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“Diabetic foot infection” is deeply embedded in the medical literature. But should it be? In this episode, Paul Bunce makes the case for retiring the term in favour of “diabetes-related foot infection”, and considers how the language we inherit shapes the way we describe disease and the people we care for. He also has a request for journal editors, authors, and guideline committees: if we want medical language to change, the literature has to change with it.

When physicians retire, we often focus on how they leave practice. Less attention is paid to the physician who inherits their patients. In this episode of The Host Response, Dr. Paul Bunce reflects on the experience of assuming care from retiring colleagues and mentors. Patients aren't simply transferred from one chart to another. Many have spent years, even decades, building trust with a physician who guided them through major illnesses and life events. Paul explores the challenges of stepping into established physician-patient relationships, managing expectations shaped by a predecessor's practice style, and earning trust that doesn't automatically transfer with a referral. He also reflects on the responsibility and privilege of continuing the work of physicians who carefully plan for their patients' future care. A thoughtful discussion on physician retirement, continuity of care, professional stewardship, and the gradual rebuilding of trust.

Are superficial wound swabs really useless? In this episode of The Host Response, Dr. Paul Bunce challenges the conventional wisdom around superficial wound cultures and explains when a swab from purulent drainage might actually provide a useful clinical clue. The key is knowing when to ignore the junk that grows, and when a culture might help guide therapy in a patient who isn't improving.

A sexual history is about much more than deciding which STI tests to order. In this episode of The Host Response, Dr. Paul Bunce explores why taking a thoughtful, nonjudgmental sexual history remains an important part of infectious diseases care. Beyond guiding testing, these conversations can uncover opportunities for prevention and open the door to discussions about relationships, consent, substance use, stigma, and personal safety. The goal isn't to catalogue someone's private life. It's to understand risk, provide better care, and build the trust that makes honest conversations possible.

Sometimes the hardest part of medicine isn’t knowing what to do, it’s recognizing when you need to do it now. In this episode, Paul Bunce explores the clinical “window of opportunity”: that period when the diagnosis is still uncertain, but the opportunity to make a meaningful difference is beginning to close. Small delays in investigations, procedures, consultations, or treatment can accumulate, particularly in patients who are deteriorating. When does waiting for more information become more dangerous than acting? And how do we recognize when time itself has become part of the diagnosis?

What happens when a patient is clearly sick, but every specialist says, “It's not my disease”? In this episode of The Host Response, Dr. Paul Bunce explores diagnostic uncertainty, specialist “not me” opinions, and the danger of becoming too certain when a patient doesn’t fit a familiar pattern. How do we distinguish “unlikely” from “impossible”? How do we communicate uncertainty to patients hearing conflicting opinions? And when should we keep looking after our specialty has supposedly been ruled out? Because sometimes “I don’t recognize this” is not the same as “this cannot be it.”

What is fever, exactly? In this episode of The Host Response, Dr. Paul Bunce explores one of the most common (and often misunderstood) clinical findings in medicine. What distinguishes fever from hyperthermia? Is "feeling feverish" the same as having a fever? Why do fevers come and go? And why is fever best understood as a host response rather than a diagnosis? Through practical clinical examples, this episode examines how Infectious Diseases physicians interpret fever, why context matters more than a single temperature reading, and how thinking differently about fever can improve clinical reasoning. Whether you're a medical student, resident, or practicing clinician, this episode offers a practical framework for understanding one of medicine's oldest and most important diagnostic clues.

For many younger clinicians, HIV is now a well-managed chronic disease. But for many patients, it carries memories of a very different era. In this episode of The Host Response, Dr. Paul Bunce reflects on how his understanding of HIV evolved; from childhood memories shaped by television and the media, to caring for people living with HIV whose stories transformed his perspective. Along the way, he explores the "bad old days" before effective antiretroviral therapy, the devastating impact of stigma and political inaction, and the activism that forever changed medicine. This is not a history of HIV. It is one clinician's reflection on what patients have taught him about illness, resilience, advocacy, and why remembering this history still matters.

How do we decide who the "great" physicians really are? In this reflective episode of The Host Response, Dr. Paul Bunce explores how reputation changes with perspective. From keynote speakers and internationally recognized experts to the quiet clinicians who keep healthcare systems functioning, visibility and excellence are not always the same thing. Drawing on experiences from Infectious Diseases and academic Medicine, Paul reflects on why proximity reveals humanity, distance amplifies performance, and time ultimately exposes substance. Along the way, he considers what truly earns lasting respect in medicine, and why trainees, educators, and practicing physicians alike should be cautious about confusing recognition with value. Whether you work in infectious diseases, internal medicine, or academic medicine, this episode offers a thoughtful perspective on leadership, mentorship, clinical excellence, and the people who quietly make medicine better every day.

In this installment, co-host Brooke Fraser returns as we discuss educational resources that have shaped our learning, including This Podcast Will Kill You, Febrile's infographic library, and a particularly memorable recent episode of Breakpoints. From the literature, we review a multi-centre study examining ophthalmologic screening in candidemia and discuss the recent randomized trial of vancomycin tapering to prevent recurrent C. difficile infection. Beyond the medical literature, Brooke reflects on The Elusive Body and the challenge of diagnostic uncertainty, while Paul revisits We Are All Perfectly Fine, a thoughtful exploration of medicine, identity, and resilience. And in our "safe space" segment, we discuss cognitive bias in fever of unknown origin, the unexpected role of trimethoprim-sulfamethoxazole as a cause of drug fever, and the surprisingly unremarkable origin of the "G" in penicillin G. As always, a mix of infectious diseases, medical education, clinical reasoning, and the occasional detour into the things that make us better clinicians.   Resources mentioned: This Podcast Will Kill You Febrile infographic library Breakpoints podcast (June 5, 2026 episode on Streptococcuspyogenes) OFID: Ophthalmologic Evaluation and Clinical Outcome inCandidemia JAMA Network Open: Initial Vancomycin Taper for Preventionof Recurrent CDI "The Paradox of Modern Medicine" We Are All Perfectly Fine – by Dr. Jillian Horton Enjoying The Host Response? Subscribe, share the show with acolleague or trainee, and visit FirstCallID.ca for additional infectious diseases teaching resources.

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?"

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.

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.

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

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