Real-world examples of pacing investigations and treatmentThis 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

    5 min
  6. Episode 24 - Definitive Antibiotic Therapy: Balancing Options in Infectious Diseases

    Mar 22

    Episode 24 - Definitive Antibiotic Therapy: Balancing Options in Infectious Diseases

    How do you choose the “right” antibiotic once cultures are finalized? In this episode of The Host Response, Dr. Paul Bunce walks through one of the most deceptively complex steps in infectious diseases: selecting definitive (or “destination”) antibiotic therapy. While it may feel like the easy part of the case, this decision involves balancing multiple competing factors and not just picking the narrowest drug on the susceptibility report. Considerations include: Antimicrobial spectrum and when “narrower” isn’t always betterIV vs oral therapy and when PO options are appropriateDosing frequency and real-world feasibilityDrug penetration, bioavailability, and site of infectionDrug interactions and toxicity considerationsPatient-specific factors (renal function, comorbidities, pregnancy)Cost, access, and healthcare system constraintsWhy efficacy still matters most — even when we may forget to prioritize itThrough practical examples and common clinical dilemmas, this episode highlights why there is often more than one “right” answer, and how to approach these decisions thoughtfully. Whether you’re a trainee or a practicing clinician, this episode will help you build a structured, repeatable approach to antibiotic selection. 🎓 More infectious diseases teaching resources available at FirstCallID.ca

    7 min
  7. Episode 23 – Tribute to the Puswhisperer, Mark Crislip, the Puscast, and Gobbet o’ Pus

    Mar 8

    Episode 23 – Tribute to the Puswhisperer, Mark Crislip, the Puscast, and Gobbet o’ Pus

    In this episode of The Host Response, Dr Paul Bunce reflectson the lasting influence of Mark Crislip, known to many as the Puswhisperer, and his infectious diseases podcasts Persiflager’s Infectious Diseases Puscast and Gobbet o’ Pus. From 2007 to 2021, the Puscast offered a biweekly review ofthe infectious diseases literature, combining sharp critical appraisal with practical clinical insight. For many trainees and practicing ID physicians, it became essential listening and a way to stay current before infectious diseases had much presence on social media. Gobbet o’ Pus delivered more than 1400 short clinical pearlscovering Staphylococcus aureus bacteremia, candidemia, HSV detected in bronchoalveolar lavage specimens, immunodeficiency screening in invasive pneumococcal disease, and much more. Many of these lessons remain deeply relevant despite evolving guidelines. In this tribute episode, we revisit several classic Gobbetsand reflect on recurring themes that shaped a generation of infectious diseases clinicians, including the limits of anecdote, the perils of spiraling empiricism in antibiotic therapy, and the intellectual breadth required of ID consultants. If you trained in infectious diseases in the late 2000s or2010s, this episode may feel familiar. If you did not, consider it an introduction to one of the foundational voices in digital ID education. The Host Response is a FirstCallID podcast focused onclinical reasoning and practical infectious diseases teaching.

    7 min
  8. Episode 22 - WWJD: Mentally crowdsourcing Infectious Diseases conundrums

    Feb 22

    Episode 22 - WWJD: Mentally crowdsourcing Infectious Diseases conundrums

    In this episode of The Host Response, Dr. Paul Bunce explores a deceptively simple but powerful skill in medicine: using the insights of your colleagues when facing challenging cases. Drawing on a real life blastomycosis case and strategies for spotting blind spots in your own reasoning, Paul shows how mentally asking “WWJD?” what would your experienced peers do can guide decisions, clarify uncertainty, and improve patient care. This episode is ideal for infectious diseases physicians, trainees, and any clinician navigating complex cases. It highlights the value of humility, collaboration, and integrating diverse expertise into your thinking. Coomes EA, Bunce PE. Sickle Cough: A Case of Nonresolving Pneumonia. Am J Med. 2018 Sep;131(9):e369-e370. https://pubmed.ncbi.nlm.nih.gov/29660349/

    4 min
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About

The Host Response is a clinically focused, practical podcast exploring Infectious Diseases and critical topics in medical practice. Designed for learners at all stages—from students to seasoned clinicians—it offers concise, high-yield insights and pearls that extend beyond infectious diseases, touching all fields of medicine. Whether you're practicing on the front lines or simply passionate about medical science, The Host Response delivers essential knowledge in a clear and approachable way.

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